Tardive Dyskinesia

Tardive dyskinesia is a side effect of antipsychotic medications. These drugs are used to treat schizophrenia and other mental health disorders.

TD causes stiff, jerky movements of your face and body that you can’t control. You might blink your eyes, stick out your tongue, or wave your arms without meaning to do so.

Not everyone who takes an antipsychotic drug will get it. But if it happens, it’s sometimes permanent. So if you have movements you can’t control, let your doctor know right away. To ease your symptoms, your doctor may:

• Lower the dose

• Add another medication to what you’re taking to act as an antidote

• Switch you to a different drug

Symptoms:

Tardive dyskinesia causes stiff, jerky movements that you can’t control. They include:

Orofacial dyskinesia or oro-bucco-lingual dyskinesia: Uncontrolled movements in your face — namely your lips, jaw, or tongue. You might:

• Stick out your tongue without trying

• Blink your eyes fast

• Chew

• Smack or pucker your lips

• Puff out your cheeks

• Frown

• Grunt

Dyskinesia of the limbs: It can also affect your arms, legs, fingers, and toes. That can cause you to:

• Wiggle your fingers

• Tap your feet

• Flap your arms

• Thrust out your pelvis

• Sway from side to side

These movements can be fast or slow. You may find it hard to work and stay active.

Causes and Risk Factors

Antipsychotic meds treat schizophrenia, bipolar disorder, and other brain conditions. Doctors also call them neuroleptic drugs.

They block a brain chemical called dopamine. It helps cells talk to each other and makes the muscles move smoothly. When you have too little of it, your movements can become jerky and out of control.

You can get TD if you take an antipsychotic drug. Usually you have to be on it for 3 months or more. But there have been rare cases of it after a single dose of an antipsychotic medicine. Older versions of these drugs are more likely to cause this problem than newer ones. Some studies find a similar risk from both types, though.

Your chances of getting TD go up the longer you take an antipsychotic medicine.

Some drugs that treat nausea, reflux, and other stomach problems can also cause TD if you take them for more than 3 months. These include:

• Metoclopramide (Reglan)

• Prochlorperazine (Compazine)

You’re more likely to get it if you:

• Are a woman who has gone through menopause

• Are over age 55

• Abuse alcohol or drugs

• Are African American or Asian American

Diagnosis

TD can be hard to diagnose. Symptoms might not appear until months or years after you start taking antipsychotic medicine. Or you might first notice the movements after you’ve already stopped taking the drug. The timing can make it hard to know whether the medicine caused your symptoms.

Abnormal Involuntary Movement Scale (AIMS): If you take medicine for mental health conditions, your doctor should check you at least once a year to make sure you don’t have TD. He can give you a physical exam called the Abnormal Involuntary Movement Scale, which will help him rate any abnormal movements.

Treatment and Prevention

The goal is to prevent TD. When your doctor prescribes a new drug to treat a mental health disorder, ask about its side effects. The benefits of the drug should outweigh the risks.

If you have movement problems, tell your doctor but don’t stop taking the drug on your own. Your doctor can take you off the medicine that caused the movements, or lower the dose.

You might need to switch to a newer antipsychotic drug that may be less likely to cause TD.

There are two FDA-approved medicines to treat tardive dyskinesia:

• Deutetrabenazine (Austedo)

• Valbenazine (Ingrezza)

Both of these medicines work in similar ways to regulate the amount of dopamine flow in brain areas that control certain kinds of movements. Both can sometimes cause drowsiness. Austedo also has been shown to sometimes cause depression when used in patients with Huntington’s disease.

There’s no proof that natural remedies can treat it.

Source: WebMD

Sylvia Plath

One of my favorite writers was born on this day in 1932, Sylvia Plath:

Sylvia Plath was an American poet, novelist, and short story writer. Born in Boston, Massachusetts she studied at Smith College and Newnham College. She married poet Ted Hughes in 1956 and had two children Frieda and Nicholas. After a long struggle with depression she committed suicide in 1963. To this day controversy surrounds both her life and death, as well as her writing and legacy. She along with some of her contemporaries (Anne Sexton and Robert Lowell among others) advanced the genre of confessional poetry. She is best known for her two collections of poetry “The Colossus and Other Poems,” and “Ariel,” as well as her semi-autobiographical novel “The Bell Jar.” In 1982 she became the first poet to win the Pulitzer Prize posthumously for “The Collected Poems of Sylvia Plath.”

Growing up in Winthrop, Massachusetts an eight year old Plath published her first poem in the children’s section of the “Boston Herald.” In addition to her writing, she showed a lot of promise as an artist winning an award for her painting from The Scholastic Art & Writing Awards in 1947. Her father died when she was eight due to untreated diabetes and led to her having a loss in faith and remained ambivalent about religion for the rest of her life. In 1942 her mother moved the family to Wellesley, Massachusetts.

