A Time For Discovery...

I'm back!  It's been months since I last blogged and I decided it was high time I got back to it.  These past few months have been tough.  This year, as a whole, has been the most difficult year of my life.  

After much deliberation and discussion, I decided not to continue with ECT treatments and had my last one in July.  The cognitive effects and the impact on my memory had become too much for me and the benefits of the treatment no longer outweighed what I felt I was losing.  Although I was seeing some positive results from ECT, it became obvious that I would have to have the treatments very frequently to continue to see the level of success that we wanted with the ECT.  However, to have the treatments so close together greatly impaired my cognitive functioning and left me not at all myself.  We had a very scary situation in May (that I have no recollection of), when I was "not myself", couldn't take care of myself, would only communicate with Kyle by shaking my head, and often could not communicate at all.  Brain scans, a spinal tap and many other tests were conducted but none showed a reason for my experience.

I had over 50 ECT treatments.  Because of my experience with the side effects of ECT, I wish I had never had it.  But if anyone asked me whether he or she should try it, I would encourage that person to carefully research it, weigh the pros and cons, and consult professionals regarding the specific situation he or she has, just as I did.  ECT has been very successful for so many people, and my specific reaction to it was not "normal".  The doctor that administered my ECT, the anesthesiologist, and the entire staff was phenomenal.  They took such good care of me, tried to minimize any discomfort as much as possible, and made me feel like my well-being was their first priority.  I couldn't have asked for better care.  In my specific situation, it just didn't work out.  But it has for so many!

After stopping treatment, I sank into a deep depression for several months and am just now beginning to make my way out of the darkness.  And it feels so good to start to see the darkness slowly turn to dawn. As much as I want there to be, there is no single solution for me.  I take antidepressants and medications for anxiety.  I see my therapist.  I have an amazing, supportive husband who loves me the way I am.  And I'm finding that walking four times a week for 3 to 4 miles each time is a terrific way to clear my head, breathe fresh air and give me a boost of energy.  Next on the list is to address my chaotic eating and set some goals for better nutrition.  But taking it one change at a time has proven to be far more achievable for me than trying to do everything and be everything at once.
  
This has been a year of hope, disappointment, grief, anger, frustration, humility, and so much more.  I've lost my identity, and at first that was terrifying, confusing, and discouraging.  Re-establishing that seemed a daunting and unachievable task when I was so deeply depressed.  Frankly, I didn't care to undertake that task.  I just wanted to curl up in a ball forever.  But as the fog started to lift, my therapist and I had a discussion about how to look at the situation another way.  Perhaps, just perhaps, I could possibly get excited about the chance to "start over".  Maybe it is not just time to mourn what I have lost, but also a time to begin to discover what makes me me.  How many people get the chance to completely re-evaluate what composes them?  I have an opportunity to rethink who I am, what makes me whole, who makes me whole, what I desire, and where I want all of that to take me.  Yes, all that is a bit daunting, but it is also a huge gift.  

The day after that conversation that gave me a faint whisper of hope, I was taking a walk and I encountered this perfect little caterpillar.  I couldn't help but believe that it was a nudge of encouragement from the Universe acknowledging that, difficult as it might be, undertaking the task at hand would be worth it.  A caterpillar holds such promise of beautiful things to come.  Maybe my life does, too.         


 

When Anger Bubbles Up...

I used to think that some feelings were "bad".  Anger was one of them.  I didn't think that it was okay to get angry, and I thought I wasn't supposed to be angry, every.  Now I believe that feelings aren't bad at all, it's simply what one does with them.  

Yesterday, when journaling, I realized how much anger was bubbling up inside me lately.  An older version of me would have deemed it "wrong" to be angry, and I would have felt that I needed to get rid of that anger immediately, or at least found a way to hide it and keep it a secret.  An older version of me would never have admitted to being angry, let alone blogged about it.  

I try to be a positive person and look for the best in everything, but my blog is entitled "The Way I Am", and sometimes, I am angry.  Once I realized that I was angry yesterday, I started journaling about the why.  It wasn't hard to figure out.  I feel angry that I don't feel like myself lately.  I'm angry that I am no longer permitted to drive, indefinitely.  I'm angry that I feel that I have lost my independence. I'm angry that ECT has helped my depression tremendously, but comes with disadvantages, too.  I'm angry that my memory has been dramatically changed.  I'm angry that most of the issues that I'm angry about are beyond my control.  

I'm a bit of a control-freak and a perfectionist.  A lot of life is beyond my control.  A lot of my current life is certainly not perfect.  It's easy to understand why I might feel a little angry right now.  Now I just have to figure out what to do with it.  

