Three steps forward

Yesterday was my sister's birthday. We went and got tattoos! 

Three footsteps representing my steps away from bulimia, anorexia, and alcoholism. 

Always progress forward! 

I am proud

Its Monday again already and a lot of significant things happened this weekend. First, P came home on Friday from being out of town and he actually wanted to go out for dinner! I expected him to want to do a whole bunch of nothing since he'd been working across the country all week, but he brought up going out.

We went to a nice brewery/restaurant that I've always loved for the food and beer, but haven't been to sober. Everything was great at the start - P felt comfortable drinking which I was more than fine with, and I ordered a virgin sparkling grapefruit cocktail. It was delicious and gave me courage to order a seitan pita for my entree.

Unfortunately, I am in recovery from an eating disorder and alcoholism. The waiter brought a surprise third drink to our table about halfway through and set it right in front of me. I still had half a mocktail left and P had finished his same drink (with booze) ages ago. As that drink sat there and stared me in the face, it hit me how damn easily I could lose my sobriety - how available and willing alcohol is for me to consume. I could have easily sipped on this mystery drink, omitting it was clearly alcoholic to P, and gone (downhill) from there. Instead, I gathered my wits and excused myself as P began drilling me about who I knew in the bar that bought me this drink, not even acknowledging the alcohol sitting right by my left hand.

This did not sit well with me, so I told him i was struggling. He reacted by becoming angry and indicating it was such a nice dinner until I ruined it. Showing, again, so that, as I'm using my voice more and more, P will have to accept I'm not always okay. We collected ourselves and went home and I did something I've never done - texted my sponsor. Even though it was pushing 11:30, she sent me a perfect response, giving me the courage to realize it's okay to struggle, to need help, and to need.

Saturday was a great day from the get-go, it was only during the evening when I returned to P's after AA, room cleaning, and laundry that things deteriorated. I won't go into details, but I'll tell you it was a struggle. I am so, so proud to say though, around 1am, after using every tool and strategy I've learned through AA and Renfrew, I couldn't lay in bed and listen to P and his friend playing video games and taking shots any longer than the 7 hours I'd already done so. Somehow, I found the courage to go home, despite the fact that I would have had a 100% chance of binging and purging for the rest of the night at any other time in my life. P walked me outside and I was able to clearly express my frustration and worry that perhaps we don't work when I'm sober. We hugged and I left and I did not even have the urge to binge, purge, or do anything but treat myself to a nights sleep in my own awesome bed!

This is tremendous progress for me and I'm ecstatic to find myself succeeding more on my own than through my codependency with P. This is recovery.

Bring it on new week!

Momentum

I'm scared to write this already today in order to not jinx what I'm feeling right now, but I'm still riding an awesome wave of motivation. I think a lot of this has to do with overcoming a rough week last week and beginning of the weekend, but separating myself from slip-ups and getting back on track. I think dealing with backwheeling in a positive, motivating way shows significant progress in overall recovery. We've also had several lovely additions to the day treatment group yesterday and today, rescuing us from a group of two last week.

I'm feeling so much progress during day treatment. Much more than I expected so quickly. Here's how a day looks like for me:

7:00 am - run my 6 glorious, wonderful and allotted miles. It's still dark and chilly outside at the beginning of my run, an awesome and motivational atmosphere.

8:10-8:45 am - drive to treatment, sipping hot tea, and worrying slightly about making weight.

9-9:45 - breakfast. Before every meal, we do a hunger/anxiety rating. 0 corresponds to starving and 10 to enormously full for hunger, 0 to completely calm and 10 to get me the fuck out of here anxiety. I start most mornings with a 7/2. Not hungry,  not anxious, but finish 100% of my meal and move on with my day.

9:45-12:40 - group, snack, group.

12:40-1:30 - lunch. Today my stomach growled around 12:30, even after breakfast and a snack. This is true progress in the girl who didn't eat before 2:30 pm a few weeks ago.

1:40-2:40 - group, then it's time to leave.

