Friday, November 30, 2007

Food

N is an hour plus late for school right now. He is paralyzed over choosing a shirt. He is so picky about how they look on him. If the fabric hangs out at all then he freaks out. He'll be fine with wearing some shirts one day and then the next time he hates that shirt. I'm sure it is the anorexia still warping how he looks at himself. He also confessed that he can tell that he is gaining weight and that he feels fat because of all the extra calories. Which, of course, is ironic given that he hasn't even gained a pound since we started refeeding. He has cried now for about 30 minutes. Then he apologized profusely, saying things like, "I suck" or I'm pathetic." I've helped him find positive messages and I've hugged him a lot, but it's not making a difference this morning. He is crying again. I've asked to him to go lay on his bed, do some relaxation and try to calm down (we call it "calm-down time").

I'm struggling to get his calories up. With a lot of effort, I can get his daily total to around 2300. I'm using the tricks that other parents have passed on (adding carnation instant breakfast etc.). Here is a sample menu:

Breakfast
4 large pancakes (made with whole milk) - 350
1 T. syrup -100 (he wouldn't eat this until yesterday)
2 pieces of bacon - 70
1 c. cocoa (with carnation instant breakfast & whole milk) - 430

Snack
PopTart - 200

Lunch
Peanut Butter Roll - 250
Orange - 30
1 c. Juice - 100

Snack
1 mini candy bar /package of starburst – 300

Dinner
2 c. Wild Rice Soup (made with half and half) - 340
1/2 apple - 60
Carrots - 50
1 c. of Juice – 100

Snack
1 cup of Breyers Vanilla ice cream - 300

Total - 2680 Calories

The problem is that he is stuffed (particularly at breakfast and dinner). I would be too! He is eating a ton of food. Yet, 2680 calories is a good day. Most days, I struggle to even get him up to 2300. Some mornings I'll make him a high calorie shake (that replaces the pancakes) or a bowl with two packets of oatmeal and instant breakfast. I'm going to rotate bagels and muffins into the breakfast/lunch mix. I just can't make him eat more of everything. Somehow I need to find better ways to make calorie dense foods.

Thursday, November 29, 2007

Sick

I've been much more diligent over the past two days about watching N's calories. Sure enough, his moods and obsessions have responded accordingly.

We've had a terrible cold going through our family. It's a cold with the works: fever, aches, coughing and fatigue. N and his brother have both been feeling it. They've been lethargic and cranky. N, however, has continued to complain about a stomach ache. He doesn't want to eat very much. I've wondered if that, in part, is him taking advantage of the situation. And I feel like I can't let him eat less. I've seen what happens when we back off on his caloric load even a little bit. I don't either want to aggravate a sick stomach. So, I've insisted that he eat. He's been a little more reluctant. But after I made it clear that eating less wasn't an option even with a stomach ache, he responded. I've tried to choose foods that are a little more bland and less heavy. For example, I let him have left-over wild-rice soup last night instead of stuffed shells with tomato sauce. I've also been suggesting hot cocoa -- but for some reason that hasn't appealed to him.

Tuesday, November 27, 2007

Counting Calories

N has been doing so well over the past 2 weeks. I'll admit that I haven't been as exact at counting all of his calories. I could tell he was getting a good amount of food each day. But now I know better. Last night, N began to spiral. I could tell that he was struggling as soon as I picked him up from school. By the night's end, I had to push to get enough calories in him. This morning, he cried again. It took a long hour to get him to school. He was feeling so self conscious. I've upped his calories again and am diligently keeping track -- but I suspect it will take a day or two to have his mood swing back. I think that the return to school (after a long stress-free Thanksgiving break) also affected him.

Sunday, November 25, 2007

Weigh-In

I weighed N this morning: 82.1 lbs.

This is actually down .1 lb from last week. I've heard other parents talk about this happening (loosing weight even though calories are significantly raised). I wonder how it's possible, though. He has eaten so well this week!