I've downloaded a meditation application to my phone that I'm going to try later today.  I've continued to do some journaling.  I saw my therapist yesterday.  I've talked about some of this with Kyle.  I have my little Pip and Dobby in my lap who provide me tremendous comfort.  I'm trying to stay away from the package of cookies in the cupboard.  What positive ways do you find to cope with anger?

Where Did Roxann Go?

I haven't complained much about any of the downsides of ECT because, frankly, it's saving my life.  Maybe that sounds overly dramatic to say, but when I think about the depression I had sunk into in late January, and the desperation I was feeling by the time I checked into the hospital then, saying ECT is life-saving is a fair assessment.  Those who know me best all agree that I look and sound better than I have in months if not years.  ECT is doing for me what a variety of other treatments could not.   

It does have its drawbacks, though, and try as I might to overlook them or to focus on the many benefits I'm getting out of ECT instead of the difficulties, sometimes I get discouraged and I feel aggravated, annoyed and saddened by the inconveniences, the challenges, the hardships, and the aspects of my life that it makes harder at the same time that it's saving it.

One of the hardest aspects lately is that I don't feel like myself and I keep wondering where my sense of self went.  A big part of this is because my memory is so deeply affected by ECT.  Not long term, deeply planted memories, but shorter term stuff.  I remember my wedding day, or more importantly who my husband is.  I remember the education I received in college (both undergrad and graduate level).  I know how to find my way to my house.  But a great deal of memories are completely obliterated, and many more are sliding away quickly.  I have no recollection of seeing the Grand Canyon, though I remember being in the helicopter above it.  Sometimes I can't think about how to get somewhere; for example, from my house to Walmart or from my house to a Dr.'s office and I have to Google directions.  Numbers that I used to easily dial from memory on my phone now have to be looked up.  Sometimes a name sounds familiar but I can't remember my connection to it.  Dinner last night?  No idea.  Have I eaten at that restaurant before?  I may or may not remember, even if it was yesterday.  I have forgotten many of the movies I've seen either just once or even several times.  This isn't necessarily bad because we just watch them again, but it's just a little unsettling to know I watched Skyfall at the theater less than four months ago and I don't remember a moment of it when rewatching it this week.  

I've lost interest in doing much of the many activities I used to enjoy including scrapbooking, taking photos, journaling, cleaning (yes, cleaning!), organizing, household projects, shopping, reading and writing.  I still do some of these activities to some degree, but I don't get the enjoyment out of them that I used to.  Part of the lack of enjoyment comes from the fact that it's harder for me to do them.  Whereas once they came to me so naturally that they just seemed to occur, their completion now requires a great deal of effort on my part.  Also, as odd as this might sound, sometimes I feel like I just don't know how to do some of the tasks required to complete these activities.  ECT brings with it cognitive difficulties, and so I've forgotten the necessary steps to do some of these small tasks and then I get frustrated and I give up on doing them at all because I feel like a failure or I feel like I won't do them right or can't do them right. 

Something that goes along with this is that I can't remember where I put or how I organized a great deal of the household and I get frustrated trying to remember where things are.  Also, when I was in the hospital for two weeks, and as I've been recovering over the following few months, Kyle has stepped in and done many of the tasks and chores that I used to do.  He naturally does them differently than me, stores items differently than me, and places household items in different locations than me, so sometimes even if I remember where I used to put it, it might not be there when I look. 

Whereas I used to have a pretty strong sense of "this is who I am", lately I struggle with this.  I try to keep a positive outlook and remember that this is an opportunity I get to redefine myself, rather than a negative.  But it's a little scary, a bit daunting, and a lot lonely.  I remember thinking to myself last week that I was watching an unhealthy amount of NCIS on DVD.  But when I thought about why I might be doing so, it actually made sense to me.  The old Roxann rarely watched TV, especially in the daytime.  She'd be blogging or journaling or looking through magazines, scrapbooking, finding a new project around the house, etc.  But the right-now-Roxann didn't want to do any of those things, and the only sense of familiarity was that of the characters and the storylines of the NCIS episodes.  I know the characters inside and out.  I've seen all the episodes at least once, some 2 or 3 or 4 times.  So NCIS was very comforting when so many other aspects of my life have become unfamiliar, foreign or sometimes even a sad reminder of what used to be but is no longer.  

Even these small realizations about myself help me figure out who I am right now, and where I might be going or should be going.  It's probably not something I'm going to figure out this week or even this month, and it's something that is probably going to be in flux for awhile.  I drive myself a little crazy with it because I'm a person that likes a place for everything and everything in its place.  I want to know what my place in the world is so I can be working towards that. 

