Finally

Today is N's appointment at the local Children's Hospital. I'm thrilled to finally be able to (hopefully) have a whole team working to help him.

N was just a little late to school, didn't make it to bed on time and didn't do his homework. He played around for 3 hours yesterday and then responded angrily and violently (by kicking his brother) when I wouldn't let him go to a friend's house. So, we had a lot of talking to do last night. Any violence is not acceptable regardless of its cause. This morning, he was refusing parts of breakfast again. Thankfully, T was here to persuade N that it was better to talk nicely and discuss things rather than yell, slam doors and refuse to eat.

Hey Mom! Guess What?

As T & N hauled N's science fair board into the car this morning, N hollered back to me as I stood in the open garage door, "Hey Mom, guess what? I earned all three for the first time!" He was so proud of himself. He did. He earned all three rewards. He was on time for school, went to bed on time and finished his homework (though it was quite an ordeal completing the science fair project). Way to go N!

As we finished the science fair project last night, I found myself searching for a balance between letting him do everything and jumping in as his attention and spirits waned. He was highly reliant upon me to help him. Instead of doing it for him though, I tried to teach him the different mounting techniques (for example) and then let him finish. I had to purposely not make suggestions because he would freak out when I did. Hopefully, I'll get better at this delicate dance as time passes. I know that ultimately he needs to be responsible for it all, but I also didn't want him to give up (as he is prone to do because of the anorexia). As he heals, I'll need to wean him little by little.

A Better Morning

N was completely on time for school this morning. In fact, he would have walked in the doors before the bell even rang, if it hadn't been for a lot of snow on the roads and very slow traffic. He did great! He did change his shirt once. I ran a whole load of laundry last night just so he could have a clean red shirt (one of the three shirts that he actually will wear).

I asked T to stay home a little later this morning. The last two school mornings, T has had to head into work early and hasn't been around at all. That also coincided with N's two last rough mornings. I wondered if there was a correlation. If nothing else, it helps to have two of us working with N (and helping with the other kids). I'll be watching that a little more closely now.

Details

N had a fine weekend. The anorexia has continued to be strong. It's coming in stronger waves multiple times a day right now. I've wondered if he is fighting off something, which in turn could ramp up any autoimmune issues. N has been pretty hard on himself. He did make it to church on time.

This morning, we had another long delay as he chose his shirt. It took him 2 1/2 hours to get to school. I think that his issue with shirts could be another example of focusing too much on the details and not seeing the big picture. He finally responded this morning after I reminded him of the reality of his shirt choices. We weren't able to find any this past weekend (though we looked). I walked him through his choices, told him that I understood that he didn't love any of them, reminded him that we couldn't get any new shirts at that moment, and helped him see the big picture of him missing school while we waited. He finally picked the shirt that he likes the most (but doesn't really like) as I helped him to put it all into perspective.

I noticed that he did something similar tonight as he worked on his science fair project. He needed to create four pages with a topic and a sentence under each topic. He had already written everything in a prior preparation paper. But he couldn't get past the font and size choices. He was paralyzed by the graph color choices. Again, it was so difficult for him to see the bigger picture of spending larger amounts of time doing those things that are most important and not taking tons of time on those little details.

Update

It ended up being a 4 1/2 hour episode. He talked to his Dad for 30 minutes, but didn't make a turn around like he has in the past. He finally made it to school at lunch time. The turn around? I told him we could buy him some new shirts. He wanted to go NOW. There was no way I was going to reinforce his behavior from this morning by letting him go shopping instead of going to school. So, I told him maybe after school if I could get all my chores done (which I wasn't being able to address while I was helping him). So all of a sudden, he was motivated to go to school. It still took him an additional 30 minutes after that, but he was trying and moving instead of languishing. I'm not sure buying shirts will solve the problem. I suspect that next time the anorexia will tell him that those shirts aren't good enough either. But I'm willing to give it a try. He did feel better about his clothes after we got the last batch of shirts. I'm concerned about it being such an extrinsic fix.

Now to get those calories back up . . .

Relapse

Boy, the anorexia is in full force today. I started to see it come on strong yesterday afternoon and evening. He has been asking his friends if he is skinny (and they are telling him, "no"). He has also been resisting (delaying on purpose) his food again. His calories have been too low the past few days because of it (1900, 2100 & 2400 the last three days). Yesterday, I pushed calories heavily hoping to stop the advance. I also hoped a good night's sleep would help. He didn't make it to bed on time, but wasn't late enough to cause problems. He told me as I tucked him into bed last night that the anorexia was winning.

