Making our way through the questions on ECT – Top 3 Reasons for Being an Advocate

  1. How do you address the issue of cognitive and memory impairments?
  2. What are your top 3 reasons for being an advocate for ECT?
  3. What are the differences between ‘old’ ECT and ‘modern’ ECT?

fancy

Ooh La La!

So much fun to play dress up! When I was a scrub, a solid big boned unkempt of the Cleveland National Forest bordered lemon groves, when I walked barefoot, disappeared for the entire day in the rattlesnake infested chaparral, when I followed my brothers around like a desperate child, I still liked to play dress-up. I would sneak into my mother’s long closet, a dressing room really, with folding doors. I could hide behind her dresses, or climb up onto her shelves and be nothing more than luggage. But mostly I remember staring at her clothes and shoes. I remember one of her all time best outfits – a blue knit bell-bottomed jumper. A wide white belt with a hand-made gold buckle was an excellent accent. Yes, it would drag down below, but all the better to cover my brown feet.

When I think of my top three reasons for being an advocate for ECT, I think of dress-up. There are so many great options to put on, and I can and do exchange them with aplomb, as Fancy Nancy would say. That’s a French word for poise. It’s fancy. If you catch sight of my brown feet here and there, well, you can’t take the hills out of the psychiatrist I guess.

For today, Reason Numero Uno, (Fancy for #1, in honor of the second language I wanna-be speak):

  • It works most consistently, and most quickly of any treatment available. One must pick her fights after all, mustn’t she?

Reason Ithnān, (Arabic for two, in honor of my fancy mother):

  • It doesn’t touch “the body,” i.e. metabolics. Clean.

Reason Trois, pronounced I think like, twa, (Fancy Nancy’s favorite language. Need anyone explain? “French is fancy”):

For example, just by requiring someone to help with transportation, it’s built in. That thereby inherently increases community awareness of mental illness, something we rarely speak of with each other.

Then there is the medical staff. Our nurses are every patient’s advocate. Our masseuse increases oxytocin and other healing neurotransmitters when the patient’s get their massage waiting for treatment and then when in recovery. Our anesthesiologists are knowledgable, see the patient in their “whole person,” often picking up other issues that then will get the patient to receive treatment and improve the patient’s quality of life (QOL); such as hypertension, obstructive sleep apnea, etc…

There’s more, but basically in ECT, none of our patient’s are alone. That stands.

Question: What are the top three reasons you prefer the treatments you engage in? 

Self-care Tip: It is always helpful to write out why you are doing what you are doing, when it comes to medical treatments.

Making our way through the questions of ECT – Memory Loss

  1. How do you address the issue of cognitive and memory impairments?
  2. What are your top 3 reasons for being an advocate for ECT?
  3. What are the differences between ‘old’ ECT and ‘modern’ ECT?

memory loss

1. Cognitive and memory impairments:

There is no brain damage done with ECT. One way to understand the memory loss is with our own not so fond memory of carbon paper and credit card receipts. It’s not too ago that we made manual credit card receipts. We used, what was essentially, a machine that held the card in place, while we rolled over a two-part receipt, including one surfaced with ink. When rolling over the card, the ink pressed into adjacent paper the outline of the card face.

Inevitably, whenever I had one such interaction, the carbon paper was used up. There would be little patches of ink left on it, but in all the wrong places. People would try to move the carbon paper around to maximize its usefulness. And we’d roll over it multiple times, using repetition to get a good enough copy, when the carbon-paper had gone almost white. Roll. Roll. Put your weight into it. Roll.

The machine hasn’t changed. The machine isn’t broken or damaged. There just isn’t enough ink on that paper.

This is a rough analogy of what happens in our cells.

When we get new experiences, our cells try to “imprint” those memories into another area of our brain for storage and later use.  We use the intracellular “ink” to do this. However, a seizure dumps that ink, the neurotransmitters, chemical messengers, hormones, ions, and all those good ingredients needed to lay down new memories. It squirts the intracellular ink nearly completely out when we are stimulated, like squeezing a bag.

ECT is a stimulation treatment. It uses electricity to stimulate, toward the effort of healing. There are other stimulation therapies that we have discussed already – magnetic and chemical. Not all stimulation therapies result in a seizure. We don’t know why a seizure is needed for such a dramatic benefit, but so far, in our 80+ years of experience with ECT, it is needed for this magnitude of healing. The seizure is the event that “tips the ink-well.”

Our cells will naturally refill if left alone, after being “tipped over” and emptied. What brings about the memory loss is that in the beginning, in the ECT index trial, we don’t. The proximity of the treatments to each other is more frequent than what will allow for the cells to refill adequately for new memories. We stimulate, Monday, then just as they start to refill, we stimulated again Wednesday. And then again Friday. Then we do it again the next Monday, and so forth.

