Scientific Evidence and the Art of Therapy

There was a very interesting article in the New York Times a few days ago: Looking for Evidence That Therapy Works. While I have mixed feelings about it (and the comments—good lord, people are getting feisty!) that are no doubt a result of my own experiences in therapy, the author raises a lot of great questions about the nature of treating mental illness, and how to regulate quality in a field that relies on empathy, trust, and human relationships as much as research findings.

This quote caught my eye:

“'The idea of therapy as an art is a very powerful one... Many psychologists believe they have skills that allow them to tailor a treatment to a client that’s better than any scientist can come up with with all their data.'”

The idea is compelling, and seems to make a lot of sense: that individual therapists—people who have presumably entered the profession out of a desire to help others—rely more on their compassionate, creative human instincts than armchair theorizing from a textbook.

BUT. Psychology is a science, no? A human science, and one that incorporates a lot of unpredictable variables, but a science nonetheless. And in order for mental health treatment to get the same attention, insurance coverage, and research funding as, say, HIV or Alzheimer's or breast cancer, there need to be measurably beneficial outcomes, and a standardized quality of care.

Of course, I've been thinking about my own therapist, Dr. P (whom I love more and more every week). I don't really know what to call her style—online, she mentions CBT and interpersonal therapy, although I'm never aware of what exact methods she's employing during our sessions. Maybe I should ask. It feels natural and conversational and "therapeutic" in that I'm able to get out a lot of what's on my mind, and invariably leave her office feeling better than when I entered. She does periodically ask me how I feel our sessions are going, and if there are any adjustments she should make. (I think I may have scared her by ranting about past therapists, haha.) Anyway, my point is: she's wonderful. I'd like to think that she's treating me according to strict, evidence-based therapy guidelines, but not knowing doesn't necessarily bother me.

The article goes on to say:

"Besides, evidence-based treatments like C.B.T. still require expertise, clinical judgment and skill from practitioners,' noted Terry Wilson, a professor of psychology at Rutgers University. 'A stereotype of manualized treatment is: you go buy a book and it’s a rigid, lock step thing,' he said. 'But when done competently, it’s anything but.'"

So, I'm torn about the issues raised in the article, and I don't necessarily have a neat conclusion to this. I feel very strongly that mental health care must be subject to the same rigorous standards of research that other medical practices are; at the same time, as someone who's been through my share of therapists, I understand that there's no "one size fits all" here. Mental illness is not a biologically reducible infection; you can't just stop by the local clinic and pick up a round of antibiotics. (Hell, wouldn't that be nice?) But I think it's certainly possible for empathy, compassion, creativity, and humanity to be incorporated into the manualized, evidence-based treatment modalities.

Redemption via Fun Facts

Because you guys have been super good sports about letting me vent about HOW HARD IT IS TO HAVE TWO FANCY SCHOOLS OFFERING ME MONEY AND AN EDUCATION, and because I'm a dork and feel like being silly, and because I have a presentation and a paper due in twelve hours and THUS I have time to be blogging right now, I thought I'd cut the negativity and share some fun facts about my life.

- One of my professors is preggers. Like, really preggers. She's due in June but wasn't really showing before spring break, and then we came back to class last week and WHOA her belly had popped. She told us a cute story about how her two-year-old daughter is super excited to be a big sis and keeps asking "IS THE BABY COMING TODAY? IS THE BABY COMING TODAY?" And she's Chinese, so you know Professor S makes cute kiddos.

- I refilled my water bottle four times today and as a result, peed every 25 minutes. Then I got coffee and peed some more.

- Still obsessed with The West Wing. 

- But thrilled to see that there are new episodes of Mad Men on Netflix.

- Perchance TMI, but I am on the cusp of Consecutive Period #9. My cycle hasn't been this consistent since high school. Maybe when it's been a full year I'll stop giving you monthly updates on my reproductive cycle. Maybe.

- Prospective Grad School #1 gave me a sweet pen with my admissions packet and I'm trying not to let that sway my decision.

- A couple months ago, I was at the pharmacy in College City and the kid in line before me didn't have enough money to buy everything he needed. He was like 90 cents short, and got totally embarrassed and flustered. The line behind us was getting out of control, so I handed him a dollar to cover it. Then the cashier came out from behind the counter and gave me a hug and said "God bless you" and told me I was a good person. It completely made my day. Anyway, that same cashier is always working, so whenever I'm at the store he greets me like I'm the pope and gosh darn it, that adorable old man is a sweetheart.

