1 Month Follow-Up

Today I had my one month follow-up appointment for the Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) that I had to help treat my depression.  Since the surgery was performed as part of a clinical trial, these follow-up appointments are more to get information from me on how I am doing rather than to provide me with any new information.  However, I did get some useful information on the surgery and what to expect from here on. 

I haven't noticed any improvement in my depression or anxiety since having the surgery.  That has been discouraging, but, as I have said in the past, they say that it can take three months to a year before I notice any improvement, so I have to be patient.  I mentioned in a previous blog post that I would be viewing online economics courses, since I am interested in economics and to help keep me occupied while I wait for something to happen as a result of the surgery.  I have been doing that now for about two weeks.  I am following an MIT online course in microeconomics.  However, I don't know how much longer I am going to keep up the concentration to do these online courses.  In the short run, I am able to follow each lecture.  My depression isn't affecting my concentration so much that I can't follow a one hour lecture, although I am not doing any of the recommended reading or assignments, because I would have difficulty doing that.  However, in the long run, I am having difficulty keeping up the concentration and motivation to follow a whole course.  I find that it is getting harder and harder to bring myself to watch each lecture.  I don't know how much longer I will be able to follow the course.  At this point I will be happy to finish one course.

The first thing that we did today was to meet with my neurosurgeon, Dr. Nir Lipsman.  He said that the results of the MRI that they performed after my surgery showed that they created a 6 mm lesion on the right side of my brain and a 2 mm lesion on the left side.  When they were performing the surgery they weren't sure that they would be able to create a lesion on the left side, so it was good that they were able to create a 2 mm lesion.  I also mentioned to him that I have been having difficulty with my sleep, as I mentioned in a previous blog post.  He said that this probably isn't as a result of the surgery, but that they would keep an eye on it.  It's good to know that it isn't a result of the surgery, as then it may be permanent, but it doesn't help me deal with the problem right now.  Luckily, over the last week my sleep problems have stopped getting worse, so hopefully they will start getting better soon.

After meeting with Dr. Lipsman, I met with the research manager who did some psychiatric scales with me.  As I mentioned in a previous blog post, they did psychiatric scales on me before having the surgery and they showed that I was severely depressed.  Now at every follow-up appointment they will redo those scales to see if there is any improvement in my condition.

My final meeting of the day was with the study psychiatrist, Dr. Anthony Levitt.  He wanted to know how my mood has been doing since the operation.  He said that sometimes people will notice in the week or two following the surgery that their mood actually gets worse.  This is because they have made changes to the brain and it has an initial negative impact.  I didn't notice any worsening of my mood.  That doesn't indicate one way or the other the potential effectiveness of the surgery.  He also said that they have noticed that even if the surgery itself is not effective on its own, it can still help other treatments to be more effective.  He gave the example of one lady who had MRgFUS for depression and didn't notice any difference, but then when they gave her a medication that they had tried before and hadn't worked, it now worked and she is doing well.  That was encouraging that the surgery may have positive benefits even if it is not successful on its own.

My next follow-up appointment will be in two months, at the three month mark.  It will include all of the same meetings that I had today, plus they will perform an MRI to see how the lesions are doing.  Apparently there can be some swelling of the lesions, so sometimes after a few months they shrink down to a smaller size.  It will be interesting to see how things are going after three months.