Zap Kat: Information Sheets

Zap Kat: The Interview

I called CAMH and they set up a meeting within a few days.  For the first time in a while I found myself downtown again, fighting off my sleepyness and anxiety while I holed up in the library across the street.  Eventually the appointment time came and I met up with one of the research analysts.  It was fairly straightforward, she checked some questions like:

• Are you right or left handed?  (They're using right-handed individuals for this study.)
• Have you ever had a seizure?  (TMS does involve some increased risk of seizure for people who have already had one)
• Is there anything implanted in your body, especially your brain?
• Have you tried other methods for relieving your depression without satisfactory results?

I filled out an information sheet and consent form and she proceeded to the HAM-D. 

The Hamilton Depression Rating Scale is a widely used questionnaire to determine the level of pathology and existence of depressive disorders.  It is used in a great majority of the TMS literature I've read, so I consider it somewhat like using standard units of measurement.  This way data from various studies can be correlated because they use the same measurement scale for depression. 

Check out a sample HAM-D form by clicking here.

As with most intake sessions, it was a little awkward to answer such personal questions with a total stranger, but you gotta do what you gotta do.

Introducing Zap Kat: An Ongoing Peek into the rTMS Protocol

After my recent relapse in August I went through the usual "tweaking" of my medications.  Up a bit on this, down on that, try a combination of this and that. 

This and that is not sufficient when one has encountered increasingly intense hyper-somnolence, paralyzing anxiety, depression sinking to the bottom of the barrel, not to mention a very promising new start at school going down the drain.    

It was a while after my worker and doctor came back before I was able to start looking at other options.  I had spiraled pretty far down.  Eventually I started looking up the recruiting pages of all the local research hospitals.  At the same time, I compiled a list of all the psych meds I could find.  The Centre for Addiction and Mental Health is Canada's largest psychiatric research hospital, so I was not surprised to find them recruiting participants for a study in rTMS.

What is rTMS?
rTMS is an acronym for repetitive transcranial magnetic stimulation.  It is a (relatively) new treatment for treatment resistant depression.  After carefully mapping your brain and marking the targeted area a magnetic coil is positioned over it to fire.  The coil has a strong magnetic field that creates an electrical current in the brain.  It's transcranial nature means that your skull and hair stay intact throughout the process.  Repetitive TMS uses multiple pulses over a longer period of time, (several weeks plus maintenance treatment) than just TMS.
rTMS, ECT, DBT, what's the difference?
ECT is electroconvulsive therapy, widely viewed as a dangerous, violent procedure.  In truth it is well regulated, patients receive sedation before the treatment and it is highly effective in treating refractory depression, but there is still a significant chance of memory loss.  DBT is a new procedure that involves threading wires into the brain and implanting a pack into the patients chest to provide constant electrical stimulation.  rTMS, and TMS are by far the least invasive of these treatments as they require no sedation or surgery however like DBS it is still in the testing phase.
rTMS Basics
In this study, rTMS is applied once a day, every weekday for three to nine weeks.  (Nine weeks if you should get the placebo first and not respond to it.)  If it is beneficial with you, they will provide a years worth of weekly maintenance treatments.  The treatments take about 30 minutes, where you lie in a fully reclined squooshy chair with the magnetic coil positioned carefully over your head.  You can read or sleep or even knit during the treatment.  With each pulse is a loud snap, like a large rubber band or a stick of wood snapping.  You feel something similar on your head, like the rubber band is snapping against your skull or at worst, like a drummer is using your skull to replace their snare drum.  They offered me earplugs, but it makes me feel like I`m an in an underwater sea world so I think I`ll skip them.
What are we learning?
The study I'm in seeks to explore three variables:
1.  Whether one-sided or two-sided rTMS is more effective
2.  To find out if using a more precise method of finding the stimulation area is more effective
3.  To understand the brain mechanisms involved in treatment depressive symptoms
I'm getting bilateral, (two sided) treatment.  One side has a steady pulse for about 140 beats and then a rest, the other is a much quicker firecracker-like group of pulses with much longer rests in between.

Head CT - Post Mild Concussion, January 2006

In late January of 2006 I was racing myself around the rink during Public Skate and took a serious face-dive into the ice. Yes, instead of putting my hands out to protect myself I tucked them in and swiftly decelerated into the frozen rink.

I saw the rink supervisor, (some college student trying to make tuition payments by showing up on skates at a stinky community centre every couple days) come towards me and then stop when I got up. I dizzily headed for the boards and inched my way over to the door to pour myself into the stinky bleachers. Blood dripped onto my sweater and my friends skated over to check me out.

It was a pretty unremarkable concussion. I fell onto my jaw which bruised where it met my skull which made my brain bounce around and go all kooky! Apart from ignoring my best friends sister telling me to "just close your eyes and go to sleep!" and my other friend looking at my wound and yelling "I CAN SEE YOUR TRACHEA!" I went for the cursory check at the walk-in clinic and went home.

