Feeling a little punch-drunk
I think each successive treatment continues to wipe me out more. Today’s #8, has just put me on my back. Not from pain or mood. I just can’t seem to get my head together or wake up. My mood held very well from #7 to #8. I was a bit irritable today, but no more than most people get at times. Otherwise, no depression, no mania, and no other mood characteristics which I would label as bad or unusual. I heard a Brian Setzer Orchestra song on the Today show this morning, and had it stuck in my head. I walked around singing it all morning. That’s not normal for the “me” of the last few years. Mic is home, and rode with us to Porter. Maggie, still a little under the weather, stayed home. Melissa ran home during recovery and brought her back to pick me up. I found myself really dreading this treatment and ready to have it behind me.
Pre-op was as usual today. I got there 90 minutes before scheduled treatment time. I was scheduled for 11:30, but actually went in at 11:00. The Day Surgery area was unusually quiet today, and there were some earlier cancellations which moved me up in the line-up. I was in Recovery I by 11:20. My Beck score was quite a bit better today, at 28. The anesthesiologist pre-op’d with 50 mc of Fentenyl (pain) Zofran (mg?) (nausea) and lydicane for the burn caused by the etomidate (sedative). My IV was in a small vein in my hand, so the etomidate hurt like hell anyway. I remember it starting to burn, and intensifying, but I think I was asleep before the pain resided. We use d40mg of etomidate. Everyone keeps commenting about how much sedative it takes to put me down. My seizure stats were: peripheral – 11 seconds and EEG – 30 seconds. These durations were significantly shorter than last treatment, but duration of 20 seconds or more with a nice clean cessation is considered therapeutic. Studies show that increased duration does not indicate increased efficacy. Rather, studies have shown that the degree to which electrical stimulus exceeds seizure threshold is a much better parameter for predicting treatment efficacy. (see http://www.cpa-apc.org/Publications/Archives/PDF/1996/June/LALLA.PDF) Likewise, seizure duration tends to shorten, given the same stimulus dose, in later treatments because ECT has an anticonvulsant effect on the brain, thus “teaching” the brain to control convulsions as treatment progresses. Seizure suppression correlates to the degree of seizure generalization, therapeutic dosage adequacy, and bi-lateral stimulation. Nonetheless, the plan is to add caffeine to the pre-op next time, which is intended to extend seizure time.
In Recovery I, I had 10 mg of morphine 5 different times (total 10mg), along with a hit of fenegrin (6mg) for nausea. Nausea was much better today, but the fenegrin made me really sleepy. The longer it takes to get pain under control in Recovery I, the longer it takes to get to Recovery II. Today, I didn’t move to Recovery II until 1:20, 2 hours after recovery began. It could just as easily been 10 minutes for all I knew. I was in Recovery II until 2:45 and then discharged after 2 325mg percocet tabs. I got home, put in a movie and slept through the whole thing.
It still appears that my medical insurance will cease working with Porter Hospital on December 31. No new contract has been finalized. Two possible outcomes are possible: 1) I will have to finish my treatments at another facility, Centennial Peaks, which is about 70 miles from my house. CP is “in network”; 2) I will convince my insurance to consider Porter “in network” since I am 2/3 through my treatment already and there is not another reasonably close facility “in network.” I see a fight coming. That’s all folks!
Pre-op was as usual today. I got there 90 minutes before scheduled treatment time. I was scheduled for 11:30, but actually went in at 11:00. The Day Surgery area was unusually quiet today, and there were some earlier cancellations which moved me up in the line-up. I was in Recovery I by 11:20. My Beck score was quite a bit better today, at 28. The anesthesiologist pre-op’d with 50 mc of Fentenyl (pain) Zofran (mg?) (nausea) and lydicane for the burn caused by the etomidate (sedative). My IV was in a small vein in my hand, so the etomidate hurt like hell anyway. I remember it starting to burn, and intensifying, but I think I was asleep before the pain resided. We use d40mg of etomidate. Everyone keeps commenting about how much sedative it takes to put me down. My seizure stats were: peripheral – 11 seconds and EEG – 30 seconds. These durations were significantly shorter than last treatment, but duration of 20 seconds or more with a nice clean cessation is considered therapeutic. Studies show that increased duration does not indicate increased efficacy. Rather, studies have shown that the degree to which electrical stimulus exceeds seizure threshold is a much better parameter for predicting treatment efficacy. (see http://www.cpa-apc.org/Publications/Archives/PDF/1996/June/LALLA.PDF) Likewise, seizure duration tends to shorten, given the same stimulus dose, in later treatments because ECT has an anticonvulsant effect on the brain, thus “teaching” the brain to control convulsions as treatment progresses. Seizure suppression correlates to the degree of seizure generalization, therapeutic dosage adequacy, and bi-lateral stimulation. Nonetheless, the plan is to add caffeine to the pre-op next time, which is intended to extend seizure time.
In Recovery I, I had 10 mg of morphine 5 different times (total 10mg), along with a hit of fenegrin (6mg) for nausea. Nausea was much better today, but the fenegrin made me really sleepy. The longer it takes to get pain under control in Recovery I, the longer it takes to get to Recovery II. Today, I didn’t move to Recovery II until 1:20, 2 hours after recovery began. It could just as easily been 10 minutes for all I knew. I was in Recovery II until 2:45 and then discharged after 2 325mg percocet tabs. I got home, put in a movie and slept through the whole thing.
It still appears that my medical insurance will cease working with Porter Hospital on December 31. No new contract has been finalized. Two possible outcomes are possible: 1) I will have to finish my treatments at another facility, Centennial Peaks, which is about 70 miles from my house. CP is “in network”; 2) I will convince my insurance to consider Porter “in network” since I am 2/3 through my treatment already and there is not another reasonably close facility “in network.” I see a fight coming. That’s all folks!
posted by DeMental at 5:37 PM
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