Wednesday, February 29, 2012

Health Inequalities

Here's something pretty incredible: aside from the anorexia, I've never really had any major health problems. As a kid, I never got sick (other than a yearly winter cold), never broke a bone, never had any major spills or accidents. I think the last time I got the flu was in like third grade. (Never had a flu shot, either!)

So it has been kind of a shock to my system to suddenly be going to the doctor all the time. In the past year alone, I have seen: two therapists, three dieticians, two general practitioners, two ophthalmologists, two gynecologists, a cardiologist, and an orthopedist. Now, I'm lucky in that I'm still covered by my parents' insurance (which ROCKS and covers way more than I would have ever expected), but all the co-pays and medications can get pretty expensive. Plus all the frustrations of shuffling appointments, waiting to get in to see certain specialists, finding doctors that are covered by my insurance plan, and keeping my parents in the loop from afar (College City is several states away from Home City). OH YEAH, and also being in school with a job at the same time.

Frustrations aside, though, my point is this: I am incredibly fortunate to be able to: A) see pretty much any kind of doctor I need, and B) have access to pretty much any kind of medication I need. Although my health is probably worse than some peoples' at the point, I also probably have better health care and coverage than the vast majority of the world's population. I think this is on my mind because I recently worked on a project that involved researching pharmaceutical companies and the gross lack of medical care in developing countries. In a nutshell: any Joe Schmoe in the US can easily obtain prescriptions for medically nonessential drugs (acne creams, wrinkle reducers, Viagra, etc.) while people in places like, say, Guatemala, are dying of treatable diseases like malaria and diarrhea because they don't have access to medications, and wouldn't be able to afford them anyway. Pharmaceutical companies have a lot more incentive to mass produce expensive vanity drugs for rich people than dirt cheap malaria pills.

I don't mean to get on my soapbox and I know that I've written about this kind of thing before, it's just that these kinds of issues are things I care about a lot. The time, energy, and money that has been poured into treating my self-hatred seems pretty darn wasteful in comparison.

Monday, February 27, 2012

Plummeting Body Image

Sometimes weekends are really hard for me, and I'm not totally sure why. This one was really lame - I was sleep-deprived and wanted to stay home and catch up on some rest, but didn't really sleep that well anyway. So I was still tired AND bored. I also had a ton of work for school; I spent most of the past two days in the library studying for my exam tomorrow, and then the professor e-mailed us at 11pm last night to say that the exam would be postponed until Friday. Which would be fine, except that I also have papers due Wednesday and Friday, so I was kiiiiinda looking forward to having this exam out of the way.

But now I'm just whining. Things are actually going pretty okay for the most part. A health issue that I've been dealing with since the fall seems to be finally resolving itself, which takes a huge load off my shoulders. I think my spring break plans are in place, and I'm super excited for what should be an amazing trip and experience. I did have a minor meltdown on the phone with Mama Bear the other night because I had too much homework and my eyes were bothering me and my jeans felt snug...but other than that, nothing catastrophic.

It is interesting to me, however, to track changes in my body image when other stuff is going on. Like now, I'm pretty stressed out with my workload and therapy and medication stuff, and oh my lordy is my body image horrendous. Normally when I start ragging on my body and feeling yucky, I am still able to maintain the implicit knowledge that I am maintaining an underweight BMI and am therefore not actually fat. But lately: uh uh nope, not only am I dissatisfied with my body, but I'm convinced that I am literally and unequivocally overweight. Doesn't matter what the scale says, Kaylee, look in the mirror. That is not the reflection of an acceptably-sized human being.

It's giving me an identity crisis of sorts. Like suddenly I've realized that for real, I'm not skinny. And if I'm not skinny, then what the hell am I? Yes, I've put on a little bit of weight over the past couple of months (not much at all, to the dismay of my therapist and dietician), but not enough to drastically change my body size. Other people probably don't even notice, but I do. I'm trying not to care, I really am, but it's hard.

I think maybe my unsatisfying weekend was part of the reason my body image has taken a nose dive. When I'm bored and frustrated and exhausted, I get stuck in my head, ruminating on ED stuff and shutting the real world out. Something to work on: not letting that happen.

Thursday, February 23, 2012

An Odd Assortment

Things seem a little off balance this week. I don't know how to describe it, there's no real pattern, I'm just not feeling quite normal.

