Saturday, 19 November 2016

Your car, your body

Image result for car clipartYour body gets you to places. Your strong legs keep you walking - even running when necessary. Your strong heart pumps blood night and day to keep you alive. Your liver metabolizes substances and excretes toxic chemicals through your kidneys. Your lungs supply the much-needed oxygen. Your arms lift up heavy things, and your hands write stories or type assignments. Your eyes see the beautiful things around you, and your ears heart the glorious sounds of nature. Your lips allow you to communicate with others, and your nose helps you smell the sweet scents of nature. Your stomach digests the food that you eat, and your intestines do the same.

With an eating disorder, nearly all of this is impaired. Your muscles become weak and it becomes harder to move, run, or exercise. Your heart becomes weak and it is harder to pump blood effectively. Your brain cannot concentrate because it does not have enough nutrition; it thus becomes harder to concentrate. Your organs are lacking the nutrition that they need, so they shrink and cannot do their jobs. Your whole body slows down because it does not have what it needs - food. And without this food, your body cannot function.

Image result for treat your body rightThe analogy of our bodies as cars may be overused, but it is certainly relevant. If your body was a car, it would need fuel or gas. Without this, it would slow down. You cannot say that it will 'survive' and drive you to places without gas - it just will not. No matter how hard you try to convince yourself, the car will simply NOT RUN without the gas. You can try to believe that you can make it go, but it will not. As the car loses gas, it becomes less and less functional. It cannot do its job properly. It will eventually crash, leaving you stranded nowhere. And you will have to call a mechanic to get it working. But if you do not give it enough fuel, no mechanic will be of use. Because the thing it needs is GAS. And without this, it will not return to doing its normal job - ever.

Related image It is like the body. Give it food, it will run. It will do its job. Your organs will be happy and will function. Take away some food, and it may appear to be functioning for a while. But continue to do so and you will see that your body is failing you. It cannot go long without food. Try as you might, you cannot survive without it. Your body NEEDS food, no matter what you think. Give it food, and it will do what it has to do. Take away the fuel (food) and you are stranded somewhere - unable to function and go on with life.

We would never leave our cars empty without gas, because then they would not function. So why are our bodies any different? No fuel = no operating car = no function. No food = no energy = no functioning body. 

It may be difficult for those struggling with ED to wrap their heads around this - that food is NECESSARY. Something that should be remembered, however, is that the body can only compensate for little food intake for some time. After a while, it will simply stop functioning. That is why it needs fuel. And that fuel, dear readers, is food. And what a tasty and fine fuel it is!

Remember:  without a functioning car, we cannot get anywhere nor do anything. So without a functioning body, we also cannot do anything. It's time to treat our bodies like our cars - give them the fuel they need, give them the maintenance that they need, and be willing to spend money on them when needed. It is time that we take steps to ensure that our bodies are not harmed - just like we do not want our cars scratched or broken. Treat your body like your car - it deserves it.

Tuesday, 25 October 2016

Why is this Patient NON-COMPLIANT?!

Image result for physician and patient communicationWhat does it mean when we say that a patient is 'non-compliant' with his or her treatment plan? Usually, this refers to the fact that they are not following what they should be doing to manage their health conditions. Of course, we can see how frustrating this can be for healthcare professionals to deal with. After all, how can we make patients better if they aren't even doing what they should be?!

The issue, however, is much deeper than what appears on the surface. The key to working with a patient who is seemingly 'non-compliant' is to actually reframe the situation - and to understand that 'non-compliance' needs to be explored.

First, let's consider the fact that 'non-compliance' means that the patient is not doing what we told them to. Well, this alone is problematic! Patients need to be at the CENTRE of our care.

