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!

According to plan

I wake up this morning after a difficult day and, guess what? It's a new day. That's the beauty of recovery, or at least a part of recovery that I have come to accept. It's not black and white and it's not all or nothing. If you're not 100%, you're still on track to getting better.

Recovery is a spectrum, a scale spanning mentally and physically sick to mentally and physically healthy. Between the two extremes, a clear definition of eating disordered or recovered does not exist. That means a rough day and a rough evening do NOT equate to failure, nor should slip-ups provide grounds to simply give up. Instead, slip-ups or bad days or even a bad week equate to getting back on track, identifying triggers and how you diverted from on track, and, most importantly, believing recovery is still always possible.

Anyway. I'll step off my soapbox for a moment to explore how today went compared to yesterday. I wake up at 6:42 am and immediately check the weather since we're in the south, expecting snow, and thus the end of the world. No such luck so I enjoy my treadmill workout, pushing hard for 6.5 miles, checking the forecast to monitor the impending "snow storm", and relish in the fact I'm hangover free! Treatment isn't cancelled by 8, so in I go.

Another new woman starts today after bumping down from inpatient literally within the last 24 hours. She's an older woman with two teenagers and her stories break my heart. Her stories, struggles, and experience, which we hear a limited amount of today, already inspire me to beat this thing into the ground before I, too, have 25 years of hell under my belt. I've been in inpatient or day treatment for almost a month and half now, and this is by far the best group I could ask for. It continues to amaze me how strong, beautiful, and intelligent these women are, whether they're struggling with anorexia, bulimia, EDNOS, or binge eating. It amazes me how similar our struggles are, as eating disorder patients and as women.

Inspiration is followed by morning snack. I get by on the lowest calorie options at all meals, a habit I can't let go of since I"m a Registered Dietitian and out of pure desperation to have some fraction of control. By the end of our second morning group, the snow is coming down in flurries and we're rushed to lunch. Today is prepare your own wrap day and we're instructed to fix your lunch and take it to go.

I'm elated at first. Leaving early! No afternoon snack! NO AFTERNOON BOOST! I don't have to eat my lunch! After managing 560 calories for breakfast and snack, I'm on a restrictive roll. Til I jet out of treatment and hit traffic, the start of what will be a 3 hour drive to crawl the 18 miles home. For the duration of the first part of the trip, I grip the wheel, my lunch starting a hole in my brain and stomach from right beside me. My stomach growls, a sign that treatment is fixing me and equally stimulating the overwhelming urge to stop at a grocery store, restaurant, or what the hell, that gas station to binge and purge.

I'm in tears for most of the trip home. So much time wasted; so much frustration at traffic, food, and myself mounting; and so much emotional drain. I am starving by 2:30 pm so I eat, dumping the contents of lettuce, tomato, cucumbers, cheese, and hummus, but eating the whole spinach wrap itself without being forced to like I am at treatment. I keep it down, tears sliding down my frustrated face. I still keep it down. It stays through the entire digestive tract, hitting me now in the form of toxic refeeding flatulents as I cheerily walk on the treadmill at the gym. The man next to me gets off his treadmill, nose turned upward and eyes squinting. I laugh. Success.

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.

Weekend Struggles

During day treatment, also called a partial hospitalization program (PHP), for an eating disorder, there's a lot of free time. Residential treatment centers allow no freedom to patients - you are constantly monitored, constantly scheduled to be somewhere, have no time to yourself thus no opportunities for slip-ups. In day treatment, we leave the treatment center at 2:30 pm on weekdays and since I'm on a leave of absence from school, I'm left to do what I please. The same is true for weekends.

It's an easy scenario to fall completely off track. Yesterday was Saturday and looked something like this. Wake up at 9:00 am. Make a sugar-free chai latte with almond milk, 45 calories, and eat a tiny handful of peanuts, no more than 50 calories, and do work even though my dissertation stipend has been suspended for now. At 11:30 am, run 10 miles at a 7:00 minute mile pace. Come home energized and feeling great with an awesome lunch restaurant in mind, since I haven't stuck with my meal plan at all today.

Instead? Drunch has been planned in my absence. Drunch is drunk brunch. The restaurant offers brunch food and very cheap mimosas. There are 4 of us and we drink 4 bottles of champagne and 2 fireball shots a piece. I eat 4 sweet potato fries and half of a caprese sandwich, picking out the mozzarella and reducing it to tomatoes, basil, balsamic vinaigrette, and the restaurant's (thankfully) thin wheat bread. 

Drinking does two things to me. It reduces my appetite to nothing, giving me an excuse to be full on booze and not hungry.

Alcohol also reduces my desire to come across as normal with my eating habits - essentially making me not give a shit that everyone sees me restricting.

At 4:00 pm, we are finished with "brunch". My boyfriend (I'll call him P from now on to make him seem more real to you readers), takes us on a tour of our neighborhood to house hunt. He is going to buy a house soon, which is very exciting, and a fun way to spend the afternoon with our two friends, who get really into it. After, everyone is tired from day drinking so we nap.

I wake up at 9:00 pm with a hangover. I pick at snacks... popcorn, peanut butter crackers, cereal... all of which come right back up. Purging is so easy when you're hungover and eating food with liquid. I don't even use my hands anymore, making it such a destructive, addictive, and impossible to overcome habit in recovery. I go back to bed. At 2:00 am I wake up again. The hangover still exist, but has quietly subsided. I prepare a bowl of oatmeal. Eat it. Vomit. Not pretty. I crawl back into bed, a sad and defeated mess. P cuddles me up and we fall asleep until now.

This is not a good day for me. I did everything wrong. Overexercising, drinking til near blackout, severely restricting food intake, and purging anything I ate in the evening. While I am proud I did not engage in binge/purge like many previous weekends, I am still very disappointed in this. I am already facing additional Boosts at treatment this week to speed up weight gain, something I've literally had nightmares about this weekend, and drinking/not eating/purging the weekend away is not going to help with weight gain.

Where do I go from here? In recovery, I am trying to learn from my mistakes and create action plans for future similar situation. Next weekend, I will say no to drunch, and instead voice my opinion about where I would like to go, what I would like to do, how impossible it is for me to "just don't drink that much". I have already figured out that scheduling meetings during the week around 3:30 pm or 4:00 pm for school or the various projects and activities I'm involved in helps reduce engaging in symptoms after day treatment, so I will continue with that. 

I will not consider this weekend a complete failure. I do recognize a very small, and mostly insignificant in the scheme of things, successes.

• I only ran 10 miles yesterday. Most days, this number is more like 15-16.
• I ordered a caprese sandwich with sweet potato fries because that's what I wanted to eat in the moment. Didn't eat much of it, but still ordered what I wanted, not a salad. 

Small steps, people. We can do this.

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.