But for now, perhaps my place is just to get well. 

Then there will be loads of potential for a new place to develop.

I'm in Love with Three Men...

Actually, two of them could hardly be considered men, but they are of the male persuasion.

Maybe you can see why it's hard not to fall in love...

 The third fella I'm in love with looks something like this.

It's this guy I want to talk about today.  You see, there aren't enough words in blog-dom for me to express:

• how proud I am of him
• how much I love him
• how loved back I feel by him

But I will try.

Kyle and I have been married almost seven years and have known each other almost eight.  I've never known Kyle to say a mean word to anyone, and he's always the first one to volunteer to help someone or assist with a project.  He's always the one who gets asked to help with those kinds of big projects, too, probably because he's the kind of guy who people know they can depend on to help them.  This applies to coworkers, family members, people broke down along the highway, or just about any person on the planet.  Almost no one is excluded.   Kyle helps just about anyone he can.

My all-time favorite pic of Kyle and Pip

Kyle has a huge heart.  He hates to see anyone get hurt.  Especially those who are defenseless, such as small animals and children. As you can imagine, "discipline" is a loose term around here when it comes to the dogs.  Kyle has a hard time putting his foot down when it comes to Pip or Dobby.  They tend to get away with a great deal.  But I'm not a whole lot better, so I can't say much.  Kyle is great with the pets and he is great with little kids.  

Kyle has definitely lived up to his vow to love me through sickness and health and he has taken care of me through sickness, too.  And not only has he done those things, but he hasn't held it against me or resented me for it, either.  When Kyle and I first began dating I was honest with him about my previous mental health hospitalizations, my history with mental illness and what I was currently experiencing with it.  I didn't want him to have any surprises there, and he took it all in stride.  I expected it to scare him away, but nothing seemed to scare Kyle away, and he persisted in appearing interested in dating me.  Before long I was just as smitten with this new guy as he seemed to be with me.  We lived hours apart, so we were emailing and calling all the time getting to know each other. 

One of the benefits of Kyle and me having a long distance relationship through the majority of our courtship is that we had some really long conversations and got to know each other, I felt, really well.  My first phone bill gave me a near heart attack, but we made some changes to the phone plan after that and billing improved.  I have never liked talking on the phone, but for Kyle, I made exceptions, and we talked sometimes four hours a night.  Looking back on what was my senior year of undergraduate school, I don't know how I got any studying done, because I was always on the phone with Kyle.  But on the plus side, I got to know his mind and heart so well, and that has served me so well as his wife. 

I adore his sense of humor.  It's quiet, sweet, fun.  Like this picture below.  This isn't something he would actually ever really buy, which is why I found it so funny for him to be holding it. 

He's a total goofball when it's just the two of us.  Those are my favorite moments together.  Those are also my favorite moments of being alive.  How special is it to be that person that someone will be themselves with?  I love that Kyle will show that side of himself with me.  

 
Monday of this week Kyle interviewed for a new job as a Real Estate Transaction Specialist with the Wyoming Office of State Lands and Investments.  He was later offered the position and after some soul searching and a family meeting he decided to accept it  He's excited for a new challenge, a chance to have some supervisory experience, and it means he will be home more with me and on the road traveling less.  What a compliment to hear your spouse say he'd rather be home with you than out on the road!  I am so excited for him to begin this new chapter, to have less stress and to be home more. I'm so proud of him for the 13 years of very hard work he's put in at the Wyoming Department of Transportation.  

But it's so much more than that.  At the end of January I was hospitalized for depression for two weeks.  Kyle continued to work full time and do some travel for that job.  But he also visited me at the hospital and called me frequently to check on me when he couldn't visit.  Then I made the life altering decision to do electroconvulsive therapy (ECT) treatments, and Kyle fully supported that decision.  This meant that Kyle would have to make some serious adjustments to his work schedule.  He didn't bat an eye, filled out FMLA (family medical leave act) paperwork, and regularly showed up for my medical appointments while I was still inpatient.  Mind you, I was hospitalized two hours from our home, so this wasn't the easiest for him to do.  Although I was still inpatient for my first ECT treatment, I was scared out of my wits, so Kyle arranged to come to the hospital for it (even though he couldn't be with me for the actual treatment).  I was away from him for about two hours from start to finish for the ECT.  So even though Kyle came to support me, I was away from him and it's a lot of sitting around and waiting on his part.  Then, when I came out, I was still groggy from anesthesia, so I often slept a lot when we were back together.  But he came back to my hospital room and sat beside my bed for hours and just held my hand until he had to go.  

