Archive for July, 2009

July 29, 2009

greeting-card messages for the ECT patient

Greeting cards are fascinating, I kept thinking as I perused the aisles of this Hallmark card shop, which sold other non-card items besides those ornaments and little keepsakes. They had a large collection of Crocs and other footwear, in case people need to buy shoes as they pick up a thank-you card, I suppose. It’s interesting how cards are so tailored to specifics these days. You can’t buy a generic birthday card; they make you choose according to the recipient’s gender, age, if s/he enjoys humor, religious preference, or any other category you could think to distinguish that person. So, when I was looking at the Get Well card section, I noticed that you can now buy get-well cards specified for a particular illness: cancer. There are even cards targeted just for breast-cancer patients and ‘happy 1st year of survival’ cards. It’s understandable since over one million people get cancer each year. Though there are only 100,000 or so who receive ECT per year, I figured, why don’t I think up of some catchy greeting card phrases for the ECT patient?

Here are a few ridiculously lame card messages. Please send your suggestions so I can draw up a card.

Outside: “Heard you were having ECT…”
Inside: “Hope the treatment goes shockingly smoothly.”

Outside: “You said you needed more sparks in your life,”
Inside: “I guess you’re getting them now.  Get well soon.”

Outside: “You may experience some memory loss…”
Inside: “At least you might get to forget all the bad times! Hope your treatment goes well.”

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July 28, 2009

a random journal entry

The following is such a dumb, little story, but I’m writing it out anyway.

My mother, sister and I were at Trader Joe’s yesterday looking for some dried currants. We didn’t find them, but I believe I spotted Dr. F, my new ECT psychiatrist in the frozen foods aisle. I nearly froze as I saw him; I could not say hello to him. I’m not quite sure why I became so nervous from seeing Dr. F. After all, he is such a nice doctor that I’m glad he is my ECT doc.  But maybe it had something to do with the fact that I’ve only met him three times, twice for brief moments just before the ‘little sparks.’ Still, how could I have been that nervous to see someone who knows quite a lot about me? I still feel a bit odd about this whole near-meeting.

Speaking of seeing Dr. F, my next ECT is in a little over a week.   After listening to  how I was feeling last week, he told me that I will be receiving ECT every two weeks for few more series rather than moving it apart to once-a-month. As much as I have a tendency of talking about my ECT days like a routine dental appointment, the amount of nervousness I felt when he told me about my ECT frequency did indicate to me that I had a fair amount of apprehension and worry left in me. (Maybe it is this feeling that carried over into my hesitation toward seeing Dr. F.)  The thing is, ECT is becoming even more routine than going to a dentist. ECT is now a part of my life that gets planned around like it’s a weekly meeting where I must be in attendance. As I think about class schedules for the fall, I find myself planning to sign up for classes that accommodate my regular ECT schedule. It apparently looks like things will work out in the fall, schedule-wise.

Perhaps I should have approached Dr. F at Trader Joe’s. Dr. A, my regular psychiatrist, is on vacation this week and I could’ve used some face-time with a professional. Oh, well. I’ll be seeing him at Parthenon Pavilion for many times to come.

July 27, 2009

My health-care bills and the Health Care Bill

$20,000. What can you purchase for that amount of money? Pay one year off a mortgage, purchase a nice used car, buy a whole bunch of stuff.

I finally got an ‘explanation of benefits’ (EOB) letter from my insurance company about my initial 15 treatments (The hospital accidently tried to file the claims with my old insurance company). According to them, the whole process, including the pre-ECT exams, cost close to $20,000. Upon getting this letter, I thought this may be a good time for me to bring up the whole topic of health care, or more specifically, health insurance and the battle on Capitol Hill.

Because I do have insurance, a large portion of the treatment is covered (When I get the real bill from the hospital, I’ll post the amount). Obviously, this is something I am very thankful for, especially since it wasn’t that easy for me to find insurance – and I’m in my 20s! I was even turned down by several companies simply because I have bipolar disorder. Thank goodness for my insurer, Golden Rule/United Healthcare. Even though my monthly rate is close to $400, it is worth what I save on medical costs. There are some younger, healthy people who may not see the need for insurance, and  they may be against the new health reform because according to the new proposal, it would require that everyone be enrolled in a health insurance program. What they need to realize is that an insurance is just that, an insurance when those unforseen events arise. Obviously, they’ve never seen the base cost of a simple procedure or a doctor’s appointment, because even seeing just the true cost of one prescription would make a person realize why health insurance is so important.

