New Steps

This is my detailed plan of action. This plan came about after having severe internal conflict about continuing with my current dietitian. The purpose of this plan is to help me construct the greatest post-treatment environment I can to protect myself and my recovery. I am making this plan open to my team, my family, the girls from EDA, and my friends so that they may voice their concerns, suggest alternatives, and help me maintain the most healthy lifestyle I can.

First and foremost, I have decided to stop seeing my current dietitian. The reasons for this are…

-          I have left every appointment in tears

-          I believe her style and mine do not mesh well

-          I would prefer more encouragement as opposed to criticism

-          I feel that my current meal plan is creating more eating disordered thoughts and actions

-          I feel that I have gained a great deal of knowledge from my dietitians and nutritionists since July of 2011, and I can implement this knowledge in my everyday life

-          I currently have a great mindset about weight gain, recovery, and food. I fear that continuing with my current dietitian will make me hyper-vigilant of my intake and hinder my growth in recovery.

-          My dietitian has stated that she does not trust me, and I am under the impression that she does not believe what I tell her.

-          I do not have the money to continue seeing my dietitian.

So that I do not relapse, I am committing myself to these promises…

-          I will continue to go to EDA

-          I will eat three meals a day at “normal” meal times.

-          I will eat two “Castlewood sized” snacks or one “Castlewood sized” double snack a day.

-          I will go to the grocery store at least twice a week, more if necessary, with a friend or family member (to keep myself in check so that I don’t buy fat free cheese or stuff like that)

-          I will continue to eat meals both with my family at home (not isolating during meals at home) and eat alone in public (something I’ve been trying to challenge recently)

-          I will entrust a doctor (probably Dr. Gomez if I like her, or Dr. Herrmann if I choose to remain with her) to monitor my weight. I will not weigh myself.

-          I will continue to see Thom weekly

-          I will continue to keep daily logs of all the food I eat. I will make comments about my meals/snacks as I currently do for my dietitian

It is my purpose in doing this to keep myself healthy. Personally, I don’t think that having anxiety around food and seeing my dietitian is helping my eating disorder. I am very comfortable with eating now. I like my current relationship with food. I see myself changing, and I love it. I am realizing that a large part of my disorder is my perfectionism. My perfectionist qualities are linking themselves so tightly with my meal plan that I am getting hooked on this idea of perfect recovery, which is just killing me. I do better with food and meals and getting in my minimums when I am not forcing myself to be as hyper-vigilant over my food as my dietitian would like (or what I perceive her to want from me). I am not saying that I will not ever see a dietitian again, but I would like time away from a dietitian to see if it is what is best for me. Different things work for different people, and there is no single way of recovery that is right for everyone. I really feel that I can do this without a dietitian at the moment. If I can’t and my family, friends, or team see me relapsing, I would immediately reconsider going to a dietitian and going about all of this in a different way. I just ask that people support me in my decision to work through recovery as I feel in my heart is best for me. 

A Letter to the Insurance Company

I am currently going through an appeal, hoping that my insurance company will see the error of their ways and reimburse my family for some of the money they paid out of pocket for me to remain in residential treatment. Below is one of the letters I wrote in my appeal.
*Trigger Warning, as always*

Even though my eating disorder began at the age of four, it took seventeen years for someone like Dr. Hermann to confront my problem. She referred me to The Renfrew Center for Eating Disorders in June of 2011, because I had gone from weighing above 135 lbs to below 110 lbs in a very fast amount of time. My percentage of suggested weight and my restrictive eating habits were more than reason enough for her to send me to specialists dealing with eating disorders. At Renfrew, I had a two hour long intake with Dr. Cooper who immediately recommended residential treatment, saying that I was “too sick for a lower level of care”. When I mentioned possibly doing an Intensive Outpatient Program (IOP), Dr. Cooper told me that I was too “medically fragile” for that level of care, anything lower than residential treatment was not going to be offered to me by the Renfrew Center. This was on June 20^th of 2011.

I started to try recovery on my own. I was seeing a dietitian and a therapist on a weekly basis while working full-time at a magnet school teaching middle and high school Latin.

