And speaking of running with it, CONGRADULATIONS BOSTON!!!

Had my 5th treatment today and all I can say is there's nothing here but upside folks (meaning it's all positive as far as I can tell). RUN - do not walk to get treated here as quickly as possible and get out of pain or at least get to a much more manageable level of pain!!!

Jan,

GREAT NEWS!!!!!
Thanks for keeping us posted

and MIKE
Those Celtics did indeed "run with it"
They were AMAZING :p:cool::D:):)
Our Lakers didn't have a chance :(

peeeeaaaaccceee

GnP:)

I'm disappointed to say that I'm logging back in today in order to report that this last treatment (on Friday the 20th) did not go well - pain in my knee actually increased rather than decreasing. Moreover, this time I am indeed experiencing noticeable and uncomfortable problems with short term memory loss and reliability. According to my partner (who is generally more attuned to these things than I) there has been noticeable memory dropout occurring since somewhere around the 3rd or 4th treatment.

Impact is enough that I won't be having any more treatments and am hoping that it clears up quickly now that we have stopped treatments. :(

Dear Jan -

PLEASE do not drop out without talking to your psychiatrist. It is my understanding that unless ketamine is used as the general anesthetic, a temporary loss in short term memory almost always "goes with the territory" of RUL ECT, but one recovers from it after 4 - 6 weeks. (This is in marked distiction to BL ECT, where there can be permanent retrograde amnesia.)

Frankly, I'm somewhat surprized that your practitioner didn't mention this up front. But seriously, it is not to worry.:grouphug:

Mike

Hi Mike,

Yes, they did mention it up front. And yes, I understood it to be temporary. But that will be the end of treatments for me.

Dear Jan -

I'm sorry, but not sure that I'm entirely following. Where short-term memory loss issue is apparently temporary, I am assuming that the return of the knee pain has been particularly discouraging. Is that correct?

If so, let me be forward enough to suggest something of a paradox. And here I don't mean to be intrusive, but if the return of your physical pain is largely driving your decision to opt out out of futher ECT therapy, do you have any sense of the extent to which your affect is playing a role in the weighting of the knee pain in your decision making? As opposed, for instance, to hanging in there a couple of more rounds just to see what happens, where you've already gotten substantial pain relief, bearing in mind the finding of Wasan, Artin and Clark that the analgesic and anti-depressive effects of ECT are substantially independent.

Just total speculation on my part, so take it for whatever it's worth. I wish you nothing but good things and a speedy recovery from your short-term memory loss, and my thanks for your courage in sharing your experience with us.

Mike

Mike, et. al.,

I think there's a bit of misunderstanding afoot here. Am not leaving because the pain in my knee got worse (temporarily) but because I already felt that I had gotten all the benefit I was going to get here and was merely doing a few more treatments to "feather it out" as the ECT specialist put it before ending things. When the memory problems started showing up I merely decided that they were unpleasant enough that it wasn't worth "feathering it out" and I'd had enough.

With the benefit of hindsight, I could have stopped after the first couple of treatments and gotten the same analgesic effects. Actually I think I got almost all of the pain relief realized with the very first treatment ... just wanted to make sure.

Dear Jan -

The only reason for my inquiry is that there is in fact evidence in the literature as to when and how there is a positive response to ECT, in terms of pain levels, and it is frequently progressive over time:

There was a progressive lessening of pain over the course of ECT treatment. A course of 8 bilateral ECT treatments resulted in a dramatic reduction in pain.

"Case Reports: Chronic Pain With Beneficial Response to Electroconvulsive Therapy and Regional Cerebral Blood Flow Changes Assessed by Single Photon Emission Computed Tomography," Sei Fukui, M.D., Ph.D., Shino Shigemori, M.D., Atsushi Yoshimura, M.D., and Shuichi Nosaka, M.D., Ph.D., Regional Anesthesia and Pain Medicine, Vol 27, No 2 (March–April), 2002: pp 211–213 at 212; "Electroconvulsive Therapy in Complex Regional Pain Syndromes," William W. McDaniel, MD, J ECT 2003;19:226–229 (reporting on one of three participants in ECT treatments for pain co-morbid with major depressive episodes):

Her right arm had been injured in a motor vehicle accident 5 years earlier, and although the multiple fractures had healed, she developed severe CRPS and her dominant right hand was crippled by joint contractures. She listed the pain and disability as the most important stressors contributing to the depression. She was hospitalized with suicide precautions. Her ineffective antidepressant medications were discontinued. She was treated with a series of 12 treatments of ECT with bitemporal electrode placement under anesthesia with methohexital 80 mg and succinylcholine 80 mg. Her ECT was performed using the MECTA SR-1 using a dose titration protocol with the dose set just above the seizure threshold. The treatments were well tolerated, and she demonstrated improvement in mood beginning by about the third treatment. Her immobile right hand began to move after the fifth treatment, and physical therapy was initiated. By the 10th treatment, the pain, stiffness, discoloration, and coldness had resolved. By the 12th treatment, the remission in her depressive symptoms seemed stable, with normal sleep, appetite, and concentration, and treatments were discontinued.

Finally, in their 1993 study:

King and Nuss reported the case of a 32-year-old woman status post left arm injury and arthroscopic repair of ligament damage. She subsequently developed reflex sympathetic dystrophy of the left arm characterized by weakness, piloerection, swelling, decreased range of motion, discoloration, hyperesthesia, and disability from work and sports activities. She became depressed and was admitted to a psychiatric unit. Behavioral pain management approaches, antidepressant medication, and stellate ganglion block did not help, and after a suicide attempt, ECT was commenced. For 12 hours after the first treatment, the arm was normal in function, pain free, and not discolored. Over the course of the next seven treatments, the period of improvement steadily increased. On 6-month follow-up, the patient’s arm remained normal in function and without the objective physical stigmata of reflex sympathetic dystrophy. [Emphasis added.]

"Reflex sympathetic dystrophy treated by electroconvulsive therapy: intractable pain, depression, and bilateral electrode ECT," King JH, Nuss S: . Pain 1993, 55:393–396, as cited in "Electroconvulsive Therapy in the Management of Chronic Pain," Rasmussen KG and Rummans TA, Current Pain and Headache Reports 2002 6:17-22 at 20.

I share these for whatever they are worth and, as always, would be happy to email copies of the articles to anyone who's interested.

Mike

Thanks Mike - good point! Originally we had planned to do 12 treatments for that very reason ... because it looked to be the outer edge of progressive relief being realized. Just didn't work out that way for me, but certainly may for others.