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Forum Name: Psychiatric Topics

Question: what will happen at my appointment?scared

angelkt - Wed Apr 18, 2007 1:16 pm

HI I am diagnosed anorexic-I am 21 5'5 and 100 pounds(female) I am having a really hard time-my fiance is giving me support but my family do not know. I have my 1st appointment as an outpatient on the 23rd and am worried as I don't know what they will do? some people have mentioned inpatient and this really worries me as like I say my family don't know and I would rather keep it that way!!!

Debbie Miller, RN - Wed Apr 18, 2007 7:22 pm

First of all, let me congratulate you on your decision to seek help with this serious condition. You are wise to take charge of your health and recognize that you need professional help for this. Not everyone requires inpatient treatment. If you are motivated to work closely with your health care provider on this, you may very well be able to get it under control with outpatient therapy and/or medications, etc. At any rate, your first appointment will likely be information gathering, history and physical examination. A treatment plan can be developed after this initial consultation. It is a complicated disorder so it will take a lot of work and determination on your part. I am glad to hear your fiance is supportive. I hope in time you will be comfortable talking with the rest of your family as well but no need to worry about that right now. Be completely honest and open with your doctor and/or therapist. This will give you the best chance for success. Good luck and keep us posted on your progress. A good support system can really help. You may be able to find an outreach peer support group to help you. Others who struggle with similar conditions meet together to help and encourage one another. You might try contacting NAMI (National Alliance for Mental Illness) www. nami. org. They have local chapters so perhaps there is one near you. Take care and good luck.

angelkt - Thu Apr 19, 2007 1:39 pm

aww thank you very much! thanks for that too I was really worried about that, I was worried that when I tell them everything(I also self harm)that they would want me to go inpatient so thanks for that. it is hard there is one part of me that really wants to be well but the other wants to hold on to this and not do what they say but hopefuly I will listen to the sensible part!!

Debbie Miller, RN - Thu Apr 19, 2007 10:47 pm

I can see you are battling yourself. You can do it but not alone. So, hang in there, go to your appointment, and keep in touch.

angelkt - Mon Apr 23, 2007 2:58 pm

Hiya! thought I would update!I went for mt appt today and was asked every question under the son that I think covered my life story in an hour and a half!!!! it was pretty mad as I wasnt expecting the questions to cover I think everything that is actuallt possible!!! they also took blood and urine. I wasnt actually told what was going to b done just told that there was the option of group cognitive behaivour therapy and something else(which I wouldnt wan to do)or individual in which the waiting list is longer but im not sure what exatly is happening. he said that they have their meetings on a friday where they discuss cases and I had to make an appt for may 8th so im taking it tht the course of action is decided there maybe and then they tell me? im glad I got the 1st appt out the way as its alwys the worst I think.

Debbie Miller, RN - Mon Apr 23, 2007 6:17 pm

You are absolutely right and I am so glad you have taken this first HUGE step in the right direction. Thanks for updating us and we will be looking forward to hearing your story as you progress. Congratulations on getting through this important part of your treatment! Usually the team works together to find the right course of action for you and to be sure you get the right "fit" when it comes to a therapist to help you. Good luck on this journey. May I suggest keeping a journal to record your progress and your feelings along the way? Often writing is therapeutic and later, it helps you to see how far you have come when you read what you wrote before.

angelkt - Mon Apr 23, 2007 8:50 pm

thank you. yes I do keep a diary, I have felt reall crap though all night and wanted ti cut tho I havent think maybe as there were so mant questions and I don't like talking about it all in depth cos I was literally my life story!it felt quite intense! thanks agin though. x

Debbie Miller, RN - Mon Apr 23, 2007 9:56 pm

I'm sure it was emotionally draining to cover so much ground in a marathon session like that. It's so great that you were able to resist the urge to cut yourself. Healing is hard work - keep it up. Good luck and take care!

majik1213 - Wed Apr 25, 2007 2:11 am

hey way to go! my sister's best friend constantly relapses into anorexia .. her life is unbelievably depressing.. serious physical and psychological consequences have come due to her lack of committment with respect to treatment .. I'm so glad to see that you have the power, which you exercise, to stop anorexia's devastating, fatal effects dead cold! Congratulations on your first step, and I hope for the best!

angelkt - Sun Apr 29, 2007 11:51 am

aw thank you very much!!this sites gtrest for encouragement! unfortunately since my appt I have dropped in weight-they didnt actauall weigh me at the last appt so im not sure if I should tell them when I go back or just leave it and see if they ask-a couple of pound prob isnt enough to worry about anyway...I dunno..anyway thanks!!!xx