Therefore, if we prescribe them a treatment (this could be a medication, a lifestyle change, etc.), and they are not motivated or convinced to change or implement the intervention, they simply will not do it. To a healthcare worker, this may seem like noncompliance. But really, perhaps the patient did not understand the plan properly. Or maybe there are barriers that are preventing them from following the advice, such as financial issues, lack of motivation, no social support, underlying medical or psychiatric issues, etc. If we don't explore these further, we will simply mislabel patients as being noncompliant - and then no one benefits.
Image result for non compliant patient
Another thing to remember is that noncompliance can stem from frustration or previous experiences. Let's say your patient needs to start a certain medication, but they have heard from others that this pill gives them so many side effects and trouble. Are they likely to take it? Probably not. Or what if the patient previously tried something similar and it did not work, and now they have lost hope. Again, we may immediately brush this off as being noncompliant. But without exploring these issues with patients, we will never be able to understand their experiences, opinions, and values. Thus, we will never be able to provide truly effective, safe, and compassionate patient care.

Image result for open communication healthcare quoteAt the same time, patients need to be open with their physicians. It is important for patients to let their doctors, nurses, etc. know WHY they are hesitant to follow their treatment plan, including any challenges that they are experiencing. This can be hard, as patients may feel embarrassed, they might not 'want to talk about their problems', or they might feel that this is not 'important'. However, open communication between patients and their healthcare providers is CRITICAL! It is only through these discussions that we can formulate a plan that works best for our individual, unique patients.

So, in theory, the term noncompliance really shouldn't even be used. It is not that the patient is 'not compliant', as this indicates that the healthcare provider alone is dictating what treatments should be followed; in reality, the regime is decided upon and discussed between the patient AND the healthcare team. Furthermore, noncompliance indicates an underlying issue of some sort, and needs to be explored further to determine what the TRUE factors are. Finally, open communication, honesty, and respect are the only ways through which therapeutic relationships can be established between patients and their providers, and through this, we can ensure that our interventions are patient-cantered and lead to positive health outcomes - a benefit for patients and their physicians!

Image result for nelson mandela if you talk to a man

Tuesday, 4 October 2016

Write It Out!



I love to write. When I wrote my first book a few years ago, it was a long and tiring process. But my passion for sharing information and my experiences in words drove me to continue to write, page by page, until I had an entire book!

I also love to journal. Writing down about my vacations, school year, or even just my day is fun for me. I like to look back on my journal and read through what I did two or three years ago - it is quite nostalgic for me!

We've talked before about how sharing or expressing our emotions is important. When we talk about our feelings and label them, we feel better. We are better able to cope with our experiences and to handle difficult emotions.

What about writing down our emotions? Does this have any effect? Well, this study is one example that shows that writing down our emotions can actually have important effects on our mood and functioning. In this study, participants were about to take a math test. Half the group were given a piece of paper and pen and told to write about how they felt before the test. The other half didn't write about their emotions. Interestingly, the group that did not write about their emotions (but were anxious) showed a relationship between their anxiety and marks. In other words, anxiety without writing about it was related to lower marks. BUT, those who wrote down about their worries did not show a relationship to their mark. So, those who wrote about their study performed as they normally would have, regardless of their anxiety.

What does this mean? In simple terms, it means that when we write down our emotions, we do not allow them to control us or to screw our experiences and perceptions. We are able to identify our emotions and move on. However, when we don't express our feelings (for example, through writing), we get bogged down, and this affects our functioning and experiences.

So, does this mean you must write down every single emotion you experience? No, not at all. In fact, even just verbally speaking about your emotions is helpful. But it does serve an important to be able to write down about how we feel. If you can, try getting a journal (or even use an app on your phone!) and begin writing about your day and your feelings. When you are encountered by tough situation, take time to write about it and identify your emotions as they are. I guarantee that you will realize a big difference in how you are able to cope with the emotion and the entire experience. You will be able to understand what exactly you are feeling, why this situation is making you feel that way. Then, you can ride through the emotion and take steps to make the experience less distressing/difficult for yourself. Similarly, writing about the experience after it is over can help you reflect and realize what you learned from it, how you dealt with the whirl of emotions, and what you can do differently next time.  Even if it is ONE WORD such as 'ANGRY!", you will still feel some relief in identifying the emotion.

Try it today! Grab a pen and paper (or your finger and your phone....), and try writing down how you feel!





