Thursday, 28 January 2010
Waif has been asked to be in the cross country team at school and is very keen to run; only 5 girls in her year have been invited.
I have told her that she needs first to have put on weight this week - 500g minimum - and for the Maudsley to confirm that it will not actually damage her heart. She doesn't yet know how far the race is or when. She has promised to eat "loads extra" if she is allowed to compete. She is a very natural runner so it could boost her confidence a lot to be allowed to enter but I don't want her getting into the obsessive exercise category or it causing her to put on weight more slowly than she would otherwise.
It's a tricky call.
Tuesday, 26 January 2010
Tuesday 26 Jan
Breakfast: 40g branflakes and 200ml milk, 2 pieces of toast and jam and a glass of oj. (400 cal)
Midmorning snack: an apple and a small chocolate teacake (100 cal)
Lunch: Butter chicken curry (250cal), rice (100 cal), a mango and pineapple smoothie (75cal) and a large slice of homemade chocolate cheesecake (25o cal).
Teatime: 200ml hot chocolate (160cal), 2 honeycomb clusters (130cal) and a piece of wholemeal toast with jam (120 cal)
Supper: Jamie Oliver fish pie and baked beans (400 cal) , cheesecake again (250 cal)
Late night snack: 200ml hot chocolate (160 cal), 2 biscuits (100 cal)
TOTAL FOR DAY: about 2,500 calories :-) Ok for the moment. Really we should be aiming at 3,000 calories. I am happy as long as it is well over 2,000 cal every single day without exception.
Monday, 25 January 2010
It was the first time that all four of us - Waif, older daughter, Hubby and I - have attended the Maudsley Hospital together. And the first time we have seen the Head Honcho who will from now on be Waif's doctor. She has a reputation for being hard hitting and direct. This could be just what Waif needs although Waif was in tears for most of the session :-(
Head Honcho took one look at us all and announced that she was in a room full of underweight people. She asked each of us why we thought Waif had not put on weight. I said I was surprised as I felt that Waif was now eating a normal amount of food - the same as me, at least. HH asked Hubby if he thought that #I# ate enough food (!) This put Hubby in a bind as he actually reckons I eat far too much. He settled for a "yes". Oddly, he is looking terribly thin at the moment.
Whatever the reason, Waif need to eat more in order to get well. HH read us the riot act and said that Waif is not just a "bit" anorexic but that in Canada or Australia she would have been compulsorily hospitalised by now :-( This was just after Hubby came out with his theory that he was very skinny as a teen and that Waif is also a "slim" build, although he did admit that he conceded that she is underweight (phew).
Older Daughter said that mealtimes can be stressful and records Hubby asking her to put back food when he thinks she has taken too much (yes, he used to do that, although he has now stopped) and said that there was not enough to eat last Thursday night (when I left Hubby to cook supper which he subcontracted to Waif). He said he was too busy to cook any more food as he had to take OD to choir.
Waif has grown a cm since she was last measured, and is now 160 cm. This makes her more underweight for her age and height which is a worry. On the plus side, she has put on 300g since her last visit :-) :-) ten days ago, which is not far off her target gain of 500g every 7 days, especially as she was wearing leggings today instead of her usual heavy school skirt :-) :-) That's the best news I have heard in months :-) :-) and gives me hope.
Ho hum, having promised to eat 40% more again, we followed the Maudsley by dining out at Pizza Express where Waif opted for the children's menu. Sigh. At least she ate every morsel of all three courses, and has now eaten some cheesecake and has drunk a hot chocolate as a late night snack. She is not, naturally, talking to any of us tonight as she finds her appointments challenging.
Waif's target weight is now about 46-47kg. At 500g a week, we could be there by the end of June. I reckon that every kg will make her look healthier and give her more strength to live her life happily.
Our next appointment is not for 2 weeks, given HH's prior commitments (really, we are aiming at weekly meetings) so I hope that Waif will be 39kg in her school skirt by then.