This morning he has rotated between apathetic, angry, crying, apologetic, and in complete denial at times. I've not been very patient. We've had this same battle so many other mornings. I've lectured, threatened and tried to punish him this morning (all things that I try really hard NOT to do). But, I'm tired. And I'm tired of these loaded, emotional mornings. He needs to go to school and I need to have a moment to take some deap breaths. I'm doing better right now. I'm aware of the mistakes that I have made this morning and am currently trying better strategies.

All of this drama is over the choice of a shirt. N says that they aren't fashionable, they are too big, or they're too small. He has many choices. Choices that were fine even two days ago. I know it's the anorexia pushing at him hard. He says that the anorexia hates him -- and that he hates himself. In situations like this, I try to help him as much as possible. But I can tell he just needs some time. So he's in his room, curled up, but not crying -- thinking, I think. I go back in every few minutes to see where I can help. He is moving into the guilt portion of the typical cycle. He is processing things and starting to try a little harder. I've encouraged him to skip the shirt issue and to just work on brushing his teeth. N is currently talking to his dad on the phone. We'll see if that strategy works this morning. We've already been in this cycle more than 2 hours now.

Reward System - Day 7

N didn't get to bed on time last night. But he did get his homework done. He had an astronomy poster due. He was struggling with paying too close attention to the details and not finding the main ideas. Luckily, T is a professor and teaches writing skills (which the poster basically used). T was able to walk N through the process of ignoring certain details in order to find the main points. After 10 minutes of talking, N had applied that concept to his poster and was moving along fine. I suspect that we'll have to hold N's hand a bit as he struggles with those concepts in the future.

N was only 10 minutes late for school this morning. He said that the anorexia was strong, but not with his shirt, instead it was with his food. I had some idea that he was struggling. He was saying things like "I'm too full to finish this" or "I'm trying to listen to my body and I feel full." When I responded that he had to finish his oatmeal and I said that he didn't get to use intuitive eating until he was weight-restored, he fought me a bit (which is when I suspected it was the anorexia). I made sure to remind him that his morning snack is not optional. He has been skipping that snack and has not been eating much of his lunch. I try to recover the calories later in the day, but it's almost impossible. I'm currently logging his foods in anticipation of our visit to the Children's Hospital. So, I'm extra aware of the deficits at the end of the day. Maybe I need to go eat lunch with him. I know that he really doesn't want me to do that. Perhaps the suggestion that it could happen would be enough to get him on board.

Reward System - Day 6

I would say that generally the reward system is working for N. He is almost regularly making it to school on time and is also getting to bed on time. His moods have also improved as a result. However, the reward is not really helping with his school work. I would venture a guess that the problems with school work are more affected by the anorexia. We'll leave that reward in place, but may have to set up a reward just for the school work later. N's school load is extra heavy right now. He is trying to get caught up, finish his homework and anticipate upcoming projects. I would be overwhelmed, too. I'm just not going to worry about it or push him. I'll let him set the pace on the school work issue.

N's calories were low yesterday. He didn't eat his lunch and was behind, calorically, the rest of the day. I suspect the anorexia will affect him more today because of it. I asked him if he had a battle with the anorexia this morning. He told he that the anorexia had been quite strong. When I asked, "who won?" He said, "me." He is getting better all the time at pushing back at the anorexia. Hopefully, he'll be able to do that today.

We received a packet of information yesterday from our local Children's Hospital. It listed all of the services and checks that will be available to us - dietitian, physicians, social worker, etc. It sounds like a true team will be assessing N at his appointment. The packet said to plan on at least two hours. The hospital is about an hour away, so it's going to be a long afternoon I'm sure.

As I read the information, I was struck with how valuable this resource is to us. I also realized how much more valuable this information would have been three months ago. N's therapist once mentioned that there is very little awareness of anorexia amongst our local pediatricians. Not only do they not screen for it, but then when parents, like me, bring it to their attention, they don't know where to send the kids. If only our pediatrician or therapist had been aware of this eating disorders clinic at the Children's Hospital, I can only imagine the time and anxiety it could have saved us.