Exhibit A: My sleep sucks. I've been going to bed at the usual time, between 12 and 1ish, but then waking up around 5 for no reason, and then I can't go back to sleep. It's a really weird pattern for me, since my past episodes of insomnia have usually been characterized by trouble falling asleep, not staying asleep.

Exhibit B: My weight has gone up an absurd amount over the past couple of weeks. Okay, not an absurd amount (e.g. less than five pounds), but enough to freak me out and frustrate me beyond belief. Maybe this should be a positive, since I'm supposed to be gaining weight anyway, but I haven't changed anything (diet, activity, etc.) that should account for the gain. Plus, it doesn't seem to be a random fluctuation; it started creeping up several weeks ago and just settled there. Not the end of the world, I know, but I hate that it happened without my permission.

Exhibit C: I'm so freaking thirsty all the time. Like, I'll chug three glasses of water back-to-back and my mouth still feels like it's coated in cotton. I normally get really thirsty and drink a lot, but it's gotten so much worse lately. Dry mouth is one of the side effects listed for my medication so it could be that, but either way it's really annoying. Plus, sorry for the details, but I have to pee constantly. I wish some of that water going in would help hydrate my mouth and my eyes rather than just running right through me. (Again, I'M SORRY FOR BEING GROSS.)

Exhibit D: Seriously, why am I so bloated? I feel like my stomach sticks out six inches past the rest of me. (Including boobage. And yeah, my boobs are e-fucking-normous. (That was sarcasm. Even at my highest weight, I barely fill out A cups. (How many parentheses can you fit in one paragraph?))) Anyway, it really sucks. I guess this could be related to the weight gain in Exhibit B, but isn't bloating temporary? This has lasted for weeks.

So, there's nothing majorly wrong with me, I just feel kind of weird. Another factor: I should have gotten my period this week, but I didn't. I had major cramping right on schedule (exactly 28 days from my last period), but no bleeding. I was positive it was coming, and I am really disappointed that it didn't. Maybe it's just late? But the cramping has mostly subsided, so I'm guessing that's that. But I suppose my hormones could just be doing funky things and messing with the rest of my body, too.

Monday, February 20, 2012

Awareness Conflicts

Apparently it's Eating Disorders Awareness Week? I actually had no idea, only found out when a friend invited me on Facebook (not just me specifically...I think she's one of the organizers and just invited everyone on her friend list). Anyway, there's a whole list of events happening - speakers, movie screenings, etc. What I've noticed is that most of them are not exclusively ED-related, per se, but more of a feminist celebration. It's as if "eating disorders awareness" has become synonymous with "body acceptance" and "girl power."

I have mixed feelings about the whole thing. Part of me is really curious about how ED issues will be presented. Part of me knows I'll just get frustrated when the presentations don't line up with my personal experiences. Part of me wants to stay as far away from the whole thing as possible. I think most of my friends know about my ED, although I never discuss it and the whole topic has pretty much been established as Off Limits. So I'm super uncomfortable with the idea of being seen at any of the EDAW events.

And honestly, I have no desire to sit through a motivational speech on body image and female empowerment. I'm all for that stuff, but not in this context. There's already too much of the "anorexics just want to be skinny" mentality out there. Yes, I've spent most of my time entrenched in the ED wanting to be skinny and yes, my body image sucks. But there's so much more to it - like genetics and biology. A peppy girl power speech isn't going to cure my bad body image. And even if it did, that wouldn't cure my eating disorder.

That sounded way more bitter than I intended. To be clear: I think it's incredibly important to promote ED awareness. I also think it's incredibly important to promote positive body image. But I don't necessarily think the issues go hand-in-hand. I think it belittles the severity of the illness to associate it with this idea of female vanity.

Friday, February 17, 2012

Weekly Summary

I feel a little bit like I haven't had a chance to sit down and breathe for a few days. School and work are getting super busy, so I've been spending most days zipping around campus for class and meetings and office hours and stuff. Plus, this week I had no fewer than FIVE different appointments with various medical professionals (R twice, J once, my ED doc, and my OB/GYN). So yeah! I've been a little busy. And I got lots to update on!

First, therapy: When I saw R on Monday, I was in a crappy mood and wanted break things and murder everyone around me. But as per usual, I zipped my lip and pretended everything was great and waxed poetic about drinking Boost. Of course R saw right through me and concluded that I was "quite unwell," to use his words. When I went back this morning, I was feeling much better and a major point of discussion became my ridiculous mood swings. (My ED doc switched my meds on Thursday, so maybe that will help things a bit.) I also told him that the twice-weekly sessions are seriously getting to be too much. It's a huge drag to shuttle back and forth to ED Clinic (about a twenty minute drive) 2-3 times a week, and I really just don't have the time or inclination for it. R said that since I seemed to be doing better (aka not losing weight, not a sobbing ball of nerves, not really being uncooperative or opposed to recovery in any way), we can cut down our sessions to once a week for now and see how it goes. Progress!