What about for those who need electroconvulsive therapy but can’t get insurance? Currently, over 40 million Americans are uninsured, many not by choice. Under the new plan, insurance companies will not be allowed to turn people down simply because they have a pre-existing condition. And those who are uninsured and cannot afford insurance will be helped by an expanded form of Medicaid. Even those nowhere near the poverty level will be given an insurance subsidy to help pay for their insurance.  Now, ECT clearly isn’t for everyone, but shouldn’t everyone be given all medical options when choosing treatment? I know that had I not had the ECT, I would have been dead by February.

To put simply, I can’t imagine being without health insurance. Without it, I wouldn’t be able to afford ECT nor would I have been able to afford some of the non-generic medications. And I certainly wouldn’t be seeing my psychiatrist on a regular basis. But I see all of these items as being crucial to keeping me alive. Moreover, I’m sure there are plenty of others who need these services even more than I do yet do not get them because they cannot afford or are denied health insurance. It’s easy to say that one is against “socialized medicine,” but does one realize what it’s like to try to get medical care when they don’t have insurance? Do they know just how much medical care costs without insurance? It’s utterly obscene. Call it ‘socialized medicine’ if you’d like, but is it such a horrible thing if it’s going to allow someone to get the care they truly need?

Though I’ve been for health care reform, I admit I haven’t been paying to much attention to the debate. However, seeing that EOB gave me a good ‘shock’ to my senses about just how much relevance this topic has in my life and others and how important it is that I become more aware about this issue.

FYI: A quite concise editorial “Health Care Reform and You” was in the New York Times on Saturday.

July 26, 2009

On “Guideline is Function”

**I wrote most of this a while ago but totally forgot to post it, so here it is.**

Guideline is function. That’s what Dr. J, my previous ECT doctor, said to me about what the whole purpose of psychiatric treatment was. He explained to me that the process was to get me to reach a point where I can get through daily life and what comes with it. That point where I can perform everyday tasks consistently, without crumbling with every depressive episode.

I’ve been thinking about what he said to me for a while now. (I wish I had taken better notes when we had this conversation. He made the comment when I called him to ask about the sine wave machine issue.) That view seemed so callous and detached at first when he told me. Is that all he wants his patients to aspire to? To just function? Shouldn’t I get to actually like and then “thrive” at this life deal? I mean, I go through ECT and all the other psychiatric treatments only to just “function” like some programmed robot?

Then I remembered that when I was hospitalized five years ago (he was the attending), Dr. J drew me a circular diagram on how to have a balanced life. On that table in the common-area kitchen where the ward patients had their consults with their assigned doctors, he explained that the medication and therapy are only part of my road to building back my life. I think I got a bit annoyed that time five years ago, because I thought I already knew what he was talking about. But now, I realize that I didn’t quite understand how to even function at life then and how crucial it is that I live the balanced life he’s talked to me about. Along with that ‘balanced life’ diagram, his ‘guideline is function’ comment is slowly making more sense to me, though I still think it’s not the most optimistic view on psychiatry.

Functioning at life first.  If I can’t function, I can’t start thriving. It’s not their job to give me some “thriving pill” or whatever. If I can learn to function again, it is up to me to keep it up – with the help of the profession. As much as I’d love for everything to turn around in a flash, now that I’ve started maintenance ECT I’ve come to realize that things take time. And that while the ECT hopefully will change my life for the better, I must do what I can to contribute to make that change ever more possible.

And as for the function I’ve been trying to gain since the first ECT, it looks like I got into graduate school for the fall semester (At least that’s what my status says on the web; I’ll wait for my confirmation via real mail).

July 24, 2009

ECT Lessons-I’ve-Learned #5: after ECT, treatment continues

My psychiatrist Dr. A tore out  for me a new article from this month’s Archives of General Psychiatry entitled “Effect of Concomitant Pharmacotherapy on Electroconvulsive Therapy Outcomes.” Written by Harold Sackeim, et al., their research found that “treatment with nortriptyline (a second-generation tricyclic)  enhanced the efficacy and reduced the cognitive adverse effects of ECT relative to the placebo, and Venlafaxine (Effexor)  resulted in weaker degree of improvement and tended to worsen cognitive adverse effects (but still better than placebo).” They also concluded that high-dosage right unilateral ECT equaled or surpassed in efficacy to bilateral ECT and caused less cognitive side effects. (Here’s an article about this study from Medical News Today.)

