How a patient is treated when they first come in for TMS Treatment
So we start off by asking them, is there any contraindications that would prevent them from being able to have this treatment? After they pass the screening process, they come in, they meet with the doctor and we start doing our measurements. Now we check their motor strip for their Motor Evoked Potential and a lot of the times, we find that people who would have expected to have a high threshold using the CloudTMS, they have a lower threshold, so this more comfortable for the patient. With other generations of the TMS machines, you can noticeably see that the patient might be a little bit uncomfortable. With the TMS, patients describe the feeling is almost feeling a cold sensation on the scalp or the area. They don’t typically report having any sharp pain or shooting pain.
As far as side effects go, we’ve had little to none with the CloudTMS. I would tell patients to make sure that they are committed to treatment because we do require them to be consistent and coming to their appointments. We also hold them accountable. We let them know that it’s also up to them. Also, it helps the machine do it’s part as well.
What sets us apart here at Blackhawk TMS is we are not the typical, get in your chair, have a seat and we’re going to give you your treatment. We’re asking you, “what are you doing? How’s your diet? How are the family dynamics? Do you have any social connections?” We’ve had patients who have had no support systems. We’ve had patients who have had a little bit too much support systems but we do enjoy patients bringing in family members because they can also help report. A lot of the time, the patients themselves don’t realize that they’re changing and getting better, so we really use that outside influence to help us observe their care. We also have them fill out weekly TMS scales that rate their anxiety and depression. Sometimes we don’t go by that always because as you know, scales can be a bit misleading but we are very present in our patient’s lives.
How long is the typical TMS session that you administer?
Initially, when we first started doing TMS, it was about thirty-seven and a half minutes. That’s without stopping, without moving locations to make sure the patient is comfortable. Now, at CLoudTMs, we’re down to about 18 minutes or less, depending on which protocol. So there are protocols that are 6 minutes, there are protocols that are 10 minutes and this is much more convenient for the patient because a lot of them are coming here on their lunch break or before school or after school so it’s very convenient to have them come in and out.
Do you spend the entire time in the room when they’re getting their sessions or do you just check up on them maybe every three or four minutes. How does that process work?
We are in the room with the patient the whole time from beginning to end. Initially, we review the sheet that they fill out before, letting us know if there have been any medication changes. If there has, then that requires us to redo their MT (motor threshold), so we have to check to see if their motor threshold has increased or decreased. This is the amount of power that we’re using to stimulate the area to get the neurons firing again.
What we’ll ask the patient is, in regards to what they like, as far as music or visual scenery. So we always turn on the television and we can put something nice on. We have patients who would like to talk during their treatments, which is fine. With other TMS machines, we didn’t have that flexibility because it would move the patient out of position. With CloudTMS, it’s very stable and secure, so pretty much, once you place the coil on the patient, there’s little to no movement as long as the patient is sitting up properly.
Can you tell me, how soon is it before you start to notice results in the patients yourself without them saying anything?
I’ve seen as quick as the first treatment, honestly.
What do you typically notice?
The patient is more talkative. The patient asks me questions instead of me just asking them. The patient may have not been able to remember things that they did last month and it’s coming to them during their session and that’s a miracle in itself.
What do patients typically tell you it feels like?
They typically say that it just feels like there’s tapping on their head and if they ever tell us that they’re very uncomfortable, we can simply pause the machine, just make a slight change to the coil and get back to business. Whereas with the other machine, we would have to enter a bunch of different codes and parameters to be able to pick up where we left off. With the CloudTMS, it allows us to simply press on and off and to get back to helping the patient.
I wanted to know, specifically, what does the patient feel inside or what kind of changes can they expect to feel in their personality or behavior?
Most patients start off by telling us – the first thing they notice is – things are starting to become a little bit brighter, whereas before it was like it was shady all around and we’ve had patients tell us that there’s light at the end of the tunnel. We’ve had patients who have been in and out of different psych facilities for many many years and TMS is just their last hope and after coming here for TMS, they become like a part of the family. We actually still keep in contact with some of the first patients that started with us. So I think that it’s good to say that TMS definitely impacts the patient, not just emotionally but it just really registers with them. Patients will say things start to taste better. People are able to smell certain scents they hadn’t smelled since they were children or adolescents.
Another thing is memories and I know there hasn’t been a lot of research done, but I’ve first-hand witnessed many patients who have had memories that they’ve suppressed for many years due to trauma or depression and with TMS – I’m seeing this more with the CloudTMS – patients are remembering good memories, fond memories. And with that I always think, “well what about the bad memories?” and that hasn’t been an issue. So I think there’s something that TMS is doing that we’re not sure about yet but I think we’re getting there.