Supersize Me!

Just found out that N was shown "Supersize Me" in his Foods class. I'm dumbfounded. I just can't believe it. How did this get past me, his teacher and/or N? Not sure what to do with this information. N seems fine about it -- but is he really?

His Brother

The last few days have been interesting for me. My shoulders are tense all over again, but not because of N - it's his brother, J.

J is currently 11 years, 9 months. He is only 7 months older than N was at the onset of the anorexia. I can't remember if the beginning was Sunday or Monday, but it was like a light switch got flipped. J has experienced three days of intense anxiety, and paralization. He said that he only feels it here at home. But last night it was enough to keep him from heading out to scouts. I had asked him to sweep and he had played on the computer instead. I got after him about it, but then he obsessed over my being mad at him -- said he couldn't leave if I was still mad.

This is so unlike him. I've got warning flags going up all over, but know I need to wait before reacting. There is a major possible cause of his anxiety. His grandmother was just diagnosed with stage 3 - vaginal cancer. We're all out of sorts because of it. He insists that it isn't related -- but I'm not sure that any of us know how much our anxieties tie into fear and death. So, I'll give J a few weeks and see if we can work/talk through this.

Then I'll panic.

A Lonely Parent

Being the parent of a child with anorexia is terribly isolating. We continue to be quite private about our struggles. I really wish that the public perception of anorexia was more accurate and not so based on assumptions of the past. It would be good to speak publicly and help change these inaccurate perceptions. But the reality is that those old perceptions are prevalent and most of those around us really don't understand. And N is going through such a tough time in life anyway. I just feel like we can't openly discuss the anorexia and not have people prejudge him (because I continue to see evidence of that judgement). N is a great kid -- but it seems that the anorexia gets in the way of people seeing that.

In the past few weeks, I've felt this loneliness more than usual. I've had several conversations with people who are aware of N's illness. I thought that they understood the realities of the disease. But in these conversations, I became quite aware of how much they don't understand. I spent many minutes last week, for example, trying to explain to someone how exercise figures into the problems of anorexia. It was hard to help her understand the idea that not exercising (regimentally) was in N's best interest. The media's misunderstanding of weight right now just adds to the isolation as I realize just how much of a paradigm shift I've already had (and how crazy I must sound sometimes).

Thankfully, I have a few friends and family members who really listen to me and believe in me regardless of understanding. [Edited to include]: And I also have a wonderful community of parents supporting each other as we all go through the same thing!

A Trip to the Therapist

N's OCD behaviors have been increasing significantly since school started. So last night, T & N went and met with his therapist for the first time since January. We had some new concerns because the OCD patterns have changed some. Instead of touching door jambs and holding his breath when someone "fat" is on the tv, he has started being concerned about chemical contamination, becoming autistic, becoming gay, and masturbation. Some of these are pretty tough topics - which we don't avoid, but are trying to be sensitive about how to talk with him about them. He hears his friends bring up these topics (in a less sensitive manner) and it scares him. I've been concerned about whether our reassurances "that he isn't autistic" for example, were just feeding the OCD loop. I didn't know whether to reassure/discuss (and potentially enable the cycle) or to refuse and potentially make things much more difficult.

N's therapist indicated that it was okay for us to reassure him once -- to give him the information and reduce his anxiety. But after that, if he seeks reassurance on the exact topic again, we should refer to our earlier conversation. His therapist didn't seem to think that the intense topics were indicators of larger issues, but rather were just the anxieties N was encountering at this moment.

Other than some of this new information, the appointment was just a rehash of many concepts and principles that have been addressed before. In some ways, it felt like a waste of time, but I wonder if N needs to be constantly reminded of the ways he can address the OCD.

I also suspect that the stress of a new school year is aggravating the OCD behaviors. N is doing well with his grades and assignments. I'm trying to let him be responsible for when he does his homework and the potential natural consequences of waiting to the last minute. He's had some of those consequences and it seems to make a difference. N is pushing himself pretty hard to get all As. We don't really care about his grades - just that he turns his assignments in. But he often lapses back to that typical "all or nothing" approach. He would rather not turn in an assignment than turn in one that is imperfect. In fact, last night I drew attention to the fact that he had very little time left to do his homework -- but he was so wrapped up in finding the perfect "third argument" that I could envision his essay taking another two hours (and it was already late). So I reminded him that it was better to get the paper done, turned in, and get a B - than to not have it done at all. I don't know if that helped or not.

