The First Treatment

They finally called me back about 20 minutes after my appointment was to begin.  I guess they just do a cattle call for everyone at the same time and then filter people back as the treatment cubes become available.  Thankfully I was the first of the 8 or 10 people there to be called back. 

I did ask for the anti-nausea meds in the lobby but they said they would notify the doctor but no one came out with them so I asked again when I was taken back.  I was also able to use the restroom.  The area in the back is very spa like.  Quiet, dark, soothing décor. 

They walked me to a cubicle which was on its exterior like a small hospital cubicle in the ER.  Very sterile walls and behind the large leather recliner a full set up medical devices.  On the wall next to the chair was a noise-canceling headset and on the small tray was a little sleep mask wrapped in its safety cellophane.  The nurse left me there for a bit.  I think this is where it really caught up to me.  I was alone there in the cube and feeling all of that.  

Finally, after what seemed like forever in my mind but was likely only maybe 5 minutes, Caitlin showed up.  She is the nurse practitioner who administers the treatment and she was very calming to me which was good since I was in near full mental meltdown and I am sure I was wiping away tears as we spoke.   She explained how the dose schedule works and how to administer the treatment for myself.  She also brought me a meclizine (for motion sickness) and a Zofran to hopefully keep me from going into a vertigo induced vomit session.  She said if I did feel sick, they had a third med they would be able to administer.  I chewed the meclizine (a small pink pill) didn’t taste great but was tolerable.  The Zofran went under my tongue and dissolved.  Again, did not taste great but was tolerable. 

Next they took my blood pressure and told me that they would do the same 45 minutes into the treatment as well as at the end.  They tested it on my lower arm as I sat in the chair and rested my arm on the armrest.

The first treatment of Spravato is a low dose tester so to speak, an introductory dose.  I assume this is to gauge the side effects and reactions as well as any allergic issues you would encounter.  On Friday I will advance to a higher dose if I tolerate the lower dose, but Caitlin did say that I do not have to advance the dose and I can just stick with the lower dose if I feel that is all I can handle.  I personally do not want to do less than the protocol.  I know it is my choice to do less if I want but I want to have the full benefit of the drug.  I have to at least try that.  I mean if I get too sick or whatever then fine, but I feel like I don’t want to diminish my chances for this to work. I want to give this everything I have.  That means the full dose.

For this session, I had 2 dose bottles.  The first one I would administer and then put on the sleep mask and wait 5 minutes and then do the second if no reactions were occurring.  On Friday I will do this dance 3 times with 3 squirts in both nostrils. 

The bottle has a sort of “green light” on it which means the dose is ready.  You squeeze the first one into your nostril and then you see the green light disappear and then you do the second nostril and the other light disappears signifying you have successfully administered the dose.  This was fine initially but 5 minutes later I was afraid to remove my mask and doing it blindfolded was a chore.  I am not even sure I did it right except that Caitlin assured me it was good.  It is a very odd situation. 

I sat back in the chair and used the electric button to recline the chair and Caitlin covered my feet up with a blanket and “tucked me in”.  You can bring your own blanket but theirs is very fluffy and soft.  Almost as soft as my Nemu which I was hugging under the blanket with me.  I will definitely bring my own socks though as my feet did get cold even under the blanket and I also decided to bring my own sleep mask.  Theirs was ok and did the job but mine is much better at blocking light and also sits more above my eyes than tightly over them so I think it will be more comfortable.  Lessons I am learning as I go. 

I also forgot the warning about the taste and burning.  I think possibly because I was crying and my nose was maybe stuffed up, I am not certain the drug completely got into my nose right because I felt no burn at all until it reached my throat.  The burning and the taste were TERRIBLE.  Like OMG awful.  Unbearable almost.  I inquired when she came back for dose 2 if that was normal and how long it will last.  Usually with nasal sprays in the past they dissipate pretty quickly.  Not this one.  It lasted probably a good 20-30 minutes.  I mean I didn’t have any reference of time in that state but it was a LONG time.  I kept swallowing and hoping my saliva would wash it away.  It did not.  She did give me a small water so I took a sip which helped but didn’t fully erase it.  She also offered me a mint (which I hate) and said I can bring my own lozenges if I want to help tamp down the taste.  I might do that.  Maybe a fruit flavored mint. 

I did sit very still in the chair with the sleep mask on at all times.  This is something I learned from my bouts with vertigo. If I lay very still and do not move my head or my body at all I tend to be able to control the vertigo so I used that technique for myself with this as well and it seemed to keep me from getting dizzy.  I did notice that if I adjusted at all or when I peeked out from the blindfold later on that it did make me immediately dizzy.  So I hope I can use this technique going forward to fend off any puke attacks.