Weeks later I could move my jaw again but I was more dizzy than when I was on Zoloft. I almost threw up every time I moved my head even an infinitesimal amount. My mom dragged me to see my GP even though I felt too horrible to move and he gave me a script (hooray for Serc!) and ordered a CT.

Voila, here we get a chance to look at a brain scan! No strange findings, so it's pretty typical. It is somewhat distorted from putting it into a gif. Cool or what?

Fighting the Relapse Beast

Part of why it's so difficult for me when people say that I'll get better and I'll be so close to remission again is because I was so close. I was about to rock a college certificate, I had proved to myself that I was ready for university, but it all came crashing down two weeks before I would have finished that achievement. It just makes me think that there's no point to moving forward from this because I'll have another relapse and become completely capable of anything again. And when that's over, I'll have to start all over again.

Life isn't linear, it's not like once you've failed college you can't go back and try, but it does go on despite whatever is happening in your life. I can work so hard and not really get significantly better and time is going to keep on passing. I'm never going to catch up to my age mates in the rat race and that's something I think I'll feel badly about for a long time. They have had so many different experiences while I am having a completely different one that really gets me nowhere in the calculation of success. I haven't completed any level of education past grade 10, I haven't lived away from home, I haven't dated, all because of this damn illness that's going to dog me forever. There is no cure for depression. I can deal, I deal with my anxieties and my OCD, but to be completely honest that's not the life I want. I don't want to deal, I don't want to be afraid that the next week somethings going to conk out and my life is going to grind to a halt again for reasons that I can't really explain. This summer everything stopped because I was exhausted, and that led to a million other things. Next time maybe it'll be the anxiety which will lead to the other things. The uncertainty of not knowing when or if a relapse is going to strike bothers me quite a bit.

My urgency to find something now is because I know with my history it's most likely that I'll have more relapses throughout my life. I've been so close to the edge this time that if I were to get that close again I don't think I would have the strength to fight it, and with that experiences I`ve gathered of the adult mental health system there are strong barriers to seeking help for it. You don't know...even when you've experienced it, once you're healthy and you're part of the world again you always think it's not going to be that bad. Next time you'll be stronger because you have the perspective of having been healthy. It doesn't work like that. Once it's back, you're in it. It's all consuming, overwhelming, there is no thought that doesn't lead back to it. If I don't find something that will work now and in the future, I'll die because that's just how strong my episodes are. I truly don`t know if I can face more jagged edges like that and come back from it. It`s taken a lot to be at a place where I want to come back. Even now I`m extremely hesitant, I can`t see a future for me that I want to live through.

Anaphylaxis: Etiology Unknown

TUESDAY, APRIL 6th:

24 30h
Looking at Easter pictures with my dad. Laughed so hard I started coughing and couldn't stop.

24 40h
Realized I wasn't coughing from laughter, I was coughing because my throat was itchy and beginning to swell. Can't find "my effin' epipen!"

24 45h
Family zooms out of house.
24 50h
Arrive at Scarborough Grace Hospital. Immediately put on oxygen and IV fluids.
Doctor orders: 0.3 epinephrine IM
Respiratory Tech orders: Ventolin breathing treatment, nebs

WEDNESDAY, APRIL 7:
00 00h
The Ventolin tastes weird. The only things I ate was some bread that I get from the same place, every week, and Pepsi. So what caused this reaction? And where the EFF was my epipen?! I need to go to the washroom really, really badly. Discover that I'm less stable on my feet than I thought.

My mom helps me down the hallway and then I see a dead body, all wrapped up. We have a hissing argument about whether or not it's dead before I go in the washroom. When I emerge, and we're walking back, she sees it and tells me it freaks her out. She's the one with all the ghost stories!

00 30h
RT and MD listen to my lungs. Still wheezy, although I feel almost completely normal. Another breathing treatment, another half hour.

01 00h
Doctor sends my mom and dad out to buy an epipen from the closest 24h pharmacy. He tells me to rest, because the epi and the 2 Ventolin treatments caused my heart rate to go up. I fall into a fitful sleep, which is partially made better by the nurse in the yellow scrub top.

03 30h
Free! My O2 and heart rate are at normal levels. I'm exhausted from the reaction itself, but the epi gave me a lot of nervous energy. When I get home, I hold onto the kitchen counter and jump up and down to release some of it. Doesn't work. It's a really strange feeling- full of energy and completely exhausted at the same time.

All throughout Wednesday my throat hurt, probably from coughing so hard to get some air in. I didn't eat until the evening because I was so frightened- I still don't know what caused the reaction, so how can I eat anything?! It's out there- lurking- Beware The Allergen.

Sleep Medication Dependence

In the past couple of months I've slept without my meds a handful of times. There were a few nights I was on melatonin, and a few more where I was so exhausted I didn't need them. It freaks me out that I can't sleep without them anymore.

It scares me that during that time I wasn't on my meds I was a fucking wreck. I can't believe that I ever was that anxious all the time, it's like some kind of nightmare. Which by the way, I am chock full of. Every night I dream horrible scenes that go in circles.

Every night, and every afternoon because although I can't sleep in my bed I sleep soundly on the bus.

It feels like forever.