A Tale of Two Nutrition Appointments

Appointment #1
Date: 1 September 2010

I’m stressed, as usual. My finances are dwindling and I am trying so hard to find employment, to no avail. All that aside, I’m in a fairly good mood. I joke about my most recent faux pas — sending the wrong cover letter to an organization. My dietician plays counselor and reminds me that it doesn’t mean I won’t get a response. Reminds me that even if I’d sent the correct letter, it wouldn’t guarantee a response.

She asks about how the week went food-wise. I tell her my successes, of which there are many. Tell her about the day I had to completely rearrange plans, get a snack while I was out, talked myself through it. Tell her about how I cooked dinner with friends twice that week. How I ate cheese, arranged the situation so that I could feel safe doing so. She congratulates me on these successes, reminds me that it’s okay to be proud of myself for these things. Asks about my exercise. I’m training for a half-marathon again and tell her about my run planned for that night. She asks how far I plan to run and I tell her I plan to do a long run.  She asks why I don’t do a shorter run and I explain my reasoning (my weekend is busy, I haven’t done my long run, I’ve got the time tonight).

“Okay,” she says.  “That sounds like good reasoning.”  For the first time ever, I’ve got my dietician’s blessing for a long run.  But it is a blessing that comes with a warning to be careful.  To add more protein and be aware of my body’s signals.  The headaches and chills could easily be a virus, but could just as easily be my metabolism ramping up and the first signs of starvation again.

Appointment #2
Date: 8 September 2010

I take my place on the couch, wonder if I should be concerned that I want to use the blanket.  It is September in the south.  It is not cold.   She asks where I am on a scale of one to ten.  “Five?” I say.  I am numb, completely out of my element.  Frustrated, overwhelmed, anxious.  She asks about the phone interview I had only hours earlier, one of the final steps to admission for a residential program I’ve been dragging my feet on.  Something about my answers – or lack thereof – raises a red flag for her.  She asks about my eating, my exercise.

I admit that I had trouble over the last week, that I was alone most of the time.  It was a holiday weekend, there was no structure.    She nods, says that weekends are hard for overeaters – and undereaters.  Asks about my exercise.  It looks like it did a few months ago.  “So you’re restricting and overexercising?” she asks.  I shrug.  It hardly feels like restricting.  It hardly feels like overexercising.  It’s fine.

The tone of conversation shifts.  An appointment that began with my nutritionist telling me that recovery is going to involve blips like the past few days is now ending with her telling me to be careful.  She tells me that we may be looking at an entirely new manifestation of the eating disorder.  Reminds me that I do, in fact, have an eating disorder.  Reminds me that I’ve got to be careful, vigilant, smart – or risk the hospital. Reminds me that while I might think I’ll be happier if I drop just a few pounds, she’s walked this road with me. I wasn’t happier. I was sick.

“Careful, Jess.”

Date: 11 September 2010

She was right, of course. I don’t understand how she is always right, but she is. I thought I was doing okay – I am not counting calories, not obsessing over meals. To be honest, I don’t need to. The list of safe foods is dwindling and if I really needed to count I could do so quickly and easily.

I thought I could just drop a few pounds, that I could control this. I forget that I am biologically programmed for this, that this will always be a possibility. Somewhere around day four, a switch goes off in my brain. The fear and rigidity that defined the last year return. I shy away from people and telephone calls. Those rare instances where I do go out are marked with the inability to be present in the conversation, my mind too terrified by the food that is passing through my mouth. My head pounds consistently.

My homework this week is to keep track of three or four things I am doing every day to keep this relapse at bay. Things related, specifically, to food. (“We’ll tackle exercise next week,” my dietician says.) They have been simple: eating a full dinner, acknowledging that the headache means I need to eat a snack (and eating it), attempting to eat pizza at a friend’s going away party, accepting an invitation to get frozen yogurt.

So I’m still fighting. I am sitting on the couch writing a blog instead of running. I am eating. I am speaking truth over myself and reminding myself of why I’m fighting. I am praying, whining, crying. I am doing my counseling and nutrition homework, reading my Bible, journaling. I am trying to beat down the despair and hopelessness that threaten to overtake me.

I’m doing everything I can to keep this down. Except…I haven’t told my closest friends and supports that I’m struggling. Part of me still thinks that I’ll eventually just snap out of this and it will all be fine. No need to worry people unnecessarily. My dietician knows and that’s enough, right?

So, loyal readers, a question for you:
When do you alert your support team to a possible relapse? How do you even start that conversation?


5 thoughts on “A Tale of Two Nutrition Appointments

  1. I would start now. Send them this blog entry or just say, “hey, I am in a rough place right now. I need some help. Here are some things you could do to help:
    1-I am struggling not to exercise. Can we rent a movie/do crafts/go window shopping/sit and read together/insert other not exercising activity?
    2-I am having a hard time eating all my meals. Can we get together for a meal? This is what feels safe to me yet is still enough _____.
    3-I am isolating. I like having you as a friend, but I’m having a hard time being a friend right now and it’s to my detriment. Can we make plans? And if I try to cancel, can you come over and tell me we’re doing something anyway?”

    It’s never “too early” to alert someone to this problem–there is only “too late.”
    I will answer your other questions soon (on my blog) but I felt this was very important to respond to.

    I have asked for help from very unlikely people, and sometimes you don’t even have to explain everything–you can just say “I’m lonely” or “I’m going through something rough right now” and that’s enough of an explanation. If they are the right kind of people, they can sense urgency and can usually respond in a very positive way.

    • Thank you, thank you, thank you. These are such great suggestions. I don’t know why it seems so terribly difficult to put together a sentence like the ones you scripted, but my brain just doesn’t work that way.

      I am seriously considering doing just what you said and sending my support team this blog entry. :)

  2. Oh, and have you read “What color is your parachute?” It has a lot of really helpful suggestions for job hunters. It’s really cliche, but it helped me get my most recent position.

  3. Jess,
    Admitting to a relapse is hard … because when you are relapsing you are flirting with something that doesn’t want help. And you lose energy (emotionally, spiritually, and physically)

    Yesterday my mom said “you don’t want to relapse” and I almost laughed. I wanted to say “what do you think THIS is?”

    But, of course I didn’t.

    Last night I read something about the physical reaction we have…how small restriction just triggers stuff inside. It used neuropathology to explain that when you do something, a “rut” forms in the brain and gets deeper and deeper …but never goes away.
    Like if you were to take a sled in the same path in the snow, the groove would get deeper and deeper and you’d be less prone to meander or go anywhere different. It basically directs the sled. Even if you take a brake for a while, the moment you come back you are “in it” hardcore. You don’t have to really “break it in” You know?
    Anyways…thought that was profound.

    • Missy, if you’ve got a link to this article (or a title if it’s a book or can’t be found online), I’d love for you to send it my way!

      This makes PERFECT sense in terms of eating disorders and relapse – and explains why relapses often get consistently worse if one doesn’t catch them quickly enough. I’m really surprised that I didn’t have to “break it in” this time – especially being weight restored, I thought I would eventually just sort of snap out of it (like I used to do in my pre-diagnosable ED, “only” disordered eating days). However, this whole idea of neuropathology and brain ruts explains why it was so quick to go back into full-blown addiction.

      Thanks for the perspective.

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