He had a great morning. He was only a few minutes late for church. There were not any delays over clothing (he did have a new white shirt).


Note: (added in 2011)  What I learned later is that kids recovering from anorexia typically have a hypermetabolism.  They need double or even triple the amount of calories normal for other kids just to maintain their weight. 

Saturday, November 24, 2007

Thanksgiving

I am so thankful that N has made so much progress. We'll weigh him tomorrow, so I don't know exactly where he is. But he's had a great week.

He met with Dr. R. on Wednesday. The doctor was so pleased with N's progress that we've shifted our appointments to every other week. Dr. R. said to continue with all that we're doing.

The anorexia isn't gone. N will argue and resist when his meal has a lot of calories. But there hasn't been any yelling or crying these past few days. He'll protest and then quickly relent. I'm sure that no school and no scouts have helped keep his stress down. Also, his dad has been able to take these days off. There has been a lot of support and love. Hopefully, this trajectory will carry into next week as the pressures start up again.

Wednesday, November 21, 2007

More Of The Same

N continues to do well. It seems like each day he has one or two moments where his anorexia resurfaces. Those moments seem to happen around meals -- especially with new menu items or in the morning (dressing time) and evening (when he is tired). Those moments, though, seem to get farther between, shorter, and less severe. I hope that continues. Often he will yell and get mad, but will regret it and apologize pretty quickly.

Monday, November 19, 2007

Pancakes

N had a great time camping! I packed him full of calories before he left. Then on Saturday, I made up any deficits. According to both N and his scout leader, he ate well.

N was tired of course from late night camping. Sunday morning was tough. I was ready to go to church (announcing all throughout the morning how long until church) and he hadn't even started getting ready. He cried and I hugged him for several minutes. Then I told him to do some relaxation and say a prayer. He did and came to church quite late. But his attitude was a lot better throughout the rest of the day. We had Quiche for dinner. N doesn't like it, but he ate it without complaining. He also had two treats at an evening church meeting.

N went to bed late last night. I knew that it would affect him this morning. But it wasn't too bad. He's tired of shakes. I was willing to substitute pancakes this morning (4 with syrup). He wanted to negotiate the syrup. I think the idea of syrup being pure sugar really scares him. So, his Dad stepped in and compromised cherry preserves instead. I was worried that it would turn into a huge meltdown, but N jumped up and got ready for school. With a lot of cheerleading on my part, he made it to school only a few minutes late.

Saturday, November 17, 2007

Tests

All of N's test were normal. So, he got to camping. I'm anxious to hear how everything went.

It was good to have a nice quiet night here at home. We missed N -- but it is always good to have some moments away from the emotional drama. T took J out for ice cream. I'm glad they had a chance to have the one-on-one time. It's been especially hard on J these past few months.

Friday, November 16, 2007

Timing

The timing was terrible this morning. N wants to go camping tonight. It's also the last day in the term to turn in his math assignments (which are done, but just need to be recorded). I also added a generic version of "ensure" to N's shake this morning (of which he was aware). So, it all added up to another meltdown this morning. He spent an hour or more crying and refusing to go to school. I really think the extra calories in the shake were at the root of the issue. In the end, he changed his shirt to one that makes him look "skinny" and then he was fine. I'm sure that he was also motivated by the knowledge that there would be no camping if he didn't go to school.

N has been spending extra time after school catching up on his assignments. I like having him stay after because it serves as a natural consequence for being late -- and it increases his interaction with other students (who are still in class once he is done with school). I know that he didn't want to stay after today because he wanted to pack. But, again I felt like it was a good natural consequence (and he will still have plenty of time to pack). N really functions fine at school. He has neglected his studies and his grades have gone down. I'm not worried about either of those things. I am concerned, however, about his developing bad habits. And when he can, I think he should still be responsible as much as is reasonable. I know that some kids with anorexia can't handle school at all and need to be pulled out. I think, though, that he needs to be there. School truly serves as a distraction for him.