Debbie Miller, RN - Sun Apr 29, 2007 1:02 pm

I would encourage you to be completely honest and open with those who are trying to help you professionally. They will be better able to treat you if they know everything that is going on that relates to your life - everything is connected and our brains are very complex. But, professionals also understand that we are all human and we will make mistakes, make wrong choices occasionally and have setbacks. The trick is to recover from the mistake and go on from there. We can learn from these situations if we confront them head-on. Admit the mistake, forgive yourself for being human and re-commit to doing better next time. You will feel better about it and you will learn that you don't have to be perfect to still make progress. You can do it! Thanks for sharing. We hope to hear from you throughout your journey to healing.

angelkt - Thu May 03, 2007 8:55 pm

Hi me again Ok so its probably nothing but I want to make sure.. since my appt last week I have lost 3 pound (down to 97)as I have really restricted my eating alot and I have had periods of being tight chested and it has hurt a few times-not for ages but like short sharp kinda pains-obv I am due back next week but I just want to make sure it will be ok till then? I was gonna go bk to the docs but it put me off the last time this happened and he said 'I hadnt lost eonought weight t be gerring those probs' fair enough I was a bit heavier at about 103 pounds....

Dr. K. Eisele - Sun May 06, 2007 12:28 am

Dear Angel KT: As you know, anorexia nervosa is a dangerous disease. There are a few signs that are particularly concerning, and I would like you to be aware of them. 1. Loss of menses for at least three months 2. Heart rate less than 60 beats per minute. 3. Development of fine, downy hair all over your body. These are signs that anorexia is becoming an extreme health risk. I think you should call your doctor as soon as possible to report your symptoms of Chest pain. Thank you for keeping us posted on your condition, and please continue to do so. Best wishes, Dr. Eisele

angelkt - Tue May 08, 2007 6:56 pm

ok so I had my second appt and he said he wants me to do day treatment which is a bit scary!I hace to have an appt with with the manager of the programme to see what its all about... I wasnt expecting it as at last appt he was just in about therapy!but he said hed spoke to others and this is what they had come up with...this bloke isnt the best and doesnt explain things fabulously so I was wondering what day treatment is all about? is it everyday??it all a little worrying plus I dunno how id get there everyday as its a bit of a mission...I guess this is things id have to discuss with the woman at the appt..... he said he was concerned especially as im now down to 94 pound and was 00 2 weeks ago and to be honest it was all a litle unexpected!!!

Dr. K. Eisele - Wed May 09, 2007 6:09 am

Dear Angelkt: I'm very concerned about your continued weight loss. That's six pounds in two weeks. I think that's probably why the day treatment was recommended, and I think it is a good idea also. In the US, we have day treatment, which means that you go everyday (Monday thru Friday, here, anyway), for about 5 or 6 hours. These kinds of programs here are very popular, because they keep people from needing to be hospitalized. I don't know how things are done where you are, but I'll be very interested to hear all about it. Please do come back and let us know about this day treatment program.

angelkt - Thu May 17, 2007 4:11 pm

hi again...ok I think I meantioned before that I have Endometriosis..I have an operation scheduled for the 28th june.. I was wondering will they have any probs operating??my current weight is 93 pounds which makesmy bmi around 15. 4...my pre op is the 8th june...shud I tell them?as the last time they weighed me with my clothes on and had my bmi down as 19 and it was 17. 5.......

Dr. K. Eisele - Sat May 19, 2007 7:35 am

Angelkt: It is EXTREMELY important to tell them about your true BMI !!!!! Because you are malnourished, your body in general is weakened, including your immune system, and the very important electrolytes (calcium, sodium, potassium, chloride, etc.). Surgery is a major stress on the body, and whether you are a 20-something athlete, a 40-something stay-at-home mom, or a young lady with anorexia, your body needs all its available reserves to withstand the surgery and then be able to recover afterwards. The electrolytes I mentioned above are so important because they regulate how your body responds to various things. For example, if you ran out calcium in your body, you would die very quickly. Many important systems in your body depend on calcium to function. One of those systems is your heart. Calcium is so important to certain organs that if the level of calcium in your blood is low, your body will quickly begin to move calcium out of the bones to maintain the function of vital organs. Sodium, potassium, and chloride are other equally important electrolytes. If you have too much of one, your heart might stop. Not enough of another, your heart might stop. Likewise, your brain will not function very well, nor will your immune system. If you have surgery and your ability to fight off infections is impaired, you could end up with a life-threatening infection. The infection could be resistant to treatment, because it was acquired while in the hospital. Hospital germs are "supergerms" that tend to be treatable by only the strongest of Antibiotics, a combination of Antibiotics, or Antibiotics that are not as safe as the usual medicines chosen for the same type of infection acquired from a germ that is not resistant. To complicate matters further, the relative levels of each of the electrolytes is critical for normal functioning. And, to complicate matters EVEN FURTHER, anorexics tend to have fairly Slow heart rates because of their malnourished state, which would have an effect on the anesthesia. It would not at all be safe for you to keep your current health status under wraps. You must tell the surgeon as soon as possible.

