Admission

Most of 2018 was pretty good - just full of small ups and downs.  N held his weight high, but shifted into an "I-don't-care-about-anything" mode.  By the end of the year, he had to drop several classes because he was failing.  He was sleeping all the time and seemed to be showing increased markers for depression.  He met with his primary care doctor who told him to start keto.   That did not go over well with me and I made it pretty clear.  However, the doctor insisted that his objective was to help N control his insulin spikes, not for weight loss.  He's an adult now and despite my objections the decision was made to carry on.  They also put him on adderall, increased his sertraline dose and eventually added olanzapine to the mix. 

Of course, N's weight plummeted.  I insisted upon a weight line that he wouldn't cross.  It started as 215, but then he dropped below that weight.  He hovered right below 200 lbs. for a while.  He was okay - OCD not totally flaring, but it was there in the background.  The olanzapine was a good addition to the mix because it usually causes some weight gain, but unfortunately it also causes him to sleep.  His mental health was declining.  He was having relationship problems with a girlfriend.  Things were not good.

The last week of February as we prepared to go to a family funeral, I contacted him to make sure he was coming.  He asked if I had gotten his texts.  No.  He spent the night at the ER for a suicide evaluation, but was doing okay.  We had no idea.  A week later, I took him to the hospital where he was admitted for a three day stay in the psych unit. 

While in the hospital, he had access to a great psychiatrist who slightly adjusted his meds and halved his olanzapine.  Some additional mental-health evals showed high anxiety, but not so much depression.  That same weekend I had a work training on anxiety and was surprised how much it can look like depression when it gets bad - but needs slightly different approaches to treat. 

Up until now, he has been resistant to getting help from a therapist.  At one point, his dad walked him over to our university mental health crisis center only to be asked by the receptionist if they could come back tomorrow (crazy, right?).  This further entrenched him in his resistance to get help.  I was thrilled that one of the requirements of his release was making sure he had ongoing mental-health services lined up.  However, there is such a back-up of mental-health care in the valley and unfortunately, not even the hospital could make arrangements for a therapist.  We were released with a referral to return to the same university mental health services (which had previously turned him away).

Thankfully, we were able to find a new (not fully licensed yet) therapist to see him.  N wouldn't make the call so my husband dialed the number and handed him the phone.  Waits have been three weeks or more.   He's only been seen once and his next appointment isn't until next week  He's not making any progress yet because of care availability.  He also missed his scheduled psychiatrist appointment.  I feel like he's doing better in some ways, but there is still so far to go. 

Thriving Again

Right after the first break-up, N rapidly experienced a second.  This was a rebirth of a long-term relationship.  They expected that they would reunite and reconnect, but both had changed.  Right after this, N began his second year at the University.  Within a few weeks, he had an opportunity that brought his load up to 19 credits.  I wasn't sure how the semester would go with the lingering waves of the break-ups, but he's held his own.  

His weight has stayed high enough that we only see very low levels of anxiety and OCD behaviors.  He continues to be more independent.  We still interact with him a fair amount and regularly check in with him about his anxiety and depression levels.  Those continue to stay low.  He has a better apartment, good roommates and a good friend group right now.  All of that, I think, is contributing to his current success.  

He'll be home for Christmas!  I'm so grateful.  

A Break-Up

It was inevitable, I suppose.  N experienced his first heart break as he ended an eight-month relationship.  I was worried about how he would do in terms of depression and potential weight-loss and return of OCD behaviors, but he's done okay.  He felt peace about his decision and though there has been a lot of sadness, his depression hasn't gotten too bad.

The one concern I do have is that he labeled himself as broken and described himself as a burden to anyone who might have a relationship with him.  I remember mulling over similar sentiments long ago myself, so I hope it's just a stage in the break up.

He also has been very flat.  I know that happens a bit with the medicine (that's what he blames).  It's making it hard for him to feel deeply.  He's at the end of the semester and there's a lot to be done.  He's busy, sad, and frustrated.   He'll be moving home for the summer to save money while working.  I hope that gives him a chance to recover and refocus.

Medication

This summer it will have been ten years since N's initial diagnosis of anorexia.  In the interim, we've discovered a significant genetic manifestation of anxiety and depression in our family.  Each of our children, around age eleven, has started to struggle.  We hoped that our baby would be the exception.  However, last night he had a full-blown panic attack.  He'll be eleven next month.  We are already helping him to compile a tool box full of strategies to help him deal with anxiety in those moments.  

