It's been a hard weekend. I took Frances in to see the doctor because I felt like her allergy management needs to be changed a bit. She was looking washed-out last week, with dark under her eyes and just that "allergy look." It's not surprising, since it's really quite challenging out there now with yellow pollen brazenly settling on the cars and mold counts very high with all the rain we've been having. Plus we are suddenly spending infinitely longer amounts of time outside than we were, say, three weeks ago. I've been having a hard time with occasional headaches, post-nasal drip (I can see slime in the back of my throat when I look in with a flashlight), and stuff catching in my throat when I talk or read aloud for a long time. Rutledge also needed another vaccine, since I've been slow vaccinating him and try to prioritize the ones that I feel are more important without overloading his system at any one given time.
So I asked about Walter at the end of the appointment. He's looking skinnier again, and I asked if I should be worried. My pediatrician absolutely jumped down my throat in a personal way, accusing me of canceling appointments with specialists (not true--we went, we followed up with 2 of the 3 suggested tests, we were told his issues are more than likely "constitutional," we were not told to follow up), and threatening to put in a feeding tube. She repeatedly and pointedly kept saying, "Prove to me he is getting enough calories." The implication is that I'm not feeding him and he is getting inadequate nutrition. I can't prove it--I truly haven't kept a food diary. She kept asking if I've kept a food diary. Well, no one has ever asked me to do it before. Honestly. And I can't "prove" that he's getting a certain number of calories (I had to press her to get her to tell me what a target number would be). I felt confident that I was not starving him, that even with all the vegetables and fresh fruits I've been pushing lately and with him saying he's full, that he's getting enough calories. She suggested his metabolism was probably unnaturally low because of his low caloric intake, and that this was then creating a cycle where he wasn't hungry because he wasn't consuming enough calories to create an adequate metabolism. My understanding of human metabolism is that being overweight and less active creates a lower metabolism. But whatever. She threatened me and him with a feeding tube if he doesn't get enough calories (though she didn't ask for me to actually come in to prove it...). Poor kid is terrified! I feel awful because I was the one who came and asked a question about a child who wasn't even in there. When she saw him when he came back from walking the dog, she said he didn't look too bad. As a person who has struggled to gain weight myself, the prospect of a feeding tube would scare the bejesus out of me, too, because I eat as much as I possibly can, even if it's not always adequate.
I am now concerned that she will call Child Protective Services, and I am prepared. I came home that evening and even without changing a single thing in our house, I believe that anyone who came to inspect our cabinets, refrigerator, pantry, and freezer would be amply satisfied with the variety and healthiness of food in our house. We have multiple types of bread, milk, cheese, eggs, fresh fruits and vegetables, frozen fruits and vegetables, two hundred pounds of grass-fed, local, organic beef, about eight pounds of chicken, nuts, legumes, pastas of all types (whole wheat, semolina, white rice, brown rice, quinoa), and more types of flours than any gluten-eating family would ever have--whole wheat, corn, tapioca, white rice, brown rice, buckwheat, unbleached white, quinoa, fava, garfava, potato, and on and on. We have semi-local syrup, local honey, vitamins, omega-3 supplements. And prior to this whole Easter thing, very little "junk food," although to be fair, that's partly because we had eaten what I last got at the store.
I am very, very guilty of letting Walter and I eat some candy. My pediatrician kept suggesting that it was the lack of Big Macs and fast food that was making Walter underweight and malnourished. There's a severe breach of logic in this, but even so...it's not even true. No, he doesn't eat Big Macs--they're not on his diet. But he had been eating plenty of McDonald's fries--at least 1200 calories worth a week. He does eat grilled chicken from there. I'm not a crunchy purist. I'm not sure if she was tagging me as a tofu and kale eating vegan who has some exotic and restrictive diet, but she surely is wrong. I'm probably the most dietarily "moderate" person out there--I like my meats to be organic and local, I like my vegetables to be non-genetically modified and organic, I like to know who I get my eggs from, I go out of my way to use the more nutritionally dense GF flours, which probably gives more variety to my baked goods than to the average wheat-eater's. I read labels. But I don't mind Snickers bars if they fill us up for a little bit until we get to other food (we can't eat a cookie someone offers us, a cupcake, crackers, or other snack foods you commonly encounter when you're out). I know fast food is bad for us, but it doesn't stop me from taking advantage of its convenience more frequently than I'd like to admit.
