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.
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