10 Day Outpatient Ketamine
Posted: Mon Dec 26, 2011 5:12 pm
I started a 10 day outpatient Ketamine protocol on Dec. 12th. The infusions were M-F during the morning (2-4 hours), home on the weekend, and then M-F during the morning again finishing up on Dec. 23rd.
They obtained a urine sample before they started the Ketamine for drug screening. Was weighed in as maximume infusion rate is based on weight plus some patients lose alot of weight because of nausea. They have cut the 10 day protocol short for some patients if they lose too much weight. I think the nurse told me if a patient loses 5 pounds in 3 days they stop the infusions.
The first day they started the infusion at 7mg/hr and increased the dose every 15 minutes with the goal of reaching 67mg/hr for a total of 100mg. It took about 2 hours for me to get the total of 100 mg and didn't quite reach the 67 mg/hr before I hit the 100 mg. They gave me Versed for hallucinations, Zofran for nausea and put on a Scopolamine patch for nausea. The hallucinations were mild and tolerable. The Ketamine really affected my vision and made things look like things were under a strobe light and very difficult to focus my vision. It took a long time for it to wear off each day. I got really sick the first day and was throwing up. They gave me some extra Zofran just before discharge which helped. My pain was worse when they were done with the infusion than before they started. Spent the whole day in bed but by dinner time was able to go out and keep dinner down.
The second day they started the infusion at 14 mg/hr and increased again every 15 minutes to a maximum dose of 67 mg/hr for a total dose a 150mg which took about 2.5 hours to infusion. They gave me Phenergine instead of Zofran for nausea which worked great and Versed again before they started the infusion. For the next 7 infusions they gave me Phenergine and Versed before starting the Ketamine infusions. No nausea at all and I didn't have nausea after the first day. The nurses and doctors told me that they have found the Scopolamine patch has done wonders for nausea. They gave me a prescription for the Scopolamine patch which I changed every 3 days. My pain was better in my legs after the infusion was complete but made no difference in my pelvic pain. Went back to the hotel and slept until dinner. That really pretty much was the routine. I would sleep off and on during the Ketamine infusions, go back to the hotel, sleep all afternoon, out for some dinner and then back to bed.
The third day the infusion started at 20 mg/hr and again same thing as far as increasing and they went to 200 mg over about 3.5 hours. CPRS pain was better in my legs but not the pelvic pain.
Unfortunately, the morning of day four I woke up feeling like a I had a 500 lb gorilla sitting on my chest. They decided not to increase in the dose and left me at 200 mg. The gorilla sitting on the chest did decrease and go away after about 3 days. Each day I would have hallucinations during the infusions. Every sound and sensation is intensified. There were two days that I was having really bad left lower quadrant/groin pain and adductor pain which was just intensified during the infusions. The nurse said that they have found occasionally that some patients pain is intensifed during the infusions. The Ketamine infusions during the first week helped the CRPS/RSD pain I have in my legs but not the pelvic pain nor the adduction pain. I told both the doctors and the nurses that adductor and pelvic pain is a very different pain from the CRPS/RSD pain and the Ketamine worked on the CRPS pain.
Originally they were going to do some Lidocaine infusions the second week but because I was tolerating the Ketamine so well they decided not to. Day 6, which was Monday was a little tough going but that is quite typical since you have a few days for the Ketamine to decrease in the system and they repeated the 200 mg over 4 hours. On day eight they increased the dose to 225 mg over 4 hours and I knew it when I really came out of it as I just felt generally "yucky." The next two days I received the same dose, 225 mg, and just felt generally awful at that dose.
The second week they also started me on Namenda 5mg twice a day. This is an off label use for this drug as it is for Alzeiheimers but it works on the NMDA receptor just like the Ketamine dose.
Overall, my CRPS pain in my legs is so much better. I had no CRPS flares in my legs and they were between 0-3 for 2 weeks. The Ketamine never touched my pelvic pain or the adductor pain in my legs. Some of the CRPS pain is just starting to return to my legs. The Ketamine did wonders for my TMJ and right shoulder pain which is nice.
Some general comments: Both the doctors and nurses told me that they have done Ketamine infusions on 3 other pelvic pain patients with excellent results but that my case is much more complicated because of all the different nerves I have damaged in my pelvis and legs. They also told me that they have had several patients with CRPS that the Ketamine infusions didn't help at all and some patients don't tolerate the Ketamine and they had to stop the infusions. It is one-on-one nursing care during the infusions. The nurse told me many patients they can't even leave the bedside because of the hallucinations and disorientation during the infusions. They have no way to know how long any improvement will last and is different for each individual. The nurse told me no two people tolerate or react to the Ketamine infusions the same way so they are prepared for pretty much any type of response to the medication. I told them I thought the reason the Ketamine works is because you basically sleep for 2 weeks and we all know the correlation between sleep and pain. I was told there is one doctor in the practice who believes exactly that, that the Ketamine doesn't do anything directly but that it is the sleep that the patients get that causes the improvement. This pain group has been collecting very detailed data for 1 year now on all their Ketamine infusions and will eventually publish their results. They asked me very detailed questions about location, type of pain, quality of pain, etc. before and after each infusion. Lastly, this pain group considers the infusions a success if you have 50% improvement in pain. The doctors did not anticipate my pain to be zero, were very upfront with what they thought would be a reasonable result and did not expect a cure.