Wednesday, 20 January 2010
It seems that our meeting on Monday at The Maudsley Hospital is now going to be with the Head Honcho as she has reviewed Waif's case and decided that it needs a fresh pair of eyes. Good grief, that must make her one of the most senior people in the world in the area of the management of eating disorders. I hope that she is able to help us to start to make progress with the Waif. I have 3 line whipped my husband to come along too.
Everything is as set as I can make it: top level support at the hospital, I am on sabbatical from work to supervise meals and do chauffeuring, and Waif is at her new school and seemingly enjoying it. Please let the rest follow on.
Meanwhile, I took the dog for his annual vaccination this morning. He has put on 6kg in the last year!!!! That is a lot for a dog. He should weigh about 30-32kg but is now 38kg. Three thoughts occur to me:
1. Has Waif been feeding him lots of food without me knowing? and
2. The dog now weighs more than my teenaged daughter whereas a year ago he weighed 10kg less than her; and
3. I am so NOT putting him on a diet, or even mentioning his weight gain to the rest of the family, although I will forebear from feeding him tidbits during the day when Waif is out.
Tuesday, 19 January 2010
Summer (Waif's new fellow anorexic friend) says that seeing Waif makes her (Summer) feel fat. Hmmmm....... I am not sure that they will be good for one another.
Waif was too tired and cold to stay on for netball trials today as they followed directly on from her outdoor PE lesson. I guess that's a good thing. I am glad that she was prepared to forego it when she felt worn out. She looks remarkably exhausted, with big black rings around her eyes.
We go to yoga tonight so that should be relaxing.
Monday, 18 January 2010
We waited for Hubby for supper tonight: roast beef, roast potatoes, buttered carrots and leeks, petits pois, cauliflower cheese and gravy.
Hubby began by announcing that he "eat(s) too much meat". He said that there was a top scientist today saying that we should ban butter, cheese and red meat. He said he had read it in The Metro. I presume it was this article. Actually it doesn't mention meat.
I thought this not an overly helpful observation to come out with in front of the Waif just as I was serving roast beef, and probably taken out of context. Hubby is on the skinny side and not in danger of needing a heart bypass operation. Waif (and indeed Hubby) is in much more danger from not eating enough than from eating too much saturated fat.
Later, when it came to pudding (syrup sponge pudding), Hubby said he would have some because he had been "good" and cycled home. This is just the kind of false logic that I do not want Waif to pick up on - the idea that she can only eat without guilt if she has been exercising.
Sigh, I had never realised until recently how loaded our language is when it comes to food: it is as if it has a moral dimension, but actually it is a fuel and should be also a pleasure. It is not "good" or "bad". One's diet as a whole can be healthy or unhealthy - equally for being too light on calories as for being too heavy in fat - but an individual item of food is not a moral item.
I am not sure that Hubby "gets it".
The team co-ordinator from the Maudsley, Gloria, called. She said that she understood my concerns about wanting someone more senior on Waif's case due to lack of progress and said that she herself could start seeing Waif.
I asked her if she was a psychiatrist: whilst she is a lady with great natural authority, I thought she had made some basic scientific errors in our first and only meeting with her and am not convinced about her intellect. Sigh, perhaps intellect is not important in this context but I would be worried about Waif pulling a fast one. She said that she was a trained family therapist. Psssshhhhh. I reckon that doesn't mean too much. Still, when she suggested that perhaps Waif would like someone younger to relate to, I thought perhaps not, and perhaps Gloria with her "no nonsense" bull in a china shop straight speaking might be worth a go. Waif took an intense dislike to her in that first meeting, but, ho hum, perhaps that is because she was challenged. Waif said it was because she was illogical: Gloria had asked her what her favourite chocolate bar was and she had said Mars Bar, and then 10 minutes later Gloria asked me if she ate Mars Bars (she doesn't) and I said "no" so she accused Waif of lying. Waif objected that she had never claimed to #eat# Mars Bars, just that they were her favourite, and felt unjustly accused.
