Anorexia

[JenTheSchoolRN]

I would love to poke the folks here who have more experience than I working with a student with anorexia.

I have a middle school girl who was inpatient this summer, back to school on first day of school. Bi-weekly weigh-ins at doctors, scheduled 2x daily snacks with me. Any beverage consumed must have a calorie (no water). Concern about continuing tachycardia. Student has 504 plan in place.

Student's weight has moved +/- 5 or so pounds since beginning of school, currently stable. She never checks in for snacks unless reminded, but when I can peer in at lunch, is eating lunch consistently (though not always extra snacks that are packed). Parent reports student does not eat much at home.

Tachycardia still a concern at weight-ins. I'm trying to see what else I can do. I've offered to have student eat with me, but bringing attention to student's eating just makes student less likely to eat.

[Farawyn]

OK....my hackles just went up. This is...odd.

Sadly, not so odd. I find that some PMDs will brush over a lot, and write whatever the parents want them to.

[FolksBtrippin, BSN, RN]

Not sure if bulimia is an issue with this girl, but another possible intervention is 1 hour bathroom restrictions. Meaning, if she has to go to the bathroom within one hour of eating, she must do so in your office, or in such a way that you would be able to hear her vomiting.

[bitter_betsy, BSN]

I don't think there is much you can do for her specifically, unless you can get more people involved in her care. Anorexia is about control and if she still isn't eating, the issue isn't corrected. It could come from her sibling(s) or parents or friends. The entire family needs to be in counseling together and individually for many reasons but 1) so the counselor can determine that the parents / siblings aren't aggravating the issue

2) so the family knows how to help her

3) so SHE knows that no one is out to get her and they are all in it together.

As a teen I was diagnosed with Bulimarexia. I would eat something and then starve myself as long as I could. Someone would intervene and make me eat and the process would start again. I never got the help I really needed (I had help - they just couldn't fix the problem no matter how much they tried). At 25 and 86 pounds - when my doctor looked at me and said - you're pregnant - this baby better not die - thats what changed my life. At the time I didn't even have the enzymes to break down protein. I had to drink some nasty crap in order to properly feed that sweet innocent baby. I still struggle - but I handle it much better now.

The truth is she needs a safe place to talk and someone that understands. Someone who will hold her accountable for eating and help her understand what this is doing to her body. Most importantly she needs someone to teach her that food isn't the problem and eating a strawberry is just eating a strawberry. Maybe you need a mandatory time with her everyday where she eats a chosen safe snack. Take that time to be interested in her and just listen. Maybe eventually the real problem will come out once she completely trusts you. Maybe not. Worst case you know that she's eaten a little bit every day - even if its a ho ho.

[River Song, RN]

As a teen I was diagnosed with Bulimarexia. I would eat something and then starve myself as long as I could. Someone would intervene and make me eat and the process would start again. I never got the help I really needed (I had help - they just couldn't fix the problem no matter how much they tried). At 25 and 86 pounds - when my doctor looked at me and said - you're pregnant - this baby better not die - thats what changed my life. At the time I didn't even have the enzymes to break down protein. I had to drink some nasty crap in order to properly feed that sweet innocent baby. I still struggle - but I handle it much better now. .

I just wanted to send some supportive *HUGS* to you and hope that you continue to gain the upper hand in the struggle.

This is a topic close to me as a good childhood friend developed an eating disorder in high school that I suspect was bulimarexia as she would binge and purge as well as starve herself. Her family wanted to remain in denial that her dramatic weight loss was just "healthy dieting" until the first time she ended up in the E.R. with an esophageal perforation when she was 19. She was occasionally hospitalized throughout her 20s and 30s for various issues but the eating disorder always remained. She died at the age of 36 and even now, those closest to her will not admit that she had an eating disorder

[bitter_betsy, BSN]

I just wanted to send some supportive *HUGS* to you and hope that you continue to gain the upper hand in the struggle.

Thank you so much. I am actually doing really well - I would love to say that I'm recovered, but I don't believe the problem is ever really gone. I am so sorry for your friend and her family. It is so hard to see others go through this, and harder to get them the help that they need to really heal. I wish that there were better programs in place, because I haven't met anyone else that has ever "recovered". I got lucky - that doctor just threw it in my face and I realized I had to make the choice to eat everyday - no one was going to do it for me. My daughter was a reminder to eat. Most everyone I've met, lies through therapy, lies about food and they never really get better. Like you said - their family believes that they are better or just aren't sick in the first place - what ever it is - they don't help the situation. They also don't want to say the wrong thing and make the situation worse either. I'm sure that my OB was not trained in dealing with an anorexic person - but his statement sure has a lasting effect and changed my future (and my daughters future) for the better. Thanks for the hugs! Can never get enough of those!!

