It is with decidedly mixed emotions that we announce our founder and chief medical officer, Julie O’Toole MD, MPH, will retire at the end of this year.

First I’d like to mention that (for once!) this has nothing to do with the pandemic. Dr. O’Toole’s retirement has been planned for some time; more than anything an exact date has always been dependent on our ability to prepare our clinical team for this momentous transition. And we are ready!

Second I’d like to stress how much things will remain the same. Replacing Dr. O’Toole at the helm will be our current medical director, Naghmeh Moshtael MD, assisted by our excellent team of medical and behavioral health providers, many of whom have been with us for the better part of two decades. We remain the most experienced pediatric eating disorder treatment team in the country (if not the planet), bar none.

Lastly I want to thank all of our families over the years – and for all the years to come – for entrusting us with the care of your children. Dr. O’Toole taught us that it is an honor and a privilege to do so, and we pledge to continue the pioneering work she began back in 1998. The mission continues.

Happy Holidays and a health and prosperous New Year to you and your family.

Thank you.

Morgan O’Toole, CEO, Kartini Clinic

We just graduated an 11 year old boy from the Kartini Clinic and on his way out, proudly, he showed me a project he had been working on. He was supposed to build and design his own box of cereal and then promote it.

And since his cereal box is just about the cutest thing I have ever seen, I have to share it with you; he of course gave me permission to do so. Merry Christmas.

 

The front of his box: “Max's marvelous o[a]ts” with exhortation: “Allwase be coo

 

 

 

 

 

 

 

 

 

 

The back of his cereal box. I especially love “100% Me”.

Now, I have to say that I would be proud if I were able to draw such a fabulous self-portrait as he did. But how great is the “teck expert”! And it’s true.

Would that all of our kids could absorb some of this eleven-year-old’s self confidence: smart, “teck expert”, kind, nice, fair and funny! And he’s right, that’s exactly what he is.

So treatment can be successful, and the kids are pretty much always wonderful. Enjoy!

When patients graduate from the Kartini Clinic I am often asked by the anxious/happy parents how they are to deal with any eating disorder symptoms going forward.  What if they refuse to follow their meal plan?  What if they lose weight? Should they see a therapist for this? A dietitian for that? 

What I tell them is this:  You are the expert in your child’s meal plan.  You know far better than any professional what degree of mealtime supervision is still needed (100% at first).  You know what their meal plan looks like and why it looks like it does.  Trust yourself, trust your teaching.  And recently I have begun to use the phrase “Life stops until you eat” for any situation of food refusal they might encounter.

I’m not sure where I first heard this phrase or who the original author of it was — please let me know if you know, so I can quote it with proper attribution.  After all, how many people know that Kartini Clinic was the originator of “parents don’t cause eating disorders and children don’t choose to have them” or “without weight restoration you will get nothing”.  Or that I was the originator of “State not Weight”.  And the pithy and apt “life stops until you eat” is too great not to share; I would like to tip my hat to the author.

Sometimes a child who has graduated from treatment will need to see a psychiatrist for medication or complex mental health management, or sometimes see a therapist to deal with school anxiety, social anxiety, trauma or adolescent adjustment issues.  But as far as the meal plan is concerned, parents: you are the experts.

The only spine-stiffening motto you need, should your child leave treatment and try to return to restricting is this: “life stops until you eat”, no friends, no going out, no cell phone, no parties, no car, no clothes shopping, no college visits.  The first job is to nourish the body and all else comes after that.

We had a therapy dog at Kartini Clinic for many years, and when the honorable Cleo, a black standard poodle, died it left a hole in our hearts.

I’ll never forget the day a small boy arrived in our office from another Children’s Hospital. His mother had removed him from the locked psychiatric ward where he had been placed for anorexia nervosa and terrible social anxiety. His transfer records labeled him as, “the worst case they had seen.” His mother was terrified we would say we couldn’t help them, and as her son lay on the exam table curled into fetal position, refusing to look up or speak, I did wonder.

In those days, my husband Steve managed Cleo and I asked Steve to bring her into the exam room that day. Now, standard poodles are not happy, lick-y, snuggly dogs. They tend to be aloof and watchful, and Cleo was exactly that type. She came in the room and simply sat next to the boy, who by then had slid off the exam table and was curled up on the floor. Short of lifting him up bodily there was little I could do about this unsanitary situation. His mother tried in vain to get him to stand up or sit up. Cleo just sat quietly. Suddenly, his small hand shot out and touched her curly black dog hair. She still sat quietly. Within a few minutes he had sat up and was petting her. It was the opening we needed, the small crack in his defenses that let us in and let us, ultimately, return him to his life.

When Cleo died Steve did not have the heart to replace her. We went for several years without any animal assisted therapy. Then came Ryla and with Ryla her therapist-trainer Lisa.

Cleo was tall and aloof. Ryla, a white miniature poodle-mix is enthusiastic, cuddly and cute. Her short legs take her everywhere the kids go, her round eyes take them all in, her certainty about being loved gives her free reign. She owns the clinic.  

