Yesterday was the nervously awaited, Eating Disorder appointment. Although my Doctor doesn’t bite I still fill with dread and fear on the run up to my appointments. At the minute I have been seeing the doctor every couple of weeks while I wait to start weekly therapy. Today’s appointment left me feeling surprisingly optimistic (instead of the usual post appointment deflation) so I thought I’d share some of what went on, what we spoke about and my action plan for the next 2 weeks! If I veer off track, feel free to give me a kick up the bum (or a slice of toast)!!!
Prior to the appointment I always feel an overwhelming sense of anxiety, which kicked in over the weekend (I spent most of Sunday afternoon with my head on another planet). I tried to think of why I feel so on edge in the run up but really struggled to fathom the reasons. After getting my cogs turning and working backwards I realised it wasn’t so much the actual appointment or the doctor himself but more the fear of judgement. Despite my best efforts I hadn’t been able to make all the changes we had discussed previously. I find it quite hard to accept that Anorexia is an illness and not a weakness so not succeeding, despite my hardest efforts and best mindset, is all part of the disorder and not my own personal failure. As a Healthcare Professional I know the frustration of people coming for follow up appointments having not taken on board any of my advice. Feeling like I am that person brings a whole heap of disappointment in myself, although I am aware that the circumstances are totally different (another branch of the irrational thinking, I guess). On top of the fear of judgement there’s the big (or not so big) ‘weigh in’. No-one with an ED looks forward to this part of monitoring (I’d rather be prodded and poked and have my veins drained for blood tests) but it is an essential part of it and I get that. Despite knowing my weight to the tenth of a kilogram at all times and whether I’m up or down from the last appointment, the weigh in still makes me nervous (ridiculous isn’t it!). This week I was down. Not by an awful lot but I’ve headed the wrong way! I knew it was going to be that way, given how things are going right here and now but there’s always something psychologically tough with someone else knowing what I weigh – I guess it goes back to the point I made about feeling judged. I want to please my doctor and gain the weight, not to mention for myself and family more than anything, but at the same time gaining weight feels like failure (back to the rational vs. irrational… again!).
Any how when I’m in the consultation room the first questions (Every. Single. Time.) will, without a doubt, be something along the lines of “How are things? Has anything changed? What’s different?” Yet every, single, time, I never know what or how to answer. You’d think by now I’d be ready for it? Well you couldn’t be further from the truth!! It’s made me chuckle writing it down at how insane the reality actually is and how silly it sounds but that’s just how it goes, without fail. I avoid thinking about anything appointment related before hand in an unsuccessful attempt to limit the anxiety. In addition my eating pattern is often so erratic and variable it’s hard to pin point whether things have improved or declined and gauge an ‘average’, hence my lack of preparation for the ever dreaded opening question. You kind of find yourself getting used to the reality of the ED in day to day life without much reflection, it becomes ‘normal’. Having said that though, I have been star patient these past couple of weeks and kept a very detailed food diary (clap and cheer, please! I’m very shocked and proud of myself for achieving this). I have previously always been in a state of denial (or some may call it stubborn), in the sense that I have never wanted to admit to myself, or anyone else for that matter, the extent of my struggles, let alone the thought processes that accompany. In a nutshell, everything and anything related to meal times/food/drinks is written down – the time, what’s consumed, who you’re with, where you are, whether it felt like a binge, if you purged and the thoughts/feelings (ie. how you feel physically, what you’re thinking, the general context etc.). Seems a lot, huh? Tell me about it!! I have probably lost days of my life to filing this thing in but in all honesty, I have found some solace in it (silver lining, or what?!), even if it is a massive chore at times (unfortunately, not one I can bribe Harvey with £1 to do!). I have been using my food diary as a way to try and be more mindful when I’m eating (I often won’t sit down, still, to eat, but instead flit around doing bits and bobs or anything to keep my mind busy – which are probably my most productive times of day, so it’s not all bad). Being more aware of what I am eating, with writing it down, has helped me think twice when I’m falling into the Binge-Purge trap and equally when I haven’t really managed much it’s there in black and white as a bit of a ‘pull yourself together, Caitlin’. I’ve also used it to vent, big time! If something’s on my mind and its affecting how I feel or my eating pattern I’ve written it down, no matter how significant or silly and almost always felt a little weight lift (not literally, weight loss is not the idea of the food diary but you know what I mean!).
During my session, my doctor asked me, as a Dietitian, what I would advise if he was in my shoes, as my patient. After being a bit cocky, thinking “well I wouldn’t see you anyway – you’re an adult, I only see children” I did manage to be semi-serious. It was almost funny at how insanely easy (and general common sense) the suggestions were (eat regularly, gradual changes, start with ‘safe’ foods, don’t fill up on fluids etc…) but at how hard they are to put into everyday practice with the ED mind. I’m not great at “gradual changes”. I tend to have a go hard or go home attitude so if I’m doing something, I’ll do it – there are no baby steps! But we spoke about this and trying to take on too many challenges in one go which ultimately leads to being hugely overwhelmed and frustrated! Regular eating has been another one of my huge downfalls as of late too. I tend to go all day on barely anything then come the afternoon/evening I am absolutely ravenous and then feel guilty for breaking the fast or my rules or plans etc. then it’s a vicious cycle of depression, guilt, binge-purge, restriction and so on… Even during relapses before, breakfast has been my one meal that remained intact – not this time though, (I do miss Weetabix a bit) so I really want to get on top of this one!
The last thing that was mentioned were my motivations to maintain my weight. Obviously top of the list is my darling (sometimes devilish) son, Harvs!!! We touched on him being aware and how it affects him and what it would mean to our relationship if I got myself better (that’s a whole new blog post on its own – watch this space). Driving was another biggie! I have recently been given the go ahead to drive again from my cardiologist, after what seems like years under house arrest, losing that again would be soul destroying!
So there you have it! That was the main bulk of our conversation for today, minus the nitty gritty, overly sensitive, slightly boring bits!
To finish up, here are my action points for the next 2 weeks, plain as day, in black and white for all to see (remember I asked you for a kick up the bum if I go off track?):
- Regular Meals and Snacks (shouldn’t be too tough – must remember small steps)
- Make sure I have something (anything) for breakfast (this one may be tougher)
- Keep going with my food diary (easy peasy)
- Weight Maintenance (or gain if I’m going for bonus points)