Life coaching for eating disorders

I've always wonder how life coaching would be for eating disorders. Several well known eating disorder recoverers have ventured into this field. Caroline Miller comes to mind. In this snippet from The Democrat and Chronicle out of Rochester, NY, a transition program will begin in mid January for those who've finished eating disorder treatment but are still having trouble reconstructing a normal life. The program runs for eight weeks, is free, and will be led by Cindy Bitter, an anorexia survivor, certified life coach, author, and educator on eating disorders.

If anyone is in the east Rochester, NY area and participates in the program, I'd be interested in hearing your comments.

New laws to usher in the new year

As 2009 is literally less than ten hours away in the EST zone, over 100 new state laws will take effect. Some of the more prominent laws fall into the sectors of insurance, driving, cyberbullying, guns, and domestic violence.

• In insurance, eating disorders are defined as a "serious mental health illness" requiring coverage.
• Texting while driving is banned.
• Breathlyzer devices will be installed in vehicles of individuals who have been charged with DUIs. Also, stricter penalties even if failing a breathlyzer for the first time.
• Schools will be allowed to suspend and penalize students who are found cyberbullying classmates.
• Schools are also to bring awareness to internet safety at least once during the school year.
• In domestic violence cases, two-year expirations are eliminated, but must be abstained unless modified.
• Medical personnel cannot release medical records of a child to a parent who has a restraining order against them.
• Increase penalties for knowingly purchasing firearms for those prohibited.

This is just a sampling of new laws. There are a variety, ranging from politics to renewable energy to smoking bans, to tax changes, and many more. Make sure you check your state for law changes. Amazingly, those in government are actually working.

Sources: New law tougher on DUIs
New laws will take in effect in new year
MSBNC--Texting while driving...
MSNBC--School bullying law...

Meet Tovah Aliyah!

Blogging has been a little sparse lately. Much of it has to do with work, the holidays, major sleep deprivation, and the new puppy! It's been almost ten years since I've had a puppy, and I now remember how much work they are. It's one thing telling clients, but it's another thing to be reminded. However, it keeps me humble.

I admit I have a whole list of things I want to make sure to expose this puppy to. One of the main ones is a camera. So far she is not shy about it, and I know with time, the pictures will get better.

I mentioned a few posts ago that I found a name.

Meet Tovah Aliyah!

I liked both Hebrew names and didn't want to have to search forever for a name. Tovah means "good, pleasing." I thought I read "thankful" somewhere too. Aliyah means "ascending, rising to."

So in the week and a half since little 11 pound Tovah has been here, what she has been been up to?

playing at the kennel

chewing on tree limbs

chewing on bark

chewing on Daphne's collar

pretending to be a "big" dog

playing some more with Baxter

play bowing

chewing on Hank's leg
(notice she is underneath him)

exploring

waiting to ambush

chasing Hank

last but not least, sleeping,
something I wish she would do more of!

Coca-cola slammed by FDA

In 2007, Coca-Cola marketed the Diet Coke Plus with a tagline of "a good source of vitamins B3, B6, and B12, and the minerals zinc and magnesium." Now, the FDA has issued a warning letter to Coke for their "mislabeling of it claims.

The "plus" to a product can only be used if the product has at least 10% or more of the Reference Daily Intake or Reference Daily Value. Apparently, Diet Coke Plus's nutrient content fell short on this. The FDA also said in their letter that they felt it wasn't appropriate to fortify snacks like carbonated beverages.

Truly, this doesn't surprise me. Soft drink companies and alike continuously try to reach sales of their products by adding new marketing schemes. I no longer drink soft drinks, but I keep coming back to those who do and wondering whether people really believe you can get sufficient vitamins and minerals from these substances.

Fortification, in general, has been around for a long time. Most notably, cereals are on the most fortified products, however, I'm seeing a lot of other nutrients added to products. For example, omega-3 is now available in some yogurt. Fiber is now in splenda! Tell me how
that one makes sense? With each fortification, strict rules apply in accordance to the FDA
guidelines. And even with the correct labeling, it can still leave consumers confused.

