Big Test

Vacation was the biggest challenge I think I'll face this early in recovery, but less than a week later, I'm heading into another significant challenge. I was very anxious going into vacation, mostly about the sobriety part, but I feel much less anxiety going into a 3-day conference in Texas. The conference is a meeting of dietitians who work in the field of genetic and metabolic disorders. I happen to be doing my dissertation on a population with PKU, a genetic disorder, so I'm presenting some of my work and also helping to man a booth for my dissertation adviser.

I'm riding public transportation to the airport and I'm feeling excited instead of nervous. My most significant challenge will be staying in a hotel room by myself, but I'm not going to let myself think of that in advance, or make any plans to abuse my freedom. I find that when I expect or plan on something happening, the chances that it will are 100%. I have no desire to binge or purge on this trip and I have a goal of coming home on Saturday and announcing to Peter I did not purge once.

To make this weekend a success though, I'm going to have to eat and eat foods I'm not completely comfortable with. I am planning for a healthy amount of exercise each morning before activities, pending my knee is okay, and plenty of outdoor activities in the evening after the conference concludes each day. I can't restrict or label foods as good or bad or I will end up compensating, which always results in the binge purge. I'm also thinking back to all of the other trips I've made to new and exciting cities, spent with my head in the toilet, miserable, broke, and so sick. I have never been to Dallas before, and I'm not about to mess this up!

I will use this blog as a resource to help ne through any urges or difficult times, so hopefully I can get some great posting in over the next few days!

Going public

Today, in light of 60 days of sobriety, a lot of hard work, and my struggles as of late, I decided to post about my eating disorder and sobriety on Facebook. Most people I've known well over the years have an idea about my disordered eating, but it feels incredibly awesome to come clean and hear from close friends from the past. I've also received several surprises in the form of messages and support from friends and family who have also dealt with, or are dealing with, eating disorders or substance abuse.

Most importantly, a younger girl who attends the summer camp my research group organizes each summer messaged me for more information about the Renfrew Center. If I can inspire one person to get help, I've been successful in my own journey to help others find and maintain recovery.

Recovery Ain't Easy

I haven't posted in a while because I've been so busy and focused on the momentum I carried out of residential. Luckily, I'm still on track and feeling positive though a stint in residential is ny no means a quick and easy fix. While P, my friends, and my family are easily convinced that I'm fixed as I scarff down breakfasts of oatmeal, lunches of veggie wraps with cheese and mayo, and dinners as wild as BBQ pork sandwiches, I still hear the eating disorder.

My biggest struggle has been resisting the urge to compensate for my daily food intake through exercise or sobriety. I'm over 45 days sober, but sometimes I worry it's the calories I'm avoiding instead of the fact that I'm likely an alcoholic. Either way, sobriety is helping me in every way except inducing hangovers bad enough to prevent over-exercising. Today at therapy, we worked on exploring how I'm still compensating and yes, occasionally purging and the impact of these behaviors on my recovery. I've vowed to keep a food and exercise log in an effort to keep myself in check, reimplement an escort system at home to make sure I'm not given the chance to purge after meals, and take a Boost every day I'm running to gain the weight my body lost after residential.

I am not going to have a completely perfect recovery process and that's okay. As long as I'm moving in the right direction, exploring the triggers underlying slip-ups, and trying my best to challenge all eating disorder thoughts, I can be very proud of myself every day.

Houston, we have recovery

So I made it through 27 days of residential treatment at the Renfrew Center of Coconut Creek, Florida. I didn't binge, run, overexercise, or drink for almost a month and I ain't dead yet. In fact, I feel better than I ever have. 

From now on, this blog will explain what real recovery from an eating disorder looks like and how beautiful life can be when you're actually living. 

It's a brand new chapter in my life and I'm so glad I've finally understood 26 isn't too late to start living. Happy Sunday, folks. 

Residential treatment starts in 3, 2, 1

Well folks, I'm elipticaling and running my little heart out at a random hotel in southern Florida before leaving for residential treatment this morning. I drove 10 hours alone yesterday and spent my last evening at the hotel alone, too, but managed to not binge and purge. Instead, I finished 16 miles last night and have put in another 10 before 8 am today. I weigh 95 pounds at 5'4. Residential has to work.