Second, dietary: I saw my dietician J today for the first time in a couple weeks. I had been purposely putting off scheduling an appointment with her because I had been getting fed up with her, but this morning we had a really good, productive session. We didn't actually discuss food much at all, or make any adjustments to my meal plan. Instead, we did an exercise where we mapped out my chain of thoughts leading up to a meal in order to pinpoint when/how I decide if/how much to eat. Usually, this kind of exercise seems pointless and irrelevant to me; I find it impossible and futile to identify core beliefs and thought patterns. R has tried similar exercises with me and I just don't get it. It never seems to apply. Anyway, today was different and J seemed more willing and able to understand where I struggle the most.

Most of the time, J is super perky and positive, which is great, but doesn't exactly resonate when I'm sitting there fighting tears, tuning her out, and thinking I'm not going to drink the Boost, dammit, so stop asking. But today, she took a blunter approach. At one point, she even said, "I hope I'm not coming across too harsh." (And "harsh" for her is still incredibly sweet and friendly.) I felt like she acknowledged that, okay, just telling Kaylee to drink more Boost and add another half cup of trail mix is not exactly getting through. So she stepped back, reassessed, and took a different approach. Now I feel really positively about how things are going and I'm definitely more motivated to work with her.

Next: OB/GYN. I'd never seen this doctor before, so I was giving her my history (anorexia, majorly irregular periods) and she immediately started pushing birth control. She even gave me a sample pack of Beyaz and called in a three-month supply to my pharmacy, even though I was pretty ambivalent about it in the appointment and don't even plan to pick it up. I talked to my ED doc about it, who confirmed what I thought was true about BC not improving bone density. I'm definitely not opposed to the pill, and would consider in the future if it becomes necessary for, um, non-bone-density-related reasons. (I just broke up with my boyfriend, remember?) For now, though, I want to keep doing what I'm doing and see if I can have periods naturally.

Okay, I think I've covered most of the major developments in my life over the past week. Sorry for that! I hope everyone has a great weekend planned.

Tuesday, February 14, 2012

Unexpected Side Effects

When I saw R yesterday, we spent most of the session talking about meds. The situation is this: I started taking an SSRI about a month ago for anxiety, and now I want to stop. I think the drug definitely helps with the anxiety, but my mood is incredibly low. I'm not suicidal or anything, but there has been a definite shift since I started the medication. I don't know if or how they are related, but something's up. I haven't felt this crappy in a long time. Could depression be a side effect of an antidepressant? It doesn't make sense, but that seems to be what I'm experiencing.

The other big side effect: it has made my eyes UNBELIEVABLY dry. It sounds minor, but hear me out. This wouldn't really be a problem for a most people, maybe just a little annoying, but I already have horrible dry eye (it got a lot worse at my lowest weight, when I developed epithelial erosions) and the medication has made it pretty much unbearable. I can't wear contacts, and even in glasses my eyes are so dry that I can barely even keep them open by the end of the day. At first, I figured I could just deal with it by using artificial tears and getting a humidifier in my room etc., but it's really becoming a quality of life issue.

I saw my eye doctor last week who confirmed that my eyes are "bone dry" and that the drug is most likely to blame. Apparently, dry eye (and dry mouth) is a pretty common side effect of all SSRIs. I'm already using multiple prescription drops, and nothing really seems to be helping much. So that sucks.

So now I just don't know what to do. It took a really long time for me to be okay with even trying the drug in the first place, and it really does seem to be helping with the anxiety. I'm nervous about what will happen if I decide to drop it, and instantly revert back into an irrational ball of nerves.

R is understandably reluctant to talk about me stopping the medication. At first he sort of dismissed my eye issues, which pissed me off, but now he seems to be taking it more seriously. I am seeing my GP on Thursday, so hopefully she will have a better idea about where to go from here.

