My first visit at the eating disorders clinic

On Tuesday 16th February I had my first session at the Eating Disorder Clinic. It was pretty damn scary, but the psychiatrist was super nice. He's obviously treated all different kinds of people. I basically got asked a bunch of questions about my past - my childhood, my family relationships, my eating habits, my school life - everything! It took about an hour and 15 min in total, and towards then end of the session we agreed on a number of 'improvements' that I had to work on until the next time I see him (Monday 29th February).

The improvements:

• Cut down on walking to 7,500 steps a day
• Increase calorie intake to 600 kcal a day
• Drink 0.5 l of water a day
• Cut down weighing myself to once a week

The first week went pretty well. Although I walked far more than 7,500 steps a day (I was in Edinburgh and walked around being a tourist), I increased my calorie intake accordingly. I also drank all the water I needed to. But then I weighed myself on Sunday (a day too early, but never mind) and found that I'd put on weight. It's difficult to tell what this 'weight' is - it might just be water, seeing as I was really dehydrated, but either way, it made me feel a bit awful.

So this week has not been great, and I haven't followed 'the rules' at all... I also weighed myself again today and I'm back down to the weight I was when I went for the treatment session on the 16th. That made me feel relieved, so maybe I'll give the improvements another go!

Enough for now. I'll write again after I've had my second treatment session on Monday :-)

How my anorexia was discovered

So, in my second post, I explained that I consciously and intentionally started restricting what I ate in mid-November, after having visited home for a week. In this week I received a few comments about my weight loss, which, so far, had been mostly unintentional.

Visiting my Crohn's consultant
At the beginning of December, I went to see my Crohn's consultant, Dr Mehta, as I do every few months. My mum insisted that I should point out my weight to him. So far, my weight loss was largely due to a lack of appetite: I just didn't feel very hungry, and this is what I told my mum. When I told Dr Mehta, he agreed that something should be done. My weight had fallen to about 44 kg (in September it was about 46.5 kg and my weight before the weight loss was about 51 kg. I'm 164 cm tall, and the weight that is considered 'underweight' for my height, i.e. BMI lower than 18.5, is anything below 49.8 kg, so I've always been in the low end). Dr Mehta prescribed some nutrition drinks for me, which contained all the vital nutrients and a bunch of calories. It was important not to lose anymore weight if I was to go through with the surgery to get rid of my Crohn's disease, as an underweight, malnourished body can lead to severe complications during and after surgery.

Seeing my General Practitioner
I took my prescription to the hospital pharmacy, who explained that they did not stock nutritional drinks at all, and instead I had to get a different prescription from my General Practitioner (GP); in the UK, there are apparently two different prescription forms: ones from the hospital, that only work in the hospital pharmacy, and one from the GP, which work in public pharmacies, where they would be able to provide me with the nutritional drinks. So I took my prescription form to my GP, Dr Kuna. She is the best GP I could have ever asked for, and has cared a lot for me throughout the process of diagnosing my Crohn's disease. Dr Kuna explained that the dieticians that the GP collaborate with do no recommend prescribing nutritional drinks for various reasons, one of them being that it encourages people to stop eating. Especially people with Crohn's, who can get stomach cramps from eating (I get this sometimes too). Instead, Dr Kuna encouraged me to eat little but often, and to eat high fat food; as it was Christmas, this was the perfect time to really go crazy! I said I would give it a go, and she asked me to book an appointment with her for when I returned from Christmas break about a month later.

Christmas with the family
Over Christmas, I obviously had to eat a fair bit at various family events, and I found this tough. The day after a 'feast' I would often restrict my food intake as much as possible, although this was difficult with my mum around. But in the the final week of Christmas break, my mum had to return to work, so I restricted my food intake during the day (I would have a low-calorie smoothie for lunch), and then I could eat a small dinner with her when she returned home from work. This made it a lot easier to eat less.

Returning to London
I returned to London, and went to my appointment with Dr Kuna the following day. My weight had now fallen to about 42.5 kg (Dr Kuna weighed me). She became suspicious and asked if there was anything I would like to tell her. I confessed, that I restricted my food intake slightly, but at the time I didn't really see an issue with it; it wasn't like I totally stopped eating. But I got upset nonetheless, and Dr Kuna asked me if I'd like to be referred to an eating disorders clinic. I thought this was a bit drastic and unnecessary, as I still didn't feel I had a problem, so I said no. I also didn't want to have an eating disorder on my medical record. Dr Kuna decided that I needed to have my heart checked (an ECG) and to have a bone density investigation to check for osteopenia/osteoporosis, which is common in people with low weight. More about these results in a later blog post.

Dr Kuna asked me to see her again in 2 weeks, at which point I had neither lost nor gained weight. Dr Kuna was concerned that I wasn't trying to put on weight, and again she asked me whether I would like to be referred to an eating disorders clinic, as she felt this was really the best for me. Again, I said no, as I didn't want 'anorexia' on my medical records. However, she explained that she had already diagnosed me with anorexia at our previous meeting, as I showed all the signs. This meant that anorexia was on my medical records anyway, so I agreed to be referred to an eating disorders clinic, and a couple of weeks later, I received a call from the clinic. They explained that I had been referred for an emergency appointment (normal waiting time is about 3 months), and that they would like to see me the following week. It was a shock that I had been referred to have an emergency appointment, as I still didn't feel that my eating disorder was out of control.