- I need more blogs to read! Any suggestions?

More Decision Angst

This decision is making me sick. I hate that I am in a fantastic position regarding my future, but am getting totally bogged down by the what if what if what if of making a wrong decision, focusing on the wrong factors, sealing a miserable situation for myself, etc. etc. etc.

I know that I'm not giving you guys enough specifics, and I apologize—that's the nature of blogging pseudonymously, I suppose. Basically I want to combine certain features of both universities and meld them into one Super School in one Super City. Sound reasonable?

Doesn't help that PMS is in full-force this week, I've got a paper and presentation tomorrow, I'm feeling fat, and the drugs from Dr. A haven't yet had any real noticeable effect. We are fast approaching the end of the month, which was my self-imposed deadline for determining whether or not the steroid was going to work; I'm feeling a little better but nowhere near 100%. Maybe this is a case of "the grass is always greener," but I really do feel like this decision would be orders of magnitude less difficult if I were feeling physically capable. My health makes everything seem completely unmanageable and overwhelming, and the stakes of a bad decision are so, so much higher.

Hopefully Dr. P will have some words of wisdom tomorrow. And at some point, I need to just make the freaking choice and remember that these are two years of my life, not an eternity.

Oh, and you all might be glad to hear that we did finally manage to get that bottle of wine open using a combination of two paperclips, a knife, a screwdriver, and a pair of pliers. Suffice it to say that the integrity of the cork has been compromised.

Random Sunday Tidbits

Things are just kind of chugging along, nothing huge happening other than a bad case of senioritis and that major life decision looming ahead of me. I did manage to get the commitment deadline pushed back at both schools, so I'm not under as much of a time crunch anymore, thank goodness.

Did anyone watch "Gilmore Girls" back when it was on? I've been told "You're just like Rory!" three times in the past week. I think it might have something to do with my grad school pros/cons spreadsheet and the attached page of color-coded notes. I suppose it's an improvement to be obsessively recording something other than food and calories.

On the food front, I'm pretty sure it's official: the weight-lifting is totally responsible for my massive appetite increase. Things had settled down over the past 2-3 weeks when I laid off the workouts, but I've since gone twice this week and holy moly I'm starving. Guess it's time for some more of these:

yum

I think I mentioned this before, but I really am trying so hard to up my fat intake. I've heard over and over from ED doctors how important it is for my bones and stuff, but only in the past year or so have I learned the effects that fat has on other stuff—for me, specifically, my eyes and hormone levels.

In related news, it is becoming more and more clear every passing month that PMS wreaks havoc on my mood. As a teenager, I never really had the cramps, moodiness, zits, or any other stereotypical symptoms. I used to roll my eyes at girls who complained about them because I thought they were full of bull. Looks like I owe them all a big apology, because gosh darn it if the anorexia and weight restoration haven't totally reset my system. For the past few months like clockwork, despite a drastically improved mood overall, I descend into a two- or three-day-long emotional crisis leading up to my period. I call my mom in tears. I get crampy and cranky and icky feeling. I question the point of life. Also MY BOOBS HURT. It's like the most cliché thing ever but totally true. This, this, and this were all written in hormonally-induced hazes. Ugh, I'M SUCH A GIRL.

One of my best friends came over last night to chit-chat and split a bottle of wine (except that we suck and destroyed the cork and weren't actually able to retrieve any of said wine from the bottle) and creep on people we hate on Facebook. It was all very high school-ish, actually, but it was raining so we didn't want to go out, and we ending up having a great time. Today I'm looking out the window scratching my head wondering how the heck there can be snow coming down when it's almost April. It's seriously like the freaking tundra out there.

I think this post was an exercise in stream-of-consciousness. Welcome to my mind!

Pain, Probiotics, Procrastination

I'm still agonizing about my grad school decision, but there's not much more I can do other than pester as many people as possible with questions and mull it over. I just sent my parents a quite extensive Excel sheet with pros/cons of each school, and will be talking with my dad about that later.