Source: Scientific American

Happy holidays

Happy Holidays to all.

May you have peace and joy.

Best Always,

Tiptoe

Black ice, panic, and a roller coaster of emotions

I have to admit, tonight would have been a good night for anti-anxiety medication. (Score one for the pro anxiety medication side! Yes, I'm slowly swaying in that direction, finding the light of its benefits. Now, I just need to still decide who to see and make the call)

The day started off well. I got up a little before 6 AM--that seems to be the time I am automatically waking up, did all my doggie morning duties, swung by the vet's office to get an intranasal bordatella vaccination for the puppy, and then went to the fitness center for a workout.

After finishing that, I took the puppy to doggie daycare to play with ones her age and headed off to do errands and do last minute gift shopping. I picked up the puppy at 6 PM and headed home. There had been freezing rain off and on all day, traffic was now backed up due to some accidents on the road, so extra care needed to be taken on the roads.

About 3.5 miles miles left from my home, this one road was practically all black ice. I almost reached the kennel where I work, but then spun around in the road twice, eventually with my car in the middle of the road. Another guy in front of me was also stuck. I called emergency services and waited. Meanwhile, a few men from up the road helped turn my car so I could at least get to the kennel. I did make it there safely and was trying to get in touch with the person who worked for me today who was still at the kennel. However, I could not, and I don't know, for some reason, I was panicking over that, because I really needed to get home to let our my other dogs and was worried I would have to come back to do late night kennel

After numerous attempts of banging on the door and calling her name, finally, she came down, apparently not hearing me in the shower. It was fine for her to do late night kennel which was relief to me. I also had to leave the little one there (by the way I have figured out a name for her) as she doesn't yet know how to walk on leash (she just freezes) and was cold. I left and ran/walked the two miles home with a flashlight. My only saving grace was that I had left my yak traxs.in the car. I bought them last year when we had ice and found them beneficial.

On my way home, I called a friend who had left a message for me. We talked for two hours. It was very nice to talk to her, and I'm kind of excited about her proposal.

I also called my parents and recounted the events with them. I must have been talking a mile a minute, because that is what was going through my head. I realized just how frightened I was of spinning in the car with NO CONTROL! I've experienced driving on black ice before, but this was super scary. I'm thankful that nothing serious happened and I was able to safely get to the kennel, make sure my puppy was okay, and go home. Though I'm horrendously tired, my thoughts are still keeping me up. This is also exacerbated by work. Basically, I kind of lost it, venting my frustrations with my boss yesterday over the way the last two weeks have been handled while she's been gone. Currently, she is delayed flying back due to the west coast weather. I'll have a post later on "anger" and speak more about this.

Tomorrow's weather will be 20 degrees warmer but very windy with rain. It does not make for a fun day, but at least I'll be able to drive back with no repercussions of black ice.

Intervention: a look at dysphagia

I'm not sure how many of you watched Intervention on Monday, but it was a very interesting case with a young woman with dysphagia, a swallowing disorder. Dysphagia can occur at any age for a variety of reasons. It can be due to a congenital abnormality, a structural problem or damage, a medical condition like Parkinson's, or for a psychological problem.

In this case, dysphagia was psychological. This episode featured Nicole, a woman who had been molested at a young age. This prompted her descent into anorexia where she became very malnourished and eventually had to have a feeding tube placed in her stomach. The feeding tube has been in her stomach for fourteen years. During this time, she got married and had two beautiful children.

Her family has become increasingly worried about her children as they feel she has neglected them. They also fear that Nicole could overdose on the many medications she's on for depression, anxiety, and I believe her heart. Since Nicole fears swallowing food so intensely, stemming from her childhood molestation, she chews and spits her food as well as mashing it up and dissolving her medications through the feeding tube. Her rationale for the feeding tube is that without it, she would not live at all, simply starving.

Nicole has been in various treatment centers, including those specific for eating disorders but did not feel they helped her. When she reaches the point of talking about the molestation, she has much difficulty dealing with it and shuts down. Thus, she has not gotten that far in therapy. In the intervention, her family's and husband's hope was that she would accept receiving treatment at a residential eating disorders clinic. At the end of the show, it said she stayed in the treatment program for two months, and then went home. She learned to swallow baby food and had gained over 25 pounds.