I'm not going to do it right now -- N is the main focus of all my energy. But once he is better, I've been thinking about creating a packet that includes a list of resources and maybe some screening questions and send it to all of the pediatricians in the area. The local treatment center provides a wonderful resource for adolescent girls over 14. But there is almost nothing available for younger patients or male patients. The treatment center gave me a list of doctors which was of no help to me. They were all adult doctors that just happened to diagnose anorexia once or twice. None of those doctors had any real specialty or training with eating disorders (I know because I called them all). Maybe this is where I can make a difference. It would be worth it if even one family could find more appropriate care more quickly because a doctor knew what resources were available.

Reward System - Day 5

N was in bed on time last night. This morning, he was only 6 minutes late to school. Yesterday, we struggled some with his calories. N resisted some when I told him it was time to eat or have a snack. Again, the lack of routine, I think, upset him some. Last night we had scones (our word for fry bread) for FHE (a required snack). N wanted one this morning for breakfast. When I went to make his cocoa, I noticed that he had drizzled a good amount of honey-butter onto his scone without any prodding.

Weigh-In//Reward - Day 4

N made it to church on time on Sunday. He has fought visibly with the anorexia both yesterday and today. I think Sundays are a bit hard, because things aren't as structured as normal. I really have to stay on top of his calorie intake, because it's easy for me to forget about counting as we are out of the normal routines.

We got around seven inches of snow last night. So this morning, T, N & J shoveled our driveway and then went to make sure that some of our neighbor's driveways were cleaned off. N struggled with the fashion of the snow-wear. He went outside in his tennis shoes and low rider socks. After 15 minutes he was freezing, but didn't want to wear my waterproof duck shoes (they aren't in-style). He fussed and fought for about 10 minutes and finally relented and changed. He won, but it was a pretty rough battle.

N barely made it to bed on time Sunday night. We had family prayer and read scriptures together on his bed, so he could qualify as "in bed." He also barely made it to bed on Saturday night. At least he's generally getting to bed a lot earlier. It's been nice for T & I as a couple to have a bit of time again. I can also tell that N does better the next morning because he is better rested.

His weight was up a half pound on Sunday morning to 87.5 lbs.

Reward System - Day 2

We sabotaged any possibility of N getting to bed on time last night because we invited neighbors to watch a movie. They have a son that is N's age (and has a similar intellect). I was glad that the boys were able to hang out together. Obviously, the reward system isn't as applicable on the weekends. So, we made some weekend adaptations. N had all of his chores done by noon, which earned a reward. Tomorrow the goal is for N to be to church on time.

He continues to fight back against the anorexia. This morning, N said that he didn't feel self-conscious at all (a very rare comment). I think his own successes make him feel stronger.

Reward System - Day 1

N has done so well over the past 24 hours. He has talked about feeling self-conscious, but he is fighting back hard. So far, his reward system is working really well. He was in bed last night at 9:00 p.m. He said his prayer while already in bed (to make sure that he was "in bed"). He was only 1 minute late for school this morning (I gave him full credit). He was dressed and had combed his hair an hour before it was time to leave. He got hung up on eating (to be expected) and brushing his teeth. He still struggled with actually getting out of the car. He was so close to being on time, but didn't have his shoes on his feet. I tried to encourage him and he lashed out. I had to remind him about being respectful. He made a good effort yesterday with his homework, but didn't finish it in the end. Still, two out of three is fantastic!

Long Term Effects of Anorexia

I don't worry about N dieing from the anorexia anymore. He is doing fairly well now and I see some of his physical health returning. What I do worry about (and T confessed he is worried about too) is suicide.

N's emotional health is getting better, too. But, we're protecting him from so many things right now. Eventually, we'll have to ease him back into real life. Will he be able to take it? Will he relapse? How will he do when he is living on his own? I worry about the self-loathing spiraling out of control. That combined with frustration from the long-term recovery as well as the stresses from living, could lead to him becoming despondent and defeated. I just want to love him away from that possibility.

My Plan

My husband and I went out for dinner last night. It was nice. One of the impacts of the anorexia is that we've lost our alone time at night with each other. N, for some reason, won't go to bed until we do. He was struggling with this before he got sick -- so it's just 10 times worse now. We're lucky if N goes to bed 10 minutes before we do. We're all suffering from a lack of sleep because of it. Anyway, it was good to be able to talk and reconnect a little. We probably need to be better about finding time for "dates."

