D is for Doctors, Disgust, and Discombobulation

So, I went to my internist yesterday.  Normally, I don't mind going to doctors, you know, when I'm sick.  I HATE going for eating disorder related issues.  I have tried for months to get into the eating disorder specialist here and when I finally get an appointment, it's for like three months from now!  Frustrating.  But, I digress.  Because I haven't been able to get into Dr. O I had to go to my internist.  I have to say that she is extremely sweet, but there is probably a reason she has a 2 rating on healthgrades.com.  I've seen her a few times now, never for anything eating disorder specific, however.  We've talked about my eating disorder and she has made it very clear that she really hasn't dealt with eating disorders before, which, kind of made me weary, but I just kept going to see her because she was such a sweet lady and I hadn't really needed her for treatment of my eating disorder yet.  Well, that time came.

I saw her last about two months ago.  I'd have to say I was probably at my "ideal" weight then - I was following my meal plan pretty well, still having slips, but nothing terribly major.  I made the appointment for this week a few weeks ago when I was doing pretty poorly.  I had lost into the double digits and really needed to make sure everything was okay, plus (this might be TMI) my bowels weren't moving - AT ALL.  In between the time that I made the appointment and yesterday I have gained most (not all) of the weight back, but I'm still struggling pretty hard.  And by pretty hard, I mean, probably relapsing again - sadly.  

The nurse took my blood pressure (it was pretty low) and asked me to get on the scale.  This is where I made MY mistake, not weighing backwards.  I wasn't expecting the number to be as high as it was, but I know it's not just about the number.  When the doctor came in she asked what was going on and I told her a little about what had transpired (obviously not everything because then we'd both be there for a week at least!) and asked her if she might call Dr. O's office and ask to get my appointment moved up because it was kind of necessary NOW not, three months from now.  This is where things started to break down...rapidly.  

She told me she didn't think I needed to go to Dr. O because all he would do is put a pic line in me and then I would never get better because I would be reliant on a pic line, or feeding tube, or whatever.  I told her I didn't really care, I just knew that I needed to see him.  She then says "well, you've only lost 4 pounds since the last time I saw you, so I'm not sure that this is that big or a problem yet."  To which I retorted, "You didn't see me three weeks ago when I had lost 13 pounds since the last time I saw you.  I've gained a significant amount of it back, and it wasn't easy."  Then she says, "Well, you don't look malnourished."  This is where I start fuming, on the inside, on the outside I keep my cool because I know there is know way anything is going to get accomplished by yelling at this retarded woman who obviously wasn't at the top of her medical school class.  I just told her, "Well, I feel like shit".  

I didn't bother telling her that it doesn't matter about the weight.  BMI doesn't matter.  What matters is that I'm SICK.  What matters is that my behaviors are out of control.  Is she aware that obese people can be malnourished?  Obviously not.  She says we will run my labs and then she will look and see if anything is out of whack and if it is she will call Dr. O's office.  Again, I didn't bother to mention to her that she is probably unaware of the false positives that you can get with eating disordered patient's blood work.  Things can look perfectly "normal" when they are REALLY wrong.  Things can look slightly low or slightly high and they can signal big things, things that cannot be looked over.  At least she's going to send me a copy of my blood work results, which I will take to my nutritionist who knows how to read these things and will be able to make sure things are a-okay.  

I left with a few pretty complicated feelings.  First, I was disgusted by the way she treated me.  The things she said to me are things that one should NEVER say to an eating disorder patient.  Which, I should add that she does agree that I do have an eating disorder, so it's not like we aren't on the same page here (cough, cough, Caroline).  I was disgusted by the fact that I was coming in with questions and orders (for lack of better words) from people who work with eating disorders all day, everyday, and she pretty much scoffed at what they had to say!  I don't understand!  