What I found interesting about this episode was not only the fact that it presented dysphagia psychologically which I've known has occurred in some abuse cases, but also the reliance of the feeding tube from an eating disorder perspective. I've personally never experienced this, but I have heard of people both refusing a feeding tube and also fearing the removal of one as well.

In the case with Nicole, she had had the feeding tube for fourteen years which is an extremely long time, especially evident by the sores around her feeding tube site. Feeding tubes' initial purpose has always been as a temporary measure to help individuals with eating disorders or any other ailment receive the nourishment they needed for a short time. After that, it was to be removed with resumed feeding/learning to eat on one's own.

The other aspect I found surprising was how forthcoming Nicole was about her feeding tube. She publicly fed herself through the feeding tube. She figured this was how she was going to eat, and if people were repulsed by it, then they needed to not watch. In general, this goes almost completely against normal eating disorder characteristics. Eating disorders have always thrived on secrecy, but she puts hers out on display. It gives a feeling of "attention seeking" even if that is not her intention.

The show also featured the toll this swallowing disorder has taken on her family. Her oldest child felt like she did not love her, while the younger one held out hope but was still clearly hurt.

Overall, I'm glad that she accepted treatment and has found some success. I hope she continues on with recovery and will be able to overcome her abuse issues and mend her relationship with her daughters and family.

If anyone saw this episode, what were your thoughts?

A few puppy photos

These aren't the greatest pictures, but I know some of you wanted to see photos of the puppy. It's pretty difficult when she moves or I get down to her level and she just comes running at me!

Awww, a sleeping puppy is a good puppy!

I still have not decided what to do with her yet. I'm taking her to the vet on Monday for a general check-up and check to see if she is microchipped. I'll also check the local paper to see if there are any lost pets, as I feel that is the "right" thing to do. If these all turn out to be negative, there is a good possibility I will keep her. There's really something quite special about this little one, and I normally don't spontaneously decide to keep an animal. Plus, being as young as she is, there is an ability to "mold" her, as everything is from scratch, a blank slate in a way.

So any takers for names? My dad mentioned to me, "Aliyah" which origin is Hebrew, meaning "rising, ascending to" and was the name given to the immigration of Jews to Israel. It's also the name given when reciting a blessing during Jewish services.

Perhaps, a new addition?

I knew today was going to be a busy day, but I didn't expect it to be this busy. First, I overslept and missed my early morning workout. I was a bit peeved at myself for it, but I also knew I was incredibly tired. I decided berating myself was not necessarily the best thing, so I drank my decaf coffee and got ready for my therapy appt.

Today was my last therapy session for the year. I can resume them after the first of the year when my benefits are renewed. I knew C. was going to ask about my decision on medications, though I was hoping to avoid the issue. I was truthful. I'm still on the fence about it. She was okay with that, but I think still wishes I'd really try them.

We also discussed my bouts of panic attacks. Though I knew these occurrences were anxiety-related, I never considered them actual panic attacks as I don't exhibit the classic symptoms. I should really know by now that symptoms are different for everyone. I guess I have this tendency to think that if I know the sky is not going to fall and the world not end, then I really don't have anxiety problems. I know a bunch of B.S.

The last thing we briefly talked about was my work situation. I have realized that my uncertainty fear is so high that even if I'm treated not as well as I should be, that it is at least predictable. According to a study in Psychological Science (can't find the actual article online) where brain activity was measured after participants were given negative, positive, and ambiguous feedback, researchers say,

What this study shows is that neurotic individuals are actually more comfortable with clear negative information than they are with uncertainty – even when the outcome of that uncertainty could be positive. In other words, people who are high in neuroticism appear to prefer the devil they know over the devil they don't know.

I think this can be related with eating disorders too. That's a post for another day.

After therapy, I did a little shopping, came home, crashed for a bit, though still felt a guilty over missing my morning workout. I was determined to go for a run outdoors even though the weather was less than stellar--cold and cloudy.

