Should NG Tubes Be Used In The Treatment Of People With Eating Disorders?

When it comes to treatment for people with eating disorders there are many different options and interventions to be explored, various therapies, meal plans, pieces of group work and even hypnotism. However, alongside all the perhaps more psychological treatments, there are other more invasive practical treatments that can be used such as the NG tube (a tube that is inserted through the nose and into the stomach to feed a patient who is unable to consume food orally themselves), and this is something I never had much of an opinion on before it happened to me recently for several weeks of my admission to hospital. It may seem silly or odd to be bringing this up now as my tube came out over 8 weeks ago so surely I should be over it and not thinking about it anymore, but I have to say that even though it has been a while since its removal, the method of being NG fed still affects me to this day, is a fairly traumatic thing for people to go through, and it has made me wonder whether or not NG feeding should actually be used in eating disorder treatment full stop. 

Obviously if I am going to open up a debate in this blog about whether or not NG tubes should ever be used I am going to have to say that aside from all the ethical, psychological, long term effect complicated sides to the issue, bluntly yes NG tubes should be available as a way to treat people with eating disorders. Despite their perhaps negative side effects down the line, it makes no sense to rule them out completely (unfortunately…I really hate admitting this…excuse me whilst I go away and grumble). 

Sometimes, whether we like it or not, NG tubes are life saving necessary pieces of treatment and there are people out there who arguably would have died without them. If a person is unable to nourish themselves adequately and becomes seriously medically compromised, sometimes the only option is to NG feed them as a matter of saving a life and I know that, as much as I disagree with the methods used on me and wish more than anything it hadn’t happened, that that is the argument doctors and nurses have had with me in defending that method of treatment. 

Aside from life saving serious stuff, NG tubes can also be positively used not just for getting nutrition into people but for providing a motivation to eat orally despite the screaming eating disorder wailing in their head like a banshee who just stubbed her toe on a particularly sharp piece of lego. 

When someone is struggling to eat because of an eating disorder it is often made harder by the fact that eating always feels like a choice, an option you actively choose to partake in, and who would choose to torture themselves by forcing themselves to eat when they knew their brain would go off screaming at 90 miles per hour? With an NG tube in place however, the act of getting nutrition is no longer an option or a choice, it is going to happen one way or another and with this choice of whether or not the food will go in eventually being taken away, sometimes eating becomes easier. 

Personally I can at least admit and testify to the fact that I found the NG tube helpful in the sense that it did motivate me to eat because the choice was taken away. No longer did I have the raging debate of “do I eat or don’t I”, it was just a matter of how it was going to go in/happen (“up the nose or down the throat” as I used to think). It also gave me encouragement to eat in a way because there were times when I knew that if I didn’t consume what was in front of me orally, I would get an increased number of calories down the tube and that certainly served as some motivation! 

Indeed at my unit there was a rule that I was presented with a meal and if I were not to complete it, the entire meal would be started again via the feed. Therefore if halfway through a meal I was struggling and really wanted to give up, having the tube there motivated me to carry on as I knew that were I to stop, we would have to start all over again and I would essentially end up having to go through the same meal twice. NG tubes can also be helpful in the sense that they offer a way for medication to go into a patient when a patient is unable to take a medication themselves (another thing which I hated and disagreed with personally but can understand is necessary in some circumstances.) 

As I said at the beginning of this debate however, alongside these positives there are a lot of negatives and it is the effect of these long lasting negatives that I am still feeling today. You see, when you have an NG tube, it takes responsibility for eating away, and whilst this is a good thing when a person is unable to eat by themselves, it is a bad thing because in learning to eat again or going through the re-feeding process they are not actually learning how to do it for themselves. Indeed, people go from needing the tube in an emergency situation to becoming dependant on it and that is what happened to me. For the first few months of re-feeding I was going through the motions but psychologically was making no progress and then when it came out I didn’t know how to eat. Without the tube, suddenly the guilt became much worse because eating went from being the lesser of two evils with the tube in to simply “evil”. 

Another negative from using an NG tube and perhaps the one I am struggling the most with today is that of rapid weight gain. When you are on the tube it is possible to gain a lot of weight very quickly that mentally you are not ready or prepared for and although it can again be life saving and good treatment medically, it can be an incredibly traumatic experience. Similarly, now I have been left at a weight far higher than I am comfortable with because of the tube and because I reached this stage far quicker than I would have done without it, I am still struggling with the repercussions and am feeling overwhelmed. 

In terms of trauma it can also be a traumatic experience to be restrained for feeds and when this happens it can damage the patient vs treatment team relationship. For example I used to trust my treatment team and even get along with a lot of them, but if I am honest, now I resent them all and want to be discharged from the entire service because the act of having something so traumatic being done to me has led me to dislike and mistrust them all. Having something like an NG feed physically done to you whilst you are held down means being treated as an object not a person, there is no therapeutic benefit, you are just a thing being pumped full of stuff you are terrified of with no chance to work through it or figure out a long term solution at home. It is a temporary fix and though you can force feed someone food, you cannot force feed them long term recovery, so in a sense the NG tube method is unhelpful long term. Then again that is just my experience and I know that for other people actually starting with an NG as a temporary measure can help long term as it gets enough nutrition for their brain to work and allow recovery long term afterwards so it really is all down to personal experience. 