His doctor was very surprised to see how much N had grown -- and that his voice has now deepened (I knew that it was happening, but it just isn't as noticeable when you live with him everyday).

8th grade

School has started and N seems to be doing fine. We met with his counselor prior to school and she agreed to "pull" N out of his health class during the week of questionable curriculum. She also gave him a pass that he can use if he is ever in a class and can tell that he needs to leave (because of how he is feeling or what they are talking about -- whatever).

N is taking a Foods class that we discovered may also cause some problems. I thought it was just a cooking class, but it turns out they do much more with calories and food analysis, etc. It looks like they will have one day on the problems of obesity and another which is just about fats/oils. I'm a little nervous about the class on fats/oils because the teacher was coming from the camp that these are "bad" foods only to be eaten occasionally. So that's two more classes that he will be missing.

I think P.E. will be fine. He has the same teacher that he had last year and there weren't any problems at all. I did opt him out of a scoliosis check (they have to remove their shirts to get checked). I knew that would be an issue for N. And on top of all of this, we had to give approvals for sex-education. But that's an entirely different issue.

Health Class

I met with N's health teacher last Wednesday. She provided worksheets for a 5-day portion of the curriculum, which included:

1) Fitness - flexibility, strength, endurance, BMI, pulse, workout principles.
2) Food Pyramid - a discussion of the nutrients and important aspects of all portions of all food groups.
3) Calories - how many do you need, burning calories, creating a menu within a calorie range, ideal percent of fat in a diet.
4) Nutrition - create menu using pyramid, self assessment profile that uses emoticon to asses amounts in each area including fat, oils, cholesterol, sodium; determining exercise needed; caloric intake and expenditure summary;
5) Eating Disorders - anorexia, bulimia, obesity, movie (Little Miss Perfect).

She was willing to excuse N from the entire unit.

I'm so glad that I met with her. I (and N) could see potential triggers on most of the days. I suspect that he would be fine on day 2 -- but that's borderline. And would we want him to be there for just one day of the unit anyway? N really wanted to be there for the discussion on day 5, but I can see huge issues with that! On day 5, not only do they discuss "potential problems" from being overweight, but the bulimia discussion includes "other" methods of losing weight like laxatives, etc. I've never seen the movie, but suspect that it wouldn't be healthy for N to indulge in seeing someone else's methods of losing weight.

N was concerned about his "smart" friends figuring out that he was missing for this whole unit (yet he was unconcerned about making comments during the anorexia discussion - go figure). We'll be meeting with his new school counselor this week to determine if she can pull him out (thus N can state that the counselor "made" him leave). I think she'll be willing.

I've known this class was coming and would be an issue. Hopefully we can handle this in the best way possible.

A Question

Would you, experienced parents, answer a question?

We seem to have reached a stalemate of sorts with the anorexia. For the most part, N is eating normally. He is currently weight-restored. With growth spurts, he'll sometimes drop his weight in proportion to his height which results in a resurgence of anorexic behaviors, but usually we're on top of those drops and help him to bring his weight up as quickly as possible. He has several OCD behaviors that he just can't seem to shake. He is still quite self-conscious and is always fixating on his clothes as well as his relationships with friends. He is struggling a bit to find his identity (but I really attribute that more to his age).

Will we just be maintaining this stalemate indefinitely? Is that what recovery from anorexia looks like? Or will there be a cessation of these low level issues as he matures and stops growing? Is there more we can do to eliminate the current stalemate?

Staycation

Our family took a week-long staycation this past week. N had a few struggles, but we were so busy that he wasn't able to indulge them too much. He did fixate on a few OCD behaviors late in the week. I'm thinking that he was also tired from a long, packed itinerary which had weakened some of his strength against the OCD.

Scout Camp 2009

N just returned from this year's scout camp. This year the leaders planned a local trip for just the 11 or so boys in our congregation. N had a fabulous time! He fished, shot arrows and shotguns, rode a tube down a river, went rock climbing and even repelled. I love that the leaders also included religious discussions nightly.

