Miracle On The Gurney

My Miracle on the Gurney

So what happened while I lay on gurney at Naples Community Hospital? Did I die on gurney, and Dr Yin brought me back to life? Seems unlikely, although I like idea.

I have my own version of “Big Bang Theory.” That’s how it seemed to go. One moment I was weak, depressed, next moment, “BANG!” I was free from anxiety, depression…I had a new life. What’s a likely explanation? I went over an explanatory list in previous section.

Anesthetic I was given in hospital for my failed catheter oblation is my best guess as to what happened. I was given Propofol twice in as many days.
This general anesthetic blew my depression to smithereens, or at least that’s my suspicion.

Is there a medical/scientific basis for this suspicion? Research on question is limited, but studies have found a link between depression and anesthetic.

For example, results of one study suggested: that it is possible to improve symptoms of depression earlier by using ketamine anesthesia.

Ketamine has a reputation as an illicit party drug due to its hallucinogenic effects. But in a handful of ketamine clinics around the country, people who weren’t helped by standard treatments are getting a series of infusions to ease their depression. The drug has also been used in emergency rooms for curbing suicidal thoughts, making it a potential lifesaver.

“The benefits I’ve seen are pretty impressive, and the data are very strong,” says psychiatrist Kyle Lapidus, MD, PhD. He’s an assistant professor of psychiatry and neuroscience at Stony Brook University. Lapidus says there have been a large number of positive studies, though the number of participants in those studies has been small.

PropofolResearchers have also investigated the Propofol link, although precise neural mechanisms of propofol anesthesia in humans are still unknown. The authors examined the acute effects of propofol on regional cerebral blood flow (rCBF) using positron emission tomography in patients with severe depression. No question depressive symptoms were eased, perhaps even eliminated, with Propofol infusion.

The following was aired on NPR’s “Fresh Air.”

Emery Brown is a professor of computational neuroscience and health sciences and technology, with a joint appointment at MIT and Harvard University. He is also a professor of anesthesia at Harvard Medical School.

“If you’ve gone in for surgery, it’s likely that your anesthesiologist has told you to count backward from 100 — and that you’ll wake up after a nice deep sleep.

But that’s not exactly true.

“Sleep is not the state you’re going in, nor would it be the state in which someone could perform an operation on you,” explains Dr. Emery Brown. “What we need to do in order to be able to operate on you — to perform a procedure which is, indeed, very invasive — is to put you in a state which is effectively a coma which we can readily reverse.”

Dr Brown, a professor of anesthesia at Harvard Medical School and a practicing anesthesiologist at Massachusetts General Hospital, recently co-authored a study in The New England Journal of Medicineoutlining what scientists know and don’t know about anesthesia. Unlocking its many mysteries, he says, will help scientists better understand consciousness and sleep — and could lead to new treatments for pain, depression and sleep disorders.

Anesthesia And The Brain

One of medicine’s biggest questions is how anesthesia — which knocks patients unconscious, renders them immune to pain and keeps them immobile during procedures — actually works in the brain. Brown’s team has been conducting imaging studies on volunteers under anesthesia to see how different parts of the brains change activity levels as the volunteers lose and then regain consciousness.
From ‘The New England Journal of Medicine’
General Anesthesia, Sleep And Coma

“We would like to understand, when the drugs are given, what areas are turned off and turned on in what sequence to get some sense of how the drugs work,” Brown tells Fresh Air’s Terry Gross. “We know a lot about the properties of the drugs — in terms of how they’re metabolized by the body and certain behavioral effects they might have. We also know a lot about certain receptors they bind to, but these receptors are all over the brain and central nervous system. But the state of anesthesia is this very complex behavioral state. So to decipher it, we are at first order using the imaging where it is happening. Then, from there, we can start asking other questions: Is this the way we want to do it? Are there other ways to achieve the same state which might be better for our patients?”

So far, researchers have learned that different drugs create different patterns in the brain, Brown says. For example, propofol — one of the most widely used anesthetics — is a very potent drug and initially puts the brain into a state of excitation.

