Lisa is back. Directly after breakfast on Friday morning she, along with most of her belongings, had been hastily packed up and escorted via wheelchair to the actual hospital part of Columbia across the street. She is the one here most at risk of refeeding syndrome and findings that morning had revealed dangerous potassium and electrolyte imbalances. Due to the high possibility of cardiac arrest there was someone at her bedside throughout her entire 48-hour stay. She returned to us unexpectedly this morning in a stabilized condition…for the moment anyway.

Refeeding syndrome, if its going to happen at all, usually occurs at the beginning of treatment when patients are first introduced to a healthy diet. Metabolic disturbances are a common effect from a sudden shift from fat to carbohydrate metabolism and and increase in insulin levels. Very basically, its a major shock to the system of a starved or severely malnourished person. When instituting a new diet the shifting of electrolytes and fluid balance increases cardiac workload and amps the heart rate. Our hearts, already depleted of muscle strength, sometimes just can’t handle it and it puts someone starting the refeeding process at acute risk of heart failure.

All of this is why inpatient treatment is so highly recommended for more sever eating disorder patients. Even if a greatly malnourished person wants to change and has the wherewithal to just fix their diet and start eating more at home inpatient is still the better choice. There has to be gradual steps in the process of renourishment. Every few days adding a little more into the diet to avoid an overload of healthy eating that can ultimately kill. Refeeding syndrome, for us, is just as big a threat as death by starvation is. All of it is a scary, delicate process.

One of the problems in successful eating disorder treatment lies within the basic diagnosis. There is no specific weight range that simplifies a written report for someone seeking treatment. The outward appearance of someone with the disorder does not dictate the amount of physical danger they are in. Some people with anorexia can be slightly overweight, while others with a binge eating disorder can also be underweight. Without constant medical monitoring, the checking of vital signs, pain level documentation, blood testing, and EKGs there is no way to tell who is at risk of refeeding syndrome.

When Lisa was taken 2 days ago we weren’t told anything even though it all happened right under our noses. The realization of actual death being that possible was a heck of a reality check as we all sat around trying to make sense of the wheelchair and panicked nurses busting around us. I don’t know what would have happened if it turned out that we never saw her again and I don’t really want to think about it. All I can say, and I think I speak for the group of us patients in this, is that we are glad to have her back no matter difficult it may be to look at her in her state. At least shes alive.