Upon my release from the hospital, Kyle had to promise my doctors that he wouldn't leave me alone at all and that he would drive me anywhere I needed to go.  So Kyle had to take sick leave from work to basically take care of me as if I were a child.  This lasted two to three weeks.  He filled my prescriptions, measured them into my med organizer and wrote down any side effects I was having or questions we had for the next appointment.  He coordinated everything with Dr. Fisher, my ECT specialist, and wrote down my instructions.  Kyle was basically an extension of myself for myself.  He joked with me and kept it light when it could have gotten dark.  He has to put up with me asking the same questions repeatedly.  And he's super patient.  
 
A dear family friend told me he couldn't tell me how proud he was of Kyle, that "Kyle is the ultimate help-mate".  He captured it so so perfectly.   When I left teaching and then work altogether to focus on getting better, Kyle supported me and gave me opportunity to do what I needed to do to get better and be a healthier person.  He didn't berate me or make me feel like a lesser person for the money I wouldn't be earning.  

Kyle's new job opportunity at State Lands has financial repercussions for us.  Leaving his current position and taking this new one meant a substantial pay cut.  Sure, that stinks.  But there are so many other more important aspects of our life that warrant consideration as well, and I'm very glad that I am married to someone who considers all of them, and not just the $ signs on the paycheck at the end of the month.  I think this job will make Kyle happier, and a happier man will be healthier.  A healthier man will live longer, meaning my husband will live longer. 

Kyle has fully supported me, in everything I have needed, wanted or tried to do since we meet.  And yet, he doesn't treat me as anything less than a complete and equal partner in our marriage.  What could have reduced me in his eyes; what could have somehow made me seem far less than his equal has somehow brought us so close together.  Each day I see the strength in our love and am so grateful for this man who brings me such immense joy and happiness.  

Most little girls dream of their wedding days.  They fantasize about Mr. Right, Prince Charming and Happily Ever After.  I never did, because I truly never saw myself married when I was growing up, but it's just as well, because nothing would have measured up to this. 

 

On a final note, before anyone leaves me a mean comment saying that my blog isn't realistic or anything along those lines, I'm not saying our marriage is perfect, nor is either one of us.  We get frustrated with each other and with circumstances.  But I'm saying with the big issues, and when circumstances really matter, we take the time to listen and to hear.  A quote in my planner that I love this week says, "A successful marriage is not a gift; it is an achievement." ~Ann Landers

A Little Bit About My World Lately...

I have a severe lack of pictures lately.  I am not sure why that is, but I will try to remedy it.  

It's very hard for me to write these days.  The ECT treatments that I continue to have weekly affect my memory and cognitive abilities dramatically, but the payoff of the dramatic affect they have also had on my mood is, for me, well worth it.  It has not been easy at all, but it has been quite humorous at times, too.  Kyle and I have a good laugh over my absurdity and ignorance many times. I'm learning to leave myself very detailed notes and post-it notes are becoming my very best friends.  Bear with my writing - it's a little off and requires a lot of me looking up words in the dictionary and thesaurus to get a blog written these days.  But I'm determined to get back to my old self, especially once these treatments end.

I adore the television series NCIS, and we own every season of it on DVD.  Kyle and I have watched them all, but the ECT obliterated many details of the series from my memory, so we are enjoying watching several of the episodes again.  It's like the first time all over again for many of my favorite episodes! Such fun!

Kyle and I were in a fairly serious car accident Sunday and to be honest, it's made me a bit gun-shy about driving lately.  No one was hurt, thankfully.  The other driver was cited, but we are still waiting to hear whether she has valid insurance.  If she doesn't, our insurance - Allstate, will cover us for a deductible, so we're covered one way or another, but I still hope that in the end hers comes through and our Escape is repaired without costing us.  We were taking Kyle's father out to dinner, headed down Dell Range at about 40 mph, the speed limit.  A woman turned in front of us, the oncoming traffic, and though Kyle tried valiantly to slam on the brakes, he couldn't keep from hitting her.  Because Kyle's Dad is hard of hearing I always have him sit in the seat next to Kyle so they can chat and so he can hear Kyle more easily.  Because I am so short and because I was in the backseat, I didn't have even a hint of what was about to happen, and the accident took me by total surprise.  Shocked me, would be more accurate, and as my dad joked, isn't the kind of shock therapy I am accustomed to.  The glasses flew off of Kyle's face and he couldn't find them, nor could he open his door (due to the damage) to step out and look for them.  Once I had myself pulled together, I got out of the Escape and jerked a very damaged driver door open.  I felt around on the floor and found Kyle's glasses and handed them to him.  He was very rattled. 