I've been mulling over a lot of things in my mind lately: the reward system, grades, N's progress, and my other kids. These things just swim around in my head all of the time. I'm the kind of person that likes to have a plan when I face a challenge. So, I'm wondering what my plan is. Here are some random thoughts:

About N's grades:
As we talked last night, we compared N's school work now with his school work when he was at his sickest. Even though N was very sick in early fall, I still set limits and helped him to be responsible for his school work. N's grades were better -- and so were his feelings about school (but not about his friend-situation). Also, his feelings about himself -- in regards to his school success were better. I changed my approach with him in October after reading (for the first time) all of the accusations of controlling parents causing anorexia. Now that I understand that anorexia has a medical/chemical/metabolic/strep cause (although no one is exactly sure of the details yet), I'm less worried about the control issues. But, I really think N feels worse about himself now than he did then. I see him full of self-loathing because he isn't doing his school work. We've let him not do it, largely not wanting to add pressure on him. But I think that instead of helping him, we've just allowed him to fail. Not that failure is bad. I think that I do need to let him fail at times. But right now, he needs to feel good about himself in every way possible. We worried that setting limits about his school work would make the anorexia worse. But now I'm thinking that the lack of limits has made the anorexia worse instead.

N is doing a lot better. He isn't better. But, I want to try setting some limits about school work in hopes that he is able to feel better about himself in turn. He also needs some reminders/limits about being respectful. It's so hard to know where the child that is growing up and going through puberty ends and the child with anorexia begins. Where are limits appropriate and even needed? And when are they too much to expect because of the anorexia? I'm not sure. But I do think that we've missed the line and need to readjust some. We'll probably be tweaking those lines until he leaves home someday.

About characteristics of anorexia:
I read some statements online about personality traits and anorexia yesterday. I feel like many of these common characteristics explain why N is struggling at school. One of the characteristics was having an "all or nothing" approach to life. N's teacher has them turn in their assignments in packets. N will turn nothing in rather than turn in a partially completed packet. He won't turn in an almost finished assignment for some points. In his mind, it has to be completely finished. He does this with his homework and chores. He has a hard time breaking his tasks up into smaller components and doing some of them at a time. Instead, he overwhelms himself by all that has to be done -- and then never does anything. Another characteristic was "attention to detail, but not able to see the big picture." This seems like an opposite to the previous characteristic, but it really isn't. N is such a detail person. I am constantly amazed by the details that he can remember. I think it is why he is such a good test-taker. We'll watch a movie and he will be able to rattle off the dialogue exactly as it was in the move. On the other hand, he struggles with things like summarizing. If you ask him to tell you about the movie, he'll take 30 minutes. He'll tell you every detail found in the movie. I once watched him give a book report to his class (supposed to be a summary). It was probably the longest book report ever. Sometimes, in his homework, he'll get so caught up in the details that it takes him forever to complete the project/problem. He can't see the bigger picture of just getting the main points and moving on.

About my other kids:
I continue to worry about J. He is just 9 years old. I can see him cringe now whenever an issue starts. He tries to be gentle with his older brother, but I can really see it taking a toll on him. He also just got a report card and did really well. I've got to find a way to reward J, without it being a stress for N but not taking away from J's achievement. J is a good boy. I don't want him to resent his brother. J has tried to be so flexible -- even when things are so unreasonable.

About rewards:
We agreed to try a reward system to just see if it would help N. We started this morning. He wants to earn a "multi-tap" for his PS2. I told him that he could earn $.50 towards it every time that he 1) gets to school on time, 2) goes to bed by 9:00 p.m., or 3) completes his homework. I am not ever going to take away from the reward. I realize that often the anorexia gets in the way of these goals -- so we're going to do this as positives only. I'm also willing to give a partial reward.

The reward system already helped to motivate N this morning. N really wanted to earn that first $.50. He tried so hard to make it to school on time. However, the anorexia got in the way when it came time to choose a shirt. He started into the crying cycle out of frustration both about the reward and the anorexia. But he steeled his face and stood up to the anorexia. A few minutes later he was completely ready for school (when normally the crying cycle would result in him being at least an hour late to school). I was so proud of him. I told him that he could have a partial payment because I saw him try so hard to beat the anorexia. Maybe I should have let him have full payment. I'll have to think about that.

Grades

N showed me his report card yesterday morning. He hadn't showed it to me earlier because he was worried about us freaking out. He has all Ns. They don't give Ds or Fs -- so an N is anything less than a C. I'm trying to not freak out about it. He doesn't know that it is a concern to me. I did a really good job of being understanding and reassuring him that the grades really didn't matter. And what mattered most was his getting better. I understand why the grades are so low. I've known that he wasn't completing (or even beginning) many of the assignments. Right now, I'm trying to help him get caught up as much as possible (his teacher gave him a week). Cs would be wonderful right now. If it is too hard for him, then I'll take a deep breath and be okay with Ns.