Wednesday, 7 September 2016

ED Recovery and Meal Planning

Image result for clock clipartWhy is it so hard for patients with ED to choose recovery, make a plan, and stick with it? Why can't patients simply decide that they will get help, enter into a treatment program, and start eating?

There seems to be evidence that patients with ED may have a hard time planning their meals/food intake ahead of time. While they could do this well in all other areas of their lives, making decisions and plans about their meals/recovery was harder. Are patients stupid or dumb because of this? No. It is simply that their brains have not had to think about eating in so long. So, making plans for recovery is something new to them. And new things take time to get used to or to master.

Why is this important? Does it really matter if meals are planned beforehand?

Well, yes. Kind of. Imagine this: if the patient is anxious about food intake, it is already difficult to eat. Now, it is time for the individual to eat. And there are so many options to choose from! Instead of thinking, 'hmm...what looks good to me? What do I WANT to eat now?', the individual may simply choose not to eat because he or she is overwhelmed.  Or, there might not be any (or little) food options, and the person may therefore feel that they don't 'have an appetite' or are too anxious to go find food elsewhere (or doesn't have time, etc.).

Or what about an event where one does not plan meals, opens the fridge, and discovers that there is no food inside? Do you think ED will tell them to go to the grocery store and buy it? NO! 'You don't have what you need to eat? Oh well. I guess that means you cannot eat', Again, ED wins. So, by planning, the patient ensures that they are one step ahead of ED. They are  prepared for all the challenges he might throw at me because they know that he will take any small chance to make them slip back into his control.

So, while the brain chemistry of ED patients may show that there is some difficulties with planning, this does not mean that patients are stupid or silly. It does not mean that they cannot make decisions. It simply means that their brains have been used to avoiding food, so it will take time to get used to it again. In the meantime, planning is the safest way to go. Plan your meals, what you will eat, when you will eat, who will make your food, etc. It may sound challenging and boring, but putting in about ten minutes to plan a week's meals will save patients the anxiety and stress of not eating and falling back into ED's traps. 10 minutes from a day planning  meals for the next week saves the individual a lifetime of health issues related to ED. 10 minutes of planning what they will eat for the week means that ED has NO TIME to try to convince them not to eat. 10 minutes of planning - that's all it takes. An ounce of prevention is worth a pound of cure.

Wednesday, 10 August 2016

Dopamine and Responses to Food in EDs




'Why is recovering from ED so hard?'. It can be difficult to understand why and how eating can be so difficult for someone. If you have read around this blog, you will likely have noticed that I am very interested in the brain/hormone changes that occur with ED. You will have also noticed that there are many of these changes, thus partially accounting for the changes we see in people who battle EDs.

Well, yet another study now gives us more insight into why eating for ED patients is so hard (http://onlinelibrary.wiley.com/doi/10.1002/eat.20937/full). This study found that in patients with ED, eating does not stimulate the 'reward' centre in the brain (the dopamine system, DA). In people without ED, eating causes DA release, which makes our brains realize that it is 'happy' or 'good'. As a result, our brains learn that food = happy and food = reward and food = good. But, what if our brains DID NOT release DA when we ate? What would happen? We would think food = bad, food = not exciting and food = not rewarding. So, why would we want to eat? We wouldn't. And it appears that this is exactly what goes on in the brain of a patient with ED.

This finding also helps to explain why patients with ED find that restricting helps alleviate anxiety or stress. Think about it: if dopamine (DA) is released and this makes us feel happy, we would not feel anxious at that time. So, if DA is NOT being released in response to food, we would feel anxious. When presented with food, patients with ED feel anxious, angry, and frightened. Why? Perhaps because of the DA malfunction. The brain seems to sense that food is dangerous and unrewarding. As a result, the patient truly is fearful of eating - their brain is telling them so! What this also implies is that if their brains are saying that food = bad, it might also be saying that no food = good. This would help to explain why starvation is a symptom of ED - patients seek out restriction and stop eating because it really DOES feel 'good' to them. The reward centre in the brain is altered and no longer recognizes food as being enjoyable - and this seems to explain why patients with ED restrict, but also why recovering from ED is so hard. To recover means to eat, and the patient does NOT want to do this...plus, their brain is giving off signals that food is not rewarding. If it isn't rewarding, why would anyone possibly want to eat? AHA! So now we can come to see why this is hard for ED patients.

