On Compliance

I've been back in College City for almost two weeks now, going to therapy and dietary every other day. Since I get weighed and show my food records to R at every appointment, this keeps me super accountable. At the same time, I'm staying alone in my apartment, so there's zero accountability in that regard. No one to make me eat, or to watch what I do/don't eat. I'm fully aware that it would be easy peasy to fill my fridge with baby carrots and lettuce and buy stock in Diet Coke, then guzzle a gallon of said Diet Coke before zipping over to R's office and hopping on the scale. It would be easy to keep fake food records with Boosts and butter and meat and eggs and cheesecake written all over them. I KNOW THIS. I'm not stupid. In some ways, these two weeks would have been the perfect chance to lose a few pounds that I oh so desperately need to lose.

But honestly, that just would've been a huge waste because R and J are expensive and I'm here to get well, not to keep myself sick. It's only two weeks - it's not even like I could lose any significant amount of weight in two weeks, plus the fact that I have anorexia and I do not need to lose any weight and I am actually supposed to gain XX pounds overall.

No, I have not been perfect. I have not hit the full meal plan once since being back here, but I come damn close most days. I've never in my life falsified food records or intentionally gamed the scale. I'm being honest in therapy, drinking my Boosts, and not exercising. I gained a lil weight this week, of which I am trying to be proud. It sucks when doing the right thing feels so crappy and wrong. Although, it is amazing to me how much more progress we make in therapy when I've actually done what I'm supposed to. If I've wimped out on the meal plan all week and/or lost weight, R spends a good portion of our session harping on food issues, which is probably necessary and reasonable if not enjoyable. But if I've followed the plan (or come close), we can actually talk about other stuff. On those days, I leave R's office feeling one hundred percent different and better.

One thing that has befuddled me in the past is how to be compliant but also to struggle. I've always had this implicit sense that if I am a good girl and eat all my food and gain weight, R will think I'm cured and donezo and I best get my well-fed butt out of his office to make room for the real sick people. If I'm not starving and pale and emaciated, then he might think this is easy for me and that I want this, and how the hell will he ever know how terrible I'm feeling? What if I actually have to - gulp - talk about it?

But I am, I'm talking, even though it feels icky and uncomfortable and I've probably cried every single day for the past month (and I am NOT a crier). I think today's session with R was the first one ever that did not involve a ten-minute lecture on Why Kaylee Should Strongly Consider a Higher Level of Care as She is Clearly Not Making it Outpatient. (I guess now I'm fishing?)

Anyway, that's the status of things. Happy Friday everyone!

A Snowy Day

Boo yuck gross it's cold and snowy, so I'm stuck inside today. When I was little, I adored snow days. Nothing seemed cozier than being holed up in the house baking cookies or playing Scrabble or watching movies. Now, it drives me nuts to be snowed in. Thank God for the internet and books.

I spent a good chunk of the morning cleaning - like, real cleaning. As in dusting, scrubbing, mopping, sweeping, disinfecting, and toting loads of trash out to the dumpsters behind my building. I've never been a compulsive antibacterial-wielding neat freak, but I do find cleaning to be oddly therapeutic. My favorite chore is washing dishes (except for cups and oddly-shaped utensils). I was feeling antsy and claustrophobic earlier, and some good scrubbing was just what I needed to take the edge off. Plus, every visible surface in my apartment is now gleaming. Who needs therapy? I've got a can of Scrubbing Bubbles.

My friend P called earlier. She's my best friend from high school and we're still super close. (She's the one I took a trip with last March). Since she goes to school across the country, we don't really see each other much anymore outside holidays and summer, but we always make a point to stay in touch and text/talk/e-mail regularly. Hearing from her gave me a huge mental  boost. We took turns venting about our various injuries (she has an inflamed SI joint, among other things). We actually met during cross country season our freshman year of high school and she still runs as well, so it was nice to talk to someone who "gets" it.

I actually asked my dietician J about exercise yesterday. She said that while she would "greatly prefer" it if I didn't work out, if I'm going to do anything I should stick to low-impact stuff like Pilates, yoga, weight-training, that type of thing. AKA no running. In fact, J told me that none of her underweight patients have her blessing to do any cardio whatsoever. That's what I expected her to say, I guess, although it was still kind of disheartening to hear. Sometimes it's hard to remind myself that even if I were injury-free tomorrow, part of me is still not well. But that's a topic for another day.

Exercise Temptations

I haven't posted about my foot injury too much lately, mostly because it was getting seriously old and there wasn't much else to say other than ouch, still hurts. When it originally happened, I thought I might take a day off from running, maybe two, and then I'd be all better and back in action. Since that didn't happen and my foot kept hurting for weeks and weeks, I stopped ALL exercise (except for walking around campus) and have basically been sedentary for about two months. Actually wait, almost exactly two months! I hurt my foot on 11/11/11. I only remember that because I was rushing to meet S to watch the time change together at 11:11, and the limping slowed me down. But I made it! Unfortunately my camera was being lame and took the picture at 11:11:12, but that's neither here nor there.