N is actually doing better than he has in a long time.  We've tried a new strategy that seems to be working.  The stress of the semester continued to become a heavier and heavier burden.  We saw depression emerge at a completely different and dangerous level.  At the point that he started having suicidal thoughts, we knew it was time to intervene.  After consulting with his new doctor, we decided to try medication.  All this time, N has persisted without it.  

The amazing thing is that by the second day after starting the meds, he was already benefiting.  We use a scale to discuss depression in our home.  A "1" means you're doing well.  A "3" means you are feeling blue.  A "5" includes feeling blue with having occasional suicidal thoughts.  A "7" means constant suicidal thoughts and ideas of how to follow through are forming.  A "9" is the point where plans are in place and they are actively working toward them.  As we contemplated needing to get N additional help he was up in the 5s and sometimes as high as 7s.  Since going on the medication, he's had all 1s.  In fact one day he commented that maybe he needs a new scale because he is doing even better than the scale allows.  I'm amazed that it has made this much difference.  

He is on a med that addresses both anxiety and depression.  I suspect that N has lived with daily anxiety for so long that he (and we) didn't realize how much it affected him.  The meds usually take two or three weeks to really help with the depression, but they address the anxiety much more quickly.  That quick response suggests that the anxiety has continued to be a major contributor to his struggles.  I'd hoped that a reduction of anxiety would also help with anorexic issues, but those haven't completely gone away.  His weight is in a much better place, but he continues to look in the mirror and dislike what he sees.  The good news is that he is doing a great job of holding his weight instead of giving into those thoughts.  

On to College and a bit of a Relapse

After two years in Texas with only four phone calls and an hour of emails once a week, we were thrilled when N returned home in July.  His jaw was squarer and his beard a bit thicker.  There is nothing as sweet as being reunited with a child after being apart for so long!  He had held steady at that 185 weight through his return home and even put on a bit of weight during the month that he was here.

Starting college and moving back out was trickier than we thought it would be.  For him, the issue hasn't been overt restriction, but neglect.  He is busy working 20 hours a week and attending classes full-time.  He doesn't make eating a priority.  And so we've watched his weight creep down to a low of 172.

His OCD has ramped up significantly.  He is counting calories and salving his OCD through exercise (though not excessively).  He isn't spiraling, but I feel like he is on the edge.  The good thing is that he is much more self aware.  He has agreed to maintain the 185 - though he did initially argue for a lower standard because he had so far to go.  He also can tell that his OCD gets worse when he loses weight.  Just this last week, he was calorie counting (which I know is almost always an over-estimate) and was certain that his weight was on its way up.  But I could tell that his OCD was worse and I suggested that he was probably fooling himself and that it was probably down.  Sure enough, at this morning's weigh-in, his weight was down.

He didn't have a scale there in his apartment, so I finally purchased one and sent it to him.  We've agreed to a Saturday morning check in where he weighs himself and texts it to me.  That way I'm not always asking him about it.    I really dislike that our conversations always come back to his weight.  I'm making an effort to limit that mostly to our Saturday morning check-ins, so I can also engage with him about different issues.  But it's especially hard because as I see him struggle with life in general, I recognize that so much of it could be easier if he were up to a higher weight.

I happen to also be taking classes at the university.  So each Monday and Wednesday when I'm on campus, I drop off a lunch.  His dad is a professor there so he also keeps nuts and other foods on hand so that he can share when N stops by (which is usually daily).  We're researching the on-campus food plans for the future.  I think N will eat better if he doesn't have to cook.  I know that this isn't a long term solution, but a temporary one.  I'm hoping that we can help him to create new patterns for himself with an awareness of how they contribute to his well-being.

Holding Steady

The good news is that once N got past that initial weight-loss, he has held steady.  We agreed upon 185 weight which is a reasonable weight for him.  He has been good about catching the bounces and not letting himself drop. 

There was a period of time where his roommate with the scale was transferred away.  It's no surprise that N assumed he was gaining tons of weight when he was actually losing.  Once we insisted that he find access to another scale, he acknowledge the weight loss and got right on top of putting the weight back on. 

He seems mentally stable and well.  He said that there have been a few struggles with OCD stuff, but I bet that is completely associated with the drops in his weight.  It would be wonderful for him to put on another 10 pounds just to give him a better buffer from sickness or something like this, but this is a liveable goal. 