In the call, I then mentioned that Waif had made friends with a very thin girl at her new school called Summer. I was about to say that I thought it possile that Summer, too, had an eating disorder as Older Daughter had been looking at her FB page and thought so, when Gloria interrupted with "omg, we see her here. How on earth did they meet one another?" Hmmmm, so much for patient confidentiality! Anyway, Gloria thought it might or mgiht not be a bad thing.
Bizarrely, just 5 minutes after Gloria's call, Waif phoned me to say that she wants to walk home with Summer, who also lives in this direction - a 3.9 mile walk. Sigh, I said that was fine, not least because our car has ANOTHER puncture and is back in the garage, otherwise I would have picked her up. She will have to eat extra when she gets in to make up for the calories used up walking an hour home. As it is lunchtime now, Waif must be having (or not having) lunch with Summer right now.......
All four of us went out for a family roast with neighbours last night.
"Come round, and we will force feed Waif with roast chicken" said my friend. And he did :-)
Seriously, Waif does seem to eat enough (maybe 2,000 calories a day) but doesn't put on weght :-(
I bumped into him again this morning on my way to the park with the dog, and he asked if Waif was okay. He knows about the anorexia, so I asked what he meant. He said that even his 8 year old daughter had thought that Waif looked very pale and had big dark rings around her eyes. Hmmmmm....perhaps I should arrange that paediatrician's appointment.
Then, in the park, I met another neighbour, Jane - she was cycling to the hospital where she works. Coincidentally, she is a family psychiatrist. She stopped to ask me about triathlons (we are down for one this year) and about Waif. She was a great help. She said:
1. If Waif is eating 2,000 calories a day then she should be putting on weight. If she is not, then there is something else going on. I relayed the advice that the blood tests showed she was not being sick, so Jane wondered if she was over-exercising. Hmmm... not that I know of. Mind you, yesterday she took her bike off to the park to do some sketching. On her return she said she had in fact just sat in the cafe and eaten a large piece of cake. I suppose it's "possible" that actually she spent the time cycling up and down the large hill. But on balance I doubt it.
2. She said that if Waif s growing (she is) then she must be getting enough calories for the time being (great news), but that also it means she is getting thinner for her age and height. Jo said that what could be affected first are Waif's ovaries and her bone density and that these can have long term effects. She told me that she always tells her anorexic patients this so I will tell Waif when I next have a chat with her about eating.
We have fab friends.
In the meantime, I am waiting for the nutritionist team co-ordinator to phone today. I will still have the same conversation that I was planning - Waif is not making progress, she is obviously a hard case to crack and could we please have someone more senior. Another point struck me too: our current psych said that his strategy is to work up a rapport and trust with Waif over time in the hope that she will then confide in him. Well, noone on 6 month placements can do that!!! Waif also needs someone who is present, and not in exams, every week so that she is monitored closely.
Friday, 15 January 2010
I took the Waif to The Maudsley yesterday. Her new school is further away so we couldn't get there until 4.15 for our 4pm appointment (Waif doesn't want to miss any school) which left us a little short of time as the psych was on duty at 5pm.
Cuttting to the chase, Waif weighted 100g more than last time, and the time before. But her new school skirt has a belt on it and Waif had a big drink of water just before being weighed so I reckon her weight is the same or even very slightly less than last time. Basically, her weight has remained the same throughout her treatment since September, whilst she had grown 2cm and, obviously, got older, making her weight for age and height diminish :-( This is despite the fact that she is eating fine in front of me.....not 3,000 calories a day, I am sure (no sauces, no butter, crusts cut off, negotiations hard) but at least 1800 calories, so I am surprised and deeply worried that she has not gained weight.
The psych told us that he is free next week, then away for a week, then back for a week and then finishing. Really, since it has been decided that Waif should be on weekly appointments, the psych had only been available fortnightly. Hmmmm... perhaps a new guy won't be a bad thing. I am going to phone the Team Leader and see if I can request someone with more experience. Whilst this psych is a lovely chap, he is still learning and never seems to get to the point - we just have nice chats about what Wiaf is up to at school. Or rather, he initiates a nice chat, Waif refuses to talk in more than monosyllables and I fill in politely with detail and encouragement.
