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What’s up Doc?

What’s up Doc?

This is a slightly different post to my usual.

I want to talk about well-being amongst healthcare professionals.

The people that look after you when you are sick are humans too but it can be hard to view them as anything more than the doctor/ nurse/ psychologist in front of you. They have a life outside of the workplace, they have their own families, insecurities and problems.

Doctors, nurses, first responders & all members of the healthcare profession make huge sacrifices for their patients and do so willingly.

But who looks after them?

Mental health problems amongst medical personnel is at an all time high. If we don’t look after our healers they can’t look after you.

Yet, we are a profession that is notoriously bad at seeking help for ourselves. It’s a common theme of jokes “doctors/ nurses make the worst patients”. We provide diligence to our patients but it’s a hard pill for us to swallow when we need help ourselves.

What are some of the reasons behind the resistance for a healthcare worker to seek the same help they provide without a second thought?

A study published by the lancet offered several reasons for this.

An old fashioned and harmful rhetoric that still bleeds into the healthcare industry: “we don’t get sick, we treat the sick”. It’s hard for healthcare workers to accept they are not infallible and often this narrative alone prevents them from seeking help, often meaning problems are advanced by the time the do access care.

The well-being of doctors is becoming increasing challenged.

The medical field is an unusual one.

For most of us, we give up our twenties to dedicate ourselves to studying or long hours working as junior doctors. We are often forced to make difficult balances, missing out on important life events and socializing because of the restraints of the profession. It’s not uncommon to battle to get leave for major events such as weddings or funerals.

Often, we can’t just go home when our work day is supposed to finish because we are looking after someone in their moment of need. We stay late because we care.

But this can come at a cost.

Our contracts can mean constant changes, junior doctors move around every 4 months, sometimes this means transferring miles away from your loved ones. This can make things like registering with a general practitioner difficult.

Long shifts, antisocial hours, plugging gaps in rosters, studying for endless exams and extracurricular activities can take their toll both mentally and physically.

Often these are accompanied with limited access to healthy food or basic self care including rest, relaxation or exercise.

There is an undertone within the healthcare profession that being anything less than perfect 24/7 is failure. Fear of disclosure and the implications it may have on our license to practice I’m sure is a common barrier to seeking help.

Doctors have an increased rate of suicide compared with any other profession, high rates of mental illness, including depression, anxiety, burnout, imposter syndrome and substance abuse. But it doesn’t get talked about. It remains “taboo”.

The resources for help aren’t made readily accessible, the encouragement to seek help is virtually non existent. This needs to change as early as medical school training. This needs to be openly discussed and normalized. Otherwise the stigma stays and nothing changes.

Doctors are making life or death emotionally demanding decisions. This is what being a doctor is. But sometimes the weight of these decisions is enormous without resources to help.

The threat of litigation is real, the trauma of some of the decisions they face, with often no debrief or acknowledgement of the enormity of these decisions.

Burnout rates are increasing.

Dealing with uncertainty is something doctors become adept at, changes in rosters, no two days being the same.

Teamwork can be challenging when there is conflict between management and the frontline workers or finite resources.

It’s not uncommon to come across bullying and not enough is done to mitigate or reduce this.

If you are a healthcare professional what were the barriers you faced to seeking help? I’d love to hear your experiences

What do you think needs to happen to protect our community’s wellbeing? How can we do this?

There are some charities that exist but again they’re not widely known about. I’ll share some links below. If you know of other’s please share.

References:

Wading upstream…

Recovery tight-rope ED recovery

Anorexia recovery

Recovery doesn’t have to be complicated. But I think it can be made easier.

Yesterday I got my haircut. ( I know lucky, in non lockdown) But I didn’t appreciate HOW LONG it was going to take! 4.5 hours, Two things firstly, I was able to sit an do nothing for this period. Something I have found really hard to do before, giving myself permission to be still, not fidgeting, standing, on the go or doing something productive. Because our ED’s tell us this is the worst thing a human could do, and it’s lazy. So that’s a victory that this was easy, outside of the boredom of being in the hairdressers on one of my only days off!

But…..today is harder. Why? Because I didn’t plan ahead very well. I always make an effort to eat 3 meals, and normally 2-3 snacks between, because I don’t have hunger signals yet so I eat regularly.

Second…I thought I’d be out in time for lunch yesterday. I wasn’t. I took a few crisps with me * also a win, would have never eaten anything before and I used to envy the people who would sit and snack care free. But I ended up missing lunch. Doing this feeds ‘HH’. I normally plan to have stuff with me at all times. Because missing a meal whether it’s intentional or not leads to energy deficit, which opens up pathways to old thoughts, behaviours. I cannot afford to do this. I expect with time, the odd unintentional meal miss won’t be an issue but early in recovery when there are neural pathways that are so brittle and easy to ignite it’s not a good idea.