But it turns out that some of the physical consequences of anorexia meant that Dr Kuna had good reason to refer me as 'an emergency'. More about this in my next blog post, which I will post tomorrow.

The consequences of anorexia

Heart problems
As mentioned in my previous post, my GP referred me for an emergency appointment at an eating disorders clinic. This was, I assume, partially due to the fact that my BMI was very low (under 16), but more importantly, that the ECG of my heart showed abnormal activity. I also have 'heart murmur', which is common when the heart has to work extra hard to pump blood around the body. My heart has to work harder, as it is not getting enough nutrients. It's like walking up the stairs after 10 hours of not eating; you just have less energy and so have to work harder. I especially feel this at night when I'm lying in my bed - feeling my heart really working hard to pump blood around my body can keep me awake for hours, as I worry that it might suddenly give up.

Dr Kuna has now referred me to have an echocardiogram (or just 'echo) to find out more about the issues with my heart. This is particularly important for my surgery, as the anaesthetist will not allow the surgery to go ahead before they know it is safe. There is a long wait to have an echo, and I still have not received an appointment, despite being referred for a 'priority appointment' on the 25th January. I am meant to have my surgery on the 26th February, but more about this later.

Bone problems
I had a bone scan on the 3rd February, where the doctor conducting the scan printed the results, and asked me to give them to my GP. He put the papers in an envelope, but he didn't seal it, and obviously I couldn't help myself but have a look. It said quite clearly that I had osteoporosis in my spine, and osteopenia (less severe form of osteoporosis) in my hips. My bones were comparable to those of my granny. This was tough to read. I have an appointment with my GP on the 3rd March to discuss the results and, I assume, to get some medication for it.

Other consequences
The other not-very-nice side effects that I am experiencing as a result of anorexia include Lanugo (small hairs growing on my back - this happens as your body tries to keep itself 'warm'). I'm freeeezing all the time, and often wear several layers of clothing to keep even remotely warm.

I also have very dry nails and hair - my hair and nails have otherwise always been very nice and healthy, so it's tough to see my hair falling out and feeling dry, as well as dealing with my breaking nails.

It's probably no surprise that I often feel weak and tired, as I don't consume enough energy to feel properly 'alive'. At the same time, I also can't fall asleep at night, as I lie awake and worry about where my anorexia is going. As I gain more and more control over my eating, I feel like I'm losing control to the anorexia, and I am desperate to revert this. I have my dream job waiting for me in September, and I don't want to jeopardise it.

When the hurdles 'help'

So this blog post was not intended to be the in my journey to recovery, but bad, unplanned things happen and sometimes they help, sometimes they make things worse. My intention was to explain my journey so far, and my first two blog posts cover my journey until November 2015, but for this post, I am just going to jump ahead in time, to yesterday.

Yesterday, after two great days in Edinburgh, Scotland, where I visited a friend from High School, I returned home. My mum called me and said that she was about to head off to the vet with one of my two cats. I've had my cats since I was 11 and they're a big part of my family. One of them, Mouse (there's a long story behind that name), was throwing up, had stopped eating and was just skin and bone. I told my mum not to let the vet put her down, because if she needed to be put down, I wanted to fly home first to say bye.

An hour later my mum called me. She was crying. Mouse had kidney failure, and it would have been cruel to keep her alive any longer. So I spent yesterday afternoon crying.

Mouse, when she was fit and healthy

Why am I telling you this? Well, one thing that was particularly tough to hear was that my mum said "I'm glad you didn't get to see what Mouse looked like. She was just skin and bones, she wouldn't speak to anyone and just hid in dark spaces on her own. She could barely walk up and down the stairs. I'd rather you remember her as a healthy, loving and social cat". My mum doesn't know that I'm being treated for anorexia, and she hasn't seen me since mid-January. Since then I've lost about 3.5 kg, and before then she was already worried about my weight. But I'd told her that it was because of the Crohn's, and that the doctors had an eye on me, so she calmed down. But she would be so upset if she saw me now. I've started cancelling some of my social plans that involve eating, I'm weak and tired - I'm not myself. I promised myself that I wouldn't let the anorexia get so bad that it hindered my social life, but it has creeped up on me, and I've started to cancel more and more plans with friends.

Hearing how she talked about Mouse and how upset she was made me realise, that I need to work harder to get out of anorexia. So yesterday, for the first time in I-can't-remember, I decided to eat the number of calories a normal person my size should eat in a day. It was tough, and for the first time I googled how to make myself purge - another thing I'd promised myself not to do, as I don't want to damage my teeth. But I stopped myself, and I kept all the food in me. A success, I guess. But today I feel awful, and I will be restricting my calorie intake severely once again. Constant ups and downs.

