Frequently Asked Questions
WHAT IS A CRNA?
A CRNA is a Certified Registered Nurse Anesthetist? We are professionals who have a Master’s Degree, or Doctorate in Nurse Anesthesia. Nurse Anesthetists may practice independently in 38 states. Minnesota and Wisconsin are two 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. 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/Therapist to determine if you are eligible for the treatments we offer. Beth Maki, Co-owner and Operator, is the CRNA here at Bloom and she has over 20 years of experience in administering anesthetic agents and is 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. 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 dramatic in relation to the treatment of depression and other mood disorders. It is a new option to explore and it is making a lasting impression on clients and practitioners who have embraced it. It is providing an attainable goal,(remission) from these chronic conditions.
HOW DOES INFUSION THERAPY WORK?
We will schedule an initial complimentary 20 minute phone consultation. At the initial consultation, if you are a good candidate for IV infusions, we will schedule you for your initial appointment. We will ask for health records from your provider and review your medical history. Although many clients have a positive response after one or two infusions, we highly recommend completing the series of six for longer lasting results. Schedules are flexible depending upon individual needs and client response.
Each IV infusion will begin with 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 client experience, around 40 minutes. Clients 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, we will need to get your 6 infusions in over 14 days for the best resolution of symptoms. However, we will work with you to determine a treatment plan that works with your situation. Once the initial infusion series is complete, we encourage mood monitoring in the coming months to determine if and when you may need a booster. Boosters are one infusion only to re-establish remission. Remission periods vary widely, from weeks to many months. Boosters can also be given as an intramuscular injection as a more affordable option.
WHAT IS KETAMINE?
Ketamine is an FDA approved medication that was synthesized in 1962 and was approved for use as an anesthetic medication in 1970. It is a blocker of the cellular NMDA receptor, a neural receptor for glutamate that has proved to play a significant role in major depression, chronic pain syndromes, fibromyalgia and other ailments. It is also known to have potent anti-inflammatory properties and is known to stimulate neuronal growth, synaptogenesis, and neuroplasticity. It is a Schedule III drug and should only be used and administered by a skilled licensed anesthesiologist, nurse anesthetist, or trained physician.
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 40 minutes 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.
IS KETAMINE SAFE?
Although it got a bad rep in the 70's and 80's as a drug of abuse i.e. “Special K”, ketamine is very safe drug when administered for anesthesia or as a treatment for depression as we do at Bloom Neurotherapy. The doses used for depression are much lower than those used for anesthetic purposes and clients are monitored closely for the duration of the 40-minute infusion. Most clients feel very relaxed and free while they are receiving the infusion and these effects wear off within an hour or so afterwards. We carefully assess your medical history and medication list before the treatment and will consult your primary care physician or mental health professional as needed.
WHAT ARE THE SIDE EFFECTS OF KETAMINE?
The side effects of the low dose ketamine infusions in our protocols are minimal and will only last about an hour or two, but may include mild drowsiness, nausea, and increased blood pressure. We routinely administer medication for prevention of nausea. Less common side effects include vivid dreams or agitation and these can be controlled by adjusting dosage. Most clients don’t mind the relaxed and free feeling they experience during the infusion.
HOW WILL I FEEL DURING THE INFUSION?
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.
IS KETAMINE 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. We do not write prescriptions for ketamine use outside the clinic.
WHAT MEDICAL CONDITIONS EXCLUDE ME FROM TREATMENT?
Medical conditions that are not well managed would disqualify 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. Relaxing or inspiring music is highly recommended and can affect the quality of your infusion! 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 Bloom.
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 by your primary care 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 mental health 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 Flex Benefits.
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 Bloom and your treating provider to communicate throughout infusion series to ensure this treatment is working toward substantial remission.
WHAT IS THE COST?
Prior to your initial infusion, we will discuss a payment plan and expectation with you. Infusions are $500 each, or $2400 (pre-paid) for the entire series of six, for substantial savings. Personal checks are not accepted, however cash, credit/debit cards, and cashiers checks are acceptable forms of payment. If you are a veteran, please let us know for special pricing ($1900/six infusions, paid in full). For more information on cost and financial responsibility please call. We do not want to turn anyone away for purely financial reasons, and will try to work with you!
For other information on the factors behind the cost of treatment and a wealth of other information please refer to the link: ketamineadvocacynetwork.org/cost/.
WHAT IS THE KETAMINE ADVOCACY NETWORK?
The Ketamine Advocacy Network was founded at the National Institutes of Health in 2012 by ketamine clinical trial volunteers. They personally experienced the power ketamine has to rapidly relieve the excruciating pain of refractory depression.
The founders quickly learned how difficult it is to get ongoing ketamine therapy from local doctors at affordable rates. And they encountered firsthand the powerful forces preventing widespread adoption of the treatment. The Ketamine Advocacy Network was born from their desire to overcome these obstacles and share the relief they experienced with fellow sufferers.
Since 2012, our ranks have grown to include alumnae from other clinical studies, clients of ketamine clinics, doctors and administrators who run those clinics, and concerned loved ones. We all share the same desire to spread awareness and acceptance of this powerful new weapon against depression, bipolar, and PTSD.
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902 E 2nd St. Suite 325, Winona MN 55987