N has always been an A student. Last semester, when grades came out, he was getting As and Bs. That was when he was still in the worst of the anorexia and was still losing weight rapidly. I guess I thought those would be the worst grades. But I've seen his resistance to homework and work in general get worse instead of getting better over the past few months.

I think I'll ask his therapist to work with him on stress-management. Any sort of stress seems to aggravate the anorexia. If I even mention "homework" he freaks out and will curl up into a ball and cry. In the past (before the anorexia), we've not let him play with friends, play video games or computer or watch tv if he hasn't done his homework. But I can't do any of those things now. He needs to be with his friends as much as possible. He uses video games/tv/computer as a distraction when the anorexia is pushing him. Plus, I don't want to punish him -- because I feel like the problem really is the anorexia. We're also going to try an experimental (small) incentive system to see if it helps.

Snow Cones

I feel like N made a huge leap last night! He told me that he wanted a snow cone. Then he went and made it and ate it, even though I didn't make it mandatory. I couldn't believe it. In the past few weeks, there have been moments when I thought the same thing could happen. But the anorexia always won the battle.

It really was a strange day to have such a leap. N had struggled all morning. When he came home, he continued to struggle. He wouldn't eat his afternoon snack. He yelled at me and was getting in my face and kicking walls. He was yelling at his brothers and being mean. I had to ask him to back off and ultimately to go to his room for calm-down time. He couldn't do anything but lay in his room and read.

I warned T about N's mood when he got home from work, several hours later. J had just persuaded N out of his room and had him playing a video game with him. T started off with a lot of humor. It was like my own N came back. He was fine for the rest of the night. Guilt? For Family Home Evening, we make travel bugs for our geocaching hobby. Then we stopped at Sonic for treats. N had fries. He did complain that I ordered too many. He ate most of them (shared some with his 2-year old brother) and then after our family lesson, he said he still wanted a snow cone (and made it and ate it). Amazing.

Sunday Weigh-In

N weighed 86.9 lbs on Sunday morning. That is down .1 lb from last week.

Snowboarding went well. N had a lot of fun. He accidentally left his lunch in the car and had to buy two nutri-grain bars instead. He did finish off most of his lunch during the ride home. We worked all evening to make up the calories. He has been super sore from the rigors of beginning snowboarding. He said that he didn't ever go really fast. I think he was nervous about hitting other people, so he would crash on purpose. He also wouldn't go on any of the official runs. I think the anorexia makes him extra anxious about all sorts of things. He did stay warm.

On Sunday, N was still very sore. He was typically slow and anorexic in getting ready for church. He was also quite erratic about eating. Throughout the day, he told me that he was hungry several times. I always insisted that he have a snack at those times. I really think that he wanted a snack and that is why he told me and reminded me about his snacks. It's interesting to me, that he can admit that he is hungry, remind me that it is time for a snack, but ultimately he needs me to be responsible for making him eat it.

We had to make a decision yesterday about N going camping at the end of January at the Klondike. We've both been quite concerned about the extreme cold camping conditions as well as the rigors of completing a Klondike course (making a sled and pulling it, using snowshoes, for a mile or two). They would be in these conditions for more than 24 hours. The potential for problems with N would be extremely high. If he did go, then T would have to go too. We still weren't sure it would be a good idea -- even with Dad going. N's scout leaders are aware of his anorexia. One leader didn't really understand how this could be a bad thing for N. I think he really views the anorexia as a choice. The other leader was as concerned as we were. He has a daughter that has recently had some neurological issues, so he understood better. After discussing the camping trip with both leaders, we decided not to let N go. N handled the whole thing well. However, it will be extra hard for him when the boys come back and talk all about it during church.

Snowboarding

N went snowboarding this morning. He's never been before, not even skiing. I've been so worried and eager to hear how he did. We required him to wear his heavy coat (which he doesn't like because it doesn't make him look slim). I was surprised that wearing the gear presented a lot of issues with the anorexia. Snow gear, by nature, doesn't make you look skinny. We had battles last night and this morning about almost every component of the gear. We fed him extra well before he left. He had a bag of snacks for the ride up and the ride down. I also packed him a good lunch. If there are any deficiencies in his calories, I can make them up tonight. However, I am nervous about him having enough energy for the day. I'll report how things go later.