Anyway, this injury was right after a hip injury from the summer that just would not get better even though I'd taken time off and iced and popped ibuprofen. THEN on Christmas Day, my mom and I went for a walk because it was beautiful outside and I managed to hurt my other foot. Seriously? So that's been bugging me for past couple weeks, but finally finally finally knock-on-wood-I'm-scared-to-jinx-it I think I am close to being injury free. My hip still twinges occasionally and my left ankle gets angry if I stop short or climb stairs too quickly, but the pain is almost entirely gone. All good, right?

Yesterday, R asked if I was tempted to exercise again. I just sort of stared at him. Tempted? Dude, I've been chomping at the bit to lace up my sneakers and show that treadmill who's boss. "Tempted" doesn't begin to cover it. I miss running so much it hurts. Without it, I feel yucky and sluggish and off-balance. I need my exercise like a junkie needs his high. (FYI Cammy has an awesome post about this.) I have a strong suspicion that the mega-out-of-control-anxiety I've been walloped with lately has something to do with my poor, confused, endorphin-starved brain not knowing which way is up. I'm dying to get back in a routine of working out - not to burn calories, but to feel like myself again.

So yes, R, I am extremely tempted to exercise. But here's the thing: I'm also scared. I'm scared of getting hurt again. Between my hip and then my foot and then my other foot, it seems like I haven't gone a single day without some kind of pain, even weeks after I'd stopped exercising altogether. The Christmas Morning Foot Fiasco was hugely disillusioning because I hurt myself just walking. Slowly. For barely twenty minutes. I've been afraid to do anything - walk to the mailbox, spend a day shopping in the city, get out of bed too fast - because who knows what body part will give out next? It makes me feel fragile and useless. I'm twenty-one years old, it shouldn't be like this.

Besides that, I'm also scared of going backwards in recovery. I'm scared of restarting the ritual, by which I march to the gym like a robot, pound out my XX minutes, and march home. The ritualistic exercise takes care of my anxiety and quiets the private fat talking, but it consumes way more time and energy than is necessary or reasonable. If I've gotten away from that, why would I want to go back? Honestly, it's a relief to not have that hanging over my head every day. But I feel disgusting and on edge all the damn time, so is it a fair trade-off? I don't know.

I think my therapist and dietician were both secretly thrilled when I stopped running, but here's the thing: my weight hasn't gone up an ounce. And I've increased my intake. So if they were hoping that cutting the workouts would boost my weight, that hasn't happened. Plus, I'm no less obsessional or compulsive about food weight, meal times, etc. than I was before; cutting exercise hasn't broken that mental pattern for me in the slightest.

So here's my dilemma: physically, I will probably be able to start exercising again in the very near future, but I'm not exactly sure how to go about doing it in a way that is healthy for both my body AND my brain. I do genuinely believe that, ED or no ED, exercise (in moderation) is good for my mental health, so I really want to get back into it. But I don't want to hurt myself again and I don't want to regress into exercise-obsessed ED Land.

Monday Update

When I first got back to College City last Tuesday, I was a basket case. I've never stayed in my apartment alone before, and I was suddenly terrified of getting sick, hurt, locked out, robbed, murdered, fat, and on and on and on. I became convinced I'd leave the stove on and burn the place down. My anxiety was out of control and I absolutely could not imagine getting up each and every morning without some catastrophe occurring.

Now, things are a lot better. Well...let me amend that: things are better. Not a hundred percent better, but significantly better. Better in that I'm not having near-panic attacks multiple times a day. Better in that I feel okay, almost happy, most of the time (for the past two days, that is).

I've been busy, which helps with the anxiety tremendously. I started work at the end of last week, so that's taking up a good amount of time/brainpower. Then on Friday, my roommate got into town to stay for a couple of days before leaving for a trip. Having her around was good for a lot a reasons, but the main ones were 1) It kept me from getting stuck in my own head, worrying and worrying and worrying about everything, and 2) It shook up my private food routines. I don't eat in an explicitly disordered way when I'm alone, but I definitely eat differently than when I'm with other people. It's not that I restrict, but the balance/variety/general wholesomeness factor suffers a bit when there's no one around to watch me prepare my safe meals. For example, I might eat something breakfasty or snacky for dinner if I'm by myself, but with K here, I would take the time to get out my meat and vegetables and grain etc. and actually cook a real person dinner because that's what normal people do.

