Tms charges

 28 year old male  Major depression, recurrent, moderate and ADHD  Two year history of constant depressive symptoms including: o depressed mood o fatigue o difficulty concentrating o poor appetite o weight loss o anxiety o insomnia o anhedonia o low self-esteem o thoughts of suicide  Medications of Trazodone and Strattera  Course of 20 treatments over 4 weeks  6 taper treatments over 3 weeks  Noted depressive symptoms lifting after 8th treatment “Life is pleasurable”- patient quote  Appetite improved and sleep normalized  36 year old male  History of depression and intermittent psychotic symptoms present since college  General feelings of guilt with aggressive behavior at times  History of poor work performance  Inconsistent with taking medications: Abilify, Geodon, Prozac, Zyprexa, Cymbalta, Invega, and  Presented with feelings of depression, hopelessness, helplessness, anergy, anhedonia and  Obvious delayed verbal responses in conversations; somewhat suspicious but no overt psychotic  Medications of Risperdal .5mg and Lexapro 20mg  Risperdal was increased to 2mg a day  Patient received 29 TMS treatments over 6 weeks  Patient underwent a 3 week tapering phase of 6 treatments  Patient received Ibuprofen 800mg and Lidocaine/Prilocaine to the scalp to ease mild discomfort “I no longer feel depressed.”- patient quote  Self-initiating  Decrease in aggression and agitation  No facial grimacing  Response time in conversations greatly improved  More active and more sociable  Both patient and family want to continue as appropriate per physician  Risperdal and Lexapro to continue
 Family history of depression and mental health challenges  First depressive episode was in high school  In 2005 had recurrent major depression with a bipolar diagnosis  Present episode has been severe for 1 year beginning approximately 8 years ago  Symptoms included: o Hopeless, helpless, and worthless feelings o Experiencing despair with low self-esteem issues o Insomnia , irritability and inability to focus o Social withdrawal and a loss of 2 jobs over the last 3 year period o Diabetes, Hypertension, fatty liver disease, allergies  Lexapro, Wellbutrin and Cymbalta- all without benefits  Paxil with side effect of inability to orgasm  Lamictal- patient “loses his creative edge and becomes flat” with too much  Patient was on: Pristiq, Nuvigil and Lamictal  48 treatment sessions with 6 being in the tapering phase over a 3 week period “There was a definite neuro-chemical change that took place for me!”  His wife and friends noted the depression becoming less  Experienced increase of cognitive abilities and became more hopeful  1 month later he said he is doing better “ I never thought it would be possible, my family notes a change from one year ago, I am thinking clearer, able to focus and enjoying work, which I never thought I’d say”.  Continued on Pristiq, Nuvigil and Lamictal to prevent relapse  Continues therapy with a psychiatrist  55 year old female  Has suffered from depression the majority of her life plus anxiety later  She has been under a psychiatrist care for the last 8 years due to need of medications, also sees a o Coughing to the point of regurgitation (although there was no medical evidence found to o She experienced 3 pneumothorax’s plus a fractured rib  Came to us on Lexapro 80-mg, Buspar 90 mg and Provigil 200 mg. PRN  38 treatment sessions with a 3 week tapering for a total of 44 sessions  Stopped having nightmares  Noted greater quality of sleep  Increase of energy  Greater desire to be social and interactive with children  Main symptom of chronic cough gone  Anxiety diminished plus experienced greater clarity with thought process  By end of TMS treatment, patient was able to stop the Buspar and was tapering the Lexapro  Patient also found that the 200 mg. of Provigil was too much for her
 61 year old male  Divorced and hospitalized for 30 days shortly thereafter  Depressed for several years  Symptoms Included: o Sporadic sleep o Helpless, hopeless, worthless feelings o Fatigue and decreased interest in life o Social withdrawal and isolation o Thoughts he would never get better o “Something has to change, I can’t go on like this”- patient quote  Celexa, Abilify, Ativan- all without benefits  6 taper treatments over the next 3 weeks “This is the best I’ve felt in a long time!”-patient quote  After the first 2 weeks he was more upbeat, less in a “deep hole”  Over the next 2 weeks he wanted to work on interpersonal issues  Family noticed improvements  Over the next few weeks total resolution of depressive symptoms  Said he was “happy”, “hopeful”, and “coping better”  Mood much better, more interest in life  Continued on Celexa and Abilify to prevent relapse  68 year old female with Major Depression, recurrent over 9 years  Symptoms included: fatigue, panic, anxiety, depressed mood, anhedonia, weight gain  Patient wanted off meds and to feel better again like she felt before 2000.  Past medication trials: Lamictal, Zoloft, Buspar, Prozac,  Luvox, Lexapro with no benefit or too many side effects  On Lexapro and Wellbutrin  Decreased and discontinued both Lexapro and Wellbutrin “This is the best I have felt in years”-patient quote  Started responding after 8 treatments  Decreased depression, fatigue, appetite and anxiety  Increased energy and motivation  After 11 treatments her depression went into remission; now off Lexpapro and Wellbutrin  Completed a full course of TMS and remains in remission



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# 096 diarrhea in palliativ.

# 096 Diarrhea in Palliative Care, 2nd ed FAST FACTS AND CONCEPTS #96 Author(s): Jeffrey Alderman MD Diarrhea is a debilitating and embarrassing problem, defined as an abnormal looseness of the stools (increased liquidity or decreased consistency). Patients with uncontrolled diarrhea are at increased risk for dehydration, e

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