Question

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.

1) What are your thoughts on the treatment approach taken with the patient? What are the pros and cons of this approach? Explain.

2) 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

1.The patient was very aggressive in the initial stage of the treatment.

Pros:

• The pros being the patient was not taken for a direct G -tube where basic measures where tried
• Regain of the normal appetite
• Cessation of the vomiting
• The patient gained weight in about 6 weeks after G tube insertion
• The child was not restrained

Cons:

• Aggressive decision making of inserting a G tube
• The emotional pain of a mother
• Yet parentral nutrition could have been tried before the procedure

2.Some of the behaviour modifications techniques to be handled with the patientand her family are

• Health educating about the importance of proper nutritional diet to stay healthy and disease free
• Teaching the mother about the diet plan
• Encouraging mother to monitor her child in home,provide foods which the child likes and not to force or compel the child
• Encouraging the patient to talk about her needs and planning care accordingly
• Inform about the health problems related with extrem low Wright and its consequences
• Support the family psychologically and do not reinforce any negative information as a way of giving confidence.