The most difficult part of this process will be losing my running capabilities and access to this blog. Don't worry though, I'm going to journal these 30 days away because what else do I have to do besides read the 15 books I brought while getting chubs?

This is going to be, hands down, the most difficult month of my 26 years thus far, but I'm resolved to make the most of it. I have too much life to live and too much to lose to waste it on calories, miles, numbers, calculations, and compensation. I can't wait to start really living so I'll see you folks on the flip side!

Plans

Plans are always just plans without action.

First, I planned to lose weight by not eating anything but cereal and fruit as a senior in high school. I planned to run 8 miles every day, in addition to intense soccer practices and tournaments for my competitive soccer team. I planned to avoid social situations and restaurants where eating is not avoidable. I planned to have control, be perfect, and look the part. After I succeeded in losing 20 pounds, reaching a goal weight of 104 right before college, I was skinny enough to raise some red flags around school and home, prompting my pursuit of thin even more.

In college, I planned to maintain my thin physique and even lost weight during my first semester as a freshman soccer player. 100. What I didn't plan for was the introduction of alcohol to my lifestyle. Alcohol took hold in a way I could have never anticipated, made me relax, and loosened my grip completely on controlling my diet and exercise. The more I drank, the less I cared. Until drinking because the norm and the feelings of fat, ugly, and out of shape set in.

What I also didn't plan for was learning how to purge. I learned to purge during college by trying it once. I was somewhat of a natural, or at least had the ability to purge food fairly easily. Having the wherewithall to purge changes your life forever. It provides a guaranteed sense of guilt for keeping anything down. This aspect of an eating disorder can make everything so much more complicated. You don't want to eat, but you know you can and have minimal consequences on weight - at the expense of heavy consequences on health and quality of life. Learning to purge set the stage for the rest of my life. I type this blog 7 years after learning to purge and the repetitive emptying of my stomach has resulted in an inability to hold anything down. I purge hands-free now, simply bending over and releasing. Try recovering from that, even if you want to.

I have always planned to start living my life without my horrifying habits and binding eating disorder. I've always thought I could shake it if I really and truly tried. In recent years, I have started to hate feelings of fear and anxiety that accompany every bite of food and obsession with burning calories through exercise. I desperately want to be like my friends and significant others, giving zero thought to planning meals, exercise, and calories. No more calculating and recalculating calories in and calories out. No more undereating, overdrinking, and obsessive exercise. No more obsession over deviations in life that cause deviation in plans.

I planned to get over my eating disorder in college as a Nutrition and psychology major, then as an intern studying to be a Registered Dietitian in graduate school, and then as a PhD student studying, you guessed it, Nutrition. But as life progresses through ebbs and flows, trials and tribulations, and constant stress and strain, the eating disorder and associated issues persist, flaring up and subsiding slightly, but always existing.

Sometimes, more often than not, facing your fears requires changing your plans. Day treatment was an attempt to change my plans by facing my fears, but it's not enough for me. On Monday, I start residential treatment for my eating disorder, exercise addiction, and alcohol abuse after relapsing heavily over the past week and a half. Today, I've run 19 miles, thrown up 4 times and keeping no food down, and weigh 98 pounds. I am ready for treatment and I'm ready to be healthy and happy. I am ready. I am terrified, but I am ready.

Downward spiral

Last night, P and I went out for drinks with a crew of rowdy friends to a bar where we notoriously drink too much. After purging any substantial food I ate (except a small bowl of oatmeal and a pack of peanut butter crackers), I let my anxiety and exhaustion get the best of me. P and I got into a big fight which has been the norm lately. We went out, having settled nothing with my stomach growling and 2 shots already coursing through me. I think we can all speculate how this ended.

