An Unhappy Birthday

I’ve never really liked birthdays. In fact, I grew up dreading them. My mother almost always forgot the occasion. Relatives I hated swarmed in from out of town. People watching me eat meant I had to eat more. I felt I didn’t deserve any of the presents I received. The passage of time made me anxious about how little I’d accomplished. I frequently spent the day in a hospital of some sort. And then there was the cake.

The cake! Oh god, the cake! The cake was the worst part. I’d spend all year worrying about the cake, planning for the cake, calculating how many calories were in the cake, devising ways to compensate for the cake. A slice of cake had 1000 calories, right? So, if I ate nothing else that day, I could have half a slice and not gain any weight, right? Or I could eat normally and exercise for five hours to burn it off? Or I could purge it? No, that would only get rid of 30% of the calories, providing I did it properly, and I’d still have 666.66 calories in surplus. What if I restricted for two days before? Could I have a whole slice then? Or could I just have a bite? How many calories were in a bite? Or a tiny bit of the frosting? Just a lick! That was my favourite part anyway. But there would be crumbs on the frosting. How would I account for those calories? It wasn’t worth it. I just wouldn’t have any. But I would exercise extra anyway—just in case, to burn off the cake I didn’t eat.

That was my birthday every year, and it was miserable. Like many people, I used birthdays as an opportunity to beat myself up, to get down on myself for all the things I hadn’t done, for everything that I wasn’t. The event emphasised my biggest insecurities—failure and fatness—and I spent the holiday punishing myself for my ‘obesity’ and ‘idiocy’. Needless to say, it was not much of a celebration.

It was my birthday last week, and although my circumstances were not ideal, I tried to make the best of it. I bought myself a book I wanted. I didn’t receive many other gifts, but I’m glad I have this text for my research. I attended two dance classes. They weren’t the challenging jazz ones back home at Pineapple, but they gave me an opportunity to work on my technique. I redeemed my birthday reward for a free drink at Starbucks. Maybe I ordered my hot chocolate with nonfat milk and scraped the whipped cream off in a panic, but at least I challenged my fear of liquid calories. I spent some quality time with my cat Katherine. It was sad not to be in London, but Katherine is so adorable and sweet. I stopped at my favourite bakery. My cake was delicious even though my friends were not there to share it with me. Did I have the best birthday ever? No, not by any stretch of the imagination, but I know that I’m lucky to be alive having this birthday at all.

Birthdays can be hard, I know. You don’t have to like them, and you don’t have to celebrate them. You can treat them like an ordinary day if you want to! Just please, please don’t use them as excuse to hurt yourself–mentally or physically. Acknowledge who you are and where your at. You may not be who or where you want to be, but you are someone, somewhere. I hope you can appreciate that.

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Disclaimer: This cake was from the Saturday before my birthday. I enjoyed a chocolate cake on the day itself, but the icing smudged on the bus trip back to my flat, and consequently I didn’t get any good pictures.

“Am I Dying?” and Other Hunger-Related Questions

Hunger is a tricky thing for people with eating disorders. We’ve disregarded it for so long that we forget what it feels like. I, for one, ignored my hunger until it became a perpetual part of my reality. I started experiencing it again in recovery, and I was honestly so confused; I kept asking my dietician “what’s happening to me? what am I feeling? what is this? am I dying?” Today’s post answers these questions and more. Read on to learn about hunger:

Question: What is hunger?

Answer: Hunger is the physical sensation generated by the body when needs more nutrients. It is caused by hypothalamic processing of the hormone ghrelin (lenomorelin), which is secreted by gastrointestinal tract in response to blow blood glucose levels and/or an empty stomach.

Q: How do you know if you’re hungry?

A: We all know about the obvious stomach growling, but hunger can manifest in many other ways, too. Symptoms include a churning, hollowness, or tightness in the stomach, lightheadedness, dizziness, or fainting, headaches, muscle cramps, shakiness/jitters, rapid heartrate, exhaustion and fatigue, irritability/agitation, lack of concentration, and even nausea.

Q: What should you do if you feel hungry?

A: Generally, if you’re hungry, you should eat. Exceptions include if you are fasting for a surgical procedure, on a meal plan that dictates your intake times, or have been otherwise advised by a medical professional not to do so.

Q: Why are you hungrier on some days than on others?

A: Hormone, activity, and stress levels can all influence your hunger. For instance, women tend to require extra nutrition prior to their menstrual periods (on account of increased calorie expenditure), and cardiovascular exercise has been shown to stimulate appetite. Growing children will also consume more calories than average, and studies have shown that lack of sleep leads to inversely proportional food consumption.

