This is the letter that I will be handing to my T tomorrow at our session

I skipped Monday’s therapy appointment and e-mailed my T, saying I was “vacationing.”  I will show up tomorrow.  Instead of explaining myself and my “vacation” out loud, I will hand her this letter and ask her to read it.  Here it is:

Written Monday 5/2/11 and also Tuesday 5/3/11

A LETTER TO MY T REGARDING MY BRIEF VACATION…FROM THERAPY…THAT WOULD HAVE BEEN LONGER EXCEPT THAT I STARTED TO FEEL GUILTY ABOUT FIBBING

Dear T,

As of the time I am writing this to you, I am on a vacation from therapy.  That’s where my vacation was.  I didn’t go to Hawaii (which would of course have been my first choice), rather, I stayed at my home and didn’t come to therapy and told you I was “vacationing,” which is the truth.  I am doing this vacation because I needed a break to mull things over and try to figure out exactly how I felt about what was going on with my body and with what you expected of me.  I am also on vacation from my weight check appointments with Dr. K, for the same reason.

Sometime after April 12 and until April 30, I experienced unexplained rapid weight gain.  During the last week of this 18-day period, my weight showed a 5-1/2 pound increase in a single week between weight-checks with Dr. K.  In addition to weight gain, I noticed many other changes.  These included the following:

Ankle, calf, foot, and leg swelling

Abdominal (stomach area) swelling

Slowed digestion

Food staying in my stomach for many hours, even overnight, instead of going into my intestines after a short while

Constipation despite vigorous exercise (running)

Sluggishness, especially in legs

Depressed mood

Difficulty walking due to pain from what were now ill-fitting shoes

Difficulty tying shoes properly due to enlarged feet

Decreased physical stamina

Slowed running, difficulty running, and finally inability to run at all

Extremely lowered energy level

Loss of “bounce in step”

Feeling cold all the time

Loss of motivation

Insomnia every night

Feeling ashamed of my enlarged body

Feeling hopeless about my body

On Thursday, April 28, I finally experienced severe depression due to my hopelessness over my weight.  I knew something was drastically wrong.  I had counted how many calories I was consuming and how many calories I was burning.  I had watched my scale read a half pound a day gain for days.  I cried all day long over my weight and could think of nothing else.  Our session that day was only a quick fix.  I went home and cried some more.

The following day, April 29, I went to see Dr. K and showed her my swollen ankles.  She explained that I had refeeding edema.  I wasn’t familiar with this term, so I looked it up when I got home.

You know, if you Google refeeding edema, refeeding syndrome, which is fatal, comes up on the very same page.  I clicked on both.  I clicked on a lot of things.  I read some scholarly information, as well as some posts on message boards from people who were experiencing refeeding edema.  I learned that swollen ankles is a sign of refeeding syndrome.  Dr. K’s reassurance that the refeeding edema was temporary was also only a quick fix.  Even when she explained that this was the reason for the weight gain, I was not satisfied, because at this point, I was beginning to distrust both of you.

I awoke April 30 to a 2-1/2 pound weight increase.  Water weight, huh?  I went to tie back my hair in the mirror.  I did something at that point that I rarely do.  Normally, I use the mirror to look at my hair only, just to tie it back.  But I felt my face with my hands.  It felt fleshy and less angular than it had been.   I felt round cheeks, like a doll’s.  Slowly, I tilted my head up and looked at my face.

I didn’t even recognize the woman I saw in the mirror.  What I saw was a soft, round, chubby face, like the moon.  It was a sad face.  It had a pasty, white, stretched look, and no life in its darkened eyes.

I haven’t looked at that face in the mirror since.  I just tie back my hair and ignore what’s underneath.  But seeing what I saw then was the breaking point for me.

Was my body really playing this trick on me? Who was tricking whom?  No, T and Dr. K, it is you two that are playing the trick on me and on my body.  Why?  Because you expect me to sit back and watch this happen to myself.  You expect me to accept this rapid weight gain, extremely high fluid level in my body, and subsequent sudden larger weight and size as my fate.  You expect me to live with a myriad of other symptoms as I described above.

No, no no no no no.  I will not let this dangerous, cruel, thing happen to my body.  I am taking back my body.  I own this body–you do not–and I am going to care for my body right here right now.