Ryla is sometimes accompanied by her fellow dog therapist, a boxer. They, in turn, share the spotlight with a hedgehog, a chinchilla, and several hermit crabs. I kid you not: hermit crabs. It’s hard to predict what will reach the heart of a child who is hurting.

But it’s Ryla I’m writing about today.

Kartini Clinic specializes in children with all conditions of disordered eating. We have a partial hospital program that serves children from ages 6 to 18 with anorexia nervosa, purging eating disorders, binge eating disorders, ARFID (avoidant restrictive food intake disorder), cancer cachexia, failure to thrive, and just about anything that causes a young person to refuse food.  And because we are so specialized, we get children who are very ill and several who require tube feeds to save their lives. That’s right: to save their lives.

But tube feeds can be scary, and having to have a nasogastric tube (a tiny tube from the nose to the stomach through which life-giving fluids and calories can be sent) can be a frightening procedure for a child, and for their parents. Our nurse Sherrill places most nasogastric tubes right in our office. And her chief assistant is Ryla.

“Can you come in extra early?” Sherrill asked Lisa this week, “Our new patient is going to need a tube and she is terrified. I need Ryla’s help.”

So that little ball of white fluff jumped into the lap of that frightened child and made it possible for her to endure a scary procedure. Five minutes after the tube was placed, the child was laughing and petting the dog, who followed her upstairs for her first day of treatment.

Thank you Ryla, and thank you Lisa.

As Will Rogers once said: “If there are no dogs in Heaven, then when I die I want to go where they went.”

It’s lunchtime at Kartini Clinic, and patients in our partial hospitalization program are settling in for their midday meal. Joining them at the table is Nutrition Counselor Annastacia Weiss. Annastacia came to Kartini Clinic with decades of culinary experience. She studied at Western Culinary Institute and the Institute for Integrative Nutrition in New York City, interned at farms, founded the much loved North Portland cafe SweeDeeDee, and incorporated her knowledge of food as medicine while teaching in the Masters in Nutrition program at Portland’s National University of Naturopathic Medicine.

Throughout her culinary career and in her personal life, she has wanted to help people gather with their families, slow down, and enjoy eating together. Kartini Clinic’s emphasis on parents preparing meals for their kids and eating with them felt like a natural extension of her own philosophy about the importance of food in our family lives.

Families arrive at our doorstep from all walks of life, and with different circumstances and routines. While each family is unique, we prescribe the Kartini Meal Plan to all of them. Annastacia is instrumental in helping our families make the adjustments necessary to follow their meal plan at home. She meets with each new family to learn the basics about their eating habits and rituals.  She finds out if they eat together regularly, if they have a dining room table that they use for meals, and about what the family typically does after mealtime. She works with them to address their individual challenges such as addressing the needs of siblings and adapting a menu that fits with their food culture.

Children in our partial hospitalization program eat breakfast, lunch, and snack at our clinic daily and dinner once a week. Annastacia adapts the meals offered at Kartini to take into account each child’s food preferences, allergies, and other dietary restrictions. While the meals adhere to the Kartini Meal Plan, Annastacia notes, “We’re not offering heavy duty gourmet food here. We are feeding kids, after all.”

Annastacia also eats meals with our patients. Typically, there are several sandwiches and high protein salads to choose from. Parents are sometimes surprised that even the humble peanut butter sandwich, served on whole grain bread with fresh fruit or vegetables, fits within a meal plan. “Really,” Annastacia says, “all food in our meal plan looks pretty normal. It’s all about getting the right amount of healthy carbs, protein, fruits and vegetables, and some fat on a plate.”

At home, some families rely on a recipe book that Kartini Clinic provides to prepare meals. Others are able to adapt their own family food traditions to the plan. To Annastacia, the meal plan is both medicine for our patients and a means by which their families can turn away from the many health problems that stem from our society’s current approach to food.

“We have seen food evolve to a place where it is making people unhealthy. It’s processed food, unconsidered eating, and then the fad diets. These diets create ‘food police’ in these kids’ heads. As a society, we create a lot of craziness around food.”

As a child moves through our program, much of Annastacia’s work involves preparing them and their families for life beyond their time at Kartini Clinic. The meal plan can – and often is – a bridge of continuity for our patients after they graduate from the program.

“As our patients leave our care, their meal plan is a safe set of rules to follow to get them back to health, and it greatly reduces their anxiety. Of course, it’d be great if they could get back to the ability to eat with hunger, when they need it, and to eat well, but the meal plan is something they can use until they are there. They don’t have to think about it, because they know intellectually they are getting what they need right now.”

In her daily interactions with patients, Annastacia thinks back on times in her adolescence when the adults in her life kept her on a healthy path. She didn’t always appreciate it at the time – and knows the patients she sees don’t always appreciate what happens in treatment. But her hope is that one day they will look back with a greater understanding of what it took to get them well. In the meantime, Annastacia invites them to the table and to give food a chance, one sandwich or salad at a time.