One woman's journey into the controversial world of Electroconvulsive Therapy
Monday, October 31, 2011
Journal Entry 5
Happy Halloween. Today my joke was that for Halloween I was going as a mental ward escapee... minus the escapee. It was pretty legit.
Today was lonely, my main buddy here left yesterday so the social dynamics have been different. I slept most of the day, although that was largely due to the fact that I received my first ECT this morning, I journalled about it soon after ((that entry is in the prior post)). How appropriate that my first electroshock treatment falls on this particular holiday, what with the image of ECT in many peoples' minds consisting of grainy black-and-white hollywood-style images of restraints and wires and electricity levers and bone-breaking convulsions. How different it actually is though, these days at least (thank god).
I asked the doctor how we will be able to tell whether I am improving since I currently don't have any strong symptoms. Not that I'm complaining really, I always enjoy those periods of my life that lack significant suffering, obviously. As encouraging as it is that I still feel good despite being taken off of the majority of my medicines (only Celexa remains), I am sure it'd be helpful to have symptoms develop in order to gauge the effectiveness of my treatments. The psychiatrist told me we will do six inpatient treatments and then go from there, see how that lasts me I guess. I am authorized for up to a total of 12 treatments. He said he is hopeful of full remission with me, but I suppose that is always the best hope.
According to the nurse I underwent anesthesia at 7:20 AM with the procedure having been performed soon after and lasting barely a minute. As I gradually became more oriented I thought to document the time and saw it was then 8:00. I've been told I awaken from the anesthesia quickly, and had already been regaining conciousness for a time before I thought to look at the clock.
I wish I had a witty way to conclude this, but it's all factual for now. It's nearly midnight and in 4 hours the process will begin again, starting with a blood draw. So it's off to bed for me. Goodnight world!
Journal Entry 4
On Monday, 10/31/2011, ECT #1 was completed. I have elaborated now on notes I jotted down that evening...
Pre-op consisted first of the application of three of those annoying little stickers used during EKG monitering; you know, the sort you seem to continue to find on odd places of your body days later. Then, a pulse-and-oxygen monitering clip is placed on your forefinger. As the time ticks down to the procedure an IV catheter is inserted, hopefully in a tolerable location as it will have to remain in until your next treatment. Arms, hands, feet: these are all viable options for placement, it is in your own best interest to have convenient vein access so as to avoid the more unsightly insertions like the neck.
Immediately before the procedure begins the administering psychiatrist presents himself beside my bed, pulling beside him a small machine atop a cart. The machine has two handheld electrodes attached by cords, the electrodes look rather like large black play pieces from the boardgame Sorry. I can see that one of the drawers in the cart is labeled "Bite Blocks", and there is a large plastic bottle full of a clear blue gel - presumably a sort of ultrasound gel.
Nearly as soon as he enters, the psychiatrist pulls my peach-colored curtain, shielding me from the view of other patients, who are in various stages of preparation or recovery. As he does this he smiles at m and inquires about my mental state. I assure him that I am holding on okay despite the med drop, all of this taking place in a matter of seconds. He doesn't seem too interested in conversation or questions as the anesthesiologist and a nurse enter bedside. The nurse states my name and the procedure to be done, and everyone present including myself expresses that we are in agreement to initiate the treatment. Then a brown, rubbery, foul-tasting "bite block" is placed in my mouth and the anesthesiologist begins pressing a syringe of propofol into my IV as the nurse holds an oxygen mask over my face. "You will begin feeling sleepy soon" says the anesthesiologist, still squeezing the contents of the syringe into my vein. "I already am" I mumble, my speech impeded by the presence of the bite block as I begin to slip away.
I first noticed the regaining of my conciousness about half an hour later, realizing that the psychiatrist and the machine were both gone. There was an oxygen mask strapped to my face. The nurse beside me told me that I reported earlier in the recovery from the anesthesia "I'm not under, I'm not asleep yet", apparently having thought the procedure had not yet started, although it was already long over.
The nurse also told me I had been "chatty" coming off the anesthesia, which she claimed was a good sign as it indicated less depression than did silence during recovery. After that I was to be known as "Chatty Cathy", not to mistake the fact that my name is not actually Cathy.
So went my first ECT treatment.