So, other stuff. Since that nutritionist visit earlier this month, I've been trying really hard to increase my fat intake. Lotsa nuts, peanut butter sandwiches, 2% yogurt, cheese, etc. In general, I think it has made a difference in my hunger levels—a.k.a. I'm not positively starving all the time—although that could also be a result of not having worked out in a couple weeks. Before my spring break, I was heading to the weight room about twice a week, but haven't lifted since seeing Dr. A. Speaking of, my pain levels are somewhat improved...not dramatically, but some. I'm giving it until the end of the month before I make any concrete evaluations about whether the drugs seem to be working or not. At that point, if there still isn't any major improvement, I'll call Dr. A and discuss what's next.

Oh, another nutrition-related thing: anyone have any opinions/data on probiotics? My gastro mentioned them once as a "can't-hurt-might-as-well-give-them-a-try"-type thing back over the summer, but I didn't really pay much attention. This most recent nutritionist definitely recommended them, although I've obviously been taking her recommendations with a grain of salt.

Okay, this post was a shameless exercise in procrastination. As soon as I submitted my thesis, every last shred of my school-related motivation instantaneously dissolved, but now I have to get my butt in gear and write a paper. Happy Friday!

Grad School Dilemma

For once, I'm having a major major internal conflict about something totally unrelated to food, weight, body image, bodily health, eating disorderedness, treatment of said eating disorderedness, or any other iterations of eating disorderedness. It's this damn graduate school decision. Basically, I have offers from my two dream schools and have zero concept of how to make a decision that will determine my academic/professional/personal future. I never expected to get into either program, and therefore never expected being faced with this kind of dilemma.

School #1: Big name, highly prestigious university located in Big City about an hour from my parents' house. Same Big City where my brother lives, my dad works, and my mom visits at least once or twice a week. I should also add that my dad (who is helping me fund this venture, and therefore should probably get some input into the decision...) very much wants me to go here. Because of the school's reputation, this would probably open a ton of doors for me, and would give my daddy something to brag about at the water cooler. Plus, Big City has every possible type of opportunity imaginable in terms of research, internship, and job opportunities. That being said, I'm a little iffy on how the school's curriculum is set up. When I visited last week, I didn't get the impression that the faculty and administration were super approachable, and I feel like it might be an uphill battle to get the kind of education I want.

School #2: This is actually my undergraduate university. While the university itself is not as well-known as the first school, the graduate program I'd be attending is actually ranked first in the country. So while School #1 has the name/prestige factor, School #2 has a more prestigious position in my particular field of study. In addition, School #2 has a whole research center devoted to the kind of work I want to do, and there would be several formal opportunities for me to work in both labs and clinical settings. I would have more control over my own curriculum. Plus I'd be staying in College City (which I adore), so the living arrangements would be much simpler (and cheaper!). Big City intimidates me a little, but College City feels super manageable and comfortable. Also, my eye doctor is here.

If this weren't obvious, I have a gut feeling about School #2. I love this university, this city, this part of the country. A lot of things about the program seem pretty perfect. BUT. I hate living a thousand miles from home, and I hate knowing that my dad would be disappointed. School #1 is a prestigious, fancy, globally recognized institution and there are a lot of advantages that come with that.

And to be perfectly honest, my health needs to enter the equation. While I'd like to be optimistic, I have no way of knowing what sort of shape I'll be in six months or a year from now. I feel like a pathetic little kid admitting this, but having so many health problems makes it really hard to be fully independent and hard to be so far from my parents. After four years of living out here in College City, the prospect of being able to hop on a train and head home for the night or weekend when things get rough is hugely appealing.

I talked Dr. P's ear off today in my appointment and she definitely helped me isolate some of the major factors affecting my decision, but I'm still totally floundering here.

HELP.

Dim Sum, Nonexistent Credit, and Lemon Scrubs

I'm leaving home for College City in a few hours—just wanted to pop in and say hi and give some updates about my week! I had a lovely spring break hanging out at home, seeing family, watching The Bachelor and The West Wing, spending less than .002 seconds on schoolwork (I opened a book! Once!), and getting increasingly wound up about this damn grad school decision. I honestly didn't expect to get in anywhere, and now I'm faced with these unexpected options that are making my head spin. More on this later, but sheesh its a big decision.