So I am still preparing for a visit from the County, and I hope and pray they will be pleased with what they see. A house full of books, a completed math book, test scores above the 90th percentile, craft supplies and musical instruments and obvious signs of education happening. Children who can identify the location of every country in the world and most of their capitals. And food that exceeds WIC standards by a long shot.
I also began keeping that exhaustive food diary. I'm the skinny girl that everyone loves to hate, and I truly hate myself for being thin. If I could rub a magic lamp and get three wishes, one of the wishes I'd have would be for me to look physically more like other people and to even have to watch what I eat not because it's going to land me in GI distress, but because it might affect my weight. I'd trade my GI issues for just about anything! And I'd like to not be "hated" for my "lucky" genetics. I certainly didn't choose it! It is true that I can eat just about anything, and I know that my day is likely coming very soon when this won't be the case, just as it did for my mother and grandmother. But for now, I don't know a lot about calories, only as much as I've had to learn in order to attempt to eat 4000 calories a day while pregnant with the twins (super-hard!) and to help my underweight children. I know about adding cheese and butter and heavy cream to anything that will take it. The standard medical advice for underweight people is to drink a lot of milkshakes. We are no strangers to ice cream!
And here's what I learned from my diary: Walter is not starving to death from lack of calories or food variety. I have tried not to actively push radically different foods from our normal ones, and on the first day he had around 2000 calories, and yesterday he had 3465. Today he had already had 1478 by 2:30. I'm still not sure how many calories an underweight 11 year old boy of slight frame should be eating, but these are probably in the ballpark. I did get him Homestead Creamery chocolate Creamline milk, which is what he drinks if he drinks milk. We don't have it all the time. I don't force it on him the way my mother forced me to drink it twice a day every day of my lactose-less-tolerant childhood (I'm just now able to drink milk without a lot of distress and bloating and without Lactaid after healing some with the gf diet). But if the number of glass bottles rattling around my car waiting to be returned for my deposit is any indication of what we've been drinking the last two months, I would say that again, I'm not starving anyone.
So this leaves the mystery, but I think I have a theory. It is not true that a celiac can eat anything at McDonald's except the buns. First of all, the "eat a bunless Big Mac" thing is clearly said by someone who has never tried to eat a bunless fast food burger! Second, most everything except the condiments and drinks at McDonald's contains gluten. The "special sauce," the french fries, the grilled chicken. Things that you don't even know how they got gluten in them in the first place (the fries are in a beef base that contains gluten). What opened my eyes in my hurt (I was stunned and greatly saddened to think that I was starving a child I love very much) was looking for backup for my gut response. And though I had kind of heard that the french fries are now unsafe (they once were considered gf), I didn't want to believe it. But we have been eating a lot of them. And we had been eating the grilled chicken salad. It could just be possible that if Walter has an absorption problem when he eats gluten that I've been contributing to that situation. It's not underfeeding him. It's not inadequately monitoring his food intake. It's feeding him the wrong things with the best of intentions in trying to make him bigger.
I am going to continue to keep a food diary for the next week. I want to see variety over the course of days. I want to see what he gravitates to on his own. I am no authority on healthy eating because I am not overweight myself and have always had trouble with three larger meals a day. I absolutely cannot finish most restaurant meals. I have difficulty with hypoglycemia and tend to eat frequently to keep my blood sugar even. If I go too long, I have trouble eating because I'm over-hungry and than I get full too quickly. As a result of this little episode in our family life, I'm coming to terms with the idea that I most likely am anorexic. I've never thought of myself that way. I've never restricted food except to protect myself from feeling sick. One of the things that I'm hoping to address with the counselor I'm seeing is my unhealthy relationship with food. I grew up in a family where food was not adventurous, where my Dad got physically ill if he had much beyond his very basic 10 or so meals. My Mom cooked a lot of things from boxes and wasn't exposed to much ethnic cooking and had grown up with very basic foods--pork chops, fried chicken, steaks, salisbury steak, pasta with a meat sauce. I'm now seeing how this has affect me and my attitude toward food. It also probably made me the small person I am today who has some kind of metabolic problem with food. And my attitude toward food isn't as adventurous as it could be, and I tend to be an eat-to-live rather than a live-to-eat person. I wish I was the latter. I deeply desire to be a good food model for my kids, and when they see me thin or feeling sick after I eat, it is not modeling the food-is-to-love-and-brings-people-together that they need to be seeing as they get closer to going out on their own.
