Meet Our Team: Megan Bendig

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1. What is your name and what are your credentials?
Megan Bendig, Senior Primary Therapist in Casa Verde; MSW, RCSWI

2. What is your background (brief introduction)?
My professional background is rooted in residential eating disorder treatment. Prior to coming aboard at OPC, I worked for a residential ED center in Birmingham, AL which is where I’m from. I also completed my internship there during graduate school at the University of Alabama. (ROLL TIDE!!)

3. What does a typical day look like for you at OPC?
One of the reasons I love OPC is that this is a very difficult question to answer – every day keeps you on your toes! Senior primary therapist is a new role within our organization so each day comes with new challenges and opportunities to aid in the healing process of our women. I wear various hats, one of which is that of primary therapist to two to three of the women in Casa Verde. I meet with my clients daily for individual and family psychotherapy. Additionally, I supervise or oversee the care of 2-4 Casa Verde women which includes weekly case management sessions. These sessions are truly unique and address the in the moment needs of each woman… whether it be a general check in or a snack exposure to a fear food. I also run body image group and oversee the Mindful Movement Program.

4. How does the team at OPC work together? How does your role overlap and differ with other roles?
The team at OPC is unbelievable – I’ve never experienced a more inspired group of women (and men!) I believe the key to our team’s functioning is that each member puts our women’s needs above all else. In working from this perspective, the rest seems to flow naturally!

5. What is your favorite thing about OPC?
I cherish the moments in our work that allow us to meet our clients as humans – not as treatment provider to treatment receiver. My favorite thing about OPC is that this mindset is infused in our day to day operations. For example, I consider myself to be creative and I find it incredibly meaningful to be able to infuse creativity into my work with our women. Another example is how we as a staff interact with the women outside of our professional context. I’m always up for a game of scattergories or banagrams and love being able to relate to our clients in a way that is lighthearted, social, and non-threatening.

6. What are three facts about you that people do not know?
I was born on the 4th of July. My brother, who was three at the time, thought the fireworks were for me! The start of football season is my favorite holiday (that counts as a holiday, right?!) I love DIY projects and crafts. 

Ten Things I Wish Physicians Would Know About Eating Disorders

We are so pleased to share a guest post from our esteemed colleague, Edward P. Tyson, MD. We were impressed and inspired by the original posting of this article on the Gurze – Salucore Eating Disorders Resource Catalogue website. We think it is extremely relevant and important for all physicians to understand how to assess and treat individuals struggling with an eating disorders and hope your find the following post helpful. To connect with Dr. Tyson, please visit his website. For more information from the Gurze – Salucore Eating Disorders Resource Catalogue website, please visit here

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The most important things physicians need to know have to do not with technical aspects of assessing or treating physical aspects of an illness, although those are important. It is about the physician first addressing his or her own attitudes about eating disorders and those who have those illnesses.

1.  Physicians are lucky to have people with eating disorders as their patients. People who suffer from eating disorders are a special group. Almost without exception, they are empathic, creative, intuitive, hard working, and usually gifted in at least one of the following (and quite often in all 3): academics, creative expression, and athletic endeavors. When these sufferers are free of their illness, they are incredible people to know and be around. And their recovery encompasses all the reasons why, hopefully, most doctors go into that profession.

2.  Don’t be afraid of an eating disorder.  It is an illness, with signs and symptoms and causes, and really good treatment. What other illness would a physician feel so inadequate about and also not seek the advice of colleagues or the literature? Sadly that happens so frequently and it is the topic of sufferers, family members, and professionals in the eating disorder field. Please do not be one of those people we talk about like that. Get educated or get help, but do not ignore, dismiss, or fail your professional responsibility.

3.  Eating disorders will test one’s ability to be humble. These are some of the most complicated illnesses there are, as they involve both complex medical and psychiatric issues. In addition, there are not that many medical experts around, so, yes, most doctors will feel like they are in unchartered territory. And you will make mistakes; we all do. But learn from them and approach the problem in the way that patients expect of physicians—with a cool head and keen mind, unfettered from a sensitive ego.

4.  You will likely need help at some point. A physician cannot know all details about every illness, especially ones as complex as eating disorders. As with any illness one encounters as a physician, the professional approach is to determine what the best assessments and treatments are. Again, be humble enough to ask for or seek advice.  One can seek opinions of experts in the field in any number of ways—a phone call (a so-called “sidewalk consult”), go to the literature, use the AED medical guide, or any number of texts on the subject (consider the books by Mehler & Andersen, and Birmingham & Treasure, or, maybe even my chapter in the book by Maine, McGilley & Bunnell).

5.  You will not be able to successfully separate out the physical from the psychiatric. Both must be treated at the same time. It is no longer appropriate to say, as a physician, that these are psychiatric illnesses. Nor is it permissible for psychiatrists to say that they are not the ones to deal with the medical. Again, if you do not know, do not reject the patient—instead, call in a consultant and work with that other physician.

The same applies to medical and psychiatric hospitals. Eating disorder patients should never be placed in a medical “no-mans land” where they are ping-ponged back and forth from one to the other, each claiming they cannot treat an eating disorder. These hospitals, by the way, do not have a sign outside saying, “WE TREAT EVERYTHING…except eating disorders.”

