I See You

She sits across from me in a café in the downstairs of a local bookstore. She wears a black sweater adorned with patches of lint and a strand of hair here and there. It rarely makes its way to a hanger between wearings. It is creased where she crosses her arms over and over, more in an effort to hold and comfort herself than in an attempt to show displeasure or aggression. Pleasure looks lost in the black of her eyes. Pleasure used to live there though, its echo visible in occasional glints of light.

Ribbons of red against a nest of black sit atop her head. She takes enough interest in her hair for dye, but not enough for style. Her skin looks more pale and cool beneath it; where it wasn’t starting to blush from sadness.

She chooses to sit in the smallest corner of the café where few will even notice her head in her hands or the fact that she misbuttoned the fourth and fifth buttons of her sweater. Her black-rimmed glasses sit on a small, dark, wooden table in front of her so she can be truly alone, not even able to see glimpses of the world through the spaces between the fingers over her eyes. She thinks she’s invisible.

Exposed brick sits behind her, ragged and raw promising not to be worn down no matter how much she cries.

A wisp of a waitress appears dressed in the uniform of the tortured artist; all black, loose-fitting, cotton pants and shirt with long, untamed hair and places the latte on the small table in front of the girl. The latte’s arrival seems to wake the girl. She lifts her head, tried to blink back the water in the eyes, painfully ekes out a smile, and says thank you. The waitress spins while barely uttering an uh….huh. The girl is even more convinced of her invisibility.

Depressed, Crazy Girl Actually Approves Of Her Own Existence

Today is my birthday which follows three plus days of nonstop celebration. A time to celebrate the novel idea that my life, here on the planet, actually was a good idea. I don't usually buy into this, naturally, but recently the celebration has changed my mind. Maybe the last 31 years weren't such a mistake. Shocking.

We shopped, we drank, we laid, we watched, we walked, we ate, we spa'd, we kissed, and we otherwise celebrated liberally. But the shocking part is, I liked it. I actually had a good time. the headline should read, "Depressed, Crazy Girl Actually Approves Of Her Own Existence". OK, it doesn't have a lot of ring to it, but the shock and awe from its creation makes up for it.

It doesn't even bother me that I'm older. Meh. Another year, another day, it just doesn't matter. Other than people insisting on making fun of my agedness, and my own proclivity to harshly judge my own failures, it's really fine. Old, older, oh well.

Yes, it means I'm not depressed. Shocking on any day, really, but on a birthday, probably unprecedented since I met with double-digits. What did I do to deserve such luck? I have no idea. Nothing that I'm aware of. But I should keep doing it. The nothing, whatever it is. Because this, is one of the better moments in my recent history.

And if anyone's listening, or anyone cares, I really appreciate this pleasant breath. Best. Present. Ever.

More on rTMS and VNS and MRI

I frequent poster, Herb, has introduced more information on the rTMS with VNS topic. Some doctors are saying it is possible. Additionally, if you read the whole thread, someone corrects me and notes that MRIs are possible with a VNS implant. This is, actually, true. Cyberonics has put together some physician information on this, copied below.

So it goes back to exactly what I said, no one really knows in the implications. Proceed at your own risk.

Additionally, if you read the whole thread, someone corrects me and notes that MRIs are possible with a VNS implant. This is, actually, true. Cyberonics has put together some physician information on this, copied below (no, I don't know what this stuff means, sorry):

MAGNETIC RESONANCE IMAGING (MRI) ______

Caution: Magnetic resonance imaging (MRI) should not be performed with a magnetic resonance body coil in the transmit mode. The heat induced in the Lead by an MRI body scan can cause injury.

If an MRI should be done, use only a transmit and receive type of head coil. Magnetic and RF fields produced by MRI may change the Pulse Generator settings (change to reset parameters) or activate the device. Stimulation has been shown to cause the adverse events reported in the “Adverse Events” section in the indication-specific parts of the multi-part physician manuals. MRI compatibility was demonstrated using a 1.5T General Electric Signa Imager with a Model 100 only. The Model 102 and Model 102R are functionally equivalent to the Model 100. Testing on this imager as performed on a phantom1 indicated that the following Pulse Generator and MRI
procedures can be used safely without adverse events:

Pulse Generator output programmed to 0 mA for the MRI procedure, and afterward, retested by performing the System Diagnostics (Lead Test) and reprogrammed to the original settings