In 1950 while attending Smith College she wrote to her mother, “The world is splitting open at my feet like a ripe, juicy watermelon.” The summer after her third year of college she spent a month in New York City as a guest editor of “Mademoiselle” magazine. It did not go as well as planned. That summer she was refused admission to the Harvard writing seminar and began an emotional downward spiral. In August 1953 she made her first suicide attempt by crawling under her house and taking her mother’s sleeping pills. She was not found for three days. Later she would write of the experience, “blissfully succumbed to the whirling blackness that I honestly believed was eternal oblivion.” She would spend the next six months at McLean Psychiatric Hospital. While under the care of Dr. Ruth Beuscher she would receive insulin and electric shock treatments. She appeared to recover and returned to Smith College.

Plath and English poet Ted Hughes were married on June 16th, 1956. Plath described Hughes as, “a singer, story-teller, lion and world-wanderer with a voice like the thunder of God.” In 1957 they moved to the United States with Plath first teaching at Smith College, and then moving to Boston in 1958 where she worked as a receptionist in the psychiatric unit at Massachusetts General Hospital while in the evening attending a creative writing class by Robert Lowell (Anne Sexton was also in attendance). During this time both Lowell and Sexton encouraged her to write from her own experience. She openly discussed her depression with Lowell, and her suicide attempt with Sexton. At this time she began to see herself as a more serious and focused poet and storyteller. She also began a lifetime friendship with the poet W. S. Merwin. In December she resumed her treatment with Dr. Ruth Beuscher.

In December of 1959 Plath and Ted Hughes moved to London. She remained anxious about writing confessional poetry from her own experience. Around this time she would explain that she learned, “to be true to my own weirdnesses.” In 1960 she released her first book of poetry. In 1961 her second pregnancy ended in a miscarriage, severely of her poems address this including, “Parliament Hill Fields.” In January of 1962 her son Nicholas was born. In June she was in a car accident which she would explain as one of her many suicide attempts. That July she would discover Ted Hughes was having an affair and they would separate in September.

Beginning in October of 1962 she would enter into the greatest burst of creativity of her career. It is at this time she would write almost all of the poems for which she is remembered and released posthumously in the collection “Ariel.” Her novel “The Bell Jar” came out in January 1963 to critical indifference. On February 11th, 1963 Plath was found dead having committed suicide by carbon monoxide poisoning in the kitchen with her head in the oven and the gas turned on. Hughes was devastated and in a letter wrote, “That’s the end of my life. The rest is posthumous.”

In the years following her death there were many accusations that Hughes had been abusive to Plath. The feminist poet Robin Morgan published a poem which openly accused Hughes of assault and her murder. In 1989 Hughes wrote an article in “The Guardian,” with this quote, “In the years soon after [Plath’s] death, when scholars approached me, I tried to take their apparently serious concern for the truth about Sylvia Plath seriously. But I learned my lesson early. […] If I tried too hard to tell them exactly how something happened, in the hope of correcting some fantasy, I was quite likely to be accused of trying to suppress Free Speech. In general, my refusal to have anything to do with the Plath Fantasia has been regarded as an attempt to suppress Free Speech […] The Fantasia about Sylvia Plath is more needed than the facts. Where that leaves respect for the truth of her life (and of mine), or for her memory, or for the literary tradition, I do not know.”

Hughes inherited the Plath estate and has been condemned in some circles for burning Plath’s last journal. He lost another journal and an unfinished novel and instructed a collection of her papers and journals should not be released until 2013. In 1998 he would publish a collection of poems called, “Birthday Letters,” which consists of 88 poems about his relationship with Plath. It would go on to win the Forward Poetry Prize, T.S. Eliot Prize for poetry, and the Whitebread Poetry Prize. He would die later that year of cancer.

A couple of quotes :

“If you expect nothing from anybody, you’re never disappointed.”

“Perhaps when we find ourselves wanting everything, it is because we are dangerously close to wanting nothing.”

“Death must be so beautiful. To lie in the soft brown earth, with the grasses waving above one’s head, and listen to silence. To have no yesterday, and no to-morrow. To forget time, to forgive life, to be at peace.”

~ Sylvia Plath

Tulips – By Sylvia Plath

The tulips are too excitable, it is winter here.

Look how white everything is, how quiet, how snowed-in

I am learning peacefulness, lying by myself quietly

As the light lies on these white walls, this bed, these hands.

I am nobody; I have nothing to do with explosions.

I have given my name and my day-clothes up to the nurses

And my history to the anaesthetist and my body to surgeons.

They have propped my head between the pillow and the sheet-cuff

Like an eye between two white lids that will not shut.

Stupid pupil, it has to take everything in.