We donated 60+ candy bars like we did last year. We sent them to make sure that N always had something to eat, which apparently was not a problem at all. His leaders said that N ate well the entire time. N did say that he struggled the first few days with feeling ultra self-conscious. He coped, I think, by relying on some OCD comforts, which is too bad, but typical.

Now, if I could only get him to take a shower! He is so dirty that he literally has dirt caked on the back of his neck.

Planetarium Pitfalls

N went to our local planetarium last night along with his peers and leaders in his scout/church group. He arrived home, holding back tears, telling me about a "giant scale." All of the boys weighed themselves and then pressured N to get onto the scale. What could he do? He stepped onto the scale and was, unfortunately, the heaviest of the bunch. I think he is also the tallest, but that detail didn't reassure him at all. He said that he was the heaviest by "like 15 pounds." When I pressed him, it turns out that one boy weighed two pounds less and another 10 pounds less. But to N the difference was monumental.

My first question was, where were the leaders? My second thought was that there was no way I could expect them to anticipate everything. They probably didn't even think twice about the boys climbing onto the scale.

The devastation to N's spirits has been huge. He stood back while the other boys loaded up one of the vans to come home. He rode home, instead, with two other leaders and no boys. Thankfully, they threw in a stop to McDonald's which helped N's spirits a bit. He came home afterwards instead of playing street hockey with the boys. Today, he begged me to not let him ride bikes with the boys who had come to our front door asking.

He seems to be eating fine, but he is very anxious and sad. I'll need to watch carefully and hug him a lot.

A Genetic Link Between Anorexia and Autism?

Interesting article: A Genetic Link Between Anorexia and Autism?
http://www.time.com/time/health/article/0,8599,1904999,00.html?xid=rss-topstories

I was actually more interested in the end of the article. They discuss Maudsley as being the only treatment with evidence-based success. The article also addresses problems that parents are encountering with traditional therapy that are similar to hurdles faced with autism 20 years ago.

It's good that the media is finally catching up with the reality of anorexia as a biologically based illness. Now, I just wish these things would sink in with the public (and all of their preconceived, but erroneous notions), and more importantly, the doctors, therapists and psychologists that treat anorexia.

Boy Scouts of America

We are members of The Church of Jesus Christ of Latter-day Saints. Currently, our church uses boy scouts as the activity arm for the boys' youth activities each week. That is why N is doing so much with scouting right now.

Just recently the Boy Scouts of America released their new health form which is required to be filled out annually by both boys and leaders participating in any activities. Anytime that they participate in "any event that exceeds 72 consecutive hours, a resident camp setting, or when the nature of the activity is strenuous and demanding, such as service projects, work weekends, or high-adventure treks," they are required to fill out "form b." What concerns me is that "form b" is an extended health form with a heavy emphasis on BMI.

Here are two quotes from the form:

"It is important to note that the height/weight chart must be strictly adhered to if the event will take the unit beyond a radius wherein emergency evacuation is more than 30 minutes by ground transportation, such as backpacking trips, high-adventure activities, and conservation projects in remote areas."

"Individuals desiring to participate in any high-adventure activity or events in which emergency evacuation would take longer than 30 minutes by ground transportation will not be permitted to do so if they exceed the weight limit as documented at the bottom of this page. Enforcing the height/weight limit is strongly encouraged for all other events, but it is not mandatory."

There is a doctor's allowance (that basically transfers liability to the doctor) that can override the BMI requirements up to a point. But the basic guidelines suggest that anyone with a BMI in the "overweight" category (BMI of 25 or higher) should not be allowed to participate in the activities listed above. Interestingly, they don't restrict anyone who falls into the "underweight" category.

I have several HUGE concerns with this. BMI is NOT a good indicator of health or fitness levels. It's not even a good indicator of fatness. In fact, the most physically fit tend to fall above the "normal" weight category because of additional muscle mass. My Brother-In-Law who regularly rides his bike 25 miles, is considered border-line "obese" (which is basically where the doctor can't even make a medical exception) based on the BMI scales.

Also, my boys tend to gain weight, grow tall, gain weight, grow tall, etc. If you weigh them right before a growth spurt, you are almost guaranteed that they will not be allowed to participate in the youth BSA activities because of these new BMI guidelines.