Q: What if your hunger can’t keep up with your metabolism or vice versa?

A: A healthy individual’s hunger and fullness cues will be accordance with their body’s nutritional needs, and they will eat enough to maintain a healthy weight at a reasonable activity level. Of course, this is not the case for all people; a number of factors including metabolic syndromes, chronic dieting, eating disorders, autoimmune diseases, certain medications, and economic factors can disrupt the body’s natural rhythm, resulting in skewed conditions on either side. In such cases, dietetic services are required to prevent and treat the effects of malnutrition.

Q: How does hydration affect your hunger?

A: Apparently, 37% of people confuse thirst with hunger. This is primarily due to the lack of stomach volume presented by each.

Q: How do you know whether you hungry or thirsty and what should you do about it?

A: At times, hunger and thirst present with similar indicators, notably dizziness, fatigue/exhaustion, headache, nausea, muscle cramps, tachyarrhythmias, and stomach churning/emptiness. Thirst is often accompanied by the following differentials–dark urine, dry mouth, and perspiration. If you are thirsty, you should rehydrate with fluids or eat foods with a high water content (like melon). In the past, dieticians have advised patients to drink water fifteen to twenty minutes before a meal to make sure they are actually hungry, but due to frequent disordered manipulation of this guidance, doing so is no longer a common practice; instead, nutritional professionals recommend you hydrate throughout the day and honour your hunger signals.

Q: What is emotional hunger and why wasn’t it mentioned above?

A: Emotional hunger is a psychological craving for a certain food. It was not included in the above designation, as it is a separate biochemical process. Emotional hunger is a psychological phenomenon while physical hunger is physiological.

Q: How can you tell if your hunger is emotional or physical?

A: While both physical and emotional hunger can make you crave certain foods, they are very different in nature. If your body is craving something, it is because it needs a specific nutrient contained therein; any food containing that nutrient will satisfy it, and your craving will subside. In instances of emotional hunger a food is desired on account of its associations; that food and only that food will do. Emotional hunger also tends to be accompanied by a (typically negative) emotion; it comes on suddenly and does not respond to physical hunger/fullness cues (the processing and secretion of the hormones ghrelin and leptin respectively), leading to an over- or under eating of the specified food.

Q: What should you do if you experience emotional hunger?

A: A little emotional eating won’t hurt you. It’s perfectly normal to celebrate your promotion with a slice of cake or to pick up pizza from your favourite restaurant after a bad day. Just don’t make it a habit. Food can facilitate celebration and comfort, but it is not (and never should be) a substitute for actually dealing with your feelings.

Is there anything else YOU want to know about hunger? Drop your questions in the comments below, and I’ll try to get back to you as soon as I can. Have a delicious day, everyone, and Happy Spring! xo

Obligatory Post-NEDA Week Post

Last week was National Eating Disorders Awareness Week, and I never finished my obligatory “I hate anorexia” post. I had planned on describing my experience with the disease. I was going to tell you how I suffered for eleven years, how I weighed 70 pounds, how I refused to eat more than 200 calories a day, and how I was forced to dropout of school (twice!) to go to treatment. I had intended to throw in some gruesome details about hospital stays, ambulance rides, residual health problems, and diet pill overdoses. I was hoping to include some statistics, too—pie charts featuring mortality rates, bar graphs with instances of relapse, colour-coded information about demographics, etc. I had even picked out some literary-rhetorical devices to enhance the gravitas of my manifesto. I was supposed to convince you that anorexia was the worst thing in the world and that recovering from it is the best thing you could ever do. But I can’t, because that would be a lie.

The truth is I loved being anorexic, and I loved anorexia. It made me happy like nothing else ever had, perhaps like nothing else ever will. I genuinely enjoyed losing weight, and starving myself gave me an irreplaceable sense of self-actualization. I found solace in every pound that I lost. Each new bone that protruded was a badge of honour. Exercising five hours a day became a point of pride. Hunger made me feel elated, and there was no euphoria like resisting it! I delighted in the scared looks from strangers on the street. I greeted each hospitalization with a smug smile, because at least, they meant I was doing something right. Cutting up a protein bar into seven pieces and eating it–and only it–throughout the day was thrilling. And most of all, there truly is no greater joy than stepping on the scale and seeing that you’ve reached your ultimate goal weight.