The nurses pass and pass, they are no trouble,

They pass the way gulls pass inland in their white caps,

Doing things with their hands, one just the same as another,

So it is impossible to tell how many there are.

My body is a pebble to them, they tend it as water

Tends to the pebbles it must run over, smoothing them gently.

They bring me numbness in their bright needles, they bring me sleep.

Now I have lost myself I am sick of baggage —-

My patent leather overnight case like a black pillbox,

My husband and child smiling out of the family photo;

Their smiles catch onto my skin, little smiling hooks.

I have let things slip, a thirty-year-old cargo boat

Stubbornly hanging on to my name and address.

They have swabbed me clear of my loving associations.

Scared and bare on the green plastic-pillowed trolley

I watched my teaset, my bureaus of linen, my books

Sink out of sight, and the water went over my head.

I am a nun now, I have never been so pure.

I didn’t want any flowers, I only wanted

To lie with my hands turned up and be utterly empty.

How free it is, you have no idea how free —-

The peacefulness is so big it dazes you,

And it asks nothing, a name tag, a few trinkets.

It is what the dead close on, finally; I imagine them

Shutting their mouths on it, like a Communion tablet.

The tulips are too red in the first place, they hurt me.

Even through the gift paper I could hear them breathe

Lightly, through their white swaddlings, like an awful baby.

Their redness talks to my wound, it corresponds.

They are subtle: they seem to float, though they weigh me down,

Upsetting me with their sudden tongues and their colour,

A dozen red lead sinkers round my neck.

Nobody watched me before, now I am watched.

The tulips turn to me, and the window behind me

Where once a day the light slowly widens and slowly thins,

And I see myself, flat, ridiculous, a cut-paper shadow

Between the eye of the sun and the eyes of the tulips,

And I hve no face, I have wanted to efface myself.

The vivid tulips eat my oxygen.

Before they came the air was calm enough,

Coming and going, breath by breath, without any fuss.

Then the tulips filled it up like a loud noise.

Now the air snags and eddies round them the way a river

Snags and eddies round a sunken rust-red engine.

They concentrate my attention, that was happy

Playing and resting without committing itself.

The walls, also, seem to be warming themselves.

The tulips should be behind bars like dangerous animals;

They are opening like the mouth of some great African cat,

And I am aware of my heart: it opens and closes

Its bowl of red blooms out of sheer love of me.

The water I taste is warm and salt, like the sea,

And comes from a country far away as health.

#SylviaPlath #Poet #Author #MentalHealth #ABellJar

Transcranial magnetic stimulation (TMS)

Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. TMS is typically used when other depression treatments haven’t been effective.

This treatment for depression involves delivering repetitive magnetic pulses, so it’s called repetitive TMS or rTMS.

How it works

During an rTMS session, an electromagnetic coil is placed against your scalp near your forehead. The electromagnet painlessly delivers a magnetic pulse that stimulates nerve cells in the region of your brain involved in mood control and depression. It’s thought to activate regions of the brain that have decreased activity in depression.

Though the biology of why rTMS works isn’t completely understood, the stimulation appears to impact how the brain is working, which in turn seems to ease depression symptoms and improve mood.

There are different ways to perform the procedure, and techniques may change as experts learn more about the most effective ways to perform treatments.

Why it’s done

Depression is a treatable condition, but for some people, standard treatments aren’t effective. Repetitive TMS is typically used when standard treatments such as medications and talk therapy (psychotherapy) don’t work.

Risks

Repetitive TMS is a noninvasive form of brain stimulation used for depression. Unlike vagus nerve stimulation or deep brain stimulation, rTMS does not require surgery or implantation of electrodes. And, unlike electroconvulsive therapy (ECT), rTMS doesn’t cause seizures or require sedation with anesthesia.

Generally, rTMS is considered safe and well-tolerated. However, it can cause some side effects.

Common side effects

Side effects are generally mild to moderate and improve shortly after an individual session and decrease over time with additional sessions. They may include:

• Headache

• Scalp discomfort at the site of stimulation

• Tingling, spasms or twitching of facial muscles

• Lightheadedness

Your doctor can adjust the level of stimulation to reduce symptoms or may recommend that you take an over-the-counter pain medication before the procedure.

Uncommon side effects

Serious side effects are rare. They may include:

• Seizures

• Mania, particularly in people with bipolar disorder

• Hearing loss if there is inadequate ear protection during treatment

More study is needed to determine whether rTMS may have any long-term side effects.

What you can expect

Repetitive TMS is usually done in a doctor’s office or clinic. It requires a series of treatment sessions to be effective. Generally, sessions are carried out daily, five times a week for four to six weeks.

Your first treatment

Before treatment begins, your doctor will need to identify the best place to put the magnets on your head and the best dose of magnetic energy for you. Your first appointment typically lasts about 60 minutes.