My biggest concern is for N. His BMI has traditionally fallen at around the 75% percentile. So that is where we've aimed for his weight gain as he has recovered from anorexia. He is currently above the 75th percentile for height and right about the 75th percentile for weight. In other words, he is right where we want him. However, if we utilize the BMI charts, he is just a few pounds away from being considered "overweight."

It would be completely devastating for him to be assessed using this new BSA "form B" and consequently restricted from participation in many of these youth activities because of being "overweight." In fact, I won't let that happen. I don't think our local leaders will let that happen either. I suspect that they will change activities from being BSA activities to simply "church activities" in order to protect N in particular. They will probably have to do that anyway because I think that 95% of the men in our congregation (potential youth leaders) will fall outside of those BMI guidelines anyway.

Here is a link to the new BSA health form.

4.0

I think this is both good and bad news. After much last minute work, N was able to get straight As (a 4.0) this quarter. It was a personal goal and I'm proud of him for working so hard to achieve his goal. He is very smart -- I've never doubted that. It shows how far he has come from a year and a half ago when his grades were all Fs. But I also don't want these grades to create continual pressure. It's okay if he doesn't get a 4.0 in the future. He definitely doesn't need anymore perfectionist tendencies.

Physical Fitness Merit Badge

Last night N attended a church youth group meeting and worked on his Physical Fitness Merit Badge. I talked about my concerns about the requirements for this merit badge in a previous post found here.

Our previous plan had been to keep N home and work on a modified worksheet (that I had already created). But, N's merit badge counselor checked in with me during the afternoon to let me know about the changes he had made to the requirements. The counselor had rewritten much of the worksheet to accommodate N. He had eliminated the body measuring, anything about weight loss and the emphasis on obesity as a risk for cardiovascular disease. [The Boy Scout program allows for modification of merit badges based on medical needs.] The counselor wanted to know if we had any specific instructions regarding diet. I just indicated that we emphasize eating a variety of foods and staying active. I didn't want him to talk about counting calories or regimented exercise. I also didn't want him to "ban" any foods. The counselor was willing to do as I asked. I was pleased with the changes he had made and I allowed N to go to the meeting.

It went really well. The only hang-up that N seemed to have afterwards was his risk for diabetes. We have a huge genetic diabetes history. He fixated on that for a while last night. I can't take that risk and his awareness of it away. But now isn't the time, either, for him to restrict or exercise with the prevention of diabetes in mind.

I'm thrilled that N was able to participate with his peers for this merit badge. I really appreciate the extra effort that his merit badge counselor gave to help accommodate N's needs.

Good Read

I loved this article in yesterday's Huffington Post by Laura Collins: She's Anorexic and You're a Bad Mother.

Reconsidering

Well, I'm not sure that N is going to end up doing his Eagle Project as I described two posts ago. We're trying to figure out if there is a way for him to demonstrate leadership without having to fully disclose the anorexia to his peers. Unless, we can spin things the right way, he probably won't do it. Right now the idea on the table is to involve the other scouts in fundraising only and label his project as "providing resources for pediatricians" or "pediatrician education" or something like that.

I have to admit that I'm disappointed. I'd like to attach some meaning -- and making a difference -- to this whole experience. But it's not my project, it's his and it's his life and his friends.

Time Travel

N is struggling a bit again. He's probably growing. The last five or six days of school, he's been late. His friends have stopped waiting for him, which is so sad because they really are part of the motivation some mornings. But he was making them late repeatedly. I can see why they would be frustrated. This morning was like a throw back to last year. He even was angry and lashing out.

School is almost over. Most of his teachers have already stopped requiring "regular" work and are instead working towards end-of-year-testing, which actually might be stressing him out. We continue to utilize the magic plate at all of his meals. I may need to magic-plate his snack in order to force some more calories. If we can survive the next two or three weeks, then we'll have the whole summer to address his growing caloric needs at home.

Eagle Scout Project

N is currently considering doing an Eagle Scout project that would involve eating disorder advocacy. He is thinking of putting together informational packets about anorexia and distributing them to local pediatricians and middle-school counselors. He is thinking of including a page telling his story, a list of symptoms and treatment options, a pamphlet with local treatment resources, and maybe the Kartini Clinic DVD. What else could he include?

