Outpatient ED treatment

I’m always relieved and a bit surprised when I eat adequate amounts of food and I don’t gain a load of weight. In hospital when I began refeeding, I gained 4 kg in a week. Even the nurse was surprised at how much weight I gained in such a short time- “How is that even possible? You must really want to get out of here,” she said. And because it’s happened before, there’s a part of me that’s afraid that’s going to happen every time I start eating more. But it hasn’t.

These past three days I’ve been eating well and my weight has remained at what I think is possibly my body’s set point. On Friday when I saw my psychologist we talked about weight and the fact that while I’ve managed to maintain the weight I was discharged from hospital with, I’ve also been controlling it so that it hasn’t gone above that number. Technically my current BMI is just under the “healthy weight range,” but I am naturally petite anyway. I said that I may be okay with it if I gained a couple of kilos from eating what a person is supposed to eat in a day- regular meals and snacks that are balanced and nutritious. What I can’t justify is gaining weight for the sake of gaining weight or if I gain weight from overeating, eating lots of unhealthy foods and/or bingeing and purging. My psychologist is fine with that, which makes me so glad I’m getting outpatient treatment for my eating disorder instead of inpatient treatment. Instead of inflexible and ridiculous rules being imposed on me, I get to have a say in my own treatment and recovery. Which means for me eating regular and balanced meals and snacks throughout the day, and if I gain weight that’s okay, but if I don’t gain weight that’s okay too. What recovery and good treatment doesn’t mean to me is being forced to eat to the point of almost vomiting, and being forced to gain a certain amount of weight and punished if I don’t.

Though being in hospital was such an awful experience, it’s almost a good thing it was so bad, because it serves as an additional motivator to be well and stay out.

Assessment appointment for ED treatment

I received a call today from the CCI, which is the only public service in the state that offers an outpatient eating disorders program. I was offered an assessment appointment which I accepted, and it’s been scheduled for next Friday. There’s a part of me though that has doubts about whether obtaining treatment is the right decision or not. As I’m now weight restored after being in hospital, I feel as though I don’t need or deserve treatment for anorexia. After all, I’m not underweight any more so not only do I not look like I have anorexia, I don’t even fit the criteria for a diagnosis any more. Although I know it wouldn’t be a good decision, I’m tempted to lose weight before next Friday because I fear I’m going to go and be told that I don’t really have an eating disorder and don’t need help, after all, I’m not underweight.

I also had a visit from A, the Community Mental Health Nurse this morning. She asked about me appearing on the media about my experiences of ED treatment in hospital, which made for an interesting conversation. She mentioned she didn’t actually see the segment when it aired on TV, but was told by other staff about it. “Which staff?” I asked her, curious to know. “Oh I couldn’t remember names,” she replied. I told her a friend was advocating for better ED treatment in the eastern states, she asked me whether I was interested in talking about my experiences so I did. A asked me what I wanted to see so I told her- a dedicated inpatient ED program like they have in the children’s hospital, for hospital to also address long term recovery and psychological aspects instead of simply force feeding, and for there to be a step down, like a day program, so that people aren’t just going straight from hospital to home with no support.

Struggling with being over 40kg

Since the last post I’ve been transferred from the open ward to the locked ward, then moved back to the open ward where I’ve been for a few days now.

On Monday I was reviewed by the dietitian. I was told my weight had stagnated as it had hovered at 39.2kg for a few days ever since I’d come on to the open ward which was attributed to me “walking around” even though the most walking I was doing was 5m from my room to the lounge room. It’s a ridiculous distance to have to be wheeled in a wheelchair when I can walk, and honestly, walking that short a distance is not going to affect my weight in the slightest. She again reinforced the restrictions of being wheeled around in a wheelchair and having meals in my room as opposed to the dining room with everyone else. I was upset after this review, as I felt I was being blamed for my weight stabilising, and despite me eating most if not all of my three meals and drinking all three Ensures a day, I was still being so restricted. I was already upset, and it was made worse when two nurses came in and started going through my belongings. I can’t stand having my privacy invaded and on two previous occasions when I’ve had my room searched, I’ve ended up restrained and put in the seclusion room. I tried not to completely lose my shit again this time. I took the blade I had in my bag and held it in my hand to try and calm myself down with the knowledge that it was there just in case. Unfortunately the nurse who was specialling me cottoned on after a while that something was up, and came to investigate. She had a glimpse of the blade, which I quickly took in my hand. She tried to get it off me, I wouldn’t let it go, and other nurses were then called and the duress alarm pulled. I was restrained and taken to the seclusion room where the security guards prised the blade out of my hand, I had all my clothes, glasses and jewellery taken off me, and was given an IM injection. After a period spent in the seclusion room I was wheeled out of the open ward where I found myself once again in the locked ward.