I am wondering if Waif might be depressed: she bursts into tears very easily eg when the cleaner cleaned her room after Waif had asked for noone to go in there.
Meanwhile, I have heard rumours from Waif''s friend at her new school that she is throwing away her lunch.
Waif mentioned to the psych that she has been asked to try out for the school netball team - this is a large part of the reason why she wanted to change schools to somewhere nearer, to have the time and flexibility to get into teams and go to matches. The psych said that she wasn't to play netball as she needs to conserve calories. Waif was devastated.
I have taken a unilateral decision that we will ignore that diktat- netball is a quick game and doesn't involve a lot of fitness training. Waif has instead agreed that she will eat something extra on netball days. I would rather Waif had a normal, healthy lifestyle that she can then keep up, than that she has to give up everything she loves and sink into gloom. I hope she will build up some muscle. I will however be VERY STRICT on the extra food she has to eat. I hope I am doing the right thing.........I know how difficult she would find not being allowed to participate in netball. I am however going to ensure that she doesn't go out for runs etc which she had been doing. In St Lucia, there is no doubt that she did a lot of sport - she would never stop and relax: reading a book was not an option.
So I have two goals this morning: 1. Phone the Maudsley and ask for a senior psych
2. Finally arrange Waif's neck scan.
3. Write to her old headmistress to thank her for the lovely letter she sent saying that Waif was welcome back any time and that we did not have to pay fees in lieu of notice.
UPDATE: 1. The hospital never received the scan form :-( The GP receptionist is adamant that it was sent. Ho hum, we are starting again with another form today and a 3 day wait before I am to call the hospital (according to the GP). Mind you, when I called the hospital just now they said that I COULDN'T make an appointment by phone but had to wait for them to post one out to Waif, and then let them know if it was inconvenient. What a stupid system! I am glad I am not trying to fit this around work.....
2. The "team co-ordinator" is the nutritionist, a capable middle aged woman. Whilst she is not a medic, she seems to have plenty of authority and experience so might not be too bad a person to talk to to ask for an experienced psych next time in view of Waif's lack of progress. She is to call me back on Monday as she is in interviews today.
Thursday, 14 January 2010
The Waif is back to the Maudsley today after school.
The psych explained to me last visit that he is hoping to build up a rapport with Waif in the hopes of having her confide in him. He is certain that there must be some trauma or emotional disturbance that is causing Waif to be anorexic.
Waif is well aware of this goal and is immensely frustrated by it:
"I haven't got any secret worries, Mother. So how can I tell him any? Should I make something up to get him off my back?"
Anyway, I mentioned to the psych that Waif had drawn quite a disturbing self portrait: you can tell it is her, for she is an excellent artist, but it is full of frowns, dark shadows and crooked teeth. He wanted me to bring it along.
Now I can hardly bring it on its own (Waif would never forgive me) so I suggested to Waif that we take along her portfolio to show psych so that he can see her main interest. She said no. Hmmmmm.......... Much of her work is beautiful, colourful and fun. It is always intricate and perfect, and betrays hours of careful labour. I am not even supposed to look at most of it myself but now and again Waif will let me peep.
Perhaps I will put some pics in the car and see if I can change Waif's mind on the drive to the hospital.
Oh, she is loving her new school :-) She says it is a lot more relaxed than her old (girls only) school and that the presence of boys makes it more fun. Hmmm....chaotic, more like. The class had a plan that halfway through English one boy would shout "dead mouse" at which signal, the others would all bang down their desk lids (God help their teacher). They did it! At Waif's last school, the whole class would have been in detention. At he new school, the teacher affected not to notice. She will simply have nightmares about it, I guess..... Waif is thrilled at this concept of freedom and power. I am guessing that is no bad thing.
Oh, please cross your fingers for her to have put on some weight. I will be surprised if she has but here's hoping.
Tuesday, 12 January 2010
My secretary is in hospital.