But Let’s Get Real—that was this year’s theme, after all—there are other things I want to do with my life; I have hopes, I have dreams, I have goals, I have plans. I want to go back to school to earn my PhD in English Literature. I want to be Shakespearean scholar. I want to publish a variety of criticism and lecture at universities across the globe. I want to act in the Royal Shakespeare Company. I want to write a novel. I want to dance. I want to win a Tony. I want to perform in Carnegie Hall. I want to fall in love. I want to get a dog. I want to visit Australia. These are all things I cannot do with an eating disorder, so I have to make a choice. Anorexia is an all-consuming illness. It’s it or everything else. And I choose everything else; I choose a life, I choose the future, I choose recovery. Not because I want to, but because I have to.

Our Unhealthy Bodies Can’t: The Problem with Project Heal’s New Campaign

“My Healthy Body Can” is the title of Project Heal’s new campaign. In conjunction with Straight Curve Film, the organization is encouraging participants celebrate their recovered bodies by posting pictures of themselves engaging in various (presumably physical) activities that they are now healthy enough to enjoy. The endeavour and its endeavourees are admirable, but there are some very obvious issues here.

This is a remarkably ableist, exclusive, and offensive campaign. With its tagline, “My Healthy Body Can” this movement neglects and excludes a huge portion of the recovery community–the chronically ill, the disabled, individuals who settled at unconventional body weights, and those with irreparable damage done by their eating disorder. What about them? Their unhealthy bodies can’t. Does that somehow disqualify them from celebration? Does that deprive them of support? Does that discredit their achievements? Does that discount their recoveries?

It shouldn’t. They have had to fight even harder for recovery. Treatment resources are harder to come by, care is more expensive, certain problems are taken less seriously, and every day is a struggle to balance the mental and physical components of their recovery. Some of of them will never recover from their eating disorders; some of them literally can’t.

I am one of those people–one of the unhealthy, one of the excluded, one of the perpetually sick. I will never recover from my eating disorder. I have incurable cardiovascular, endocrine, reproductive, digestive, and metabolic damage from ten years of severe anorexia. I suffered a heart attack that has led to irreversible myocardial tissue death and dangerous tachyarrhythmias, which will only get worse; I do not get periods, have a less than optimal body fat percentage, and can never bear children; I eat a specialized diet of 4000 calories a day, catered to my numerous acquired food tolerances and permanently low electrolytes, to barely maintain a below minimum BMI; I see doctors weekly, exercise daily, and take medications (nearly) hourly to keep my liver running, my kidneys working, and my heart beating, but, despite all that, I will someday need transplants anyway. My body is not and never will be healthy, and because of that, there are many things I cannot do. Maybe you can ride your horses and do your yoga (thank you, Amalie Lee for that gem!), but I’ll be here in a hospital, hooked up to a heart monitor, trying not die.

So, Project Heal, I’ll ask you once again. What about us? I see you’ve replied to your dissenters with a copy-and-pasted link to a tokenistic (phrase borrowed from the wonderful Michelle Elman) blog post, but I think I speak for everyone when I say, that isn’t good enough. Please apologize, please revise your campaign slogan, and better yet, please help us. We want and need, deserve and demand change. Increased support and resources for the minority members of the eating disorder recovery community–for those of us who don’t have the perfect, conventional recovery–are essential. Our unhealthy bodies can’t, but we matter, too; we deserve help, too; and most importantly, we can recover, too.

A Walk Down Wardour Street on a Late December Evening

Note: I set out to write a cheery Christmas vignette, but this is anything but! The following post, an account of a past Christmas, contains mature themes, disturbing imagery, mentions of suicide, descriptions of eating disorder thoughts, and “sick photos”. If you are easily triggered, please exercise caution when reading. Thank you, and have a very Happy Christmas.

There were lights on lamp-posts. They flickered—on and off, on and off. Were they dying, too? Blurry through the haze. And they were barely visible now, hard to see; hard to keep her eyes open, she could hardly breathe. But really, they were just lights, lights in the darkness, what was there to see? Incandescent and rainbow, festive and free.

And there were pies in the windows—tiny, white, dusted with powdered sugar, filled to the brim with fruit—with apples, with cherries, with blackberries, with pumpkin, with rhubarb, with mince meat—with pecans, with chocolate, with creams… Should she get one? A smile cracked her lips, ripping through her cheeks, shredding like scissors on wrapping paper, and a laugh clogged her throat—a gurgling sound, a gravelly sort of choking. Was she gagging, asphyxiating? And my god, she couldn’t breathe. It was the thought—the thought of it, the sheer ludicrousity of it, the misery; it was just so funny, so funny that it was killing her. But she had to get going now; she really had to keep walking.

The pies could keep leering at her through the bakery windows for all she cared. She really had to get going; she really had to keep walking. She really wanted one, though; yes, she really did want one. But no, it was fine; she was fine. And no, no, she would not be getting one. Besides, she only needed to see them to taste them, smell them to feel them—in her mouth, against her teeth, down her throat, sitting in her stomach, squatting in her skin, boiling in her blood, infiltrating her cells, turning to fat. So no, no, she would not be getting one.