Most likely, during your first appointment:

• You’ll be taken to a treatment room, asked to sit in a reclining chair and given earplugs to wear during the procedure.

• An electromagnetic coil will be placed against your head and switched off and on repeatedly to produce stimulating pulses. This results in a tapping or clicking sound that usually lasts for a few seconds, followed by a pause. You’ll also feel a tapping sensation on your forehead. This part of the process is called mapping.

• Your doctor will determine the amount of magnetic energy needed by increasing the magnetic dose until your fingers or hands twitch. Known as your motor threshold, this is used as a reference point in determining the right dose for you. During the course of treatment, the amount of stimulation can be changed, depending on your symptoms and side effects.

During each treatment

Once the coil placement and dose are identified, you’re ready to begin. Here’s what to expect during each treatment:

• You’ll sit in a comfortable chair, wearing ear plugs, with the magnetic coil placed against your head.

• When the machine is turned on, you’ll hear clicking sounds and feel tapping on your forehead.

• The procedure will last about 40 minutes, and you’ll remain awake and alert. You may feel some scalp discomfort during the treatment and for a short time afterward.

After each treatment

You can return to your normal daily activities after your treatment. Typically, between treatments, you can expect to work and drive.

Results

If rTMS works for you, your depression symptoms may improve or go away completely. Symptom relief may take a few weeks of treatment.

The effectiveness of rTMS may improve as researchers learn more about techniques, the number of stimulations required and the best sites on the brain to stimulate.

Ongoing treatment

After completion of an rTMS treatment series, standard care for depression ― such as medication and psychotherapy ― may be recommended as ongoing treatment.

It’s not yet known if maintenance rTMS sessions will benefit your depression. This involves continuing treatment when you are symptom-free with the hope that it will prevent the return of symptoms.

However, if your depression improves with rTMS, and then later you have another episode of symptoms, your rTMS treatment can be repeated. This is called re-induction. Some insurance companies will cover re-induction.

If your symptoms improve with rTMS, discuss ongoing or maintenance treatment options for your depression with your doctor.

Source: The Mayo Clinic

Marguerite Porete

Marguerite Porete (?-1310)

Marguerite Porete was a French mystic and the author of “The Mirror of Simple Souls.” It is a Christian Spiritual work concerning divine love. When she refused to remove her book form circulation and recant her views she was burned at the stake as a heretic in 1310. Little is known of her life except through her trial for heresy and it is certainly biased and incomplete. She has been a rather obscure figure until recent years as until 1946 her work had been published anonymously since her death.

Porete was officially warned by the Church that her works were heretical and they were publically burned by the Bishop of Cambrai. She had written her book in Old French as opposed to Latin and was ordered not to circulate her ideas ever again. She was eventually arrested by the local inquisitor. Twenty-one theologians scoured her book for evidence of heresy. In the end three bishops passed final judgment on her. After a year and a half in prison in Paris her trial began. She refused to recant her ideas or cooperate with the authorities. Because she did not recant she was found guilty and burnt at the stake. As she died the crowd is said to have been moved to tears by her calmness.

“The Mirror of Simple Souls,” is an allegorical conversation between Love, Reason, Soul, and Truth. It deals with Porete’s belief that when the soul is full of God’s love it is united with God and in a union which transcends the contradictions of the world. In this state one cannot sin because the soul is united with God’s will and incapable of such. A few quotes:

“O Truth, says this Soul, for god’s sake, do not say
That of myself I might ever say something of Him,
save through Him;
And this is true, do not doubt it,
And if it pleases you to know whose I am,
I will say it through pure courtesy:
Love holds me so completely in her domain,
That I have neither sense, nor will,
Nor reason to do anything,
Except through her, as you know.”

“Theologians and other clerks,
You won’t understand this book,
— However bright your wits —
If you do not meet it humbly,
And in this way, Love and Faith
Make you surmount Reason, for
They are the protectors of Reason’s house. ”

“God has nowhere to put his goodness, if not in me no place to put himself entire, if not in me. And by this means I am the exemplar of salvation, and what is more, I am the salvation itself of every creature, and the glory of God.”
~ Marguerite Porete

Hildegard of Bingen

Hildegard of Bingen (circa 1098-1179)

Hildegard of Bingen was a German writer, composer, philosopher, Christian mystic, Benedictine abbess, visionary and polymath (a person whose expertise spans a significant number of different subject areas. An example of another famous polymath would be Leonardo da Vinci). She wrote theological, botanical, and medicinal texts, as well as letters, liturgical songs, poems, a morality play, also supervising over miniature illuminated manuscripts. Her morality play is the oldest surviving example of its form. In 1136 she was elected a magistra (teacher) by her fellow nuns. In 1150 she founded the monastery of Rupertsberg and in 1165 Eibingen.