"Baby, we're all okay.  Everybody is okay.  It wasn't your fault."  I had my hands on both sides of his face, reassuring him that everything and everyone was okay and that we knew that he had done his best to keep us from getting hurt.  Fortunately there had been four witnesses; one of whom was already on the phone with the police.  They all stayed until the police got there.  We wanted to drive our Escape home but the police said it was too damaged for that and would have to be towed, so he dispatched a wrecker.  My sister-in-law came and picked my father-in-law, Kyle and me up and took us back to my father-in-law's house.  

During the earlier phases of my ECT treatment I was not permitted to drive.  This is not unusual.  To quote the guidelines:  "You may NOT drive a car during the entire course of the ECT treatment phase.  You must have a release from your ECT doctor to begin driving again.  This will be considered 2 weeks following the completion of ECT or when your response to maintenance ECT (ECT frequency of once per week or less) has been established.  S0, since my driving privileges had been curtailed, my car had not been maintained as well as it might normally have, thus its battery was in sketchy condition and so my father-in-law had to take Kyle and me to get a new battery because my car was dead, and a jump start wasn't enough to keep it going for long.  So we got a new battery, took that to the house, and then we all finally went to dinner.

It took a couple of days for the paperwork to get through from Allstate to Enterprise but it finally did and we got our replacement vehicle midweek - a Subaru Forester.  I was super ecstatic to discover the heated seats and may never return the rental for this reason.  

I went to pick up my prescription for Lunesta (to help me sleep) today.  Kyle dropped it off for me last Friday, so almost a week ago.  I had some problems getting it filled.  I'm not sure what those were, but it was finally ready for me, so I went to get it today and brought it home.  Should have checked it before doing so, because I get it home, and I notice a slight problem.    The directions on the bottle and the printout that came with the prescription says TAKE ONE TABLET BY MOUTH EVERY NIGHT AT BEDTIME.  It also says QTY: 15  and right beneath that it says Days Supply: 30.  

Now, I am really horrible at math, but the last time I checked, if I was supposed to take one tablet every night, I'd need thirty for a month's worth.  When I called the pharmacy back, they explained that my insurance will only cover 15, not the full 30 and that the other 15 must be covered at my own expense out of pocket, which:
a) I wouldn't pay over $100 a month for a sleeping pill even if I did have the budget for it
and 
b)I would really appreciate having been told all of this when I was at the pharmacy the first time around.  I find it slightly important for them to have let me know.

So this blog post is really about all the craziness that is my life lately.  None of it really amounts to anything, but it keeps affecting me nonetheless.  I could get really worn down by it and either depressed, angered or otherwise ill-affected by it.  However, I'm just grateful that the craziness continues to appear to be of little consequence.  No one was harmed in the accident.  Insurance is covering at least SOME of my prescription.  My mind is compensating somehow to cope with the ECT treatments (to a degree).  My husband continues to be an amazing support.   Life isn't the same as it was six months or even four months ago, but I'm learning to measure successes and failures differently lately.   

Today My Heart Is Happy Because...

• My hubby is coming home after being gone for five days. 
• My depression appears to be lifting and I may be able to see a reduction in the number of ECT treatments needed each week.
• I have these guys who keep me company and make me smile.

• I found these lovely green blades of grass popping up in the yard. 

 

• The sun is shining beautifully and I get to have the doors and windows open.  
• I had a wonderful lunch yesterday with someone who is a dear friend to me.
• I spent two days with my beautiful Mom just hanging out, which is something we haven't done in years. 
• An old friend and I are working on repairing our broken relationship because she reached out to me.  I really appreciate that.  
• I feel loved and fortunate.

Conquering Fear...

I've been thinking a lot about fear this week and how I conquer it.  Fear has been a consistent part of most of my life living with an anxiety disorder.  Sometimes I am tougher on fear and manage it better than other times.  At times in my life, fear and anxiety have kept me from participating fully in my life.  At other times I surprise myself and I'm able to act in spite of it.  

I have been afraid of a lot lately, and that can get really exhausting.  But the flip side of that is, I've had a lot of opportunity to overcome fear and act in spite of it lately, too, and that gives me more chances to prove to myself how strong I actually am.  I also learn that situations don't usually end up being as scary as I anticipate they will be in the beginning.   

I dreaded going into the hospital in January.  Going into the hospital is crummy enough, but going into the psychiatric ward seemed even crummier because there are so many restrictions there.  I didn't know what to expect from the staff of the hospital and from the other patients.  I was terrified of starting ECT and of having anesthesia three times a week to start.  I was scared to be away from Kyle.  I was scared what friends and family would think of me.  I was scared about how the things that I usually handle at home - bills, etc., - would get taken care of while I was away. 

