Question

1. The following testimonial was posted on a clinic website (some information has been changed and/or edited to respect privacy). Read the statement and answer the questions that follow. My daughter spent three weeks in an eating disorder medical stabilization unit in Phoenix, Arizona, for restrictive purging anorexia. She deteriorated physically as she intractably vomited everything she was encouraged to eat. She was refusing fluids as well. She fainted frequently with a resting heart rate between 35 and 45; they told me they could not help her. They would not place a life-sustaining NG-tube for fear of aspiration from her vomiting. After my daughter spent almost two weeks in another hospital in Sacramento, vomiting NG-tubes out 7 or 8 times, the very desperate decision was made to surgically place a gastrostomy tube for life-saving nutrition. I was terrified at this aggressive measure, but I was also aware of the fact that my daughter was slipping away. The G-tube was placed and nutrition was given completely via the G-tube for 4 days. Guess what? It broke the cycle of vomiting. She began to eat 100 percent without vomiting. The tube was used for a total of 5 days. Next, we began the hard work of refeeding together, FBT style. With the support of the doctors, nurses, aides, clerks, and therapists, we nursed my daughter back to physical stability. After almost 6 weeks, her G-tube was removed. She is weight restored and is fighting for her life now. She continues eating 100 percent of her three meals and her snack, and she shares more and more about how her anxiety rules her life. • What are your thoughts on the treatment approach taken with the patient? What are the pros and cons of this approach? Explain. As a follow-up to this treatment, you are assigned to work with the patient and her family. What behavior modification techniques would you use and why?

Answer 1

●The patient who has eating disorder and if at high risk of aspiration,some of the best possible way to provide are by parentral nutrition (this is not possible for a long run) or by a PEG feed (gastrointestinal feed- where a tube is inserted into stomach and liquid foods are administered).The main pros is it has decreased chance of aspiration, as good absorption rate.The cons are ,it is a smaller surgical procedure,risk for infection due to incision and a foreign material,accidental dislodging, meticulous care and trained ,skilled staff,etc.,

●The best behavior modification techniques to be used in this family is the positive reinforcement techniques to cope up with the past and help them to plan ahead to care for their daughter and prevent reemerging of the illness.