Bouncing back again

I’ve been absent from the internet for a few weeks. I hadn’t really talked about it on this blog, but I’d been surfing a lot of eating disorder websites and purposely triggering ED thoughts. I swear I’m my own worst enemy. Well, actually, the ED is kind of my worst enemy. I kept telling myself I was looking to talk to people who understood so I would feel less alone with all this. Just before I left the web my BMI dropped below a healthy level for the first time in years and I finally twigged what was happening and made myself take a step back. I’ve had a good couple of weeks now and have been sticking to a (self-devised) eating plan. It’s taken about 3 weeks but I am back to just over 18.5 again, which is where I was about a month ago, and hope I can maintain this at least. I hate how split down the middle I feel. Part of me (the part that is me, I hope) wants to be healthy. But part of my head... it really fights what I know is the right thing to do. So, I’ve pushed the scales to the furthest corner of the darkest cupboard. I’ve got a daily meal plan, though at the moment I’m mostly sticking to the same things and I‘m embarrassingly making up my calorie count and reducing my anxiety with alcohol. And I’m also still purging occasionally.

One of my last entries before I absented myself from the web was about an upcoming psychiatrist appointment. I saw my shrink and did manage to start talking about what was going on. He noticed that I’d lost weight and asked if I was ok, though he asked it more in a context of drug use. I did try and explain what was going on (with the purging and ED thoughts) but I freaked out and said I’d “just been dieting”. However it was partly that appointment that made me realize just out of control this was. So even if I didn’t actually talk to my shrink it at least had a positive effect.

Anyway... I’m happy to be back on my blog with some fairly positive news - that this is the first time since last October that I’ve gained weight, even if it is only a couple of pounds. I just need to try and keep this up and not lose it again.

So my goals are to keep to my plan to not gain or lose. And try and stop purging. And try to speak to my GP/shrink to see if I can try some meds... or anything really, to deal with how stressed out I feel.

rejection and being triggered

I had a job interview recently and found out today that I didn’t get the job. I’ve got a few other irons in the fire but it still was a bit upsetting. I really, really, wanted this post. The eating disorder/self hate thoughts have been really bad since then. Even though I can spot what’s triggered the thoughts it’s not been making it any easier. And I’ve started a slightly vicious cycle of triggering myself further. I’ve spent all my free time today reading diet sites and watching diet programmes (Channel 4OD Cook Yourself Thin – seriously… how annoying is that presenter! But I can’t tear myself away). I even started myself an account on a diet site to track weight loss and calories for fucks sake.

I couldn’t really be bothered trying to fight the thoughts so haven’t eaten much. I did end up breaking and eat ten sweets and then spent five panicked minutes trying to find out how many calories were in a single Skittle (about 4.6 apparently). Again… for fucks sake.

Not a great day overall. But I’m spending the evening trying to distract myself, playing with the dogs etc.

American π Day

It's one of my favourite days of the year. 14th March, the 14/03 or, if you're American 3/14. Or even better 3.14 - mmmmmm pi.

There's not many irrational numbers that I like. They normally bother me tailing off into the distance without an end in sight.



But I like pi because it fits in with the date the 14th March. And also because I like ratios. There's just something about dates that I can break down into ratios that I find a lot less stressful. The only thing that's better is dates that can be re-written as binary. Sometimes the very numbers in the date can have a huge affect on whether I have a good day or a bad day. Though I can balance this out by booking appointments at specific times to create further patterns.

And finally a word from Weebl and Bob (couldn't seem to link to the proper site so have linked to Youtube - but you can see the original video here)

Scared

My weights down a little bit this weekend. But I think it's partly as I got very drunk on Friday and was physically sick all day Saturday - so weight change is pretty much just dehydration I think. Apparently I will never learn what my limit is for drinking and won't stop until I have borderline alcohol poisoning. Today was a lot better, at least, I've stopped throwing up. I feel quite shaky and achey. But the weather was nice so I went for a long walk around some lakes near where I live. The dogs came to and they had a lovely time (you could see the epic dog joy in their faces - is there anything happier than dog joy?) I've also managed a bit of life admin today - paperwork etc, not fun, but at least I've been slightly productive.

I've only purged once this weekend (Friday night). Although, what with being a shaking/vomiting mess on Saturday I couldn't even look at food and my stomach rapidly rejected even the small sips of water I tried to offer it. (In my head hangover vomitting is apparently acceptable - though probably just as grim - in comparison to self-induced vomitting). Today I've eaten what amounts to a lot for me and I've managed to fight the urges.

