Chapter 13: My Brain Scans; Inside Active View

I have been off clonazepam for 15 days.  I am still taking extra Neurontin for the anxiety, I am more irritable, but I am sleeping well.  I visualize my brain healing, and I am starting to get excited about being able to start the last part of my medication treatment plan.  As soon as the anxiety calms down I will begin taking Wellbutrin.  It is important for me to wait until the anxiety calms.  The 100 milligrams of Luvox I am taking per day is helping to calm the increased activity in the deep limbic system.  The 1200 milligrams of Neurontin per day is helping calm the anxiety in the basal ganglia.  Wellbutrin will help increase the activity in my prefrontal cortex.

Here are SPECT scans of a healthy brain when it is active.  This is a 3D Active rendering, looking at the most active 15% of the brain where fluid (Ceretec) injected into an artery reached the tissues.  A normal scan shows increased fluid in the tissues of the cerebellum, with all else being relatively quiet.  Pictures are from the Amen Clinic.
                                    

                                    

                   Here are my SPECT 3D Active rendering scans after rest:  R=rest.

These are my SPECT 3D Active rendering scans after concentration:  C=concentration

                           

                                                                           

My SPECT Study Findings Report from the Amen Clinic is 4 pages long.  Here is a brief overview of what was found on my scans.  The most significant finding is decreased activity bilaterally (both sides) of the temporal lobes on the rest and concentration studies. 

Decreased activity was found in the following areas:

• Bilateral inferior orbital prefrontal cortex, worse at rest.
• Bilateral parietal lobes, worse at rest.
• Medial parietal lobe, on both studies.
• Left and medial dorsal prefrontal cortex, at rest.
• Bilateral occipital lobes, at rest.
• Anterior medial prefrontal cortex pole, on both studies.
• Internal cerebellar activity, worse at rest.

Increased activity was found in the following areas:

• Thalamo-limbic system, worse on concentration.  The basal ganglia are a group of large nuclei that partially surround the thalamus.
• Anterior cingulate gyrus, on both studies.

Below are pictures of the anatomy of the brain.  PFC=prefrontal cortex; FC=frontal cortex; TL=temporal lobe; PL=parietal lobe; OL=occipital lobe; BG=basal ganglia; ACG=anterior cingulated gyrus; PCG=posterior cingulate gyrus; R=right; L=left.  These photos were included in my notebook from the Amen Clinic.

                                                              

I am not well yet, but I am making progress toward feeling better.  Having SPECT scans done did not cure anything, but they gave my psychiatrist at the Amen Clinic more information which helped him write a treatment plan that is working for me!

Chapter 12: I Hate Clonazepam, Supplements

I have been off clonazepam for 10 days.  I would not want to go through the withdrawal symptoms without the help of Neurontin and the supplements recommended by my doctor at the Amen Clinic.  Going off the drug caused increased anxiety, irritability, and not being able to sleep as well.  I went back to taking 300 milligrams of Neurontin four times a day.  Increasing the dosage from 1200 mg a day to 1500 mg a day made me so dizzy it was hard to function.  If the anxiety gets too uncomfortable, I open a 300 milligram capsule of Neurotin, put a little bit in an empty capsule and take it.

These are the supplements that have been extremely helpful to me:

Restful Sleep: Serving 4 capsules   4/bedtime
Vitamin B6 10 mg, Magnesium 100 mg, Melatonin (immediate release) 2.5 mg, Melatonin (controlled release) 2.5 mg, Valerian 600 mg, GABA 100 mg.

Neuro PS:  Serving 1 capsule   2/bedtime
Phosphatidyl Serine 120 mg, Phosphatidylcholine 72 mg, Phosphatidylethanlamine 54 mg, Phosphatidylinositol 30 mg.

Brain Vitale:  Serving 2 capsules   2/morning
Acetyl L-Carnitine 500 mg, GlyceroPhosphoCholine (GPC) 200 mg, Inositol 200 mg, Phosphatidylserine 120 mg, GinkgoSelect Phytosome 90 mg.

I have continued with the diet changes I talked about in Chapter 7.  I am also taking the supplements Dr. Mark Hyman recommends in his book, The UltraMind Solution.  I believe giving my body the nutrients it needs will help it heal.  This is what is included in the The UltraMind Solution Essentials Kit.