Pre-op consisted first of the application of three of those annoying little stickers used during EKG monitering; you know, the sort you seem to continue to find on odd places of your body days later. Then, a pulse-and-oxygen monitering clip is placed on your forefinger. As the time ticks down to the procedure an IV catheter is inserted, hopefully in a tolerable location as it will have to remain in until your next treatment. Arms, hands, feet: these are all viable options for placement, it is in your own best interest to have convenient vein access so as to avoid the more unsightly insertions like the neck.
Immediately before the procedure begins the administering psychiatrist presents himself beside my bed, pulling beside him a small machine atop a cart. The machine has two handheld electrodes attached by cords, the electrodes look rather like large black play pieces from the boardgame Sorry. I can see that one of the drawers in the cart is labeled "Bite Blocks", and there is a large plastic bottle full of a clear blue gel - presumably a sort of ultrasound gel.
Nearly as soon as he enters, the psychiatrist pulls my peach-colored curtain, shielding me from the view of other patients, who are in various stages of preparation or recovery. As he does this he smiles at m and inquires about my mental state. I assure him that I am holding on okay despite the med drop, all of this taking place in a matter of seconds. He doesn't seem too interested in conversation or questions as the anesthesiologist and a nurse enter bedside. The nurse states my name and the procedure to be done, and everyone present including myself expresses that we are in agreement to initiate the treatment. Then a brown, rubbery, foul-tasting "bite block" is placed in my mouth and the anesthesiologist begins pressing a syringe of propofol into my IV as the nurse holds an oxygen mask over my face. "You will begin feeling sleepy soon" says the anesthesiologist, still squeezing the contents of the syringe into my vein. "I already am" I mumble, my speech impeded by the presence of the bite block as I begin to slip away.
I first noticed the regaining of my conciousness about half an hour later, realizing that the psychiatrist and the machine were both gone. There was an oxygen mask strapped to my face. The nurse beside me told me that I reported earlier in the recovery from the anesthesia "I'm not under, I'm not asleep yet", apparently having thought the procedure had not yet started, although it was already long over.
The nurse also told me I had been "chatty" coming off the anesthesia, which she claimed was a good sign as it indicated less depression than did silence during recovery. After that I was to be known as "Chatty Cathy", not to mistake the fact that my name is not actually Cathy.
So went my first ECT treatment.
Sunday, October 30, 2011
Journal Entry 3
Report: no ECT so far. Because of the bloodthinner Coumadin that I have
to take my treatments have been delayed. I explained in past entries
that on Thursday, which was supposed to have been the day of my first
procedure, my blood wasn't drawn as it was supposed to have been. This
resulted in an unproductive trip down to, and back up from, the ECT
room. Friday was another unsuccessful day since my blood was too thin
for ECT that morning, and again they did not realize this until I was
already being prepped downstairs.
I have learned a little about the procedure from sitting in the section of the hospital where it is performed. I will summarize what I know about the process so far: they wake patients up at around 5:30 AM and we are provided with hospital gowns and our blood pressures are taken. By 6:00 AM we are waiting in seats near the nurses' station wearing our gowns. CNA's come up with wheelchairs, one or two at a time, to transport us down to the second floor. once downstairs other nurses put clips on a fingertip to moniter pulse and oxygen level, and the stickers used with equipment to moniter our hearts during the procedure are placed in three locations on the chest. We each stay in a hospital bed, one among many in a large room and separated from other beds by peach-colored curtains on tracks, which are drawn around one's bed during the actual procedure, and pulled back once the seizure is over and the patient is recovering from anesthesia. Most people sleep until the anesthesia has fully worn off once back at the unit, which usually isn't until about noon.
Tonight is Sunday night, which means ECT will be performed again in the morning. This evening my blood was drawn and my blood levels were good, my blood isn't too thin for ECT. So in the morning I will have my levels checked, and hopefully I will finally have my first ECT by 7:00. I'll try to update on that tomorrow.
I have learned a little about the procedure from sitting in the section of the hospital where it is performed. I will summarize what I know about the process so far: they wake patients up at around 5:30 AM and we are provided with hospital gowns and our blood pressures are taken. By 6:00 AM we are waiting in seats near the nurses' station wearing our gowns. CNA's come up with wheelchairs, one or two at a time, to transport us down to the second floor. once downstairs other nurses put clips on a fingertip to moniter pulse and oxygen level, and the stickers used with equipment to moniter our hearts during the procedure are placed in three locations on the chest. We each stay in a hospital bed, one among many in a large room and separated from other beds by peach-colored curtains on tracks, which are drawn around one's bed during the actual procedure, and pulled back once the seizure is over and the patient is recovering from anesthesia. Most people sleep until the anesthesia has fully worn off once back at the unit, which usually isn't until about noon.