I don't remember most of the ride home, but I remember the feeling of thinking this break up is for real...we really are over this time. I hate what I put this wonderful man through and I constantly feel guilty and resentful at myself and my eating disorder. We go around in circles, with me apologizing for everything, assuming I'm always doing something wrong, and finally apologizing for apologizing. It becomes increasingly true what they say, I cannot fully love someone who tries so hard to make me happy and make things work until I can love myself. I hope that happens sometime very soon because I fear the fighting and the tears and my inability to trust when P promises, over and over, he does want to be with me, regardless of my problems, is doing irreversible damage.

This morning I wake up with bruises and scrapes, mementos of my drunkenness and pain. I wake up with a gnawing hangover and the urge to binge and purge and make the hurt go away. I know none of this will do me any good, but I know I'll spend the rest of this beautiful Sunday fighting the already embedded urge. P and I resolve our fight and seem to be in a much better place than last night, but I'm still so damn disappointed with myself, my stubbornness, and my inability to maintain a functional relationship without bringing my partner down with me.

It's all or nothing with me right now and I'm afraid I'm teetering on a very dangerous, very narrow edge, close to giving up.

Anxiety

I have never taken medication for my eating disorder, anxiety, depression, or for any other psychological issue. I take ibuprofen when my hangover won't go away, or tums when the acid reflux from chronic purging flares up. Other than that, nothing. I think it's time to investigate the (non-addictive) options.

The more severe my disease gets and the longer treatment takes to "fix me", the more anxiety I'm prone to. One minute, I think my moods are becoming more stable with treatment, but then the next, something really small and insignificant sets me off. I have, admittedly, had a string of bad luck lately, but I think it's overexerting myself during the day and not following my meal plans when I'm not at treatment, that sets me up for extra anxiety. I feel like I'm constantly running on Empty and it's Exhausting.

Today, for example, I had a 150-calorie bowl of oatmeal for breakfast, ran 11 miles, and went out and about with P to look at houses. After house hunting around 4:00 pm, I had half a veggie sandwich (no cheese, no fat, etc), then nothing else. I ended up purging the sandwich while walking the dog for 5 miles, mostly unintentional, but it left me with no fuel at all. I also ran into an ex-boyfriend on the walk. I return with a lot in my head, but nothing in my stomach. The other half of the veggie sandwich goes in and I promise myself I'll keep it down. But, my clumsy and careless self has other plan as I spill roasted tomato vinaigrette all over P's suitcase which contains a white and a light blue suit shirt. Completely ruined. The stains will never come out. I'm a failure. I freak out, overreacting completely, and the sandwich comes back up.

It's a nightmare of a night so far and I'm not looking forward to going out with friends now. I'm going to drink too much, compromising my integrity and my relationship. I'm going to fail. Every day that passes affirms that I do, indeed, need residential treatment. I'm falling back into restrictive habits. I'm falling off the I'm getting better and I'm happy about it! train. I hope it's not too late for me...

Time for change

I messed up again today. Again and again and again. I'm dizzy with regret and the sinking, empty feeling of hopelessness and wondering if this eating disorder will ever be past tense.

Last night, I went out with P to the local bar for dinner. I managed to eat the lettuce out of my salad and half of a plain black bean burger. Much more eagerly consumed though, were the 3 drinks, enabling the inevitable purge of said dinner. We had an excellent time and I met everyone at the bar, just like my old fun, funny, and infectious self. I was happy and animated despite messing up all day yesterday, something I've noticed as treatment has progressed. My mood is generally better and I'm overall happy, excited, and so much more stable, even if the day isn't perfect. We went to bed buzzed, early, and in love. I am lucky to have this wonderful person in my life and continue to remind him as much as possible. I would not be in treatment if it weren't for him.

I was already anticipating a rough day today in treatment today after resolving to give up my resistance and accept the consequences, but I could not bring myself to go to treatment this morning. I call the treatment center at 6:45 am. I can't come in today. I think I'm sick (again). I seriously doubt they're buying all of my sick days, but in my head, I see today and this weekend as a last resort before accepting treatment like I promised myself I would. P leaves for work at 9:00 am and it's off to Kroger I go, a premeditated binge and purge already ingrained in my mind. I woke up in the middle of the night several times, the consequence of too much to drink, and planned out exactly what I'd purchase - what I'd eat on the way to the store as a marker, what I'd eat on the 3 minute drive back.