Discussion on Incentives

I asked the other parents on the "Around The Dinner Table" support forum about using an incentive to help N. Their responses have really made me think twice about using incentives. Many of the parents there have been battling anorexia with their children for years. Here is the link to my question and their experienced comments and suggestions: http://forums.aroundthedinnertable.org/tool/post/laura/vpost?id=2415045

Incentives

We met with Dr. R. last night. It's been a while since I went with N. We seem to talk about the same things now. I brought up the issue of N's prayers. We also discussed the continued problems that N has in the morning -- with choosing a shirt causing the anorexia to resurface in force. Once before, Dr. R. suggested that N choose his shirt the night before. We tried that, but it just moved the conflict to nighttime. And then, N was extra tired and still hadn't chosen a shirt. We'll need to discuss some other solutions to that problem. We talked about keeping score in N's battle with the anorexia and even posting points as the battle wages each day. We'll give that a try.

We also talked about setting up an incentive system. Several months ago, N's therapist suggest trying something like this. We did and it didn't work. But at that point my son was still declining rapidly. The incentive catapulted us into a terrible match with his anorexia. I've been thinking more about trying it again. He is doing a lot better. He isn't weight-restored, but we are within 8 to 10 pounds. The anorexia resurfaces here and there in force, but more and more the battle stays under the surface. I can see it happening, but our son is winning more often.

I have really mixed feelings about this. Presuming that anorexia has a medical cause and is not a choice, then I'm not sure it is realistic to tie his getting better to a reward. It would sort of be like saying, "we'll get you a new game if you will get better from the flu." Obviously, that is ridiculous! However, there are times when N is waging that internal battle with the anorexia where extra strength (and motivation) could help immensely. Sometimes he is able to make a choice about how he acts or reacts even though it is extremely hard. I think it might be okay to put incentives with things that N can do something about. I also think that there should not be ANY penalties. I recognize that sometimes N is unable to make the right choice because his brain is basically malfunctioning. Just like it would be silly to reward someone for getting better from the flu, it would be as silly to penalize them if they didn't get better.

N really wants a wii (for our family, not just for him). I was thinking we could tie "wii dollars" to things like getting to school on time, finishing his homework, and getting to bed on time. Eventually, after he has reached his weight goal, we could switch the incentives to things like eating all of your snacks on your own, or being on time to school for a whole week. Ultimately, he could earn wii dollars for each day that he listens to his body (eats intuitively), though that could be hard to measure. I'm not sure about this and need to think about it. I'll ask my fellow parents on the Parent's forum if they have ever tried something like this. If an incentive would give N just a little extra strength to fight past the anorexia sometimes, then it would be worth it. Plus, if it speeds up his recovery, or simply helps to maintain his recovery, then the cost of the wii might actually save some money in treatment costs (which really is the least of my concerns, but worth mentioning).

OCD - Obsessive Compulsive Disorder

I've been surprised about how much OCD seems to bleed into anorexia. I'm interested in why they seem to be interconnected. N's therapist has said that he has "flashes of OCD." I've seen them in N -- the routines that cause him great stress when interrupted. N has a little speech that he gives whenever we say goodbye. I'm not sure if it has stopped, but recently we figured out that when N prays, he feels like he has to ask Heavenly Father for help in every area (he would pray for such a long time). N's afraid that if he leaves anything out of his prayer, that problems will result. N keeps a spotless room (but a disaster closet - go figure). Lately, he has been very concerned with changing his underwear everyday. If he gets behind in his school work, it's paralyzing. He adheres to rules almost too tightly.

I also hear other parents talk about how smart their children are. N is too. He is so smart, that almost every doctor we've visited has commented about his intelligence repeatedly.

These common threads of high intelligence and OCD that weave through the anorexia make the brain function of anorexic patients even more suspect, in my opinion. There has to be something going on in the brain -- or affected by the brain to connect such neurological characteristics. The current research about chemical, metabolic and autoimmune causes make sense to me in a lot of ways because of the connections I see with N.

In some ways, it's like the "duh" that we say today about doctors figuring out they had to wash their hands to prevent the spread of infection. It seems so obvious to us now. I wonder if someday, the research on anorexia will result in a very simple explanation that will seem like a "duh" to us in the future. Maybe we're already on to something.

