Yes, Stomach, I hear you

Score one point for getting through things that I didn’t want to do. My tally must be pretty high right now but this time I think I will count double points for the added factor of having to do it 2 days in a row. These back to back trials of perseverance that I refer to are the long-awaited research meal days. I was too anxiety-ridden to write about it while in the midst of the experiment but, now that I can breathe with the assuredness of it being over, hindsight has again set my thoughts in motion. part of me, the forgiving part, wants to shrug and chalk it up to just having been an experience. The other part, however, would love to riddle the telling of the last 2 days with some very colorful language. I think I’ll try to find a happy medium.

The anticipation on Tuesday, the morning of reasearch meal #1, was quickly dropping like a fog over my world. When I sat down to breakfast I knew what to expect on my measly tray – two 4 oz. apple juices, a yogurt and an apple. Everyone else got the pancakes we had been asking for fervently through the last two months. Balls. I missed out on that one. I was told that they were really good though. After that I was okay until about 9:30 or so…until the hunger started to claw its way into my consciousness. Then it was all over. I couldn’t think about anything else except the pending lunch. The others did their best to help distract me but the anxiety grew to an all-consuming high. Its strange to think that I used to eat so little when my body craves so desperately now. At this point there is no denying what it wants. No confusion.

Finally, just before noon, one of the research assistants came up to get me. I followed her, in her white lab coat, downstairs and back to the same tiny room I had done both the exercise study and the sweetener test in. Everything was the same except this time there was a little round table with a plastic tablecloth ala “Lady and the Tramp” in the middle of the room. She sat on the bed while I sat at the table and in front of me was placed a sheet with a 1-10 scale and varying degrees of anxiety provoking situations listed throughout as a guide. We sat in silence for a full 3 minutes while I was instructed to think about the upcoming meal. At every one minute interval she asked me to rate my anxiety level on the scale.

Before the meal came I was repeatedly scoring quite high. I was anxious because I just wanted to eat. There were no guidelines as to how much had to be eaten. It was just whatever I wanted to do while the video camera in the corner taped my actions and her voice buzzed in over the monitor to periodically rate my levels. The tray that was finally placed in front of me had only a few items on it but they were large. I was suddenly staring at a large bowl of regular potato chips, an 8 oz. bottle of water, a family-size tube of real mayo, and a footlong turkey and swiss Subway sandwich on wheat. Other than the meat and cheese there was only lettuce and tomato on the sandwich.

That was it. Once I got the go-ahead I dug in. That first day it was excellent but I think I would have eaten just about anything they had put in front of me. I only ate 2 or 3 chips but I got through almost all of the sub, eating all of it’s insides and leaving about 1/3 of the bread; all the while my anxiety slowly decreasing. It felt great to just get some substance. After that they had some paperwork for me to fill out, some questions to answer, and then I could go about the rest of my afternoon as usual. That didn’t stop me, though, from dreading to have to do it all again the next day.

When I awoke the next morning I was calmer. The exact same test two days in a row so I knew what to expect. I was armed with knowledge. Then they threw a wrench in my gears. I was hungry going into breakfast and actually looking forward to the small amount of bulk I would get from the meal. Something, anything, to fill me up just a little. When I got in the dining room and saw my tray my jaw dropped. Apparently all I was to consume today was one lowly toasted English muffin and a 4 oz. container of apple juice. I grudgingly ate, trying to make it last as long as possible, and then spent the remaining time at the table not only hungry and anxious but pissed off as well. No one else who had done the same study before had gotten the English muffin version of research breakfast.

I got through it though. Lunch and a twin meal to the previous day was placed in front of me. I ate, with less anxiety this second go-round. I’m going to have to ask at research group next week what exactly they are looking for in this study but, for now, I’m okay. For now I can go back to enjoying my normal size expected meals.

At least until I have the third research meal day just before I head home.

Hunger Games

Today is the day! I just made it this morning with the scale balancing right at the 3/4 pound gain that has occupied my line of vision for the past 2 weeks. Not only am I not RTU for the weekend but I am finally at my 85%. The next step is to put in a privilege request form to move up to level 4b so I can roam the building at my leisure. I could, potentially, be annoyed that I have to wait through the Labor Day holiday weekend before they approve the request at the next staff team meeting on Tuesday…but I’m just not feelin’ it. I’m too happy that I got to where I wanted for so long to be at to let it frustrate me.