I can feel when I haven’t eaten enough, or have allowed myself to get into energy deficit. I don’t have to be hungry to get this, it’s a feeling, and I am grateful I can now recognise it because I avoid it like the plague (or COVID to be more to relevant) But life happens. Like yesterday.

I ate as soon as I left, but I could already feel I felt out of gear. I made an extra effort to have a ‘big’ dinner and a snack before bed. I was not going to let ‘HH’ in. But just to explain how brittle recovery is in the early parts. I went to bed. I woke at 2:00 wired, with a feeling of what I guess was hunger. I felt empty. A feeling I was way to familiar with and “HH’ was there, ‘I remember this feeling it feels clean, now we need to do something, move, we don’t need to sleep’

Insomnia was a huge issue for me when I was sick, possibly the worst part, that and being bone cold all the time. Now for the most part I sleep like a baby, except if i’ve got the balance wrong. So its a warning for me. I got up and had a biscuit, because ‘HH’ thoughts were creeping in and demonising anything. So I ate my hobnob and slept through.

I knew today would likely be a bit harder, this morning questions of ‘ isn’t that too many oats, too much almond butter’ were there. So I added extra. But this is the thing, this is how we can either carry on moving forward, or a slip can happen after a simple innocent incident. Something that someone who has never had an eating disorder never has to think about, or likely understand. But for us, it’s something we cannot be complacent with it’s a tightrope. But again, the rope becomes more like a bridge than a rope with time, because now although the thoughts are louder today, I’m not acting on them. Before I would have and that’s all it would have taken to knock me off my rope. But through repeatedly getting back on the rope, it’s wider, stronger.

I know for next time, I will take my lunch, just in case. Recovery is learning, growth. Prepping like a boss for all the things that knock you off that rope is key. But getting back on the rope is vital no matter how many times you fall.

Recovery bridge Pexels.com

Resources:

  1. https://tabithafarrar.com
  2. https://edinstitute.org/blog/2013/3/31/homeodynamic-recovery-method-guidelines-overview and Gwyneth Olwyn’s book, also available at this site.

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Re-reading old journal entries, anorexia recovery. What language does your ED voice use?

Reframe negative eating disorder thoughts

I’ve been journaling for a long time. I was re-reading an old journal, one I started in early recovery. I found there was a theme to the language I used to describe how I was feeling, or when journalling about behaviours.

It was all self critical. Extremely negative.

Common words I used: ASHAMED, DISGUSTED, LONELY, ANGRY, FAT. This was even when I’d documented small positive steps to change.

“I feel ashamed, I want to crawl out of my skin, I feel trapped, consumed & powerless. I’m disgusted I’ve allowed myself to get into this predicament. I don’t feel I deserve the help. It’s a spell I cannot break no matter how hard I try I’m stuck”

This was an entry I made a few weeks into recovery.

Comparing this to more recent entries, there’s none of the negative language. It’s incredible how consuming our eating disorders are, they overshadow us, they thrive on secrecy and feed the feelings of isolation and shame grows and grows.

Now that I’m much further into recovery, I can seperate this unkind voice from my own, kinder, compassionate in built healthy self voice. I do not allow myself to use language such as ashamed, disgusted, instead I reframe them and ask myself what I’m needing. Why the ‘HH’ voice is spouting these terms. If I have a thought that sounds hypercritical I know it’s coming from ‘HH’ and not me, and serves no purpose in driving my recovery.

Self compassion is difficult in early recovery because we are listening to the negative thoughts. But as we grow stronger in recovery it’s easier to be kinder to ourselves. Something we have to re-learn to do. After being the opposite for so long. It feels uncomfortable. But anything in recovery that’s uncomfortable is good.

I found it hard to do NOTHING. Or pause have a cup of tea when I felt tired, or allow myself to feel emotions. But with time, one of my favourite pass times is to sit and literally do nothing with a cup of tea ( and most often a chocolate hobnob) Yes I am English and do believe this solves everything. I never thought that weekend early in recovery I would be able to to do that. I thought ‘HH’ would berate me for sitting for a second. Sure, there are days where I do hear the negative utterances. But the difference is now I don’t turn against myself, I don’t tell myself I’m ashamed of myself, not deserving etc. I tell myself I am worthy, I can live however I want and I don’t have to listen to the thoughts. I am not those thoughts. What thoughts do you need to re-frame?