Multivitamin/mineral, ProThera, MultiThera 1 Capsule Formula: Serving 6 capsules
2/breakfast  2/lunch  2/dinner
Vitamin A 10,000 I.U., Vitamin C 750 mg, Vitamin D3 800 I.U., Vitamin E 400 I.U., 
Thiamine 50 mg, Riboflavin 25 mg, Niacin 100 mg, Vitamin B6 25 mg, Folate 800 mcg,
Vitamin B12 200 mcg, Biotin 300 mcg, Pantothenic Acid 150 mg, Calcium 250 mg,
Iodine 150 mcg, Magnesium 250 mg, Zinc 15 mg, Selenium 200 mcg, Copper 2 mg,
Manganese 10 mg, Chromium 200 mcg, Molybdenum 150 mcg, Potassium 50 mg,
Boron 2 mg, Vanadium 100 mcg, Choline 100 mg, Inositol 25 mg, para-Aminobenzoic Acid 50 mg, Citrus Bioflavonoids 100 mg.

Calcium/magnesium, ProThera, OsteoThera Capsule Formula: Serving 2 capsules
2/breakfast  2/lunch  2/dinner
Vitamin D3 200 I.U., Vitamin K 200 mcg, Calcium 250 mg, Magnesium 100 mg,
Boron 0.5 mg, Silicon 3 mg.  I have an extra bottle of this formula delivered with my kit to get 1,000 milligrams of calcium every day.

Vitamin D3, Pure Encapsulations, Vitamin D3 1000 IU: Serving 1 capsule   2/breakfast
I am also taking a 50,000 I.U. capsule of vitamin D every month.  My vitamin D level is at 45, and should be between 50 and 80.  I am looking forward to warmer weather so I can be out in the sun more.  Too much vitamin D can be toxic, so it is important to have my level checked by a blood test every six months.

Methylation, Designs for Health, Homocysteine Supreme: Serving 2 capsules
1/breakfast  1/dinner
Vitamin B2 50 mg, Vitamin B6 50 mg, Nature Folate Blend 2 mg, Folinic Acid 400 mcg,
Vitamin B12 1000 mcg, Zinc 5 mg, Magnesium 10 mg, Trimethylglycine 500 mg,
Choline 100 mg,Serine 100 mg, N-Acetyl-Cysteine 100 mg.

Omega-3 fats, Metagenics, EPA-DHA Extra Strength Enteric Coated: Serving 2 capsules
2/breakfast  2/lunch  2/dinner
EPA 600 mg, DHA 400 mg sardine, anchovy, herring.  I have an extra bottle delivered with my kit because I am taking 6,000 milligrams per day.

Probiotics, Metagenics, UltraFlora Plus DF Capsules: Serving 2 capsules
1/breakfast  1/dinner
15 billion live organisms: 50-50 blend of Lactobacillus acidophilus & Bifidobacterium lactis Bi-07.

There are days this seems like a lot of supplements to be taking, but I am starting to feel small glimpses of feeling better!  Being sick has motivated me to give my body the nutrients it needs.  The UltraMind Solution is a comprehensive guide to helping your body and brain be healthy.

Mark Hyman, M.D. states the following in his book, The UltraMind Solution.  "The most powerful tool you have to transform your health and improve your mood, mind, and metabolism is your fork!  Use it well and you will thrive.  Choose poorly and you will suffer."

"The varied components of a whole-foods diet not only taste better, make you feel better, and prevent disease, but they are literally medicine.  Mounting scientific evidence points to the power of food as medicine.  These "medicinal" foods are simply the foods our bodies evolved eating---fresh, unadulterated, slow-burning, high-fiber, vitamin- and mineral-rich, omega-3 plentiful, and phytonutrient-dense foods."  (Chapter 14, page 292)

"Think of nutrients as fertilizer for your brain.  Think of them as little helpers that improve communications and connections.  In a perfect world, no one would need supplements.  But given the stress of our modern life, the poor quality of our food supply, and the high load of toxins on our brains and bodies, we clearly need a basic daily supply of the raw materials for all our enzymes and biochemistry to run as designed."  (Chapter 15, page 304)