I actually haven't run outside in two weeks. I've stayed indoors since the weather has been crappy, didn't want to get my shoes wet with rain, and just kept making excuses about how cold it was. I just needed to get over it, because normally, I run okay in the cold.

The run was nothing special until the very end. What do I see about half a mile from my place? A puppy! Now, I live out in the country and see a lot of dogs, but normally do not see ones as young as eight weeks. I immediately stopped, called to her. She came slinking to me, showed me her tummy. I picked her up as a car was coming and tried to figure out who she may have belonged to. One neighbor was not home, the other didn't know and had not seen her before.

So I couldn't just leave here there to get potentially squished! I carried her the half mile home in my arms. She was lovely and did not protest at all. She met my three dogs well. They tolerated her, Baxter's a bit guardy but I knew he would be. He isn't a fan of puppies this young. He likes when they are older, and he can play with them. Daphne, however, is quite intrigued and offering nice play.

I took the puppy with me to dog obedience class and then to late night kennel. She's now finally crashed but still had lots of energy at 11PM.

I'm really unsure of what to do. I highly doubt someone is going to look for her. I think she may have just been dumped, but it's hard to say. She has a wonderful temperament which is so nice to see. For now, I'll take care of her as I really can't bring myself to take her to a shelter. I may get in touch with one of the rescue places I worked with in the past and foster her for a bit, and then adopt her out to a good family.

This has kind of thrown me for a loop. Puppies are a lot of work, and it's been almost ten years since I've had one this young. It's work I can do, but my schedule has to be changed. I'll try to post pictures soon. I think she is a chow mix, but it's hard to say this young.

Revising the mental health "bible"

In today's New York Times, there is an article about the new revisions of the DSM, scheduled to be published in 2012 or so. Every edition of the DSM sparks controversy as these psychiatrists hold the "bible" to mental health illnesses in their hands. There are a variety of decisions to be made, including changing semantics, diagnostic criteria, implementing new disorders, and deleting others. It's really not an easy task, and sure as heck, I definitely would not want to be one of those people in the closed door rooms.

This too sparks debate, as the issue of "transparency" comes up. Currently, the revision process is closed to other mental health professionals and the public. Some feel that this rule should be lifted, while others have a fear of criticism. The other big issue is that each of the chosen psychiatrists had to sign a nondisclosure agreement and limit their income to only $10,000 per year from pharmaceutical companies and other sources. Some have felt this was a conflict of interest, especially feeling there was an underlying influence between pharmaceutical companies and doctors' decisions. Laura posted an LA Times article that speaks about this very issue. More can also be read on the Psych Central blog.

It'll be interesting to see what the new DSM-V has in store for everyone. Many with eating disorders are especially curious whether the diagnostic criteria will be changed, especially about the exclusion of amenorrhea for anorexia and whether Binge Eating Disorder will be included as an official disorder in the manual. There was also talk of "purging disorder" to be considered.

In general, I think having the DSM is a double edged sword. It's positive in that it gives clinicians objectifiable criteria and data. However, I think some clinicians rely on it too much. The manual is really only a guidebook and clinicians should be able to feel as though they can give leeway with patients who may exhibit much criteria for a certain disorder even if it is not all of it.

I'm also wondering what happens to those disorders that were named as illnesses but are excluded from the manual revision? My feeling is that it's another way for insurance companies to NOT pay for treatment. On the up side, other illnesses could be "legitimized" or criteria changed so more or less people fall under that disorder.

What's your feeling on the revisions of the DSM and its current closed door policy?

A few related posts I wrote awhile back:
Eating disorder diagnostic criteria investigated
Diagnostic crossover in eating disorders

Preventing youth smoking: tell them they could become fat

stock.xchng
This article caught my eye today. Now, we all know the effects of smoking on one's health. There are a number of illnesses that can cause damage later in life, including a variety of cancers and heart disease. Experts are always trying to find ways to prevent youth from starting the smoking habit. The latest now is that by smoking in adolescence, there is an increased risk of being fat later in life. They feel this may be more effective than mentioning the risks about heart disease, diabetes, and lung cancer.