I'm seeing my psychiatrist later this week. Partner has managed to secure a couple of days working so he won't be there - he's going to write down a few of his concerns (forgetfulness/obsessive behaviour) so I can discuss them with my doc, though it would be easier if he was there with me. In good news however he definitely feels I've been less of a space cadet since reducing my antidepressent dose and I haven't noticed a change in my mood. Part of me is glad he won't be there because it means I'll be more likely to talk to my psychiatrist about the eating problems. In my head I was already using him being there as an excuse to not bring it up. I didn't manage to talk to GP about these issues because partner was there and I think I've accepted the fact that I do need to get some support with this. I've been actively trying to fight the eating disorder by myself now since the end of January. Yes, the weight loss has slowed down and yes, I'm purging less than I was, but I'd be decieving myself if I said that I now think I can stop this without something more. I've lost 12lbs since starting the blog and I'm purging probably 5 or 6 times a week. And the thoughts haven't really gotten any easier - and as someone pointed out the other day, they're just as much part of the disorder as the actual behaviours.

A huge part of me doesn't want to ask for help... I'm scared. I'm scared about telling people in real life and them judging me and thinking less of me. I'm scared about my friends/family finding out and it changing our relationships. I'm scared about it having an impact on my job. I'm scared about asking for help and not being taken seriously (because I'm not sick enough). I'm scared about letting other people in on what I'm doing because it feels like losing control of the situation. I'm scared that if people know I won't be able to use purging/restricting and how I'm going to handle all these feelings if I don't have that to fall back on - would I just end up self-harming again instead? I'm scared about what will happen if I ask for help and I still can't get better - at the end of the day even with support it will still be up to me to recover. What if I can't do this?

Something wicked this way will come...

... and by come, I mean, ejaculate on a book.

Best sci fi pop video ever.

On being surrounded by people on diets

The last couple of days haven’t been great in terms of eating/purging. (Though I haven’t purged so far today!) I think because I have been trying so hard to eat meals and not restrict/purge I’ve not been losing as much weight (the weight loss has slowed down a lot) and this is triggering the thoughts to get worse. I try to not get on the scales... but sometimes I just can’t help it. And without explaining to partner the “why” I should really throw out (or hide) the scales they are just going to sit on the bathroom floor and stare at me. And I guess my antics at the weekend haven’t helped with mood either... though I’m starting to feel a lot better now. So maybe this is just a blip and once my serotonin replenishes I’ll rally the forces and fight the thoughts.

On another note it’s driving me mad the number at people at work who are asking me about my diet, asking for tips and congratulating me on how much weight I’ve lost. Pretty much all the ladies in the office are on on/off diets. They’re not particularly great at them... in that they starve themselves all morning and then give up and eat snacks all afternoon. “I have no idea why I’ve not lost weight!”, “because you’re still eating over the recommended daily amount of calories”. In a screwed up kind of way part of me feels almost smug – that I’ve succeeded. That I’ve lost weight and they can’t/won’t/haven’t. Not sure if smug is the right word – just the feeling that I can finally do something right, even though I really know I’m not. The office environment is sending the thoughts I’m dealing with into overdrive. When people go and get their lunch and pick like birds over their tiny salads it just makes me feel bad for actually eating lunch even though I know I do need try and maintain my calorie intake. But I can’t avoid them. I trying to put on headphones and listen to music. But it’s a bit like when I was a smoker. If I was trying to quit and around other smokers, even though it made me dislike myself, I’d still not be able to keep away from the group trips out to smoke. I only finally managed to quit when I changed my environment. But without everyone at work knowing about what’s going on I don’t see how I can do that. I can’t not go to work. Firstly I need the money and secondly I’m a complete workaholic.

Individualised Medical Care

In my former life (the life before I couldn’t cope with stress) I used to work in pharmacy research. The way pharmaceutical research and development works is a multistage process.

The initial “preclinical stage” is where small pharmaceutical research teams (e.g. at universities) do research e.g. lab and animal studies to check safety/bioavailability etc. Articles will be published and conventions will be attended and hopefully, if they’ve discovered something interesting, it will manage to enter the next stage of the process. I think an estimate is that for every 1000 compound looked at only about one will enter the next stage of the process.

