WHAT IS A CRNA?
A CRNA is a Certified Registered Nurse Anesthetist. These professionals have a Master’s Degree in Nurse Anesthesia. Nurse Anesthetists may practice independently in 38 states. North Dakota is one of these states. Nurse Anesthetists complete a bachelor’s degree in nursing, work in an intensive care unit for an average of 3 years and then complete a Master’s program between 2.5 to 3 years in length. Traditionally we provide all inpatient anesthesia services including pre-operative and post-operative evaluations, plan of care, general anesthetics, sedation and regional anesthesia as well as private pain management. CRNAs are credentialed and nationally recognized as experts in anesthesia. CRNAs are well educated in the effects and adverse effects of medications and are highly qualified to administer them in an outpatient setting as well as possess the skills to evaluate and intervene should potential or life-threatening events occur.
We are NOT psychiatrists or psychologists and do NOT specialize in the clinical treatment of depression or other mental health illnesses. You will receive the highest level of expertise in our professional field and we will work alongside your primary care provider to determine if you are eligible for the treatments we offer and if it is in your best interest to receive the treatment. Both CRNAs here at Thrive have over 7 years of experience in administering anesthetic agents and are highly skilled in providing you with a safe and comfortable private environment.
WHAT IS IV INFUSION THERAPY?
Intravenous (IV) infusion therapy is a treatment option for people who have been diagnosed with treatment-resistant mood disorders and chronic pain. The treatment is administered via a small IV catheter, in low doses, and in a comfortable, safe outpatient setting. Currently, there is an overwhelming amount of emerging evidence-based clinical data and research that has revealed results that are so dramatic in relation to the treatment of chronic pain and MDD that physicians and advanced practice nurses are bypassing usual protocols and medication that have proven to be inadequate time and time again. It is a new option to explore and it is making a lasting impression on patients and practitioners who have embraced it. It is providing an attainable goal, which is remission from these chronic afflictions, to those that have been left resigned from life.
HOW DOES AN IV INFUSION SERIES WORK?
After we have received and reviewed your medical history and completed acknowledgment of ongoing care by a mental health professional or primary care practitioner, we will schedule an initial complimentary consultation which is 20 minutes in duration. At the initial consultation, if we decide that you are a good candidate for IV infusions, we will schedule you for your initial 2 treatments. IV infusions have been shown to bring about a positive change in 70% of patients so the majority of our patients will notice relief in pain and mood disorders within 1 or 2 treatments. When it has been determined that the infusion is a success, we will schedule additional treatments in accordance with our protocols. Schedules may vary depending upon disease process, individual needs and client response.
Each IV infusion will begin with completing a questionnaire, establishment of an IV, and placement of vital sign monitors. The medication required for your plan of care will then be mixed into a saline infusion and administered via the IV catheter. Infusions will take place over a variable amount of time depending on the patient experience, adverse effects, and current diagnosis. Patients will be monitored throughout the infusion period as well as for the post-infusion period that may last from 30 minutes to an hour.
As a guideline, the more days of ketamine therapy in a row, the better resolution of symptoms. However, each disease process is different and we work with you to determine a treatment plan that works with your situation. Some patients may do well with a less intensive treatment plan but CRPS and RSD require intensive therapy. More than one series of infusions may be required to achieve resolution of symptoms.
WHAT IV INFUSION THERAPIES DO YOU OFFER?
There is a variety of IV infusion medications that have significant positive effects on mental health and chronic pain management which include but are not limited to:
- Clonidine: α2-adrenergic receptor agonist believed to reduce norepinephrine in the peripheral nervous system which decreases the intensity of pain.
- Dexmedetomidine: a selective α2-adrenergic agonist which may have a role in treating painful conditions that are manipulated and/or attenuated by the sympathetic nervous system.
- Magnesium: a competitive NMDA receptor antagonist that decreases acute and chronic pain by stabilizing abnormal nerve excitation.
In order to facilitate the most optimal outcome for you, one of our clinicians will select an appropriate medication and treatment plan individualized to you. We will incorporate your diagnosis, medical history and symptoms that you are currently experiencing to maximize the benefits of your infusion therapy.
WHAT IS KETAMINE?
Ketamine is an FDA-approved anesthetic, amnestic and analgesic that has been in wide use around the world in operating rooms, emergency rooms and trauma fields for over half a century and is on the World Health Organization’s list of essential medications. Current research suggests that ketamine infusions poses a myriad of groundbreaking but unconventional attributes that hold a lot of promise in the future of CPS and MDD.
Over the past 15 years, ketamine infusions have been relentlessly studied as an alternative treatment for refractory depression, chronic pain syndromes, post-traumatic stress disorder and many other conditions and they illuminated great success.
Although Ketamine is FDA approved, its use in these conditions is “off-label” and it is currently not covered by insurance. It is estimated that almost 25% of all prescription medications sold in the United States are prescribed off-label. While thousands of patients are having success with this treatment there is no guarantee of relief of pain, depressive symptoms or length of remission should it be achieved.