Tonight is Sunday night, which means ECT will be performed again in the morning. This evening my blood was drawn and my blood levels were good, my blood isn't too thin for ECT. So in the morning I will have my levels checked, and hopefully I will finally have my first ECT by 7:00. I'll try to update on that tomorrow.
Thursday, October 27, 2011
Journal Entry 2
Night two of only Celexa and Klonopin PRN. Took the Klonopin tonight but I still have a lot of energy. It's a fun, sporadic energy but very inappropriate for 11 PM. Probably the beginning stages of some sort of hypomania. This was only day one off lithium, and I'm sure some of you Bipolars can relate to this guilt I feel for enjoying what is probably a little manic burst. I just hope ECT kicks in before I get too loopy on these reduced meds.
Now to businss: ECT. I was supposed to get my first treatment this morning, so I didn't eat or drink after midnight as instructed. I was awoken at 5:30 AM and given a hospital gown. By a little after 6:00 I was sitting by the nurses' station, waiting to be transported down to the second floor. Around 6:30 a wheelchair was brought up to transport me to ECT. After taking the elevator, I was pushed through a hallway and through a large room lined with hospital beds, separated by curtains on tracks. This is where the treatments are done, I was put in a hospital bed in a side room while my pulse and blood pressure were taken and my charts, located on a table beside me, were looked over. In the meantime I was offered warm blankets. After maybe twenty minutes I was wheeled into the procedure room where I again waited, then answered some questions from the anesthesiologist. After a while I was told I couldn't have the procedure performed that morning since nobody had done the bloodwork that is required of me pre-op in order to gauge how thin my blood is from the Coumadin I have been on since the discovery of the pulmonary embolism. I apparently need to have blood drawn each morning, they don't want my blood too thin in case I have a vessel "malformation" somewhere which might rupture from the minor convulsions and muscle tensing, which occur during the seizure despite the administered muscle relaxants. I was very disappointed that I couldn't have the procedure performed today, and I wasn't sent back upstairs until after 8:00. Hopefully all goes well tomorrow morning and I am able to report back on the actual ECT procedure. For now I'm going to try to sleep, and tomorrow I will attempt to have my Klonopin increased to counter this bout of persistent energy.
Now to businss: ECT. I was supposed to get my first treatment this morning, so I didn't eat or drink after midnight as instructed. I was awoken at 5:30 AM and given a hospital gown. By a little after 6:00 I was sitting by the nurses' station, waiting to be transported down to the second floor. Around 6:30 a wheelchair was brought up to transport me to ECT. After taking the elevator, I was pushed through a hallway and through a large room lined with hospital beds, separated by curtains on tracks. This is where the treatments are done, I was put in a hospital bed in a side room while my pulse and blood pressure were taken and my charts, located on a table beside me, were looked over. In the meantime I was offered warm blankets. After maybe twenty minutes I was wheeled into the procedure room where I again waited, then answered some questions from the anesthesiologist. After a while I was told I couldn't have the procedure performed that morning since nobody had done the bloodwork that is required of me pre-op in order to gauge how thin my blood is from the Coumadin I have been on since the discovery of the pulmonary embolism. I apparently need to have blood drawn each morning, they don't want my blood too thin in case I have a vessel "malformation" somewhere which might rupture from the minor convulsions and muscle tensing, which occur during the seizure despite the administered muscle relaxants. I was very disappointed that I couldn't have the procedure performed today, and I wasn't sent back upstairs until after 8:00. Hopefully all goes well tomorrow morning and I am able to report back on the actual ECT procedure. For now I'm going to try to sleep, and tomorrow I will attempt to have my Klonopin increased to counter this bout of persistent energy.
Journal Entry 1
It's 4:30 AM and I'm glad I woke up because I haven't written in
several days. All we have here on the ward are the little pencils I
remember using to record scores at the miniature golf course as a
child. Hell, I hate all pencils anyway, unless they're mechanical.