The next stage is the clinical trails phase. There are several stages/phases starting with healthy volunteers and then moving onto larger trails on actual patients. This process is very expensive (millions upon millions of pounds) and is only really carried out by the Big Pharma™ companies. And then there are usually final steps (an “approval stage”) to be jumped through for approval depending on the country/region. For every five to start through clinical trails/approval stage it is estimated that only one will make it to final approval and release as a drug.

So maybe one out of five thousand potential chemicals evaluated might make it to the point of being released as a drug. Generally what happens is that the preclinical research is done by small research companies/universities/spin out companies and then Big Pharma™ will buy the rights for any promising looking research (with or without the original researchers being taken on in the continuing process as advisors).

This (after pre-clinical, but before or during clinical trails) is often the stage that research gets buried. There may be many good reasons that a potential drug would get stopped at this stage. It might be that there are other, probably better, drugs in development. There may be other valid scientific concerns. However if the Big Pharma™ company are concerned that a new drug will put a current money-making drug out of use they may buy the research and sit on it. For example there is commonly believed to be several preliminary drugs that would cure Alzheimer’s Disease, but the profits in curing a disease using a short-course of medication it may not be out-weighed by the current profits in treating Alzheimer’s for many declining years of a persons life, so as yet there is no financial incentive to continue with the development of these drugs.

Another category of drug that gets ignored in terms of development is a drug that would only target a small subset of a clinical population. What Big Pharma™ like are drugs called Blockbuster Drugs. Blockbuster Drugs are the big money spinners. Generally a drug becomes a Blockbuster Drug if it’s widely clinically used (by doctors/prescribers) as a standard drug to use for prevalent conditions that often require long term treatement – a lot of Blockbusters Drugs are currently things that treat blood pressure/blood clotting/heart problems/cholesterol i.e. is generally works for a large segment of the population. An important addendum needs adding to this definition however – prevalent conditions, but mostly this only applies to conditions prevalent in the developed world. Obesity, heart problems, pulmonary conditions are on-going problems in richer (older/fatter) nations so drugs that treat these conditions well across a wide spectrum of the population become Blockbuster Drugs. This is the same reason you’ll see psychiatric drugs occasional slip into the Blockbuster Drug lists – mental health conditions are relatively prevalent in the developed world and people tend to take these drugs on the long term, as such Big Pharma™ are happy to oblige in the provision of a whole variety of drugs. (Cynically, especially if the drugs make you put on weight and end up on more drugs </snark>)

What Big Pharma™ doesn’t like are conditions that aren’t common in rich nations, or uncommon conditions, or small genetic subsets of prevalent medical conditions that don’t respond to the standard drugs. Take cancer for example, if you have a common genetic subtype, of a common cancer, that responds well to drugs then you may have a good chance of recovery. Something like testicular cancer has a 90% plus survival rate, if it’s got the “right” genetics, even if it’s caught at a late stage. But if you have an uncommon cancer – say for example Neuroblastoma, a horrendous cancer that affects predominately very young children, where there may only be few hundred suffers worldwide - then Big Pharma™ just aren’t really that interested in helping (and survival rates are as low as 20% 5 years after diagnosis). Unless you have a fashionable illness you're kind of screwed.

Fundamentally, like a lot of things in life, it comes down to money. Big Pharma™ want to make money and they do this by focusing research and development on drugs that they think will do that – and by blocking the development of drugs that may risk the money making potential of their current catalogue. This is great for them but not great for health care as a whole. Arguably all medical conditions will have a genetic component at some level. And every person is an individual – created from their own personal genetics/environment. Drug companies want to find one drug to treat an entire clinical population, whereas the reality of what disease is/humans are, humanity would be better suited to finding a way to one drug tailored to fit that person/disease interaction.

I’ve talked about this from the point of view of drug development seeing as that’s what I know (well, knew). But maybe this logic can be extended to other aspects of health care. Surely the future of medicine should lie in determining the interaction of medical condition with a particular person and applying an individualistic approach to medical treatment. A person would have individualised/tailored drugs/therapy designed specifically for them as an individual and their particular version of their medical condition.

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NB: Emotionally I'm not in a great place right now so I’m not even sure I managed to say what I wanted to say and may continue this theme another day. Numbers I’ve quoted in this post are from memory so don’t jump at me if they’re not exactly right by current research. I left pharmaceutical research in 2007. This was a bit of a flow on consciousness after reading this post by RuftyRoo II.