It was before lunch, only a few short hours since I had been weighed and realized my goal in the scale clicks, when Dr. G pulled me aside. With 85% comes the two major therapy studies that Columbia is doing right now: exposure and CRT. There are 4 weeks of each, 12 sessions apiece and each person eligible does both. Its a random draw as to which one you start with but I’ve got my fingers crossed for exposure.

First things first though. I won’t know which will be kicking me off until I’ve done whats known as research lunch for two days in a row. From what I’ve seen and the details I have been told by other patients who have already been through it I am curiously anxious to start. The breakfast and morning activities (or lack there of) prior to research lunch has me a little nervous towards my mixed emotions.

Its all very moderated so that each person doing the meal has the exact same thing for the breakfast leading up and the standard that they serve is much less than what our bodies are used to having. Every person I have seen with the diminished breakfast on their chosen research day ambles around the whole morning try their darndest to not gripe too much about the every persistent stomach pains growling audibly.

Aside from the miniscule meal, in order to keep everyone’s physical exertion and intake in check, there is no morning coffee allowed. So there goes the once daily caffeine boost we are each allowed and then we also omit the 10am morning Ensure as well. It may seem that being on so many calories each day would cause us to kneel and thank the ceiling at the cutback but thats just not so. All there will be is annoyance and hunger, hunger, hunger. We need all of those calories right now! Our bodies want them. They crave them! To top it off, on research lunch day, we are RTU till the afternoon meal is over. That means no fresh air, no trips to the store, no nuthin’.

Thankfully all of this only goes until 1:30 in the afternoon and, with my newly approved 4b status I already know where 2 pm will find me. I’ll be sitting in the upstairs cafe with my Boston Globe Sunday crossword book lounging in full relaxation mode. Oh, and one more thing, my nice caramel-colored steaming cup of coffee will be my teatime guest of honor.

Earning the goods

I elevator down with Clara in her stiff white lab coat for the next research study on the agenda. We floor-hop for a minute, letting others on and off, before deboarding to head to the same room that the sweetener study was held in. Mostly the room hadn’t changed still housing the same little bed, same cameras on the walls, same desk with the same laptop computer on it, except this time there was a large black treadmill in one corner. I had to stop myself from scanning the paneled ceiling for a water bottle drip within the confines of the human hamster cage.

I sat down at the desk and was given a two page questionnaire to help pinpoint different levels of emotion I might be feeling at the moment. Before shutting the door behind her as she exited the room Clara placed the same little call button as last time to my right so I could notify her when I was finished. Not being particularly angry, depressed, excited or overly emotional in any other way I flew through the paperwork and started my stint on the laptop. This study also involved the repeated pressing of buttons in order to earn rewards but the incentive was different this time. This one was called the “work for exercise” study.

I couldn’t help thinking in the back of my mind that it was silly for a person to be willing to sit and push a button for upwards of 40 minutes, switching hands until both wrists hurt, just for a maximum of 30 minutes of slow walking on a treadmill. I understand how this would be a totally fine reward for a person who has an exercise addiction, which many people with eating disorders do have. However, I couldn’t keep my mind from ruminating on the absurdity of that reward anyways. If we didn’t have fresh air time that we were able to walk around during, and had to remain sedentary on a constant basis like I did at Remuda, that tiny bit of movement may have been seen as much more desirable. Heck, who knows, I may have even worked the full 40 minutes for the half hour trade.

Apparently I wasn’t the only one who saw the treadmill time as something not worth working for. They had added in a second reward of cash that I could press the button to earn. The maximum of that was $30 and it was received at the end of the session. As the exercise minutes accumulated 3 at a time, the money built $3 at a time as well and at the end of each earning I could decide which of those two things I wanted to work for during the next session.

I picked the cash. Of course I picked to work for the cash. If the treadmill had been the only reward the test to see how hard I would work for it’s company would have been over before I laid one finger on the button. I clicked away for about 12 minutes, switching hands, switching fingers, and eventually stopped when my wrists started getting sore. My need to do artwork pain-free outweighed my desire for more money. If I had kept it up, going for the whole $30, I doubt I would have been able to draw anything for the rest of the afternoon, or even write this entry now, without feeling the repercussions.