At any rate, I was relieved to see that my instinct that I'm not starving or providing inadequate calories was correct. I have had a hard time trusting my instincts lately because I have some pretty weird ideas about a lot of things. But my accounting has been in accordance with my perception. Walter, on a typical day, will eat such calorie bonanzas as mixed nuts, pistachios, cheese, and bacon. The only milk he drinks is calorie-charged (not necessarily a "good" thing, since I'm sure all the chocolate and whole fat isn't a "good" in many people's book). He does eat candy, and that's naughty of me. But for an underweight person trying to add in a few extra calories in a day of baby carrots, grapes, apples, bananas, spinach, and lettuce, this doesn't seem off the charts awful.
Here's today, a holiday, so much worse than usual. Still, not horrific in the grand realm of child-feeding! As my friend Christi said this morning, this is one of two days a year when she lets her children eat candy for breakfast:
* Easter candy (150)
* 1 cup strawberries, 1/2 cup grapes, tangerine (100)
* Chocolate milk, Homestead Creamery (220)
* Orange juice (55)
* Sausage quiche, no crust (250)
* 2 deviled eggs (128)
* Easter candy again (180)
* Tangerine (25)
* 13 bean chili with beef (450)
* mixed nuts (200)
Dinner will be T-bone steaks, asparagus, rice, and baked beans. Not sure of calorie count on that.
I have a bad feeling I'm lowballing his candy intake for today. I'll be honest--I'm in the camp of let-them-eat-a-lot today when it comes to things like Easter and Halloween so that it gets gone and there aren't weeks of candy-filled days and monitoring.
So I'm prepared. I'm prepared for jail, having my children removed from me, or a fight. Whatever comes, I feel that I'm doing my best. I was given this particular child for some reason, and though I often feel ill-equipped to be the best parent to him, I'm trying to figure out what is right, what is the root cause. I want him to be on track to reach puberty and become an adult. It's disconcerting to have a child who is so obviously smaller than his same-age or even younger-age peers. And he feels the difference, too. I'm willing to change to help him.
What I picked up that I didn't intend to:
If you want to lose weight, eat fruit. Lots of it. Like strawberries. You can eat strawberries all day and it won't add up to anything significant. Grapes, too. Tangerines. 25 calories! And steak. I never knew that meat had way fewer calories than it seems like it should. That's Walter's favorite food, and here I had been thinking that it had substance. It's just a pile of protein. Actually, I hate to admit this for fear of being clobbered, but it seems like if you just avoid cheese (even cheese sticks seem like they should be far more calories than they are!) and nuts and whole chocolate milk and certain candy that isn't all that filling but adds up quickly (Snickers isn't in this category--it's not a crazy number of calories, and as they say, it's satisfying so I don't find myself wanting to eat three of them...), it seems like the calories just don't add up to all that much. I know when I was pregnant with the twins it was absolutely oppressive to aim at 4,000 calories a day (and 100-120 grams of protein). I had to carefully pick every single thing I ate to even try for that, and it meant always having to choose the "calorie bonanza" like a really huge hamburger with lots of sauce or something from McDonald's (which I totally couldn't stomach) at every single meal. Even eggs aren't that calorie-dense. Seems like deviled eggs ought to be really bad for you, but they really need to be put in a context of a bunch of other things--like a big portion of a breakfast casserole or three tablespoons of maple syrup and a whole stack of pancakes--to push into the big zone. So the past few days have been eye-opening. No wonder I've had food issues all my life!