It is believed she was born about 1098, but the exact date of her birth is unknown. She was the tenth child of a family of free nobles and was sickly from birth. From a very young age Hildegard experienced visions. Perhaps due to her visions her parents offered her as a tithe to the church. Her enclosure date is cloudy and there is no written record of the next twenty-four years of her life in the convent. She was enclosed with another girl Jutta who also had visions and attracted many visitors. Jutta taught her to read and write, but not how to interpret biblical meaning. The two of them likely prayed, meditated, read scripture and did some type of handwork together. It is also believed it was at this time she learned to play the ten string psaltery. Upon Jutta’s death in 1136 Hildegard was unanimously elected magistra of her community by her fellow nuns. She wanted more independence and requested Abbot Kuno to be able to move the convent to Rupertsberg. This was to be a move towards poverty. She was denied. Hildegard in return went over his head and was granted permission from the archbishop. In 1150 Hildegard and twenty nuns made the move and were granted their own monastery.

At age 43 she received a vision from God to write down all that she had seen. Her first book the “Scivias” (Know the Ways) was the result. In it she described her struggles from within:
“But I, though I saw and heard these things, refused to write for a long time through doubt and bad opinion and the diversity of human words, not with stubbornness but in the exercise of humility, until, laid low by the scourge of God, I fell upon a bed of sickness; then, compelled at last by many illnesses, and by the witness of a certain noble maiden of good conduct [the nun Richardis von Stade] and of that man whom I had secretly sought and found, as mentioned above, I set my hand to the writing. While I was doing it, I sensed, as I mentioned before, the deep profundity of scriptural exposition; and, raising myself from illness by the strength I received, I brought this work to a close – though just barely – in ten years. […] And I spoke and wrote these things not by the invention of my heart or that of any other person, but as by the secret mysteries of God I heard and received them in the heavenly places. And again I heard a voice from Heaven saying to me, ‘Cry out therefore, and write thus!”

In addition to her writing she composed sixty-nine musical compositions including the oldest surviving morality play “Ordo Virtutum.” This is one of the largest outputs among all medieval composers. She also wrote over 400 letters to people ranging from Popes, Emperors, abbots, and abbesses. In addition she wrote two volumes on natural medicines and cures, an invented language called, “Lingua ignota,” a gospel commentary, two works of hagiography (writings about holy people such as saints), and finally three volumes of visionary theology : the “Scivias (Know the Ways)”, “Liber vitae meritorum (Book of Life’s Merits)” and “Liber divinorum operum (Book of Divine Works)”. In each of these texts she first describes the vision and then interprets them throughout the Bible. The books were celebrated in the Middle Ages in part because of the approval given by Pope Eugenius III. She also wrote “Physica” and “Causae at Curae”. Well known for her healing ability in these texts she describes the natural world including the cosmos, animals, plants, stones and minerals. She particularly focused on the healing abilities of plants, animals and stones. She also created her own alphabet with abridged words of a form of Latin. It is believed she used this alphabet to increase solidarity among her nuns.

Her belief was man and woman had complimentary roles and wrote:

“Man and woman are in this way so involved with each other that one of them is the work of the other. Without woman, man could not be called man; without man, woman could not be named woman. Thus woman is the work of man, while man is a sight full of consolation for woman. Neither of them could henceforth live without the other. Man is in this connection an indication of the Godhead while woman is an indication of the humanity of God’s Son”
~ Hildegard of Bingen

Schizophrenia and Breakthrough Symptoms

This seems like a good time to discuss breakthrough symptoms of schizophrenia. This is not easy for me to admit, but important if I want people to understand what it’s like to have a psychotic disorder.

“People can be on the best psychotropic medication targeting a mental health disorder and still experience disruptive and paralysing symptoms. These breakthrough symptoms can be voices, delusions, paranoia, anxiety, or perhaps even depressive features that go unchallenged and uncontrolled by medication. Breakthrough symptoms can be very disturbing, and demoralising, due to the chronic, sporadic, and their seemingly unpredictable nature. This type of symptom activation can be triggered by something external.”

~ psychreg.org

I’ve been feeling numb for a few weeks now and hoping to control it through positive coping strategies such as increased meditation as I did not want to go through a med change of increasing my antipsychotic medication.

It didn’t work and this past week breakthrough symptoms of thought broadcasting and thought insertion which drives my paranoia continued rising to the level of needing a change. After consultation with my psychiatrist I’ve increased my antipsychotics, anti-anxiety medications and one on my antidepressants which is a noradrenergic and specific serotonergic antidepressant (NaSSA) and encourages sleep, i.e. drowsiness is one of it’s side effects.