Guess I'm spoiled.
Anyway, they discharged me from the cardiac unit on Monday, but there was no bed available in the "Retreat", the psych hospital voluntary unit where I was supposed to go, so I was kept one more night at the general hospital before being transferred to the psych hospital. When I got here though, there were STILL no beds at the Retreat so I had to stay on the involuntary unit a night.
I'm sure some of you know what it's like in an involuntary section of a mental hospital. It's not fun. I wasn't allowed to have any of my things except for a glasses case, a book, and my clothes (as long as there are no cords in them). They took my knee and ankle supports which I have been relying on since my injury in summer, so I am in pain when I walk.
I was moved up to the Retreat yesterday afternoon. The rules are similar here but I am more at ease. Having my own room, my own shower, having some art on the walls and being around more or less sane people - these things all help.
I did start getting second thoughts yesterday, though. Am I sick enough for this? Then I found out I may have to stay up to twelve treatments, initially I thought six. My dog is not boarded that long and god knows I miss her and my cat and my apartment as well. But two things soothed my mind regarding this decision, the first being my dad's visit. He told me to do what I came to do and that he would take care of my dog and everything else. Then, I went to speak to a psychiatrist for an in-hospital second opinion, which is apparently required. The psychiatrist I spoke with has been performing ECT for many years and was encouraging about the treatment. He told me that I will know whether the ECT is working within two to three treatments and that I can stop whenever I want.
I'm getting my first treatment here in a little over an hour, it's 5 AM and I go down at 6:30. The tech just popped in to take my blood pressure and he said he'll bring up a hospital gown for the procedure. They stopped my lithium last night for some sort of medical clearance for the treatment. I'm scared about that but I guess I won't know whether I am improving unless I have at least some symptoms in the beginning. Hopefully the ECT picks up and starts working before the lithium wears off too much.
Anyway, they discharged me from the cardiac unit on Monday, but there was no bed available in the "Retreat", the psych hospital voluntary unit where I was supposed to go, so I was kept one more night at the general hospital before being transferred to the psych hospital. When I got here though, there were STILL no beds at the Retreat so I had to stay on the involuntary unit a night.
I'm sure some of you know what it's like in an involuntary section of a mental hospital. It's not fun. I wasn't allowed to have any of my things except for a glasses case, a book, and my clothes (as long as there are no cords in them). They took my knee and ankle supports which I have been relying on since my injury in summer, so I am in pain when I walk.
I was moved up to the Retreat yesterday afternoon. The rules are similar here but I am more at ease. Having my own room, my own shower, having some art on the walls and being around more or less sane people - these things all help.
I did start getting second thoughts yesterday, though. Am I sick enough for this? Then I found out I may have to stay up to twelve treatments, initially I thought six. My dog is not boarded that long and god knows I miss her and my cat and my apartment as well. But two things soothed my mind regarding this decision, the first being my dad's visit. He told me to do what I came to do and that he would take care of my dog and everything else. Then, I went to speak to a psychiatrist for an in-hospital second opinion, which is apparently required. The psychiatrist I spoke with has been performing ECT for many years and was encouraging about the treatment. He told me that I will know whether the ECT is working within two to three treatments and that I can stop whenever I want.
I'm getting my first treatment here in a little over an hour, it's 5 AM and I go down at 6:30. The tech just popped in to take my blood pressure and he said he'll bring up a hospital gown for the procedure. They stopped my lithium last night for some sort of medical clearance for the treatment. I'm scared about that but I guess I won't know whether I am improving unless I have at least some symptoms in the beginning. Hopefully the ECT picks up and starts working before the lithium wears off too much.
Friday, October 21, 2011
Unexpected Testing
I am still in the cardiac unit, on this extended field trip away from the Electroconvulsive hospital in which I was orginally hoping to receive treatment for my mental illness. As you may know from reading past posts, during my ECT screening while doing intake at the hospital on Wednesday they found some symptoms I was describing as suspicious and soon detected pulmonary ebolism, bloodclots in my lungs. Its Friday now and they're nowhere near discharging me as far as I can tell. A 22 year old woman without any real obvious causes for this, I think its an abnormal case for the doctors.
I was debating whether to post about this section of my hospitalization since it doesn't directly involve ECT at this point, but I am deciding to stray from a strictly ECT blog for now.