We’ve probably encountered the stats that the effectiveness of ECT is somewhere between 70-90%. Though I wasn’t led to believe that I would be free from medication after the ECT, but it wasn’t made that clear to me that without any augmentation the relapse rate for ECT is around 50%, and according to one 2007 study, the rate could be up to 100%. So, I’d like to think that ECT just eradicates our lifetime of madness, but we need to realize that there are still work to be done after the little sparks are over. That may mean just continuing with your old meds, adding lithium, or turning back to ECT. I know that by the time we’re considering ECT, we are barely able to make it through the day, but I think it’s better to ask and know upfront what turns your life could take post-ECT rather than be surprised by something that’s already been documented that it might happen.

 

Read other “lessons”

July 23, 2009

ECT #18 (maintenance ECT #3)

My mother came into town (well, country) just yesterday, and what does she get to do first thing today? Take her daughter to ECT. Somehow it’s become some sort of a routine for her to take me to the psych hospital whenever she’s here. What a lovely mother-daughter activity.

I’ve been concerned about the decline in my mood since the treatment two weeks ago, and I somehow wanted to express that to my doctor.   Thankfully, my ECT psychiatrist Dr. F was back from vacation, so we chatted for a bit before the procedure. Seeing that I’m a little better at just writing stuff out rather than talking, I wrote him a note about how I just wanted to evaporate into the sky while I was overlooking the landscape from the airplane. He told me that because the last ECT did make me feel better for a while, as I have more treatments, my suicidal inclinations should dissipate. “You’re still young,” he assured me. I must say that his calmness and smile actually made me feel somewhat encouraged. I’m grateful that he’s my ECT doctor and that he’s still working even though he’s in his 70s.

Before I was given my shot of Brevital, the anesthesia, for the first time, the nurse put the electrode headband around my head. I had actually never seen how the currents were administered to my head. With the new machines, it’s just two patch-like electrodes, but because they’re using the sine-wave machine on me, they are wrapping an old-fashioned device on me (my headband looks even older than this one).

And next thing I know, I’m awake.

As I was wheeled back to the prep room to get my stuff, the nurse let me know that I had a 50-second seizure. Hooray. It’s all because I’ve halted taking alprazolam (Xanax), she said. I’m hoping that the longer seizures will lead to a better outcome.

It’s a relief when I can say that I feel better after the ECT. The question now is, how will I hold up until my next ECT two weeks from now?

July 21, 2009

Identity Protection, or in defense of ‘secrets’

My friend Tom, who went to high school with me, has often introduced me to readings that I wasn’t familiar with at the time. Over the years, he gave me a copy of Camus’s The Stranger (Dubya’s favorite) and sent me books by Jhumpa Lahiri and John Irving. More recently, the sharing has moved online. In the last few months, Tom told me about Google Reader and how it works. Being not so deft with technology, it took me some time to figure out the whole ‘subscribing’ stuff, but in the previous weeks, I finally managed to start ‘following’ Tom and the item he’s chosen to share. He shared an item with his ‘followers’ today from an apparently well-known blog by Penelope Trunk called ‘Penelope Trunk’s Brazen Careerist.’

It was an entry entitled “How to Decide How Much to Reveal About Yourself.” In this post, Trunk, a founder of three start-ups who uses the blog to give career advice and intertwine personal stories, reveals a great deal about her past, especially her childhood. In a single entry, she manages to tell her ‘secrets’ that would be painful for anyone to share, and she concludes that we should be open with others because “when you think you cannot tell someone something about yourself, ask yourself, ‘Really, why not?’.”

I do understand why most comments to the post lauded her for her ‘courage’ and ‘inspiration,’ and sure, I concur with many of them. But I took away something else from this post. How about the practicality of being open (e.g. by disclosing my real name on a blog) for someone like me?

I visited Brazen Careerist and saw that one of the featured posts is called “8 tips to building and maintaining a professional online image.” In the article, it warns that potential employers can easily google our names to find information about our lives through our web habits, such as posts on Facebook or a personal blog. With such advice, this point is where I tend to contend with Ms. Trunk’s statement that we should be completely open, even with the darker personal stuff. The problem is, when you are not well-known, past stories aren’t  going to be seen by employers as ‘inspiring’ or ‘brave.’ Instead, they just give ammunition for them to not hire that person. She has a clear advantage of being already well-established enough to get more respect rather than suspicion by posting this sort of content. Most of us aren’t in that boat. The warning about maintaining an online image is the very reason why I’ve chosen to use a nickname to write this journal. Writing under my non-real name has actually given me much more freedom to just write, rather than giving a narrowly edited picture in fear that my future employer will find what I’m really up to. Her advice isn’t that practical even according to that featured post on her social network website.