My breakthrough symptoms can best be summed up as more invasive auditory hallucinations, paranoia and delusions that people can read my mind and insert thoughts into my head against my will. At this time I realize it is just a delusion and not real. If I didn’t make the med change it wouldn’t be long before I believed my delusions despite all evidence to the contrary which would probably require hospitalization. The med change will probably take a couple of weeks until I am completely back at my baseline. It’ll be an interesting couple of weeks, but this is part of the reality of living with a severe mental illness.

#MySchizLife #BreakthroughSymptoms #PsychoticDisorders

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions.

ECT often works when other treatments are unsuccessful and when the full course of treatment is completed, but it may not work for everyone.

Much of the stigma attached to ECT is based on early treatments in which high doses of electricity were administered without anesthesia, leading to memory loss, fractured bones and other serious side effects.

Why it’s done

Electroconvulsive therapy (ECT) can provide rapid, significant improvements in severe symptoms of several mental health conditions. ECT is used to treat:

• Severe depression, particularly when accompanied by detachment from reality (psychosis), a desire to commit suicide or refusal to eat.

• Treatment-resistant depression, a severe depression that doesn’t improve with medications or other treatments.

• Severe mania, a state of intense euphoria, agitation or hyperactivity that occurs as part of bipolar disorder. Other signs of mania include impaired decision-making, impulsive or risky behavior, substance abuse, and psychosis.

• Catatonia, characterized by lack of movement, fast or strange movements, lack of speech, and other symptoms. It’s associated with schizophrenia and certain other psychiatric disorders. In some cases, catatonia is caused by a medical illness.

• Agitation and aggression in people with dementia, which can be difficult to treat and negatively affect quality of life.

ECT may be a good treatment option when medications aren’t tolerated or other forms of therapy haven’t worked. In some cases ECT is used:

• During pregnancy, when medications can’t be taken because they might harm the developing fetus

• In older adults who can’t tolerate drug side effects

• In people who prefer ECT treatments over taking medications

• When ECT has been successful in the past

Risks

Although ECT is generally safe, risks and side effects may include:

• Confusion. Immediately after treatment, you may experience confusion, which can last from a few minutes to several hours. You may not know where you are or why you’re there. Rarely, confusion may last several days or longer. Confusion is generally more noticeable in older adults.

• Memory loss. Some people have trouble remembering events that occurred right before treatment or in the weeks or months before treatment or, rarely, from previous years. This condition is called retrograde amnesia. You may also have trouble recalling events that occurred during the weeks of your treatment. For most people, these memory problems usually improve within a couple of months after treatment ends.

• Physical side effects. On the days of an ECT treatment, some people experience nausea, headache, jaw pain or muscle ache. These generally can be treated with medications.

• Medical complications. As with any type of medical procedure, especially one that involves anesthesia, there are risks of medical complications. During ECT, heart rate and blood pressure increase, and in rare cases, that can lead to serious heart problems. If you have heart problems, ECT may be more risky.

What you can expect

The ECT procedure takes about five to 10 minutes, with added time for preparation and recovery. ECT can be done while you’re hospitalized or as an outpatient procedure.

Before the procedure

To get ready for the ECT procedure:

• You’ll have general anesthesia. So you can expect dietary restrictions before the procedure. Typically, this means no food or water after midnight and only a sip of water to take any morning medications. Your health care team will give you specific instructions before your procedure.

• You may have a brief physical exam.This is basically to check your heart and lungs.

• You’ll have an intravenous (IV) line inserted. Your nurse or other team member inserts an IV tube into your arm or hand through which medications or fluids can be given.

• You’ll have electrode pads placed on your head. Each pad is about the size of a silver dollar. ECT can be unilateral, in which electric currents focus on only one side of the brain, or bilateral, in which both sides of the brain receive focused electric currents.

Anesthesia and medications

At the start of the procedure, you’ll receive these medications through your IV:

• An anesthetic to make you unconscious and unaware of the procedure

• A muscle relaxant to help minimize the seizure and prevent injury

You may receive other medications, depending on any health conditions you have or your previous reactions to ECT.

Equipment

During the procedure:

• A blood pressure cuff placed around one ankle stops the muscle relaxant medication from entering your foot and affecting the muscles there. When the procedure begins, your doctor can monitor seizure activity by watching for movement in that foot.

• Monitors check your brain, heart, blood pressure and oxygen use.

• You may be given oxygen through an oxygen mask.

• You may also be given a mouth guard to help protect your teeth and tongue from injury.

Inducing a brief seizure

When you’re asleep from the anesthetic and your muscles are relaxed, the doctor presses a button on the ECT machine. This causes a small amount of electric current to pass through the electrodes to your brain, producing a seizure that usually lasts less than 60 seconds.

• Because of the anesthetic and muscle relaxant, you remain relaxed and unaware of the seizure. The only outward indication that you’re having a seizure may be a rhythmic movement of your foot if there’s a blood pressure cuff around your ankle.