This is only in the index trial though, the first part of ECT that we do in order to get healing. Once the first 2-4 weeks, approximately, are done, treatment response is achieved, and we progress to a maintenance program of ECT to keep those benefits. Just as with medication therapy, if we stop treatment, if we stop the pills, if we stop the stimulation therapy, often, we will relapse and become ill again.

In maintenance ECT, we treat as infrequently as once a week to once a month or more. By allowing our cells to refill with “ink” between stimulus events, the difficulty imprinting new memories goes away. Those memories of events that happened during the index treatment, (the 2-4 weeks when we first start ECT,) may never come back. But we wouldn’t expect them to, necessarily, because there wasn’t enough ink to imprint them at the time. Like a carbon copy paper without ink on it, no matter how many times we roll over it, mechanically, we don’t have the ability, the ink, the ingredients, or whatever you want to call that stuff needed to save the memory of an experience permanently.

I’m not going to go into the obvious juxtaposition of this with what happens cognitively with brain disease untreated, or with other treatment options toward brain health. I hope you do though. Because there’s so much there and it’s fun, liberating, and increases our personal freedom to choose.  Keep on.

Questions: What do you think about not being able to keep the memories of your life for a brief time? What is the cost benefit ratio to you, when you think about this? Please tell us your story.

Self-care tip: Be as careful as you can in your accounting, book-keeping, of your risk-to-benefit ratio of treatment.

Questions From Someone Important – On ECT

Hi. I was hoping I could ask you a couple questions about ECT for a research paper I am writing.

  1. How do you address the issue of cognitive and memory impairments?
  2. What are your top 3 reasons for being an advocate for ECT?
  3. What are the differences between ‘old’ ECT and ‘modern’ ECT?
My thesis statement is:
Although there are many different treatments for Bipolar Disorder, Electroconvulsive Therapy (ECT) has proven to be the most effective therapy, treating both mania and depression.
Thanks in advance,
Priscilla

Good morning Friends!

What would you answer to Priscilla?  Do you have personal experience with ECT, primary, secondary, etc? Where did your beliefs and attitudes about ECT come from?

Last week I almost lost control of my functions when my patient told me about his sister’s comments.

Frank, my patient, had called up his sister, asking her to help drive him to ECT in the morning. Frank’s sister hadn’t even known Frank was getting ECT. She was alarmed but didn’t say anything until they were in the car together, a California dawn and sleep in their eyes for context.

Is this for real Frank? Where are we really going?

Frank was straight faced in his pragmatic style.

She thought maybe we were either going to doughnuts or the devil.
I don’t want this to sound bad or anything, but you know how people go, like to TJ, Mexico, to get some sort of cancer therapy that makes their skin fall off, that’s what she thought. Or we were going to get the psychiatry equivalent of a coat-hanger abortion in someone’s garage.
Don’t judge me for peeing a little.

One of my secretly favorite comedians, Amy Schumer, has a way of taking the worst negative biases in our community and denuding them w/o remorse. She did this with “rape.” The internet exploded that, demonstrating that sure enough, our community doesn’t get it. We don’t understand what rape is!

Then Schumer did it again with women. The idea is that we lose value because of age. Sure enough, the world started talking. For example, a few someone’s noticed when Maggie Gyllenhall was told she was too old, at 37, to get the role of a 55 year-old man’s girlfriend.

I wish Schumer would do a skit on electroconvulsive therapy, (“ECT.”) I wonder what she’d play with. Because there is awesome material there!

First introduction to ECT, some people wonder where the leather straps are. Dr. Schumer, in her white coat would say, “Oops! I forgot them at home.”

And what do you wear in an operating room, really? Scrubs for spine surgery. Scrubs for gastrointestinal procedures. And psychiatry?

Dr. Schumer, psychiatrist: “I’m a surgeon!”

Funny how you celebrate things you would otherwise not…”Hey, what a great seizure!” (High fives all around.) Never Say say, “I just push a button.”

Adding to the list of things not to say in the operating room (“OR”):

  • My Bad
  • Who is this?
  • Whoops!
  • I hope this works

ECT patient: “I want to be the placebo guy.” Patient (an older man:) Lifted his head, slightly, after the procedure was over, and asks, “Can I still have children?”

Patient: Being wheeled out of the OR (operating room) on the gurney, she stares up at the ceiling and mutters, “I can see why I need a driver.”two steering wheelsHow do People learn how to drive a gurney?! I just touch the thing and it’s like solid objects appear everywhere. The patients get nervous. One said, “Doctor, there can’t be two steering wheels.”