This thinking is all based on an upcoming article in the American Journal of Public Health of a long-term Finnish study of 4300 twins. The study looked at their smoking habits as adolescents and their body shape in young adulthood. Of the 12 percent who smoked during adolescence, 24 percent of men and 11 percent of women were overweight in their early 20s. These results were independent of health habits, participants' body weights, and genetics. Females who also smoked at least 10 cigarettes daily during adolescence had double the risk of becoming overweight as their non-smoking counterparts, according to this study.

While it is true that teenagers certainly feel as though they are invincible, I don't know that telling them they could be fat later in life is a better alternative for the prevention of smoking. This is yet another reminder how fat phobic we are as a society and this only provides a mere scare tactic.

How much role does cash play in weight loss?

Tonight is the finale of the popular television show, The Biggest Loser. If you're not familiar with the show, basically, it's where obese individuals lose extreme amounts of weight in a short period of time through excessive hours of exercise and supposedly proper nutrition. I believe the show starts out with 14 or 15 contestants and one gets voted off per week depending on how much weight they have lost. The person who has lost the most amount of weight, aka "The Biggest Loser" receives a cash prize of $250,000.

I find this all so fitting, especially with a recent article that came out last week in the Journal of American Medical Association about the financial incentive for weight loss. Researchers at the University of Pennsylvania studied 57 obese, but otherwise healthy individuals and randomly assigned them to three weight loss plans: a lottery incentive program, a deposit contract program, or monthly weigh-ins (control group).

In the lottery incentive program, individuals received money if they reached their weight loss target. The deposit contract group consisted of participants investing a small amount of their own money per day. If they reached their weight loss target, they would also receive a bonus, otherwise, they lost their money at the end of the month.

At the end of four months, the incentive groups lost more weight compared to the control group with about half reaching their target weight loss. However, seven months later, when there were no longer financial incentives, weight loss was not sustained among the incentive groups.

The idea behind the research was based on the loss aversion theory. Researchers say they wanted "to create a mechanism where loss aversion would help drive people's motivation...we wanted to create a reward system which gave them rewards in the present."

I'm not sure how to feel about the financial incentives for weight loss (for those who may need to clinically speaking). It adds such another factor into the mix of real motivations for weight loss or anything for for that matter. Rachel at The F-Word wrote a post awhile back titled The Biggest Loser or the Cash Cow? which made you think twice about the show.

What I find even more interesting is turning the tables--instead of weight loss, weight gain. How come we don't give cash incentives for that? Even so, it wouldn't matter, because weight gain is looked down upon in society, except for those with eating disorders or other medical illnesses where weight restoration is important. Even if those with EDs were given a cash incentive to gain weight, it is highly doubtful that they would embark on it. The motivations are different and money, objects, etc. aren't powerful enough.

In the end, however, for most with eating disorders, their motivations to gain weight (and I say this lightly as weight gain is difficult) and hopefully recover actually turn into more intrinsic values. The value of health and vitality, the motivation to (excerpt activity here), the ability to self nurture, and the list goes on and on all become more important than living a life with an eating disorder.

CBT-E and eating disorders

The hot article of the day is about about a "new" form of Cognitive Behavioral Therapy (CBT) called Cognitive Behavioral Therapy-Enhanced (CBT-E). It's interesting to see how the media decides to title the article. Words range from "potential" to "curing" eating disorders.

CBT-E, developed by Christopher Fairburn, professor and researcher at Oxford University, is an extension of the standard CBT treatment used for bulimia. Fairburn developed two forms of CBT-E--one focuses only on the eating disorder, while the other also delves into low self-esteem and extreme perfectionism issues.

In a study of 154 patients with bulimia and "atypical" eating disorders, results found the majority showed improvement and had sustained effects over a period of a year with both forms of CBT-E. Two-thirds of those finishing the study had complete and lasting responses.

Fairburn says, "Now for the first time, we have a single treatment which can be effective at treating the majority of cases without the need for patients to be admitted into hospital." He is now currently studying a large-scale trial using CBT-E with anorexic individuals.