By the time K left yesterday, I was feeling calm and normal, and was remembering what it's like to not be a ball of nerves all the stinking time. I was actually able to function like a real human being again, so I spent yesterday and today running errands, finalizing school stuff, submitting internship applications, arguing with my insurance company over the phone, and catching up with one of my best friends. The anxiety is still there, but feels so much more manageable. I hesitate to write that because I do still sort of feel like it could burst out again at any moment and turn me back into a freaked-out worry monster, and I'm scared to set it off. For now, though, I'm okay.

In my appointment today, R could tell I was feeling better. He told me that after I left last week, he was "concerned." Why is it that this makes me feel guilty and stupid and ashamed? I should be relieved that he picks up on it when I'm struggling, not embarrassed. I should be grateful. And I am grateful, but mostly I just feel like an idiot for letting him see through me. What can I expect to get out of therapy if I'm more concerned with upholding some perfect image of invulnerability than with asking for help?

That being said, we had a good session today. I was still super uncomfortable (as always) but lately, I've found myself letting R in on a lot more of my private thoughts and fears than I would have in the past. For example, today I brought up body image. I've never been totally comfortable talking about this with him before, I guess because it seems like such a girly issue to me. (Of course, boys and men have body image concerns, too. This is just me being stereotypical and insecure and lame.) I told R about how my body image sucks (shocker!) and how long it takes me to get dressed in the morning. It's a small thing, but I felt really honest and brave admitting this to R. So I guess I'm finally warming up to him, and it only took me a measly four months!

Oh, I also got some blood drawn today, the third time in a month. My arm hurts. Why can't these doctors decide which tests they want to do all at once, instead of thinking up more and sending me back to the lab every two weeks? Just saying.

Resuming Treatment

I'm back in College City and saw both my therapist R and dietician J this week after a three-week holiday hiatus.

J was first, on Wednesday, and she was all about More Treatment. IP IP IP. She brought it up so many times that I was honestly just tuning her out by the end of the thirty minutes. She asked if I'd thought about taking another semester off to go to residential for a few months, to which I gave a resounding no. I've told her so many freaking times that I'm not even considering IP, and I wish she would just drop it. I realize that this would be more likely if I actually drank all the Boost she wants and put on the weight I'm supposed to, but still. I'm improving, albeit glacially, but I'm trying, okay? I promise. And there is just no way I'm leaving school again and no way I'm doing inpatient.

The Weight Thing is seriously weighing on my mind. She wants me to gain so much. This isn't a battle I'm going to win, I realize, because J has science and research on her side, but even thinking about the number makes me panic. I just don't know if I can do it, I really don't. We made a list of the pros and cons of weight gain, and obviously the pros (medical stability, reduced anxiety, increased energy, better concentration, etc.) outweighed the ONE con (temporary bad body image). But it's not like I can just read the list and realize, Oh! So weight gain is a GOOD thing! Okay, I'm game. It's so much harder than that and there's so much more at play.

When I saw R this morning, he said this: "It's time to fish or cut bait."(He had a lakeside upbringing, apparently.) I laughed at first, and I'm still not entirely sure what the mechanics are behind that idiom, but I believe it means something along the lines of "Shit or get off the pot," which is a bit more straightforward. Either way, the message was pretty clear; I've been tiptoeing around the meal plan, the weight gain, yada yada yada for long enough. I'm here, in treatment, and things aren't going to change unless I change them. He asked about IP too, I said no, and that's when he made the fish statement.

He was pretty blunt with me and expressed some serious doubts about whether I would make it outpatient. This upset me (although it doesn't take much to upset me lately) because he has always been so positive and has always reassured me, even when I doubt myself. So it was definitely a wake-up call - a necessary one, but unpleasant all the same.

But there was some positives, too. We talked a lot about the anxiety stuff, and he was completely understanding without being judgmental even though I was super duper uncomfortable and embarrassed and sat there jiggling my foot and wringing my hands and letting my eyes dart anywhere except R's face. He's pushing the medication again, and I think I might be down to try it this time. We'll see. I've waffled on this so much in the past that he just kind of dropped it, but today I came very close to agreeing.

Anyway. I'm drained from all the therapizing, but I'm trying to stay positive and remember how freaking lucky I am to have this chance. Two whole weeks of nothing but working on myself and my health, some of the top local professionals working with me, and a fully supportive mama bear who listens to me vent and wail and cry on the phone every night. (And some mornings.)

The Fat Trap

EDIT: Just a heads up, this article contains calorie amounts, weights, descriptions of diets/exercise regimes etc. that some people might find triggering. Feel free to skip it!

The original article is pretty long so if you don't feel like reading that, the interview with TPP is much shorter and covers the main ideas anyway. In the article, Tara Parker-Pope talks about how when people lose weight through dieting, their hormones/body compositions/metabolisms essentially reprogram themselves to promote weight regain. I guess it's basically the same idea as starvation mode in EDs, where the body slows everything way down to sustain itself. After losing weight, people get obsessed with food, food starts tasting better, cravings get more powerful, and hormones kick in to fight the loss. Basically, the bodies of obese people make losing weight and keeping it off Very Hard to do.

