Thursday, November 15, 2018

MRgFUS Screening/Baseline Testing Part 2

Today I completed my second day of screening and baseline testing for the Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) that I am scheduled to have on Monday (November 19).  The title of the clinical trial in which I am taking part is "Phase I trial of MR-guided Focused Ultrasound (MRgFUS) bilateral capsulotomy for the treatment of refractory Major Depression."  It's getting close now and I am starting to get nervous about having brain surgery.  I wonder how I got to this point that having them ablate a portion of my brain seems like the best path forward.

I received my scores on the psychiatric scales that we did last week.  There were three tests that I did that measure level of depression.  The first one was the Hamilton Rating Scale for Depression (HAM-D).  I received a score of 25 on this test.  Scores of greater than or equal to 23 indicate a very severe depression.  The second test that I did was the Montgomery–Åsberg Depression Rating Scale (MADRS).  I received a score of 36 on this test.  Scores of greater than 34 indicate severe depression.  Finally I did the Beck Depression Inventory (BDI).  I received a score of 36 on this test.  Scores of greater than or equal to 29 indicate severe depression.  Thus, it is clear that I have severe depression and need to do something about it.

Today we started out with a pre-operation appointment.  I started out meeting with a nurse who took my blood pressure, asked me some background history questions and did an ECG.  Then I met with a pharmacist who reviewed all of my medications and made sure that I didn't have to make any medication changes before the surgery.  Finally, I met with an anesthesiologist, who made sure that I was okay to deal with the sedation that they will give me for the surgery.  The instruction that I was given that this process could take anywhere from 2 to 4 hours, however I was done in 30 minutes, which was much appreciated.

Then I did some neuropsychological testing.  That was pretty challenging.  Some of it was easy, like I had to sort different cards into as many different categories as I could in a certain amount of time.  Other parts of it were more difficult, like having to remember a page of shapes that I was shown and reproduce (draw) all of the shapes, and having to remember a list of words that was read out to me.  Finally, I had to play this strange betting game on the computer where I was given four stacks of cards and had to choose cards from different stacks.  I either won or lost money based upon the card that appeared and the stack that it was chosen from.  I was supposed to come up with an optimal strategy, but as far as I could tell, I was winning and losing at random, so I don't think I did very well on that part.

Finally I had a PET scan.   They told me that it would take 90 minutes, but it ended up taking three hours, which I didn't appreciate.  In order to prepare for this scan, I had to eat a low carbohydrate, high protein diet for the 24 hours before and not eat anything for 6 hours before.  I did not like this diet/fasting routine.  When I got there they put in a saline solution IV and I had to wait for two hours.  Then, they injected me with a tracer and I then had to wait another 30 minutes.  Finally, we did the PET scan and that took about 30 minutes and was not unlike a CT scan or MRI scan.

So, now I am just about ready for my surgery.  I just have to shave my head on Sunday and go to the hospital early on Monday morning.  I hope that it all goes well.

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