I guess I'm not quite seeing what the big hoopla is and how this CBT-E is "different" from standard CBT. I'm certainly not a fan of some media outlets saying how this therapy could "cure" eating disorders. Perhaps, that's just the skeptic in me.

I guess my other qualm with all this is, well, shouldn't issues of perfectionism, low self-esteem, depression, etc. already be addressed in whatever therapy is considered?

Obviously, more information on this new psychotherapy needs to be given. Maybe those of you in the UK might know more about this since it is apparently increasingly being used there.

Here's an interesting article The Independent which asks similar questions and looks at both sides of the coin in how CBT is effective and also its problems.

"Let them eat cake"

Since I am unable to watch House during the week, I like to watch the reruns on the weekends. Some of the cases are quite fascinating. The one I watched last night was from a few weeks ago, titled "Let them eat cake."

In this episode, a personal trainer comes in after she has collapsed from a fitness infomercial shoot. As usual, House and his assistants go through a battery of tests to figure out the right diagnosis. They wound up scanning her for a tumor and realized that she had gastric bypass surgery since her stomach was stapled. Some of the assistants ask her about the ethics of her career choice as a fitness trainer yet having medical intervention. She replies with that she is helping her clients to get healthy as she did once she had the surgery.

Anyway, this post isn't geared towards the contradiction of her career choice and previous lifestyle. This post is about what happens at the end of the show. After many tests, House finally makes a diagnosis of hereditary coproporphyia, a condition in which the liver lacks an enzyme that interrupts heme production. There is no cure for the condition, however, the treatment protocol is to reverse the gastric bypass surgery and implement a diet high in carbohydrate and sugar.

When House tells the patient, there is a look of mortification with her pleading for another way. The only other thing was medications for pain control. In the end, she chose the medication, and refused the surgery. House's final statement is, "Most people don't have the guts to admit they'd rather be pretty than healthy."

Now, I think that statement is slightly shallow, but I do get the point he is making. For this patient, having the bypass surgery helped transform her life so that she wound up living a healthier lifestyle. Therefore, I'm sure she felt like if she reversed the surgery, it would all be for nothing, or there was a fear she would regain all the weight lost, or simply unsure she could trust herself.

If I was in that position, I'm not sure what I would have done. I'd like to think that the "healthy" rationale would win out, but would it really? If you were placed in a medical situation of being thin or healthy (excluding weight restoration), which would you choose? What if your diet had to drastically change to all your fear foods, how would you react?

Transcript for episode

To tell the truth

image: amazon

I recently read Maya Angelou's Letter To My Daughter. The book is a series of lessons based on Angelou's life experiences which she has found useful. Although she has never had a daughter, the book is an offering to all the daughters of every race, ethnicity, shape, education, background, etc.

One particular chapter intrigued me called "To tell the truth." She opens with the three word question of "how are you?" Everyday, people ask this to one another. It has become just a simple conversation starter. Do people really want to know how you are when they ask this question?

Angelou mentions the fact that people may say blatant lies about someone, such as "you look great" when they've lost dangerous amounts of weight or vice versa. As she says,"we all swallow the untruth in part to keep the peace and in part because we do not wish to deal with the truth."

She goes on to say how liberating it is to be honest, and that we should try to answer truthfully when people ask how we are. There will be people who do not want to hear what you have to say, however, Angelou says, "But think of it this way, if people avoid you, you will have more time to meditate and do fine research for a cure for whatever truly afflicts you."

I think about those three words, "How are you?" Most the time, I simply answer FINE. For some the FINE acronym is "Fucked Up Neurotic Emotional." I guess it seems easier to answer this way (especially with my parents) instead of going into all the complicated, irrational, fearful thoughts I may have. There is still such a fear of worrying people, of feeling pity, of shame, of them thinking what a basketcase I am. Even the instances where I've been truthful (other than therapy), there isn't a feeling of people really caring. The truth can place people in awkward positions, and they don't know what to say or how to react; instead, they just go on talking about the weather.

How do you answer the question of "how are you?" Do you tell the truth or the untruth? What does meaning the truth mean to you?

When you really can't relax...