N and his Dad saw the therapist last night. I got the recap later on -- but there were some interesting comments. 1 - Dr. R. was surprised that we weren't getting simultaneous medical care from N's pediatrician. There have been 2 or 3 other things that Dr. R. had also taken for granted. I need to make sure I mention everything to him so this doesn't happen again. 2 - I was surprised that Dr. R. was not aware of the Maudsley Approach. I took him the summary from the http://www.maudsleyparents.org/whatismaudsley.html website. He browsed the article and said that it was credible research. For the most part, the Maudsley Approach is similar to the approach that Dr. R. advocates anyway. He said if it is working then keep doing it. 3 - He said it was okay for N to go camping (just overnight: dinner and breakfast). But he said it was important to get a medical evaluation today (especially since he hasn't been seeing his pediatrician regularly). So, we've made an appointment. His scout leader is aware of the anorexia. He'll have instructions to call us if N isn't eating (and we'll go get him). We won't make the scout leader responsible for making N eat. So, I'll pump N full of calories before and after. N has been good about eating away from home (but a little conservatively) so I really think this can work.

Thursday, November 15, 2007

Food

N had another good day.

I am struggling to find ways to get more calories into his diet. N is not excited about the addition of ensure to his morning shake. He has seen the cans in the fridge. He didn't melt down about it, but I haven't actually used the stuff yet. I'm not sure where else to add calories. I've thought about adding an evening shake -- but I would get so tired of shakes if I were having two a day.

Wednesday, November 14, 2007

Hope

N is still doing well. There have been several "blips" everyday. But they are shorter and less severe. He seems to get control of himself faster now. His Dad had been out of town over the weekend. He said that the difference in N was amazing! N has color in his cheeks and has been more himself over the past few days. He has even been seen smiling.

I attribute the change to both the increased calories and the limited choices. I hadn't realized how paralized he had become about simple choices. He spent almost 30 minutes yesterday at the supermarket trying to choose a candy bar. His calorie intake is still only in the 1900 to 2500 range. I'm trying to go "low and slow" to avoid the refeeding syndrome.

I have some hope for the first time since he got sick.

Monday, November 12, 2007

Calories

Last night, after a pretty good day for N. He started rattling on about how many calories he had eaten. He was throwing numbers around like 3000 and 3500. I've been paying attention to his caloric intake, generally, but had not been adding every little thing -- and I certainly didn't think he was even in the area of 3000 calories. So, we sat down and added things up from his day. I was so surprised to find out that he overestimated his calories significantly in almost every area. The reality was that he had barely had 1900 calories -- which is only enough to maintain his weight. He has "allowed" himself to eat up to 1800 calories with not a lot of resistance. But he has been fooling himself. I've got to be extra dilligent now about counting the calories for him.

N has had a good 24 hours. His anorexic obsessions/thoughts have still been there -- but are much more muted. I can tell he feels better (and that's just with 1900 calories). I've limited his food choices to two per meal and I don't negotiate. That's already eliminated half of the meltdowns. N had a little blip this morning when choosing his clothes (another example of too many choices right now). I think I will have him set his clothes out the night before. He had a great breakfast (shake, sausages, toast). It's the first time I've seen him really full in a long time.

Sunday, November 11, 2007

New Low

We did our weekly weigh-in this morning. N reached a new low: 76.5 lbs.

I told him how much weight he had lost. He was all geared up for a battle -- but once he knew how much weight he had lost, there was no battle and he ate fine. I told him his weight because I knew he would eat.

Yesterday was rough, but he definitely is starting to get the idea about the new ground rules. For lunch today, I offered two choices. He wanted to argue -- but I reminded him there were no other choices or negotiations -- and he responded. It's been hard to know how much to limit his choices.

Note: (Added in 2009) This is the day that I knew we had to completely change our approach. When I discovered how low his weight had fallen, I was desperate and afraid for his life. I was willing to try something new. So on this date, I started applying the principles that I had been learning from the other parents at aroundthedinnertable.org based on the Maudsley Method.

Starting with Sunday evening dinner, I gave him a plate full of food and required that he eat it. I told him that we wouldn't be going anywhere or doing anything until he ate.  That first night was really tough. He sat at his chair much past dinner time crying, getting angry, and refusing to eat until he realized that I was completely serious. Then he started eating -- but just a bite at a time.  It was a long night, but he ate more than he'd had in a long while.  The difference was almost immediate.

Saturday, November 10, 2007

Saturday

This morning was terrible. I made pancakes thinking I could "sneak" some calories/fat into them. N freaked out as soon as I said I had made pancakes. He didn't see me make them and I wouldn't let him see the mix or tell him which recipe I used. Pair this with the fact that he had a scout activity that he didn't want to go to. We were in utter meltdown for 45 minutes. Maybe I shouldn't have forced him to go to the scout activity. But I felt like he needed to get out and do things with other kids. Anyway, I did get him out the door (20 minutes late and with breakfast in hand). I gave instructions to the boys to make sure he finished his breakfast. He'll hate eating in front of them -- but he'll hate them bugging him worse.

N usually does okay as long as his menu is predictable (i.e. he knows the calories). Any choices are hard. Even a choice of toast or cereal sends him into space. For some reason, he is a little more flexible with dinner -- but has started to be less so. We worked out a compromise with Dr. R. to help with the battles at dinner. We work out our month's menu together. I don't mind his choosing some of the main courses -- but I get to put the quantity in front of him. Dr. R. told us that N would become more picky with time, but not to let him do that. [In fact, at this inpatient facility they don't "allow" people to be vegetarians. He said that is a common thing for people with anorexia to decide that they are vegetarian.]

Also, I'm realizing that I've got to up his calories. He's only getting enough right now to barely maintain his weight. He's okay with most of what he eats because he knows that he continues to "maintain." I think bigger battles are coming as I increase the calories and the weight starts to come back on. So, we probably haven't even experienced the worse yet.

N has a chance to take a test today to be placed in an accelerated 7th grade program. He wanted to take the test -- but lately started freaking out about it. I have to admit that I would like him to participate. This is because for so many years I saw him bored in regular classrooms. He was finally challenged when we moved him into an accelerated class (which he is still in). Now, the least little thing makes him completely stressed. We've discontinued every other extracurricular activity including sports and guitar. All he has left is scouts and school. I'm not pushing achievement in either right now. Still, I wonder if he'll get better by next year and then be bored in school again. Is it worth the stress the test would put on him today? Ultimately I guess I'll let him decide.

Thursday, November 8, 2007

Family Dynamics

I had no idea, until today, that parents were once blamed for children's anorexia.

I've been looking for a support forum and finally found one today. The reading was so interesting -- and I can tell I have so much to learn. I posted this blog link on that support forum and I've had many wonderful messages of support today. I didn't realize, however, that "family dynamics" was such a hot topic. I probably need to clarify some of my previous posts. I have been the one exploring my own possible roll in the development of my son's anorexia (based on my reading of "Skinny Boy"). Dr. R. has never suggested that I (or our family dynamics) have played any role in N's development of anorexia. We are treating the anorexia as a disease with food as the medicine. Our main objective right now is to get N to eat.

I've learned some about the Maudsley Method. From what little I've read, I think that it is pretty similar to what Dr. R. is teaching & promoting. We've also talked a lot about "Intuitive Eating" as a new way for N to approach food. I'm not sure how these two things work together but I intend to do a lot of reading and find out the best way to help N.

A Change Of Pace

Two steps forward and one step back.

N's aunt M & uncle J came to visit over the weekend. Though, N did seem to struggle at moments, he didn't let it consume him. He resolved things rather quickly and did well. Once they left, N did allow his emotions to show more but overall seemed to do better.

Tuesday morning, T & N went to a local school district camp for the night. T said it was a good experience and that N did well overall. T did say the N has no friends -- not even a group to hang out with.