After day treatment, I know to keep myself busy. Today, for example, I had a meeting with a leading eating disorders research scientist about a project I'm just starting on to increase my experience in the field. It's my goal to land a post-doc in eating disorders, so this opportunity is extremely important to my future career and invaluable motivation to get through treatment and fix myself ASAP.

Another key aspect of my renewed sense of motivation is the group composition during treatment. One of the girls who started yesterday really came out of her shell today and the other very poor soul who started yesterday was moved to residential. She was not in a good place and really affected group morale yesterday. Today, another new woman started. She's in her 30s with 5-year old twins and a husband, and a raging bulimic (self description). She also battles multiple addictions and this is her first bout of treatment. I love her already and forsee a lot of awesome and relevant and mature discussion with her in group.

As you can tell, I'm feeling good. 100% of meals at treatment and dinner to boot. I do continue to struggle with sobriety and overexercise (I write this from the eliptical), but my head hasn't seen the inside of the toilet in going on 3 days. Recovery is a choice, and I'm making it. And sticking to it.

Hope

Today has been a perfect day. It's only 5:00 pm, so there's still room for error, but the progress and positivity I feel within myself is as hot as today's 60 degrees in January.

I'm writing this on my smartphone as I walk my pup in shorts and a t-shirt.

I'm not thinking about how many calories I didn't purge today. I'm not thinking about the pounds I inevitably gained from my week long nightmare called binge-purge. I'm looking around me at the beautiful blue, cloudless sky, the buzz of the city, and the fulfillment I've found. 

It's gotta be a combination of the sunny weather, an awesome Sunday with friends yesterday, and a hell of a lot of perspective at treatment today with the addition of two new ladies to our day treatment group, in the throes of a serious and heartbreaking struggle. 

Seeing these young ladies in such isolating and internal pain is difficult for me as an extrovert. I wear my heart on my addicted, self-loathing sleeve, and I find myself with an excellent support system because of my outgoing nature. Treatment is easier for me because I know I'm a Mess with a capital M. I don't know what hurts or what I'm covering up and numbing with my eating disorder and addictions, but I know how to communicate with anyone to figure it out. I was, perhaps, at one time, as closed off and terribly sick as these women, but I can hardly bear to see someone younger than my baby sister refuse to eat, in tears, shaking with fear and anxiety. 

I am so lucky to have chosen treatment and been able to afford it before descending into the depths these girls find themselves. From here on out, I must find it within myself to set the best example I can, pull them out of their shells, and show them how to live. While also showing myself.

Music Therapy, A Recovery Playlist

It's a toss up which I enjoy more - running or music. Generally, both go hand in hand, for example "I love this song because it's perfect for my running playlist!". Part of recovery, though, is disentangling eating disorder symptoms like excessive running, from healthy parts of life like music.

To help me start, I've decided to put together a recovery playlist. I also included explanations for why I included each song - whether it's lyrics really hit home, or if it's simply a beautiful piece of music. I encourage you to assemble a recovery playlist for times you may need a little extra support or if you're just looking to chill out and relax. Enjoy!

1. Bonobo - Terrapin - This lovely song is one of the most relaxing tunes I've ever come across. When I'm feeling frustrated, anxious, angry, nervous, or overwhelmed, it can calm me down almost every time.

2. Classixx - Holding On - A dance-y tune guaranteed to get you moving. The chorus, "I been holding on, and I can't take it anymore" repeats throughout the song, a good mantra to beat your eating disorder.

3. Telepopmusik - Breathe - One of my all time favorite songs. There's nothing to do but believe, just believe, just breathe... And a cool video.

4. RAC featuring Kele and MNDR - Let Go - Seriously strange video, but a great tune. Light and funky.

5. Alt-J - Dissolve Me - I love this song, mostly because of the lead singer's voice, but also because of the lyrics and meaning, if you can figure them out.

6. HAERTS - Wings - I listen to this song almost every day and it's happy and fun and always lifts me up. Bonus? HAERTS are excellent live. Check em if you get the chance.

7. Francis and the Lights - Like A Dream - How can you not like this song? One of these days my mind will stop racing, and I'll get me some sleep. Cause I'm ready for the big time, is it ready for me?