HOW DOES KETAMINE WORK?
Ketamine is a non-competitive NMDA glutamate receptor antagonist with additional effects on dopamine and mu-opiod receptors. While it does stimulate opiate receptors, much like morphine, its NMDA receptor antagonism at subanesthetic doses is thought to be much more important in the treatment of chronic pain and psychiatric disorders. It is this low dose of intravenous ketamine that has been found to cause a glutamate surge, which appears to play a critical role in the rapid and robust effects of ketamine.
Ketamine is largely different from that of typical FDA-approved antidepressants and pain medications because it works more broadly by reducing NMDA receptor function therefore modulating or preventing the brain’s glutamate transmission. This leads to a rapid increase in glutamatergic activity causing regeneration of synaptic connections between brain cells that have been chronically damaged by stress, anxiety, depression, and pain. It is a sort of “rebooting” for the communication system between areas of the brain and body that have previously been damaged by these chronic conditions.
Recently performed and published studies have shown that a very low dose of ketamine infused over one hour has had a dramatic positive effect on clinical depression, especially towards suicidal feelings and in cases that don’t respond to standard treatment. The results indicate an immediate resolution of depression and the relief from a single infusion can last for as little as a few hours to as much as a few weeks. In general, most patients typically experience one to two weeks of relief.
WHAT IS LIDOCAINE AND HOW DOES IT WORK?
Lidocaine is a local anesthetic or more commonly understood as a numbing agent. For some patients, intravenous injections of lidocaine minimize whole-body pain by numbing the nerves which are causing discomfort. Lidocaine blocks sodium entering the nerve ending at the site of the pain thus blocking the pain impulse. This prevents an electrical signal building up and passing along the nerve fibers to the brain. The blocking of voltage-gated sodium channels may play a role in the attenuation of both neuropathic and inflammatory pain. This type of infusion has been found to be equal to morphine, gabapentin, amitriptyline, or amantadine for treatment of neuropathic pain.
The IV infusion will be administered at a very low dose and over an extended period of time. The first 15-20 minutes are typically uneventful with no noticeable effects, however, within 20 minutes or so, people tend to notice some blurring of vision, a feeling of “lightness”, “floating”, or intoxication and sometimes some numbness in the toes or area around the mouth. Over the course of the next 20 minute period, these feelings tend to build, so that the medicine is at the peak of its intensity at the very end.
Other common feelings include euphoria, talkativeness, a feeling of being “disconnected” or in a dream, heightened perceptions (background noise may seem louder, colors or lights are more intense) and a feeling that people often describe as “weird, odd, different, or interesting”. Less commonly, people may experience nausea and rarely hallucinations. These feelings start to subside approximately 10-15 minutes after the medicine is done and last for a total of 45 to 50 minutes. Most people can expect to be with us for about 90 minutes, with no side effects beyond your release from our care and none between treatments. Most adverse affects can easily be treated by adjusting the rate of your infusion or with other medications to make your infusion experience pleasant and calming.
HOW WILL I FEEL DURING MY INFUSION THERAPY?
The IV infusion will be administered at a very low dose and over an extended period of time. The first 15-20 minutes are typically uneventful with no noticeable effects, however, within 20 minutes or so, people tend to notice some blurring of vision, a feeling of “lightness”, “floating”, or intoxication, and sometimes some numbness in the toes or area around the mouth. Over the course of the next 20 minute period, these feelings tend to build, so that the medicine is at the peak of its intensity at the very end.
Other common feelings include euphoria, talkativeness, a feeling of being “disconnected” or in a dream, heightened perceptions (background noise may seem louder, colors or lights are more intense), and a feeling that people often describe as “weird, odd, different, or interesting”. Less commonly, people may experience nausea and rarely hallucinations. These feelings start to subside approximately 10-15 minutes after the medicine is done and last for a total of 45-50 minutes. Most people can expect to be with us for about 90 minutes total, with no side effects beyond your release from our care and none between treatments. Most adverse affects can easily be treated by adjusting the rate of your infusion or with other medications to make your infusion experience pleasant and calming.
ARE KETAMINE OR ANY OF THE OTHER MEDICATIONS ADDICTIVE?
In past years, Ketamine has received a stigma of being a “party drug” or “street drug” and some may be concerned about the potential for abuse or addiction. Academic research and clinical experience have shown that the very low dosing and adherence to protocols dismiss the risk of addiction. Again, access to ketamine is limited and difficult to attain outside of the controlled atmosphere that we provide so there is virtually no concern for abuse.
WHAT MEDICAL CONDITIONS EXCLUDE ME FROM TREATMENT?
Medical conditions that are not well managed would preclude you from any infusion treatment. Uncontrolled high blood pressure, any serious cardiac or respiratory condition, untreated thyroid disease, a current manic phase of bipolar and active psychosis (hallucinations/delusions) need to be discussed with your clinician to avoid any potential complications. We will review your medical history, contact your primary provider and perform a brief physical assessment to ensure this line of treatment has little to no risk to your physical or mental health.