Overall then, should NG tubes be used to treat people with eating disorders? Well, I don’t know is the honest answer, it is a tricky one because I think the answer will be different for different people. For some people using the NG tube is not a matter of something to be debated but a necessary life saving act of treatment and sometimes it can even help long term recovery by motivating someone to eat orally by taking away the choice. Also the more nutrition someone gets the more likely it is that their brain will be receptive to treatment but then again there are the negatives of cases like mine where I have been fed up to an unbearable weight via physical methods without going through the proper therapeutic work, meaning that I am now stuck unable to deal with it and thus struggling with relapse. I don’t think when it comes to this question there will ever be an answer for everyone but it is certainly a controversial topic that I think we need to keep working on and talking about. 

Take care everyone x 

NGdebate

Is It Possible To Be Too Open About Your Mental Health?

TRIGGER WARNING: This blog post contains reference to certain medical treatments that can be used with people with eating disorders, so if that is something you would find unhelpful then please do not read it for your own safety. If you are like the witch in the Wizard of Oz who melts when coming in contact to water, THIS is your warning to STEP AWAY FROM THE FLUME.

In both the mental and physical health worlds, confidentiality is a BIG thing. When it comes to your wellbeing, there are a lot of rules between professionals, your medical notes and what can or can’t be said in front of friends and family.
Want to keep that random extra hand sprouting from your lower back a secret from Aunt Enid so that she doesn’t start knitting you an extra mitten every winter? No problem, medical confidentiality has got you covered (unlike your third hand which is now not going to have a mitten for Christmas).
Don’t want people at work to know that you have a condition that causes you to temporarily morph into a teapot whenever stressed? That’s fine. Tell the doctor and they will keep that tidily hidden away on a computer protected with lots of codes and National Health numbers that would make your deepest medical secrets hard to find, even if people were looking for them.
You see, when you are dealing with hospitals, everything is kind of like some kind of James Bond spy film, it is all very hush hush, very top secret, very “who can we talk about your bunions in front of” (which, coincidentally was the alternative title for the 1964 classic “Goldfinger” but Shirley Bassey didn’t want to sing about Bunions).
Not only is medical confidentiality important though, it is also fragile, and like all fragile things, this unfortunately means that it can very easily, even accidentally, get broken.

My question however, is if it is YOUR personal medical confidentiality, is it ok/are you allowed, to break it yourself? Are you allowed to be “too open” about matters that other people would usually keep private, in the interests of raising awareness of those issues?
Not to talk about any single person or specific situation in particular or anything (THIS ENTIRE BLOG IS ABOUT ME AND MY VERY CURRENT AND SPECIFIC SITUATION), but is it possible I ponder, for one to be too open say, about a mental health condition and the treatment that may be involved as a consequence?

Like I said, we are not talking about anyone in particular (THIS IS ALL ABOUT ME), but as a very rough, vague and unspecific example, lets go back to Monday the 27th of November 2017 at 10:01am when a link to a post on this fabulous mental health blog you might have heard of, was uploaded to try and give a rough update to readers of said blog regarding the situation (or rather, the colossal mess of a situation) of the writer.
Oh screw it, I cant keep the secret anymore. Ok yes! You are right! I am talking about my blog aka this blog and my situation last Monday when I tried to write a post to tell everyone the latest news and was incredibly vague about everything, which is unusual for someone who usually speaks honestly and openly about everything personal and mental health related. Why was I incredibly vague? Well, because I was scared after staff had raised concerns about me sharing certain things on my blog, which really freaked me out and had me very worried and confused.

Thing is, when it comes to medical confidentiality, I kind of see it like you see a piggy bank, it belongs to you, you can look after and protect it, but at the same time, you and you alone are allowed to break it.
Were you to go over to someone else’s house, find and destroy their piggy bank and run off with all the money inside (or say medical details), that would be wrong on many levels. It would be theft, it would be a breach of someone’s privacy, destruction of their property and the murder of a perfectly good ceramic piggy. If however you have your own piggy bank and, after several years of amassing various coins of experience, decide that you don’t mind sharing those experiences and spending those coins out in the world in the hopes of making a difference, and consequently smash your own ceramic oinker to smithereens with a mallet…I think that is ok, because it is your property, your information to share, your little piggy to destroy (and then mourn over appropriately of course).

It is still important to be responsible for your information of course, and I don’t believe people should, as it were, shove their information coins into other peoples faces whether they like it or not.
There should always be warnings to alert people when someone is talking about a sensitive issue that could be triggering or harmful to others, so that they as a reader can use their own personal responsibility to choose to remove themselves from potential harm. Nobody should be forced on a flume and plunged into a bath of emotions without the opportunity to get their rubber duck out but similarly, if you know you melt when you come in contact with water, maybe don’t go on a flume.

