Monday 15 October 2012

Help in the Mideast - Around the Dinner Table

A2Z

Registered: Today
Posts: 5

Reply with quote?#1?
My husband and I live in Israel with our three children. My middle daughter 17 years old has been sick with anorexia for 3-4 years now. When she was 13 years old she suffered from psychosomatic seizures for over a year. In trying to find help for that the anorexia went unnoticed. By the time we realized she had anorexia the family psychologist treating us suggested feeding her at home. After one week of cooperating she refused to eat. She was then admitted to a child psychiatric ward that also treats eating disorders, in a hospital. She was there for 7.5 months. After gaining weight she was released but the anorexia was very strong still. We then did a modified FBT under the guidance of a psychiatrist. It was not called FBT but from what I read on this forum it basically followed the same ideas. For 15 months we struggled with suicide attempt, depression, self harm,and not to mention the anorexia. After 15 months my daughter cut herself badly enough that it needed medical treatment in the hospital. At that point we agreed to hospitalize her again. That was one year ago. She has been hospitalized in an adolescent psychiatric hospital for one year. We are stuck between a rock and a hard place. No eating disorder unit will take my daughter as long as she is suicidal and self harms and the psychiatric hospital is doing a dreadful job of treating the eating disorder. Basically all the things that are written on this forum about bad providers describe this place. I am wondering if anyone out there has experience with what is available in Israel. Names of professionals or someone we can consult with. thank you very much
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Perdido_USA

Mentor
Registered: Oct 21, 2011
Posts: 2,199

Reply with quote?#2?
Welcome to the forum, sorry you had to find us but you have found a place of support and hope.
We saw the same behaviors of self harm and suicidal thinking while our d was underweight. These behaviors melted away when she was refed.
Have you read around the forum? Read the first few threads at the top and become familiar with what you need to.
I don't know of any treatment facility that will help your d if the first thing is not setting a proper target weight. Leaving sufferers at low weights is sad as they are in so much agony.
Do you know how much weight your d needs to gain?
Are you able to do magic plate at home?
Is your husband able to help you?
Many questions I know, we can help you.
There are folks on here all day and night.
How can we help you?
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JangledUSA

Mentor
Registered: Jan 04, 2012
Posts: 1,208

Reply with quote?#3?
A2Z, is there the possibility that your daughter and you and your husband (or either you or your husband) could travel abroad for treatment if you cannot find good treatment in Israel?

While potentially very logistically challenging it might actually be the easiest way when it is all said and done.

Just a thought.

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A2Z

Registered: Today
Posts: 5

Reply with quote?#4?
Thank you for your quick reply. I have been reading on this forum for over a year without posting. I believe that my daughter was weight restored but the psychiatric hospital she is in is not able to supervise her eating and after meals properly. In the past year three times she has lost significant amount of weight and three times she was put on a feeding tube. She also has had multiple visits to the emergency room due to self harm, even though she is in a hospital setting. We did take care of her at home for over one year, but I feel that we cannot do that at this point because she is dangerous to herself. The hospital has proceeded with legal action to have her hospitalized after she refused to continue hospitalization. I don't feel that we would have the support to take care of her at home and every time she needs medical attention we would have to fight the hospital and I am not sure we could win, even if I wanted to.
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A2Z

Registered: Today
Posts: 5

Reply with quote?#5?
jangled USA
I know you are a big fan of UCSD program. I think in retrospect it would have been helpful to us when we started to treat her at home. Unfortunately we are in a different place now. we are no longer struggling with her to eat meals, at least when she is with us. the problem is in the hospital that she started purging and skipping meals and it is hard for them to control that. On the other hand she suffers from other co morbid issues, suicidal thoughts, attempts, self harming to name a few that make it difficult to keep her at home. I am also reluctant about going abroad with her due to other stresses that it involves and how she does not cope well with stress. Although my husband and I are fluent in English her English level is not fluent and that would be an added stress to her. I speak from personal experience of being in all sorts of therapy not in my native language.
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sarabandeUSA

Mentor
Registered: March 12, 2010
Posts: 228

Reply with quote?#6?
Can you request Dialectical Behavior Therapy (DBT) for your daughter while she is in the hospital?? DBT is considered the best evidence-based therapy for crisis situations, self-harm, and suicidal threats.? It's a first-line treatment and then you could switch to CBT (Cognitive Behavior Therapy) or Acceptance and Commitment Therapy (ACT).

What type of professional support outside the hospital could your daughter have?

If you can arrange for a team of professionals outside the hospital, would you be able to care for your child at home?? Can you arrange for 24-hour supervision at home??

It often helps to consider turning your home into a temporary residential environment with structure, rules, medical care, consequences for breaking rules, etc.? Can you gather friends and family to help you care for your daughter?? Could your hire people to help you cook and keep her safe?

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sarabandeUSA

Mentor
Registered: March 12, 2010
Posts: 228

Reply with quote?#7?
I should also mention that this illness stops or decreases normal development (social, mental, academic, physical, etc).? And the lengthy hospitalization your daughter has had would add to her lack of development.? Would it help to care for her as if she was a 13 yr old?? I think this is an important factor in deciding how to care.
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sarabandeUSA

Mentor
Registered: March 12, 2010
Posts: 228

A2Z

Registered: Today
Posts: 5

Reply with quote?#9?
SarabandeUSA
I don't know how open the hospital is to bringing in outside professional help. Unfortunately we are dealing with a place that is run by the concept "we know what we are doing, don't interfere". I know that everyone on this forum would say to run as quickly as possible from such a place, but we don't know where to go. We did have 24 hour supervision at home for over a year, put our lives on hold , both financially and socially, but things got worse. We were able to deal with the eating and preventing purging but our Daughter became more isolated, more depressed and more suicidal until we felt that we could not do it anymore. And yes, I agree with you about lack of development. Our daughter has not been in school, normal social settings for three years now. The only good thing I can say about her present hospitalization is that at least she has some contact with adolescents her age and some social interactions. Unfortunately this is not the peer group I would have chosen for my daughter, adolescents with a wide range of mental illnesses. But I have to face up to the fact that my daughter also has a wide range of issues.
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Perdido_USA

Mentor
Registered: Oct 21, 2011
Posts: 2,199

Reply with quote?#10?
AZZ,
I know with my d, she had a whole range of co-morbid conditions when she was not weight restored. We saw our d regress to about a 2-3 year old when she was at her worst. And now a year later we see her acting like a 12-13 year old (even though she is 16). I think regression is typical with this disease when refeeding.
Is there any way she could get some medicine to help with the thoughts?
How far from WR is your d?
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Charlotte_UK

Coffee Breaks Social Coordinator
Registered: Aug 23, 2010
Posts: 6,771

Reply with quote?#11?
A2Z

I happen to know that there is a FEAST presence in Israel. ?I also came across this on linked-in the other day

Dear Colleagues,?

I would like to invite you to attend the following conference and perhaps submit a short paper abstract (deadline end of October):?

Treatment Modalities for Eating Disorders: Consensus and Controversy?
February 4-5, 2013?
Welcoming reception: Sunday evening, February 3, 2013?
Ramada Hotel, Jerusalem, Israel?
WEBSITE FOR MORE INFORMATION: http://www.isas.co.il/ED2013?

The conference will have a clinical focus, offering professionals from all disciplines who treat eating disorders an opportunity to broaden their knowledge about topics on which there is consensus as well as about more controversial issues in the field. All plenary lectures, as well as most of the workshops and some parallel paper sessions will be held in English. Confirmed keynote speakers and workshop presenters are MK Dr. Rachel Adatto, Ms Judith Banker, Dr. Eric van Furth, Dr. Rose Geist, Professor Debra Katzman, Professor James Lock, Dr. Philip Mehler, Professor Ulrike Schmidt and Ms Kate Williams. The conference is organized by ISAS International Seminars in collaboration with the Israel Association for Eating Disorders.?

Abstracts for short papers/posters relating to recent research or clinical issues such as treatment approaches, controversies, and unusual case reports are invited. They should contain no more than 250 words, in English, and be sent by October 31, 2012 to: conventions@isas.co.il. Title, presenter?s name (underlined), collaborators? names, affiliations, and preferred presentation method (oral presentation or poster) and language of presentation should appear at the top. The body of the abstract should include theoretical background, aims, methods, results and conclusions, without subheadings.?

Conference Organizing Committee:?

Professor Yael Latzer?
Past President, Israel Association for Eating Disorders?
Email: latzer@zahav.net.il?

Worth a contact? ?xx

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sarabandeUSA

Mentor
Registered: March 12, 2010
Posts: 228

Reply with quote?#12?
I agree with everything Perdido wrote.? Long-term malnutrition?combined with chronic anxiety creates a great amount of co-morbid illnesses or diagnoses, some temporary and?some not.? Anorexia comes with a constellation of other problems.? It's highly unlikely that your daughter's weight has been?restored in the hospital.? They don't understand the importance of weight restoration and don't know how to do it.?

To help you formulate an appropriate weight range, you need to refer to her individual growth chart trajectory (look at pre-puberty ages 7-10 to see what percentile on the trajectory she should be at) -- this is just one of the many factors to consider to calculate a weight?range, but her current state is a huge indicator that she is not at the right weight.?

And her weight isn't the only important factor in her recovery process -- she needs the love, security, and confidence of her family.? For many children, the recovery process takes many years of vigilant, consistent care at home.

In my humble opinion, your daughter will have a better chance of living a full life if she could be cared for at home and you need professionals to support your caring for her at home.? The other issues you refer to are typically all related to Anorexia, malnutrition, and chronic anxiety and they all can be treated at home with a small team of professionals.? The best combination of care often includes the right people, the right therapy, the right medication, full nutrition, security, and structure.

Charlotte has provided some wonderful contact information.? I hope you can contact this group and create a new beginning for you and your daughter.? I think you need to find someone to help you regain your hope for your daughter.? She can recover.? There is hope.

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Source: http://www.aroundthedinnertable.org/post/Help-in-the-Mideast-6047352

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