I went running and did a lot of thinking.  I noticed that I was very, very sluggish on my run.  In fact, my pace was so slow that a walker in good shape could have passed me!  Whereas I normally run three to five miles, my legs were so filled with fluid that I was only able to run for seven laps, less than two miles.  My stamina was very low as well.  I gave up and came home, and did some more thinking.

After lengthy consideration, I decided to do the sensible thing: I cut back on my food to rid myself of the edema, get my digestion back in order, and bring my weight to a number that I can accept as okay for me right now, not some out-of-control and rapidly rising number that I am not ready for.  I knew that I was specifically not following your and Dr. K’s wishes by doing this.  However, I am following what is stated in my contract, that is, to take care of my body lovingly and with respect.  If I saw Puzzle puffed up and swollen, I’d be so alarmed that I would think that she was going to die.  I’m sure the vet would be extremely worried as well, and would respond appropriately and not tell Puzzle to “sit with the fear” and continue to allow Puzzle to remain an ill and bloated dog.

I chose to cut down on my food quite a bit.  After one day of reduced caloric intake, I felt much, much better.  Already, the swelling had gone down considerably.  On the second day, I noticed some body changes happening quickly. Although I am now eating less, I actually have more energy because there is much less bloat in my legs and the rest of my body, and the stomach fullness has almost completely come back to normal, though my digestion was still very slow.  After three days, my sleep quality was better than it had been in over a month!  My depression has been alleviated due to the fact that I no longer see out-of-control weight gain in the future.  I have taken back my body, and intend to keep it.  It is mine.

I have kept a careful log of everything that has been happening to me since I have cut back on food starting Saturday.  It is all good stuff, except for minor pain in one foot to walking in ill-fitting shoes (same shoes, expanded feet).  The foot is on the mend.  I also took photos of my ankles every day to illustrate the progressive lessening of my edema.  I may print out these photos and bring them in to show you.  I have posted these progress photos daily on the Internet, and have intentions of posting a warning to people with anorexia about refeeding.  Boy do I ever hate the term “refeeding.”  I intend to say that you shouldn’t suddenly start eating “normally” because of this horrible thing that can happen to you that happened to me, that plus the chance of developing refeeding syndrome is high if you’ve been starving yourself for a while and then suddenly change your regime, with a note that refeeding syndrome is indeed fatal.  Let it be a warning.  I will not do this again to my body.

I hope you understand.

Julie

Sad

I am depressed now and have little desire to eat.  I don’t feel hungry and didn’t eat breakfast, but forced myself to eat a seitan sandwich and some cantaloupe for lunch.  I walked to the supermarket and bought some more food for myself but haven’t a clue how I’m going to eat it all.  I bought a fair amount of fruit.  It was on sale.  It is going to rain.

Two letters to my T

I wrote two letters to my T that I will present to her when I go back on Thursday.  This will be after I have skipped my Monday appointment.  I skipped it because I was intensely angry at her and needed time away from therapy.  Instead of telling her this, I lied, and said I was “vacationing.”  I think, though, she suspects that I was lying.  She’s no dummy.

The first letter is lengthy.  It states the reasons why I cut back on my food and that I stand by my decision.  The letter states that I want my body back, and that in cutting back on my food I am in fact following my contract.  I am reducing the edema and treating my body lovingly and with respect.

The second letter states that I am afraid that I will die of complications from anorexia nervosa.  In the letter I told my T who to contact if anything happened to me.  I also requested that she refrain from force-feeding me in any way.  I said I was very scared, and left it at that.

Progress with yesterday's injury

This is what turned out:

I think the injury isn’t my old ankle sprain, but a foot injury–something separate.  The pain seems to be in my foot, lower down.  That is where I am icing, at any rate.  I iced first thing this morning, and took Ibuprofen.  I have had it wrapped most of the day.  I experience mild pain while walking.  The pain is on the distal side of my foot under the ankle only, but slightly toward my toes, and not on the bottom of my foot, nor on the medial side, heel, or anywhere else.  While not putting weight on my foot, I can circle it in all directions without any pain or weird sensation.  I don’t have to be anywhere today.  I took Puzzle out into the yard earlier, and once walked down the hall to pay my rent, and that’s it.  I consider myself fortunate.