Today is genetic testing, leg ultrasounds, and stomach CT scan.
Thursday, October 20, 2011
Just a Minor Detour
So right now I am in the cardiac unit of a different hospital than the one where I was planning on being, getting shots twice a day in my stomach fat. It's all incredibly glamorous. So, how the hell did I get here?
I went in the ECT hospital yesterday and during the intake screening they took my shortness of breath pretty seriously even though I attributed it as a side effect of my new medication, Fanapt, which can cause that symptom. But the CAT scan disagreed... turns out I have pulmonary embolism - blockages in my lungs, which are most likely bloodclots. Suddenly I am not allowed to walk and bam. ER. Bam. Ambulance. Bam. Cardiac unit at another hospital. They have me on Luvonox shots and I should be on my way to the ECT within a day or two.
I don't know if I'll be able to have my phone after I leave this hospital but if I can, updates will be convenient.
Monday, October 17, 2011
Finally Hopefully
I got word today that the doctor's office finally has everything in to my insurance company and we may hear back as soon as tomorrow. Judging from my past experience with this office, albeit limited, they may want me in the hospital tomorrow if we get the "okay". But I am really not sure yet. I would love to use this post to go over the history and development of ECT as I had planned, but my eyelids are currently gravitating downwards due to the bedtime medication I took earlier (I'm sure plenty of you understand this dilemma). I still hope to do this before going into the hospital, but we will see what tomorrow holds.
Friday, October 14, 2011
The ECT Procedure and its Stigma
One Flew Over the Cuckoo's Nest. A Clockwork Orange. Images of dilapidated hallways, cold medical personnel, trembling patients. The worn leather restraints are secured, wires and entangled qith the patient and then screaming and convulsions, bones breaking against the pressure exerted against the restraints. To some extent this was accurate, very high currents were passed through patients while they were awake, and yes sometimes bones were broken against the restraints. These images fitfully barrage peoples' minds at the mention of ECT. But those days are long gone, and let me update your knowledge on the topic.
First, these days the patient is not concious during the procedure, a shortlived general anesthesia is administered. The amount of electricity used has been reduced so that it is now only slightly above the individual's seizure threshold. The patient no longer has an active seizure during the procedures as muscle relaxants are administered. The muscle relaxants are cut off from accessing a single hand and the practitioner uses the seizure activity in that hand to moniter that there is successful seizure activity in the patient. Extra oxygen is supplied to help protect against brain cell death, and the patient is hooked up to an EKG heart moniter to ensure safety of the heart. I believe an EEG, which measures electrical activity in your brain, is used as well.
More to come later.
First, these days the patient is not concious during the procedure, a shortlived general anesthesia is administered. The amount of electricity used has been reduced so that it is now only slightly above the individual's seizure threshold. The patient no longer has an active seizure during the procedures as muscle relaxants are administered. The muscle relaxants are cut off from accessing a single hand and the practitioner uses the seizure activity in that hand to moniter that there is successful seizure activity in the patient. Extra oxygen is supplied to help protect against brain cell death, and the patient is hooked up to an EKG heart moniter to ensure safety of the heart. I believe an EEG, which measures electrical activity in your brain, is used as well.
More to come later.
Thursday, October 13, 2011
Depression and the Wait for ECT
I am still waiting for news of clearance from my insurance company for ECT. I hope I hear something tomorrow, I'd like to go in the hospital Friday and get medical clearance over the weekend so I can begin treament on Monday. In the meantime I am suffering through a seemingly unsuccessful med switch. I think in this post I will give a sort of summary of this mental condition of mine that has lead me to this point, the point of embracing an opportunity for such a stigmatized treatment. I will try to go over the subject of the stigma carried by ECT, and maybe its history, in a subsequent post. But for now, I present the situation which has led this particular individual to seek ECT.
I think I should begin with a rundown on the history of this battle with myself and my faulty mind. I am doing this to provide you with an idea of how one apparently ECT-qualifying background looks.
What would over time become a barrage of conflicting diagnoses had humble enough beginnings. At the age of eleven I found myself suffering through an escalating cycle of abuse in my family while I was homeschooled, and I will admit that my oftentimes rebellious reactions didn't bring much relief to the situations. Upon entering private school I found few friends and the interactions that carried the greatest emotional impact were those degrading exchanges I had with "bully types". Eventually I landed in a shrinks office, I cried for the duration of the visit and left with a diagnosis of Major Depression and a bottle of Prozac which I was practically force-fed with threats of institutions and medication-laden IVs.
