To be angry with comment from A&E doctor

[whethertheweather]

DD is 18 and anorexic with BMI of 14.5. After months and months of delays she is just starting to be dealt with by an NHS eating disorder clinic. They called her in for the first in person appointment to do a blood test and physical exam, where she fainted. Blood tests were apparently off, they said O2 levels were at 80% and blood pressure was really low. The doctor at the clinic was very concerned and walked her over to A&E across the road for more tests with a letter explaining her position and the results of their own tests.

Nurse at triage says she needs a blood test so to wait and that O2 levels are hard to check with a pulse oximeter as DD's circulation is so poor in her fingertips. 3 hours later a doctor calls DD in, says he doesn't need to check her O2 levels "as I can see you're breathing". He then went on to say to her that people can exist quite well on 500 calories a day and that it's the constant going up and down with calories from one day to the next that is doing her body harm. He did an ECG, said it was OK and sent her on her way.

AIBU to feel incredulous that anyone would tell an anorexic it was OK to eat 500 calories a day? DD is trying so hard to eat but she's lost 45kg in a year and the scales are still going down.

I tried to complain to PALS, but they've said as DD is over 18 she has to authorise the complaint and I feel she's got enough on her hands. I'm sure the doctor's doing his best in extreme circumstances, but I want him to understand the potential impact of his words on vulnerable patients.

BTW, inside your DD is terrified. The anorexia makes her do this but deep down she wants you to take over and help her deal with it. If you make it so she has no choice, it makes it easier to deal with the anorexia demon that torments them so much. However much she may protest, she will thank you one day when she is recovered.

I have no experience of managing one myself but one of my best friends had anorexia at uni, hence my interest.

She took a couple of years out in the end and went back later to finish her degree. I guess it must have felt scary stepping off the conveyor belt but it really didn’t make any difference in the long run.

There were other women at my uni with anorexia under varying degrees on control. One of them sadly died when she felt down the stairs, it was inferred, while feeling faint from hunger.

From what I saw I would insist DD defers until it’s better under control. She needs reassurance that lots of people take time out from uni or start drop out go back, or work and then decide to go. It’s not as big a deal as it might seem now. The consequences of not getting this under control are far more terrifying actually than taking time out.

But if she does take time out she needs something positive to focus on. My friend did an art course, which she found highly therapeutic, and fed into her degree career in the long run.

[quote TatianaBis]@Balaboostah You’ve completely missed the point.[/quote]
Anorexia is a biological, brain-based disease, genetic to a large degree. This is what the best scientific evidence says as I have shown.

Which is not the same as a brain disease.

So sorry you and your dd are going through this op. However clinically, the Dr is likely to have been correct. If someone increases their calorie intake drastically after a significant period of malnourishment they are actually at higher risk of becoming unwell (refeeding syndrome) which is why people are monitored and calorie intake increased at a gradual level. Of course the difficulty with AN and their poor sufferers is the psychological component which makes the process such a difficult task. Of course this will depend on a huge number of variables and as we don't know your daughter's situation and blood results etc it may not be the case here, just that it is in fact a possibility. Good luck going forward to you both x

You keep saying your daughter wants to eat and that she thinks she’s too skinny. If she did, then she wouldn’t have anorexia. You must understand that anorexia will make her avoid eating and will make her starve herself. Her being angry at the 500 calories thing doesn’t make any sense at all

Sorry but I don’t agree with this. I had anorexia from the age of 12-18. I spent a lot of time in and out of inpatient facilities. When I first got poorly I fell from 12.5 stone to 6 stone in a year.

At my lowest I weighed just over 5 stone. I knew I looked awful. I knew I was too skinny but I just couldn’t eat. I wanted to. I really, really wanted to get better but I needed help. I needed a push and that’s when I went into an inpatient facility. At one point my organs were shutting down and I was told if I didn’t eat I would die. I didn’t want to die and I WANTED to eat but I still could not eat. I ended up being tube fed.

I would gain weight, be let out and then I would think I was too fat and the cycle would repeat itself. It wasn’t until I got too sick that I would realise I needed help again. I always knew I was sick though.

Anorexia isn’t just as black and white as you think you’re fat and you don’t eat. I’m not saying that OP’s daughter isn’t lying. She could still be eating 500 calories a day. But really it depends on how much she is eating. When I was on a refeeding programme in hospital I was gradually increased up to 3000+ calories a day and I was only steadily gaining weight. At 1100 calories I would probably be maintaining 6 stone.

But really it depends on how much she is eating.

This was supposed to say it depends on how much weight she is loosing per week now.

I do think that at her BMI it would be best for her to come home though. Once she is in recovery and her weight has become stable you can look into applying for DSA and look into getting her a support plan at university which would include allowances for snack breaks and being able to bring food into lectures (which I had), I also had a 121 with me who encouraged me to eat.

But until she reaches that point I think she needs close supervision, it’s very hard to get better alone.

@Celtic1hair

So sorry you and your dd are going through this op. However clinically, the Dr is likely to have been correct. If someone increases their calorie intake drastically after a significant period of malnourishment they are actually at higher risk of becoming unwell (refeeding syndrome) which is why people are monitored and calorie intake increased at a gradual level. Of course the difficulty with AN and their poor sufferers is the psychological component which makes the process such a difficult task. Of course this will depend on a huge number of variables and as we don't know your daughter's situation and blood results etc it may not be the case here, just that it is in fact a possibility. Good luck going forward to you both x

Came on to say this too. Technically he wasn't incorrect. A person can physically survive for a long time on a constant level of low calories, but suddenly changing that amount can cause refeeding syndrome which is incredibly dangerous. I doubt he was actively advocating for continuing with the 500 calories per day, but advising that sudden changes are dangerous. In the same way you shouldn't ever stop drinking alcohol suddenly if you're dependent. No-one thinks you should drink 1l vodka a day, but stopping suddenly is very dangerous because the way the body reacts to the change.

Eating 500 calories for more than 2 days is on the Marzipan checklist for under 18s. She may well be over 18( just) but is a known anorexic and clearly struggling. He shouldn’t have said it.

No comments on eating disorders, but in case it helps, I got pregnant while I was doing my degree and I so I deferred for 2 years in the middle of it and it was no problem at all.

Definitely not a failure. (I got a first).

OP, have you looked into a centre like Westwind for your DD? www.westwindcounselling.ca/recovery-centre-brandon

It's in Canada but takes clients from around the world. Prices are much more reasonable than private UK clinics, though obviously it's still expensive. However it sounds like this could be feasible for you and of course worth it if it saves your DD.

It's particularly appropriate for patients who want to get better but who don't know how and are anxious and scared to take those steps. It's a home environment with lots of support and no forced eating/refeeding. They do online as well I think.