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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by chaaya on February 3, 2005, at 18:41:56
As you can tell by the subject line, I am anorexic. I’m currently about 4lbs away from malnourishment and for those into BMIs, mine is 15.9. I’m currently seeing my primary care doctor weekly and today when I went in, I had lost another 2 lb. She told me that if I don’t start gaining weight, that she will have me hospitalized. I thought that my weight would have to drop a lot lower before she could do that.
I really don’t want to go into the hospital but if I have lost anymore weight by my appointment next week, I’m afraid that is what she will do. She also is going to talk to my pdoc so I’m sure that I will hear the same message from him next week.Can she really have me admitted at this point? I assuming that if she does admit me that my family will be notified which also really bothers me.
I’d appreciate input from anyone.
Posted by CareBear04 on February 3, 2005, at 21:04:41
In reply to Anorexic and forced hospitalization, posted by chaaya on February 3, 2005, at 18:41:56
chaaya, how old are you? if you're over 18, in the US, and not in immediate danger of killing yourslef or hurting anyone else, i would guess that you can ask for privacy so that your family doesn't get contacted. if you live away from your family, then you can probably keep this to yourself unless you have a really long hospitalization that interferes with school or work or runs up payments that you can't handle without help. my experience is that with young adults, most drs prefer to risk privacy violations rather than not notify and get sued by shocked parents. my cases were different, though, because i had made serious suicide attempts and was in medical danger. i think if you cooperate with your doctor and show progress or willingness to progress, you should get to choose whether or not to involve your family. parents can be supportive, or they can inhibit your recovery. you know best, and i would make this clear.
as for forced hospitalization, i don't know what the threshholds are. i think it depends on the person. in the fall, my BMI dropped into the 14's and my labs showed malnutrition. i was in the hospital for awhile, but not directly for the weight. i did have nutrition consults and nurses pushing food on me, but mostly they just told me to drink ensure and boost and protein. i just couldn't swallow b/c of throat pain or keep anything down, so a feeding tube might've actually made things easier, but they said it would aggravate my throat injury. i think that if you're willing to cooperate and try to eat, they like to avoid IV nutrition and tube feeding as much as possible. like you, my weight by itself wasn't that concerning. it was really low, especially for my height, but i've heard of girls with anorexia weighing 70 or 80 pounds, and i wasn't approaching that. i can't imagine being alive at that weight!
i think you can even avoid the hospital if you see your doctor regularly, even weekly, and gain a pound or so a week. when i started seeing a new doctor in december, he said he was worried that i would need hospitalization for nutrition, but i saw him every week so they could track my BP, weight, and heart stuff. in total, i've gained only 3 or so pounds, but i haven't had big dropoffs and any red flags.
anyway, my biggest advice is to cooperate or at least pretend. if you are young and female and in denial, the drs like to stick every derogatory label on you-- anorexic, borderline, somatic, attention seeking, histrionic, making yourself sick, and more. the less you're willing to help yourself and the more dangerous your situation is, the more likely it is that your family be become involved. for me, anyway, my parents have been more of an obstacle for me to overcome in the hospital and not support that i could rely on. i talk a lot and ask too many questions and am really indepedent, so i haven't fared well with most doctors. with most, you have to go along with their plan to get treated. if you're lucky, you can find a good doctor who's not intimidated by smart and aggressive women, who likes questions and intellectual challenges. these are also the drs who listen to reasonable explanations and opinions, so if there is a reason for your weight loss other than restricting, this type of doctor will listen. i think i would've had better treatment if i'd been docile, but that's not in my nature. it's like being caught between a rock and a hard spot, but if you can't really trust or give up control, i'd at least try to try. does that makes sense?
hoping you're well, cb
Posted by Racer on February 3, 2005, at 22:02:01
In reply to Anorexic and forced hospitalization, posted by chaaya on February 3, 2005, at 18:41:56
First of all, are you getting any treatment for the anorexia beyond seeing your PCP weekly? If not, here's some advice that might help you avoid IP: ask your doctor about referring you to a registered dietitian for nutritional counseling. When this was first suggested to me, I said, "Naw, no way -- I know all I need to know about nutrition, and what's she gonna tell me anyway?"