I am off today from work which is a rarity as it is a Friday. My boss left to go out of town on Tuesday, so I've had to work more at the kennel. It's not so bad except that, I also have to assist dog training classes and do late night kennel. This means during the week, I'm running around back and forth, eating dinner much later than usual, and my day does not fully end until 10-10:30 PM.

My boss decided to bring in someone, so I could get a day off. I essentially spent the good part of this morning training her and introducing dogs. I was already a bit concerned with two dogs in the kennel, but my boss thought they would be fine with the new person since she was female.

I let them out, they met her, and seemed to be okay. Upon coming in for breakfast, however, one barks at her which sets the other off, and he goes after her hand but got her shirt instead. I'm thinking this is so not good. After breakfast, I let them out, and they act similarly, but the one who had already gotten a piece of shirt lunged at her. Great.

So for now, she won't be letting those dogs out into the larger paddocks but only the smaller one off their kennels. What does this do? Stresses me out! I feel like I can't really enjoy my day and a half off (not that I don't have a million things to do anyway), because I'm way worried that J. will bite her even though he is disarmed (his canines have been filed down). It's one of those moments that I just pray everything goes okay, and I don't get some horrendous call. I hate being positioned like this!

Okay, off to try to be productive.

Anxiety medication dilemma take two

I'm still agonizing over the decision to go on medication. One, I'm incredibly impatient when it comes to medications working. Two, I'm worried about the side effects--yes weight gain which is always a fear. Three, I'm worried about the cost. Four, I'm worried it won't work and that my time will be wasted.

On the up side, a medication could work. I could perhaps think more clearly and process things better. I may not be as overwhelmed when faced with difficult decisions. It could possibly help with my continual vacillation between some denial and actual problem with exercising. :-/

So I bit the bullet and spent most of my morning making calls to psychiatrists' offices. I had a few names from my previous therapist. The two through the university who I wanted to see are booked until February and not taking new patients. I wouldn't even get to see them unless I saw their LCSW first and then had her refer me to one of their pdocs.

I called a few others that were on my insurance list. On one call, this guy was super nice and answered my questions and knew of one who worked with ED patients extensively. The funny thing was that I asked him if he knew of this other psychiatrist whom I'd called. His answer was that "she had been around forever, and given my age and problem, he highly suggested I went to see the ED pdoc." Hmmm, that kind of left me confused since she is the one I'm waiting to hear back from.

Another psychiatrist, I was able to speak with personally. She seemed very nice and worked with patients who were referred to her by my former therapist. The rest I called don't take my insurance with the exception of two psychiatric nurse practitioners.

As my analytical brain likes to do, I've made a list of the possible psychiatrists. This is the rundown, * indicates they accept my insurance.

Pdoc C. is an anxiety specialist who founded the Anxiety Foundation. He does both psychotherapy and pharmacotherapy and also uses animal assisted therapy. He has some experience working with eating disorder clientele. His fee, however, is a bit outrageous. Either he's really good, or he jacks his rates sky high.

Pdoc W. works with ED clients extensively and apparently worked under a well known ED researcher at the university. According to the guy I talked to who gave me his name, this pdoc, in his opinion, was the best ED one in town.

Pdoc L. was a a name given by my former therapist K. His specialty is addictions and is supposed to be a really nice guy. I think he also won some award a few years ago, voted as the best psychiatrist in town.

Pdoc G-R. is the one I spoke with. She's also worked with Ed clientele, though it is not her specialty. My former therapist, K. has referred several clients to her. She seemed very nice and even suggested if I had other names I wanted to run by her, to give her a call.

*Pdoc F. has also worked with ED clients. She is the one that the guy who I spoke to said had been around forever. I don't know if that is a good thing or a bad thing. I'm waiting to speak to her personally, as that is something she just does with all new possible clients.

*Pdoc Mc. or P. are nurse practitioners. My current therapist, C., has referred a few clients to them. She says that one is apparently blunt and gruff, but was able to find alternative meds that did not have weight gain as a side effect. The other she has not heard anything negative about.

