Monday, February 29, 2016

Transcranial Brain Stimulation, Part 1

I want you to know that you can call me Jim (not his real name), he began. I'm often wary of people who seek to immediately gain my trust by using casual informality. My first thought was to dismissively label him a dude-bro and then reflexively discount everything else he had to say. But the doctor seemed to be genuine enough. He was surely young, almost my age, barely forty if he was that. In spite of my skepticism, I found that I liked him, in spite of my first few reservations.

He clearly wanted to be viewed as cool and cutting-age, intentionally throwing out a few choice profanities and hip references to pop culture. He was a rebel with a medical license, but made sure that he could never be confused as an unprincipled practitioner consumed with profit at the expense of patient safety. He knew the rules and didn't deviate from them, but didn't want to be stuffy, pedantic, and overly consumed with professionalism. It was a nice change from the routine.

The FDA approved transcranial brain stimulation for treatment resistant depression in 2013. I neatly fit the established parameters for candidacy and began my sessions immediately following evaluation this morning. If I was feared to be in danger of developing mania at any point, I would have been disqualified. Mania is not a truly natural state for me. It is created artificially by antidepressant usage and now I'm beginning to wonder whether my diagnosis as bipolar is even accurate. The psychiatrist I consulted today believed that I'd been misdiagnosed all along. Now I have more questions to ask to a very different set of doctors.

In time, I'll hopefully begin to experience the cumulative effects of each day's treatment. Between 67% and 80% of those who undergo TMS experience a net gain. Exposing the brain to concentrated bursts of magnetic force feels a bit like an extended MRI. I know today that something of consequence occurred, but I can't say for sure what it is. As almost goes without saying, brain function and dysfunction is not understood well by modern medicine. After a while, I'll make a few credible educated guesses regarding my treatment, but those will have to suffice until humanity has a greater grasp of the matter.  

In an expensive specialty clinic, a doctor and his staff have license to work at their own pace. No one was rushed or hurried. Customer service was spectacular and it was clear that everyone who was employed there was glad to have such a cushy job. Most psychiatrists out in the greater world have substantial caseloads, tons of stress, and are required to be jacks of all trades. I can better understand now why doctors enter specialty practice fields like these. No matter what reform legislation and policy is adopted, it will be impossible to prevent doctors from taking this avenue. The everlasting dollar will always speak loudest.

I felt, if you want to know, spoiled rotten. I know that in most respects I'll never be rich enough or well-connected enough to know the trappings of luxury. Yet, in only one area, healthcare, I have the health insurance and ability to pay for lavish, but effective treatments that can be ill-afforded by most ordinary people. This is not a frivolous undertaking, but it is a treatment modality that simply isn't an option for the average person.

I fully expect to see overwhelmingly positive results in a way that medication cannot provide, but the air of exclusivity that goes along with the privilege is what troubles me most. Only in America does a single ambulance ride cost $500 and a single aspirin at an emergency room cost $20. This is what has to change before we attempt any subsequent reform, single payer or not.  

I don't want to be seen as protesting too much. It, quite simply, bothers me how much money factors into the equation. A not-for-profit system would be hard pressed to keep up pace with private coverage. We already see this with private carriers versus Medicare.

This particular clinic has one function and one function alone, to perform a single procedure. A conventional doctor of any specialization must treat a broad spectrum of ailments and complaints. He or she usually has to work within the highly bureaucratic confines of a hospital or medical system. Private clinics like these eliminate the middle man. Without insurance, each TMS session costs $250. A full set of thirty-six procedures costs $12,500.

An hour long synopsis of the ins and outs of the procedure came first. I was asked to choose between two machines that performed a similar function, but in two very different ways. The older method took between fifty and fifty-five minutes from start to finish and was limited in how it targeted brain function. The newer method, developed three years ago by Israeli engineers, took only twenty minutes and stimulated more than one particular area of the brain. I couldn't decide between them and was assigned the most recent advancement by the psychiatrist who oversaw my case.

The sensation is peculiar. It reminds one of a pulsating out-of-control metronome or a chicken pecking aggressively upon one's head. The process increases brain activity, but primarily focuses on the area of that crucial organ that the forehead and cranium conceal from sight. Before anything proceeded, I was donned with a form-fitting blue cap that made me look like a Apollo-era astronaut.

A plastic bubble was placed around my head. At the count of three, magnetic impulses pulsed through the brain in quick bursts, causing everything from my scalp to my bottom set of teeth to briefly flex and then swiftly snap back into place. Though uncomfortable at first, the brain quickly adapted to the sensation.  

Twenty minutes later, the process was over. The brain felt fatigued in some weird way. I staggered out the door into the bright sunlight, feeling the impact. In a relatively short period of time, the brain had been, in effect, forced to run on a treadmill. I'll return to the clinic every day during the week, Monday-Friday, for a little over a month. My commute to and from the office is going to be extremely familiar for a good long while.

No comments: