Sunday, 11 March 2012

helping us help ourselves, or just putting the time bomb to one side?

Today I'm sharing a very interesting essay written by a supporter of ours, Sara, about the effect of late hospital admission for anorexia patients. Definately worth a read folks...

Help on death’s dying door

Anorexia Nervosa suffers shouldn’t be left to knock on death’s door until they become hospitalized whether it is voluntary or involuntary. Throughout this essay I will discuss the need for earlier medical intervention for anorexic patients. As it stands, suffers have to be critically ill before they receive intense medical care/treatment. I aim to argue that earlier inpatient admissions would prevent the illness from creating long term physical and mental health complications. Points that will be discussed include the extremely dangerous criteria that suffers’ usually have to meet before becoming an inpatient; the effect that a later admission to hospital has on patients’ recovery and the symptoms of refeeding.  Also, I will explore problems of hospitalization, the lack of education about Anorexia in the medical profession as well as giving a brief definition of anorexia. By the end of this essay I aim to persuade the reader that anorexics should be given more help earlier on in their illness, which would not only reduce their recovery time and suffering but save the NHS multiple resources in the long-term.
Anorexia Nervosa is a much talked about mental illness with many blaming the media as the cause and falsely regarding it as 'teenage girls starving themselves to become like their Runway idols'.  In reality, it is a mental illness that is commonly triggered by traumatic events that have occurred and/or high pressure from surroundings. These experiences can trigger painful thoughts and emotions with the sufferer turning to controlling their food and weight as a coping mechanism.
However there are still problems associated with hospitalization.  Patients can become institutionalized and rely on the care of the hospital staff leaving them unable to function in the community. In some cases they may find that the hospital environment is better than their own home and so this leads them to regress further into their illness. They get discharged but are so used to the hospital environment that they forget how to live in the community, leaving them scared and setting them up for relapse. Also for a one night stay in a specialised eating disorder unit such as the Huntercombe in 2010 was £500. This causes funding to often run out too quickly for the patient to get in a state of full recovery which they can continue on within the community. If they were admitted faster then they wouldn’t have such complex thinking patterns.
The first argument that I shall put forward is to provide suffers with more intense care at an earlier stage of the illness as to delay this often causes long term damage to health. The common criteria for a hospital inpatient admission for Anorexia Nervosa are set at a critical level. The American Psychiatric Association guidelines for an admission to hospital is that a person has to have less than 10 % body fat, less than 75% of their weight to height percentage meaning their BMI will be below 14 which is deadly serious, severe dehydration, a temperature of below 90 F and a systolic pressure of below 90. Although there are exceptions, consultant for the Fife CAMHS team- Dr Jones- stated that ‘We only really consider hospitalization with a BMI of below 14’. That is only some of the physically criteria that people can be admitted on. By the time a patient has met some of these there has already been short term and long term damage done. Being at an extremely low weight can result in amenorrhea (periods stop) and leave a woman permanently infertile. Over exercise and under-eating can cause the development of Osteoporosis that will last a life time and put an immense strain on the heart and all other vital organs. Many of these are already found in patients who are admitted to hospital and this is non reversible damage. Overall it would cost less lives if anorexics were treated before they got to the stage in the illness where this damage is done as they will need treatment throughout their life leaving a permanent reminder of their past. Also it would save money as less treatment would be needed later in life. About 20% of people suffering from Anorexia will die prematurely due to complications from their eating disorder. This needs to change so that long term damage can be prevented, just as would be the case for any other illness.
Furthermore, leaving hospitalization until the patient is incredibly ill decreases their chances of recovery and worseness the mental condition of suffers. A report written by Thereasa Defino from the WebMD Health News stated that ‘good results were reported for 62% of adolescents who were never hospitalized but this dropped to 14% for those who had been hospitalized, two deaths’. Hsu say ‘patients who need inpatient treatment are sicker in the first place’. This demonstrates that patients who don’t require intense treatment have better chances of recovery which logically means that if patients start recovery before they are seriously ill then the recovery rates could be higher. Also, many suffers then feel that to have achieved being a ‘good’ anorexic and have the right to call themselves anorexic they have to have been on death’s door due to the competitiveness of the illness. But anorexia is a mental illness and so shouldn’t it be treated mentally not just physically? If a patient is admitted to hospital to gain weight-which is their biggest fear- but gets no help psychologically then they will not have changed their thinking patterns and will end up worse off than before due to the trauma of weight gain. Wouldn’t it be better to treat them mentally whilst gaining weight so they don’t relapse and need several admissions? This could lead to the patient spending more time in hospital gaining weight than a long single admission with gradual weight gain and psychological therapy that allows the patient to fully recovery.
Moreover, once a person becomes severely malnourished there is the chance of developing a deadly illness called refeeding syndrome. This can occur when the human body is refeeding itself and the body has a reaction to it. From the months, possibly years of not eating properly the body has used all its resources and the sudden delivery of glucose from food causes a huge increase in circulating insulin levels. There are deadly side effects of developing this, in some cases it will result in death but other problems include fluid imbalances, renal failure and cardiac failure, just mentioning a few. This then causes lots of complications at an already extremely difficult time in a person’s life. Wouldn’t it be better to treat patients before they got to this stage so they wouldn’t have to go through any more mental or physical pain? Just as a cancer patient would receive treatment to prevent cancerous cells from spreading, should an Anorexic not get help to prevent their eating disorder from worsening and causing lasting health problems?
Also worthy of discussion is the lack of education in the medical profession about the seriousness of anorexia and other eating disorders. Anorexics can continuously collapse due to their body not being able to cope and be taken to the hospital yet the usual treatment is to receive an IV and get sent home again. This is due to the staff not being fully aware of the damaging effects of this illness and the tendency of anorexics to lie about their condition. Staff should make sure they are in treatment or are going to receive some form of help before sending them home only to see them in a few weeks again for the same problem. GP surgeries have been known to tell suffers to ‘eat a bar of chocolate a day’. What kind of advice is this? Surely even common sense is better than advice like this? If GPs are unable to help suffers what hope do they have? To go home and sit crying in front of a bar of chocolate as their mother tells them they won’t leave the table till it’s finished because that’s what the doctors stay. What kind of treatment is this? It is driving them further into their illness making them feel even more like a failure to the world as they can’t even eat a bar of chocolate, making them angry as people don’t understand a sense of hopelessness as nothing can help. If doctors were more educated then maybe the need for hospitals would be a lot less but until that happens all measures should be taken to prevent a suffer becoming more ill and often the best prevention method is 24 hour care in a hospital.
So after all this evidence do you really believe anorexics should be left to get weaker and weaker until they are unable to function? What person deserves that before they can receive the care that is required? These people will hide their sadness through smiles because they feel that they do not deserve help and when help is not given this only confirms their beliefs. It is a mental illness not some fad diet, people die from this and yet to get help they have to be dying. Some would see it as a form of every pound lost is one step closer to death. 10% of anorexics will die, 60% will recover and 30% will just continue to live in their own hell according to the National Eating Disorders Association. So why is medical intervention being left so late? It is an illness, just because you can’t see it doesn’t make it any less serious than any other illness that people are in hospital for every day. It has the highest death rate of all mental illnesses, why is this? Because they don’t get help quick enough. This needs to change so people can get their lives back. Life with anorexia is a life not worth living


-WebMD health news
-Huntercombe Hospital Edinburgh
-National eating disorder
-Fife CALMHS team

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