As mentioned, this blog post was not planned. In the upcoming post, I will write about how my anorexia was discovered, the consequences of my anorexia, how my treatment sessions are and, hopefully, I can convince myself to post a picture of myself - without my face - so you can get a better understanding of where I am. Thanks for reading.

A little more about me and how I ended up with anorexia

To understand how my anorexia was discovered, you need to understand my journey with Crohn’s disease. Suffering from Crohn’s disease means that I have to go to hospital every three months to see my consultant. As part of the hospital visit, I am weighed, which means I constantly have someone watching my weight. This is normal for Crohn’s patients, as some patients with Crohn’s suffer weight loss as one of their symptoms. I don’t though. I was diagnosed with Crohn’s in March 2015 after having suffered the symptoms of Crohn’s (diarrhoea, stomach cramps) since April 2012. I first went to the doctor’s in my home town, but the doctor failed to conduct the right tests (despite me having some of the most common symptoms of Crohn’s disease) to diagnose me. I gave up getting a diagnosis and left it until January 2014 where my symptoms were so severe that I finally dragged myself to the GP at my university in London. I had several blood tests taken and was finally referred to hospital where I had an MRI scan, an ultrasound and finally a colonoscopy. The colonoscopy I had in March 2015 confirmed that it was Crohn’s disease, and from then on I went to see my consultant, Dr Mehta, every three months.

I was prescribed to take steroids, and I dreaded the side effects, which include weight gain and acne. However, the steroids I was given were a newer, special kind of steroid (Budesonide), which did not give these side effects. But the Budesonide actually didn’t seem to work at all, so after 6 months, in September 2015, my consultant and I decided that it was better to have an operation to cut out the part of my intestine that is affected by the Crohn’s. This was a scary decision, but the operation would ensure that the Crohn’s would go away for at least a few years, although it is likely to return at some point. I was relieved by the decision, as I hate being on medication, and I just want to be free of the Crohn’s, even if only for a few years, as I want to be able to start my job in September without being concerned about potential Crohn’s flare-ups.

By September 2015, I had unintentionally lost 2.5 kg and was a little underweight - but nothing concerning - I have always been at a weight juuuust borderline to being underweight, without being overly concerned about what I eat - although I do make sure to eat healthily. I’m also known amongst my friends and family as being a huuuuge cake and chocolate lover - but when you eat healthily, it is also okay to let yourself go nuts every now and then, and have a huge piece of cake.

In November 2015, I went home for my 1-week university break, by which time I had lost 5 kg, mostly unintentionally. I weighed 45 kg, and my family noticed the change in my appearance. I don’t see my family very often (they live in a different country), and so they noticed the change more than I did. On top of the weight loss and the many comments from my family, my Crohn’s symptoms had improved, and this was where my weight loss began to become intentional…

Hello and welcome to my blog about my fight to beat anorexia

Hello everyone, and welcome to my new blog about my journey out of anorexia.

I have recently been diagnosed with anorexia, which has been tough to accept, and I still haven't fully accepted the diagnosis, despite it being classified as 'severe'. I have decided to write this blog as a form of diary to put down my thoughts and feelings; no one knows about my diagnosis, except my GP, my psychiatrist and my consultant at the hospital. I'm embarrassed and ashamed of where I have gotten myself, and therefore neither my family nor my friends know.

How have I managed to hide it? Several ways. Firstly, I have a diagnosis of Crohn's disease; this is an autoimmune disorder that affects the intestine, and means that my immune system attacks my gut to give me diarrhoea, cramps and other not very nice symptoms. Another symptom of severe Crohn's disease is weight loss and lack of appetite. But my Crohn's is only moderate, and not a source of my weight loss - nonetheless, I can use it as an excuse, so that my friends and family do not realise that my weight loss is due to me not eating. Also, I currently live away from home, as I'm studying in London. I live in student halls, which means no one is there to watch what and how much I eat - this also makes anorexia easy to hide.

Having said that, it's not entirely easy - no matter the size of my jumpers, I still cannot hide my legs, and so I know that some of my friends are suspicious. But again, a way of hiding my anorexia is by eating around my friends - and not eating when I'm alone. I have considered telling one of my friends about it, just so I am not alone with it, but I still haven't quite gathered the courage.

Now, a little about me. Firstly, my name is not Anna, but as I mentioned, no one knows about my anorexia, and so I want to stay anonymous. So I've chosen to go by the not-very-inventive name, Anna. I'm studying a master's in London and I'm 24 years old. In this blog I will be writing about my journey out of anorexia, including the ups and downs I experience. Please feel free to follow me and ask any questions you might have. Please note that this blog is not intended to help people get into anorexia - I never wanted or intended to be in the situation I'm in, and I'm still finding it difficult to understand how I got here. I would not want anyone else to be in my position. All I know so far is that I want to get out of it, but after having seen the psychiatrist once, I realise it is not going to be as easy as I thought, despite the fact that I am very motivated to get out of it. I have my dream job waiting for me when I finish my degree in September and I don't want to risk jeopardising it because of this disorder.

That was a short overview of what this blog will be about. In my following posts I will write about how I was diagnosed, how my treatment sessions are, as well as my day-to-day life.