• Internally, activity in your brain increases dramatically. A test called an electroencephalogram (EEG) records the electrical activity in your brain. Sudden, increased activity on the EEG signals the beginning of a seizure, followed by a leveling off that shows the seizure is over.

A few minutes later, the effects of the short-acting anesthetic and muscle relaxant begin to wear off. You’re taken to a recovery area, where you’re monitored for any potential problems. When you wake up, you may experience a period of confusion lasting from a few minutes to a few hours or more.

Series of treatments

In the United States, ECT treatments are generally given two to three times weekly for three to four weeks — for a total of six to 12 treatments. Some doctors use a newer technique called right unilateral ultrabrief pulse electroconvulsive therapy that’s done daily on weekdays.

The number and type of treatments you’ll need depend on the severity of your symptoms and how rapidly they improve.

You can generally return to normal activities a few hours after the procedure. However, some people may be advised not to return to work, make important decisions, or drive until one to two weeks after the last ECT in a series, or for at least 24 hours after a single treatment during maintenance therapy. Resuming activities depends on when memory loss and confusion are resolved.

Results

Many people begin to notice an improvement in their symptoms after about six treatments with electroconvulsive therapy. Full improvement may take longer, though ECT may not work for everyone. Response to antidepressant medications, in comparison, can take several weeks or more.

No one knows for certain how ECT helps treat severe depression and other mental illnesses. What is known, though, is that many chemical aspects of brain function are changed during and after seizure activity. These chemical changes may build upon one another, somehow reducing symptoms of severe depression or other mental illnesses. That’s why ECT is most effective in people who receive a full course of multiple treatments.

Even after your symptoms improve, you’ll still need ongoing depression treatment to prevent a recurrence. Ongoing treatment may be ECT with less frequency, but more often, it includes antidepressants or other medications, or psychological counseling (psychotherapy).

Source: The Mayo Clinic

Palm Valley Fish Camp: An Afternoon Lunch (Ponte Vedra, Florida)

Originally published in 2013:

Recently I stopped by for lunch after being out shooting some photos, my other passion.  I was immediately greeted with a smile and an eager server.  I was asked if I’d prefer to sit at the bar or a table.  I don’t sit at the bar often these days after my liver transplant, as it brings back memories of a time in my life I have put into the past.  I chose a booth with the sun nicely warming my side of the booth.  I read down the daily specials board as my waitress went to get me my soda.  My plan had been to order an appetizer as I didn’t feel I was starving.  I was quickly drawn to the fried green tomatoes and maybe a side of their bacon butter beans which I love.

Fried Green Tomatoes
Bacon Butter Beans

Ready to order the waitress returned with my soda and offered to explain the specials.  I agreed even though I was certain I knew what I was going to have.  I smiled and said, “I’ll have the cod special.”  She had sold me on the roasted cod knowing I could have the fried green tomatoes and butter beans anytime.  I realized this would be my first time here not having the bacon butter beans in nearly a year.  I love them that much.  I waited and watched the interactions of the staff as they took orders, filled drink orders, interacted with the cooks and delivered each meticulously designed plate.

Specials Board

Soon my meal arrived, roasted cod with black-eyed pea succotash, and squash puree all resting on a fried green tomato.  I instantly knew I had ordered the right meal today.  There was a voice in the back of my mind screaming out for a side of butter beans, but I ignored it on this occasion.  It is rare when I am at Palm Valley Fish Camp that I will order anything that is not a local wild sustainable fish, but the cod was very fresh and flown in from the west coast.  The cod was lightly roasted with just a bit of color and flaked off easily so you could see how moist it was.  One of the things that keeps me returning over and over again is that they hardly ever overcook a piece of fish.  It sounds easy, but I’ve lost count at how many seafood restaurants server a dry tasteless and thoroughly unsatisfying fish fillet.

Roasted Cod

The cod had a nice salt balance which was perfectly complemented by the sweetness of the fresh corn and black-eyed pea succotash.  My first bite was of the fish alone.  It was very pleasant, but did not blow me away.  When eaten with the succotash the flavors melded into a delightful light tasting lunch.  The squash puree was richly sweet and left me perfectly wanting more.  Then there was the thick sliced fried green tomato upon which the cod rested.  It was nicely crisp and hot inside with just the right amount of breading.  The tang of the tomato was a nice counterbalance to the lightly roasted cod.  After all the fried green tomatoes was what I had planned to order the whole time anyway.  I was very pleased that my waitress had enticed me with her suggestion of the special today.  I would go away with only a slight yearning for their bacon butter beans, but I’ll be back and quite soon I am sure.  It was a great lunch for only $16.00 with the soda.  As I left I made reservations for the Friday after Thanksgiving.  I wonder if I’ll make it the two weeks between visits.  I know those bacon butter beans will be calling me to return sooner…