CAN I CONTINUE ALL OF MY CURRENT MEDICATIONS WHILE RECEIVING INFUSION THERAPY?
This will be adjusted and discussed on a case by case basis, however, some medications have been shown to interfere or dampen the effectiveness of the infusion. These medications include benzodiazepines (such as Xanax, Ativan, Versed, Valium and Clonazepam), risperidone (Risperdal) and olanzapine (Zyprexa). These medications may not need to be stopped but the dose leading up to infusion therapy and for a short period after may need to be adjusted and we will work with your primary provider for that.
WHAT DO I NEED TO KNOW ABOUT MY DAY OF TREATMENT?
Each day of treatment will be similar in expectations and we ask that you adhere to our guidelines as they are put forth to keep you and others safe. Prior to any infusion treatment, we will require a government-issued photo ID, completion of a questionnaire regarding your illness as well as consent forms acknowledging that you understand the rules, risks and that there is no guarantee and that this treatment is not a cure but an adjunct to your current therapy regimen.
It is also good to be aware that you will be awake through most of the infusion period, however, you may rest or sleep if you choose to. Many clients find it helpful and relaxing to listen to music so you are encouraged to bring your electronic device and headphones if you choose. As you get deeper into the infusion process it may be difficult to carry on a conversation with those around you, so we encourage you to focus on getting comfortable, relax and pay attention to what you are feeling.
CAN I FOLLOW A REGULAR DIET BEFORE AND AFTER MY INFUSION?
Please do not eat solid food, drink milk or any liquids containing solids (juice with pulp or soup) for 6 hours prior to your appointment. You are encouraged to drink clear liquids such as water, apple juice, Gatorade, black coffee or tea up until 2 hours prior to your appointment. We also ask that you do not chew gum, use chewing tobacco, suck on candy or smoke 6 hours prior to your appointment. Once you are released from our care you may advance your diet as tolerated and return to a normal diet.
CAN I DRIVE MYSELF TO AND FROM MY APPOINTMENTS?
Although the effects of these infusions wear off quickly once the infusion has stopped, we ask that you refrain from driving for 24 hours after your infusion. Please plan on arriving with or arranging a responsible friend or relative who can drive you home safely after your infusion. Choosing to drive any earlier than 24 hours after your infusion is considered to be driving under the influence and can be punishable by law.
WHAT ARE THE RISKS OF IV INFUSION TREATMENTS?
Infusion therapy is typically well tolerated, however as with any medical procedure or administration of medication, there is always a potential risk of complications or adverse events. The symptoms or side effects will diminish once the infusion is completed, discontinued or slowed down. We are prepared for all potential side effects and have the necessary skills and equipment to manage the potential complications of all treatments we offer here at Thrive until emergency services arrive if needed.
HOW LONG WILL THE EFFECTS LAST?
Resolution of symptoms after a series of infusions may last anywhere from 2 weeks to 3 months and sometimes up to a year. Remission is variable and individualized. Completion of a full course of treatment is encouraged to maximize the effects of the treatment. After completion of an initial series of treatment subsequent “booster” infusions may be required to substantiate the longevity of remission. The highest chance of success is to ensure proper diagnosis and to utilize this treatment as an adjunct to your ongoing program that has been put forth by your primary care, pain management or mental health provider.
HOW DO I KNOW IF THE TREATMENT HAS WORKED FOR ME?
Prior to you beginning an infusion series, you will complete some brief questionnaires that will provide us with a baseline to compare progress. Upon completion of each infusion, we will follow up with you to determine your response. At that time, we can assess whether we need to adjust your treatment program accordingly to maximize benefits and minimizes side effects. It is not uncommon to notice positive effects as soon as 30 minutes post infusion but typically improvements begin several hours post-infusion.
DOES MY INSURANCE COVER INFUSION THERAPY?
Although IV infusion therapy is now nationally recognized as a substantial and legitimate treatment for chronic pain, mental health and depression it remains “off-label.” Therefore, insurance does not cover any portion of the treatment series. We will work with you to use your Health Savings Plans and FlexBenefits.
DO I NEED A REFERRAL?
We do not require a formal referral from your primary care provider or mental health provider. However, we will need to obtain your medical history and recent treatment history from your treating provider. Also, we strongly believe that to achieve the greatest success it is best for Thrive and your treating provider to communicate throughout infusion series to ensure this treatment is working toward substantial remission.
WHAT IS THE COST?
IV infusion treatments vary in cost, dependent on treatment frequency and length of each treatment. Prior to your initial infusion, we will discuss a payment plan and expectation with you. Personal checks are not accepted, however cash, credit/debit cards, and cashiers checks are acceptable forms of payment. We do maintain the right to refuse treatment dependent on our clinical impression. For more information on cost and financial responsibility please contact our office or email us and we will respond within 24 hours.
For other information on the cost of treatment please refer to the link: ketamineadvocacynetwork.org/cost/