He'll be home in July for just a month and then he'll be off to college.  He's been able to live independently for these past two years.  I think if we continue to have him regularly weigh himself - and be accountable to us - he'll be able to thrive without any additional relapse.  One other good thing is that some living conditions will improve upon his return home.  Also, we'll be nearby and can easily send food and/or money if needed.

My one question is about him weighing himself.  For so long, we were told not to let him do that.  But it seems to be working.  I wonder if there isn't something that I'm not considering, though.

Maintaining Weight

The good news is that N's weight is on its way up.  He is holding to his promise that he made to maintain at 185.  He did have a dip - which was evidenced by the increase in his OCD thinking and fixating on health/calories/fitness that I discussed last time.  As I could see his mental health decline, I was pretty sure he had lost more weight.  Typically, I'm not in favor of him weighing himself, but right now it is the only way to keep him honest.  I told him that I thought he had lost and asked him to weigh himself.  He did and he was down four pounds (and surprised!).  He has been actively trying to regain back up to the 185, he mentioned that it was a lot harder to get back up than he had thought.  It's good for him to recognize this because it helps him to feel like he doesn't have to be so careful.

I still have some concerns, but am heartened to see that he is still mentally stable enough to put weight back on without us by his side.  I am reassured that the spiral stopped and is no longer downward.  As long as he isn't in that spiral, I think he'll be okay until he comes home in July.  He isn't 100% either, but once the trend switched to weight gain, it felt like his mental state correspondingly improved.

He's been gone for 15 months now.  He has 9 months to go.  He didn't get transferred, but still has access to a car and it sounds like he is getting fed more often.  This morning, I mailed a lovely Halloween package, full of good, nourishing foods.  My prayers are full of requests for God's help that he might be able to stay healthy and finish his mission. 

41 Pounds or More!

Arrgh!  In last week's communication with my son, he made this statement, "My metabolism got nuked. Like, on Tuesday and Wednesday I ate an estimate of about 6000 calories each day, the following day it must have been about 4000, the next day about 3500 and the next day 3500 again.”

In that single statement, I saw evidence of counting calories and tracking them over time.  I also saw him inflating the numbers wildly like he used to do.  

So this week, I got in his face (as much as I could over email) and asked what was going on.  This was his response:  "I'll be frank with you. There have been some recent paradigm shifts in my mental processes that have been frightening and a little reminiscent of my former days. There have been a lot of things that I thought then that I am thinking again that I had forgotten I thought. So you could say it has felt a little digressive. 

That being said, while also anxious to not regress into a complete psychological vegetable and completely incapable servant of the Lord, I am not eager to return to my physical state from immediately before my mission and in H*. Both of those times were painful and frustrating, both physically and mentally. I feel like I am in a reasonably good middle area."  

What an incredibly hard spot to be in!  What do we do about this?  The good news is that transfers are happening next week.  In his mission, there are areas where the missionaries are very well-fed.  He hasn't been in one of those areas during the past 9 months.  Any of those areas would be perfect for him at this point.  So that's what we're praying for.  

He has 10 months left.  It would be best if he could finish out those last 10 months.  I don't think he is at the point where we need to bring him home.  There are several other interventions that we can do before hitting that point anyway.  But I am so worried! 

35 Pounds!

35 pounds is how much N has lost since January!  You can imagine that my panic mom-mode is way up.  If  there was one thing that I drilled into him before he left it was that he CAN'T LOSE WEIGHT!  I knew that this was an age group with a high relapse rate.  I also knew that serving a mission would remove him from his regular patterns of eating and exercising.  I knew he had to be so careful.  So did he. 

He left on his mission a year ago, probably with 30 or 40 extra pounds on him.  But, of course, we didn't know if he could lose ANY weight at all without triggering the mental symptoms of anorexia.  We had a very terse conversation via email on Monday.  I *think* that there is not a resurgence of restricting, ocd, or anxiety symptoms, but it is so hard to be sure without living and interacting with him.  My sense is the combination of being on a bike all day long, relying on church members for meals, and all the exercise programs that have been thrown into his routine have resulted in a slow (and not necessarily deliberate) loss of weight. 

He promised me that he would make sure that he doesn't lose any more weight.  And I told him that I would hold him to that promise.  I shipped a huge box of groceries to his apartment last week.  He was also recently shifted to a new area and given a car - so he isn't on a bike as much as he was.  Will it be enough?  I'm not sure, now that he has probably erased his weight buffer. 

As I mentioned previously, this is an area where the missionaries typically gain weight.  He didn't lose any weight during the initial 6 months of his mission, but he was primarily using a car.  So, I really hope shifting him to a car will help stop the weight loss.