There are a few interviews with people who had lost large amounts of weight and are now maintaining their new lower weights, despite biology and genetics working against them. The way they described their lives, though...well, it sounded like my life. Counting calories, tallying every last bite, working out compulsively, calculating cal intakes and burns obsessively. TPP discusses this as a necessary lifestyle change, the way people with epilepsy or high blood pressure or diabetes might follow highly regimented diets in order to control their illnesses. Another article criticizes this approach taken by formerly obese people because their mentality "resembles the symptoms of an eating disorder."

Since I've never been obese, I honestly can't attest to whether or not this hyper-vigilant approach to eating and exercise is truly the only way to prevent regaining the weight. It sure sounds a lot like an eating disorder, but of course I'm not suggesting that obese people have to "turn anorexic" to lose the weight and keep it off. It is interesting though that obesity carries such a stigma that illnesses like diabetes, hypertension, etc. don't. Plus, the treatment for obesity (constant vigilance in eating and exercise) also seems to carry some stigma, like people are supposed to stay slim and trim without working at it or thinking about it.

This also made me think of my dad, who was allegedly a chubby kid and teenager (although I've seen pictures, and he never looked that big to me) before losing a bunch of weight in college. To this day, he is religious about working out and eating right, and has maintained a slim weight throughout his entire adult life. To me, it seems insane that he would have to be so careful about how much he eats and exercises just to maintain his healthy weight, but maybe he does? My dad was never obese, so I'm not sure how much this applies to the ideas in the NYT article. Plus, he could probably gain a relatively significant amount of weight and still be healthy.

I'm also wondering if it works in reverse, like if a formerly underweight person has to eat more and exercise less to maintain a higher weight than someone who has always maintained that higher weight naturally. But now I'm just thinking through my keyboard, so I'll stop.

Resolutions

I tend to be cynical about New Year's resolutions because I never follow through, and usually forget about them by Valentine's Day. This year, though, I need something to focus on, to feel like I'm accomplishing something good for myself. So, here's to turning over a new leaf and starting 2012 off with some optimism!

There are a few things I want to do this year. Maybe they aren't "resolutions" in the traditional sense (exercise more! floss every night! lose weight!) but just general areas to work on. The big one is Health. If I were feeling especially brave and motivated, I would make resolutions to Eat X Calories Per Day, Gain X Pounds, and Get a Period. But as I'm currently a lil bit lacking in both bravery and motivation, my goal is just to Do Better. I want to make a concerted effort to eat a more balanced diet; it's not that I eat a horribly unbalanced or restrictive diet now, but my intake is definitely not what it should be and I know better.

Another major goal is to be more honest with my treatment team about my anxiety. I haven't ever been "dishonest," per se, but I'm not exactly the most forthcoming patient, especially when it comes to my private, obsessive fears. It's becoming more and more apparent to me (and to my mother, who is probably much more worried than she lets on) that my anxiety level is getting a little out of control, and that it is probably my main obstacle in committing myself fully to recovery. I haven't really talked about the Crazy Anxiety very much with R, mostly because I feel stupid about how freaked out I get, and I can't put into words why it happens. When we do talk about it, then, I downplay the problem because it's embarrassing and lame that I get so worked up about the dumbest things. I'm bad at taking the lead in our sessions, which means that R focuses on the issues he sees as most important (food, weight, eating habits), and I don't always get a chance to talk about other stuff (e.g. anxieties unrelated to food/weight). I'm not saying that this is his fault (it's completely my fault) or that food/weight/eating habits aren't important (they're extremely important), but I don't think that R realizes what a problem the anxiety is, simply because I haven't brought it up.

That was a sprawling ramble of a paragraph, but basically I'm trying to explain that my other New Year's resolution - or goal, or project, whatever you want to call it - is to drop the ironclad Shield of Stoicism with R, and address the anxiety issue. It has definitely gotten worse recently, which made this holiday season nightmarish at times. Although I'm unsure of what triggers my periodic freak-outs and I'm still ashamed of them, it's time for me to suck it up and admit that I Need Help.

What else? Again, if I were a braver person, I would make all kinds of resolutions. Be more spontaneous. Eat fear foods daily. Post my meal plan on the fridge for my roommate to see. Have a real conversation with my brother about the ED. Visit my aunt and uncle on a regular basis. Throw out my skinny clothes. But I'm still fearful about a lot of things (and I've gotten even wimpier in recent months), so I'm not going to pretend that I can do all of those things.

Right now, I want to focus on the things I can do, and should do. Maybe I'll be ready for more adventurous resolutions in February, or June, or October. Baby steps!

Happy 2012 everyone!