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Interesting gaswork post
- Thread starter caligas
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Costs are only $325 per infusion....
One of our pain docs at the University used to do these, but his infusions lasted half a day. They have to be doing something different, right?
One of our pain docs at the University used to do these, but his infusions lasted half a day. They have to be doing something different, right?
D
deleted162650
My group started our own ketamine clinic de novo in this past year (we are a general anesthesia group - no pain practice affiliation). We charge a bit more than $325 per infusion, but we are in a locale that supports "high end" service and patients. We have set protocols, and are are partnered with the hospital system. We've been doing it long enough now to get some meaningful outcome data, and it has really been beneficial for some of the terrible refractory depression patients.
I don't see why you would hire this clown to help you set it up. There are established protocols in the literature.
I don't see why you would hire this clown to help you set it up. There are established protocols in the literature.
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The cost is probably more therapeutic than the medication
Pain is so subjective. (In my opinion). Lots of scams going on. But it's America. Ketamine iv infusion. It's all bs. We all know it.
Like these facial rejuvenating creams. All these fad weight loss programs.
Money is money.
If the goal is to make money. Go for it. It's just so ridiculous to keep up the pep talk how this is good for the patient. It's good for the business owners pocket books.
Like these facial rejuvenating creams. All these fad weight loss programs.
Money is money.
If the goal is to make money. Go for it. It's just so ridiculous to keep up the pep talk how this is good for the patient. It's good for the business owners pocket books.
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4 years ago when I started my internship our department was in the process of ending our outpatient ketamine infusion practice - we had to do it at the outpatient surgery center and use a PACU or block spot for 4+ hours given the level of monitoring required. From what I understand, it stopped when the surgical volume filled the center and we needed those slots. I vividly remember one patient with underlying PTSD who became very, very upset and histrionic on it which was pretty disturbing to see - I don't think anyone really misses doing it.
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What dosing do you run these at? Adjuncts (glyco, etc)?
D
deleted162650
0.5mg/kg given over 40 mins. No glyco needed. Have Midaz on standby but haven't needed it.
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Dr Oz is RICH because of Green Tea extract and telling fat women they are beautiful.
Damn Oz taught Roosh that there are many "studies" that telling fat women they are beautiful really causes them to lose weight and "shaming" them is "bad".
Makes >10 million/year. Guess the market is always right.
Roosh is a "rapist" who is doing a "war against women" because he calls fat women fat.
Makes sense actually. Totally logical.
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Not sure about ketamine infusion for pain, but ketamine for depression is definitely real and can be VERY helpful for severe depression. But like all these things, the indications get looser and looser as the money ramps up.
That's the thing. Most people don't have severe depression. Not that I'm super skinny or anything. But i see so many people on anti depression meds. I telll them if they were really depressed they would be losing weight. But 90% of people I see on anti depression meds have bmi over 35. They are fat. If they really depress they be skinny.
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Nah. That's all fake govt news. Data can be manipulative. We all know.
Use common sense. If half peeps depressed were obese. The VERY DEFINITION of REAL DEPRESSION is losing interest in things u love.
So I love food. And I'm really depressed. I would lose weight. It's basic clinical psychiatry. I'm losing interest in things I love (food)
We've become a society of whiners and make up stuff to justify depression as being normal. People aren't depressed if they gain weight. If you love food and gain weight. U ain't depressed.
Look at the data very closely. They examine people who have reported depression within 2 weeks. Real clinical depression last months. Not weeks. Like fibromyalgia crap.
I've seen so many ads for depression on tv. It's all a money maker. Like ketamine iv infusion. I do have some swamp land to sell u in Florida also.
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This is actually not true. Depression needs to have depressed mood OR loss of interest according to dsm 5 for diagnosis of MDD. And one can eat w/o being interested in eating. Ppl can suicide w/o losing all their interests
Thats a large dose!
Dsm is an ever evolving bible for an imperfect psych diagnosis.
They just make up stuff just to go along with what's in vogue with society.
Look. I got problems. 1st world problems. I guess I'm depressed? I'm losing sleep the past 2 weeks cause I can't decide whether to retire in 5 years or 10 years. So am I depressed?
Seems like half the non working women friends of my wife are on add and anti depression meds. Chit chatting and drinking and having fun at social events/country club. Are they really freaking depressed? Seriously. Half of them overweight. They got 1st world problems as well
No. They just like to drink and go out and eat.
Depression is an over diagnosed condition.
In the "old days". And I'm one of those guys who has no excuses. Deal with it. It's freaking called life. U ain't depressed if u love food. Call it what it is. An addiction. But if u have an addiction (food). If u truly depressed. U would lose interest in ur addiction (food) and would really be losing weight.
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wel you could be. each person responds to different things differently. just like pain. some ppl are in severe pain from what i perceive to be like nothing. others barely feel it. perhaps dropping a potato chip on the floor is enough to send one person into MDD while others wont even care.