I'm having to trust him right now - that there isn't any mental involvement.  But can I trust him?  I know that his own perception of reality was so altered when he was previously sick.  I don't know.  I'm going to give him a month or two.  If he is able to keep his word and stop losing weight, I'll feel much better.  But if the weight loss continues, I'll be contacting his Mission President. 

Biking and Cross Fit and Basketball?

In my last post, I mentioned my worries of N moving to an area where he bikes all day and the impact that would have on his calorie needs.  He has since told us that he his Zone Leaders (two missionaries just like himself) have added a daily unifying activity where the zone gets together and does cross fit.  Add that to their already weekly activity of playing basketball and my mom-worry-monitor is starting to beep.

I can see from his pictures that he has lost some weight.  I keep checking in, asking about his feelings of wanting to restrict.  He assures me that he is fine and is compensating calorically.  I know that his Mission President is aware of his medical needs, but of course these other missionary leaders are not - and we prefer it that way (too much chance for misunderstanding).  If things get bad enough, though, he can mention to these young missionary leaders that he can't lose weight due to a medical condition. That might raise some eyebrows, but would be an adequate reason for him to not participate.

The good news is that change is inevitable on a mission.  Transfers are coming the last week of February and the biggest exerciser of the bunch will be heading home.  I just mailed N a bulk box of Carnation Instant Breakfast.  I know he'll use that when he is in a hurry and might not otherwise eat.  It's a good high calorie and protein addition to his diet.  (When he was really sick, I used to add cream to it instead of milk)

Hopefully there won't be too much damage done by the end of this month.  I know there is a fine line where symptoms might start to ramp up and it becomes much more difficult for N to manage living independently.  Traditionally missionaries gain weight in this area.  So hopefully some weight recovery is in store.  Until then, I might be worrying a bit.

On the Border of Texas

N is just about to the six-month mark of  his mission experience (out of two years).  He has been in south Texas, living just six miles from the border of Mexico, since September.  We've missed him like crazy.  He is learning a lot about living with all types of people.  He is also learning to be independent and take care of  himself.  It has been really hard at times, but he has been able to figure it out. 

He speaks Spanish fluently now.  I can't believe it!  He took three years of German in high school and didn't know any Spanish when he left.  When he skyped at Christmas, N and his dad spent the first 10 minutes or so speaking only in Spanish.

We get an email from him once a week.  I scrutinize every picture that he sends home for weight-loss.  He was just moved to an area where they bike everywhere they go.  He'll need to make up for that additional calorie loss.  I'm so glad to know that he has some extra weight on him.  It just means that he will have a chance to make adjustments before any issues with relapse appear.  We check in with him often to see if he has had any feelings of restriction.  He has.  But he said that he knows that the way to deal with that is to make sure that he has full nutrition.  He even let his exercise/food-obsessed companion know that they could NOT skip lunch. 

He is teaching a lot of people.  He is serving the communities there in Texas and making a difference.   What an amazing experience!

Mexico City

Well, he's off.

It was so hard -- harder than I thought it would be to say goodbye for two years.  We'll get weekly letters and/or emails.  We get to Skype with him on Mother's Day and Christmas.  No phone calls or visits.  That all helps him to not be so homesick and instead focus on his work (instead of what is happening at home).  We're a close family.  I'm grateful that it was hard - it means we love each other.  A lot.

I've worried for a long time (see many previous posts) about how N would do with the stress of a mission.  The doctors all cleared him for service.  They all served missions, themselves, so they know what is involved.  We've prepped him for every possible trigger that I could imagine.  We've reviewed and discussed the importance of eating well over and over and over.

N has been gone for three weeks now.  All indications are that he is doing just fine.  Right now,  he is in Mexico City undergoing intensive language training as he tries to learn Spanish.  He has a cafeteria, a set meal schedule and set activity times.  It's a good setup for him.  After six weeks, he'll transfer to the border of Texas.  Then he'll fix his own meals and set his own eating schedule.  That's where I'll worry a little more.  But, he'll always have a companion by his side.

I pray every day for him - that he'll be happy and well.  I'm proud of all of his hard work, preparation and desire to teach people about Jesus Christ, forgiveness and forever families.  I wonder how his struggles with anorexia will affect his ability to teach.  I suspect that he will be more compassionate and kind.

Today, is his preparation day - the day he gets to email home.  I'm so excited to hear from him!