Previously, as N had thumbed through lists and lists and lists of possible Eagle Scout projects, he just ho-hummed. I could tell that he felt like these ideas wouldn't make much of a difference in the world. After several days of throwing ideas back and forth, he started exploring the idea about helping others with eating disorders. As soon as we starting talking about all the possibilities in this area, he really got excited.

You may remember that N's pediatrician was really unknowledgeable about anorexia. The pediatrician didn't recognize his symptoms as an eating disorder. Once we identified the problem as anorexia and asked for a referral, his pediatrician referred us to a psychologist that deals with children with behavior-disorders (which is obviously an inappropriate referral). As I look back now, I'm also so surprised that the pediatrician didn't immediately order tests and set up a weekly-check-up schedule. At one point when we really needed to have a quick medical work-up, we lucked out and saw a different on-call pediatrician who had done a rotation in an eating disorder clinic. He knew what tests to do and how to read the results. I know that was a huge blessing at the time. Until we found a team at our local children's hospital, N really didn't have the medical attention that he should have had.

Anyway, N feels like it could really make a difference if he provided additional (especially local) information about anorexia to pediatricians like his own. I'd like to help him find a way to do this so that he can maintain some bit of privacy and yet still make a difference. Any suggestions?

Still Good

N is still doing really well. I am still monitoring his calorie intake pretty carefully. In fact, I'm mostly doing a magic plate with him for breakfast and dinner. Though I let him fill his own plate, I'll add to it if I feel like it is deficient. He doesn't resist at all. This is where it is easy to relax and let down my guard. But I just keep relearning that I can't do that.

Doing Well

N had a great day today. He's busy doing his homework and practicing his guitar -- all in anticipation of getting to play some video games. It's the end of the school term. His grades look like they'll all be As. We've really come a long way!

I don't think I'll have to worry about class order (because of perpetual lateness) or unmanageable stress for next year. He has done well, for the most part, with the stressful moments of school this year and he's not really been late at all. Class change was a small challenge, but he has settled in now.

I will have to meet with his teacher in preparation for his health class next year. He will likely need to be excused for the curriculum portion on eating disorders -- not because he can't handle the discussion -- but because it may put him in the precarious position of feeling like he needs to correct the teacher (who may not have current information about anorexia). We also don't want to "out" him by revealing that he is an expert about eating disorders. It's not that we are embarrassed about his being sick -- though it has been an unexpected trial -- but too many people still don't understand the medical origins of anorexia and judge him and our family unfairly. We've been more open about the disease generally, but I don't think a Junior High Health class is the place for full disclosure.

I hope I can educate his teacher about anorexia. I also hope his teacher will be willing to proceed cautiously, especially when addressing any topics about weight and diet. I really wish our kids would be taught more about eating well and being active, instead of the need to be a certain weight.

Improvement

After raising N's calorie intake for several days, he's doing great. He was just a little over-concerned about what he wore this morning. Other than that, I haven't really noticed any break-through symptoms.

Everyday-adequate-calorie-intake seems to be just as important as his weight. His symptoms rapidly disappear once he is getting what he really needs.

Military and Missions

In this post (http://nourishingmyson.blogspot.com/2008/12/fears-of-future.html), I described some of my concerns for N's future. I've done a little research since then. Apparently, the military would reject N because of his eating disorder. Eating disorders are included in the "unwaiverable medical conditions," but they are only documented if they occur after the applicant is 12 years old. I wondered about civilian positions, but wasn't able to find any additional information. This makes total sense to me. In tough conditions, especially those with high calorie expense and low calorie intake, someone potentially relapsing into anorexia could compromise a mission.

As far as him serving a mission for The Church of Jesus Christ of Latter-Day Saints, they do ask about eating disorders on the application. His Bishop (like a Pastor) would attach a letter explaining the terms and severity of the anorexia. Then depending upon his current health, he would be assigned. I hope that he would be asked to serve in a country with good food. :o) I really think he could contribute positively on a mission as long as he didn't have to walk everywhere and struggle to find good food.

He's Growing Like A Weed!

I've noticed another resurgence of anorexia symptoms in N recently. This time it's been a little worst than in the past. And that usually means one (or both) of two things: 1) He isn't getting enough calories or 2) He's lost weight. So I weighed him - 119 lbs, which is down about 1/2 pound. Then I measured him. I was so startled by the results that I measured him again. A conservative measurement shows that he has grown a full inch in the past month. With that much growth, a stagnant weight is just like loosing weight. That explains the up and down struggles that he has been having over the past month or two.