I follow-up in 2 weeks and from what the residents told me the plan will be to try the Lidocaine infusions to see if it will help the pelvic pain and adductors.
I hope this answers some questions for those of you looking into Ketamine.
They obtained a urine sample before they started the Ketamine for drug screening. Was weighed in as maximume infusion rate is based on weight plus some patients lose alot of weight because of nausea. They have cut the 10 day protocol short for some patients if they lose too much weight. I think the nurse told me if a patient loses 5 pounds in 3 days they stop the infusions.
The first day they started the infusion at 7mg/hr and increased the dose every 15 minutes with the goal of reaching 67mg/hr for a total of 100mg. It took about 2 hours for me to get the total of 100 mg and didn't quite reach the 67 mg/hr before I hit the 100 mg. They gave me Versed for hallucinations, Zofran for nausea and put on a Scopolamine patch for nausea. The hallucinations were mild and tolerable. The Ketamine really affected my vision and made things look like things were under a strobe light and very difficult to focus my vision. It took a long time for it to wear off each day. I got really sick the first day and was throwing up. They gave me some extra Zofran just before discharge which helped. My pain was worse when they were done with the infusion than before they started. Spent the whole day in bed but by dinner time was able to go out and keep dinner down.
The second day they started the infusion at 14 mg/hr and increased again every 15 minutes to a maximum dose of 67 mg/hr for a total dose a 150mg which took about 2.5 hours to infusion. They gave me Phenergine instead of Zofran for nausea which worked great and Versed again before they started the infusion. For the next 7 infusions they gave me Phenergine and Versed before starting the Ketamine infusions. No nausea at all and I didn't have nausea after the first day. The nurses and doctors told me that they have found the Scopolamine patch has done wonders for nausea. They gave me a prescription for the Scopolamine patch which I changed every 3 days. My pain was better in my legs after the infusion was complete but made no difference in my pelvic pain. Went back to the hotel and slept until dinner. That really pretty much was the routine. I would sleep off and on during the Ketamine infusions, go back to the hotel, sleep all afternoon, out for some dinner and then back to bed.
The third day the infusion started at 20 mg/hr and again same thing as far as increasing and they went to 200 mg over about 3.5 hours. CPRS pain was better in my legs but not the pelvic pain.
Unfortunately, the morning of day four I woke up feeling like a I had a 500 lb gorilla sitting on my chest. They decided not to increase in the dose and left me at 200 mg. The gorilla sitting on the chest did decrease and go away after about 3 days. Each day I would have hallucinations during the infusions. Every sound and sensation is intensified. There were two days that I was having really bad left lower quadrant/groin pain and adductor pain which was just intensified during the infusions. The nurse said that they have found occasionally that some patients pain is intensifed during the infusions. The Ketamine infusions during the first week helped the CRPS/RSD pain I have in my legs but not the pelvic pain nor the adduction pain. I told both the doctors and the nurses that adductor and pelvic pain is a very different pain from the CRPS/RSD pain and the Ketamine worked on the CRPS pain.
Originally they were going to do some Lidocaine infusions the second week but because I was tolerating the Ketamine so well they decided not to. Day 6, which was Monday was a little tough going but that is quite typical since you have a few days for the Ketamine to decrease in the system and they repeated the 200 mg over 4 hours. On day eight they increased the dose to 225 mg over 4 hours and I knew it when I really came out of it as I just felt generally "yucky." The next two days I received the same dose, 225 mg, and just felt generally awful at that dose.
The second week they also started me on Namenda 5mg twice a day. This is an off label use for this drug as it is for Alzeiheimers but it works on the NMDA receptor just like the Ketamine dose.
Overall, my CRPS pain in my legs is so much better. I had no CRPS flares in my legs and they were between 0-3 for 2 weeks. The Ketamine never touched my pelvic pain or the adductor pain in my legs. Some of the CRPS pain is just starting to return to my legs. The Ketamine did wonders for my TMJ and right shoulder pain which is nice.
Some general comments: Both the doctors and nurses told me that they have done Ketamine infusions on 3 other pelvic pain patients with excellent results but that my case is much more complicated because of all the different nerves I have damaged in my pelvis and legs. They also told me that they have had several patients with CRPS that the Ketamine infusions didn't help at all and some patients don't tolerate the Ketamine and they had to stop the infusions. It is one-on-one nursing care during the infusions. The nurse told me many patients they can't even leave the bedside because of the hallucinations and disorientation during the infusions. They have no way to know how long any improvement will last and is different for each individual. The nurse told me no two people tolerate or react to the Ketamine infusions the same way so they are prepared for pretty much any type of response to the medication. I told them I thought the reason the Ketamine works is because you basically sleep for 2 weeks and we all know the correlation between sleep and pain. I was told there is one doctor in the practice who believes exactly that, that the Ketamine doesn't do anything directly but that it is the sleep that the patients get that causes the improvement. This pain group has been collecting very detailed data for 1 year now on all their Ketamine infusions and will eventually publish their results. They asked me very detailed questions about location, type of pain, quality of pain, etc. before and after each infusion. Lastly, this pain group considers the infusions a success if you have 50% improvement in pain. The doctors did not anticipate my pain to be zero, were very upfront with what they thought would be a reasonable result and did not expect a cure.
I follow-up in 2 weeks and from what the residents told me the plan will be to try the Lidocaine infusions to see if it will help the pelvic pain and adductors.
I hope this answers some questions for those of you looking into Ketamine.