Reflecting on Christmases past, present and Christmas future in anorexia recovery

Rockerfeller tree. ED freedom

This time last year, I was getting both excited and off the chart anxious about surprising my family in the UK for Christmas, with a holiday on the way via New York.

So much has happened over the past 12 months. We couldn’t go and do this now even if we wanted to. COVID-19 has changed everything for everyone.

We were lucky we could make this trip last year. However I think we become increasingly reflective in our recovery. We have to I believe, to make sure we don’t become complacent and let the foot slip off the gas of progress and allow ourselves to slip backwards. SO naturally this means we reflect on where things lie. I have been thinking about last year’s trip a lot these past few weeks, partly because my family bring it up at every zoom chat and partly because we are making plans for this Christmas.

I can see how far I have come during this time. I felt more dread and fear around the whole trip than I did excitement. How fucked up is that?! I have always loved Christmas and a massive dream was to visit New York at Christmas time. My family Christmases have always been epic and I hadn’t spent Christmas with my family for 8 years so it was going to be special.

Uptight and not present…

Seeing the Rockerfeller tree, snow in Central Park, Macy’s displays was magical. But something still felt missing. ME. I wasn’t really present. It was like I was observing someone else experiencing what I’d always dreamed of. I sat feeling the coldest I had ever felt at a Soccer game, worrying about what we’d eat, how I’d compensate. Fixating on what my families reactions would be having not seen me for ages. Worrying about the Christmas dinners, socials it went on and on.

Then the Christmas itself- I felt numb and empty and so sad. It was not the reunion, surprise I envisioned. I was stressed the whole time, controlling everything. I wanted nothing more than to make last Christmas special, happy. But I hadn’t really committed to recovery at this point, so I had set myself up for a difficult time. Which was unnecessary.

Reflecting on progress…Now fast forward 12 months- I don’t act on ED behaviours, we are spending Xmas with friends this year. I have worked hard to be here, I have so much more freedom with each day. I’m not worrying about this Christmas, I’m looking forward to it. Looking forward to being present, being relaxed and not a controlling freak who has to micromanage everything. But this brings me sadness too. I cannot share this with my family. I cannot show them how things have changed. I hate that, the memory that should have been really special I allowed my ED, yet again to dominate, dictate and taint.

This brings me on to my next point, I know in order to get here, to keep moving forward so that I will be able to share happy holidays with my family again, I have to make a conceited effort every day to make positive steps. If you had have asked me 12 months ago, what does recovery mean, I didn’t really have a clue. I remember my therapist asked me to write down what recovery meant. However, I think at the beginning of recovery we don’t know because we are still overshadowed by our ED personality. Not so much our healthy self. I think it’s important to think about this early on, but I’m not surprised my list is different now. For starters 1 thing that is on my list of full recovery means, being able to spend time with family without any ED anxiety, complete freedom. Being able to travel without any compensation, anxiety about eating a different routine. Not being bothered by other peoples comments pertaining to my food, appearance, diets bla bla. So many more.

But in the early days it was two dimensional and clearly written by “HH”: I.e I don’t want to be cold, develop healthy relationship with exercise etc.

I think we grow in every sense as we recover. I have a far better understanding of who I am now. So in short reflection helps us to continue forward.

These would have given me so much anxiety a year ago. Now they’re just yum.

Clothes shopping in eating disorder recovery…

Phases of clothes shopping through recovery is Like “the origins of man” demonstrated by this spongebob gif!

I went clothes shopping last week. No one tells you how hard this experience is in recovery.

I decided to charity shop my “skinny” clothes. I will never need them again. It’s almost like a grieving process. I never liked how I looked at my lowest weight. I was self conscious. But buying small clothes was something my ED used as targets. Although I never felt better when I met them. I actually felt worse and worse, especially when nothing actually fit. When I started gaining weight, “HH” freaked out. Suddenly nothing fit and I felt self conscious all over again.

EDs will try and make you hold on to old behaviors or reminders of it. For me it was keeping these clothes “just in case” but they were holding me back. How can you recover with the thought you might one day fit in the clothes that fit when you are nowhere near your natural body shape or size. You can’t stay there. Not healthily anyway.

Buying clothes throughout the “weight restoration phase” is traumatic. I would recommend if you’re going through it, you don’t do it alone. It’s triggering no matter how far in you are or how committed. I would say this corresponds to the third picture in the gif. You are in no mans land. You’re not in the emaciated shell, you have fat in weird places so it’s hard to find things that fit and feel comfortable.