Each of these songs reminds me that recovery will be sweet and something to work for. No matter how difficult and hopeless it may seem on the long journey there. I hope these songs can help you feel a little something - whether it's a push towards seeking help, a boost during recovery, or support no matter where you are in the process.

The Art of the Meal Plan

While I haven't been formally diagnosed with an eating disorder until my recent acquisition of anorexia nervosa, I've experienced every diagnosis on the eating disorder spectrum. I strongly suspect my core diagnosis is and has been bulimia. It seems I've just gotten so good at it, I'm able to stay at a BMI that qualifies me as AN.

In all honesty, I wear my anorexia badge with pride, a reflection of my success at eating disorders lately. This is a statement I will surely regret in the future, but for now, I am happy that I am so malnourished, so thin and so bedraggled, that I have achieved this gold star of approval. What I fail to consider is that in recovery, we with anorexia must Eat A Lot.

Breakfast

2 starch

1 dairy

1 fruit

1 fat

Lunch

3 protein

2 starch

1 dairy

1 vegetable

1 fruit

1 fat

Dinner
3 protein
2 starch
1 dairy
1 vegetable
2 fats

And
2-3 snacks throughout the day

Each patient has a plan tailored to her needs with snacks and supplements (Boosts or Ensure) as needed. Snacks and supplements are added or subtracted to meet weight gain or maintenance goals during treatment. Everyone must meet the basic, minimum food group exchanges.

Physiologically speaking, high calorie meals are required to ensure calories in exceed calories out, especially with the 6 10 miles I'm allotted doing every day, necessary for weight gain. The contract I signed when bumped up to day treatment listed 2-4 pounds per week as a weight gain goal. There are 3500 calories in 1 pound, so to achieve a 2 pound gain, an excess of 7000 calories per week is required (1000 per day). 4 pounds per week? That's an extra 2000 calories per day.

The average 26 year-old female of my height and weight burns approximately 1290 calories per day doing nothing. These calories are expended through basic metabolic processes like breathing, muscle turnover, and heart contractions. If you're ambulatory, up and moving through daily life, with no additional physical activity, this number jumps to 1548. If you're me, running 10 miles every single day, this number jumps to 2225 to maintain weight. Add the 1000-2000 extra calories per day to gain 2-4 pounds per week, and you're looking at a daily caloric intake of 3225-4225, also known as a bulimic nightmare.

To me, consuming and holding down 4225 calories is more physically and emotionally difficult than any 15 mile run. Meals of cheese, pasta, sandwiches, milk, and dessert served at the treatment center are ridiculously triggering to all of us. As a professional bulimic (prolimic we'll say), it is overwhelmingly difficult. The internal struggle to eat the meal is the first challenge. The physical and mental challenge to hold the food in my stomach immediately after eating is the second challenge. But the third is the worst challenge.

Treatment concludes a mere hour after the horrific lunch meal and I am sent home with a snack. This has ended the same way every day, except a few. I drive away, clutching the snack, and devour it within a mile of the center, still painfully stuffed from lunch. I stop at the nearest gas station, purchase a diet coke in size bulimia, chug, and purge on the side of the road. It's 2:45 pm at this point. I see snack, lunch, and even the string cheese from 11:00 am emerge, clearly undigested.

Relief. Temporarily. Hungry Again. Binge. Purge. Repeat.

I have learned it is unclear how to refeed a prolimic. I do not know how many calories I retain or if my weight fluctuation from day to day sets off red flags to the treatment team, but I fear residential... babysitting treatment... may be the only way. 

I welcome any comments or suggestions from readers on how to conquer the process of weight gain and refeeding in those who are prone to purging. I'm afraid of this vicious cycle and must stop in order to make any sort of progress through recovery. 

Recovery Walker

It's finally Saturday and my first weekenparticularly  starting treatment. I wake up with the tiniest headache, but feel like a million bucks after dinner with friends and an early bedtime last night.

First thought - what's for breakfast? - followed by - weekend long run without a booze or bulimia-induced hangover?! - followed by - unlesguy cut running by half by didn'tsday (consistently), .ll be shipped off to Residential. That, my friends, is a BUZZ KILL.