I was eleven.
Being that I am now twenty-two, eleven years have passed since my initiation into the crazy club. In those years I have accumulated quite the rap sheet; mostly psychiatric, although admittedly the disorder has at times contributed to criminal activity. I have gone through an extensive list of diagnoses, each one causing substantial distress as with each new label I had to redefine my self-image, accompanied by that plaguing, ever-lingering question so many of us are undoubtedy familiar with, "am I crazy?"
The first few years after my diagnosis I fought the medicine and my need for it. However, at about the age of 17 I began to weigh my life during the short bouts away from medicine against the life I was able to experience on an effective medication regimine. I began actively participting in my treatment and complying with my psychiatrist's suggestions. I only wish that was my formula for a happily ever after like it apparently can be to a number of people. But not me.
Despite my best efforts, I have been involuntarily hospitalized several times, once at the state mental hospital following an arrest for violent behavior that took place during a high stress hypomanic episode which occurred during a doctor ordered medswitch. The medications, although they do help, are insufficient and unreliable in my case. The side effects have been rough on my body, and I know in my heart that the depression never stops looming and medications cannot keep it at bay forever. Sooner or later I will sink, and when I sink I go blind to life and to hope and cannot find my way out and my only option is death. Add to this the fact that over the years that my suicide fantasies -when I do have them- have grown more attainable.
All of these things were stressed in my ECT consultation, and they apparently are adequate qualifications. So now I am waiting, and it is a very long wait for me. I feel like my life is hingeing on this.
I think I should begin with a rundown on the history of this battle with myself and my faulty mind. I am doing this to provide you with an idea of how one apparently ECT-qualifying background looks.
What would over time become a barrage of conflicting diagnoses had humble enough beginnings. At the age of eleven I found myself suffering through an escalating cycle of abuse in my family while I was homeschooled, and I will admit that my oftentimes rebellious reactions didn't bring much relief to the situations. Upon entering private school I found few friends and the interactions that carried the greatest emotional impact were those degrading exchanges I had with "bully types". Eventually I landed in a shrinks office, I cried for the duration of the visit and left with a diagnosis of Major Depression and a bottle of Prozac which I was practically force-fed with threats of institutions and medication-laden IVs.
I was eleven.
Being that I am now twenty-two, eleven years have passed since my initiation into the crazy club. In those years I have accumulated quite the rap sheet; mostly psychiatric, although admittedly the disorder has at times contributed to criminal activity. I have gone through an extensive list of diagnoses, each one causing substantial distress as with each new label I had to redefine my self-image, accompanied by that plaguing, ever-lingering question so many of us are undoubtedy familiar with, "am I crazy?"
The first few years after my diagnosis I fought the medicine and my need for it. However, at about the age of 17 I began to weigh my life during the short bouts away from medicine against the life I was able to experience on an effective medication regimine. I began actively participting in my treatment and complying with my psychiatrist's suggestions. I only wish that was my formula for a happily ever after like it apparently can be to a number of people. But not me.
Despite my best efforts, I have been involuntarily hospitalized several times, once at the state mental hospital following an arrest for violent behavior that took place during a high stress hypomanic episode which occurred during a doctor ordered medswitch. The medications, although they do help, are insufficient and unreliable in my case. The side effects have been rough on my body, and I know in my heart that the depression never stops looming and medications cannot keep it at bay forever. Sooner or later I will sink, and when I sink I go blind to life and to hope and cannot find my way out and my only option is death. Add to this the fact that over the years that my suicide fantasies -when I do have them- have grown more attainable.
All of these things were stressed in my ECT consultation, and they apparently are adequate qualifications. So now I am waiting, and it is a very long wait for me. I feel like my life is hingeing on this.