Over the next few weeks I learned that I didn't have as much to be scared of as I originally imagined.  The staff of the hospital was phenomenal.  They treated patients with so much respect and care.  I was able to use the phone anytime group wasn't going on.  I could call Kyle as often as I wanted.  He was able to bring my computer to the hospital and check me out of the psychiatric ward for an hour and we paid some bills together easing my concerns about that.  Kyle was his usual amazingly loving and supportive self and called and visited regularly.  He came to the hospital for my first two ECT treatments even though he couldn't be with me during the treatment.  My sister in law visited me, my father-in-law sent flowers and my parents called regularly letting me know I wasn't forgotten.  The ECT treatments went well and better yet, I started to feel better after a couple weeks of treatments.  My little dogs didn't forget who I was while I was gone and were super happy when I came home.  There was not as much to worry about as I originally thought there would be.

I know I am always going to have to conquer fear.  It's built into my wiring to be a worrier and a planner.  But I can use my successes as reassurance and continue to move forward in spite of the fear.  Fear could easily paralyze me and prevent me from doing both the things in life I want to do, but also the things I need to do to be productive and successful.  I will always have to work to overcome self-doubt and fear.  

These past few weeks have been a lesson to me that life can consist of a great deal more than just my fears and worries.  There's no cure for being afraid.  I just have to keep acting in spite of it.  I can't say it gets easier for me, but I do prove my own strength to myself and I show myself just how much I really can accomplish. 

The Cognitive Side Effects of ECT...

My biggest concern when I was trying to decide whether to do ECT was whether I would hurt my brain.  There's actually evidence to suggest that ECT might lead to brain "re-growth" in areas that may be atrophied in patients with chronic, severe depression!  But that doesn't mean there's not some scary cognitive issues that occur when one is doing ECT!  However, depression in and of itself has affected my memory and cognitive functioning, so it can be a bit tricky to try to distinguish what is depression, what is ECT and what is something else entirely!

Short term memory problems have become an issue for me as I've gone through ECT, and as is not uncommon, it is getting more severe as I have more and more treatments.  Most of it is unimportant stuff - not remembering what I had for dinner last night or not remembering what treatment number this week will be.  Sometimes it's a really weird experience, like last week when I didn't even realize I had already had my ECT treatment.  I thought I was waiting to go in for my treatment and I was already done.  That was really bizarre! I also had absolutely no recollection of seeing the doctor that had done the ECT.  It was a bit unnerving but I'm reassured that it's completely normal. 

Because of the anesthesia required for ECT, I will always need Kyle or a friend or family member to drive me to and from an ECT treatment.  But in this acute phase of treatment where the doctors and I are monitoring the effect that the ECT has on me and my body, I have not been permitted to drive at all.  I was finally cleared to drive on none ECT days this past Friday.  

There's some cognitive dysfunction right after the procedure - that's the most common.  That's the sort of disorientation most of us experience when we are coming out of anesthesia.  This generally resolves within minutes to hours after having ECT.  I'm starting to experience a lot more of this in the later treatments than I did early on.   

My psychiatrist started me on the medication donepezil, which is a cholinesterase inhibitor used to treat dementia (eg, impairment of memory, judgment, and abstract thinking; changes in personality) in patients with Alzheimer's disease (or those doing ECT, apparently!)  

In the beginning of ECT, during the acute phase, ECT is administered three times a week on Monday, Wednesday and Friday.  Into my third week Dr. F. reduced my treatments to twice a week and then just once a week because I was having too many cognitive side effects.  The treatment team uses a variety of indicators to tell them how we're doing.  This past week my depression score was getting too high again, so Dr. F. told me it may be necessary to go back to two ECT treatments a week temporarily to get the depression under control again.  It's a challenging balance to try to figure it all out!

If you have any questions about ECT please ask them.  I will do my best to answer them or find someone who can answer them!    

 


 

What an ECT Treatment Is Like...

This Friday will be my ninth ECT treatment, and they're getting both easier and harder.  It's easier because I have the process down and I know what to expect.  It's harder because the process is taking a little bit more of a toll on my body as we go forward.  

So let me tell you what ECT is like for me.  I have it pretty easy because I get to sleep through most of it!  Kyle's the one who has to sit around waiting.  I am put completely under with anesthesia for an ECT treatment, so I can't eat before it.  When I was inpatient, most of my ECT sessions were pretty early in the day - around 9 or so.  Now that I'm outpatient they are late morning or early afternoon to give me time to get there.  (Or to torture me since I can't eat...I'm not sure which).  