Head coil type: transmit and receive only

Static magnetic field strength: ≤2.0 tesla

Specific absorption rate (SAR): <1.3 W/kg for a 154.5-lb (70-kg) patient Time-varying intensity: <10 tesla/sec Use caution when other MRI systems are used, since adverse events may occur because of different magnetic field distributions. Consider other imaging modalities when appropriate. Caution: Procedures in which the RF is transmitted by a body coil should not be done on a patient who has the VNS Therapy™ System. Thus, protocols must not be used that utilize local coils that are RF-receive only, with RF-transmit performed by the body coil. Note that some RF head coils are receive-only, and that most other local coils, such as knee and spinal coils, are also RF receive-only. These coils must not be used in patients with the VNS Therapy System.

I can't find the source on their annoying site, but for more info, contact Cyberonics.

Nap Time

I wake up in the morning to the bright light filling my room from my fancy sunlight alarm clock. It allows for a more "natural" and gradual slide into wakefulness. It's gentle. I blink my eyes open into the daylight. Or lamplight. Which is OK too.

And this awakening is at the same time every day. Or close to it. I wake up between 7:30 and 8:00 every morning. Better for the circadian rhythm, don't you know. Annoying better for stability. I didn't make that rule. Some stupid scientist did, I would imagine.

And the first thought that crosses my mind isn't the silky sheets against my skin, or soft down pillow beneath my head, or the fluffy cloud above those sheets. It's always that I wish I were still asleep. Why does consciousness have to greet me every morning. Why can't I just still be asleep?

Yes, I'm back to that place where I absolutely viciously don't want to be here. Don't want to be anywhere. And this wouldn't be such a problem if it weren't for the viciousness. A throbbing need not to be here. A stabbing requirement to just be gone.

Depressed people are familiar with this. It's why we sleep so much. Sit on the couch to much. Watch TV so much. Eat so much. Are alone so much. I'm lonely and want nothing to do with people. I don't want to think, or speak, or be seen. Just leave me alone. Now.

And I know what's making it so aggressive. It's the decrease in the Zyprexa. I'm trying to get off of it because I hate it so much. Because it's making me so fat.

So then, fat and less depressed, or attempting to loose weight and more depressed? Ah, fine choices. Delightful. Fabulous.

I'll get right to making that choice after I take a nap.

rTMS and VNS - no from Neurostar

I contacted Neurostar, the maker of the rTMS system, and they say:

Neurostar TMS Therapy is contraindicated in patients with implanted metallic devices or non-removable metallic objects in or around the head.

Which makes sense. So basically, Cyberonics doesn't really say one way or another, and Neurostar says basically no, so I'd say, no, you can't get rTMS with a VNS implant.

(Which is not to say that someone wouldn't do it, or that they might not say you can in the future. As no formal study has been done, it's really impossible to tell the true medical implications.)

Ah failure. You're a cold, wet blanket at night.

My doctor's receptionist (secretary? assistant? tactless shrew?) called today to ask if I would give my VNS data to the Cyberonics folks. They would like to record me as a failure. Which is great. Don't you think? It's official. I'm a failure.

Now, to be fair, the woman making the phone call really doesn't seem to have any perceptible interpersonal skills, and so she can come across rather harsh. Or perhaps as a bit of an automaton. A failure enforcing automaton. Charming combo.

To be, perhaps actually fair, no, I'm not a failure, and I can't really say that the device has done nothing. As it's a combinatorial effect (device + meds) it's impossible to say if what I feel right now is buoyed by the VNS or not. Not that I feel good. I don't. It's just that, it's impossible to say that I wouldn't feel worse without it. You can never really say that. At least, without further data. Data that's really a bitch to get.

So there I'll be. In the device failure numbers. Famous, for failure. It was a just a matter of time, really.

No rTMS with VNS?

According to the fax I got today, now I cannot get rTMS with a VNS implant. Honestly, this does make sense when you consider that you can't get an MRI with a VNS implant either.

So basically, no one knows. Different people, different opinions and Cyberonics doesn't have any specific policy on the matter. In their fax back to my doctor the only thing they say is that they have no specific labeling on rTMS. Very helpful. You can always count on medical companies to be helpful. Guiding. Honest.

So, um, I'm still trying to get a final word on it. Or I'll flip a coin I guess, and go with the medical expert that gives me the answer I like. I'll let you know.