In October, I taught all day feeling as if at any moment I could have a heart attack. After school, I saw my dietitian, Katherine Fowler, who immediately sent me to the Vanderbilt ER. I was admitted into the emergency room with dangerously low potassium levels and low magnesium levels.

Even after missing work for a life threatening situation, I still did not make the progress in recovery that one would hope. It was after this, hitting rock bottom and knowing it, that Dr. Herrmann and my dietitian decided that I must go into residential treatment. My life depended on it.

Jenni Schaefer makes a very profound statement in her book Life Without Ed, a book about eating disorder recovery. She says that she was at a seemingly “normal” weight when she was the deepest in her eating disorder, when she was restricting, bingeing, and purging the most. The same is somewhat true for me. What many people look at when they see an eating disordered patient are the numbers. The phrase, “But you don’t look sick” comes out of their mouths more often than not. If my exposed collar bones, my clearly evident scapulae, and my countable ribs were not enough to make me sick enough by the standards of an outsider, then I would encourage them to dig a little deeper. What about restricting to only 300 calories a day? What about forcibly vomiting a minimum of forty times a week? What about bingeing on Taco Bell, Sonic, and ice cream only when my body was so deprived that I needed something to stay standing only to forcibly remove the food from my body within two hours of consumption?

Not only did doctors and trained professions urge me to seek residential treatment, but I also saw the horrible nature of the life I was living. My only hope is that the insurance company sees that too. 

Rules

Every time I talk about treatment, I mention some of the crazy rules or nuances of treatment. These normally get me a "wtf face". I decided I will compose a list of the craziness of treatment. :)

This is a work in progress, much similar to my recovery :)


1. You cannot break your cookie. You must take the entire cookie, raise it to your mouth, and bite into it. It does not matter if the cookie is stale and is too hard for you to bite. The only exception to this rule is if you are at Panera.

2. When you have cereal, you must make sure that all the flakes of cereal and all the almond slices are cleaned from your bowl. You cannot have any food particles remaining in your bowl. If you leave almond slices or cereal flakes in your bowl, you will be redirected to take your spoon and get all the remaining pieces before leaving the table. This sometimes will result in you having to spend about five minutes working on getting tiny slivers of food from your bowl, but that is not what is important. What is important is that you are not acting on your eating disorder.

3. If you are having cereal, you can have Raisin Bran and yogurt. You can have Cherrios and yogurt. If they are out of Cherrios, you can have Frosted Flakes with yogurt. If it is any other cereal, or if you do not mix your yogurt into your cereal creating some weird somewhat gelatinous substance then you must put milk in your cereal. This rule gets very complicated, so I will subdivide.
a) You cannot have yogurt with cereal unless you mix the cereal with the yogurt.
b) If you don't have yogurt, you must have milk. If you have milk, you must put it in your cereal. You cannot have dry cereal and drink milk.
c) Frosted Flakes cannot be mixed with your yogurt if Cherrios are available.
d) You can put extra raisins into your Raisin Bran as your fruit component.
e) You cannot put raisins in other cereals if it "doesn't make sense" to the dietitian. This subdivision of a rule is up to the interpretation of dietitians and online staff.
f) Having dry cereal is "eating disordered".

4. You cannot put your Mini Wheats or Frosted Mini Wheats in the microwave even though the commercials and the box tell you to do so for a "warm cereal during winter months".

5. You cannot put salt in your oatmeal, including non-flavored, original oatmeal, even though it says on the instructions to add salt.

6. You can put fruits in your yogurt if they are fresh and cut up or if they are dried and bite size. Prunes (even if cut up) cannot go into your yogurt. Dried apricots, though much larger than bite size, can go into your yogurt. Apples, bananas, strawberries, plums, etc. all can go into your yogurt and can be cut into insanely small pieces to fit into your yogurt container. Preparation of the fruit + yogurt combo can take up to fifteen minutes. I've seen this happen.

7. You cannot put apples and peanut butter on your bagel, but you can put bananas and peanut butter. Duh, that's so less eating disordered...