Dr. Schumer: “I want to reduce staff work load, and since I’ve proven to be an unsafe driver of gurneys… I now control the Tylenol. I am a physician and I hate it when people say that I just ‘push a button.’ They can hardly trust me not to shock myself…. But the Tylenol, the Tylenol is mine!”

Anesthesia: “Versed isn’t really an abused street drug—if you have a good time using it. You don’t remember anything anyway.”

Dr. Schumer: “Yes, I’ve put vaseline on my nipples to help with chaffing.” (Patient: In his ‘twilight’ sleep…we thought, bursts out laughing.) Dr. Schumer: “Yeah, try and not picture your doctor in pasties… It’s not good for your healing.”

Patient to Dr. Schumer: “You’re pretty good at this.” Dr. Schumer:I’ve watched this on the Discovery Channel.” (Then, all of a sudden, she realized “I am not perfect. Such a shame.”) Dr. Schumer: “I really don’t do a whole lot in the OR… In fact, can we just get another gurney in here so that I can lie down?”

Cheap medical service, do you really want that?

Trying to explain, temporary memory loss in ECT

rain gauge

I’m trying to help explain, “Why temporary memory loss in ECT versus loss of memories prior to ECT?” It is “friendly” to understand our treatment options and dispel stigma, starting with “Me.”  Please let me know if this effort is helpful in any way. 🙂

Community opinion of ECT, largely influenced by the media rather than data, has a very hard time believing that the memory loss is of new memories, (or imprinting memory, ) during the course of the index trial; not memories before ECT, not memories after the index trial is done, not memories when maintenance ECT is going on.  

The best way I can explain this, (and this is my own Dr. Q effort,) is that the memory loss is related to mechanical issues, like a cork in a bottle.  Think of a rain gauge, for example.  After it rains, we see on the gauge that it rained 2.3 inches last night.  We uncork it at the bottom, and all the rain water flows out until the rain gauge is empty.  We let the water out. The rain gauge may fill again when it is recorked.

The electrical stimulus and subsequent seizure to a brain cell is like the process of uncorking the rain gauge.  The natural process of the brain is to “recork” after a stimulus, be the stimulus pressure, magnetic, chemical, or in this case, electrical, and let the cell fill back up each time it happens.  The recorking process happens all the time in our brain, (in vitro,) after natural stimuli act upon a cell, be those natural stimuli pressure, magnetic, chemical, electrical, or another.  

ECT is a medical therapy that uses the basic recovery methods of our own physical design and perhaps, this is one of the reasons it is so effective.

Unless the cell has that inside content, it cannot lay down new memories.  The stimulus and stimulus response does not damage the cell.  They empty it. The response is mechanical.

This idea also works to help understand why the memory loss is most often temporary rather than long-term.  The cells replenish between treatments.  It is a cumulative effect, so the closer the treatments are, the more the degree of memory loss.  As the time between treatments increases, the recovery time is so brief, that the patient doesn’t notice memory loss.  The patient is able to imprint memories without difficulty.  The rain gauge, we could say, has its cork in for longer periods of time.

Question:  Have your choices toward treatment ever changed based on dispelling your own stigma?  Has information and greater understanding of your treatment options ever specifically improved your self-care?  Please tell us your story.

Self-Care Tip:  Use information and greater understanding of your treatment options to improve your self-care.  Keep on.

What Are Our Treatment Options in Psychiatry?

choosing

I go through this almost every time I see a new patient.  I often hear that this is all they really wanted, “To know what my options are and that I’m not choosing something way out there.”

First off, most treatments for psychiatric brain illnesses are not done with intention to cure, but rather to restore health and increase quality of life.  Healthy is not the same as disease free.

This applies to all the treatments listed here.

1.  Hospitalization:

Inpatient – 24 hour locked unit, voluntary and involuntary, little psychotherapy, and daily physician care.

Partial Hospital – Day Hospital that runs during business hours such as 9AM-3PM, voluntary only, includes intensive psychotherapy, and weekly physician care.

2.  Counselling/Psychotherapy:

Talk therapy and exercises of various forms.  May be with physician or nonphysician.

3.  Stimulation Therapies, such as:

Deep Brain Stimulation (DBS) requires brain surgery to implant an electrical stimulation device in the specific brain area, controlled by a device implanted in the gut. Effective, but higher risk.  Least time consuming for maintenance care.

