Topic: The Sitters' Guide

[Eon T McKnight]

Hiya Gang!

After more questions from a new Forum member, the illustrious and kind Mr. Harveyplex, I have finally created this topic.  I had sort of refrained from doing so because I have neither experienced Eboka (yet) nor have I acted as a sitter (yet).

However, since I may have to use an inexperienced sitter myself, due to financial and other considerations, it is a subject of extreme interest to me.  Like it or not, advisable or not, there will certainly be those using Eboka without a trained or experienced sitter present.  Best to give them all advice possible and to prepare them  --  for the sakes of both ibonaut and sitter.  Plus, if Eboka is merely half as beneficial as I currently understand (and hope) it to be, I could definitely see myself as part of the process of healing and learning for others.

Guess that qualifies me to open the discussion, right?

To prime the pump, here are a few possible subjects for discussion:

• Medical Considerations:  What is happening, when?  What monitoring and equipment is advised?  What to do in life-threatening circumstances?  What other medications are safe, unsafe, etc.?  When to dial 911?  How much Eboka should be given, when?  How much is too much?  How much is not enough?  How to encourage the subject to take more, if needed, in the event of nausea/vomiting?
• Set and Setting:  What to discuss prior to the event?  What does the subject want to accomplish?  Where should it take place?  What should the environment be like, i.e. lighting, music, people?
• Interaction with the Subject:  What to do if the subject/patient/initiate is fearful?  Angry?  Sad/depressed?  When to talk and when to keep silent?  Should there be pre-arrainged activities, such as prayer, song, reminders, inspirational passages, etc. to be used in certain circumstances?  How to help the subject get to the bathroom?  How to prevent the subject from leaving or (shudder) driving?
• Use of a Two Sitter Team:  When is it advisable?  When is it necessary?  How to manage 'watches' so that all sitters get rest?
• Use of Established Techniques for 'Tripping':  What techniques have been used successfully by 'guides' for people using LSD?  How to manage 'bad trips'?
• Death:  Are all involved aware of all risks?  What should the sitter(s) do if the subject dies?

The above list is just a starting point.  Let me heartily encourage you to contribute.  Your contribution may be the one that makes the difference between success and failure or even life and death.  (Yikes, I'm sounding awfully serious here!)

Thanks from myself and all the others who will be enlightened by your questions and advice!

ET McKnight

[x]

Duuuuude, most excellent.
Here we go!!!!!

[fallout330]

Yes, very good advice there!

[Calaquendi]

Sounds to me like you really nailed it ET, insofar as this subject can be put "in a nutshell" - there's little to add.

Emphasis on experienced sitters is, quite obviously, preferable - and experience with iboga/ibogaine specifically. Certainly not everyone who wants to do this will have that 'luxury' but it's best to make darned sure a sitter has at least some idea of what eboka is and how to administer. Need for a sitter is never as important as it is with this stuff I think...

Personal experience notwithstanding, focus on the immediate safety and comfort of the participant is pretty much the basic job for any sitter. As you mentioned, knowledge of basic first aid/ pre-hospital emergency care (CPR) is desirable, and knowing when (and when not) to call 911.

If we're talking here about someone doing this on their own (so to speak) - then it's unlikely that someone doing the job of sitting will be in a position to act as a 'guide'. I would actually caution against this particular temptation, it may do more harm than good. Since iboga is such a personal endeavor, and even though the guys I had sitting for me are super experienced in plant medicine with additional personal iboga experience, I was left alone in the dark to do my work...this may sound strange, but I firmly believe this to be the most appropriate way of going about it. When I say alone, I mean that every 90 minutes or so I was quietly checked on and all my needs were met according to pre made instructions and agreements, but the vast majority of the time I spent in dark silence. We modeled this after what my brother and friend experienced in the early days of iboga clinics...this was their protocol - to have someone constantly there but only looking in on the 'patient' at intervals- the person left otherwise alone.

This is a very important topic, great job ET...

[Calaquendi]

PS> I'd like to clarify a statement I made above concerning when or when not to call 911...

This seems pretty obvious at first, and indeed for the most part it is, but just to elaborate: There are only a few instances I can think of that potentially could happen during a session and would require emergency care. First and most obvious would be respiratory arrest, this means that one has stopped breathing altogether. Not to scare anyone, as this is as rare as it gets - and I am not aware that this has happened 'spontaneously' (as a direct result of only using iboga)...not to say this as a fact but cases I have read usually have other drugs in the mix as well and iboga unfortunately outlined as the singular culprit. DO NOT FOR ANY REASON TAKE DOPE RIGHT BEFORE OR RIGHT AFTER IBOGA!

Next would be hypertensive crisis - but here I am not certain of the parameters which constitute this. I imagine it's a situation that requires little consideration on the part of diagnosis - dangerously high blood pressure. There would be other symptoms but I am not sure to lay them out here, just google it. This as well as below are two good reasons I advocate use of benzodiazepines.

Seizure - an epileptic fit or grand mal seizure would be  cause to involve emergency personnel. Among other uses benzos are a good prophylactic for seizure. Again these are all extraordinarily rare occurrences but it's best to know how to recognize them and have a plan for the unlikely event of an episode.