So. I go for a walk with the lovely, body-secure Lula, a babe of a Husky/Samoyed mix with flowing white figurativautiful blue eyes. Let me tell you, she is a show-stopper folks.

It helps to walk, but I don't know what will happen if I don't get a little run in, especially since the understand. derstorm this morning has given way to 60 and sunny in early January. I take maybe three days off per year, almost always due to crippling hangovers, traveling, or big events like weddings. Today, I limit myself to 6 miles, a feat in itself and sit down to watch some football with friends until it's time to attend a friend's boyfriend's birthday dinner.

Something I've learned in treatment is how common fear of social eating is for those with eating disorders or disordered eating. At face value, I would never considered that a particular symptom or behavior of mine. Until I consider what normally happens at dinners out. I don't eat all day, run even more than the standard 12 miles, order the lowest calorie option on the menu (salad, soup, steamed vegetables, etc), 3-4 drinks plus whatever I had before dinner, and get blackout drunk. So while I'm perfectly comfortable attending social dinners or gatherings focused on food and eating, my friends and boyfriend are always on high alert. I'm consuming negative calories regardless of my chosen entree, and drinking to keep up with the heaviest hitter in the group, usually a 200-400 pound male who orders an appetizer, entree, and dessert to share with no one. I will go shot for shot with the person in between dipping my fork in fat free dressing and picking lettuce leaves out of cheese and any salad toppings that aren't vegetables. And I'm naive enough to think that this eating disorder is mine and mine alone and no you can't possibly understand.

At this particular birthday dinner, I do particularly well. I order just two drinks after the beer I had befpre dinner and a black bean burger with a side salad. I cut the burger in half, eating 2/3 and the whole salad during a painstakingly slow hour. Everyone else finishes 30 minutes before me and when I finally throw in the towel, the guy next to me asks what I didn't like about my dinner. Better than the ever dreaded, wow you were hungry or great job that we ED-heads dread, but also a wake up call my idea of a lot of food is so far from normal.

Treatment Day 5

Well friends, today marks the end of the first week of day treatment. I haven't worked this few hours in well...ever...but I'm more tired than I thought possible from spending my days like this:

• 8:30-8:45: weights (blinded)
• 8:45-9:45: breakfast (2 starches, 1 dairy, 1 fat, and 1 fruit)
• 9:50-11:00: group session
• 11:00-11:15: avoiding snack til caught doing so today (so from now on ... a snack)
• 11:15-12:30: group session
• 12:40-1:30: lunch [misery inducing meals of fruit, dairy, vegetarian entree (potato drowning in cheese and butter, sandwich drowning in cheese, soup and salad drowning in cheese... note to self: don't choose cheese for snack, buy gas-x), dessert]. Woof. 
• 1:30-2:40: group session
• 2:40: snack and freedom

Lots of sitting. Lots of cheese. Exhaustion inducing.

My weight hasn't increased since starting outpatient in December due to maintaining a Nazi exercise routine of 8 miles in the morning, 2 miles with the dog after treatment, and 6 hard miles at night, so it's off to inpatient if I haven't reduced exercise by half and attend an AA meetings by.... Next Wednesday says my therapist. So now I comply despite the fact my stomach no longer works and food comes right back up, a second reminder that this much cheese should be illegal.

This week, a lot has changed for me though, despite little progress on the gaining of weight. My diagnoses are officially Anorexia Nervosa, Depression, Anxiety - a triple threat for someone who's struggled to admit to any problem for the past nine long years. In some ways, it's a relief to see those words on paper, confirming I'm sick enough to be sick. I've wrapped my head around the necessity of eating, my abuse of alcohol, and that my moods are out of whack, depicted by my interpretation of physical manifestation of moods in art therapy (followed by a treatment-mates).

These breakthroughs/progress leave the exercise addiction as the last and most difficult piece of the eating disorder mantra to change. Purging at will is another dangerous habit that obviously must change, but I cannot purge during inpatient hours, and my medication to help prevent reflux should kick in this weekend, so my feelings are optimistic that it's more of an interim consequence.