Moreover, she tends to argue that when we don’t share a certain information with everyone, then that information is still a secret. Just because I’ve chosen to share my story with a select set of people, does that mean it’s still a secret? Does everyone really need to know everything about you before you can say that you’re telling the truth about yourself? At this point in my life of having to find a job and career, there’s really no use to sharing the fact that I have bipolar disorder and that I’ve had ECT to my potential employers.  And I don’t think  my decision to not to tell everyone about those things make those two parts of my life something I’m keeping a secret. It’s mostly not relevant to interactions with those people.

I will say that Ms. Trunk’s post was inspiring for me on another front: it made me want to write like my self for the first time in a while. I don’t necessarily agree with all her points, but her points are so concisely and beautifully written that it made me want to start writng better. Thanks to my friend Tom, I found a much needed inspiration from an encounter with a single blog post.

July 21, 2009

The To-Enjoy List

Instead of the usual Thursday morning appointment, my therapy session with Dr. A was moved to this morning. We talked about a lot of stuff I’ve written in the previous posts, but she also reminded me to go back to doing just the essentials and appreciate them (she put it more eloquently, but I can’t quite remember her words). So, here I document some things that I have, am, or plan on enjoying today:

The smell of Peet’s Coffee as it brews in the coffee maker. The crispness of the color white on a shirt. The warm sunlight and the soft breeze that hit me  as I type this entry on my porch. A sense of accomplishment for finally renewing my car tags after a two-month delay (the office is two-minutes from my house!). How well my herb and vegetable garden has grown. The greenness of the leaves. Meeting a friend for lunch.  The way birds mock my cat by flying ever-so-close to him, but just enough to be out of his reach. Watching those birds build their nest, one twig at a time. How the light catches the movement of the pool water. The color Red. Carrying on a online chat with an old friend. The buzzing of the cicada followed by the singing of the birds.  To breathe in air and then breathe back out.

I sometimes forget that I am alive. But here I am, still alive, enough to be able to make a list that make me realize that I can’t be finished. Not just yet.

July 20, 2009

Breakfast Options

caps
Sometimes, that’s how it feels.

July 20, 2009

the center cannot hold (and maybe that’s okay)

It’s been about two weeks since my last ‘little spark.’ And today, right before work, I wished that tomorrow was my date with ECT so that I can go back to feeling like I did two weeks ago. Though it was originally scheduled for tomorrow, I must wait until Thursday since my sister’s not home to take me to and from the hospital.

It’s felt like a slow descent these past 14 days. Was the buoyant mood right after the ECT because of the ECT? Is this dip I’m experiencing only going to be fixed only by a shock to the head? Could this just be my being a bit moody?  I don’t really know. What I do know is that today I really wanted to take Xanax, something that I haven’t had the need to take since I started back on maintenance ECT.

Nevertheless, something has caught up with me, and I’m feeling a bit lonely and overwhelmed. Speaking with my mother this evening, she expressed her concern for having to go through this on a constant basis. First, does she understand that she’ll probably have a dead daughter without it? Second, I honestly think that ECT is a quick and somewhat simple procedure. It’s my own fault for not explaining maintenance ECT to my parents, but regardless of how much talking I do, I gather that they will never quite feel comfortable with my choice to have ECT, or my choice to have any sort of psychiatric treatment at all.

Tears are now welling up for first time in weeks. I’m not sure why I’m crying, but I think I just want to let go. My tightly-wound facade that I’ve created for myself has got to come down in order for everything to be built back up again.

It’s a good thing my therapy with Dr. A is in two days.

July 17, 2009

Up in air

I am on an airplane back from Santa Barbara, and I look out the window and see land below that extends beyond my imagination. The image is suppose to be breathtaking. It is supposed to evoke a feeling of wonder about the vast beauty of our nature. Instead, I found myself faintly wishing I could evaporate into thin air, to drop out of sight into the landscape.

This is depression that will not go away.

No one would know that I am at all in any emotional distress from looking at me in person. Honestly, I’m not that depressed, so there’s not much to express outwardly in terms of a depressed mood. But what’s kept at bay doesn’t mean  it doesn’t still affect me. I don’t remember what it’s like to not question why I’m alive. Let me make clear that I am not actively contemplating suicide here. It’s far from that sort of thinking. However, I just wish that this wasn’t the thing to ‘keep at bay.’ Though I cannot speak for others, I think this, the unpredictability of having to deal with what lurks around, is what makes suicidal depression so hard to manage.

