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.

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.