Transcranial Magnetic Stimulation (TMS) – The patient sits in a chair with a magnet at the head’s surface that uses magnetism to stimulate the brain for treatment, 1 hour a day, 5 days a week for various weeks, according to the patient’s need and funding.  Few side-effects.  Time consuming.  Not as effective as DBS or ECT but comparable to some medications.

Electroconvulsive Therapy – Uses electricity to stimulate the brain, inducing a short seizure for treatment.  Considered safe and of low risk.  Most effective.  Response is speedy.  Few, and mostly temporary side effects.  Does not enter into the body systems.  Less time consuming.

4.  Medications:

Chemicals for treatment in the form of pills, liquids, injections, patches, powders, vapors, gases – enter into the body systems causing physical side effects that, as with any treatment, must be weighed against the benefits.

Pills – generally taken daily, which is a challenge to treatment compliance, and activate internal conflict and personal stigmas.

Injections – generally done in a clinical setting, bimonthly or monthly.

5.  Aerobic exercise 50+ minutes, 5 days a week.

6.  Sleep hygiene.

7.  Diet

8.  Alternatives – such as over the counter herbals, naturalistic supplements, meditation, spiritual, acupuncture, acupressure, massage, or no treatment.

Questions:  What do you think of your options?  What do you choose?  And why?  Please tell us your story.

Did I miss anything?

Self-Care Tip:  Get informed about your treatment options.

What are you up to?

Image

Hello Friends,

What are you up to?

Lately, I have been working on getting our ECT book done.  I am spending more time with the kids, exercising less, quilting more, and eating tons of fruit as it is always in season and “going to waste” (which guts me to see) around our little property.  I am still listening to tons of books from audible and I think that my portrait would show me anywhere anytime with earbuds in.  It must annoy others. …What was that?

Let us know what you are doing.

Be a friend to yourself.  Keep on.

Tower-of-Babel Syndrome

COMPLETION-OF-THE-TOWER-OF-BABEL-GENESIS-XI9-2-Q6503

From time to time, I hear complaints that someone’s brain illness got better with medications and/or ECT, but just came back when they stopped. This almost always happens when a patient never transitioned to maintenance ECT and/or medication therapy.

I dub this, the Tower-of-Babel Syndrome.  We all suffer from it at some point in life, trying to be like God.  Or maybe a lesser god?  During this Tower-of-Babel Syndrome, after we have paid the price, after we have complied with the many hard tasks, after we have built ourselves up into something glorious, we are cured from illness. Right? Once we stop perceiving it, illness that is, we are closer to God, more like Him/Her, perhaps more perfect, when we feel better and do not need medical care. Little gusts of wind are all it takes to fill our wings and off we go, living life free from disease laden earth.

But this is a mistaken expression of freedom.

The number one reason for relapse is…? You remember.  Treatment noncompliance. Is relapse most often due to life stressors? There are so many. No. All those reasons for why we think we feel what we feel and do what we do, all those forces acting on us from the outside in, they are not the reasons we relapse most often.

There is something like a super-bug growing amongst us who engage in treatment on and off. We do it four or five months out of seven. We skip here and there and do not “over-react” if we do. “They don’t control me, after-all.” We apperceive the situation. We think we, by not being consistent with medical treatment, demonstrate our freedom. We are free when we engage in medical treatment or when we do not. We are free because we are human.

The super-bug in brain illness is a progression of disease process heightened and sharpened by treatment noncompliance. A growing resistance to treatment and an acceleration of our falls, how long it takes for us to drop into a relapse and how hard and far we fall.

Let us work together to take away barriers to consistent treatment.  You may laugh when you hear about the Tower of Babel.  You can laugh.  A bonus.

The Tower-of-Babel Syndrome is familiar to those of us who stop any variety of medical treatments on our own, excluding our treatment team members, (such as our physician, Wink! Wink!) in our decision to end treatment.

By stopping medical treatment, many of us have this sense of eliminating the reason we started in the first place.  Take treatment.  Disease continues.  Stop treatment.  We are superior.

When my son was about one year old, he learned that if he turned his head away from you, it was as good as denying your existence.  Turn.  You are gone.  Turn back.  You reappear.  Turn.  And just like that, you have been eliminated.  Even now, remembering it delights me.

Not so cute however, is disease relapse.  Maintenance ECT and/or medication therapy has a protective effect on the brain, prophylactic against further insult. It does not increase the distance between Me and God.  It does not increase a mislabeled dependency on treatment.  Maintenance therapy is part of our life journey.  It is part of our ability to be present with ourselves.  It is friendly.

Questions:  What keeps you in treatment?  Do you feel more diseased when taking maintenance therapy?  How do you manage that?  Please tell us your story.

Self-Care Tip:  Stay in maintenance therapy.