How to Optimize Your Nutrition for Vibrant Health

The path to better health is simple-and agreed upon by almost all scientists. In this week's UltraWellness podcast, Dr. Mark Hyman explains how to optimize your nutrition and which supplements are crucial for vibrant health.  This podcast is very good and I'm sorry I wasn't able to embed it in the post.

http://www.youtube.com/profile?user=ultrawellness#p/search/2/QNX--ZqCOQU

Chapter 11: My Brain Scans; Outside Surface View

Getting off the drug clonazepam is brutal! Clonazepam is the generic name for Klonopin, and is in the benzodiazepine family of drugs.  They are sometimes called benzos for short.  The last time I lowered the dose it brought me down to .03125 of my original dose of .50 at night.  This time the withdrawal symptoms did not subside in 2-3 days, they persisted. 

After having a headache, slight nausea, a strange dizzy feeling, and increased anxiety for a week, I increased the dosage of Neurontin.  I am now taking 300 mg of Neurontin three times a day and 600 mg before bed. The main side effect of Neurontin (for me) is a dizzy feeling; so I am just more dizzy now.  Increasing the dose of Neurontin has decreased the anxiety, and the other withdrawal symptoms as well.

The supplements recommended by the doctor at the Amen Clinic are also helping.  (Refer to Chapter 10 for more details)  I take Restful Sleep and Neuro PS at night and they have helped me continue to sleep well.  Adding the extra Neurontin capsule at night also helps me sleep. Taking Brain Vitale in the morning seems to help with anxiety.  Luvox, Neurontin, and the supplements are making the withdrawal tolerable.  I would hate to do it without them!

I am hoping in the next two weeks the side effects of Neurontin will be over, and the clonazepam withdrawal symptoms will have stopped.  If this happens, I am going to stop taking clonazepam.  I am anticipating a spike in anxiety when I do this.  If this happens I can increase the dosage of Neurontin again. 

Being addicted to clonazepam gives me more compassion for anyone addicted to anything!  I want to get off clonazepam because it is causing scalloping on my brain. This scalloping shows I am not getting the blood flow I need in those areas.  It is hard to remember the reasons to quit when I feel sick day after day and know if I took a little clonazepam I would begin to feel better.  It is a hard place to be.

Here are SPECT scan photos of the outside of a healthy brain.  These are scans of the top down surface and the underside surface of the outside of the brain.  These are 3D Surface renderings, looking at the top 45% of brain perfusion.  (Perfusion means injection of fluid into an artery in order to reach tissues.)  A normal scan shows full, even, symmetrical perfusion.

These are my SPECT brain scans of the outside of the brain during concentration.  The scalloping is circled in white. The scalloping on my brain is mild and should heal after I am off clonazepam. The scalloping holes mean cerebral blood flow and metabolism are poor in these areas.  It does not mean my brain is missing in these scalloping holes. After the scalloping heals my brain will have better functioning capabilities.

These are my SPECT brain scans of the outside of the brain during rest.  The scalloping is circled in white again and you will notice an object has been put in one of holes to show how deep it is.  I think it looks like I put a Mentos candy in my ear and it went to my brain. :)

          

                             

Below are three examples of more severe scalloping and the causes.  These scans are taken from a poster made by Dr. Daniel G. Amen.  They show a 3-D surface view of the brain, acquired by SPECT imaging, looking at cerebral blood flow and metabolism.  I think these scans are fascinating and intriguing!

                                                                                                                                                                 

                                                          

Chapter 10: Detailed Treatment Plan

I believe the psychiatric diagnosis I received at the Amen Clinic is based on a higher level of education than I have experienced in the past. Each person I worked with at the clinic was professional, knowledgeable, friendly, and caring.