Admittedly this is more complicated with things like mental health problems which can sometimes cause you to do things, read things and get involved in things you might know deep down are harmful, but we can’t all be silent about everything, and if Donald Trump is allowed his own twitter account then I like to think I can spout my nonsense freely and use my free speech on my blog in my little corner of the internet.
That is how I see all this, all the drama that I have been caught up in over the past week about what it is and what it is not ok to share, whether there are some things that should be kept confidential and whether you can or can’t be “too honest” about personal matters, and it is that opinion that has led me to just throw caution to the wind and write this post being honest about things anyway.
This is of course merely my opinion, and I am sure there are many people out there who will disagree, but there we go, we can’t all like mashed potatoes made by the same recipe, opinions vary, some people don’t like lumps, some people don’t like pepper and others don’t like to read blogs about people who talk about mental health (weirdos). End of.

So what is going on? What has been happening? What have I been skirting oh so daintily around for the past fortnight? Well I will tell you because like I said, this is my piggy bank and if I want to take a mallet to it then I damn well will.
Basically, as you know, I have been in a psychiatric unit being treated for my eating disorder for the past 10/11 weeks, but things were not going well and I was not managing mentally or physically with any of this recovery business. It was then decided that we had reached a point where it wasn’t safe to keep me where I was anymore (which feels so weird and confusing to write as I still adamantly believe that I am perfectly fine and do not need any of the things going on around me, but that is a topic for another time). Anyway, as a consequence of various decisions regarding my mental and physical health last week, I had a week or so away over to a medical ward, and, if this post is going up in time and all the professionals stick to the current plan, I will hopefully have been transferred back to the mental health place on the Friday before you are reading this.

When you have an eating disorder there are a lot of physical complications that can happen as a result and there are sometimes a lot of things that may need to be medically treated as well as mentally, but the main reason for this transfer was so that I could be fitted with an Nasogastric tube (aka a tube that goes up your nose and then down into your tummy so that you can be given nutrition without having to eat it yourself if needed).
Some eating disorder units can do this procedure on site themselves and many do, but the one I am in has been unable to until now (hence why a few weeks ago I was talking about maybe being sent to Glasgow or somewhere else across the country). With no beds becoming available in time though, I had to just pop off to get it done on the medical ward and have some treatment over there. Like I said though, if all goes to plan, by the time you are reading this, I will be back on the mental health ward, still with my tube for a bit now it is safely up and running, but working to have it out as soon as possible which would be nice, as I am not thrilled about this new accessory (I would have preferred a bowtie but alas you cannot give someone nutrition through a bow tie. Not even a sparkly one). It was this whole tube thing that caused the staff to get a bit over excited with the “shushing” (picture a librarian after several hundred cups of espresso).

If I am trying to see from their point of view, I guess I can kind of sort of understand on some level. For example, I know there are some people who might find talk of NG tubes triggering, and unfortunately there are occasions and certain sufferers/people who see them as something to take pride in, something that proves they are “really ill”. This is of course ridiculous as every eating disorder is equally severe and serious and everyone is “really ill” regardless of whether they have been through certain treatment options or not. Even if you have never received any treatment for an eating disorder you are as ill as someone who may have been in therapy for years, and the last thing I would ever want is to give a message on my blog contradicting that.
However at the same time, whilst a tube is something I do not think one should be proud of, I do not think it is something to be ashamed of either and that was what stressed me out so much last week. I was all there ready to go ahead and write as per usual, and suddenly everyone was telling me that what I wanted to talk about was inappropriate, which had me paranoid that I should be ashamed of what was going on or that this happening meant that I had let everybody down by “failing” to get better, and thus not say anything at all just to be on the safe side. To be honest I don’t think a tube is anything to feel particularly anything about. It just is. Sometimes they just happen to get fitted to people who have eating disorders to help them try and get out of being rather stuck in a highly sticky syrup/velcro/superglue bound/sellotape/plaster situation.

If you are reading this and think that me admitting any of this is to be too open about mental health/confidentiality breaching then I am honestly sorry, but like I said, talking about mental health and my experiences within the realm of mental health treatment is something I am passionate about both in terms of reaching out to others, raising awareness, breaking stigma and misunderstandings about various illnesses and overall making people feel less alone and not as weird and isolated as I did when I kept all of my problems bottled up and never had anyone to relate to. Maybe I am breaking a piggy bank, but it is my piggy bank to break and it has been my decision to be honest about it.

I won’t go on about it any more now because writing this much is scary enough as it is, but I hope in the future I will be able to write about how this experience and tube feeding in general has affected me and how it can be used in treating people with eating disorders. It isn’t a nice topic, nor is it a nice experience, but it happens.
Now if you don’t mind, I am off to hide under my bed as I do when I post all scary blog posts that could potentially make someone angry with me/get me into trouble (I also need to hide from the cleaner…that is one thing nobody warns you about when you get a tube…when you have one in there is a genuine risk of being mistaken for a Henry hoover and dragged across a carpet snorting crumbs for three hours…) I hope this has been ok, I hope having this tube doesn’t mean you feel that I have let you down and if not I really am very sorry. I promise I am still trying.

Take care everyone x

PiggyConfidentiality