I like this kind of information because once again, it gives hope to people with ED. This is proof that this is not 'all in their head'. It really is a mental illness, and sadly, the brain and body seem to adapt to restriction in such a way that works against the patient in recovery. In simpler terms, because the patient's brain is telling them that not eating is rewarding, they find it very hard to eat in recovery because eating does not feel good or rewarding. Imagine doing something that you don't like. Then doing it again and again, almost six times a day. Does that sound fun or easy? No. This is exactly what ED recovery is like for patients. Not fun. Not easy. Not enjoyable.

But it comes with its rewards in the long run. Of course, recovery is not easy. Eating may mean that the person feels full, uncomfortable, and anxious. It may be associated with weight gain if that is what the patient requires – and this is very difficult for the patient with ED to accept and be comfortable with. However, it is definitely worth it. This is what people with ED need to constantly remember: pain and challenges now will certainly bring positive and desired results soon! But you must keep going.

Recovery is challenging because one must 'ignore' what the brain and body are saying for a while (ex. Not being hungry but still eating according to a timed schedule, cruising through the anxiety of gaining weight and feeling full, not feeling excited or happy to eat, etc.). But over time, the body and brain start to adjust and it becomes a habit. Over time, the brain will start to realize that food = good, food= strong, and food = life. And soon enough, food = freedom from ED. It may take time – and unfortunately, no one knows how long that will be. But one thing is for certain: it is possible, doable, and worthwhile. In the meantime, keep fighting. Surround yourself with people who love and care for you, and can support you during this time. Find ways to cope with difficult feelings. Pamper yourself, and use distractions. Do whatever you can to keep pushing…trust me, it is worth it. And you can – and WILL do it.

Tuesday, 19 July 2016

Labeling Emotions


Stop what you are doing now, and answer this question.


How do you feel right now?

This is probably a lot harder to answer than you may think. Maybe that is because right now, nothing is truly happening. But try answering the same question when you've just found out that you may be laid off work. Or that your best friend is in the hospital. Or your parent has a car accident. Or you failed an important test. What are the feelings associated with those situations?


Why is it important to label how we feel? Why do we even bother with putting a word to our emotions? Well, interestingly, labeling our emotions is actually a lot more important than many of us (myself included!) once thought.


This study is a great example of how labeling emotions can have positive effects. In this study, participants who were scared of spiders were asked to either label an emotion (ex. I am anxious about being near a spider. I feel scared that it will hurt me") or to just approach the spider without labeling any emotions. When their brains were imaged, those who labelled their feelings had less activation of the amygdala, a part of the brain that regulates stress, fear, and emotion (so, those individuals who actually labelled their fear as being such experienced less stress and anxiety around the spiders than those who didn't label their emotions). In other, simpler words, when we label our emotions, we are less likely to feel the negative aspects of the situation or emotion (ex. labeling that you are feeling angry because your sibling just lost your phone allows you to remain less stressed, and you are less likely to 'act out' because of this anger).



Cool, huh? This has many implications for our everyday lives. Personally, sometimes I am so overwhelmed with a situation that I don't pay attention to how I am feeling, or I am unable to properly label my emotion. But, taking a deep breath and asking myself 'what am I feeling right now?" really helps me focus. For example, imagine that you are in a car accident. Do you feel angry that you lost your car? Are you scared that you hurt yourself? What thoughts are going through your mind at this moment? When we stop to analyze things this way, and put a label on our emotions, we are better able to deal with them, and cope with our experiences.


I challenge you today to begin to label your emotions - do not be afraid to say that you are feeling frustrated, angry, scared, tired, hopeless, etc. When you do so, you'll find that you feel a lot better about the overall situation, and you will also help yourself find a way to deal with that emotion. Remember that labeling your emotions is not only good for your well-being, but also helps you to slow down and push through a tough situation.



So....how do you feel right now?