angelkt - Sat May 19, 2007 1:16 pm

thank you 4 all that info-my electrlytes have all been checkd(about 3/4 weeks ago)and they were oki think he said everything was ok so wud that make a diff? I will tell them at the pre op then im just worried tht they won't do the op or say I have to wait cos then every1 will be asking y...making things very awkwad!!! do you think they will??

Dr. K. Eisele - Sat May 19, 2007 7:10 pm

Dear Angelkt: Electrolytes can change day to day. They need to be re-checked. I don't know what their response will be. I know that if I were a surgeon, though, and operated on you without knowing this information, and surgery did no go well, I would be very upset that you kept it from me. It would also leave me open to a malpractice lawsuit, and could potentially ruin my career, even though it would have been your fault. How awkward is that? Do you really want to be responsible for that? Please disclose this information openly and truthfully.

angelkt - Sat May 19, 2007 9:35 pm

ok thanks I will defo tell them then on the 8th when I go for the pre op-thanks because I might not have said anyhting if I hadnt spoken to you!!! I will let you know what is said x

Debbie Miller, RN - Sun May 20, 2007 12:47 am

Complete honesty with all your doctors is absolutely critical if you are to be healed. I'm glad to see you will be talking with them about this. Good luck.

angelkt - Mon May 28, 2007 1:36 pm

Hi me again!! ok so had my appt last week and there is a waiting list for day care of between 2 and 3 months....plus he has dwindled my chek ups till then to 4 weekly...the thing is in the week since I have been sooo much has happened-I ended up telling my mom and my nan found out-then 2 days later my step mo and dad found out by accident by a text message being sent to the wrong person!! I have also found some stuff out about my dad which has discusted me and ive had converstaions about things that I totally never ever thought I would have so I am stressed out beyond belief-my weight has dropped to 91 pound making my bmi around 15 I thinkso I was just wondering if I have the 'right'if you like to ask it to be bought 4wad as I feel like I cant cope very well atm...also the last few days ive been feeling not too good and the past 2 morning I have taken my heart rate which has been around 45-is this normal in the morning??it does go up during the day but I think the lowest it had been previous to this week is about 55 so I was just wondering?sorry to ramble!!

Dr. K. Eisele - Mon May 28, 2007 8:37 pm

Dear Angeltkt: It seems to me that when you first wrote to us a month ago, you weighed about 100 pounds. You have lost 9 pounds in one month. Your heart rate is now down to 45 in the a. m.; these are signs that you are in danger of becoming severely ill. A heart rate of less than 60 is only healthy in the best of athletes, below 50 is not healthy for anyone. When your pulse goes below 50, your brain is not able to get enough nutrients and oxygen, and to solve its problem, will try to increase the blood pressure to make up for it. This is a bad thing to do because it increases the risk of Stroke and Heart attack. You could be left with life-long disabilities, or worse, YOU COULD DIE, because of this. I think you need help right now. You should go to the hospital immediately and tell them EVERYTHING, including the 9 pound weight loss, Slow heart rate, planned surgery, etc. Please, please, go tell your mother and ask her to drive you to the emergency room! Do it now!

angelkt - Mon May 28, 2007 11:07 pm

Hi I actually only just got this and its now midnight so I havent been but I have eaten alot more today than I normally would and shock horror I do feee better for it but I think I will ring my phych tomo and try and see if I can bring the appt forward to be honest I didnt think It would be that serious as I havent felt really really ill just very tired and that...so I was a bit shocked by your respnse! thank you for replying as usual I will defo keep an eye on it now that I know it isnt right as I just thought it may have bee the fact I had just woken up maybe..so thnk you again. katie

Dr. K. Eisele - Sun Jun 03, 2007 4:53 pm

Dear AngelKt: How are you? I wanted to check in to see if anything has changed/developed or even stabilized. Please do let us know.

angelkt - Mon Jun 04, 2007 8:36 pm

hi aww thats real nice of you things are pretty much the same tbh ive still gotta wait bout a month for day care. all my familt have found out in the last wek I guess its pretty obv!lol m bmi is 14. 6 and my mom rekons they can section me for that but I doubt it cos the last time I had an appt it was 15 and they didnt really say anything cos my blood etc was fine... katie. x

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