Yesterday night and this morning have been back to the same old issues all over again. I'm concerned because I feel like N is hijacking our family. He is becoming more willful and regularly refuses to eat, to do chores, to do homework -- whatever. We've given him some allowances, but I feel like N is exploiting that space. I'm tired of tiptoeing around him -- and I feel like he needs to follow our family rules. I know that I can't make him do anything -- but I think there need to be consequences when he is disrespectful and disobedient. Even consequenses are hard. In the past, we would not allow him to have friends, or take away media time. Now, we desperately need him to have friends. Even now, he comes home and won't play because he just doesn't get to his homework. If I push his "homework time" to the end of the day, then it will create even more problems with bedtime. And his bedtime is something we are still working on.

Today I feel tired. I'm tired of the constant emotional drama. This disease is taking a toll on me and our whole family.

Sunday, November 4, 2007

Family Fast

(Post added in 2009)

It was this Sunday that we held a special prayer and fast for N. Only limited family members were aware of his illness, but we all joined together on this day in hopes of finding help for him.

It is remarkable to me now, as I look back, to realize that only four days after this prayer & fast, I found the resources that I needed to ultimately help him get better.

Friday, November 2, 2007

The Doctor Returns

It has been 2 1/2 weeks since we met with Dr. R. Yesterday we met with him at the end of the day (instead of our typical early morning time). It was a good visit. We talked about the negative messages vs. positive messages. Dr. R stated that he hadn't realized that N was doing that or he would have given us some instruction. He confirmed that I should continue what I've been doing (making positive messages out of negative ones).

I also asked about my concerns about my pushing N and not allowing him to have all of his own consequences. Interstingly, he said the parenting styles usually associated with anorexia are very different from binging -- and are usually a more controlling parenting style. However, he had not perceived me as particularly controlling and hadn't been concerned. I was wondering if I should continue changing my approach (letting the boys have more ownership over completing their own school work and/or assignments) or if N was too fragile right now. Dr. R suggested it was like a chicken/egg relationship. It could help and it could hurt. My best parent instincts right now tell me to continue giving the boys the ownership. I felt strongly at the beginning of this school year that I had never allowed to boys to fail. And until they had that experience they wouldn't decide to take care of their problems themselves. So, I had been making these sorts of changes even before reading Gary Gahl's book. I think we've had a few bumps -- but in the end N and even J are taking more responsibility.

T & I determined that N needed to get more sleep. He has been doing this cyclical thing where he stays up late (usually with much drama and crying), finally goes to bed when we do, is too tired to get up in the morning, goes to school 30 minutes late, is tired at the end of the day -- and the drama starts all over. So, we're trying to have him go to bed by 9:00 every night (we were trying to do this before, but we'd start at 8:30). We'll start the process at 7:00 pm if we have to. We almost have to plan on an hour of talking before N will go to bed.

Last night as we talked (for the typical hour), N was rehashing all the calorie/weight/good-bad food stuff. All of a sudden I realized that we were supposed to be distracting him from all those topics -- not enabling him or being sucked into his obsession. So, I informed him that we would talk about anything he wanted, but that we weren't going to help him obsess over calories and foods by talking about it. T said it really well -- that it is our job to worry about the calories and such (and N doesn't need to worry about it).

So, he was in bed by 9:00 -- but didn't stop talking/obsessing until 9:40. However, he did get to school on time this morning (the first time in a long time). He told me that he wasn't going to go to school because he was too self-conscious. But I drew the line and said that staying home was not an option. Eventually he relented. We did positive messages all the way to school.

A friend this morning read the lyrics of a song that her daughter wrote for a competition. J & N have been friends since before they started kindergarten. The lyrics really seem to talk about all the changes in N -- though J insists that they aren't about him at all. They talk about someone who used to be happy being sad and pulling away. J doesn't know about N's condition -- but she must see the changes happening and feel sad for him.