Sunday, July 17, 2011

Electro Convulsive Therapy

Friday was a knockout, literally. It was a comedy of errors too. Thursday afternoon I was reading the case of two rabid dogs in Michigan. About 130 people were treated with post-exposure medication, causing quite a ruckus. So Friday morning I headed out to find a dead battery in my car. I hopped on my bike, rolled up my pant legs, pulled my socks over them like a Scottish school boy, and pedaled up the hill towards Northwest Hospital.

Off to the side of the busy street, under a Palo Verde, stood a leaning dog who in my mind looked rabid. You know the dogs that kill in "Lady in the Water?" This is what it looked like. And he charged...

So there I am kicking the dog with my Scottish school boy leg while pedaling up hill trying to get to the hospital on time. Dr. Weigand, concerned, called for my whereabouts.

"I'm on my bike...should be....there....soon!"

And I was. And it was a fun day. After two weeks of non-procedural work I was given the crash course to electro convulsive therapy. As hands on as you can get in psychiatry. In a nutshell, this procedure is for those with major depressive disorder, schizophrenia, OCD, and bipolar mania who do not respond well to medication. It can also be used in the autistic spectrum of patients. It basically involves applying a surge of electricity to the brain of patients, inducing a real seizure.

It's a factory, filing patients through quickly. Nurses prep the patients in their gowns. Then we ask the patients how they're feeling, why they are here, what meds they are on, what concerns they have. Then the anesthesiologist puts them under. Following that, we apply gel to two pads for good conduction, and stick two paddles on opposite sides of the head. "In between the tragus of the ear and the eye, and one inch superior." After the paddles are applied, we hit the big yellow button, and a patient seizes, usually from 10 to 30 seconds. Of note, we use caffeine to lower the seizure threshold. Think about that before your next Pepsi, though you'd have to drink 12 Pepsis to equal the dose administered.

Included is a picture of the seizure of a man from whom I applied the paddles. It was a remarkable experience. I also walked away thinking it was under-utilized. We medicate so many but ECT has proven un-harmful and beneficial. One mom flies her son out for daily treatments, from California. California HMOs do not support ECT. So this mom pays $1500 per treatment and sleeps up at Star Pass Resort. She has some money for her autistic son, thankfully.

Twice in the morning were cultural references to "One Flew Over the Cuckoo's Nest." So I need to watch it.

An amazing morning of medicine in practice.

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