8. You cannot make your bagel into a peanut butter and jelly sandwich by having peanut butter and getting jelly.

Proposals

Before my nineteenth birthday, I had been proposed to three times: once by my high school sweetheart and abusive boyfriend when I was eighteen, once by a street vendor in Monaco when I was sixteen, and by Ed when I was four. I refused to recognize almost all of these as proposals until I was in my twenties, particularly Ed’s proposal. Some things are just better left forgotten, or so I believed. While all of these proposals were insanely strange, I suppose I shall start with what I still consider to be the strangest of all.

I was eighteen, a college drop out, and in a relationship with Daniel. Daniel did not have a job, and he had been homeless for the majority of our relationship. As you can imagine, his proposal was not very elaborate. It was what I refer to as the “Hey, I’m going into the military, and there’s a possibility you might be pregnant, so let’s do this thing” type of proposal that was all too common around my hometown. As we stood in my parents kitchen, Daniel threw his class ring at me, still engraved with the initials of his ex-girlfriend, and he said, “So… Yeah… You know… What do you say?” I said no, and we broke up a few weeks later.

My proposal in Monaco was not really a proposal, but I group it in here with the others because it is the happiest of the three. I had just fed a crepe to a seagull, and I was meandering the alleyways of Monaco with some close friends. The menagerie of Lamborghinis and other expensive cars caught our attention until a young man and his father in a street side shop called out for us in French. I, speaking only Latin, could only pick up a few words. Beautiful. Ladies. Something about a boy or his son? I turned to my friend travelling with me, who translated for me. “Beautiful ladies! American women! My son! You marry? You marry?” Next thing I knew, the kid was on one knee. I ran away giggling with my friends as any scared American would.

 Finally, the proposal I remember least vividly. It was the summer I turned four. I was at my maternal grandmother’s house. Somewhere along her hallway lined with mirrors, which I often compare to the Hall of Mirrors at Versailles, Ed proposed to me. I accepted without hesitation. Who’s Ed you ask? Ed is my eating disorder. Ed is the man who saved my life and nearly killed me a few times along the way. Ed and I are currently in the process of filing paperwork to finalize our divorce.

Christina Syndrome

A few years ago, my best friend started having adverse reactions to certain foods or after eating. She would have extreme stomach pain, cramping, and a ton of GI problems that no one ever resolved. We just called it "Christina Syndrome".

When I was refeeding, it would take me hours to finish 50% of a meal. My stomach could not digest properly. Digestion was a foreign thing to my body. I had deprived my body for so long of nutrients, that taking in those nutrients became extremely painful. I'm sure Ed was in there too, and that it wasn't entirely my body reacting to food.

While I don't consider myself "in recovery", I am no longer refeeding. I'm not at my goal weight (whatever that is). I have not gained enough weight to be considered an "appropriate" range. My metabolism is out of whack, and Katherine has put me on a really intense meal plan so that I don't lose any more weight than I already have coming out of treatment. Ed doesn't like this idea. Regardless of the weight I have gained and the progress I have made, eating has not become easier either mentally or physically. Here's the process...

I eat, therefore, I feel sick.
I eat, therefore, my stomach screams in pain.
I eat, therefore, I can feel my body attempting to digest food.
I eat beyond fullness cues so that I meet my meal plan, therefore, I send my body into immense pain, giving me high restriction and purging urges.
I eat, and immediately I have stomach pain.
Nothing is regulated.

I'm already horrible at assessing pain levels, but now I have to do it after everything I eat. Blood draws, GI appointments, dietitian appointments... I'm going through all of these hoops in some attempt to figure out why eating is so difficult. I know that there is a mental component to this, but there is also a physical one. I shouldn't feel like I'm in that scene from Alien when the alien comes out of the stomach every time I eat. It even happens when I eat "safe" foods. Have I really screwed up my body so much that now I have created an intolerance to certain foods because I deprived my body of them for so long?

Ya know... people say "It's not about the food." But dammit... I need to eat. I know I do. Some Part of me wants to eat! But why can't I eat, digest, and have a nice, normal cycle like that!?!? Why can't it just be food? Why can't I just eat it, and not be in pain?!




P.S. I'm really tired of Web MD-ing my symptoms... Suggestions? Get on x, y, and z medications. I'm on ALL OF THOSE. THEY DON'T HELP. SCREW YOU.