I have been spending my time writing.  I plan to do some knitting as well.  I have written a couple of e-mails, and farted around at my desk.

I’m glad I have a desk.  Now, I can fart around.

Progress with REFEEDING EDEMA following caloric intake reduction–my report as of today

I have anorexia and am experiencing refeeding edema.  I am reducing my caloric intake to get rid of the refeeding edema, against the wishes of my treatment team.  Here is my progress report, Day Three:

Today when I awoke I noticed a “shifting” of swelling in my legs.  My thighs were significantly less swollen.  My calves were somewhat less swollen.  My ankles were about the same, and my feet seemed larger, but it was hard to tell.  I really didn’t notice until I put my shoes on, which was a bit later on.  I did notice that my weight was lower, so I have lost more fluid.  I didn’t dare look at my face.  I haven’t looked at it ever since I saw it in the mirror and didn’t even recognize myself on Saturday, the day I made the decision to eat less and get rid of this horrible edema and massive, continuing weight gain over a period of 18 days that shocked the heck out of me.

I noticed that my food is now moving faster from my stomach into my intestines.  Before, my 8:30 snack would still be sitting there in my stomach the following morning.  This I noticed toward the end of the 18 days.  Now, only a small amount of the snack seems to still be there.  Of course, I have no way of measuring this.  With the knowledge that my digestive system is still out of whack, and that energy is derived from my food later than usual, I ate my pre-run food early this morning–at 4am.  From what I could tell, however, this was not early enough.  I left the house at around 5, and I guess I started walking at the track (I am not running right now, which I will explain momentarily) at 5:20, it being a mile to get to the track, though in fact I was walking as soon as I left the house.  I experienced a noticeable burst of energy at 6:30, while still walking.  I believe that this was when I finally, after 2-1/2 hours, derived energy from my food.  I need to eat it earlier.  If I am awake at 3, I’ll eat it then, so that it’ll give me energy beginning at 5:30.  But of course, as time goes on, my digestion will continue to improve–I hope.  Two and a half hours is one heck of a long time.

I didn’t run, because shoe fit is still quite difficult.  I am learning lacing fairly well.  But in order to have them laced without pain, my heels come up out of the shoe significantly.  I can’t run like that.  But I can walk just fine.  I walked to the track, walked 24 laps (six miles) then walked home.  Then I walked the dog a mile, and later, walked to the drugstore, about a mile and a half round trip, totaling 10-1/2 miles for the day.  I have no leg discomfort or discomfort on the bottoms of my feet, but there is some feeling in the way my ankles kind of spill over the tops of my shoes.  I plan to walk my dog one more mile later on.  During my six-mile walk, I had no problem with physical energy.  I didn’t slow toward the end.  My speed improved as I went along.  My attitude was great.  My body felt great.  I felt lighter, and my body, specifically my legs, didn’t feel sluggish like they did before.  If it weren’t for my shoe fit, I could have run for sure, not six miles, but maybe 13 laps, with ease.  When I was in the throes of the edema, I struggled hard to sustain a seven-lap run, and my speed was horrendous.

Let’s see…what else.  Constipation.  With all the exercise I’m getting, you’d figure this would be no problem, but it has been.  This was resolved this morning after my walk–finally.  I hope it isn’t a problem in the future, but I fear that it will continue to plague my body for a bit before this whole thing ends.

My mood has been so-so…but definitely an improvement over Thursday, Friday, and Saturday.  I had thought my life was over due to rapid weight gain that was out of my control.  Now, I’ve done something about it.  Still, last night I realized I’ve got a long way to go with this.  The swelling is going to take a long time to go down.  My digestion is going to take a long time to work itself out.  My body has been way, way out of whack for 18 days now.  Of course, anorexia makes your body out of whack!  But what I have gone through has been an absolute horrendous nightmare for me because of the threat of rapid weight gain and my fears of becoming overweight and everything that goes along with it–physically and psychologically–for a person with anorexia.

I was thinking this morning that what I am doing is the right thing.  I am taking care of myself. I am following the contract set up between my therapist and myself, which states that I will take care of my body and treat it lovingly and with respect.  Giving it refeeding edema and allowing my treatment team to tell me to accept rapid weight gain as my fate is NOT treating my body well.