Monday, February 13, 2012

A Weighty Observation

Something I've been noticing lately is that I'm not as obsessed with my weight as much as usual. By that, I mean I'm not as OCD about the number on the scale. I still weigh myself ritualistically twice a day (not good, I KNOW), but it feels different. Less single-minded, or something. I used to obsess about the number to the tenth of a pound, and spend the rest of the day mulling over why it was up or down however much, why why why. It wasn't even about feeling "fat," really, because even Deranged Anorexic Kaylee knew that a tenth of a pound wasn't visible. It was more a numbers game. This sounds super cliche, but the number on the scale would literally define my day. Down a little? Praise Jesus. (And I ain't religious.) Up a little? Kill me now.

I still roll out of bed each morning and step on the scale without thinking twice. But when I see the number, I just sort of shrug it off and go on with my day. Seems like a good thing, right? I don't know. It doesn't really feel like recovery progress; more like apathy. I'm not any less rigid or obsessive about my eating habits and my body image still sucks, but I don't seem to get caught up in thoughts of but it was X yesterday, why is it X + 0.2 today???? as much as I used to. Not that I don't care about the number at all anymore - I definitely do. But the minor fluctuations aren't devastating anymore. I can't decide if this is just a random phase, an effect of the medication, or something else.

Thursday, February 9, 2012

More than Sick

I think one reason my mood sucks lately is that I've been feeling pretty useless. None of my classes are super interesting yet and I'm still in waiting-mode for summer stuff, so there's not a whole lot going on to make me feel "accomplished." And I hate that. I also hate feeling like I can't function without meds and therapy, but I also worry about what would happen to me if I gave those up. So I'm begrudgingly sticking with it and hopefully seeing the benefits soon.

It really bothers me not to have clear projects and goals. My treatment team would say that recovery should be my biggest goal right now (and they're right), but recovery honestly doesn't feel like something to accomplish right now. It feels more like something to endure. That distinction makes it hard for me to embrace the meal plan and therapy stuff when I mostly just want to look the other way and pretend it isn't happening. Not the easiest thing to do when I'm in treatment three days a week, but still.

So I've been getting the urge to seek out new projects, organizations, something to get myself involved in outside of school and treatment, and to make a difference somewhere besides my own narrow life. There are a couple of options, and I'll write more as things materialize, but it is definitely satisfying to have some plans in motion. I want to remember how to do things besides eating (or not eating), to remember that I have thoughts and talents and interests. Anyone can count calories; so what? I can do better than that. Anorexia has made me incredibly one-dimensional. I don't like who I am when I'm sick - not because I'm fat, but because I'm boring.

Last night my friend and I somehow ended up talking about stuff from middle school and high school, and I realized that there were times when the eating disorder wasn't front and center in my mind. It's been a pretty dominant part of my life since I was about twelve or thirteen, but it wasn't always this all-consuming force. I used to be interested in things like books and music and movies and clothes. I still am, to a certain extent, but it seems like everything takes a back seat to the eating disorder. My weight is approaching healthy, I don't exercise excessively, and I eat a reasonable amount of calories, but the mental intensity of the disorder is more powerful than ever.

It is dawning on me (I'm slow, evidently) that this won't resolve itself. That I won't wake up one morning and promptly decide that life is preferable to a slow death. That right now, I need to be proactive about pulling myself out of this and finding life beyond the sickness.

Tuesday, February 7, 2012

The Upside

You wouldn't know it from reading my blog lately, but I actually have a really good life. I am so lucky. It's lost on me sometimes, but I'm doing my best to keep the small stuff in perspective and not take too much for granted.

Some things I've got going for me right now:

- R had a phone session with my mom yesterday and I think it really helped her understand some things better. College City is really far away from where my parents live, and I know that my mom worries about the distance and not being totally in the loop as far as my treatment. So having the chance to talk to R definitely alleviated some of that and gave her some insight into what I'm going through.

- I started watching How I Met Your Mother. Lots of my friends are obsessed with it but I'd actually never seen an episode until a few weeks ago. It's not my favorite show ever (I'm a bigger 30 Rock fan), but it's perfect for unwinding and getting my mind off of anything heavy.

- In one of my classes, we just finished reading Jane Eyre. I haven't read that book since high school, and I forgot how much I love it. It's been a while since I've gotten lost in a book, but I came close a couple times this past week. I love when schoolwork doesn't feel like schoolwork.

- One of my articles for work was published online last week. I've written quite a bit in the past, but haven't had anything published in a couple of years so this was super exciting and ego-boosting.

- My coffee has been tasting especially delicious to me recently. I have no idea why, since I've been brewing it the same way for years, but I'm not complaining. (I'm a total coffee snob and only drink Starbucks.) There is nothing more wonderful than waking up to a pot of hot, fresh coffee. Mmmm...