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Blame and Responsibility

As I thumb through the Rolodex that is my history, certain things stand clear. Memories I wish I had never experienced and days that happened in the early 90s and in my teens that are as vivid today as they were back then.

Recently, my grandfather passed away. Since then, we have been sorting old pictures that we found in his house, pictures of my childhood that hide this dysfunction and show the mask. Was I really wearing the mask at the age of 7? I can't help but think to myself, "How the hell did it get this way?" When did everything change? How did it change? How did I go from...

To the chronically ill person I am today? Who do you blame for that? How did that little girl grow up to have hundreds of papers and documents in hospital basements, psychiatrist offices, and therapists' offices? Who fucked her up? Was it you or was it me?

When I was fourteen, I started going to my pediatrician for pain. This wasn't the beginning of everything, but it was the beginning as I knew it at the time. You're growing. It's just growing pains. Yeah, right. I hadn't grown in two years, so that was ruled out. A few months later, I saw the same pediatrician. Tendonitis. Your tendons are just sore; take Tylenol. Okay. No luck. Again and again and again until that doctor got the idea that I should probably see someone more specialized. So then came the orthopedic appointments. Jumper's Knee. Right, because I jump all the time... Wrong. Tendonitis. Still not that... Arthritis. I'm fourteen! Juvenile Rheumatoid Arthritis. Wrong again. Torn meniscus. Nope. Broken patella. Nope. Synovitis? Well sorta. But your medication didn't help. X-rays, nuclear medicine tests, MRIs, you name it. I was given some test for it. This lasted until I was about seventeen. Eventually with the orthopedic it got to three phases of not knowing what was wrong. Phase 1: Cortisone shots! That made things worse. Phase 2: Let's just open your knee up and look at this! Phase 3: Call you a hypochondriac. So then came the new doctor, a sports medicine doctor. Mind you, I sucked at sports. My sports career had ended when everyone else became the same height as me. He said I had arthritis, and I was put on an Asprin regimen. He then referred me to a fellow at Vanderbilt who specialized in rheumatology. I swear, she and her supervisor were bound and determined to diagnose me is PsA. They failed. June 1st 2009, I was diagnosed with Fibromyalgia. 

And that was it. Life = altered. Welcome to the world of being "chronic", the world of pain medications, and the world of being an invisible sufferer (though I was already used to that). I did my research. I saw some clips from doctors. I heard some podcasts. Something about all of my research stuck out. The most common thought surrounding the onset of Fibromyalgia is severe emotional or physical trauma. Let's see, I was 14 when I started complaining of pain... and I was 14 when fit hit the shan with my grandmother... Hm. Common denominator, anyone? And with that, the blame began.

Along with being diagnosed with Fibromyalgia, in one singular doctor's appointment I was also diagnosed with Obsessive Compulsive Disorder, Generalized Anxiety Disorder, Chronic Fatigue Syndrome, and Attention Deficit Disorder. So, I'd like to say a big ole thanks to whoever gave me all that crap.

As I grew older, so did my list of medications. Exactly two years after being diagnosed with Fibromyalgia, I was diagnosed with Anorexia Nervosa. It was one of those times where I kept saying, "But this is how I've been my entire life!" A few days after being told I needed inpatient treatment, I weighed myself after a heavy restriction period followed by binge drinking. I was a little under 70% of my suggested body weight, and I was 9 lbs away from my goal weight. I think it was at that moment, knees shaking, on the scale that I realized I had been this way my entire life...

Good food. Bad food. Eat this. Not that. You have to fit into size 0 jeans. You can't even try on those jeans. Buy everything in an extra small. Breakfast is unnecessary. You're not hungry. You're just a picky eater. On and on and on and on and on. Whoever says "I wonder where Ann got that from?" obviously doesn't know me or my story very well. 

I was anorexic at the age of four, actively restricting by five, eating normally but purging by thirteen, back to restriction throughout high school and college, and once I started working it was a new beast of restriction, bingeing, and purging. 

Who does that to themselves? See that girl up there? I did that to her. 