I went with a friend I could trust and my husband. I asked them to ask me questions like, how I felt in the clothes rather than making comments about appearance or fit. I looked for clothes I’d feel comfortable in at this stage in my recovery where my weight isn’t evenly distributed. Clothes that would accentuate other features that I’m less insecure with. For me this was flowy dresses. I have spent a long time in clothes hiding my weight for the other reason. I don’t want to hide my shape at all now, but I do want to feel comfortable. ‘HH’ longs for the old clothes but healthy me sees it a triumph of how far I’ve come.

You don’t have to like your body, I have become relatively neutral towards it. However uneven distribution, clothes shopping with size tags, mirrors is not fun. I also only bought a few things I really needed rather than a whole new wardrobe.

I didn’t do it all at once and checked in regularly. I talked through my HH thoughts with my psychologist.

Last week I went shopping on my own. It wasn’t that hard. It doesn’t need to be hard. Plan what you need, check in with your support and look after yourself.

Reckon this stage 4th sponge bob on the gif. Powering through, accepting the changes. Grateful for what you can do in your body and with your recovered body. Don’t think it’s necessary to love your body but if you do that’s a win and definitely the last sponge bob on the gif.

I still freeze in supermarkets and looking at menus

I still freeze in supermarkets and looking at menus…

It’s way way way better than in the depths of my ED.

But I try to go in to supermarkets with a list now to avoid the crazy freezing!

Probably should add a trigger warning here, as I’m mentioning behaviours. If you are easily triggered perhaps skip. I will never talk about my weight, BMI on this site because I know 1 it’s triggering and 2 I don’t think you need to know.

What do I mean by supermarket freezing or blindness?

At my sickest I could spend hours walking from one supermarket to the next and come home with NOTHING!

I would spend ages staring at the foods I couldn’t have. Anguishing over the nutrient content of every option, arguing in my head about which choice was acceptable for that day.

If I had decided to go and buy a food item, I.e yoghurt, I would spend a painful amount of time debating whether it was an acceptable choice or whether I infact even needed it. Often I would talk myself out of it entirely and leave empty handed or commonly with an apple. This occurred almost daily wasting hours of my day.

I experienced this with menus too. (When I could actually eat with people, which was rare) I would become overwhelmed easily by choices. I would be conflicted in my brain. I would see something “healthy me” would want. But seconds later HH would jump in, but you don’t need that, you should have the salad bla bla bla. This happened countless times.

I enlisted my husband to help me once I started recovery, to eat out socially, to either pick something for me and sit with me while I freaked out, or if it was obvious I had chosen a sub optimal option to encourage me to push myself in a supportive manner. As I grew more confident pushing boundaries breaking rules this has gotten easier.

I had to break the rule of eating in isolation too. This is very hard in recovery because eating in front of people wrongly feels shameful for a lot of us. It feels like a loss of control, we fear judgement. I have had to work very hard on this. I can eat with my colleagues at work now, with friends, family and not feel judged. The judgement is mine alone. It’s taken me ages to get here. It’s freeing being able to enjoy company with people and not feel disgust. If I can do it anyone can. This was one of my biggest issues. For me it was in a variety of ways, eating out with my husband, meeting with close friends who knew my problem and using colleagues who didn’t know as role models for normal eating.

But there are still times I find myself overwhelmed. And I’ve found using coping skills, tools I’ve learnt in recovery to manage. An example is if I can feel the “HH” thoughts building or anxiety, I will take some deep breathes, slowly and counting in and out. To get myself from my sympathetic nervous system (aka fight or flight mode) back into the parasympathetic system. You can think far more rationally and calmly here. It works for me.

I also like to do the opposite of what HH is telling me to do. I know in the short this is going to make me uncomfortable, anxious, upset but I can get through that by knowing discomfort leads to long term change and re-wiring.

There are some days I know, going to the supermarket without a list is not a good idea, this includes when I’m hungry, tired or stressed. I try never to let myself get hungry these days but it’s something I’ve noticed makes my “supermarket blindness” worse.

Whilst taking about hunger, I’m still working on fixing my hunger cues. Mine are gradually returning. But it has taken time and I eat when I’m not hungry if my hunger doesn’t show up. This is still relatively frequent. I followed a meal plan to establish regular eating. I don’t follow a plan now because I can eat “normally” and regularly. This didn’t happen overnight and I hated the plan. But I needed it.

I will do another post about the pattern of hunger. I know it’s a common anxiety and theme in recovery and I’ve noticed a lot of different things with it too. If I think about food, I eat. Until a few months ago for me this was constantly, but now my obsessive thoughts have diminished.

Being trapped inside your head is no fun.