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Yellowbrick Eating Disorders Service

Jesse Viner, MD
Founder and Executive Medical Director

 

Assessment

Patients seeking entrance to the Eating Disorders Service are seen in consultation by a team of senior clinicians in addition to Drs. Viner and Humphrey.  For all adolescents and young adults, and occasionally spouses, a collateral family evaluation is conducted by Yellowbrick staff.  A baseline nutritional assessment is established by a Registered Dietician.  Consultation with the patient’s family physician and previous therapist is included.  Previous testing and medical records are reviewed as available and psychological testing is performed as indicated.  Patients are required to participate in written assessments evaluating their eating disorder, psychiatric and substance abuse difficulties.  Daily journal logs of nutrition, activity and emotional experiences are integrated into the evaluation.

Dr. Viner reviews and integrates the assessments and arrives at a diagnosis and treatment recommendations.  These are discussed in a conference involving senior Yellowbrick staff, expert consultants as needed, the patient, and parents/spouse as indicated.  Eating disorder, psychiatric and substance abuse diagnoses are presented along with an individualized treatment plan often combining multiple services.

Patients persistently unable to sustain supported meals for which family support is either not available or not indicated are referred to Evanston Northwestern Healthcare’s Eating Disorders Day Program.  Patients who are medically at risk, in severe denial, chaotically dysregulated, addicted to laxatives or without adequate social/family support are referred to residential treatment centers with follow up by Yellowbrick upon discharge.

Medical & Nutritional Stabilization

Dr. Viner and Dan McDonnell, Yellowbrick Advanced Nurse Practitioner and Coordinator of Health Services, will assume certain aspects of medical evaluation and treatment, while collaborating with the patient’s personal physician.  Yellowbrick also has a contractual relationship with Cynthia Bartholow, MD, an internist who served as Director of the Evanston Northwestern Healthcare Women’s Health Initiative. And initial evaluation includes a physical exam, complete blood count and chemistries/electrolytes, thyroid profile, hormone levels, lipid profile, urine analysis, toxicology screen and bone density scan.  Patients who have ceased menstruating and/or demonstrate bone density loss are encouraged to begin calcium and hormone replacement.  Patients who have reported vomiting blood are referred for endoscopy.  Patients who vomit regularly are referred for dental evaluation.

Recovery is most often enhanced when patients journal their nutrition, activity and emotions.  This assists the internalization of mindful connectedness and centering. These are reviewed individually within consultations with the dietitian, and with peers in the Goals and Strategies Dinner Group.  Patients are weighed weekly.  Weight restoration is defined as 95% of individually determined maintenance weight, as this also is associated with greater enduring recovery as well as improved fertility.  Weight restoration is achieved by collaboratively creating a stable structure for eating, broadening choices for comprehensive constituent nutrients and increasing calories in a challenging but not traumatic experience which builds confidence.  Activity plans are formulated and strategies for tolerating disruptive experiences are developed.

Dr. Viner, staff and the patient will determine both goals and the pace to reach them, and minimum weight thresholds.  Inability to meet goals and/or trespassing thresholds will trigger a conference within which alternative treatment strategies including referral will be considered.  Weight restoration is considered a required yet insufficient component of an enduring recovery.  Since lowered weight and nutrition impairs brain function and stimulates anxiety, insomnia and mood instability, weight restoration is required as an active early goal in treatment.