Other random developments:

—We had a big family dinner with my dad's side of the family last night in Big City. We didn't eat until about 9 p.m., and it was the traditional dim sum-style Chinese meal we always do with Papa's relatives—a.k.a. lots of foreign ingredients, multiple courses, etc. I did surprisingly okay, although I have no clue how many calories I ate. It honestly still amazes me how relaxed I can be about food, even in an unpredictable situation like that.

dim sum

— I got rejected by three (THREE) different credit cards within ten minutes. How the heck is someone supposed to build a credit score these days? My brother kept telling me to get one while I'm still in college, since it's supposed to be easier to get approved as a student. Not for me, apparently. Maybe because my yearly earnings are embarrassingly low.

—Mom and I were super decadent yesterday and got pedicures. It was all nice and lovely except that they did this new lemon juice scrub thing on my calves. I had just shaved my legs that morning and there must have been some razor burn or something, because GOOD LORD it stung. I nearly kicked that poor Korean lady in the face.

ouch

— May have mentioned this before, but I'm thinking of going back to see my psychiatrist again soon. I was putting it off because she works in R's clinic, but I do love her and want to be able to check in. And hey, if I run into R and the awkwardness causes psychological harm, maybe she can prescribe me something for that. But in all seriousness, I was starting to feel some of the old anxiety creeping in over the last couple weeks and don't want to let that go for very long. Haven't decided if I'd be open to increasing my meds yet, but I would definitely want to discuss it with Dr. L. Obviously I'm in kind of an anxiety-producing life stage right now, so maybe I just need to pull it together and be an adult.

Hope everyone is having a lovely Sunday!

Lazy Spring Break

Still home, just being lazy and soaking up the family time. Yesterday I laid around the house literally all day and watched about seventeen episodes of The West Wing. Today I was a smidge more productive, and got my butt into Big City to visit a potential graduate school, then met my brother for lunch at his office. After a teeny tiny panicky episode Friday night, I'm feeling really good, really optimistic, and overall really content with how things are progressing.

in love with this show!

Still in some pain, but Dr. A totally restored my faith. I'm a realist at heart and won't believe it until I start seeing actual results, but he promised me that I'm totally curable, and even said how proud he is of me for staying the course with food, exercise, etc.

Speaking of, we had a long talk about exercise in my appointment. I mentioned it briefly in my epic recap, but that was starting to resemble a doctoral dissertation more than a blog post so I didn't go into much detail. Anyway, he wants me to lay off all exercise for a couple weeks, or at least until the steroids start kicking in and I feel the nerves calming down (e.g. fewer of those horrible electrical stabbing pains). Then, he wants nothing "intense" for another year or so, assuming I maintain my weight and continue to have regular periods. I will probably also get my hormone levels tested again at some point, just to make sure they're back within (or at least closer to) a normal range. My doctor said something like: "Your brain remembers not having periods, and it wants to shut them down at the first sign of distress."

So, back to exercise. What does "intense" mean? I'm not really sure, to be honest. I'm definitely not allowed to run for a long time, unless it's super light jogging. And to be honest, I'm not sure I trust myself to keep it light; I have a tendency to keep upping the speed/incline on the treadmill or telling myself just one more time around the block and before you know it, I've run X miles and burnt a gazillion calories in the process. Dr. A said weight training was okay as long as I didn't overdo it, but again, what does that mean?? I don't do a particularly strenuous lifting regimen, but I'm also a major weakling and definitely work up a sweat from it. Is that overdoing it? I think it really might be time for me to give yoga another chance. At the moment, I'm feeling super cautious and protective of my body and do not want to jeopardize my health, but I also love love LOVE the way exercise makes me feel.

source

Well, lots to think about. On an unrelated note, I have lots to think about regarding my graduate school choices, with which I won't bore you now but get ready for some major decision angst in future posts.

P.S. Does anyone remember my eyeball saga? I haven't seen my eye doctor in over a month, which is a record for me in the past year. If anyone out there is still unconvinced about the miraculous curative powers of weight restoration, please e-mail me.

Travel Woes Part II and the Big Appointment

Okay, I realize that I may be bombarding you with posts this weekend but I have a lot to write about! Sorry I'm the center of the universe!