Please add more to this 'list' if you think of other immediate care scenarios that may present during a session. By no means is the above to be taken as a complete reference for emergencies, but this comes from what I have read and people in the field I have spoken with that are experienced providers.

 

[fallout330]

Well said Cal.  I know for myself, Benzodiazepines, have really reduced the suffering when going though heavy alcohol withdrawal, so I can see it being useful for various other emergency situations.

[x]

Set and Setting:  What to discuss prior to the event?  What does the subject want to accomplish?  Where should it take place?  What should the environment be like, i.e. lighting, music, people?

I received a communication yesterday from someone I respect. This person mentioned that treatments should be done in controlled environments, not at my home, and especially not theirs.

This is something I've been wondering about and thinking about. I was somewhat cavalier, I think, in making my home space available for people. I had instinct that there would be no medical emergencies, and I was right.
But what I did find was that it's too much to have the space support both my idea of home and sanctuary, and as a sacred space.
I think the tx space should be far more defined. I felt put out, as the folks were in my bedroom. It's the best room, hardwood floors (for puke) and close to the bathroom, but there were a couple times I wanted something from the room, and not disturbing them was a better idea. Also, having to be so very quiet, no speaking, no pots and pans (I bang a lot of pots and pans, I am a noisy, happy cook).
And making sure I had no visitors, no phone calls, etc.
There's also the point of what would happen if there was a medical emergency (read, death). I have thought about that, and dont like to dwell on it. *shudder*

About not having the journey in their own space, man, this just instinctually feels right. Unless the space could be transformed in prep for the journey, you know? Paint, move furniture, clean all the closets, wash down the window sills, on and on. Good to transform in a space transformed. I can see waking up post ibo and looking at the pile of bills, the laundry, the burnt spoon, the dog poop, whatever your triggers are, and having it be a less than reflective scene. Also, loved ones can be intrusive and, er, controlling.

My two cents for now, one just one question, from just one topic.

What, ideally is a controlled environment? A space dedicated to ibo? A space that is emotionally neutral? What do you think? I like the idea of summertime and the woods, or fall in the desert. (For myself, okay?)

[harveyplex]

i did mine in a hotel room .
it was ideal. we wanted a room with another connected but had to get two seperate rooms.
my sitter sat with me for the first 8 hrs straight and towards the ened could leave for periods up to 3 hrs. you really just go with it and it lets you (both) know whats ok to do.
time does crawl like they say .

[fallout330]

Very nice to hear, would like to hear more detail later, if possible!  Thanks!

[Indigo_JP]

Hi Everyone! 
I  have been a sitter only once, and every thing went as planed.  Let it be know that we had prayers & Blessings from all directions. Harveyplex who happens to be the person who took the extract did all of the leg work in the prior weeks to even make it possible.  I will admit I was nervous and had plenty of anxiety.  My biggest fear was that he might have an illergic reaction to the RB. Much of which resided after I coresponded with Cal. (thanks man) We went into it with an open mind and no expectations. 
He took a small test dose one hour befor he took the first bulk dose to test for abnormalities.(after this point I was much more relaxed)
I will do my best to share some of the notes I took while sitting for harvey into this forum over the next few days. 
Im Far from an expert at this, but I would be glad to answer any questions that I can.
        Later,
               JP

[Calaquendi]

Hello and welcome Indigo! Thank you for joining us man, and bless you for doing an outstanding job with your friend!

Sitting is no easy task, not by a long shot. I call it a noble endeavor. The entire spirit of an iboga experience radiates love and encompasses all involved. None of us are experts here - we're all just in this together. Your experience is very valuable and I look forward to discussing it with you and harveyplex...Great to have you on board! 

[Eon T McKnight]

Since I have never used Eboka nor acted as a sitter, I have no personal experience to contribute.  Hence, I have shamelessly plagiarized those who have both experience and the kindness to share it.  ~eon

The following has been copied from the "Manual for Ibogaine Therapy:  Screening, Safety, Monitoring & Aftercare" by Howard S. Lotsof and Boaz Wachtel.

Only select passages relating to the 'critical' period of ibogaine effects deemed relevant (by my inexperienced self) to the activities of a sitter have been included with minor edits.  The full text can be found at:

     http://www.ibogaine.org/manual.html


Whether in a hospital or outside of a medical environment the patient's safety can be best provided for by continuously observing the patient. A nursing assistant or other trained person should observe the patient continuously for 48 hours or longer if the patient response to ibogaine requires it. During this period pulse and blood pressure should be monitored at regular intervals and at any time that patients indicate discomfort or the observer has concern. The regular intervals may be as short as 30 minutes for the first four hours or until blood pressure and pulse are stable and then at time points of 1 hour to 4 hours thereafter.

Observers should have training in cardiopulmonary resuscitation and be prepared to call a hospital or emergency medical services should the patient's pulse drop below 50 beats per minute. If you are not prepared to call for emergency medical help you should not be providing ibogaine therapy. A hospital should be called at any time if a patient loses consciousness. The emergency number to be called should be available to all provider personnel at all times. Observing the patient is more work then one person can realistically accomplish. In a hospital setting nursing staff would normally rotate on 8 to 12 hour shifts.