And there was tinsel on the roofs. She could see it despite the darkness. It was hanging, hanging, hung—silver and sparkly, limp but lovely. Oh how she wanted to take a piece! She could wrap it around her neck, drape it like a scarf, pull it tight and feel the warmth, tie it to a hook, hear a crack and feel the pain until—thank god!—she couldn’t breathe. Well, it was dark inside, too, she supposed.

And there was music in the shops. Tambourines tinkled as jingle bells jingled. Shop doors opened, spewing music, spitting warm air into the cold—yes, the cold, the bitter, biting cold; she could feel it in her bones, taste it in her lungs—was that why she couldn’t breathe?—, hear it in her ears—a popping, a pressure, a pain, a pleasure. There was a heaviness to it, to the music, to how it sat in her ears and how it sunk there; it gave her that airplane kind of feeling—the one you get when you take-off or land (when the cabin pressure changes), the one you have to chew gum to get rid of. But gum has calories, you know.

And there was snow on the sidewalk. Legions of boots stamped through it, leaving lesions on the pavement, letting crusty, brown blood ooze from their scars. The wind whipped them over, beating them like frosting for a cake, concealing them from view; the flakes fell down again, and instantly they were cadavers covered in sheets, those hospital corpses that no one had claimed—hidden from view, under a blanket, yet still so very, very there. She wondered vaguely where they went, the footprints in the snow, but it didn’t matter. She just kept walking, her shoes slapping the sludge, sinking a little deeper into the spoils they had made. It was too cold out, and the snow looked too much like powdered sugar. She didn’t want to breathe it in; it might make her hungry.

And there was a girl in the middle of Wardour Street, standing on the edge of the sidewalk, too close to the cars. She was waiting for one of them to hit her, watching with bated breath as they passed her by. Snow fell all around her, and the wind threw her from side to side; she was a puppet on their string, a statuette of sticks, stuck together with the stuff of nightmares. A clock chimed through the darkness, and her heart skipped a beat. It was Christmas time in London, the perfect time to die.

Rebirthday

I died on August 29th of last year. My heart stopped, and anorexia killed me. I was technically dead for three minutes.The doctors didn’t think I would make it. I was too far gone. The defibrillators weren’t working; my heart was too damaged; I would never recover from anorexia. Why bother trying? They called my cardiologist to tell her patient had died; she told them to try one more time.

They did, and that’s when the miracle happened. That’s when my heart started beating again; that’s when my lungs started breathing again. That’s when I opened my eyes; that’s when I learned to see. There were sparkles on the ceiling and jewel-drops in my eyes. There was a buzzing in my ears and a million voices in my head; I could hear them all clearly, and they were telling me the truth–the cold, hard, cement-stairwell truth: They told me I couldn’t go on like this; they told me I had to recover. 

And they were right; I knew they were. I couldn’t go on like this, and I didn’t want to. I had to make a change; I had to do this once and for all; I had to recover. 

And so on August 29th, 2016, after ten long years, I finally began my recovery journey. I sought the help of a dietician, psychologist, cardiologist, gastroenterologist, psychiatrist, general practitioner, and liver specialist. I underwent extensive physical and psychological therapy. I gained thirty-eight pounds. I got in touch with my emotions. I learned to eat and exercise in moderation. I found freedom with food and within myself. I broke away from anorexia, and I came back to life.

I was reborn on August 29th of last year. My heart started, and I beat anorexia. I’ve been alive for approximately 525,600 minutes. I survived. The doctors saved me; my heart conditions are now managed with medications; I am recovering from anorexia. Who would’ve thought? I made it out alive, and you can, too. 

Cake at a Funeral

I went to a funeral yesterday. I brought cake. It was a pink cake, pink with rainbow sprinkles. I had to take the elevator so I didn’t drop it. I set it down on the table when I got there–the little table, the rectangular table, the table with all the magazines. I had to leave it there while I payed–two hundred and forty dollars, as it sat there on the New England Journal of Medicine, two hundred and forty dollars, pink on the orange and the white. I felt the urge to write on it, that pang again; I even had my paper out, but I didn’t know what to say. The door opened, front and to the left. A head poked out, and a soft voice said “Hello”; you could barely hear her–her lips moved, but her voice was barely there, a cloud, a cumulus cotton candy cloud on the stagnant sugar-wind. I stood up; that was my cue. My flip-flops thwacked the carpet as I walked towards her, and I saw my cake soar past the rose-gold chairs, up, up under the aureate lights. 

