Nancy’s Story

 

In 1985, Nancy was the second child born into Jack and Mary’s family.  She lived with her parents and older brother, Phillip, in a small rural town in Northern Ontario.  She was a very active child, some would call her a “Tomboy”.  Nancy played many sports at school and in local leagues.  She was quite competitive.  Nancy enjoyed the company of her father, spending many days fishing and hunting with him.

Neither Nancy nor her older brother Phillip had many friends at school.  They never really felt like they ‘fit in’ with the other kids at school.  She was ‘too white’ for some kids and ‘too Indian’ for others.  When she was younger she often got called names.

Between not fitting in and the pressure to fulfill her father’s desires to have an athlete in the family, Nancy pushed herself physically.  She felt comfortable in her father’s quiet presence.

When Nancy reached her teenage years, she excelled in basketball, hockey, track and field, and gymnastics.  Her father was very proud of her accomplishments.  With these sports taking up much of Nancy’s time, her school grades were average due to competing priorities.

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Mary was concerned about her daughter’s health and wellbeing.  She often discussed her concerns with Jack, but was dismissed as being overprotective.  One day, Nancy’s school called Mary to come and pick her up.  Nancy had injured her leg during a 10 km run.

Mary took Nancy to the local emergency department, as Nancy was in considerable pain and unable to bear weight on her left leg.

The emergency physician ordered an x-ray of Nancy’s left leg, blood work, and did a physical exam.  The diagnosis was a stress fracture of the left tibia.

The physician was more concerned about Nancy’s appearance and her story.  The physician followed-up with a more comprehensive history from both Nancy and her mother.  What come to light was the following:

• Fatigue (Nancy stated that she always felt tired, and would fall asleep if she sat still for more than 5 minutes)
• Weight loss (Nancy’s BMI is 15.7)
• Absent menstrual periods for the last six months (in the last year, Nancy had only 2 very light periods)
• Periods of fasting, binging, and self-induced vomiting (purging)
• Extreme exercise (Nancy ran 10 kilometers each day, had morning and after-school practices, games and competitions, and competed in a number of events each weekend)

Based on the clinical findings, the emergency physician diagnosed Nancy with Female Athlete Triad.  It was explained to Nancy and her mother as an interrelationship of menstrual dysfunction, low energy availability (with or without an eating disorder), and decreased bone mineral density; it is relatively common among young women participating in high-level, competitive sports. Diagnosis and treatment of this potentially serious condition is complicated and often requires an interdisciplinary team.

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Nancy’s story continues…

Nancy met with all of the healthcare specialists that the emergency physician referred her to and a multidisciplinary team for Nancy’s case was formed.  They were all in agreement that Nancy should refrain from sports until she was cleared for return-to-play.

Her father did not see what all the fuss was about, he urged Nancy to get back to what she loved to do.

Nancy went to all her appointments to satisfy her mother and family doctor.  However, she continued to secretly binge and purge.  She would often skip class to go running.

It took three years of hard work for Nancy to get to a healthy weight, eat well, and have a healthy outlook on exercise and activity; however, Nancy continued with oligomenorrhea.

Nancy went away to university and started to work out and run again more frequently.  After she graduated, she obtained a job in Toronto in finance.  Now that she had the freedom of being on her own, she was working out and running twice a day to help with the stress in her life.  It was a lifestyle that she could not give up and now that she was on her own, she had total control over her body.  She was obsessed with maintaining an ‘ideal weight’ and fell back into the binging and purging of food.

She met Paul through mutual friends.  They started dating in 2010, married in 2012.  About two years after they got married, they started talking about having a family.  Paul had adopted twin girls from a previous marriage that they saw very infrequently.

Nancy and Paul kept trying to conceive starting in 2013.  By 2016, Nancy and Paul had seen fertility specialists.  They were not hopeful that Nancy could conceive due to her history and ongoing struggle with exercise and eating and an increased amount of stress in her life.

After many unsuccessful attempts at getting pregnant, her physician suggests she change her unhealthy eating habits and ultimately diagnoses her with body dysmorphia. She was likely unable to conceive due to the severity of her health issues and recent malnutrition diagnosis.

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In 2019, Nancy was doing well in her job and going to school for her CPA.  She was relying on Paul to help out around the house, but had some concerns about his use of pain medication.  Despite her concerns, Nancy wanted to be a mother and since they had no luck with conceiving or with the costly in-vitro fertilization, they decided to adopt.  In January 2020, they were notified that a toddler named Sam was available for adoption

There are three options for adoption in Canada.  Through domestic foster care; privately with a lawyer (this usually involves adopting an infant); or internationally.

Shortly after Sam arrived to live with them, Nancy got a call from her father (Jack) stating her mother (Mary) was in hospital.  Mary had fallen and fractured her hip.  Mary would be having a total hip replacement the next day.  Jack stated that they would have to come and stay with Nancy and Paul while Mary recuperated from her surgery, as their family home was not suitable for Mary post-operatively.

Nancy asked her father about staying with her brother Phillip, but Jack would not consider that as an option.

Nancy had no choice but to book some time off work, arrange someone to come in and help with Sam, Paul, and the housework while she was away for a few days.  She hoped to find the time to continue with her studies while she was away.  She was not sure if her parents had internet, so her back-up plan was to go to the local library a few hours each day.

Nancy arrived a few days prior to her mother’s discharge to help pack up what her mother and father will need while they stay at her house.

Nancy finds her father in need of medical attention and brings him into the emergency department at the local hospital, where Jack has been admitted (see Jack’s story).

Nancy was now in a dilemma as both of her parents were in hospital.  Her mother was due to be discharged the next day.  The plan had been for Nancy to take both of her parents to stay with her while her mother recuperated.  She needed to get home to her son, husband and her studies.

Nancy spoke with the discharge planner and explained the situation.  Mary would be transferred to the Alternative Level of Care Unit, until Jack was ready for discharge.   Nancy then called her husband Paul to discuss what she should do.

Nancy returns home the next day to prepare for her parents arrival.  Over the next week, Nancy is consumed with the preparations required for her parent’s arrival in the next week.

Meanwhile, Sam requires multiple appointments, extra care, monitoring, and a special diet for his Cystic Fibrosis (see Sam’s story).  Paul is not being helpful, often being distant with Nancy and Sam.

The stressors in Nancy’s life due to her occupation, new toddler, parents’ health issues, and strained relationship with her husband take a toll on her body and mental health. She begins to focus on things within her control, and becomes fixated on maintaining an ideal weight. She feels unconfident in her body, and obsesses over her physical insecurities. Nancy’s binging and purging worsens as her need for control takes over.

Nancy’s way of coping with the added stress in her life was binge eating, then feeling guilty and purging.  She was stressed over all of the decisions she needed to make for her parents, her new son, along with dealing with her husband’s use of narcotics and erratic behaviors.