The Guerra Fisher Institute is inside the Boulder Community Hospital.   When it's time for an ECT treatment I check in at the Guerra Fisher Institute.  I kiss my hubby goodbye (the hard part!) and then one of their super amazing nurses takes me across the hall to the procedure area.  It's a nice bright area with lots of windows.  My nurse is with me from start to finish, and I'm getting to know them all pretty well by now.  My nurse shows me to a gurney, hands me my clothing bag and a hospital gown and has me change.  I get to leave my bottoms on, and my bra, removing only my shirt and putting on the hospital gown over my own pants.  They also have you use the bathroom at this time.  This is an important step! :)

Then I crawl onto my gurney and my nurse gets me a warm blanket out of the the blanket oven.  Since my veins don't like to cooperate for next step of placing the IV, the nurse usually puts hot packs on my arms.  While the hot packs work their magic, I get two medications.  One is a liquid that I drink from a little brown cup and it minimizes secretions in my mouth.  The other is an anti-nausea medication that dissolves under my tongue. 

Nausea is one of the most common side effects of ECT and one that I've had the most trouble with.  I was sick to my stomach several times after my first ECT treatment, so they've been working hard to find the right cocktail of meds to give me before the procedure to make me feel better after.  This nausea medication helps a great deal and I haven't been sick since that first treatment.  

Sometimes the anesthesiologist puts my IV in, sometimes the nurse does. Then my gurney is wheeled into the procedure room where they do the ECT.  My nurse puts the electrodes on my temples and monitors on my chest. 

This was one area that Kyle and I had to make a decision before my first ECT.  ECT can be done unilaterally or bilaterally.  Bilateral works a little faster but can have more cognitive side effects.  We opted to start bilaterally and to go back to unilateral if we were disconcerted with the effects. Bilateral means that both sides of my head get electricity.   

There are usually four of us in the room.  Dr. G.  is the anesthesiologist but is also a psychiatrist, Dr. F. is my psychiatrist and he gives me the actual ECT, and then there is a nurse.

While all the little gadgets are being attached and hooked up, Dr. G. is getting my IV in and listening to my heart and lungs.  Then he has me lie back and pretty soon he tells me "Roxann, you're on your way," meaning he's giving me the sleepytime medicines and I'm on my way to sleep.  I opted for a Ketamine anesthetic because there is some literature to suggest that ketamine can have anti-depressant properties and that it may mitigate the cognitive side effects when used during ECT.  It is also "pro-convulsant" and allows for better seizure activity.  The down-side is that it can lead to more nausea and a longer time of feeling sedated.  It can also cause hallucinations after ECT, but fortunately I haven't encountered that yet!

Anesthesia is injected into my IV to make me unconscious and unaware of the procedure, and a muscle relaxant is injected to prevent my body from convulsing violently during the seizure.  A blood pressure cuff is placed around my ankle preventing the muscle relaxant from paralyzing that particular area of muscles.  When the procedure begins, the doctor can make sure I'm actually having a seizure by watching that foot.  I think they give me a mouth guard to protect my tongue and teeth, too. 

When I'm asleep, Dr. F. pushes a button on the ECT machine and a small amount of electrical current passes through the electrodes to my brain producing a seizure that lasts 30 to 60 seconds.  I am oblivious thanks to the anesthetic and muscle relaxant.  An EEG (electroencephalogram) measures my brain's activity and shows the increased activity at the beginning of the seizure and then the leveling off that shows the seizure is over.

A few minutes later, the effects of the anesthetic and muscle relaxant begin to wear off.  They wheel me to the recovery area and monitor me for problems while I begin to come out of it.  The confusion that occurs upon awakening can last from a few minutes to a few hours.  My personal experience is that it is getting a little harder to come out of the anesthesia the more treatments I have, and that it's impacting my memory more in these later treatments than it did in the early treatments.  I've also had a pretty severe headache after the past two treatments, but I have a prescription medication for headaches and muscle aches that I can take.

As soon as I can stand and I have a basic grasp of my surroundings, my nurse takes me to Kyle and I can go!  Dr. F. and the nurse write everything down - med changes, my next ECT appointment, etc. Sometimes  it's been as much as three hours since I first came in, but usually it's an hour to two hours.  If my stomach is behaving, Kyle usually takes me to lunch somewhere.  If my stomach is not cooperating, the nurse will give me ginger ale and try to help me get it under control.  Then I get to go home!  

So you can see that while it is quite a lot for my body to have to endure to have an ECT treatment, it's really not so bad for me, personally.  I get to sleep through most of it!  Tomorrow I will talk about the cognitive side effects of ECT. 

My Choice to Opt for ECT Treatments...