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Says who?
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I bet all those overweight women are on synthroid and blame their lack of energy and obesity on their "low thyroid" too. I'm convinced hypothyroidism (at least the vast majority that we see) is a fake diagnosis.
Not sure u being sarcastic or not.
My bottom line is dsm criteria for "depression" regarding weight has evolved over the years. Since half Americans are now obese. The dsm has tried to change with the times. In the past weight gain has been more associated generalized anxiety disorder and not depression.
Severe clinical depression has always been associated with loss of appetite (weight loss).
These psych people just trying to justify fat people who claim to be depressed by saying it's ok. Read the dsm 2 and 3. Read how it evolves into dsm 4 with clinical depression and now dsm 5. It's an imperfect diagnosis.
We are an overmedicated society.
Same with ketamine infusion. It's all BS.
And don't even try to justify if the FDA gives its stamp of approval on ketamine infusion that it makes it legit. Cause most people don't realize most of the fda "fees/funding" come from drug manufacture sources. About 80% of the FDA funding of big pharma. Talk about a conflict of interest.
And many authors of the dsm 4 and 5 have so many conflict of interest (financial) with big pharma. They want to sell those anti depression meds. Half the people obese in the USA. Got to tell the authors of the "bible" for psychiatry to make it look good and include gaining weight as a criteria for clinical depression when it wasn't a criteria 30 plus years ago.
Mental Health 'Bible' Under Fire, Again
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No, I truly believe the vast majority of hypothyroidism is fake. How can true hypothyroidism be this prevelant in society? It's an excuse for middle aged women to explain why they are low energy and overweight. Instead of saying it's because you don't go outside and eat fruits and vegetables, we give them a diagnosis.
The new corollary in men is "low T." You've lost your energy because you eat garbage and don't go outside, not because of some hormone imbalance.
Yeah, I don't think it's a fake diagnosis but it's widely overused. Nothing like someone telling me they're morbidly obese because of their low thyroid....
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Nah there's atypical depression where you gain weight
We've normalized so many diagnosis like depression. They used to be so taboo. No one would talk about it.
Yes. Atypical depression involves weight gain. Note word "atypical". No one uses that word any more. It's always "depression or MDD". No ones to use the label "atypical" cause people don't want that label. Being atypical.
Schizophrenia was the in vogue "diagnosis" in the 1970s/early 80s. Yet half them peeps on illegal drugs have the time.
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Fake may be the wrong word, but when I see that my next patient is at least a moderately overweight middle aged woman, I can almost guarantee that they will be on Synthroid...as well as a PPI. Maybe ketamine can treat "low thyroid" too...
D
deleted162650
Uhhhh, no it's not. That's like 1/4 of an induction dose given over 40 mins. Right in the "analgesic" dosing range. 35mg to a 70kg pt over 40 mins is not much.
FWIW, the patients we have treated have all been the real deal. Long psychiatric Hx, failed all other treatment avenues (often times including ECT), etc. So far it seems to be helping both subjectively and objectively - they complete pre and post treatment depression assessments. If they don't perceive much improvement after the first couple infusions, then we recommend they not continue with the full course as it gets really expensive and if they are gonna benefit, then it's usually apparent early on.
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Does insurance cover or is it out of pocket
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I didn't realize anesthesia training also boarded you in endocrunology and psychiatry...
We are physicians. Well rounded.
So we have to know all specialties. From peds to ob to neurology to even psych.
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While I don't necessarily agree with everything you've said about depression, this statement couldn't be any truer. And it is often forgotten. Everyone who is in the midst of or has completed an anesthesia residency is a physician first. In theory. I see a lot of attendings who want to be called doctor without any of the actual doctoring (and these people have MD and DO after their names). It drives me nuts. You aren't an anesthesiologist, you are a physician first. Then you get to be an anesthesiologist.
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It is also important to remember that your contact with patients is the span of hours, not years to decades like providers in those specialties. Making blanket statements about something from that perspective seems arrogant at best.
D
deleted162650
OOP
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Why are you convinced that previous thinking in psychiatry is superior to contemporary practice? Mere change is not sufficient to convince me that guidelines have shifted to match social trends.
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I would rather have an anesthesiologist administering ketamine to a psych patient than a psychiatrist administering anesthesia (ketamine). The latter scenario is an EXACT analogy to a cardiologist administering propofol (Michael Jackson).
Queue to the lawyers
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We must be stingy here as we only allow 20-25min infusion, but we make up for lack of time with dosing. We have a few up to 1-2mg/kg but start at 0.5mg/kg.
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if you have the staff/equipment for ketamine infusion for mdd, why not just offer it for other reasons as well like migraines which some places already do. open your own clinic, stuff 10 ppl in a room and run them on ketamine infusion. 1 anesthesiologist can probably handle all 10 pts on infusion at once