6. Keep checking every organ system every time. Use screening tools and a consistent pattern to the history and physical to make it easier, faster, and more likely not to miss something important. Use a BMI graph in those who have restricted to predict how serious the decline is, as the more dramatic the drop or angle of decline on the graph, the more likely that cardiovascular complications are present. A dramatic drop of the BMI can be very alarming and convincing to family members and to patients (see example). As I say often in those cases, “Imagine you’re flying Southwest Airlines and this is how the plane is going down. What would you want the pilot to do about now?” The answer is universally:  “Pull up”…How soon?  “Now!”

7.  While they are complex, eating disorder’s medical complications follow specific, predictable physiological patterns resulting from the ED behaviors. However, physicians must consider the specific circumstances of that individual patient and what behaviors and conditions can predict certain medical (or psychiatric) complications. If they are purging, for example, they could have bleeding, electrolyte and dehydration issues, and signs and symptoms consistent with those conditions. Always consider cardiac complications, and in those who are restricting, screen for Refeeding Syndrome. Those who restrict should have signs of hypometabolism, with low body temperature, bradycardia, capillary refill delay, acrocyanosis, and such.

8.  Check lab values frequently, including electrolytes and especially phosphorus and magnesium in those at risk of Refeeding Syndrome. Purgers are at risk of bleeding, so the CBC needs to be followed. The AED medical guide provides a good summary of labs needed.

9.  Remember that many of the psychological issues may be a result of medical issues and vice versa. What one may think is anxiety or panic could easily be hypoglycemia. What may appear to be depression, bipolar disorder, or personality disorder may actually be malnutrition, brain starvation, and such. And the medical issues will tend to worsen what psychiatric issues are present.

10.  Athletes can get eating disorders, too. Don’t assume because the patient is a high performing athlete, that physical findings that would be considered abnormal in others is due just to the patient being an “athlete.” A common mistake is to assume that one’s bardycardia (slow heart rate) is due to being a fit athlete. However, if the resting heart rate is below 50, evaluate if hypometabolism and energy conservation are ongoing, and not due from a fit heart but one that is losing its exercise capacity.

Do not be surprised how many calories it takes to refeed someone who has been malnourished, especially one who was exercising heavily with their eating disorder. It can be enormous calories and the patient may only then slowly gain weight at first. This is because the metabolism has to be reversed and turned from hypometabolic to hypermetabolic and that requires enormous calories, fat, protein, and carbohydrates. It is not uncommon for someone at a very low weight to be eating 5,000 calories per day at a treatment center and very slowly gaining at a rate of 1 or 2 pounds a week after a few weeks of no weight gain or even weight loss.

If a physician were to follow just the above, he or she would know more about eating disorders than 95% of other physicians. We are not looking just for experts; we’re looking for volunteers to care for these deserving patients.

For more information about Oliver-Pyatt Centers, please subscribe to our blog, visit our website, and connect with us on Facebook, LinkedIn, Twitter, and Instagram

The Difference Between Internal and External Rock Bottom

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(Substance Abuse Program Director Lisa Richberg, LMHC and Clinical Director Melissa McLain, PhD)

The phrase “rock bottom” is often used loosely, in both the eating disorder and substance abuse treatment communities, to mean that someone has reached the lowest point in their disorder. Often times, this is the point at which the individual decides to give recovery a chance. Rock bottom is often associated with difficult life events – relationships ending, accidents, financial losses, academic failures; and is commonly sited as lowest points in a persons’ life. However, in exploring this experience with our clients, we have discovered it is not so much the external “rock bottom” events, but rather the internal emotional lows that matter most. It often seems to be that only by reaching her own internal “rock bottom” a person may be willing to risk attempting a different way of living. Rather than hinging on a major life event to trigger the need for change, this internal shift can take place long before, or after, a devastating event has occurred. This moment is often described as being immensely liberating. Recently, one of our patients shared her own experience: 

For me, my external bottom was when my materialistic life fell apart. I was asked to leave school, lost my spot on the softball team, totaled a car, lost most of my friends, spent all my money, and the list goes on. My external bottoms were extremely overwhelming, all consuming, and life ruining. You would think this would be enough to get me to recover, right? The reality was all of the inner turmoil was still very much alive inside of me. I still had unresolved insecurities, traumas, and chaos, which it is assumed an external recovery could fix. I was wrong… After many relapses, I hit a different kind of bottom. This was a bottom that was foreign and uncomfortable, and I wasnt sure how to navigate it. For the first time I truly wanted to stop my eating disordered behaviors for myself, and not do it just for materialistic things or other people

Exploring this idea can help an individual take time to do a personal inventory to assess where she is, and allow her to ask herself questions such as, “Have I had enough?” “Have I reached my own rock bottom?”  Then she can reflect on what she truly wants for her future, and seek the help needed to make that a reality.  

For more information about Oliver-Pyatt Centers, please subscribe to our blog, visit our website, and connect with us on Facebook, LinkedIn, Twitter, and Instagram