Ibogaine has been shown to increase the effects of opiates as well as opiate toxicity. Ibogaine may also increase the potency and toxicity of stimulants. Therefore patients should be warned that concurrent drug use during ibogaine therapy may be fatal.

...the effective dose for the treatment of chemical dependence, including opioid dependence, has been seen to be between 15 mg/kg and 20 mg/kg of ibogaine. Effects of ibogaine generally will make themselves evident within 45 minutes to as long as, three hours after administration. In most cases opioid withdrawal signs will be reduced within 45 minutes of ibogaine administration. Ibogaine is usually administered in place of what would be the next scheduled dose of narcotics. This would provide for an ibogaine administration schedule 8 hours after the last dose of heroin, morphine or demerol and 24 hours after the last dose of methadone. It is expected that the patient would be exhibiting minor withdrawal signs at the time of ibogaine administration.

Once ibogaine has been administered, effects follow. The patient will usually want to lay prone and should be encouraged to remain still as nausea and vomiting have been seen to be motion related. The skin tends to become numb. Patients will report an initial buzzing or oscillating sound. A period of dream-like visualization lasting for 3 to 4 hours in most, but not all, patients is considered to be the first prominent stage of ibogaine effects. This stage ends abruptly should it occur at all. Another aspect of ibogaine effect that is common are random flashes of light that appear everywhere with eyes open. This may last for hours or days. Visualization on the other hand is most common with eyes closed.

The second stage that follows visualization has been described as one in which the subject principally experiences cognitive evaluation or a review of issues that are important to the subject. These may cover every possible scenario from early childhood experiences to current health issues. This period may last for as few as 8 hours or for 20 hours or longer.

The third or final stage of ibogaine effects is that of residual stimulation. This stage, because it tends to leave the subject/patient exhausted is somewhat uncomfortable. Subjects may remain awake for two or more days. Most patients will sleep within 48 hours of ibogaine administration. Some within 24 hours of administration. Usually, there is a long term long term diminishment of the need for sleep over weeks or months. Some patients may require or request sedation. Sedatives that have been used include benzodiazepines, barbiturates and melatonin.

...certain effects of ibogaine may mimic opiate withdrawal. These signs may include inability to sleep, nausea, a feeling of being cold or vomiting. It is the skill of the provider that will enable the provider to determine whether withdrawal signs are real or imagined and to assist the patient in understanding the difference. It must be recognized that elimination of withdrawal signs are not necessarily isolated ends in themselves to heroin or other opioid dependent patients. Being sick is a rational justification for relief and the simple presentation by the patient that they are exhibiting opiate withdrawal to a significant other or peer or other person in their environment has probably been used by the patient to obtain opiates or the money to do so. The conditioned response of obtaining gratification and/or attention by exhibiting opioid withdrawal signs or claiming to exhibit opiate withdrawal signs has been a successful behavioral mechanism for some patients and should be expected. Generally, if the complaint of withdrawal is made it can be expected between the 14th and 24th hour of treatment and may continue through recovery from ibogaine effects.

Generally, the session room should be pleasant and the social interactions with staff members supportive. Pastel-colored walls, comfortable hospital bed, soothing murals, paintings or pictures, a comfortable chair for the staff member or therapist to constantly observe the subject during the ibogaine experience. Dim lighting and quite setting. Dialogue should be initiated by the patient. Reduce the need for walking by having a patient lavatory nearby.

Within this context, allow the patient to sleep and rest peacefully ad lib. Otherwise, when the patient is in the talkative phase, the staff member should attentively and unobtrusively attend to but not initiate conversation.

[x]

Well documented, friend eon.

I am looking forward to meeting you.

[Eon T McKnight]

I have noticed electronic devices for measuring blood pressure that fit over the wrist and provide a digital readout for around $50.  These cute little devices would appear ideal for BP measurements during treatment  --  no cuff, no stethoscope and little training necessary.  And best of all, in this situation, minimally disruptive to the work being done by the ibonaut.

Does anyone have experience with such devices?  Do you think they would be appropriate?  Do they also monitor pulse rates?

Another beneficial role would be the use of the monitor as a biofeedback device to learn how to control one's BP.  I have taught myself to lower my BP, but never had quantitative, real-time data to monitor my progress.  Using a standard cuff and stethoscope to monitor one's own BP is more than a little distracting and certainly influences the readings.

The other problem with self-controlling BP is what happens when one's attention is focused on anything else?  I am thinking that such a device would enable one to learn how to 'multi-task', i.e. to control one's BP while engaged in other activities.

What you think???     ~e

[Eon T McKnight]

Gee, I was hoping to get feedback re: Automatic Blood Pressure Bracelet by now.

Has anyone used one?  Did it work satisfactorily?  Good brand(s)?  Bad brand(s)?

Can someone help here?

If not, maybe you could send me some left-over crakk instead...   

~et