So, we've gone back to a similar routine like when he was really sick. I dish up his plates. He eats it all. I track his calories. It's just been two or three days since I measured him and I can already see a decrease of those pesky symptoms. I just have to be so attentive right now -- especially since he is growing so rapidly.

And just to clarify, these reoccurring anorexic symptoms are so minuscule compared to how sick he was a year ago (at most a "1" on a scale from 1 to 10, with 10 being his worst symptoms ever). I might notice that he is acting a little more self-conscious or emotional. He starts to be a little picky about what he eats. He also might struggle to get going in the morning. Mostly these resurgences don't interfere with his (or our) normal lives. I'm just so highly attuned to these warning signs that I try to address the problem right away.

I continue to be amazed about how consistently important it is for him to keep his weight up. A drop in weight always correlates with an increase in symptoms. At a reasonable weight, he is just like a "normal" 12 year old.

Now he is officially taller than his mom.

Nourishing My Son

Just four months after my son’s 11th birthday, he was diagnosed with anorexia. You might be surprised that my son has anorexia, both because he is a boy and because he was so young. In reality, 1 in 10 anorexia sufferers are boys and it isn’t uncommon for kids to be diagnosed as young as 9 years old.

My son wasn’t the rebellious teenager with anorexia that I had always pictured as described in my high-school health class. In contrast, my starving son was well-adjusted, kind-hearted, smart, obedient, and good. Yet, he was restricting and counting his calories. He exercised excessively and started to drop pounds quickly. He became so incapacitated about eating that he would often curl up on the floor and cry for hours. He was starving, but just couldn’t eat.

Because of his diagnosis of anorexia, we sought out the best medical and psychological care. But, he continued to decline. For four months, despite therapy and medical care, he continued to lose weight. We were desperate as he reached his low weight of 76 lbs. – a total loss of 30 pounds. He had missed tons of school because he literally couldn’t get out the door each morning. His grades had gone from As to Fs. Our whole family was really suffering.

At this low point, we held an extended family fast and I felt that I needed to become an expert on anorexia in order to help my son. I sought after and read everything that I could find about anorexia. Within a week, I discovered a wonderful parent-support-forum (http://aroundthedinnertable.org). These parents, all with children suffering from anorexia, steered me to research that suggests that anorexia is a brain disease and not psychological in origin. Consequently, this research advocated a different approach at treating anorexia. I shared this research my son’s doctor and he indicated that it was valid research. So we changed our course.

The traditional approach for treating anorexia is to try and talk the sufferer into eating and simultaneously deal with assumed underlying psychological issues. This approach has controversial success rates, a high incidence of relapse, tends to separate the children from their parents, and usually involves years of treatment and thousands of dollars. We had started with this treatment approach. But after months of continued weight loss, our son wasn’t getting better, and was actually getting worse.

Our changed approach (based on Maudsley treatment methods), encouraged family involvement and emphasized food as medicine. I learned that treating anorexia is like treating cancer. If you had a child with cancer, you wouldn’t try to talk that child into having chemo. Instead, you would acknowledge to your child that chemo is horrible, but is ultimately what was necessary to save your child’s life. With anorexia, food is the chemo. And as horrible as food seemed to my malnourished son, it is ultimately what would save his life.

Just days after my son reached his low weight of 76 pounds, I presented him with a plate full of food. I told him that the world had stopped. We wouldn’t be going anywhere nor doing anything until he ate – no school, no scouts, no church, no meetings, nothing. He argued, sobbed and yelled. After several hours, he realized that I was serious and he took a bite. It was a long night of taking one bite at a time, but he ultimately finished his food. This began an ongoing routine. Every meal was hard for him. We made jokes that food was “scary,” but eating literally was scary to him. I became an expert in making calorically dense foods. He started gaining weight. His improvement came one pound at a time. But with every pound, I could see my son emerging. It took seven months for him to regain those 30 lbs. It has been 18 months since my son got sick. We consider him to be in remission now.