So as I mentioned last night, I had my three-month follow-up with Dr. A yesterday morning. It was a small miracle that I even got there at all, logistically speaking. Dr. A's office is in Big City, which about an hour train-ride away from Home City. After all the flight/driving delays the night before, my mom and I left the house for my 10am appointment at 7:30 as there was still a lot of snow on the roads and we wanted to play it safe. We caught an 8:00 train and everything was going swimmingly until the train BROKE DOWN and we sat on the tracks for almost an hour awaiting rescue. But then, inexplicably, the train got started again and we were on our way. Lest you think I was calm throughout all this, do not be fooled; I was a nervous wreck. Good thing Mama was there to roll her eyes at me and keep a little perspective. Once in Big City, we went down the wrong block and ended up walking in circles in the snow/rain until we finally found our way to the doctor's office, stepping out of the elevator at exactly 9:59.

Before I get into the details of the appointment, I should probably give a more comprehensive recap of my progress since then. If you recall, Dr. A diagnosed a pretty severe hormone imbalance, muscle wasting, and tissue and nerve damage as a result of longterm amenorrhea and low body fat (whaddup, anorexia). The symptoms, which had been progressively worsening since December 2011, were pelvic, hip, and lower back pain along with occasionally persistent infections. Dr. A's prescribed treatment was an estrogen/testosterone compound (...no, I didn't grow a beard or anything), physical therapy, weight gain, no overexercise, and absolutely no losing my periods. So I followed all his instructions and my spirits were dramatically lifted...except that I never noticed much improvement in pain.

Onto the actual appointment: first, we went over the results of my blood work from last time. Turns out my estrogen and free testosterone were at less than HALF the levels of an average healthy 22-year-old. We talked about my weight, eating, exercise habits, and pain levels before moving onto the exam. He tested my muscle strength, tightness, nerve trigger points, etc. and the pain from that was actually all much improved. BUT the nerves were super irritated—we're not sure if this has always been the case or has developed more recently in conjunction with the other issues. He actually said, "Well we've fixed one problem but haven't been addressing the other! Is this new or did I miss it last time?" I don't think I've ever heard a doctor admit that before; admit that No I don't know everything, and it's my responsibility to get this right. Let's fix you. It takes real balls to leave your ego at the door and put the patient first.

Back when I was first doing research about Dr. A, I had read somewhere online that he was an arrogant prick. I almost didn't schedule that initial appointment, but luckily my desperation prevailed. I made my mom come with me because I was nervous to see him alone. And in the end, I am so lucky to have found him. He's one of the most highly regarded physicians in the country—nay, in the world—and has been nothing but compassionate, sweet, and funny to me. Oh, and a badass mofo medical genius. Yesterday I asked if I could clone him, but he politely declined. Jerk.

Anyway, the solution: I'm on a super potent steroid for the next 2-3 weeks to treat the inflammation that is irritating the nerves and still causing pain. During the exam when Dr. A started talking about this "new issue," I started to freak out a little, but he quickly added, "No, no, this is easy to fix." So that's it. I'm supposed to continue with the hormones and PT for another few months, as well as maintain my weight and periods of course—but according to Dr. A, the steroids should have me feeling dramatically better by the end of the month. Long-term, he's pretty adamant that hardcore exercise can't be in the picture for me until I've been having regular periods for a solid year or two. But my body should recover.

Anyway, I was obviously thrilled out of my socks to hear that. The pain is still making my everyday quality of life pretty darn crummy, but I just gotta hang in there a few more weeks. Last night I had a minor meltdown (WHY DO GOOD THINGS ALWAYS MAKE ME UPSET??) about what happens if this doesn't work? If my body keeps failing me? If I end up attending graduate school in a place without the doctors I need? My anxiety has been kind of bad lately, which is weird because it's been a nonissue for months. I am planning to see my psychiatrist when I get back to College City, so hopefully she'll have some suggestions.

Everyone please, please, I'm begging you like crazy, cross your fingers and your toes and say a little prayer to God or whatever you believe in that this is the thing that finally works. I'm so ready.

Travel Recap, More Updates to Come

Whoops, forgot to mention that I'd be home on spring break through next week. Yesterday was an eventful travel day, to say the least... First, I had an exam at 10am which ended up not being super hard but the lead-up was majorly stressful. I have been hit with THE SENIORITIS and studying was like pulling my own teeth out with a pair of rusty pliers. (Wow, where did that image come from?) Anyway, after the exam, I met my friend for lunch on campus before running home to pack/panic/clean maniacally because what better activity to perform during a pre-travel time crunch than scrubbing the bathroom? I DON'T KNOW EITHER.

