Author Topic: Kartini - what kind of approach is that?  (Read 1385 times)

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Offline Oscar

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Kartini - what kind of approach is that?
« on: December 31, 2010, 04:13:20 PM »
Paulu was creating a datasheet about Kartini Clinic in Oregon for the Wiki database. He showed me some of the records and it rather shocked me:

From their treatment page:

Quote
Most patients who come to us have already been seen by some combination of their own doctor, psychologist, gastroenterologist, throat surgeon, perhaps even a speech therapist or an occupational therapist.  Usually such a cascade of referrals simply delays resolution of the problem while the child continues to lose weight.   Some children who have not responded to treatment for food phobia (aka functional dysphagia, or sometimes psychotic food refusal) have even had a G-tube placed for long term feeds (a tube that goes through the abdominal skin directly into the stomach). Some are even admitted to psychiatric wards for long periods of time. In our experience such draconian measures are entirely unnecessary, even harmful.
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Kartini Clinic's Food Phobia treatment protocol consists of a brief hospital admission in order to place a naso-gastric (NG) tube and to begin administration of anti-anxiety medication.  This allows our pediatricians to limit any immediate complications of re-feeding and allow us to teach the parents how to manage NG feeds at night.  The child is in the hospital for only a few days before being discharged to Kartini Clinic's Day Treatment Unit. Patients spend the day in the KDTU, and evenings and weekends at home (or in the Ronald McDonald House for those from outside Portland).  During the first week in the KDTU, no food is offered; the child is encouraged to engage with Kartini Clinic's food phobia treatment team and to get to know everyone in order to feel comfortable and safe while attempting to re-establish their own normal eating patterns.  During this first week or so the doctors also adjust medication and begin manual re-feeding (i.e. without an NG tube) . Parents join us at the first possible moment, as they know better than anyone what was “normal eating” for their own child before the illness struck.  They also know their own child’s likes and dislikes. At the Kartini Clinic parents become partners in helping us to do re-training of the brain that is the focus of treatment for food phobia.

I am just a parent with ordinar children who enjoys the good side of life with food and good beer. I cannot image how a child ever will enjoy such pleasures after such a treatment.
« Last Edit: December 31, 1969, 07:00:00 PM by Guest »

Offline Ursus

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Re: Kartini - what kind of approach is that?
« Reply #1 on: January 01, 2011, 11:42:51 AM »
Wow. Lessee... The Kartini Clinic objects to the practice of placing of a G-tube through the abdominal skin directly into the stomach as palliative treatment for food phobia sufferers on the grounds that it is an "entirely unnecessary, even harmful" "draconian measure" ... and yet they themselves routinely place a naso-gastric (NG) tube in such patients for the purposes of administering anti-anxiety medication.

Why does this "logic" not surprise me? · · ·   :wall:
« Last Edit: December 31, 1969, 07:00:00 PM by Guest »
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Offline heretik

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Re: Kartini - what kind of approach is that?http://www.forni
« Reply #2 on: January 01, 2011, 12:07:04 PM »
Hey guys I am a little (maybe a lot) confused here. I am not sure if you have a problem with the actual procedures that are being used to sustain levels of nutrition (draconian) or if your are flabbergasted by the the contradiction (as Ursus pointed out in his post; posting.php?mode=quote&f=52&p=391500.  
Do either of you know of other methods being used today to deal with "food phobia's".
I ask these questions out of sincere interest. I am not just challenging you on your posts.
Thanks for any help.

edited to include...When the body has been without nutritious sustenance for a abnormal period of time.
« Last Edit: January 01, 2011, 01:11:21 PM by heretik »

Offline Whooter

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Re: Kartini - what kind of approach is that?
« Reply #3 on: January 01, 2011, 12:55:51 PM »
The most common method of treating these types of  phobias is via exposure therapy.  These people/ kids have an intense fear of swallowing or choking and need to be exposed to their fears in a safe and controlled way.  This is a systematic desensitization approach which is highly effective.  A person may be slowly exposed to eating by visiting a restaurant and just observing and slowly move closer to eating by becoming comfortable that they will not choke on their food through observing others.