Christine de Pizan

Christine de Pizan (1363-circa 1430)

Christine de Pizan (or Pisan) was a Venetian born late medieval woman poet. She was highly regarded in her own day and during her thirty year career as Europe’s first professional woman writer completing forty-one works. She tirelessly challenged misogyny and the stereotypes of the late medieval period. She was widowed by age twenty-four and much of her motivation for her writing came from her need to earn a living for not only herself but her children. Her early poetry was of the courtly genre and marked by her knowledge of aristocratic custom and fashion of the day involving women and the practice of chivalry. In recent decades her works have once again returned to prominence through the scholarly efforts of those such as Simone de Beauvoir among others. There is some argument among scholars as whether to see her as an early feminist or that her beliefs were not progressive enough.

In 1390 with the death of her husband she was faced with the prospect of being left to support her mother, a niece and her two children. She began writing love ballads which garnered the attention of several patrons within the court who commissioned her to compose texts of their romantic exploits as they were intrigued by the novelty of having a woman writer. It is estimated that between 1393 and 1412 she was quite prolific having composed over three-hundred ballads and shorter poems. In 1401-1402 she engaged in a debate over Jean de Meun’s portrayal of women as nothing much more than seducers in his work “Romance of the Rose.” The result of the debate was more profound for her than the actual conclusions as it established her reputation as a female intellectual in a male dominated realm.

By 1405 she had completed her most successful literary works, “The Book of the City of Ladies,” and “The Treasure of the City of Ladies.” In these two works she argued and showed the importance of women’s past contributions to society and then attempted to illustrate and teach women how to cultivate qualities to counteract the growth of misogyny. She argues that women must recognize and promote their ability to make peace between their husband and his subjects. She believed that slanderous speech destroys the sisterly bond among women, “skill in discourse should be a part of every woman’s moral repertoire.” The works give a fascinating portrait of women in the 1400’s offering advice for women’s lives from the lady in the castle to the servant, peasant and even the prostitute. Through all of this she asserts than woman’s influence is realized when her speech unifies value to chastity, virtue and restraint.

Simone de Beauvoir in 1949 described her as, “the first time we see a woman take up her pen in defense of her sex.” Perhaps this makes her the western world’s first feminist.

A few quotes :

“Just as women’s bodies are softer than men’s, so their understanding is sharper.”

“I say it to thee again, and doubt never the contrary, that if it were the custom to put the little maidens to the school, and they were made to learn the sciences as they do to the men-children, that they should learn as perfectly, and they should be”

“Ah, child and youth, if you knew the bliss which resides in the taste of knowledge, and the evil and ugliness that lies in ignorance, how well you are advised to not complain of the pain and labor of learning.”

“Not all men (and especially the wisest) share the opinion that it is bad for women to be educated. But it is very true that many foolish men have claimed this because it displeased them that women knew more than they did.”
~ Christine de Pizan

Edith Wharton

Edith Wharton (1862-1937)

Edith Wharton is well known as one the more prolific American writers of the twentieth century, being a novelist and short story writer as well as a garden and interior designer. In 1921 she became the first woman to win the Pulitzer Prize for one of her best known novels, “The Age of Innocence.” It has been made into at least three movies, the most recent being the Martin Scorsese film released in 1993. In 1923 she became the first woman to receive an honorary doctorate from Yale.

During her long life her literary endeavors were encouraged by a varied group friends of both the literary elite and other notable public personalities such as: Henry Wadsworth Longfellow, Henry James, Jean Cocteau, Andre Gide and Theodore Roosevelt. Additionally she met both Sinclair Lewis and F. Scott Fitzgerald. Her upbringing and varied group of friends and influences provided her with unique insights into the upper class. Through all her life her polished prose and humor produced fiction which appealed to a large audience. She received the French Legion of Honor for her philanthropic work during World War I, and was additionally a member of the National Institute of the Arts and Letters, and the American Academy of Arts and Letters.

In addition to notable novels such as “The Age of Innocence,” “The House of Mirth,” and “Ethan Frome,” she also wrote at least eighty-five short stories and non-fiction dealing with her European travels and Interior and Garden design such as “Italian Villas and Their Gardens,” and “French Ways and Their Meaning.” She is best known for her novels with portraits of New York’s upper class during pre-World War I society. She used both humor and empathy to discuss their vanishing world at the beginning of the twentieth century. In such novels as “Ethan Frome” she was much more harsh and critical of the rural lower class of Massachusetts.

A few short quotes :

“Nothing is more perplexing to a man than the mental process of a woman who reasons her emotions.”

“If only we’d stop trying to be happy, we could have a pretty good time.”

“Life is always either a tightrope or a feather bed. Give me the tightrope.”
~ Edith Wharton