“An all around great place for healing. It has only been one week since my ketamine treatment, and I have seen improvements every day with my nerves and regained a sense of hope for my future. The staff here are amazing and will take the best care of you possible. I cannot recommend Ascend and their wonderful people enough.” -Hannah T.
Peripheral neuropathy is a condition affecting motor, sensory, or vasomotor nerve fibers marked by muscle weakness and atrophy, pain, and numbness. Traumatic injuries, infections, metabolic problems, inherited causes, and exposure to toxins can result in painful nerve damage.
People with peripheral neuropathy generally describe the pain as stabbing, burning or tingling. In many cases, symptoms improve, especially if caused by a treatable condition. Nerve disorders such as trigeminal neuralgia, syndromes such as POTS and EDS, and other problems can appear in constellation with other diagnoses.
There is new evidence for ketamine’s use in Long COVID, Parkinson’s Disease, dementia, and a host of complex neurological and immune disorders, but at this time we do not recommend it as a treatment in the absence of documented pain or mental health indications–more on that below.
How We Help
Our comprehensive approach to healing neuropathic pain combines ketamine infusion therapy and medication management. These complicated syndromes may improve with nutrition, exercise, supplements and other lifestyle changes. However, beginning with ketamine allows for quick results that gives patients the hope and perseverance to see permanent changes. In some cases for established patients, we do provide non-ketamine medicine and/or vitamin infusions, still avoiding narcotics and opioids, although these tend to give relief for days to weeks instead of months to years. This has saved our patients thousands of dollars (and hours of time) compared to urgent care and ER visits with providers who may not be familiar with their treatment resistant history.
Ketamine infusion therapy works in a variety of ways: it decreases inflammation, regulates glutamate (an important brain fuel source), increases synaptogenesis and neuroplasticity, and decreases central sensitization.
Cytokines, Ketamine, and the Microbiome
“The impact of cytokines—whether exogenous or endogenous—on the brain may have lasting neuropsychiatric implications if left unchecked. Hence, determining the timing of these events is crucial, as earlier interventions, such as treatment with anti-inflammatory agents, administration of antibodies to cytokines, or injection of cytokines directly, in many instances, may prevent the development of chronic neuropsychiatric complications. This becomes especially relevant with the onset of first-break psychosis seen in schizophrenia, childhood onset of seizures, and delirium due to acute metabolic conditions.”
Cytokines, Ketamine, and the Microbiome
Cytokine storm has been in the news as a deadly reaction to COVID-19. As a plausible inhibitor of IL-6—a cytokine causing lung damage in many COVID cases—the anesthesia drug ketamine and other drugs with complex mechanisms to reset inflammation are gathering interest worldwide. What are cytokines? These tiny signaling proteins are a major part of the immune system’s defense against invaders. Some are helpful and encouraging, some are inflammatory, but without them it’s difficult for a post to go viral.
Does that mean that COVID-19 survivors could be at increased risk of mental illness? Isn’t depression a chemical imbalance in the brain (and one that ketamine can improve in most cases)? It’s much more complex than the thirty second explanation from a pharmaceutical ad. Forget about medical specialties staying in their lane. Your gastroenterologist might need to team up with your psychiatrist. This isn’t the way medicine or insurance works right now, but our patients are tired of five minute appointments with specialist after specialist, each with vast knowledge about a single organ or type of disease. They are told it’s all in their head, or a syndrome isolated to the immune system, or muscles, or nerves. We often forget that syndromes refer to constellations of symptoms, so let’s talk about one or two as an example.
Nervous System and the Gut
Chronic Regional Pain Syndrome (CRPS) and fibromyalgia are both painful, difficult to treat chronic nerve conditions. However, concentrating solely on pain management or altering the nervous system hasn’t resulted in better outcomes. In comparison to treatments at similar facilities, taking a holistic, root-cause analysis approach shows promising outcomes at our ketamine clinic. A new study shows that leaky gut syndrome and small intestine bacterial overgrowth (SIBO) are significant culprits in CRPS and fibromyalgia. This relates to the cytokines we mentioned earlier.
To use another example, cytokines function like the media. If they don’t tell the public to get worked up about Coronavirus or the immune system to get excited about a potential threat, we’ll just ignore it. When gut bacteria aren’t healthy, inflammation spreads and affects every system, often with seemingly unrelated symptoms overshadowing the true culprit. “Inflammation” in our context refers to circulating cytokines and other products of the immune system fighting a chronic war with weapons better suited for a quick skirmish. Each system depends on the others and is vulnerable to changes in the microbiome, which is the complex system of bacteria, yeasts, and even viruses living inside of every human. Recently at our clinic, a patient’s anxiety decreased substantially just from starting a probiotic. That’s all we did—not TMS, or SPRAVATO™, or medication. Multiple studies confirm this, although a meta-analysis shows results are only significant in cases of disease and inflammation. The nervous system and hormones and digestive tract and blood vessels all interact in ways science is just beginning to understand. We may be blaming our minds for dysfunction originating elsewhere, just because the brain tells us so—after all, it is the only organ that can communicate its problems using language.