She is a lovely woman in her thirties with an 8 year old daughter, whose handmade cards and photos adorn the secretarial desk. I last saw her at the Christmas party where she was wearing a flashing hat and feeling a little sick. Her nausea worsened over some days and eventually she had a brain scan which disclosed a large aneurysm. Aneurysms are life threatening if they burst so she underwent emergency surgery.
Unfortunately, surgery was not straightforward and she has spent the time since in intensive care and without the use of her left hand side. She may remain paralysed for the rest of her life. She has not yet been told (shudder). The good news is that she is alive and conscious, so there is hope.
This makes me think two things:
1. Thank goodness for the NHS. My secretary is not wealthy and there is no way that she would be able to afford a year in hospital if she were paying for it herself. We too are benefiting with Waif's treatment at The Maudsley which is available to poor and rich alike.
2. How precious is life. Who are we to throw it away? We have been given one chance and there are those who would gladly swap with us who have been given the golden cards: health, housing, loving families and enough food.
Perhaps this knowledge is what makes it especially unbearable to see a beautiful loved one starving herself into self-inflicted health problems.
I know this is an unfair thought as AN is itself a disease and a sufferer should no more be blamed than should my secretary for her aneurysm. It's just that it APPEARS at first blush to be a conscious choice, and one must resist the urge to be cross and frustrated at the apparent selfishness.
Sigh, I know, I know, it's like telling someone who is depressed to "pull themselves together" - it's simply not within Waif's capability most of the time to even understand that what she is doing is making herself ill and ugly (sorry, it's true, with her bony ribs and whole skeletal structure of her pelvis apparent to the most casual of observers) when she was so healthy and beautiful only a year ago.
I thank God that she doesn't have a brain aneurysm and that we have a good chance of fighting this despicable AN.
Monday, 11 January 2010
Waif tripped off to her new school this morning.
Our last meeting at The Maudsley was dispiriting as she had lost a little weight again (only 200g but all the same...). Although we are now on weekly visits, our holiday to the Caribbean and then the psychiatrist's examinations this week have meant that we are not being seen again until this Thursday.
I really don't think Waif ate enough on holiday to put on weight: we had to cajole her to eat the bread roll with meals, to have anything other than a tiny dry piece of bread and cheese for breakfast, and to drink the milkshakes (we managed one in a week).
This morning as Waif was dressing, she called me up to her bedroom to complain about her uniform being too big :-( With the 20 inch waist skirt and the 30 inch chest blazer, I told her that it is just that she needs to fill out a little. She was unimpressed.
She has been told to keep a food diary for this week so that is helping. It helps her to see how little she has eaten and gives me a negotiation point at the end of the day as she does, in principle, want to stick to her meal plan.
Meanwhile, she has been growing fast which must be a sign that she is at least getting some nutrition even if it probably means she should eat even more. I reckon she has grown a centimetre in December. She is now appreciably taller than I am, but doesn't "seem" it to others because she is so slight - me, less so, as I have put on 3 kg (or about half a stone) since we all started eating high calorie meals.
My husband has not yet managed to read the first chapter of the book "Treatment of Eating Disorders" that is newly published and bought by me. I wish I could persuade him to read something about the subject. It claims that the only evidence for treatment for anorexia working is for girls caught relatively young, relatively early and then treated with the Maudsley method. That is great news, but we do need to stick with it.
I have my fingers crossed for miracles with the new school day. Mind you, when I checked Waif's packed lunch box this morning, which she insisted on making herself, her "sandwich" was a wrap with a quarter tin of tuna in it. She also had a miniature yoghurt and a small multipack sized bag of quavers. This is maybe 300 calories tops, probably less. I added a cheese string and a cheese roll and told her in the car. She said that if she ate the cheese roll, then she would leave the wrap. Ho hum, that's still maybe another 100 calories I have sneaked in.
Reminder to self: stop buying multipacks of kitkats, chocolate bars and crisps, which turn out disappointingly small, and instead buy several of the large single ones.