When I went into treatment, there was a list of words and acronyms underneath MEDICAL/PSYCHOLOGICAL that made me realized how I was nothing more than a few really shitty diagnoses. ED: NOS, GAD, CFS, OCD, Depressive Disorder, Fibromyalgia, Potential for electrolyte imbalance, Hematemesis, Hypokalemia, Osteopenia, Chronic Vitamin D Deficiency, and that one I didn't expect PTSD. What?!?! You mean, that thing that all those soldiers at Ft. Campbell have when they come home from Iraq? No. Not me. What?!? Post-Traumatic Stress Disorder?! These words and acronyms brought something new to my life I had never truly understood. I narrowed it down to one of three options...

1. I fucked myself up hardcore.

2. Someone else fucked me up hardcore.

3. God made me this way.

-------

This was originally going to be a blog post about some anger I have towards people and some shame I have towards myself. How did I get to where I am now? Is it my fault or is it yours? I think I stayed from the path somewhere in there, and I ask your forgiveness for that. All I know is that right now I have no idea on how to express the shame and responsibility I feel for taking that little girl and causing her muscles to atrophy, starving her, forcing her to expel nutrients from her body. I cut her. I bruised her. I deprived her. I gave her scars. I gave her the bones of a woman 50 years her elder. I put her into chronic pain. I am the reason why she has to take a handful of pills in the morning to function, some throughout the day so she doesn't fall over from intestinal pain, and a handful at night so she can sleep and the noises of her perpetrators (those people I let get to her) will quiet down just for a little while. 

The Last Two Months

A little over two months ago, I had one of the most horrific experiences of my life. Crumpled on a bathroom floor in my work clothes, I held back every emotion possible as my shaky hands pressed against the porcelain seat of a toilet to push my body to a standing position. I wiped off the remnants of whatever semblance of a breakfast I had earlier in the day from my lips and replaced it with the mask. The mask is what I wear. She is who I am not. She is who I wish I could be. She was the woman my students saw. She wasn't always there, but she was there a lot. She covered up the tears and the shame and the guilt and the shaking in my legs after days of restriction. She made me look put together.

Only God knows how I got through two classes after that... It was after this girls' bathroom experience that I had a meeting with my dietitian. Somewhere in the mix of all of this, she and I decided that I needed residential treatment for my eating disorder. I went for seven and a half weeks until I was kicked out for reasons that I find completely illogical. Regardless, while I was there, I did learn a lot about my eating disorder. I learned a lot about myself. Communication became better with me and my family. That's the Reader's Digest version. In truth, I don't think I could ever explain what happened between October 10th and December 1st in any blog or in words at all. It was a convoluted mess of writing agendas on how I "need to be sick" and what my eating disorder was trying to say to everyone around me. I wrote a history of my life as I saw it through my rose colored glasses. I uncovered memories I had suppressed from the age of four, some when I was thirteen and the most grotesque from when I was eighteen. I had therapy, endless hours of therapy. I made relapse prevention plans. I battled insurance companies. I ate three meals a day, three snacks a day, one cup of chocolate soy milk with dinner, and tried going without acting on behaviors.

While in treatment, I did listen to Ed. He was pretty sneaky. I did what he wanted, and I still do to this day. That's a scary statement to write. He won't let me wear jeans; so I haven't worn jeans in six weeks. He won't let me wear form fitting shirts; so I haven't worn a form fitting shirt in weeks. No butter. No cream sauces. No fried anything. No ice cream. The last time I ate ice cream (save one time at Castlewood), I binged. I didn't know I binged until recently. I told you Ed was sneaky.

More recently, things have been.... different? I suppose that's a fitting word. I'm seeing Thom. Ed hates him. I love him, and that's the way it should be. I'm seeing Katherine again. Ed still hates her. I still love her. As Thom says, we need to be pissing that son of a bitch off. Who knows if I'm pissing him off now or not... Sometimes his voice sounds a lot like my own. It's pretty hard to discern. I have no idea if my forced restriction upon myself is Ed. I know... I know... Forced restriction, Ann? That sounds like Ed. But seriously, I am in pain if I eat to my meal plan. That's not right, is it? Maybe this is all rationalization. I don't know. I feel like I don't know much of anything these days.