Thursday, January 27, 2011


i'm too tired to go into it at the moment, but it looks like i may have a chance to get ketamine infusion treatments (the "awake" version) for crps. 

the problem? 

(and you know there has to be a problem.)

the two docs doing it are... less than pristine, far from stellar, not exactly objects of admiration. 

as the referring health practitioner put it, they are "cowboys."

one had his license revoked for a few years and has multiple medmal settlements.

the other is a D.O. not well liked by his patients, and is really into the ka-ching-side of pain management -- procedures, procedures, procedures. costly intervention!

 however, on the plus side?  the referring health practitioner reports that he "used to be cute."
(well, that settles it.)

additional problems?

(and you know there have to be additional problems.)

getting anyone in my life on board to be supportive about ketamine infusions.  i will need support -- logistically, physically, emotionally.  also a problem?  pitching this to my "go-to" group of doctors, all of whom are less than keen about ketamine anything, much less intravenous infusions of it done on purpose, repeatedly!  i expect resistance based on the unresolved osteomyelitis/infected prostheses and a couple of other persnickety comorbidities.

should i start a petition?  a write-in campaign? 

if i want this treatment, if i can get insurance coverage for it (oh, yeah, i forgot to mention that as a potential problem... mwa ha ha), what does it matter what my "team" thinks?  or my life partner? 

or even la bonne et belle bianca castafiore

i remember when the prospect of "only" receiving temporary and incomplete pain relief was a prospect not deemed worthy of pursuing.  now that i have a good dozen viable suicide plans, "temporary and incomplete" sounds downright enticing.

fred's only comment thus far relates to the probability of hallucinations during treatment... i keep trying to tell him that i doubt he'll be able to notice much of a change.

i'm grateful to the kind practitioner who told me about this today.  she risks putting herself in the middle of an uncomfortable and unsupported referral.  i am enormously grateful that she took the risk. 

i don't quite understand why the availability of "awake" ketamine infusions for crps/rsd in this region of tête de hergé isn't being shouted from our elevated medieval slate rooftops... but if it works out for me, i'll be yodelling the news throughout hill and dale.

from the Holy Wikipedia entry on CRPS:
Ketamine, a potent anesthetic, is being used as an experimental and controversial treatment for Complex Regional Pain Syndrome. The theory of ketamine use in CRPS/RSD is primarily advanced by neurologist Dr Robert J. Schwartzman of Drexel University College of Medicine in Philadelphia, and researchers at the University of Tübingen in Germany, but was first introduced in the United States by Doctor Ronald Harbut of Little Rock Arkansas. Doctor Harbut and Doctor Graeme Correll (of Queensland, Australia) first began studying the use of ketamine in the treatment of CRPS patients. Dr Harbut's first CRPS patients in the USA were successfully treated in 2002 with the low-dose ketamine infusion; also called the "Awake Technique" and he soon began work with FDA on an approved protocol. In early 2003 Dr Harbut began sharing his treatment methods with the Doctors at Drexel University College of Medicine, including Doctor Schwartzman. The hypothesis is that ketamine manipulates NMDA receptors which might reboot aberrant brain activity.

A 2004 article discussing ketamine infusion therapy states, "Although ketamine may have more than one mechanism of action, the basis for using it to treat CRPS may reside in its strong ability to block NMDA receptors. Experimental evidence suggests that a sufficiently intense or prolonged painful stimulus causes an extraordinary release of glutamate from peripheral nociceptive afferents onto dorsal horn neurons within the spinal cord. The glutamate released, in turn, stimulates NMDA receptors on second-order neurons that produce the phenomena of windup and central sensitization. It is reasonable to consider that, by blocking NMDA receptors, one might also be able to block cellular mechanisms supporting windup and central sensitization [4–7,15]. Ketamine is the only potent NMDA-blocking drug currently available for clinical use. Our interpretation is that an appropriately prolonged infusion of ketamine appears to maintain a level of ketamine in the central nervous system long enough to reverse the effects of the sensitization process and associated pain."[41]

There are two treatment modalities; the first consist of a low dose subanesethesia Ketamine infusion of between 10–90 mg per hour over several treatment days, this can be delivered in hospital or as an outpatient in some cases. This is called the awake or subanesethesia technique.

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