In writing this post I have two desires. My first desire is to spread the word that there is an alternative in the treatment of anorexia which works. The second is to help break down many of the negative stereotypes associated with anorexia. 1 out of every 10 girls and 1 out of every 100 boys will suffer from anorexia. These are huge statistics and you might find yourself confronting anorexia at some point in your life.

Loose Pants

I can already tell a difference in N's responses. After two days of supervised eating, his calories are up and his spirits are up. But, his pants are looking loose. I've also not been very regular about weighing him. He seems to be growing so quickly now, yet his weight is stagnant. I'm sure we need to push calories better and keep up with his growth spurts. The danger of falling behind is absolutely a motivator to me.

Update

N started guitar lessons today. Hopefully they serve as an outlet for both achievement and relaxation.

N had a really good two weeks. I relaxed and let him choose his foods again for those weeks. But he's been off the past few days again. A friend told him that his arms were chubby. He struggled to pick a shirt the other day. He hasn't been eating very well. He hid his toast one morning (I think he didn't like it -- not necessarily restricting, but deceptive none the less). He's also been more moody. All are clues that I need to be more diligent. So, I've reinstituted the "magic plate" for breakfast and dinner. I'm checking more carefully that he's actually eating lunch. After a couple of days of increased attention on my part, I can already tell that he is doing better. I've got to watch carefully for those dips. They don't happen so often anymore which is wonderful. But this one went on for too long before I picked up on the clues. I can't let that happen.

Hmmmmm

N is still struggling with the term change. I've had to take back control over his breakfasts. He was either restricting or just not taking care of himself. I'm certain that he is still growing like crazy, but his weight has been static for two months now. Either way, I'm seeing his self-consciousness (and temper) increase.

I'm also seeing increased concern with exercise or wanting to have a sport. He's decided that he wants to run track. Boy -- that's a potential problem. Do I let him try and watch him carefully? The boys at this age are so defined by what sport they participate in. I get that N feels like a "nerd" because he doesn't do sports. Is it possible for a boy who has anorexia to do a sport at a reasonable level?

We've got a winter campout coming up. N is resisting anything "puffy." We've told him that if he won't wear the appropriate equipment, including coat, snowpants and boots, that he can't go. I find myself just wanting to keep him home and protect him from the weather and the other boys. Boys at this age are so mean to each other.

Check Up

N and T met with Dr. R. last night. It was a positive visit and in fact, they didn't even stay for the whole hour because "they ran out of things to talk about." Our next appointment isn't for another four months. The topic of discussion was long term recovery.

N just started a new term at school. He has been significantly more self-conscious (even to the point of calling himself "fat") because of new kids, expectations and teachers. I think some of the anorexic feelings have increased because of the change, but I also see N dealing with it better than he has previously. Hopefully, each time he experiences change, he'll get even better at dealing with it - until it's just not an issue anymore. Dr. R told him to address the self-consciousness and any OCD stuff before it ever became about eating.

N also made an interesting confession. He said that he eats in order to avoid his homework. Wow. I'm pleased that N is honest about his motives. So they also talked about avoidance (everyone does it) and to stop and really find out why he doesn't want to do his homework. At some level I don't know how much these things really have to do with the anorexia -- but it was good for him to discuss them.

Bulimia

N is now 12 1/2 years old. When he first got anorexia, he was barely 11. At the beginning of his treatment, his therapist stated that it was good that N didn't also have bulimia -- that the characteristics N was demonstrating at the time were evidence that we would have a long, long road ahead if N's illness led him toward purging. Because of this concern, we've watched him carefully for signs of purging, kept the research books hidden (with mixed success), and haven't really talked in depth about bulimia. I assumed that N didn't really know what bulimia was and that to talk about it was to also put ideas in his head.

I briefly talked to N after our visit with his Great Grandmother (last post) and wondered whether it made him uncomfortable. You can imagine my surprise, though, when he shifted subjects and started talking about the girl with bulimia, confessing that he had "thought about it" (throwing up), but couldn't stand the idea of making his throat burn. I looked at my husband, who was also processing the comment in shock.

I'm not sure what to do with this information now. I think it was naive of me to think that by not talking about bulimia it could prevent N from purging. It leaves me wondering if we should have (or should be) engaging that topic more directly. Thankfully, though, I really believe him when he said that he has never done it.