So the trip.  I know that is the part everyone cares about.  First I will say this was the low dose so there was not a lot going on there.  I mean my mind was my own.  I could have my usual thoughts that come into my mind and I tried very hard to just allow it to happen organically and not force anything.  I admit I was waiting on the rainbows and unicorns or depths of hell whatever my sick brain could conjure up.  I did not get that. 

At one point I felt a slight feeling of separation from my body.  My lips and whole mouth were numb like when the dentist novicanes you.  I squeezed my Nemu and ran my hand over his usually soft skin but it felt scratchy.  The blanket felt scratchy.  Like when I have very dry skin on my fingers.  My fingers felt kind of numb.  I saw myself in a purple light like tentacles of light attaching to me, embracing me, not tightly but gently like a bubble.  It was all very pleasant.  Not overwhelming. Nothing harsh.

The music in the headset was a spa playlist of birds chirping a field of flowers and trees, the babbling brook and ocean waves.  There were keyboard parts where the sound of the piano keys was predominant.  Honestly I could have done without that because it was very jarring and almost intense to hear each key hitting its note.  I can’t describe that. 

I did not feel like I was sleeping or wanted to sleep.  I was rested.  Like a very deep meditative state.  I then sensed her.  The phoenix.  On my vision board in 2020 (before the pandemic and the week before I found out I was losing my job) I put an image of the phoenix.  Despite the entirety of my life collapsing having not yet occurred in that moment it was as if I knew what I was going to need before I needed it.  As if I knew the path I needed to walk before I was even on it.  But lately I am not anything close to that phoenix.  I am ash and dust with no fire.  But in the darkness of that moment, the absolute blackness that I was staring into I caught a glimpse of orange and red.  IT was maybe a head. Just a head.  I could not see the body or the form beyond it.  Just felt it.  I think she is in there.  Down deep in the darkness.  The therapist said that the mind can conjure and create strange things.  That I should not focus on what I see but more what I feel.  I don’t know what I felt.  I felt like it was positive.  It did not feel bad.  It did not feel fearful.  It was pleasant.  But then it was gone. 

I could feel the backside of the trip as I exited out of that domain.  And I felt like I had to pee.  Like REALLY bad.  I don’t know how because I drank nothing but one small sip of water for at least 7 hours prior (I did have some water at 4am).  So where was all this pee coming from.  I mean I had to PEE.  I waited for a few minutes which seemed like hours and the sensation only intensified.  I finally pressed the call button and a nurse came.  I told her I could not hold it anymore.  I was probably a good hour or more in at this point and the peak of the trip was over but I was still very dizzy when I removed the blindfold.  They took me by wheelchair to a bathroom and that was a challenge.  Caitlin said that this does happen sometimes and the drug can cause this so I pray that this is not going to happen every time.  It ruined the vibe of everything on the backside. 

I was very tired at that point and returned to the headset and blindfold again.  I at least did not throw up despite being dizzy.  It was kind of like when you wake up after surgery and are really out of it but need to pee.  Exactly like that.  So after I was returned to the cubicle they tucked me back in and I was able to relax.  Nemu felt soft again and I was starting to feel my lips and mouth again.  I actually felt tired like I could sleep and I think I did for a few winks. 

Eventually Caitlin came to get me and took my vitals one last time.   She walked me out to the lobby and that was it. 

My husband was not there but I texted and he showed up in a few minutes.  He had been exploring the downtown area while I was in treatment.  I was alert but very tired.  I can’t describe it.  They recommend not napping because it will cause you to not sleep at night so I stayed awake and my husband’s driving did not hurt those efforts. LOL. 

On Friday I will be given the full dose for the first time so I have some obvious fear about that and don’t know how I will handle that.  I am also worried about how I will handle the 2 days back-to-back next week but it is what It is.  It is just a necessity with my work and so I just have to get through it.  That will only happen twice so I just need to deal with it. 

As far as how I feel after Day 1.  Depressed.  I mean I am not grabbing a knife to off myself but I am sad and still feeling hopeless.  I also know this is a marathon and not a sprint and that I can’t expect a day 1 miracle.  I guess I hoped for one in the back of my mind.  But I need to give this time to work and as the therapist recommended, try to notice the small changes.  So far there are no small changes but it was a low dose on day 1.  So I am just writing this for anyone reading who maybe has the same experience and worries it isn’t working.  This is my experience.  I suspect everyone is different.  But that is why I am blogging this so that there is a path from start to finish whether it works or it doesn’t for me.