Protect the Brain
Lest we think of the brain as pretentious, it is fairly…quarantined, if you will, by tight junctions of cells meant to keep out harmful substances. Unfortunately, cytokines invade more than the gut. These inflammatory mediators cross the blood-brain barrier as easily as Saff’s arm in a tiger cage to cause the phenomenon cytokine-induced sickness behavior. Symptoms include increased sleep, decreased appetite, decreased sexual drive, and overwhelming fatigue, frequently combined with fever. Sounds like depression. Perhaps this is partly why vague yet debilitating chronic illnesses continue to increase, causing some patients to lose hope in modern medicine and turn to alternative practitioners who will at least believe that they are sick.
So how can we turn off brain inflammation? Ketamine infusions work well for concussion injuries, neuropathic pain, and a wide range of mood disorders via regulatory effects on glutamate at the NMDA receptor and multiple other molecular signaling sites. Research also shows it works as a glue at the blood-brain barrier to prevent the breach that allows inflammatory substances to trespass.
Multiple studies also demonstrate that ketamine enhances the proliferation of helpful bacteria in the microbiome. Obviously, decreasing inflammation is the takeaway here. You may expect advice about a niche drug that requires continuous monitoring for treatment resistant conditions as a pandemic cure-all. No. The delicate balance of cytokines can be improved simply by decreasing inflammation. This is a simple and sustainable beginning. It does require some life-style modification, but the results are in your hands. Start small and without the pressure to perform. Gently listen to your body and learn from it, treating it holistically—mind, body, and spirit—rather than as quarantined fragments.
Ketamine and Lyme Disease–Options for Spoonies
Chronic Lyme Disease, also described as Post-Treatment Lyme Disease Syndrome, is a controversial syndrome often similar in presentation to fibromyalgia and chronic fatigue syndrome. The concept involves the spirochete from a tick bite hiding from routine detection while still impacting the nervous system and causing a wide array of debilitating problems. Spirochetes are tiny bacteria implicated in acute and chronic diseases, and “syndromes” are diagnosed from a particular group of symptoms. This means the solution for complex disorders may differ and individualized care provides best results. Rather than slapping on the perfect label to define closely-related diseases, which can be a very expensive process, we should be most concerned with discovering and healing the root cause of these syndromes. We’ve found that many patients have the resources to obtain the correct diagnosis or try a promising treatment, but not both. Simply covering up symptoms only delays effective treatment–illness does not occur because of an innate medication deficiency. Lyme Disease predisposes patients to other rare and elusive infections, although some research disputes this. “This phenomenon may be related to various self-sustaining inflammatory mechanisms rather than persistent infection,” according to policies drafted by insurance companies.
Patients are understandably unconvinced and spend tens of thousands of dollars trying to get better, often resorting to years of self-pay treatments with intravenous antibiotics, hyperbaric chambers, infrared sauna treatments, and a variety of supplements. The research rarely shows these treatments to be completely effective, but as with many complex diseases, one solution in isolation won’t fix the problem. It takes several modalities to gain relief. Studies fail to convey the necessary complexity of personalized care and solutions are sparse. It’s a classic case of, “Don’t confuse my medical degree with your Google search” and, “Don’t confuse your one hour lecture in school with my ten years of living with this disease.”
Although we may recommend certain supplements to kill persistent infection in our patients, our goal is to strengthen and repair the body rather than start a civil war or “seek and destroy” mission. Our primary repair weapon at Ascend Health Center is ketamine infusions. Studies show that the NMDA antagonist ketamine is an effective, non-opioid solution for both the debilitating pain and the psychiatric manifestations of Chronic Lyme Disease. Ketamine is an anesthesia medication with potent anti-inflammatory properties that grows new connections in the nervous system, bypassing vicious cycles of pain and despair. Spoonies, as sufferers of chronic ailments often call themselves, are familiar with short-term treatments that may treat one symptom, only to exacerbate another. Many of our patients have multiple chemical sensitivities as well. Ketamine redirects the neurotransmitter glutamate to nourish the brain and build new neural networks instead of increasing hypersensitivity reactions throughout the body. Neuroplasticity and synaptogenesis occurs via the chain reaction illustrated above through a natural release of Brain Derived Neurotrophic Factor (BDNF).
What does that look like, practically speaking? Ketamine treatments in more severe cases occur over a four day period, but we tailor programs before and after at no extra charge to make sure the patients receive the best care possible. We’ve seen the infusions repair problems that patients didn’t even realize were related to the original disease. Ketamine starts a process of healing that continues long after the drug is excreted, preventing the dependence associated with opioids and the constant levels required for medicinal marijuana to remain effective. Because it targets different receptors, ketamine is compatible and enhances many other medicinal and non-medicinal approaches to Lyme Disease. It is much more cost-effective than treatments to kill parasites that may not even reside in the body any longer, even if their effects remain.
Chronic neurological diseases reinterpret pain perception in the nervous system, so we re-train the brain. Our therapists and psychiatrist assist in this effort, while realizing many of these patients have been told, “It’s all in your head” for years. Oral and intravenous vitamin and medication supplementation may also be necessary, typically after we see immediate results from ketamine. Because digestive issues are also common with Chronic Lyme and similar syndromes, we place patients on specific enzymes and probiotics, and make diet and lifestyle recommendations when indicated. We also collaborate with local practitioners to provide affordable treatments, including acupuncture, chiropractic care, medical massage, and functional medicine.