The pitfalls of good health

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.

The bottomless pit

It is a truly bizarre array of physical feelings that my slowly waking metabolism is putting me through. After laying dormant for so long it seems to be still blinking its eyes to the light as my body runs the gamut. Right now I am on 1800 calories a day, which is more than double what I have been consuming for at least the last year. Strangely enough though, most of the time, I seem to want more. Of course, right now, I can’t have more because there is a regemine set up here, but it doesn’t stop me from longingly predicting what might next be put on my plate. I’m not always necessarily stomach-growling hungry, per-se, I more just feel an emptiness that spends its time fantasizing about nourishment. In fact, the persistance of this desire even later in the day, when I do already feel physically sated with my abdomen hurting and my intestines cramping up, is one of the oddest sensations I have ever dealt with.

The method behind the madness my body seems to be delving into is one of known success however. Upon arrival we are each started on the 1800 calorie per day diet, no matter what we had been previously consuming, and for the first week we stabilize on that. Then, not so slowly, the additions come. after that week the dawning of the next Monday in line brings with it an additional 400 calories, raising the daily bar to 2200. Then Wednesday, only 2 days later, with another 400 tacked on, and Friday with a third 400. The additions continue on those same days each week until a daily consumption of 3000 is reached and they alternate between the adding of food at meal times and various Ensure shakes wherever they best fit into our individual regemines. All of this is based on the logic research has proven true behind a hyperactive metabolism.

we each need a certain number of calories per day to live and perform basic functions in a successful healthy manner. It varies greatly from person to person as to what that daily need might be but, its safe to say, that any full-grown adult needs at least 1200 and most need more. When a person drops below that required amount for a certain amount of time it will eventually send the body into a starvation survival mode. To conserve what little energy remains in the system our metabolisms go into a kind of hibernation and stay there.

Once they are jostled awake again by the onset of a more natural diet they set to work. With elation they continue to work more, with gusto and fervency, falling into the overactive state and burning more calories than a body would naturally normally need…and here that need is fed. It has to be somewhat gradual because, when anything awakes after a period of deep sleep, a time for adjustment is needed. Almost always, however, in a situation like this, underweight people in the act of refeeding wind up actually losing more weight even on an astounding caloric intake before things start to slowly even out.

As much as I think this is an amazingly good well-organized program I am still a little nervous that, due to this metabolic roller coaster, I may wind up having to stay longer than the planned time in order to gain the weight needed to proceed. It is an ungrounded fear though. All I can do is my best, continue to eat everything they put out in front of me, and keep trusting that they know whats best. My life is litterally in their capable hands.