I just feel all discombobulated now.  She said those words that my eating disorder wanted to hear, "You don't look sick", "You don't look malnourished".  Well, if I don't look sick, and I don't look malnourished then I obviously don't need help, right?  Wrong.  Everything in my right now wants to just run with it, take her challenge and show her just how sick I am, how sick I can be, how many pounds I can lose before I have to come back and see her because I'm on death's door - then she'll HAVE to get me into see Dr. O because I will NEED a pic line.  But in reality, what good is putting all that energy and effort into that going to accomplish me?  None.  I know this.  But I hate feeling so invalidated, by people who are supposed to be on my treatment team, by people who are supposed to be helping me get better.  I'd have to say that she has done a pretty awesome job of not fulfilling her role correctly.  

These days I'm praying for wisdom for this wayward doctor, peace within my soul to know that I am  sick enough right where I am and for the need to prove myself worthy of help me lifted from my heart.  

C is for Communication, Choice, and Challenge

So I went to my nutritionist appointment.  After all of my worrying as to how she would react to my new plan of action suggestions, it went extremely well!  She didn't even weigh me!!  Actually, she has decided that she isn't going to monitor my weight anymore, we are just going to monitor lifestyle choices - unless something drastic happens and she or I decide that we need to go back to keeping track of my weight.  I am quite happy about all of this.

I am excited about this new meal plan - or whatever we are going to call it.  I'm excited because I have choice.  I don't feel like I have to do what she says or else.  If I drink a caffeinated beverage during the day I have to drink an extra 12 ounces of water, if I exercise more than 30 minutes three times a week I have to eat an extra snack for every extra 30 minutes, I have to supplement myself if I restrict or purge...but the point is, I have options.  I have the options to exercise more, but I have to follow the "consequence".

On another hand I'm kind of terrified about this.  It's going to be a huge challenge to hold myself to following these consequences.  I can see myself saying "well, I've got permission to exercise more (drink caffeine, purge, restrict)" but then not actually follow through with the other half of the obligation that comes with those rights.  I'm scared that I won't be strong enough to do it.  Having choice is scary!  But having choice is also very empowering.  I feel like if I can do this, if I can hold myself accountable and follow through with what I have agreed to do I will feel so much more in control of my recovery, and thus more motivated.  But we shall see how this goes!

What have I learned from this little experience with my nutritionist?  That communication is key to my recovery.  If I had continued the way I was, and never told her that what we were doing wasn't working and was making me feel like shit, I would have kept feeling like shit....and things would have continued to go downhill fast.  I've always been and still am terrified of letting people know what I'm thinking and feeling - confrontation.  But hopefully this experience - her hearing what I had to say, taking it into account, and helping figure out how to meet my needs - will help me realize that people really will care what I have to say, but I just have to get it out for them to even know how I'm feeling or what I need.

These days I'm praying for the ability to speak my needs (to my treatment team in particular) and for trust that they will be receptive to what I have to way as well as the strength and courage to follow through with the responsibilities that come along with my newly acquired choice.

B is for Being Honest and Blase

Being honest about my needs and feelings hasn't always been that easy for me.  Ever since I was little I always have felt that stating how I felt or what I needed was futile - no one was going to listen to me anyways.  I feel like how I feel is somehow wrong, so I should keep it to myself, or that what I need is somehow superfluous or selfish.

Since the "blowout" (for lack of better word) with my nutritionist a few weeks ago, I've done quite a bit of being honest about my needs and feelings.  I should state that this did not come without prompting from my therapist.  After a great deal of contemplating what I needed I mustered up the courage to shoot my nutritionist a e-mail and let her know my thoughts.

I stated that I felt like being on a meal plan or exchanges was setting me up for failure.  And furthermore, that having "agreements" (somewhat like goals) every week was making it even worse.  To reference last post, I told her that I was feeling like a failure and a fuck up every week because I couldn't do it.  I couldn't meet my exchanges and my meal plan every day each week.  I couldn't manage to fulfill the agreements to the fullest extent either.  To give an example, one of my agreements for one week was to not drink any caffeine at all.  Well, that's really hard when you are a student and it is midterms week.  After I messed up one time I felt like it didn't matter anymore, because I hadn't done it perfectly, so I would just give up even trying for the rest of the week.  I felt like if I even did it right for the rest of the week that my efforts would be futile, because I hadn't done EXACTLY what she had asked me to do. 
I also said that I felt like it would be good for me to have negotiable options.  I thought that if we could come up with options, with limits of course, that I would feel more empowered in my own recovery.  I told her that with these options I also felt like there should be consequences for each option, consequences that we both agreed upon.