Then my uncle was late picking me up to leave for the airport so I spent the ride there fighting off carsickness and anxiety-induced nausea. Security was was a mess, so I spent a few minutes hyperventilating and wondering if I could get the TSA agents to let me jump the line. But then it turned out to be a whole lotta hurry-up-and-wait because about halfway through the line, I got an e-mail alert on my phone that my flight had been delayed. Cue two hours of sitting/pacing/texting. This was also all especially stressful because I had specifically planned to come home Thursday night for my follow-up appointment with Dr. A on Friday. He's out of town next week (my official spring break) and I'll be back in College City (several states away) by the time he gets back, so Friday was literally the only day I'd be able to see him before the summer. So if my flight was canceled and I had to miss my appointment, I'd be majorly screwed.

But alas, my flight took off about ninety minutes late and was relatively uneventful. When I finally landed in Home City, it was snowing pretty hard and the drive back to my parents' house was slow-going. We finally got home just after 11pm, but I couldn't fall asleep until about 1...which was especially unpleasant considering I had to wake up around 5:30 the next morning to drive my dad to the train station.

Thankfully, I did make it home, did manage to wake up on time, and did manage to stay on track with my eating the whole day. Like I said, I'd stopped for lunch with a friend and got CHEESE on my sandwich (fats are good! even animal fats! take that, Nutritionist!), munched on a snack in the airport security line, ate the sandwich dinner I'd packed on the plane, and even had another little snack once I got home because it had been hours since I'd last eaten and I was famished. I remember so, so many travel days in the past spent trudging through the airport STARVING and foggy and utterly exhausted because I would set these arbitrary limits of what/when/how much I could eat, and would watch other people chowing down on soft pretzels and candy and wondering why the hell I couldn't be like them.

Anyway, that was my day of transit. I've got lots to tell about my appointment with Dr. A this morning, but this post is long and rambly enough so I'll cut myself off here. Have a great weekend, everyone!

Nutrition Review

Well, I did keep the appointment with that nutritionist that I mentioned last week. Basically I was too indecisive and didn't make up my mind soon enough to cancel it, so I went. Aaaaand.....she was okay. I have mixed feelings, but overall I think I came out of it with a pretty healthy sense of which recommendations to take away and which ones to ignore.

The Good: She seemed to have pretty holistic, well-rounded ideas about general nutrition. Whereas J used to basically just say EAT FOOD ANY FOOD OKAY BYE at every single appointment, New Nutritionist definitely took a more focused approach. (To be fair, I was underweight throughout the whole period that I saw J, and am not anymore.) After talking about my history and looking at a typical day of food for me, Nutritionist concluded that my diet is majorly lacking in fats. As in, I'm not even coming close to the recommended daily percentage. I don't have any particular aversion to fats themselves, although I still have this tendency to get the most volume of food for my calorie-buck, which leads to loading up on a lot of veggies and protein—not exactly conducive to incorporating high-fat (and therefore calorie-dense) foods. Once we established that pattern, Nutritionist pointed out a lot of opportunities for me to substitute higher fat options to help regulate my whacked-out system (your body needs fat to produce hormones!) and keep my hunger in check.

girl was ALL about the nutz

The Questionable: I got the impression that Nutritionist was very very very concerned about creating the Perfect Diet. For example, when we were discussing possible fat sources, she got super nit-picky about plant vs. animal sources. Um, I don't know about you, but I don't really give a shiz about whether my fat comes from yogurt or nuts. And for a recovering anorexic, that doesn't seem like a distinction we should be worrying about. She also had major qualms with processed foods; I don't eat a ton of them, but am definitely no Puritan about the issue. Luna or Clif bars are a pretty common snack for me, but Nutritionist was definitely Anti-Bar, and wanted me to start packing nuts, cheese and crackers, fruits with peanut butter, etc. for snacks instead. I'm sure the "whole, non-processed food" thing is indeed theoretically healthier, but not always feasible when I'm running around campus ten hours a day and need something easy to toss in my backpack. I also mentioned at one point that my grandmother had had Type II diabetes, and Nutritionist launched into a lecture about sugar intake and insulin production and yada yada yada. I had to put the lid on that one because while I have no degree in nutritional science, I assure you that my sugar intake is nowhere near excessive.

