TMS? What the hell is that? Day 1

Day 1: I headed to my appointment for my first TMS treatment starting at about 8:10 for a 9:30 appointment. Though I’m only 13 miles away, I knew Seattle traffic. I should always plan an extra 30 minutes since I’m headed downtown. Not just for traffic, but I’m likely to get myself lost. Which I did. And I hit a stupid pylon in the parking garage so going into my treatment today I was worked up into panic mode.

So what is TMS? Well, it stands for transcranial magnetic stimulation. Why am I doing TMS? Well, I suffer from depression and anxiety due to a long morbid history, see my other blog posts, and so far I’m not getting the relief I need to have the life I know I can. I have tried everything so far that I can. So this is the next step. Trust me, I was extremely hesitant to take this step being a former ECT patient who has memory loss. The thought of messing with my brain anymore is scary. So are psychiatric medications or other drugs.

I wasn’t actually too anxious about trying this treatment, everything I read it was like being in an MRI kind of, just a lot more personal. Well I’ve had quite a few MRIs in my life so I knew I could handle that, I can even fall asleep in an MRI machine!

Anyways, I get in there, the office has the front desk and the waiting room separated by glass doors, which I found strange but then again, they have the coils going in multiple rooms so maybe its to protect waiting patients from that noise. I sat in the waiting room signing documents, fretting over the front bumper of my car, freaking out about what my husband is going to say, wondering if I double booked some appointments for the rest of the day or the next day, hmm was I missing an appointment on Friday? But I have TMS for the rest of the week. Yes that’s right, I have TMS treatments for an hour, five days a week, for six weeks. That is a lot. Let me ask you this though, if your anxiety and depression could go into remission for a longer period of time with six weeks of daily treatments versus being on high doses of medications for the rest of your life, would you take it? I would, well I am. I’m rambling…thank you ADD! I love you too.

One of the other patients kept glancing my way, I wasn’t quite sure what to make of it. She went back before I did, and my thoughts moved on elsewhere. Soon after 9:30 I was called back by the TMS tech that I was going to be with today, she was pretty and friendly. I’d seen her at the other office before, she’d changed her hair. We walked to the room and she had me put my stuff to the side, there was a chair, just like a dental chair, a computer on a mobile cart, and the TMS machinery in back behind the chair. I forgot to take off my glasses, no metal near the magnetic coils, so I get back up and put them in my purse. I brought a book with me just incase I needed something to busy my mind, though I didn’t have much hope for that as it’s so hard to focus on reading anyways. The tech was talking with me and telling me what she was going to be doing while the doctor walked in with the gal from the waiting room. Aha! She was a student and was there for training. Okay, curiosity resolved and I could focus my attention on the doctor. He explained that the tech was going to be placing this fashionable, white cap on my head to make measurements, at which point the tech started to do so. They were very clear that they were going to have to be up close and personal. He explained a little about the history of TMS, why they were making all the measurements they were. At one point the tech was doing one measurement in which she asked me to open and close my mouth, so while the doctor is standing there talking to me, with an intern watching, I look like a damn guppy. It was totally mortifying to me, but that’s just me. While she was still making the measurements I asked him about the difference between the bilateral and unilateral, since I was starting with bilateral I wanted to know a bit more. He seemed a bit surprised too that I was starting with bilateral and he confessed he didn’t read my actual consultations with my regular psychiatrist (she is his partner), so I explained a bit about my history (again see my other blog posts). He perfectly understood after my explanation why we went immediately to bilateral.

This is how it was explained to me essentially. TMS actually has been shown to affect the activity levels of neurons on the brain, in the hemispheres and areas where it is directed. When under going bilateral TMS, specifically High/Low, the left hemisphere is going to receive the High stimulation, which is about 10 taps (best word I can think of since it feels like something is tapping on your head) per second, to increase the activity levels on the left side of the prefrontal cortex. On the right side, they want to decrease activity levels for me, hence the Low. For the lowering of activity its about 1 tap per second.

Once they finally have all the measurements made now we have to find my threshold. So they use a specific coil with apparatus for measurement and marking that does only single taps to determine the strength/frequency that is needed. They do this by placing this special coil at a point in the brain that when at the right frequency will make your fingers in your right hand twitch involuntarily. It was interesting sitting there with the doctor moving this coil over my head, centimeter by centimeter asking the tech if my fingers twitched. They started the frequency at 50, the usual is between 50-70, and eventually we ended up around 59. The whole time I was wondering if I was going to respond at a normal level, because lets faced it my head is pretty messed up.

They mark the placement where my fingers twitched about 50% of the time and drew some more on my head on the left, then mirrored it on the right. They do not do both sides at the same time at the facility I went to, so I would be doing 15 minutes on the left and then 15 minutes on the right. Sometimes they start with the right, since its slower and such, but they decided to start on the left today. I’m special. 😀 At this point I put my ear plugs in, and drowned out the rest of the conversations that were no longer directed at me since the intern was asking the doctor questions and the tech was setting my chair up, putting the headrest in a comfortable position and leaning me back just a little.

Then they placed the heavy coil against the left side of my head, along the top, and a little forward. It wasn’t uncomfortable and they didn’t need to strap it as its on an adjustable stand. This also means I have to be careful not to move out of place or it won’t be in the correct position, well as some one with ADD, sitting still can be hard and I’ve been sitting still for a long time now. They are ready to start the treatment, I give them a big smile and say okay.

I get to feel actual TMS for the first time. It was slightly unnerving. Which they told me to expect. On the left side I would akin it to a woodpecker pecking at my head or a child drumming a pencil on my head rapidly. Kind of a flick/thunk, a flunk! I could feel some pain behind my eye, which they had told me was possible, once I said something they moved the coil around till that sensation was gone, its just a nerve being hit by the stimulus, nothing more. Once that was resolved, I then had pain in some of my teeth, so again, the tech moved the machine minutely and it resolved. It was a little irritating to be honest. I’m not going to lie about that, I wanted to brush it away but I sat as still as I could and usually just closed my eyes and breathed. Again it was not painful, only a little irritating. Just imagine that small child thunking you on the head for fifteen minutes. I will point out that for 1 second its 10 taps, then its a second break before the next tapping. It seemed to be taking a long time, but truly before I knew it I was done on the left side. She made sure I was doing well, didn’t need a break and we moved to the right side.

The right side was very different. I even felt tingly at one point. It was like a nice steady metronome. When I mentioned that to the tech she laughed and said that  she had never heard of anyone call it that, but that it was a very good analogy. By the end of the 15 minutes I actually felt a bit drowsy, calm. Whoa. Of course I told myself its just a placebo effect. It was over. She placed my fashionable, artistic cap in a bag with ear plugs for me the next day, wished me well and she would see me soon. As I was walking out, a little lighter, I asked the front desk if I needed to do anything to check out, nope! I was all good. And off I went. That was the end of my first day of TMS treatment.

I got out to my car, surveyed the damaged I had done to it parking once again and took a deep breath. I was okay. No panic. Now I don’t think TMS works that fast, but it certainly didn’t hurt.

I will see how tomorrow’s treatment goes! Day 2 TMS here I come!




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