In the future, I cannot plan binges and purges when left with an opportunity to be alone. Once I plan, it's incredibly more difficult to resist. Once I can envision the taste of the food I'll allow myself, there's no way in hell I won't eat and eat and eat. This is something I really need to figure out, make a plan in writing, and stick to it, if I ever want to recover 100%. Which I Do, So Badly.

Despite having the opportunity to binge and purge for an entire workday, I get lucky today and it's only two cycles. That is, however, two days of binging and purging in a row, a huge deviation from my week-free streak. After it's over, I take a nap, full of nothing but Powerade Zero and a drinking and purging hangover. My mouth still hurts, when I wake up, and even now, hours later. The calluses on my right hand are especially prominent. I'm afraid the skin around my mouth is visibly and noticeably chapped and red. I'm physically a mess. I drag myself to the gym and hammer out 45 minutes on the eliptical, then 8 miles on the treadmill. P comes home and I walk the dog for another 2 miles. 16 mile equivalents. I haven't kept anything down today. I'm sitting on my computer, blogging and drinking my sugar free chai with booze now, but with dinner in the fridge. When will my heart stop? Probably soon. I must eat.

So, Monday will be the day I start fresh and actively participate in recovery. Is that what I'm going to keep telling myself? That's the way recovery went when I was on my own - I'll do it tomorrow, this weekend, next week, next month. I can't live like that. I can't live like this. Time for change.

Giving in to treatment

Well folks, all it takes is 2 inches of snow, the shutdown of an entire city, the recognition of an overuse injury rapidly developing, and a few minutes of free time to reflect and realize I haven't truly accepted treatment for my eating disorder. I have been cutting any and all corners, continuing to destruct, and forcing my boyfriend to hear me purge our homecooked dinner. I cry after, overwhelmed and hopeless, collapse on the couch, and simply give in.

Yes, I have a severe and destructive eating disorder called anorexia nervosa. The end of my snow day yesterday was spent throwing up my measly 300 calorie dinner and any snacks to follow. I am a slave to this routine, no matter how much I think I've accomplished in treatment. I ran 11 miles, walked 4 more, and kept next to nothing down. Where is my dedication and resolve? Where has my motivation and positivity escaped to? Will I ever get better at age 26 with the ability to bend over and empty myself completely, as naturally and effortlessly as breathing or walking?

Today has been no better. I write from the eliptical, having already walked 6 miles, run 4, and binged and purged in the solo-occupancy bathroom at school since everyone else is at home, relishing their second snow day. Tomorrow I am going to wake up and run my 6-6.5 miles before treatment as usual, but I'm not going to drink a diet soda and a 40 ounce Nalgene of hot tea on the drive in, wear 3 shirts and 2 pairs of pants with keys and a cell phone in my pocket for weigh in. I am going to accept whatever results from abandoning my usual routine and start fresh, honest. No more skimping on my 2 tablespoons of butter, choosing the lowest calorie options for all snacks and meals, purging Boosts in the parking lot corner, or projectile vomiting lunch onto the interstate on the drive home. I will come home from treatment, painfully full, but compliant. I may walk the dog for 4 more miles if the weather is nice, to exercise her, not myself, and I will not run or eliptical another mile. I will eat dinner. I will keep dinner down. 

I will hate all of these compliant changes, but I will not be actively wasting my money and time in treatment. If I cannot do this, I will lose my boyfriend, my mind, and potentially my life. If I cannot do this, I will accept residential treatment. I cannot stand to live like this while everyone else lives their life at a normal BMI and happily. I'm terrified and I do not know of what. This is low. This is bottom. Nowhere to go but up.

Tips to reduce the binge/purge urge

Snow day alert! This means two important things. The boyfriend's white dog looks brown and I have a whole day to blog and reflect!

Today, I want to focus on several tips we discussed yesterday at treatment to reduce the urge and ability to binge and purge. Since this topic hits very close to home for me as an Anorexic binge-purge type, I was really interested in the discussion and hope to provide some helpful hints to anyone who may suffer from bulimia or is prone to binging and purging.

I've discussed briefly in several previous posts how triggering the process of weight gain and eating a lot of calories is to my binge/purge habit. Yesterday, sitting on the couch with P, I delved a little deeper into my binge/purge issues. I told him I didn't want to open a bag of mixed nuts in the kitchen on account of I'd want to eat the whole thing. He laughed and said, that's what you should be doing! It certainly makes sense to someone who doesn't know the extent of the problem and only knows you need to gain weight to eat a lot of something with a lot of calories. 

Unfortunately, eating an entire bag of mixed nuts, calories aside, would not work for me. It's practicing the binging I'm so prone to, and also not practicing self-control and preventing the loss of control feeling associated with binging and purging. Instead, I need to learn to listen to the new hunger and fullness cues that I've been experiencing through treatment. Hunger cues are wonderful and I'm actually excited to be writing this blog at 11:20 am (after having breakfast around 7:00 am), and feeling hungry again already, without having exercised. I feel comfortable relying on them to accurately instruct my body on how much I need. In the beginning of treatment, I was never hungry, though I'm not sure if this was my eating disorder or my half-starved body speaking. Regardless, this is no longer the case, and a huge achievement for me. 

For those of us prone to binging and purging, binging, or purging through self-induced vomiting, here are some of the tips to reduce or prevent these urges. Some are very small, but may have some impact on your process to recovery, even if just preventing an episode for 15 minutes. 

Preventing the opportunity to binge/purge

• Identify what time of day and what situations you are most prone to binge/purge.
• Plan activities, outings, events, anything to keep you busy for every 15 minute increment during this vulnerable time.
• Schedule someone to be with you at all times. Do not let them let you out of their sight.
• Choose an accountability partner. Take them to the grocery with you while shopping, or go alone but take a certain amount of money that won't allot purchase of binge food, or provide your accountability partner with all receipts.

Preventing the urge to binge/purge

• Wear a ring(s) on fingers you use to self-induce. This very simple trick has helped me tremendously.
• When you feel the urge, sit with it for 15 minutes. The feeling can subside if we use mindfulness, deep breathing, meditation, relaxation, etc in these 15 minutes and you may feel less of an urge.
• Get online and read a recovery blog like this one. Or check out a Youtube channel like Kati Morton, an excellent and free resource.
• Listen to my recovery playlist or make your own.
• Think of the consequences of your actions on yourself, on others (significant other, family, kids), on your recovery, on your long-term goals.

Keeping yourself safe if you do binge and/or purge

• If you slip up and binge, do not purge. This sounds crazy to me at this point, but it's something I've considered if I have another slip up. If you don't purge, even once, following a binge, your body will feel so uncomfortable you may not ever want to binge again.
• If you do purge (and I am certainly NOT promoting this behavior at all), please replenish your body of lost electrolytes immediately after. Drink pedialyte, gatorade, powerade, or another electrolyte containing beverage as soon as possible. Stay hydrated. 
• Reach out to a friend or your treatment team. Stay safe. 

I hope some of these tips are useful if you're struggling with urges. It's SO difficult to overcome, but you can do it. Today marks one week of being binge/purge free for me - the longest streak I've had since this disease set in many years ago. I think that calls for a snow day celebration!

Support is all around you

Today has been up and down and sideways and backwards and forwards and all around. It's almost hard to believe it's the same day that started off with such a strong 6.5 mile run at 6:55 am.

At treatment, I've found meal plan B to be do-able. Boosts, on the other hand, are certainly going to take some getting used to. Today, I managed to forgo Boost until afternoon snack which occurs immediately before departing, thus problematic to say the least to a prolimic. Particularly one keen on purging liquids. Chug Boost, say goodbyes, bring Boost (with most of today's lunch of cheesey, buttery, broccoli baked potato and apple) right back up in a gas station bathroom.