One of the challenges with children may be that they cannot rationalize as well as adults and typical cognitive-behavioral therapy may not be as effective.  The approach that this clinic is taking seems to combine the systematic desensitization approach with trying to get the child comfortable with staff members and get them to trust the staff members versus themselves before trying to eat solid foods again.

It would be interesting to see their success numbers to see if they meet (or exceed) a level of 75% which is seen today using cognitive-behavioral therapy on phobias in adults.

If a person is without nutrition for a long period of time then the person needs to be hospitalized, sedated, stabilized and fed via a feeding tube to get the persons strength back before proceeding to determining root cause and developing a therapy plan of action.


...
« Last Edit: December 31, 1969, 07:00:00 PM by Guest »

Offline Oscar

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Re: Kartini - what kind of approach is that?
« Reply #4 on: January 01, 2011, 03:54:36 PM »
As I said before we are charting the sector of the industry which deals in eating disorders. I can understand a tube when we are talking life and death, but this seems to be a program where the children are sent to once they are stabilized at the local hospital.

When we are talking prisoners of war, then the debate has been whether the use of forced tube feeding is torture, but when we are talking residential care there is the morale question?

Other places like Remuda Ranch offers the tube as an option. It is up to the clients whether they want to sit inactively in a corner between therapy session if they don't eat or not (It is not support for Remuda - It is just how they deal with it).

Here is a statement showing how this program handle non-eaters:

Quote
TREATMENT SUCKS

Hey Ladies!

I'm in treatment for anorexia.  I was admitted to the hospital on November 15th and stayed there for two weeks, sitting in bed and having to eat >1000 calories a day!  Now I'm in Day Treatment Unit (against my will) in Portland at Kartini.  I go four days a week, ten hours a day with other patients for therapy and such.  We have to complete 100% of our meals otherwise we go back to the hospital with a feeding tube in our nose.  Yuck. And we are supposed to eat 3000 FUCKIN CALORIES PER DAY!!!  What the hell is wrong with these people?  I hate having to gain weight!  Never, ever, EVER let your parents take you to an eating disorder clinic for a 'checkup'.  I went with my parents and ended up in the hospital.  Life really is hell for me.  I'm not allowed to excerise, see friends, or shop at all!!!   I really need support from someone who has gone through the same thing as me, because I really want to end my life.  I don't want to live with all this fat on me. Please help!
« Last Edit: December 31, 1969, 07:00:00 PM by Guest »

Offline heretik

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Re: Kartini - what kind of approach is that?
« Reply #5 on: January 01, 2011, 05:05:42 PM »
Quote from: "Oscar"
As I said before we are charting the sector of the industry which deals in eating disorders. I can understand a tube when we are talking life and death, but this seems to be a program where the children are sent to once they are stabilized at the local hospital.

When we are talking prisoners of war, then the debate has been whether the use of forced tube feeding is torture, but when we are talking residential care there is the morale question?

Other places like Remuda Ranch offers the tube as an option. It is up to the clients whether they want to sit inactively in a corner between therapy session if they don't eat or not (It is not support for Remuda - It is just how they deal with it).

Here is a statement showing how this program handle non-eaters:

Quote
TREATMENT SUCKS

Hey Ladies!

I'm in treatment for anorexia.  I was admitted to the hospital on November 15th and stayed there for two weeks, sitting in bed and having to eat >1000 calories a day!  Now I'm in Day Treatment Unit (against my will) in Portland at Kartini.  I go four days a week, ten hours a day with other patients for therapy and such.  We have to complete 100% of our meals otherwise we go back to the hospital with a feeding tube in our nose.  Yuck. And we are supposed to eat 3000 FUCKIN CALORIES PER DAY!!!  What the hell is wrong with these people?  I hate having to gain weight!  Never, ever, EVER let your parents take you to an eating disorder clinic for a 'checkup'.  I went with my parents and ended up in the hospital.  Life really is hell for me.  I'm not allowed to excerise, see friends, or shop at all!!!   I really need support from someone who has gone through the same thing as me, because I really want to end my life.  I don't want to live with all this fat on me. Please help!

Thanks Oscar for the clarity concerning my questions I asked.
« Last Edit: December 31, 1969, 07:00:00 PM by Guest »