Friday, February 3, 2012

The Invisible Cage

I'm feeling a little bit down lately. I don't know why. Just a little bit sad, a little bit lonely. It's not quite the crippling depression from last summer or the paralyzing anxiety from last semester, but maybe elements of both. There's some body hatred, although that's better than it has been at other times. More so, I'm just feeling discouraged with recovery. I want recovery, I want it so bad. I'm even almost sort of maybe ready to accept the fact that I will get bigger...I'm almost willing to subject myself to that. But actually following through day in and day out - that's where I fail again and again and again. I don't know what's wrong with me, but I just can't do it.

It's discouraging to be in therapy twice a week and still feel like I'm not making any progress. It's discouraging for one bad therapy session to cast a gloomy shadow over my whole week. Since R has been out of town since Tuesday, we skipped a session today and I'm not seeing him again until Monday. Part of me feels overwhelmingly lost without that extra treatment boost, and part of me is disgusted with myself for feeling so reliant on it. Most people don't need therapists; most people do just fine on their own. Why am I such a needy freak?

When I saw J, my dietician, on Wednesday, she asked me if I ever have moments of clarity when I realize how much time and brainpower I'm wasting on the ED. And honestly? I have those moments constantly. I am fully, painfully aware of how ridiculous the anorexic thought processes are. That doesn't stop me from compulsively tracking my calories and walking the long way to class to burn off a few more. It doesn't stop me from arranging my day around insane food and exercise rituals. Or from avoiding lunch out with friends because I've already planned my meal. For whatever reason, this pathetic pathological obsession trumps everything else in my life, hands down.

I don't know why I'm suddenly feeling so lonely. I have friends, I have my roommate, I have my mom, I have R and J. I just can't ever shake this nagging sense that there's something wrong with me. It's impossible to articulate how scared I really am sometimes, how hard it is to break out of this invisible cage I've erected around myself. Before going out, I am meticulous about assembling my happy face, and I refuse to discuss the ED on pain of death most of the time. I am: the perfect student. The smiling, helpful intern. The reliable friend who always listens. So then why does a tiny part of me have this incredible urge to get it all off my chest? To admit that I am bound by a million unspoken self-imposed rules? To tell someone: I'm not okay. I don't know why, but I'm not.

Sorry this was so lame, guys. I'll be more interesting another day.

Thursday, February 2, 2012

Talking to Strangers

Personality-wise, I'm pretty reserved most of the time, but I actually love talking to strangers. Not in a creepy way, but just small talk in waiting rooms, elevators, lines, that sort of thing. I think I get it from my mom, who can make conversation with anyone - doormen, cab drivers, cleaning ladies, you name it. While I'm not quite as chatty as she is, I do still enjoy meeting people in unexpected places. It's actually something I really like about myself and am really proud of, since I'm normally pretty quiet and withdrawn.

So this morning, I had to take my car in for an emissions inspection and oil change, and spent two hours sitting in Jiffy Lube. I met a young black guy in his late twenties/early thirties who started telling me about his job, his kids, his friends, etc. It was fascinating. He had three kids from age eight to eleven, their mom was "gone," he moved to this city to be closer to his mom and sister so they could help out, he had been saving for his kids' college educations since they were born, he regularly made an eighteen-hour drive to see his brother who lived on a Navy base, he wanted to join the Navy too but didn't think it paid enough for him to support his kids so he ended up in construction instead, and he had "a fucking ball" when he went to Tijuana with his friends last year. Then he gave me some advice on how to avoid getting ripped off by mechanics, and offered to change my spark plugs if I ever needed.

Not exactly the kind of guy I would normally spend two hours talking to, but entertaining. And eye-opening, in a lot of ways. Experiences like these never fail to remind me how small my world can be sometimes, when all I worry about is myself and my weight and food and school. It also proves how artificial a lot of my problems really are, like how many calories were in that banana? or will the walk to campus burn off the milk in my coffee? or why do my jeans feel tighter in the butt than they did yesterday? Like really, why do I care?

When talking to strangers in a waiting room or on the street or in a store, I can be someone normal, no assumptions or expectations, just a snapshot of a person. Strangers have no clue that I'm in therapy twice a week, that I need a registered dietician to tell me what to eat, that I track my weight and calories obsessively, that I doubt myself in everything I do. Strangers just see a youngish girl, brown hair, jeans, kind of quiet but polite, easy to smile, happy to chat, nothing more.