In the end I wound up with $15 which i figured would buy me about 3 weeks worth of morning coffee from the upstairs cafe. All in all it was a satisfying experience. I filled out one more short questionnaire about my moods and anxiety levels at that particular moment, rang my little buzzer, and sat back to wait for Clara’s escort to go upstairs again.

The sweetness

I sat, feeling goofy in my disposable plastic apron, ready for the scheduled research study to commence. The table in front of me in the small lab room had been laid out systematically with 10 clear plastic cups filled with a set amount of cherry Koolaid and accesorized with large red straws. The cups themselves were marked 0-10 in black Sharpie and in front of each was a line of Equal packets corresponding to the cup’s number. With a set of rating sheets in front of me, a call buzzer to my right, a rinse cup, spit bucket, and short stack of napkins to my left, I was primed and ready to take the sweetener test.

The object of this little exercise was to start with a sip of the “o” marked unsweetened Koolaid, roll it in my mouth to taste and rate its sweetness, how much i liked it, and weather or not I wanted more on the corresponding sheet. Then spit, rinse, and repeat with the next cup after first adding the required number of Equal packets. The rule was to do this until i got up to the cup I didn’t like due to too much sweetener and then do one beyond it.

Alone in the small stark room through this I took my time and tried to rate each one as accurately as I could. Having gotten to 10 and still not finding the drink to be more than moderately sweet I wiped my mouth and rang the call button for the lab tech. That was the first part of the study.

Next, after the table had been swept clean of anything having to do with the Koolaid testing, a small laptop was brought in and placed in front of me. This part was titled “work for Equal”. It involved sitting, staring at a screen with an Equal packet pictured on the left and an empty column on the right. With the promise of actually receiving a cup of coffee containing the number of Equal packets you were willing to work for, the button pushing began.

Basically I was asked to just sit and continuously press a key on the computer repeatedly until an Equal packet appeared in the column on the right. Each time a packet appeared it would take almost double the amount of key taps to earn the next packet. If you really wanted all 10 available packets for your coffee it would take up to 40 minutes of continuous button pushing to earn them. All of this was to observe and track just how much a person with an eating disorder relied on artificial sweetener for taste. How long we were willing to sit and do this tedious work just to have that one last packet of Equal. The study, though, was still in its very early pilot phases and was hindered for what I could see as accurate results by some definite flaws.

(to be continued…)

Plugged in

This morning brought with it wires and monitors. I have been hooked up, taped down, and activated in order to participate in the first comparative phase of one of the many studies. The device they have me tethered to really isn’t all that obtrusive. Mildly annoying and slightly awkward at best what it does is monitor movement and activity. The study, which consists of two parts, is one that is exploring the expenditure of energy in a person who is underweight versus a person at at least 90% of their natural body weight. The little tabs and wires I’ve got on will only be with me for 48 hours this time and then again for another 48 much farther into my stay here, once weight stabilization has been reached.

Although the findings from this haven’t begun to get analyzed, being only a year running so far it is still in its baby phases, there are some interesting theories that come from nature behind it. In a natural basic environment history has shown that a person or animal of a low body weight, despite lack of energy, actually moves quite bit more than they do at a higher weight. It would make sense that their lack of food would give their bodies the drive they need to actively seek nourishment. The question is: Is there such a compulsion in eating disordered patients? How do we move and when?

If bulimic the drive to find food would presumably be there due to the binge aspect of the illness, but what about anorexic patients? There is no conscious desire or need to go forage because of anorexia’s defining restrictive nature.

The hope is that, through this, we may find out if there is any excess movement when underweight due to the subconscious need to satisfy hunger. If so it would lead to theories having to do with the excessive exercising that so many eating disordered patients partake in under the possibly superficial guise that they are trying to burn off extra calories. Could the many long hours spent at the gym and walking the streets be actually due to the body’s misplaced need to seek nourishment? Only time will tell. This study still has years left to it but I’m already intrigued to learn what the findings from it are. In the meantime, though, I can definitely say that I won’t miss the device I am wearing once they take it off Wednesday morning. So far 8 hours down – 40 to go.