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.