I was extremely surprised and relieved when I got an e-mail back from her saying that we could work with this and that I should come back sooner than later.  I'm supposed to go back this week, instead of the two weeks from now that we set a few weeks back.

Normally one would think that I would be happy about this.  That she was still willing to work with me and that she was going to work with me with what I feel will actually help me recover.  HOWEVER, I'm just feeling quite blase these days.  I'm blase about life.  I'm blase about recovery.  I'm blase about my eating disorder.  I just feel blase about everything.  I kinda feel like I don't understand what the point of recovery is, if life sucks either way you slice it.  It sucks with an eating disorder.  But it also still sucks pretty much just as bad without one.  So, why recover in the first place? I keep thinking about canceling my appointment for this week, I mean seriously considering it.  I HAVE gained since I saw her last, so that's good.

These days I'm praying for the continued strength to verbalize my needs and feelings and an understanding that recovery is ultimately the best option.

A is for Ambition and Ambivalence

Ambition: an earnest desire for some type of achievement or distinction, as power, honor, fame or wealth, and the willingness to strive for it's attainment.


It's no secret that I'm an ambitious person.  I've always been striving toward some insane, seemingly unattainable goal: becoming a professional ballerina, going to medical school and becoming a pediatric neurosurgeon, training to run a half marathon, having the "perfect" body.  I guess until just recently I have never realized that all of this ambition comes with a great price.  It's really no secret that I've been doing pretty pitiful with this whole recovery thing as of late.  My weight has been slipping, I've been acting out a lot, and I haven't really been taking very good care of myself.  Last week my nutritionist and I were talking about why I wasn't doing so well, and the only thing I could come up with is "I'm just so stressed. School just stresses me out."  So, she and I decided that I should come up with boundaries for my school work - and so I set up daily "office hours", for lack of a better description, for myself.  But when I started thinking about limiting my study time to just those minimal hours a week I started to panic.  It wasn't enough, I wasn't going to be able to study as much as I felt like I needed to, I was going to fail.  But 40+ hours a week to study is more than ample for an undergraduate.  Why is it not so for me?  And why do I feel like if I can't get that much in that I'm going to fail, that I'm going to end up a failure - a homeless person, working at McDonalds?  That's totally irrational.  


So, then there was more thinking.  I realized that school is not the only thing that I feel this way about.  I feel this way about EVERYTHING.  I always feel as if I should get things perfect, especially the first time, or else I'm a failure.  I'm a disappointment.  I'm a fuck up.  


The problem with this line of thinking is that I'm always striving for extremely difficult things to attain, and I expect myself to be able to do things perfectly, but most of the time that just isn't possible.  So I fail.  And therefore, I'm a disappointment, I'm a fuck up.   


Ambivalence: the coexistence within an individual of positive and negative feelings toward the same person, object, or action, simultaneously drawing him or her in opposite directions.


Recently I've been feeling quite ambivalent towards recovery.  I want to be healthy, but I don't want to be uncomfortable.  I want to be happy, but I don't want to work for that happiness.  I would rather just stay with the familiar.  It's easy to forget that when you are in your eating disorder, you are still always a failure.  You can't lose enough wait, you can't fast for long enough, you can't exercise enough, you eat too much, you're too fat...I could go on.  But at least when I'm in my eating disorder I'm thin, right? And then I'm not a disappointment, right?  Rationally, no, that's totally wrong.  But I've convinced myself of this.  I've convinced myself that because I'm always going to be a disappointment to everyone else, a failure in everything else, that I should at least just go back to my eating disorder because at least then I'm not a complete failure.  


So these days, I guess I'm just praying for balance - to even out all this hasty ambition I've got, and for direction - to mitigate this nasty ambivalence.