Friday, October 7, 2011
From the Beginning
So here I sit, having just gotten off the phone with the office of the practitioner who will be administering my ECT next week. I will be
doing six treatments while inpatient at a hospital located a couple of cities away. We are not sure what day I will be going in, we are waiting on clearance from my insurance company. I am now
prepared, awaiting the "Okay Go" from the ECT doctor. My dog's shots are now up to date for boarding, I have arrangements for a friend to pet-sit my cat. I have transportation set up and some clothes outfits ready. This weekend I will purchase a legal pad, I am not sure in which section of the hospital I will be, but I know on the psychiatric units they would not want me to have the metal wire of a spiral-bound . However, I will have a notebook, because I will be journalling daily updates on the hospital stay, the treatments and my status.
My first step in this direction was a visit with the ECT practitioner, whom I saw a week ago today. Although the hospital in which I Will be staying does take my insurance the doctor himself does not, so I had to pay out of pocket for my visit with him which lasted maybe thirty minutes. The goal of this visit was an approval for the ECT, and I spent quite a bit of time preparing. I made a timeline with pen and highlighter showing the course of my illness, hospitalizations and methods of treatment. I gave him a seperate presentation of this information in list form. I included photos of my anorexia at its worst, stomach caved inbetween my sides, ribs pressing against the skin stretched taut across them. I included photos of my self-injurous cutting from the past, with red thoroughly speckling the carpet behind the mutilated limb. I included every report, evaluation and test I had: neurologist reports, assessments from hospitals and specialists. I also threw in my GED and college intake scores as the arrogantly insecure part of me felt the need to reassure the doctor, and myself, that despite all of these flaws I do have worthwhile attributes that are
also documented on paper.
During the meeting I explained my condition: that although specialists have been unable to agree on a diagnosis for me, what is universally accepted is that I am on the bipolar spectrum, with depression being the most prominent manifestation of my mood disorder. We ran quickly over my traits of personality disorder and childhood abuse, and I reiterated several times that over the last eleven years my condition has deteriorated substantially, despite continual compliance with psychiatrists' medication regimens. Hospitalizations, arrests, suicide attempts... all of these had happened under the care of a doctor. I really have responded poorly to medications, with Depression always looming just under
the surface, bursting out of tranquilly medicated waters to gnaw on my mind, claw my skin, swallow me completely until I am trapped in the black oblivion of its stomach....
And then there's the side effects of the medications which I think have more effects on me than they have the proportedly beneficial effects. Increased hunger, irregular menstrual cycles, heat exhaustion, fluid retention, lactation, libido effects... basically, these meds have been turning me into a fat lump who can't go outside, and my body has basically skipped the whole sex part of reproduction, meds having made it so unappealing, as well as the pregnancy thing and went straight into breastmilk production. Yummy.
Well, apparently the doctor found me crazy enough to warrant the application of the still-controversial ECT. He explained to me that he does bifrontal ECT rather than traditional unilateral or bilateral. He told me that with unilateral the results were unpredictable, that yes there were few side effects but the positive effects were not satisfactory to him. With bifrontal he claims an 80% apparent remission rate, although he was hesitant to use the word remission because as I'm sure we all know, the effects of ECT are not exactly permanent: maintenance treatments must be done and even with those there is a chance of eventual relapse. I do see statistics online as lower then the 80% he quoted me, but either way I am sure I have a good chance of significant improvement at least. I will explain the different types of ECT in a follow-up post.
I am optimistic about this treatment, I am excited about the idea of not needing as much medicine. I hope this blog is useful to youif you are considering ECT or are interested in learning about and understanding the procedure and the people who get such a publicly controversial treatment.
doing six treatments while inpatient at a hospital located a couple of cities away. We are not sure what day I will be going in, we are waiting on clearance from my insurance company. I am now
prepared, awaiting the "Okay Go" from the ECT doctor. My dog's shots are now up to date for boarding, I have arrangements for a friend to pet-sit my cat. I have transportation set up and some clothes outfits ready. This weekend I will purchase a legal pad, I am not sure in which section of the hospital I will be, but I know on the psychiatric units they would not want me to have the metal wire of a spiral-bound . However, I will have a notebook, because I will be journalling daily updates on the hospital stay, the treatments and my status.