This is my treatment plan:

1. Blood tests: CBC with differential, thyroid panel, chemistry panel, lipid panel, hemoglobin A1c, and 25 hydroxy vitamin D level.
2. Neurontin:  Prescription drug I started when I got home. I am taking the supplements Neuro PS, Restful Sleep, and Brain Vitale. Neurontin and the supplements are helping calm down the anxiety, and I have been able to slowly lower the dose of clonazepam. I will continue to take Luvox.
3. Clonazepam:  When I am off this drug and the anxiety has calmed down, I will begin taking Welbutrin SR or XL to stimulate the prefrontal cortex.
4. Effexor XR: This antidepressant may be effective for me. I would like to try Wellbutrin first, because I don't want to go through Luvox withdrawal and adjusting to Effexor XR side effects.
5. Vitamin D:  I need to raise my level from 45 to 70.
6. Fish Oil, Omega 3 Fatty Acids:  I am taking 6,000 mg per day.
7. Aerobic Exercise:  30 minutes every day. I have only missed a few days since we got home. I feel so much better when I exercise it motivates me to be consistent.
8. Psychotherapy:  My husband and I went to a therapist for 2 years.  Then I went on my own for 3 three years.  In the past I have done group work dealing with depression.
9. Education in Brain Healthy Strategies:  Reading Dr. Amen's books, Healing Anxiety and Depression, and Change Your Brain, Change Your Life, have helped. There is also a lot of good information in my AMEN CLINICS, INC. notebook.  This notebook also has a copy of my scans and treatment plan. I'm sure there are other authors who could help in this area as well.
10. Dietary Strategies: The Amen Clinic supports the diet recommendations in the UltraMind Solution, book by Dr. Hyman.  I want to continue with the diet changes I made before going to the clinic.
11. Transcranial Magnetic Stimulation: Would be helpful on the prefrontal cortex and cortex. This therapy is available at the Neuropsychiatric Institute in my area.  My insurance company considers this therapy experimental for depression and will not cover it.  I need to find out how much each therapy session would cost.  If I were to have it done in Newport Beach it would be $180.00 per session.  The number of sessions needed can be 20-40, or sometimes more.
12. Mental Exercises:  Reading, playing music, doing puzzles, or playing memory games to keep the brain active.
13. Behaviors To Avoid:  Anything putting me at risk for a brain injury or toxic exposure.
14. Television:  Limit my time watching the tube.

The supplements I am taking have the following ingredients. I purchased the supplements at the Amen Clinic.

Restful Sleep:  4 at bedtime   Serving 4 capsules
Vitamin B6 10 mg, Magnesium 100 mg, Melatonin (immediate release) 2.5 mg, Melatonin (controlled release) 2.5 mg, Valerian 600 mg, GABA 100 mg.

Neuro PS:  2 at bedtime   Serving 1 capsule
Phosphatidyl Serine 120 mg, Phosphatidylcholine 72 mg, Phosphatidylethanlamine 54 mg, Phosphatidylinositol 30 mg.

Brain Vitale:  2 in the morning   Serving 2 capsules
Acetyl L-Carnitine 500 mg, GlyceroPhosphoCholine (GPC) 200 mg, Inositol 200 mg, Phosphatidylserine 120 mg, GinkgoSelect Phytosome 90 mg.

I am following my treatment plan everyday and I am making slow, steady progress.  It has not been easy to come off the drug clonazepam, and I was only taking .25 mg at night before bed.  I have been shaving a small amount off the tablet every ten days.  Three or four days later I have a headache pain medication doesn't relieve, nausea, and a dizzy feeling.  These withdrawal symptoms will last 2-3 days until my body adjusts.  I have a healthy dislike for this medication, but I also know I should not come off too fast.  There are some days I feel impatient.  

It makes me angry I am addicted to a prescription drug that is damaging my brain!

This is the program I was watching on PBS when I first heard about 

Dr. Amen and SPECT Brain Scans.

  

 

Chapter 9: Three Days At The Amen Clinic

Wednesday morning I had my first SPECT brain scan.  The IV was inserted with ease and I had no bruising later.  The concentration scan is done first and I did an activity to get my brain focused.  The radioactive isotope was put into my IV during the activity.  I did not have any sensation in my body when it was injected.  After the activity I laid down on my back on the scanning machine.  I needed to hold still, but the the time went quickly; it took about 15-20 minutes.  A band was wrapped around my forehead to help me keep my head still.  The scanning machine made a noise, but it wasn't irritating.  Part of the machine went around my head, but I did not feel claustrophobic like I have during an MRI.