They say desperate times call for desperate measures.  Last month my psychiatric nurse practitioner had me go to the ER because my depression was unmanageable.  The psychiatrist in the ER recommended I go to Boulder, CO and begin receiving ECT (electroconvulsive therapy).  

Kyle and I spent some time discussing this and then decided to try it.  This was a huge decision for me.  I was scared to death!

We drove to Boulder and went through the admissions process at their ER.  I was finally admitted to the Boulder Community Hospital to the the psychiatric inpatient unit.  I was admitted on a Friday night and I was discharged on a Friday.  I was inpatient for two weeks. It is a great facility and the staff was very compassionate.  

While I was inpatient I started ECT.  ECT stands for electroconvulsive therapy.  ECT is a procedure in which electrical currents are passed through the brain deliberately triggering a brief seizure.  They aren't sure how ECT helps, but it seems to cause changes in brain chemistry that can alleviate symptoms of some mental illnesses. Most people think of the brutality of ECT in One Flew Over the Cuckoo's Nest, but it's a much safer treatment today and is administered much more peacefully. 


ECT is given up to three times a week in the beginning (Monday, Wednesday, Friday).  As it begins to work it's required less frequently.  The beginning phase is the "acute" phase.  The acute course is generally 6-18 treatments and can take 2-6 weeks.  Some people need more. I needed less.  I was starting to have too many cognitive problems and my psychiatrist felt we should back down to two treatments a week, and then one.  So now I have one treatment a week on Fridays. 

Kyle filled out paperwork to take FMLA time off from work.  His supervisor has been amazing and his work in general has been great about giving him the time off he's needed.  When I was inpatient, clearly I had the supervision I needed, but when I first came home from the hospital I needed 24/7 supervision.  I'm a pretty independent person so this has been one of the hardest requirements for me.  Kyle even had to dispense my medications to me!  Kyle went back to work yesterday but we had certain times we checked in with each other throughout the day.  I also haven't been allowed to drive during this acute phase.  I'm hoping to get cleared to drive when I go for treatment this Friday.  It's been five weeks!

As hard as it is for me to need to be "babysat", I don't have the words to describe the gratitude in my heart for how amazing Kyle has been through all of this.  His love, support and humor are superior to anything I could wish for.  He takes care of me and shows his love for me in ways that continually astonish me and make me deeply grateful.  He's even taken me for my nail appointments and sat there and while I had them done - twice!  

So this Friday will be my ninth treatment.  Tomorrow I will tell you about what a treatment is like.  I will say that I am feeling tremendously better than I was when I was admitted to the hospital last month.  I made a turn for the better after about the sixth treatment.  So ECT is definitely helping and I'm glad I made the decision to give it a try, even if it is a really extreme choice.   

Does Taking Lithium Make Me A Battery?

It seems I am the troublesome patient who makes my doctor earn her fees.  I have treatment resistant depression/bipolar disorder and it's living up to its name this year.  I've tried many, many medications.  After dissatisfaction with how I felt on my medications in April and May of 2012, I decided it was time for big changes.  I spent the next few months in a hell of tapering off Effexor, Seroquel and Zoloft.  This withdrawal caused me to go into a deep depression and in October I sought the help of a new doctor and new medications.  Prozac has helped with my irritability and some of my obsessive thoughts and compulsive behaviors, but has done nothing for the depression.  The past two months have been two of the hardest of my life.  I have never been this depressed for this long.  

I saw my doctor again today and it's time to start getting creative and aggressive with meds, so we are going to try lithium.  Lithium has been around a long time and has been a go-to treatment for bipolar disorder, but because of lots of new meds that have come along it's been shoved to the side and less popular in recent years.  I'm dreading a new medication, new side effects and the unknown, but I'm also hoping BIG time that it helps.  

The side effects are nothing I having faced before - in fact, I dug myself a hole and gained 13 pounds on Zyprexa in two (yes TWO) months.  And since I have zero, or even negative motivation, it's not going to be easy to undo the weight gain.  But I'm realizing I have to pick one battle at a time and right now I am trying to combat the depression and deal with the rest later.  

Lithium can cause toxicity quickly so I have to have my blood drawn once a week for the next two weeks as I start it.  We are going up with it as quickly as we possibly can without hospitalizing me, although I'm so desperate to feel better that I'd gladly do whatever it is I need to do to feel better immediately.  Unfortunately, psych meds take a bit of time to get to their therapeutic levels, so it may be later rather than sooner. 

Unfortunately, docs and scientists don't know how lithium really works on depression, but it sort of jump starts the central nervous system.   There's more info on lithium all over the web, but no one really knows how it works except that it has been monumentally helpful for some people.  I hope I am some people!