My first step in this direction was a visit with the ECT practitioner, whom I saw a week ago today. Although the hospital in which I Will be staying does take my insurance the doctor himself does not, so I had to pay out of pocket for my visit with him which lasted maybe thirty minutes. The goal of this visit was an approval for the ECT, and I spent quite a bit of time preparing. I made a timeline with pen and highlighter showing the course of my illness, hospitalizations and methods of treatment. I gave him a seperate presentation of this information in list form. I included photos of my anorexia at its worst, stomach caved inbetween my sides, ribs pressing against the skin stretched taut across them. I included photos of my self-injurous cutting from the past, with red thoroughly speckling the carpet behind the mutilated limb. I included every report, evaluation and test I had: neurologist reports, assessments from hospitals and specialists. I also threw in my GED and college intake scores as the arrogantly insecure part of me felt the need to reassure the doctor, and myself, that despite all of these flaws I do have worthwhile attributes that are
also documented on paper.
During the meeting I explained my condition: that although specialists have been unable to agree on a diagnosis for me, what is universally accepted is that I am on the bipolar spectrum, with depression being the most prominent manifestation of my mood disorder. We ran quickly over my traits of personality disorder and childhood abuse, and I reiterated several times that over the last eleven years my condition has deteriorated substantially, despite continual compliance with psychiatrists' medication regimens. Hospitalizations, arrests, suicide attempts... all of these had happened under the care of a doctor. I really have responded poorly to medications, with Depression always looming just under
the surface, bursting out of tranquilly medicated waters to gnaw on my mind, claw my skin, swallow me completely until I am trapped in the black oblivion of its stomach....
And then there's the side effects of the medications which I think have more effects on me than they have the proportedly beneficial effects. Increased hunger, irregular menstrual cycles, heat exhaustion, fluid retention, lactation, libido effects... basically, these meds have been turning me into a fat lump who can't go outside, and my body has basically skipped the whole sex part of reproduction, meds having made it so unappealing, as well as the pregnancy thing and went straight into breastmilk production. Yummy.
Well, apparently the doctor found me crazy enough to warrant the application of the still-controversial ECT. He explained to me that he does bifrontal ECT rather than traditional unilateral or bilateral. He told me that with unilateral the results were unpredictable, that yes there were few side effects but the positive effects were not satisfactory to him. With bifrontal he claims an 80% apparent remission rate, although he was hesitant to use the word remission because as I'm sure we all know, the effects of ECT are not exactly permanent: maintenance treatments must be done and even with those there is a chance of eventual relapse. I do see statistics online as lower then the 80% he quoted me, but either way I am sure I have a good chance of significant improvement at least. I will explain the different types of ECT in a follow-up post.
I am optimistic about this treatment, I am excited about the idea of not needing as much medicine. I hope this blog is useful to youif you are considering ECT or are interested in learning about and understanding the procedure and the people who get such a publicly controversial treatment.
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About ECT
Let me explain a little bit about the bifrontal method of electroconvulsive therapy I will be receiving. It is a newer application of electrodes, but the studies I have seen on it do seem promising, although we don't know as much about it since it hasn't had the time to be used long-term or even experience widespread usage.
The Three Types of ECT Currently Available
- Bilateral: I think this was the older electrode placement. In this placement, the electrodes are placed on the temples of the face, one on either side. During the procedure, electricity travels between the two electrodes through the temporal lobes of the brain. This placement has shown to be the most effective, but also carries the highest risk of memory effects. The electricity used is I believe about one-and-a-half times the seizure threshold, the seizure threshold being the amount of electricity required to initiate a seizure.
- Unilateral: Pretty sure this one is newer than bilateral. In this form of ECT, two electrodes are placed on the same side of the head, on the temple. This way there is no electric circuit travelling across the brain, but is instead limited to one side of the brain, I assume this one is effecting the temporal lobe as well. Although this placement is effecting a smaller portion of the brain, it is done at a minimum of six times the seizure threshold of the individual. Although the cognitive and memory effects have been shown to be significantly lower than the bilateral placement, the effectiveness unfortunately is noteably lower as well.
- Bifrontal: This is the newest placement. During this procedure the electrodes are place on either side of the front of the forehead and I believe the amount of electrical current used is similar to that in bilateral. The point of this placement is to avoid running current through the temporal lobes all together, which are attributed substantially to memory. Indeed, the effeated that bifrontal may carry more weight in side effects of a cognitive rather than memory nature. Time will tell, I suppctiveness of this placement is nearly comparable to bilateral with a lower memory side effect profile, however one has to wonder about cognitive effects instead, since the frontal lobes are attributed to cognitive functioning. It has been speculose.
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