What’s changed for the better since I’ve started ECT is that I haven’t given up and given in to these thoughts. Now, if only they would go away….

July 17, 2009

News: Stanford To Offer Bipolar Education Day On July 25

Stanford To Offer Bipolar Education Day On July 25

Shared via AddThis

July 11, 2009

The Bell Jar: a reason why we love America?

My sister and I are on our way to Santa Barbara, Cali. We’re meeting our father there since he has some sort of a conference down there. While I brought my own stuff to do in the airplane, I picked up my sister’s copy of this month’s Marie Claire, mostly so I could find some picture to draw. While flipping through the pages I came upon an article entitled, "50 reasons we love America." The article lists a lot of random things like labradoodles, but then there is was, in #25, The Bell Jar (they even included the cover pic). The Bell Jar? As much as I love that book, have I ever considered that book to be one of the reasons why I love America? I’d really like to know why it is that we would love this country because of this particular novel. I mean, I owe a great deal to Sylvia Plath for inspiring me to keep such a confessional log of events, but would I say that the book, and by extension, Plath, is one of the very reasons that make America so great? Maybe I’ll think on it during the next plane ride before I give my concrete answer.

July 8, 2009

ECT Lessons-I’ve-Learned #4: Write ’em down!

  • When I went through ECT the first time around, I wrote down my passwords to the various online accounts that I have on a sheet of paper. This advice came from the book Shock by Kitty Dukakis and Larry Tye. It’s a great safeguard measure, and it was probably good to have my memory refreshed about those passwords anyway.
  • Keep a record of what you did each day during your ECT series. I think my main reason why I was able to remember a lot of the events surrounding my ECT treatments is because I wrote stuff down. Even just writing down your mood may be helpful in tracking how you are doing.
  • If there’s something you’re supposed to remember (even if you remember at that moment), write it down.

Lesson #1
Lesson #2
Lesson #3

July 7, 2009

on illness career change

Sometimes, it seems like people who are very publicly open about their mood disorders talk of taking medication as something they do, not because they will be healthy, but because they’re depressed.  In a way, their choice to take medication sounds like a choice to at least internally label oneself as ‘mentally ill,’ even though the medication may be what would allow the public to never place that label on you.  I do know that sometimes deciding to keep on taking medication feels like an exercise of the depressed; most of the time, it is that way where I’m getting no better, but I have another prescription in hand.

My thoughts about how mood disorders are framed in this society and how I view my own disorder shifted quite a bit after reading Peter Kramer’s book, Against Depression. But when it is ‘eradicated’ from me, what’s going to be left?

I have read some articles and books in the past that looks at depression from a sociological lens. Until now, I’ve been able to connect with reading about the typical illness career that involves wrestling with medication or having to spend time in a hospital. With only about 100,000 patients per year that undergo ECT in the US, I haven’t been able to read up to see if there’s any emotional transition from having a ‘typical’ illness career to one that’s a little less common to that career. I tend to think that self-identity kind of changes when ECT comes into play.  With just medication and therapy, I do have the luxury of accepting or denying my illness at some points.  In the case of ECT treatments, I’m not sure that flexibility is available anymore.  A clearly physical procedure (like having surgery), I will not have a daily moment when I get to decide if I want to take medication. Instead, I don’t get to deny the seriousness of my illness. The thought process, at least for me, has been very different from how I’ve felt about medication. The process has been interesting (intellectually speaking–my body doesn’t find it all that amusing).

In Is It Me or My Meds?, David Karp asks his interviewees about their relationship with their psychotropic medication.  He found that most “had become wedded to a biomedical version of mental illness.” In the concluding chapters, he becomes skeptical of the growing acceptance of biological psychiatry that has led to an overmedicated society. The skepticism toward embracing a totally medical model of mental illness is, to an extent, understandable.  Karp notes that his issues are with the “confluences of forces that lead doctors to routinely medicate for life distress.” Sure, we don’t do enough to examine larger social problems that has led to our developing these psychiatric issues. However, when one chooses to have ECT, isn’t the acceptance of biomedical reasonings important to the ECT patient, at least so that s/he can come to terms with having to go through this procedure? By the time someone reaches the point of being treated by ECT, accepting biological psychiatry isn’t leading to an overmedicated patient.

Perhaps by choosing ECT, the patient is, for the first time, coming face-to-face with the gravity of his/her illness. And I don’t think that’s necessarily a bad thing at all.

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