Turns out, a lot. Not just about nutrition, but about treating eating disorders. She's awesome, and very helpful. In fact, she's more supportive and helpful in moving me towards recovery than my therapist is! Truly, I didn't know what I could eat, and was so frightened of eating and gaining weight that I was just stuck. She helped get me out of that rut, and while it's still horrible, it's a bit less so knowing that I have someone to turn to for information.
In your situation, if you're willing to try to work towards recovery, and willing to cooperate with a refeeding program that -- I won't lie to you -- will make you very uncomfortable, then I think telling your PCP that you'd prefer to try OP treatment that includes nutritional counseling with an RD just might be enough to make a compromise between you. Maybe work out between you how much time has to go by and how much progress you have to show before she pulls out the big guns and sends you IP?
I think it's worth a shot, to ask her to help you get more intensive OP treatment before sending you OP, with the agreement that you'll go quietly if you can't make progress OP with the more intensive program.
Another option for compromise is a partial hospitalization program. That depends on there being one nearby, of course, but if there is one, that might be a better option for you. Or at least a less frightening option.
I hope that helps. Let us know what happens, OK?
Posted by chaaya on February 3, 2005, at 22:06:29
In reply to Re: Anorexic and forced hospitalization » chaaya, posted by CareBear04 on February 3, 2005, at 21:04:41
CB,
I am an adult. I have read somewhere that when adult women become anorexic, they are usually doing it to relive stress (rather than for looks) and are more likely to seek help, which does describe me. I had lost about half of the weight because of a medication that I was taking and the other half by restrictive eating. I did go to my therapist and pdoc right away and the pdoc told me to see my PCP. So I have been trying to work with them. I have a serious potassium deficiency but other wise, my labs are good (and I’ve had potassium deficiency even when eating right). We set goals each week – which I keep. I think that she was really bothered that I lost 2 lbs when she had hoped that I would sustain my weight or gain some. I had been losing as much as 3-5 lbs a week so I thought I was doing well. I had been doing well until something really stressful happened this week, and then I quite eating again (other than the scoop of protein powder that I promised to do at least once a day).I am also bipolar (unstable) and have had some SI incedents. I think that they see this as being another form of SI for me.
Thanks for all of the input; it really helps to talk to someone (besides my cats) about this.
Posted by chaaya on February 3, 2005, at 22:18:51
In reply to Re: Anorexic and forced hospitalization » chaaya, posted by Racer on February 3, 2005, at 22:02:01
Racer,
The idea of seeing a nutritionist Is a very good suggestion. I never eat very much (never have), so I frequently end up with nutrition problems even at my normal weight. So it would be a good idea for me to see a dietician Thanks for the input.
Chaaya
Posted by CareBear04 on February 4, 2005, at 1:06:52
In reply to Re: Anorexic and forced hospitalization » CareBear04, posted by chaaya on February 3, 2005, at 22:06:29
hey-- it's always good to hear about other people's experiences, i think. i had the low potassium problem, too. i've never purged or anything, but the drs in the hospital were convinced that low potassium had to mean purging. like you, i guess i just didn't take enough in. hope you're well!
Posted by Maxime on February 12, 2005, at 22:55:59
In reply to Re: Anorexic and forced hospitalization » chaaya, posted by CareBear04 on February 4, 2005, at 1:06:52
Since you are an adult, your family would not be informed. Also, your doctor should not focus only on your weight. Have you had blood tests done? What deficiencies do you have (potassium etc).
How do you feel about going IP?
Maxime
Posted by chaaya on February 15, 2005, at 23:09:23
In reply to Re: Anorexic and forced hospitalization, posted by Maxime on February 12, 2005, at 22:55:59
All of my blood work is normal except for the potassium deficiency. I have actually gained a couple of pounds which should make her happy. I’m on a new medicine(paxil)which has really increased my appetite. I now understand how someone can become bulimic. The exercising has become obsessive but I haven’t been purging. I see my doctor again on Thurs and I don’t know if I can tell her that I’ve broken some of the agreements that I made with her. I see my psychologist before seeing the PCP so I think that this is what we will be talking about. I know that I could let the PCP think that I've gained weight because I getting better (and not tell her about the exercising), but I don't think that I can lie to her.
I don't plan on going IP. This is why I even think about letting my PCP think that I've gained a couple of pounds because I'm better.
This is the end of the thread.
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