She asked me “How are you?”

I handed her the cake. 

“Is that for me?”

I nodded.

“It’s very pretty.” 

I shrugged. 

“What kind of icing is that?”

“Vanilla. Vanilla with sprinkles.”

We reached the door. She stopped. I went in first. She closed the door. We both sat down. The chairs were brown. 

“How are you?” She asked again.

That’s when I began to cry. She wasn’t going to ask me that anymore.

“Are you okay?”

Silence settled like ashes in an urn.

“Do I have to go?” I asked her. 

“You don’t have to do anything.”

I curled up into a little ball, bringing my knees to my chest. She peered across the carpet, watching as I sobbed, watching as my tears rolled down onto my knees. 

“I heard your session with Adrien was hard.” 

“It was… It’s just…”

“I know.”

“You really can read minds.”

Smiles. Silence. Sobs.

“Thank you for the cake. It’s very festive.”

I looked up. Her eyes were such a pretty blue. “It’s a cake of mourning.” I informed her. 

She laughed. It wasn’t supposed to be funny. 

“I feel like I’m going to a funeral.” I told her. “Preparing for this appointment, I felt like I was going to a funeral.”

It was her turn to nod.

“It’s like… I just…”

“I know.”

“I feel like I’m losing a parent.” 

“Yeah.”

“But, like, an actual parent. Not like when my dad died, that didn’t matter, and my mom could die now for all I care.”

She didn’t judge. I could see the sadness in her eyes; I could see my sadness; I could see the care, the compassion there. There was no judgement; no, she didn’t judge; she just listened. 

“A parent I actually care about.”

“You’ve learned to care. You’ve learned to sit with your feelings.” She was right. Always.

“I just didn’t think I’d have to say goodbye. I just expected I’d quit treatment, die, or just not care…”

“But you do.”

“But I do.”

“Is it hard to say goodbye to me?”

“No.” I wiped my nose on my sleeve. The lie was so obvious that we both laughed.

“Do you think you’re never going to see me again?”

Another wave of tears, heavier this time, a downpour, torrential like an Austin August.

“From my side, I can still answer your emails, and you can call me anytime. If you’re ever in Austin, if you ever need anything, you can come and see me.” 

I looked out the window. A bird flew by. A bus drove down a hill.

“If I don’t hear from you for a while, I’ll have to close your chart. That just means that part of our treatment is over.”

“I’ll send you copies of my books when I publish them.” I said. 

“I’d like that.”

“And when I write a goodbye letter–which I will do–I’ll mail it to you.” 

“From London?”

“You’re probably disappointed I didn’t write one.” I said, avoiding the issue. “I meant to, but I didn’t know what to say.”

“That’s okay.”

“It’s not. Adrien and Vanessa both got one.”

“It’s okay.”

I wept. My tears hit the couch this time.

“When I heard you were moving to London, my first thought was that you were running, and then I thought maybe she’s ready.”

“Am I?”

“Only you can answer that.”

“But you know everything.”

She smiled. I memorized pattern on the tissue box–white with yellow diamonds, white with yellow diamonds and blue dots. 

“Do you need a prescription from me?” She asked finally. 

“I don’t know.”

“Can you fill it there?”

“I don’t know.”

“Can you get three months’ supply here?”

“I guess.”

“That gives you a little wiggle room, time to find someone in London.”

I didn’t want to find someone in London. “According to Google, all the psychiatrists in London are old white men who specialize in serial killers.” 

She laughed. I didn’t. 

“Seriously.”

“I’m sure they’re not all old white men who focus on serial killers.”

“They are.”

She smiled and walked over to her desk. I watched. Her white skirt swished as she walked, her Toms changing the colour of the carpet. I could hear the pen scratching.

“I don’t want to go.” I whispered. 

She looked at me, her blue eyes melting. 

“I don’t want to go.” 

She handed me the prescription. I took it. 

“I’ll be here, if you change your mind.”

“Promise?”

“Promise.” A single tear rolled down her cheek.

“Thank you.” 

She didn’t say anything. She just wrapped me up in her warm arms, and held me close as we both shook with tears. 

“I’ll finish the goodbye letter.” I said, pulling away.

“I’m excited to read it.” She replied, putting her hand on the doorknob. 

“It’s time, isn’t it?”

She nodded.

I gave the office one last look, one last time, and then I stepped into the hallway with a smile on my face and tears in my eyes, because I knew I was ready, because I knew it was time to move on. London was calling, and life was waiting. So goodbye for now Dr. S, and thank you, thank you for everything. I love you so much.