Let’s Talk Coffee (and Treatment Teams)

Okay, I’ll admit to it. I’m a coffee addict. That’s probably what they find when they do my blood analysis during program – coffee. My father, English born and raised, tried to convert me to drink tea from a young age, but my mother – an American coffee guzzler – was victorious. You caught me. I also drink loads of tea, it’s just not my drink of choice when my eyes first crack open in the morning.So coffee or tea? Yes, e) all of the above! I’m a drink-o-holic. Let’s just be glad I’m not 21?

On a more serious note, the topic I’d like to cover today is treatment teams.

It took me thirteen years of disordered eating to accept therapy. Yes, thirteen. It took me another five to enter into an eating disorder specific program and put together a specific team. That last step? Absolutely crucial to completing the circuit (oh gosh, you can tell what my 11a class was this morning!).

Yes, my therapist throughout my first three and half years of high school was unbelievably special and undeniably helpful! I owe my life to her, and we still keep in touch to this day. In fact, we have plans to meet up again this summer. But, in the end, I had to be transfered to eating disorder specialists. And after a while of course, my whole team had to be adapted to fit the fact I moved five hours away to college.

I want to share what I’ve learned about the most traditional treatment teams (what I originally had), to what I have now, which is custom fit to myself almost a year later.

kaiser-ontario-illuminated-sign-full-packageMy health insurance provider, throughout the entirety of me needing therapy at least, has been Kaiser. I cannot say I have the kindest things to say about how they treat their mental health providers, but ultimately they have some gems within their care. When you are a high-risk case like me you do (sometimes) get the attention you need, but other than that Kaiser clearly lacks the ability to provide adequate mental health care for its patients. Which is, quite frankly put, ridiculous. But that’s a whole different post that’s bound to come later on.

Anyways, my team originally consisted of the prescribed: 1 eating disorder specialist, 1 dietitian, 1 family therapist, 1 psychiatrist, and 1 general practitioner. Except, I was seventeen, so my family therapist was my adolescent therapist, my eating disorder specialist was the head of both the adult and adolescent IOP programs because, I, uh, scared everyone else (my personality, not my weight), and my GP was a pediatrician. And not only did it have to change in five months for my move to college, but it would have to be different again on breaks when I was finally eighteen!

The Eating Disorder Specialist – My, this sounds fancy, doesn’t it? Well, her job was to keep me on track, challenge my behaviors, and push ED out! Did I find her aggravating, frustrating, and emotion-provoking? Yes. Did I find ED gone? No. Did I find her particularly helpful?  Well, yes, in that she is the gateway to the rest of the team, as she is director of the program. Don’t get me wrong, she’s a delightful lady, and nice to chat with for an hour once per week, but overall she brought me down a lot. She encouraged me to focus on the parts of me that were just about my ED, and not a lot about the rest of me.

The Dietitian – You can tell I like this one, she gets a name! Ayn. Yes, a first name is all I need for this doctor, and she’s awesome. She single-handedly held me together through my first quarter of college from five hours away via video calls. Now, not everyone has this experience with their dietitians by any means! And my original dietitian back when I was thirteen (later post on that) was technically part of the adolescent ED team and was still super toxic. They are out there, and dietitians are dangerous territory. But when you find the good ones, they are gold.

The Family Therapist – Haha, Mondays are the worst, right? WRONG! Now end every Monday with a thirty minute awkward car ride sat in the back seat two feet from your sulking little sister who would much rather be playing with her friends, your dad who’s tired after working all day, and your mom who’s just trying to fight through Monday night traffic. Now spend an hour processing the past week with your family. Repeat car ride home except now everyone is H-U-N-G-R-Y (ironic, right?). Somehow, these sessions were never helpful for me, haha. (Note: my mom found these sessions very helpful. My father, sister, and especially I, did  not.)

The Psychiatrist – Okay, so he’s a pretty chill guy. He’s technically not supposed to see me anymore because I’m over eighteen but we work really well together and I’m such a complicated case it’s easier on everyone to just pretend I’m under eighteen still. Psychiatrists aren’t the solution for everyone, but oh god did medication make a world of difference for me! More on this in another post.

The General Practitioner – I find these just annoying in general. But I always have, ever since I was old enough to go in and be like, “this is what’s wrong, can I have this to fix it?”. Doctors are used to kids coming in and saying, “this is what hurts, how do I fix it?”. Nobody who’s spent five million years in school wants to be told the answer to a question, especially by a five year old, so I imagine I’m probably more annoying to them than they are to me, but still… But they do the weekly vitals and weigh-in.

So where are we now, 11 months after entering treatment?

Now I see a nurse weekly at the health center here on campus for weekly vitals and weigh-ins. Still?! Still. *eye roll* STILL. But, yes, it’s actually really important because I live by myself so no one is here to monitor me if I were to stop eating. This is supposed to be twenty minutes, but usually ends up taking an hour, then with walking to and from the health center, an hour and a half.

I Skype with my dietitian weekly after my weigh-ins to discuss my exercise, vitals, and stability. It’s about a 30 minute appointment from any location.

I go downtown via bus connection to see in-person an eating disorder specialist therapist weekly. It’s about an hour commute round trip, and a 60 minute appointment.

I no longer see a family therapist and I see my psychiatrist via phone call or when I’m home on breaks.