Yes, I know this seems ridiculous. "It's just a psychiatrist" as one of my friends said. I called my mother to get feedback since she has been on what seems like every single medication known to mankind for depression. She tried really, but she wasn't very helpful.

See, this is the thing. I'm placed with a number of options in front of me, and then I have a hard time choosing. One part of me says I should just go through insurance as it would be cheaper. Another part of me thinks I should go for the specialty. Then, another part of me says I should bite the bullet for the high initial cost of the first appt. if the arrow points to them helping me more. Maybe I should just play spin the bottle?

Why am I making this so difficult? I think part of it is that I really want to be able to have an actual relationship with whatever pdoc I see. I don't want it to just be med management which unfortunately is how it mostly is since insurance companies have "ruined" the field of psychiatry. This is according to my mother's current pdoc.

The other thing is I think that the follow-up appts. would be a waste unless there were serious side effects going on. And I guess I'm just having trouble thinking about paying that much money for a mere 10-20 minutes at the max when you could just call and say how you were. I know most see pdocs much less frequently than a therapist but still.

Then, the really bad thing with all this (and why I'm really hating insurance at the moment) which I just found out is that any pdoc session would count toward my mental health coverage. Currently, I only have a ten session limit/year, so it cuts my therapy by at least two or more sessions. I can continue of course, it's just everything would be out of pocket, and I would not be able to go as frequently.

This is where everything stands right now, and I'm having a terrible time in deciding what to do. It's essentially the story of my life. :sigh: Does anyone have any special wisdom? Or want to commiserate with me?

Part one of anxiety medication dilemma can be read here.

By the way, my day ended up strangely. I went to the store to pick up a few items. When I got home to put the items away, I realized there was a pack of cigarettes in the bag! I have not a clue how they got in there. Hmm, maybe this is some sign? Just kidding, I seriously doubt someone is trying to tell me to just kill the anxiety with a few smokes.

Fountain of youth?

So anyone care to guess how old this man is? Really, take a guess.
This physician, named Jeffrey Life is 69 years old! Do you call this fit or obsessed with youth?

Dr. Life is the chief medical officer at Cenegenics Medical Institute, a clinic in Las Vegas that specializes in "age management." In order to achieve a body like this, Dr. Life and patients like him have changed their diets drastically, exercised more, injected themselves daily with low dose human growth hormone and have given themselves weekly testosterone injections.

And for what? Well, they say it isn't about appearance but to live a longer, healthier life. And the expense of this "hormone therapy" is more than $1,000/month!

The proponents of this anti-ageing theory--good nutrition, supplements,, and
balance of hormones, say that this allows them to stay biologically younger. They claim that their cholesterol, lipids, libido, energy level, immune system, and memory all improve by this regimen.

However, this hormone therapy is not without its critics. Some physicians feel that there is a risk of diabetes and cancer while others feel quite the opposite. In recent years, HGH has been studied in various capacities. (pubmed)

**********

This whole obsession with youth isn't really that new. There is cosmetic surgery which has steadily increased in years with nearly 11 million performed in 2006. Breast augmentation topped the list, followed by nose jobs, and
liposuction. Teen bariatric surgery has also tripled in recent years, according to this article. Though age is still controversial, there have been teenagers as young as 12 who underwent the procedure.

Then, there is the Calorie Restriction Society, individuals who feel that by reducing their calories, they will live longer and be healthier. This too has its controversies, though there have been a few animal studies demonstrating calorie restriction with longer life. It's still uncertain in humans, but this group is willing to be those guinea pigs despite the fact that one of their gurus still died at around 79 years of age which is not an astonishing feat. By the way, I recently saw a recipe book for living like a Cronie, that's their term. The book's recipe had like no real food in it--just mostly veggies seasoned in a variety of ways with occasional meat thrown in.

So where does this put us? Really obsessed and spending so much money! Where and when does it end? We are only teaching our youth that we need to be beautiful, thin, and young-looking at any cost.

Question: What's your opinion about the process of aging? Should we be trying to manipulate ourselves to eternalize youth? Would you subject yourself to hormone therapy at the possibility of staying youthful?

Other article: HGH and youth