So there you have it.

Refeeding Edema–progress photos over a period of three days, while reducing caloric intake

I am a person with anorexia nervosa fed up with very rapid weight gain that has resulted due to sudden increase in caloric intake, though my caloric intake is very little relative to the high level of daily caloric burn that I have been allowing myself during this period.  The rapid weight gain occurred over an 18-day period in which I experienced a myriad of disturbing physical symptoms.  Most of the weight gain was the result of REFEEDING EDEMA.  This is the swelling of tissues common among folks with anorexia who are “refeeding” (eating “normally”–or shall I say “not starving themselves”–after a period of starvation).  The most common indication of refeeding edema is swelling of the ankles (which I am experiencing); however, refeeding edema can be seen all over the body.  Swelling of the ankles can cause discomfort while walking or even inability to walk.  I am fed up with weight gain.  As of two days ago, I have decreased my food, against the wishes of my treatment team, during which I am taking a break from seeing them.  I plan to return to treatment after a week’s vacation time.

Here are photographs of the results of caloric decrease over the past 2-1/2 days:

April 30
May 1
May 2


Refeeding Edema–the continuing saga

Today, my condition seems improved after lowering my food intake.  My shoe fit has improved.  I was able to wear my running shoes okay, but very, very loosely.  My normally narrow feet are very wide now because of the edema, so my narrow running shoes aren’t right for my feet.  If I tie my shoes in a way that’s comfortable for me, my heels come up.  But I found that I was able to walk well enough, and after a number of attempts, I got the laces to the point of comfort for my feet.  I walked Puzzle (my dog) for two miles this morning, then walked to the track, walked four miles (16 laps), walked home, then walked to the supermarket and back–two miles–making it a total of ten miles so far today.  I have yet to give Puzzle her evening walk–and I will.  This is a typical foot-day for me, except normally I run a few miles of it instead of walking.

So, compared to yesterday?  Not too bad.  Much more comfortable.  Yes, I did run yesterday, but had a lot of shoe problems.  I didn’t particularly enjoy my run, either, and found that I was very, very sluggish running and walking.  Today, I am beginning to feel lighter and more airy, possibly because I feel less depressed, but also because I have less edema and feel more comfortable in my body.  I even have some bounce returning to my step.  I noticed this at the track today.  (It helps to have nice music to listen to.)

My energy level, despite lowered caloric intake, is very good.  I had no trouble walking 16 laps today.  I was a little tired coming home from the track, but I think I am always a little tired coming home from the track, especially given the fact that the sidewalk is bumpy and hilly.  I am less tired coming home the longer, flatter route, but I didn’t have my “thinking cap” on today and it didn’t occur to me to take that route.

One thing I have not mentioned in previous posts that occurred to me while reading outside sources, that is, on the Web, is that while refeeding, digestion can slow to the point that there is delayed stomach emptying into one’s intestines.  So normally, what’s in one’s stomach stays there about an hour and a half, and then goes into the intestines. I ate a snack at 8:30.  This would be digested by the time I went to bed at 10:30, or nearly so, because it was an easy-to-digest snack.  However, with the refeeding, and especially toward the end of the 18 days that I was gaining weight at an incredibly rapid weight and developing very noticeable edema, my stomach simply didn’t empty at night.  My 8:30 snack, which I always ate at 8:30 (I am kind of rigid), was still in my stomach, right where I had left it, when I awoke at 4 or 4:30.  At first, I believed that this was my imagination, but it wasn’t!  Nothing digested properly! Not only that, but my bowels had slowed as well, despite the fact that I was running three to five miles a day.  I hate to think of what would have happened if I hadn’t been running.  This is a documented phenomena that occurs among refeeding patients.

Today, my digestion seems to be working better, to my knowledge.  I do feel hunger between meals, and I feel an empty stomach between meals.  It seems that I have more energy sooner after I eat, as well.  I believe this is because my body is metabolizing my food quicker and my digestion is working better.

I may be no doctor, but I do know my body.  I own my body.  In the Women’s Movement in the 1970’s (and today) activists would say, “Take back our bodies!” meaning to free us from sexual violence.  I say, free me from unnatural mental and physical anorexia treatment and let me gain weight and gain a healthy mind naturally and wholesomely.  It is time for me to take back my body in every sense of the term.