Wednesday afternoon I had an appointment with one of the historians.  She had read my intake questionnaire and asked me questions to clarify, or give her more details on my answers.  This was a calm, deliberate process. She gave me plenty of time to add any information to what was included in the questionnaire. She compiled a well written history for the psychiatrist I had an appointment with later in the week.

Thursday morning I had my second SPECT brain scan.  After the IV was in place I was taken to a dim lit room to prepare for the resting scan.  I was asked to let my mind wander or daydream, but not to think about any specific subject, meditate, or fall asleep.  A short time into my resting the isotope was injected.  There was an interesting rug in the room with geometric shapes on it.  I wanted to see how the pattern repeated itself, but I didn't, I kept resting.  There was also a picture of Dr. Amen with information about his work in brain imaging I wanted to look at.  I didn't, I kept resting. After 15-20 minutes, I laid down on the scanning machine for my second scan.

On Thursday afternoon, my husband and I had a delectable seafood lunch at a restaurant called Rusty Pelican.  It is on 2735 West Coast Highway, Newport Beach, CA 92663-4798, (949) 642-3431.  http://www.rustypelican.com/

On Friday afternoon I met with a psychiatrist.  He showed me my brain scans and went over what was found on them.  It was awesome to see the scans!  He showed me rippling, called scalloping, on the surface of my brain.  For me, it is probably caused by taking the drug clonazepam. I have not abused or been exposed to drugs, alcohol, or environmental toxins. I have used this drug for approximately 8-10 years and the Amen Clinic uses it only for short periods of time for severe cases of anxiety.  I am in the process of coming off clonazepam so the scalloping on my brain can heal!

Other Findings:

1. Luvox has been helping calm the activity in my deep limbic system; where depression originates. 
2. There is too much activity in my basal ganglia; causing anxiety. 
3. I have an atypical depression needing to be treated in layers.  This is why I haven't achieved a more complete remission of symptoms in the last year and a half.  The basal ganglia (anxiety) must be calmed down first. 
4. My prefrontal cortex is not functioning effectively.  After the anxiety is calmed down I will need to take a drug to stimulate the prefrontal cortex.  If I take this drug too soon, it will over stimulate the basal ganglia and cause too much anxiety.

I now have an extensive treatment plan giving me hope I can get feeling better!

Chapter 8: Amen Clinic, Newport Beach, CA

I decided to go to the Amen Clinic in Newport Beach, California and I had an amazing experience!  Thank you to my family and friends for your support and encouragement. I wanted the added information a SPECT scan could give me. I read almost everything on Dr. Amen's website: http://www.amenclinics.com/, and ordered his book, Healing Anxiety and Depression, on CDs. The Amen Clinic is affordable.  A complete evaluation is $3,375.00, and some insurance companies will help pay for the expenses.  I needed the complete evaluation.  I have been so sick I felt I couldn't afford not to go!

The first time I called the clinic, the person answering the call gave me a lot of information and answered all my questions. After talking to her I knew I wanted to go, I just needed to work out the time frame I could make it happen.  I scheduled my appointments on my second call to the clinic. If you are coming from out of town you need to plan on being at the clinic for three days.  My husband and I flew out on a Tuesday, and went to my appointments on Wednesday, Thursday, and Friday.  We flew home on Saturday.

My patient care assistant emailed me the intake questionnaire and a list of possible places we could stay while in Newport, Beach.  The intake questionnaire can be filled out online, or you can print it and fill it out.  I answered mine online and then printed a copy to take with me.  It was twenty pages long.  It is an extensive and thorough history, and I think it is an important part of the evaluation.

We decided to stay at the Radisson Hotel.  The Amen Clinic has a contracted price for a room there which includes a free buffet breakfast each morning.  We had a beautiful room with soft, fragrance free linen and a firm, comfortable bed.  The bathroom was clean, and had plenty of towels and washcloths. The food in the hotel restaurant was delicious and we appreciated the nice accommodations. 

We rented a car, but the clinic is so close to the Radisson Hotel you could walk to it.  The Radisson Hotel is across the street from the John Wayne Airport, but I think it would be a tricky walk.  The Radisson Hotel may have a shuttle service to and from the airport. I didn't ask for information on their shuttle service. There are also places to eat west of the hotel offering good food.  You could probably do the trip without a car if you wanted to.