Luna bars

The Bad: Calories. I told her the number I eat every day, which even I know probably isn't sufficient. My biggest concern was that I'm eating this lowish amount, exercising, and still slowly gaining weight. J used to say that was because my metabolism was sluggish and that the only solution was to eat more—of course that was scary for me to trust, but it makes sense. Basically, Nutritionist said that my caloric intake was fine; that I should maybe increase eventually, but focus for the time being on swapping out stuff for higher fat options. I brought up the possibility of increasing calories a few times, and she sort of shrugged it off as unnecessary.

New Nutritionist definitely had some positives to offer, but I'm not going to take her word as gospel. And probably won't be seeing her again, although may check in periodically via e-mail. I am coming to the conclusion that my current weight gain (again, veeerrrrry slow but of course still freaking me out) is a combination of post-anorexia internal recovery happening with my bones, organs, cells, etc.; water-weight/muscle-building from resuming exercise; medications (I'm on a couple different ones, so who knows what effect/interactions could be happening); and funky hormonal action. Plus, who knows what the heck is going on with my body after the hell it's been through over the past few years?

My plan of action from here on out is going to be: increase fat and calories, keep up with the exercise in moderation, continue the hormone treatments from Dr. A to hopefully take care of this damn pain, and hopefully maintain my sanity in the process. I may need to accept the fact that the last time I was really at a healthy weight, eating regularly, and not being an anorexic FREAK was at 16 or 17 years old, and my body just may naturally want to be at a higher weight now that I'm 22. It's kind of hard to come to grips with the fact that I may need to be a higher weight for a while (and of course, by higher I just mean "higher than what I'm used to"—my BMI is still lowish-normal. Perspective...), but I so badly want to be healthy, to graduate from college, to go to graduate school next year, and finally leave all this crap in the dust.

Big Week Recap

It's been a pretty monumental week for me, for a couple reasons. 1) I submitted my thesis yesterday. Still have to defend in a couple weeks, but the bulk of the work—eighty-five pages of dis girl's unparalleled wisdom—is DONE. 2) I got into grad school! Big Name University sent me an offer Thursday night, which I opened in class and then proceed to spend the rest of the hour blatantly texting the news from the front row. Sorry Professor K! I think your class is really fun! Thanks for not yelling at me! Even so, the news definitely hasn't sunk in yet and I'm still in a bit of disbelief.

And how did I react to all these wonderful exciting things happening? Did I throw myself a party? Bake myself a cake? Paint the town red? Um, no. I called my mother in tears.

YOU GUYS. I don't know what the hell is up with me. I've just been down and lonely and kind of depressed. Not super bad, like not crying all the time or anything, just down. It's not even so much about the pain, although that definitely contributes. I'm feeling fat and blobby, and just so totally insecure about everything. Maybe it's hormones? I have my period, although I don't think it's ever had such an effect on my mood before.

Anyway, Mama Bear figured something was up when I called her yesterday to say "Hi Mama, guess what? I got into _______ University. Yay!" and then promptly burst into tears.

My mom helped me see that while I may be having a down period now, I've still made tons and tons of progress since last fall when things were the absolute worst they've ever been—physically and emotionally. And even though I may feel super unstable, I definitely have more tools and motivation at my disposal to get back on my feet. For example, I've kept up with my meal plan, got my butt to the gym today, and e-mailed my psychiatrist.

One main issue, like I wrote about earlier, is loneliness. My roommate was out of town Wednesday-Friday, and I spent a lot of time stuck in my head, ruminating about this, that, and the other. I tried really hard this past week to get out and be with people—I saw friends Monday and Thursday nights, and we have some major Post-Thesis Festivities planned for tonight. Then I'm getting lunch with friends on Monday and Tuesday of next week. But while all that stuff does eventually bolster my mood, I always get anxious beforehand. HI INTERNAL CONFLICT.

That all being said, I am still kind of Cloud 9 about the grad school news, and am really trying to bask in that success and keep all the other crap in perspective. And with the thesis done, I'm giving myself a break with schoolwork this weekend (except for that one pesky midterm) and am doing my best to get excited (not anxious) for the partying.

Happy Saturday everyone, hope the weekend is off to a fantastic start.