I spoke to an anesthetist, and he said Propofol shuts everything down which is why it should only be administered in hospital. This is drug that killed Michael Jackson. MDs jokingly refer to Propofol as “milk of amnesia” for its vanilla shake look and how it wipes mind clean.

Propofol doesn’t really cause a state of sedation or anesthesia [initially],” Brown says. “Then what we actually see next is the brain start to slow. [So first you see] a period where the brain is active, and then [when you give] a higher dose, the brain starts to slow.”

In contrast, the drug ketamine — which is used in conjunction with anesthesia to make certain drugs work better — puts the brain into a state of excitation even at higher doses.

“The state of unconsciousness you get with ketamine is created by making the brain active,” Brown says. “As you transition through this active state, you very frequently hallucinate. It’s this hallucination or sense of euphoria or dissociative state that people who are using it as a drug of abuse are seeking.”

Recent studies conducted by scientists at the National Institute of Mental Health have indicated that administering extremely low doses of ketamine can help treat patients with chronic depression. Brown says he is excited by these findings.

“If this turns out to be reproducible, it could change tremendously how chronic depression is managed,” Brown says. “For 70 to 80% of patients (in the study who received low doses of ketamine) they felt better almost immediately. This is an exciting finding, because right now there is no way to make a chronically depressed patient feel better immediately. So this is an exciting finding, and if it’s shown to hold, I think it may change tremendously the way chronic depression is treated.”

That’s what I think happened to me. Propofol made me feel better immediately. I did ask my doctors if they were aware of these and other studies to back up my claim. Clearly this is not their area of expertise. Dr Koslov…”I doubt CLL would cause depression, these are different things.” Dr Yin shrugged his shoulders.

Stepping away from details…”Do I I have to explain what happened?”

JV…”No. No. Who cares? We must enjoy your rejuvenation. From this day on look forward, step away from dark past and into light. Count our blessings.”

11/4 Problem for me was a Dr. Yin follow up appointment he requested back on 3/31. I suspected he wanted to see JV again in hopes to smooth things over.

JV…”Why don’t you cancel? Didn’t he sever the cord some months ago.”

PV…”I have a few questions, would like to review options again.”

So I go to Dr Yin’s office, now in fancy digs at Physicians Regional Medical Center (PRMC). Tracy, Dr Yin’s RN has the honors. Her specialty is electro physiology. She gives me an EKG. “Your A-fib is alive and well. You are a young 75. I have patients who’ve lived with A-fib for 25, 50 years. Stroke risk is only thing A-fib does, and we can manage that risk with blood thinner. Dr Yin wants to give you another option; it has a 5% chance of complications. He would do oblation again, this time all from right side. It would last 5 to 6 hours, and it may not work.”

PV…”And I would go through all that other stuff.” “Yes.”

Tracy…”Way your heart beats, it’s strong albeit irregular. You could do very well living with A-fib. Moreover I’m not convinced your breath shortness is from A-fib. Leukemia could be underlying culprit.”

(Tracy walks me to check out.) “Do you want to schedule oblation procedures?”

I look at Tracy, I look at check out person, shake my head, AND I WALK AWAY. As Yogi Bera stated, “When you come to a fork in road take it.”

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2 Comments

  1. I have had a-fib for 12 yrs, and I have been on a medicine called tikosyn for the same amount of time. I have only had 2 relapses of my a-fib in the 12yrs. I don’t know why it isn’t more widely used because it has helped me immensely. I too see dr yin for my a-fib. however he didn’t put me on the tikosyn . I had my three attacks when I lived in Columbus oh.

    • You are so lucky. Dr Yin put me on tikisin, even had me in hospital for observation. Didn’t work. My a-fib is stubborn. My primary MD wants me to be seen by a medical center, such as Yale Medical, or St Vincent’s in Bridgeport CT. St Vincent’s is one of US’s leading a-fib centers. Might have them check me out this summer, only 1/2 hour away from us in Fairfield CT. So who knows. Maybe I’ll join your ranks as getting over a-fib.