I listened to the CDs of, Healing Anxiety and Depression, three times before we left for California.  On the front of the book it says, "Based on cutting-edge brain-imaging science, this book:  Reveals 7 types of anxiety and depression, Provides proven-effective treatment plans for each type, Explains the source of anxiety and depression through brain images, Includes a type-determining self-diagnostic test."  The 7 types of anxiety and depression are:  Pure Anxiety, Pure Depression, Mixed Anxiety and Depression, Over focused Anxiety/Depression, Cyclic Anxiety/Depression, Temporal Lobe Anxiety/Depression, and Unfocused Anxiety/Depression.  I didn't predict exactly which types my symptoms of anxiety and depression fit into, but my results were fascinating!

Chapter 7: Keys to UltraWellness, Food Sensitivity

A friend who knew I was battling depression recommended I read the book, The UltraMind Solution, by Mark Hyman, M.D. An excellent recommendation! Dr Hyman writes, "I call myself the 'accidental psychiatrist.' I never set out to be a brain or mood expert. In fact, my focus was more on how the body works as a whole system. And people saw me not to treat depression or autism or Alzheimer's, but to deal with chronic complaints and illnesses of the body. . .Over the years as I worked to correct the fundamental imbalances that are the cause of all disease (the seven keys to UltraWellness, which you will learn about in a moment), I discovered that mood and brain disorders would often magically disappear as I treated a patient's physical problems."

I have been dealing with depression since 1981, and I have a strong genetic predisposition for the illness. But I wanted to find out about other ways to help my brain heal, along with taking psychiatric medications. These are the seven keys to UltraWellness:

1. Optimize Nutrition
2. Balance Your Hormones
3. Cool Off Inflammation
4. Fix Your Digestion
5. Enhance Detoxification
6. Boost Energy Metabolism
7. Calm Your Mind 

Meet Dr. Mark Hyman as he talks about the 
future of medicine and the Seven Keys to UltraWellness.

I was motivated to make major changes in my diet after reading this book.  Dr. Hyman recommends taking dairy and wheat out of your diet for at least six weeks to see if you feel better. If you read this book it will help you decide what diet changes may be helpful for you.  I have several allergies to weeds, trees, and grasses, and have responded well to immunotherapy allergy shots.  If you have an allergy to something it usually causes an immediate reaction; if you have a sensitivity it can take 2-5 days to cause a reaction in your immune system.  I don't have any allergies to foods, but I thought I may have some sensitivities since I am so allergic to other things.

My son and I had blood drawn for the IgG Comprehensive Food Sensitivity Assay test. It is also known as the ELISA test. Dr. Hyman talks about this test in the book. We found out my son is gluten intolerant, so that has changed our diet dramatically. After receiving the results of my ELISA test I have eliminated or cut back on all of the foods I am sensitive to. I am hoping this will help reduce the inflammation in my body and help heal my brain.  Dr Hyman educated me on this issue in his book.  I eat the +1 foods occasionally.

These are the results of my test: +4 is the highest sensitivity and +1 is the lowest sensitivity.

Alfalfa +1               Mustard +1                 Salmon +1                           Wheat +1
Cumin +1               Onion +1                    Seed, Caraway +1               Yeast, Baker's +3
Egg +4                   Paprika +1                 Squash, Yellow +1                Yeast, Brewer's +4
Garlic +1                Pumpkin +1               Tomato +2                            Zucchini +1
Milk, Cow's +1

If you are interested in finding out more about the IgG ELISA test, go to http://www.immunolabs.com/.  Their customer service was very helpful.
  
I also decided to eliminate white flour, white sugar, and most fats other than olive oil from my diet.  (I still put a little butter on my sweet potatoes and baked white potatoes. :)  My digestion is more efficient and I feel better after I eat.  It hasn't cured my depression, but I believe it is an important part of my treatment plan.  The changes in my diet, and exercise helped bring my cholesterol down from 216 to 163.  Yay!

Dr. Hyman includes The UltraMind Solution Companion Guide with his book.  It has a page in the, Set the Stage for Success, section which recommends items you may need to prepare the food in his recipes.  He calls them UltraEssentials.  Amazon.com has many of these items if you are interested.  I love to shop at Amazon.  They usually have what I need (or want) for the best prices.