[NutmeggeRN, BSN]

I just wanted to send some supportive *HUGS* to you and hope that you continue to gain the upper hand in the struggle.

This is a topic close to me as a good childhood friend developed an eating disorder in high school that I suspect was bulimarexia as she would binge and purge as well as starve herself. Her family wanted to remain in denial that her dramatic weight loss was just "healthy dieting" until the first time she ended up in the E.R. with an esophageal perforation when she was 19. She was occasionally hospitalized throughout her 20s and 30s for various issues but the eating disorder always remained. She died at the age of 36 and even now, those closest to her will not admit that she had an eating disorder

How sad.

[JenTheSchoolRN, BSN, RN]

I don't think there is much you can do for her specifically, unless you can get more people involved in her care. Anorexia is about control and if she still isn't eating, the issue isn't corrected. It could come from her sibling(s) or parents or friends. The entire family needs to be in counseling together and individually for many reasons but 1) so the counselor can determine that the parents / siblings aren't aggravating the issue

2) so the family knows how to help her

3) so SHE knows that no one is out to get her and they are all in it together.

As a teen I was diagnosed with Bulimarexia. I would eat something and then starve myself as long as I could. Someone would intervene and make me eat and the process would start again. I never got the help I really needed (I had help - they just couldn't fix the problem no matter how much they tried). At 25 and 86 pounds - when my doctor looked at me and said - you're pregnant - this baby better not die - thats what changed my life. At the time I didn't even have the enzymes to break down protein. I had to drink some nasty crap in order to properly feed that sweet innocent baby. I still struggle - but I handle it much better now.

The truth is she needs a safe place to talk and someone that understands. Someone who will hold her accountable for eating and help her understand what this is doing to her body. Most importantly she needs someone to teach her that food isn't the problem and eating a strawberry is just eating a strawberry. Maybe you need a mandatory time with her everyday where she eats a chosen safe snack. Take that time to be interested in her and just listen. Maybe eventually the real problem will come out once she completely trusts you. Maybe not. Worst case you know that she's eaten a little bit every day - even if its a ho ho.

Thank you for this perspective and ::hug:: on you continuing struggles and major, major :claps: on your gains.

She eats the most during her day at school and eats at least 1/2 her lunch consistently each day. Her last week showed no weight loss/gain, and her currently weight is on the low end of healthy. But the tachycardia remains and they are doing additional tests as well.

[JenTheSchoolRN, BSN, RN]

Further update - parent now ready to blame the school if student is re-hospitalized, though I'm not certain how. Of course I also always wonder if I can help more. I've set up some staff to help me discretely monitor student's specific food intake at lunch to gather more data (teachers aren't reporting anything unusual like student not eating lunch) and update 504 if needed. Student's weight is still stable, but tachycardia still present.

But as several folks have shared, I also wonder if the meat of the control issue isn't improved, behavior patterns can repeat or continue. I'm not part of the counseling piece, though that is in place. I'm not sure if having having her eat lunch with me and making her eat (as much as one can) will help things. Parent reports that encouragement to eat at home is not helping.

[ruby_jane, BSN, RN]

Wow. Whelp....if parent is telling you (and you're documenting the heck out of) that she's not eating at home, there you have it. The control issue is still strong. No amount of you having her in to eat will actually fix that. I'm sorry. I'm sorry for you and I'm sorry for her, and her mom.

[JenTheSchoolRN, BSN, RN]

Update: student is being readmitted to the hospital as her weight plummeted down 8 pounds in last three weeks. Mom and I are on good terms now trying to work with how to help her. I'm helping with tutoring options currently, well working with my awesome SPED team.

But I really appreciate all of your insight as I'm thinking about how to work with her and support her again when she returns back to school.

[Farawyn]

Update: student is being readmitted to the hospital as her weight plummeted down 8 pounds in last three weeks. Mom and I are on good terms now trying to work with how to help her. I'm helping with tutoring options currently, well working with my awesome SPED team.

But I really appreciate all of your insight as I'm thinking about how to work with her and support her again when she returns back to school.

I'm sorry. I know you did as much as you could. Please keep us posted.

[kidzcare]

Update: student is being readmitted to the hospital as her weight plummeted down 8 pounds in last three weeks. Mom and I are on good terms now trying to work with how to help her. I'm helping with tutoring options currently, well working with my awesome SPED team.

But I really appreciate all of your insight as I'm thinking about how to work with her and support her again when she returns back to school.

I hope she gets all the support she needs!