An Apology

So, ECT ended up ultimately being ineffective for me. I got disheartened and lost motivation to post the entries from my hospital visit, but after seeing the interest some have shown to reading about my experience I feel it would be beneficial to post my entries. And so, here follows my first journal entry while I was at the psychiatric hospital. I will try to post an entry a night.

Update: Those Mysterious Emboli

I think the title of this post is more interesting than the post itself. Anyways, I know I posted during my little drama of my detour I had to take prior to ECT in order to treat bloodclots in my lungs. Nobody could give me a clear answer on what caused the bloodclots, oral contraceptives were the prime suspect but even with them I was not part of a particularly high-risk group. Genetic testing was ordered.

I recently got the results, and it turned out I have something called a Factor 5 Leiden genetic mutation that causes my blood to hypercoagulate. It's something about communication via amino acids (?) and somehow my body has faulty communication with itself in regards to regulating the coagulation of my blood. It is believed that somewhere between 3 to 8 percent of people of European descent have the disorder, it is lower in other races. Being caucasian, I feel like this is almost like my race's version of sickle cell anemia or something.

A lot of people with the genetic mutation don't suffer ill effects from it, but 10% of us develop abnormal bloodclots, and the chances of a bloodclot dislodging and relocating to a more dangerous area is higher in us, too. Because I have already had bloodclots (pulmonary emboli) from this disorder when I wasn't otherwise a particularly at-risk person, I will have to continue the coumidin until further notice. So long, new tattoo ideas and cool piercings I want. At least for now.

Out and About

Yesterday I received the last of five inpatient ECTs, and I was released yesterday afternoon. The doctor wants seven more done outpatient, I am set to return to the hospital for the next treatment on Thursday, assuming I get the okay from my insurance company by then. I plan on posting several journal entries from my stay at the hospital, detailing ECT among other observations. The procedures were done with bifrontal electrode placement, using a machine that output 101.4 joules for four seconds and the treatment was administered four times a week: Monday, Tuesday, Thursday, Friday. The ECT was done early in the morning. I was taken off of 1500mg of lithium and am now only on 40mg of Celexa and 50mg of Seroquel, which is a low dose. I'm noticing an appetite decrease, assumably due to the change in/reduction of medication. My mind feels less prone to falling into negative thought cycles and my mood is stable, less irritable and flighty than before.

Upon my discharge from the hospital yesterday following until this afternoon I experienced a bit of a trance-like state, possibly psychological as I was animated and alert in the hospital. Upon arriving home I found things to feel possibly more unfamiliar than three weeks away might be suspected of causing. Even my cat and dog felt rather foreign and strange at first.

These are just my initial thoughts upon my release and I will continue to update my blog, both with the aforementioned inpatient journal entries as well as with upcoming notes on the progress of the treatment.

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.

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.

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.