The first few days there I wasn’t allowed any of my personal possessions, not even my glasses, as apparently it would pose “too much risk.” On the second night there I got very frustrated at the situation, took myself into a bathroom stall and started hitting out and punching the wall. The nurses heard me banging around, led me out and into my room where I pushed over a chair in anger. I was then escorted to the seclusion room, where I was made to lay down and once again given an IM injection.

Whereas on the open ward they’re a bit more relaxed, the staff on the locked ward were very rigid in following the management plan down to the letter. I was told I couldn’t have honey with my weetbix at breakfast because it’s “not on my management plan”. There was a plum on my dinner tray and I don’t like plums so asked for an apple instead and was told no. And though the point is for me to gain weight, when I asked if I could have a tub of yoghurt or an ice cream, I was also told no. Out of spite I then ate exactly what it said on my meal plan, nothing more, went everywhere in a wheelchair and drank only a minimal amount of water to prove that it wasn’t being in the open ward that was making my weight stagnate and by not allowing me extra food, I wouldn’t gain weight. I did end up dropping 0.2kg and was 39.0kg on Friday morning.

Thankfully on Friday afternoon I was transferred back to the open ward and have been here ever since. Still on a 1:1 special which means it’s been three weeks that I’ve been continuously watched by a nurse. The dietitian added even more to my meal plan which means daily I’m having three full meals, three snacks and 200ml of Ensure Plus three times a day. Eating six times a day feels excessive and surely normal people do not eat this much.

Up until now I’ve been eating and gaining weight quite easily without it being much of a struggle, but these past couple of days I’ve been feeling awful as my weight is now over 40kg. Being under 40kg felt safe, and now that I’m over that number, I feel like I’m fat enough and any more weight gain is unnecessary. Clothes that used to be loose on me now feel tight, and I feel like I need to punish myself by self harming for being such a fat, disgusting pig. But of course I can’t, and I just feel low and I can’t cope with them wanting to be 46kg which would be a BMI of 18.5. I’ve never been that heavy in my life and at that weight I’d either just restrict again to lose it or kill myself. I could go home and eat without trying to restrict at about 40kg, but 46kg? There’s no way I could deal with that and that’s just setting me up to starve and lose weight all over again.

Inpatient ED treatment

So I find myself back in hospital at A St, in the same ward I was in during May. Which makes it my 6th psych admission, though for the first time it’s not after being sent from the emergency department after an overdose but instead for an eating disorder. Or specifically, anorexia nervosa, though it still feels odd when they call it that as I don’t feel as though I’m thin nor sick enough.

On Tuesday I had gone to see my GP. “I can see you’ve lost a lot of weight, I almost didn’t recognise you,” she said, which I thought was a bit of an exaggeration. I weighed in at 35.4kg and according to her records, the last time I’d been weighed in her office I was 43.6kg. She requested for me to get my bloods done, after which I started experiencing nausea, dizziness and my vision started going fuzzy. They put me in a wheelchair so that I could be taken to a bed to lay down. My blood glucose at the point was 3.7 which according to GP was quite low, and my blood pressure dropped to 76/40. “I’m not surprised you fainted,” she told me, after quizzing me on what I had eaten the previous day & the weight I had lost.

On Wednesday morning I had an appointment with the psych registrar at A St. She again kicked me out if the room while she consulted with her consultant then told me they wanted me admitted to hospital. I agreed this time as I did not want to be put under the Mental Health Act and really, I’m just tired of it all. I went home to pack my things and in the afternoon returned to be admitted to the ward. The medical doctor on the team did a physical check up on me, and they also had the results of my blood test back. They were all quite normal, except my white blood cell count was just a little bit low. Which again made me feel like I’m not sick enough to require hospital and don’t need to be here.

After lots of waiting around I was finally taken to the ward. A nurse did the admission paperwork and took my observations, and also did an ECG. She’s a recent graduate and was nice which was good as we both had a bit of a laugh when it came to doing the paperwork and her having to ask me about using weapons, wanting to harm others, and my non-existent drug and alcohol habits. “It’s good to do groups,” she said, in which I just laughed in response.

This morning I was seen by the doctors. My current BMI is about 14 and he reckons an ideal BMI would be around 20. I disagreed and told him that would be too high. “How about we make a goal for you to gain 10kg?” He asked. How about no. I was told I’d have to have daily blood tests to check I don’t develop refeeding syndrome. Given I really dislike needles and blood tests, I was not pleased to hear this. I asked him how long I’d likely be here, he said probably a couple of weeks.

Then met with the dietitian who said that they will do a meal plan for me and also give me nutritional drinks in the form of Ensure.

Unfortunately me being in hospital meant that I missed the last session of emotional regulation group. It also means missing uni and having to cancel with work, and they did not sound happy when I did so :/