There isn't much to report today. N came home yesterday with more resolve to eat better. He ate all of his snacks & meals without complaint. He even told me that he was hungry once. Although, when I suggested that he have a snack, he said, "no." I made sure that he had his evening snack right then. He didn't resist once I made it mandatory.

I think the improved response after a terrible morning like yesterday must be motivated by guilt. The guilt must be stronger than the anorexia in those moments.

A Bucketful of Ideas

15 years ago, when I was interviewing for teaching positions, I was often asked what method of discipline I would use in my classroom. My response was that I didn't subscribe to just one method of discipline, but rather had a bucketful of ideas. I felt that each student and each situation might call for a different method, so I became knowledgeable about them all and and applied them as needed. My future employers must have liked my response because (in a market where there were 75 applicants for each job) they offered me the job.

I apply the same approach to discipline now that I'm a mother. More and more, I am recognizing the importance of applying the same principle, a bucketful of ideas, to N as he recovers from the anorexia. N's therapist started the idea. He called it a tool box.

This morning, N lapsed into some of his worst anorexic behaviors. He spent 2+ hours trying to choose a shirt, comb his hair, get out of the car, etc. Each new step in the process reset the anorexic behaviors again and I would have to start over -- trying to convince him that he would be okay, trying to help him find a shirt, and trying to get him out of the car and into the school. I found myself mentally scrolling through the different strategies that we've used to help him in similar situations. I realized that I had developed a bucketful of ideas for use with N. N often struggles most in the morning and late at night. We've had these same issues a million times, it seems, before. But some of the strategies only worked once. Other strategies have been used too many times and don't work any more.

Here are some of the contents of my Bucketful of Ideas.

Encouragement - This didn't work at all this morning. But sometimes, just expressing our belief in him helps N to pull through the current struggle.

Time - Sometimes N can work things out on his own, if I leave him alone and he has some time to think.

Calm-Down Time - This is different than "time" as listed above. Sometimes I have to send him to his room for "calm down time." It's kind of like a time-out -- but the purpose is not punishment. I usually use this idea when he is starting to get out of control (hitting, yelling, pushing, etc.).

Talking - I've tried to talk him through what is happening, to acknowledge the struggles and discuss what we can do to help him in that moment.

Listening - This is different than talking. Sometimes N just needs to talk. He doesn't need or even want me to say anything. He'll usually feel a lot better once he just gets everything out.

Hugs - We apply this to almost every situation. I'll hug him while he cries.

Lecturing - I try to not do this very often. Every once in a while, I can see that N is mostly just having bad behaviour. I'll just remind him of our rules and expectations.

Music - Music seems to help him calm down. N also recovers more quickly if he plays his guitar for a while.

Distraction - We use tv, video games, books, basketball, family discussions, and daily life as a distraction. Sometimes nothing will distract him. Sometimes all he wants to do is be distracted (like this morning he wanted to read instead of going to school). I try to not let him use distraction as denial.

Prayer - N has found inner peace and personal revelation about the anorexia when he has prayed for guidance.

Phone Call - Sometimes if N calls dad, Dad will say something that turns N around.

Write - N has a blog and a personal journal. He doesn't use this outlet much, but there have been a few times when writing down his feelings has helped.

Persistence - I just have to keep working with him and helping him through these hard moments.

Humor - Ultimately, this is what worked this morning. Really, this is my husband's talent. I had cycled through the whole bucketful of ideas this morning and couldn't get my husband on the phone (bad snowstorm). I found myself asking, what would T do? I knew it would be humor -- but I wasn't sure I could pull it off. It takes a lot of energy to find humor in anorexic situations. But I did it. I can't even remember what I said. But N laughed. And once he laughed, his whole approach to the morning changed.

Yesterday, N did really well. There were moments that you could see the anorexia just under the surface, but he kept fighting those anorexic urges. He's had several hormonal puberty-induced moments over the past couple of days. But they seem to be based on typical "becoming a teenager" self-consciousness, and not so much the I'm too fat consciousness.

Size 12 Pants

N struggled throughout the day yesterday. He was in tears before church. He wanted to wear J's size 8 pants instead of his own size 12 pants. He put on some old size-10 pants and had to really squeeze to get them on -- plus they were three inches too short on his legs. He kept saying that his size 12 pants were the wrong size. He wanted size 12 -slim (which they don't make in church pants, but they do make regulars with adjustable waists).