I look forward to, and am equally terrified of, the freedom afforded by the impending weekend. I have dinners already scheduled for evenings and I spend days with the boy I love who still managed to loves me back. Structure and plans boost my mood and keep me busy and accountable, reducing the likelihood of getting off track. This weekend, I am optimistic about concrete progress during the week and the ability to choose how much cheese I eat.

We don't realize the importance of things until we must forego... coffee, Diet Coke, choice.

Here's to a successful and recoveryfull weekend!

Treatment Day 1 (TD1)

Well folks, turns out 26 isn't too old to get in trouble! Treatment Day 1 (TD1) started with a bang for this eating disorder senior citizen. I was plenty used to trouble and reprimanding in my rebellious years, so I suppose life goes full circle more often than not. Here's how it went down.

Up til 1:00 am last night. Alarm at 6:25 am. Up and at em....................
   ✓ 5.25 hours of sleep
   ✓ Hangover
   ✓ Bags under eyes
   ✓ 22 degrees (wind chill 6 degrees) outside
   ✓ Run 7 miles at the gym
   ✓ Drive to treatment

I arrive at 8:15 am sharp to knock out the paperwork requirement, but spend 45 minutes hanging out with the building security guard waiting for staff to show. Guard and I put our heads together and decide to call the main phone line in case a staff member snuck in. Low and behold, the center voicemail confirms: weather delay on account of we're in the South and it's Cold Today.

So what does one with an eating disorder do with an extra hour and change? Why, she grabs the running shoes, socks, shorts, and dark memoir from her car, and hops on the treadmill in the building gym of course (for 1.5 miles til she's caught cruising at 8.3 miles per hour).

Using symptoms, they say! ooops.
Proceed to weigh in. Weight loss, they say! Double oooooops.

Am I going to be kicked out of treatment on my first day? Nope, but I will be supplemented with 360 calories of Boost Plus. At least I can choose if I would like chocolate or vanilla. Vanilla it is.

In hindsight, I shouldn't have consumed -700 calories yesterday and run 7 miles this morning. My stomach doesn't appreciate the Boost, then the extraordinarily large baked potato + butter + broccoli + cheese, string cheese, and apple for lunch, but understands what making my own meal plan and rules accomplishes. Nada.

Something did go well today though. I suppose it's only fair to mention successes and breakthroughs amidst the negative nancy-ness of this post. It comes in the form on art therapy, which I really love. Check out our group (well, it was just three of us today) mandala. We started with a circle and ended up with....

Okay, that's all the positive I have in me. After we are cut loose at 2:45 pm, I fail again, drinking diet soda and coffee and eating peanut butter crackers and oatmeal until I hands-free purge. It bothers me that the potato and apple consumed at 12:40 still come up at 3:30 (and again at 9 pm).

Free time means I walk 3 miles with my boyfriend's dog, learn that treatment is cancelled tomorrow because it's Still Cold, and wind up with more free time. I write this blog post from the treadmill at the gym, walking 2 more miles after running 3 in 20 minutes.

I feel tired. I must eat dinner. I will drink tonight. I must get better.

Reactions to change include slip ups

Periods of time leading up to a big change are particularly difficult. Sometimes the change is scheduled or anticipated like accepting a new job or going to college. Sometimes the change is unscheduled, but inevitable, like admitting a problem, accepting help, or entering treatment. No matter the pretense, a big change is difficult and can initiate a cascade of emotions or fears.

A change curve demonstrates the most common reactions to change. As an exercise for myself and to help define each concept, I'll give examples of response behaviors under each category. For me, each step in recovery has been a change and extremely triggering, but exploring reactions may help overall progress in recovery and prevent relapse.