In taking back my body, I take back full responsibility for caring for my body.  I suppose this means a lot more than just brushing the few teeth I have left.

See ya.

Depression, part zillion

Today was the third full day of really bad depression for me.  I woke up with it and it’s been with me all day.  This is not “anorexia recovery”!  This is bullshit!

I have very few comforts right now.  When I was out walking Puzzle, I had trouble with my feet because of the refeeding edema.  My shoes didn’t fit properly and I had to loosen them in the middle of our walk.  Still, they didn’t fit right.

I have found comfort in my old friend, starvation.  I am not starving myself too badly right now.  Just stopping by to leave off something I don’t want–extra weight.  My choice is to be gaining weight rapidly and uncomfortably and feel miserable, depressed, hopeless, and full of self-loathing, or be thin, reasonably happy, alive, and not suicidal.  It’s a no-brainer.   I’m doing this for my own survival.

My therapist did send me an e-mail back after I e-mailed her saying I was “vacationing” and wouldn’t be there Monday.  She doesn’t suspect anything.  She didn’t ask me where I was or how long I’d be or if I wanted to reschedule of if I’d show on Thursday.  On Monday, I’ll write to her and tell her I won’t be in on Thursday.

“False recovery….”  No thanks.  Goodbye.

My "vacation" Day One this is how it's going at 3pm

3pm-my ankles are still swollen.  I have cut out a total of 230 calories so far from what I normally eat up till now.  By the end of the day, it will be another 120, total 340. I was starving this morning @9am even though I had eaten after PZ’s walk.  I kept myself busy until lunch.  I didn’t feel up to walking to the supermarket today.  Too depressed I guess, so I walked to the convenience store and bought diet cola–my friend–like the old days. Or maybe I was just too hungry to walk anywhere.  I walked to the track, walked a mile, ran 1.75, walked .25, walked home, walked PZ a mile, and walked a mile (total round trip, that is) to the convenience store and back–total 7 miles so far today.

Knowing my luck, my weight will probably still go up, up, up.  It is my body’s fate right now.

This is ridiculous.  I shouldn’t be telling you these things.  I should keep it to myself.  It is none of your business.

My "vacation"

Yes, I am taking a vacation.  From therapy.  I have had it.  I snapped.  This morning.  I stepped on the scale and was 2-1/2 pounds heavier than I was yesterday.  As someone with anorexia, I find this devastating, especially since I am doing nothing to cause this to happen.  I am barely eating enough to maintain my weight.  I have been told that I am doing “all the right things” by my treatment team to “move toward recovery.”

Well, this is bullshit.  I hate my body and I hate myself.  This is not recovery.   Now, I desperately want to lose this weight, and I intend to do so.  I have been so depressed over the past three days that I can barely move.  I am stuck in paralysis and a thickness in the air.  Running was incredibly difficult this morning, and I stopped after seven laps even though I want so much to lose the ten pounds I have gained in eighteen days.  This is about as fast as they made me gain it at the ED hospital.  My running speed has slowed to what I believe is under a 12-minute mile! I was running an 11-minute mile not long ago and could sustain a 10-1/2 minute mile for about a mile if I pushed myself.  I suspect that this is because of the weight gain but I’m not sure.  It could be–believe it or not–because of depression.

I am vacationing–yes, in world called depression.  This weight gain is not worth the depression I feel, the sluggishness, and the loss of the bounce in my step over the past three days.  I want my joy back.  The only way I can do this is to lose the weight.  Then I will feel much, much better.  I think the moment of realization was when I glanced in the mirror and saw, for the first time, my round, round face.  It was then that I knew that I had to do something.  Now.

I am taking a vacation from therapy.  I’ve decided that I can’t deal with it right now.  No weigh-ins, either.  I don’t have one scheduled and I have no intentions of doing so.  It happens that I don’t see my psychiatrist until the end of June.  Fine.

Sorry.  I don’t mean to let folks down.  I need to do what I need to do.  If I am going to gain this weight, I’ll gain it slowly, not suddenly. Not 10 pounds in 18 days.  No thanks.