I cannot let this happen regularly, or at all moving forward.Today was too much at once... a bump up in the meal plan, the addition of Boosts, a baked potato lunch that racks up a whopping 1300 calories without butter, and a number to the goal weight - 115. Woof.

Regardless of the major fail after treatment, I can pick myself up and recognize that several important, positive things also happened.

1. My individual therapist commended my progress and let me know the treatment team will be discussing how I progress from here - if it's nearing time to bump back down to outpatient. Finger's crossed here.
2. Masks today in art therapy! Behold the transformation from Vaseline face to mask! 
   
   
   
   
   
   
   
3. After treatment, I met with the director of one of my doctoral programs (I'm in two - Nutrition and Health Sciences is my "home" program, and also Molecules to Mankind, geared to those interested in translational research). Anyway, the director responded to an email I sent announcing that I'm taking a leave of absence from school and voiced concern. It became clear through our correspondence that she's also suffered from disordered eating for years. She's also an overexerciser. We chatted for an hour over coffee and I feel like I've gained a great source of support, knowledge, and experience. 

Steps backward seem to be accompanied by small steps forward at this point. If the weight gain is the only barrier between staying in day treatment and bumping down to outpatient, I'm just going to have to suck it up. Here's to a better tomorrow and no more baked potatoes for a long, long time.

Weight Gain Plateau

Hello ladies and gents. Another good day under my belt, even with some unwelcome news at the end of the day. In the past, unexpected stress-inducing news would have sent me into a tailspin of binge/purge, restricting, and running 12,000 miles. Today? It didn't really affect me.

First, the unwelcome news. My weight has plateaued. At what? I have no idea. I do not wish to know my weight, as it's extremely triggering, and not all that important to me. The dietitian blames this on the increased metabolism that accompanies weight restoration, but I know it's because I can't incorporate any more clothing layers before morning weigh in without this.

Refeeding is a tricky process indeed. Severe restriction of calories slows the body's metabolism greatly. The body conserves as much energy as possible for essential processes - keeping your brain, heart, organs, and peripheral muscles functioning. Everything else slows down. Metabolic rate [non-science speak: the amount of energy (calories) needed to simply exist], lower blood pressure, lower heart rate. Low and slow. 

Non-eating-disordered women in their teens to mid-20s may burn up to 1500 calories just being. Add activity and you've got a lot of calories to eat just to maintain, girl. Those who restrict experience a decrease in metabolic rate. During recovery, additional calories may shock the system at first, a dangerous phenomenon known as refeeding syndrome, but once the body becomes used to a more normal intake, metabolic rate rebounds. We take advantage of the adequate energy, burning through it and happily functioning somewhat close to normal. 

An increase in metabolic rate with an increase in caloric intake causes a weight gain plateau after the initial phase of treatment and refeeding. So it's true. I've either plateaued, or I simply haven't gained much weight at all. For me though, it's less important to gain weight and more important to normalize my relationship with food. I am not obsessed with being super skinny - or at least that's what I tell my out-of-touch-with-reality-self. I want to be in shape, athletic, run as much as a I please, and forgo binging and purging for the rest of my life. To me, that is successful recovery from this eating disorders.

Anyway, on to the unwelcome news. Next week, as a result of this plateau, I bump up to meal plan B from meal plan A. In food exchange speak, that means an additional fat and dairy with breakfast and lunch. Nothing extreme, or even noticeable if I'm not counting calories, but additional food nonetheless. Aaaaaaaaand, I'm also adding a Boost to both snacks during the day. 360 x 2 = 720 more calories. Per Day. More Than My Daily Caloric Intake Before Treatment. 

Okay, that initiates panic. I have to stop with the numbers already. I think I will have to do some negotiation with this new development. I'd so much rather eat an additional 720 calories of delicious food than drink 12 ounces of Boost Plus. Not ideal. I've deviated from the point of this post. I'm making progress. Taking things in stride. Treatment is so much easier when you're compliant, follow the rules, and accept that you have to make these changes in order to get out. 

I'm still going to have an excellent weekend, show up on Monday, and deal to heal.