Resistance: Process where the ego opposes conscious recall of anxiety-producing experiences

• Arguments regarding seriousness of eating disorder, addiction, or condition
• Hiding symptoms and tricking or lying to others about behaviors
• Refusal to participate or comply with treatment

Denial: Defense mechanism involving refusal to acknowledge painful realities, thoughts, or feelings

• Conviction the problem is under control
• Using functionality in other areas (academics, work, athletics) to deny problem
• Anosognosicism: unawareness or failure to recognize one's own problems

Commitment: Being bound emotionally or intellectually to a course of action or to other persons

• Complying with treatment recommendations and meal plans 
• Attending treatment regularly and recognizing its benefit
• Being up front with others about the problem and/or course of treatment
• Demonstrating actions or outcomes in attempting to achieve goals

Exploration: seeking and understanding new ways of doing things

• Understanding how and why to change habits 
• Looking forward to changing behaviors and maintaining changes for the long haul
• Making a plan to optimize recovery, promote wellbeing, and prevent relapse

Anyone making a big change can benefit from identifying behaviors that would fall under each category of response to change. Focus on commitment and exploration, while identifying how to minimize resistance and denial. Identify treatment strategies, support groups, individuals including friends and family, and resources (exercise, yoga, writing, journaling, hiking, fishing, biking, boating, outdoors) that will assist you in making this change. 

Most importantly, change for YOU. Do not include anyone or anything else in your list of reasons to get help and start living. YOU are worth change. YOU are worth success. YOU are worth recovery.

Health insurance, medical leave, and making no money

Today was supposed to mark Day 1 of day treatment, but as we all know, plans do not always fall into place accordingly. Low and behold, taking a leave of absence in graduate school (unless you're birthing a child) suspends health insurance. Pretty intuitive when given some thought, but probably not something considered before making the painful, difficult decision to tackle more intense treatment.

The decision to switch to day treatment was not an easy one for me. From the get-go, all of my doctors, therapists, and folks at the treatment center recommended the most intense level of care, but I declined because, well, I can do this myself damnit. Turns out, denial and borderline ignorance served me about as well as it has over the past 9 years.

Surprise!

While I failed outpatient treatment, I've been lucky to have a team willing to be flexible and accommodating with the demands of being a doctoral student, teaching a class, and assembling a dissertation. These are difficult, stressful, anxiety-provoking demands for the average Joe. Add treatment for an eating disorder, substance abuse, and obsessive exercise, and you have Way Too Much On Your Empty Plate.

So, in light of my plate and recommendations from the powers that be of treatment, I will suspend my student stipend for the next two months to just do me. It's scary and disheartening and feels like giving up, but also comes with a sense of freedom, hope, and motivation. 

In light of challenges, I am deciding to see opportunities. I will be too broke to binge eat and purge. I will not be in my office, leaving quality time for just the two of us, me and my dissertation. I will have time to push myself to recover, challenge my thoughts, and develop and indestructible rapport with recovery, including a plan for relapse. 

I will eat. I will run (less), I will live.

Hello blogmosphere!

Tomorrow, I start a day treatment program at one of the country's most respected eating disorder treatment centers. Whew, I actually said it, sans freak out.

First of all, I know I am so lucky to have resources, time, and support to undergo this level of treatment. To those of you struggling on your own, I encourage you to reach out to whatever type of support if feasible for your financial, school, work, or living situation. Any help is better than no help. Maybe this blog is a start.

To give you a little history. During the past four weeks, I have participated in an intensive outpatient program at the same center. I received treatment for anorexia binge-purge type, overexercising, and alcohol abuse after experiencing heart palpitations and developing a heart murmur, but still failed to reach goals. I'm a Registered Dietitian and have a Master's Degree in Nutrition, but I cannot seem to practice what I preach. In light of treatment, I am currently taking time off from my doctoral program in, you guessed it, Nutrition.

After 9 years of struggling with myself, it's time to take my health into my own hands, feet, and typing fingers. I'll need a little extra support during this step-up in treatment, so I'm turning to anonymous blogging. Things I hope to accomplish are:

1. Help me.
2. Help you.
3. Recover.

I also hope to tackle my most challenging behavior, a wicked addiction to running and exercise, and turn my obsession with burning calories into talent. While lofty, my goal is to participate in the USATF Women's Open 5K Championship in 2014 and see where I can go after that.

I hope you will follow my journey through recovery and that my words can help you, too. Please leave any positive comments, links, advice, recommendations, questions, etc., and I'm happy to answer.

Best wishes and thoughts.