There are times when I feel like I am at the end of my rope. I just didn't have the patience and tender touch that N needed at that moment. Thankfully, his Dad was there helping everyone get to church (he is usually at church meetings). He had that needed tender touch for N. I find that we often "trade-off" in dealing with N. Some days, I'm the one able to handle him. Yesterday, it was my husband that was able to pick up my slack.

There are times that I am the only person available to help N. In those moments when I am struggling, I find that I have to walk away for several minutes. Then I can force myself to dive back in.

I feel like N is trying to hold tight onto the anorexia. He even talked about liking that he was anorexic and so thin. But then at other times I know that he hates it.

Sunday Weigh-In

87 lbs this morning!

N had a fantastic calorie intake yesterday. He was aware of the calorie count, of course. So last night he was very emotional & tired and the anorexia was making him feel terrible about what he had eaten. It was a bad evening because of it. He laid on my bedroom floor for about 30 minutes sulking. At one point he curled up on the floor and cried. He also yelled at me for trying to help. Later when he got a grip, he came and apologized twice. He seems better this morning, though he is still making comments about how he looks.

Mom Counting Calories

We've fully implemented the "magic plate" idea. N isn't fighting us at all anymore. It is so much easier! I, however, am still having a hard time keeping track of his calories. So yesterday I tried something that worked better than a daily total. I divided his day into 3 segments: breakfast/snack, lunch/snack, and dinner/snack. I just aim for 1000 calories in each segment. Yesterday, lunch and dinner came up a bit short. But I'm able to calculate the shorted calories easier than trying to track a whole day's worth.

N said that he was feeling very self conscious yesterday. He kept asking questions with the main motivation of getting us to tell him that he was skinnier than everyone else. Even with the anorexia working hard on him, he kept his emotions in check. I could see him exercising purposeful self control in a few situations. He has talked a lot about hating the contention in our home lately. He realizes that he is a root cause of it and has set a goal to work on it. He did a really good job yesterday.

Pediatric Infectious Disease Doctor

Dr. O met with us for an hour today. He spent a long time discussing N's history of strep and his test results. I think that Dr. O had made up his mind before we even came. He said the research on PANDAS is weak and the research on PANDAS-AN is even weaker. He said he didn't want to put N on antibiotics -- and was worried that that we would perceive improvement even if there was none. There were a couple of missteps as he discussed the anorexia and I had to correct him. The end result was that he was going to call the Eating Disorders Clinic at our Children's Hospital and see if they thought there was anything to the PANDAS-AN research. I'm willing to let him. I also intend to discuss it with them later in the month when they finally see N.

I think if I insisted, he would let us try the antibiotics, but I'm willing to wait until after we go to the Children's Hospital later this month. I don't understand why it wouldn't be worth a try -- even if the researched links are still tenuous.

More on the Magic Plate

We went out of town this past week. We've also been pretty busy trying to squeeze out the last drops of our Christmas break. So, I haven't posted.

N has done okay, but not great. He's been fluctuating between feeling okay and listening to his anorexic thoughts. He's also been very cranky, which of course rubs off on us all. I've mentioned this before, but sometimes I think that is more because of puberty and his becoming a teenager than it is about the anorexia. We have the expectation that all members of our family act kindly towards each other. We've always had a happy home where we love and even like each other. I can see N wanting to assert his independence, though. He is learning that he has opinions and he wants things his way. But then he sees that he has created friction in our home and then he feels guilty. He can be as hard on everyone else as he is on himself.

School started again this morning. N was on time. We were really good about starting bedtime early last night. N was asleep by 10:00 pm last night. It's not great, but it is an hour earlier than normal. We've have pink-eye and colds amongst the rest of us. We were all tired last night and even T & I were in bed by 10:00.

I had a question asked in the comments about the Magic Plate concept. I must confess that what I know about it is from the Parent's Support Forum & the Maudsley website. But the main idea is that N doesn't choose his foods or quantities. Instead we present him with a plate with all the foods already on it -- hence the plate "appears" in front of him. This allows us to not battle over every calorie and food (which we do). We've had to reimplement this concept with N because he was trying to negotiate every food and every meal. He was really mad this week when we informed him that we were returning to this practice -- and we placed the plate in front of him. But like usual, once he realized that it wasn't optional, he relented and ate. He really hasn't thrown too many fits since then. There have only been one or two battles, which were more intense, but short lived.

We are meeting with a Pediatric Infectious Disease doctor this morning as we explore any possible strep connections. I'll post later about the visit.