In total this adds up to four hours. That’s as much as a four unit class requires of lecture time, but I have in terms of sheer hours worth of appointments.

“Yeah, but that doesn’t include the eight hours of homework!” (2hrs of homework for every 1hr in class).

Trust me, it takes me more than eight hours per week to stay on recovery, of hard work all by myself without professionals. That’s why teams exist. That’s why residential programs exist.IMG_20160218_141530

So how the heck does coffee relate to any of this? Come on Rose, I needed caffeine! Well, I’m tapping this out sat in my favorite local coffee shop. The one I visit every time I have therapy and sit and relax at. Usually I study, but today I’m taking some self-care time and a moment to blog. It’s about a 5 minute stroll from my therapist’s office and a 5 minute brisk walk from the bus stop, so I come here after class to eat lunch and kill three hours before my appointment.

The question then becomes, do I find my team excessive here at college? No, not if I’m honest about it. I really do the accountability of my weight and vitals checked weekly. I do need help meal planning. I definitely need therapy on the weekly. We’ll just have to see how it changes once I get back home for summer!

Speaking of which, most of my semester friends should almost be done by now. I’m on the quarter system, so I’ve got a while to go. But I’m proud of you guys, keep going you’re almost done!!

What does your team look like? Do you find them helpful?

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Do I Calorie Count? And Calorie Counting in Recovery

This is one of the questions I get asked most often by members of the recovery community on Instagram, Tumblr, and even in my support groups. “You still count calories?!”

Yes, I do. But let me tell you a secret that ED doesn’t want me to tell you: I wish I didn’t.

Do I think people should in recovery? No. I pretty firmly believe you shouldn’t, unless it’s prescribed by your treatment team, like it is for me.

I have consistently struggled with providing accurate nutrition for my body my entire life, despite being overweight, and then obese, preceding my anorexia. I was raised in an extremely disordered family, my mother being a binge eater and my father mostly absent.  My mother forced me on diets – to compensate for her own overeating – from a very young age (think pre-school and up) to prevent me from gaining weight like her. Of course, this only backfired and in turn caused me to gain weight.

I realize there are infinitely different stories out there, and as part of that there are bound to be many that mimic mine. But the point here is I was never raised with a normal eating pattern that taught me what a good caloric intake is. In fact, for years and years, a “normal” day looked like no more than 1200 for me. Yes, we religiously weighed and measured our foods. Well, to be exact, I did, and my parents supported my doing so under the cover of “dieting”. Others would try to keep up with me, managing it for maybe a week or so, but I have been tracking my food intake and exercise precisely since 2011.

Normally, upon entering the treatment program my parents chose to place me in last summer (they refused to send me to residential) they would take over my food, but because of the history there they were asked to continue tracking my food in MyFitnessPal on their own. Since I was almost eighteen, I was given say in my treatment plan, and I insisted (admittedly entirely ED driven) that I needed to stay involved. So I never missed a day of logging, of analyzing macros, and of course torturing myself over the details of what “massive” increases were occurring.

Naturally, this led to much internal struggling throughout the course of my “recovery”. I put this in quote marks because it was false and faked. A simple facade in order to fool my parents and team. They said I needed to gain x amount of weight in this amount of time, go to so much therapy per week, and I could go to college in the fall. So I did, and so I went. Of course, with this, relapse was inevitable. But…

I was still counting calories. So, my dietitian could see my relapse in progress. She was able to catch me each time before it was in full spiral. I share my MFP logs with her each week. So in short, my dietitian firmly believes she would have lost me completely within a few weeks, probably week one, if it weren’t for my calorie logs. Make of that what you will.

This cycle has happened once or twice per quarter consistently, and I have not been able to maintain within my prescribed healthy weight range, though I am well within the healthy BMI. Do I consider this recovered? No way. Do I consider this recovery? I am working on it. I am definitely making progress!

It also allows me to be more flexible with my meal plan. I can eat larger snacks and smaller meals in order to fit in my meal plan, etc. I can eat a wide variety of foods and feel ‘safe’. I realize that is very disordered, another drawback of allowing myself to stay in such bad ED behaviors.

The biggest drawback to this whole charade is the obsession. This drives my OCD up the walls. I cannot go more than literally twenty minutes without checking MFP to make sure something hasn’t changed, plan out my next snack, alter a meal ahead of time, adjust something, plan out the next day, calculate a new recipe (even ones I’d never make!), etc. This happens while I’m walking to class, talking on the phone, sadly even while I’m in lecture.

I can tell you one thing for certain. If I didn’t count calories there is no way I would still be here at college, I would have full out relapsed by now. I would second guess everything and always choose small quantities of low calorie options. I would not trust myself, with my own personal history haunting my every decision. I feel too alone here to do this, and still too alone even with my parent’s ‘supervision’. But, I’m in this quasi-recovery state while calorie counting as well. It’s quite the dilemma.

My therapist strongly disagrees with it, but she’s new around here. She thinks it’s making my anxiety, depression, and OCD too awful to be worth it. My dietitian won’t do without it, she insists I keep tracking until I can get support and supervision. My general doctor wouldn’t know the first thing to have an opinion on the subject.

Do you still count calories? What does you treatment team suggest? Do they all agree? Let me know in the comments below!