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A recent study has found that repetitive Transcranial Magnetic Stimulation (rTMS) is effective in treating depression. The results showed that the majority of patients experienced a significant reduction in symptoms, with some even achieving complete remission.

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The combination of TMS (Transcranial Magnetic Stimulation) treatments and Ketamine Infusions is gaining national attention as a powerful way to alleviate Treatment Resistant Depression. For more information or to schedule an assessment call or text us at 330-754-4844.

IV Nutrition

KMI Wellness owner Crystal Harper, ARNP, CNP discusses IV and injection alternatives to oral supplements. Nick Angelis, CRNA, draws on his own experience with ketamine and adjuncts such as magnesium to discuss who can benefit most from intravenous infusions. We do offer IV nutrition at Ascend to current patients, but refer to Crystal in cases where the fluids, vitamins, and minerals we offer aren’t sufficient for a patient’s diagnosis. For example, POTS is a condition where the autonomic nervous system doesn’t regulate blood pressure correctly. Malabsorption disorders make it difficult to digest nutrients from food and oral supplements correctly. We also discussed the type of person for whom IV or injectable supplementation would be inappropriate. Transcript below.

Nick:
Welcome to the Ascend Health Show. I’m your host, Nick Angelis. I’m a nurse anesthetist and one of the owners of Ascend Health Center in Fairlawn. And I’m here with Crystal Harper, family nurse practitioner. How are you doing today?
Crystal:
I am doing great, Thank you. Thanks for having me.
Nick:
So we were saying just before the camera rolled that we should just do a morning talk show every day. Yeah, absolutely. We laugh obnoxiously at each other’s jokes.
Crystal:
I think we’d have a lot of them.
Nick:
Yeah. Talk about news that nobody cares about. Have pictures of people’s pets. Yeah.
Crystal:
We could add some fun stuff in there.
Nick:
Absolutely. But I guess nobody’s watching this to hear about pets. Although I do have a really nice pet. He’s. He’s a golden doodle dog. His name is Peanut. Oh, are.
Crystal:
Those the big ones? Golden Doodle? Yeah. Okay.
Nick:
He looks like a deer. I need to put an orange vest on him during deer season so he doesn’t get shot.
Crystal:
Yes, that would be important. Yeah.
Nick:
Anyways, why don’t we talk about your practice, my wellness and how that started.
Crystal:
Okay, so I started the clinic February 8th, 2021. So we just a couple of months ago hit our two year anniversary. Congratulations. Thank you. So I started the clinic really? Because I was working in family practice at a community health center and I just was becoming a little frustrated with the lack of time that I got to spend with my patients and, you know, realizing how sick our country is. And I wanted to spend more time with them and I wanted to look at some alternative ways to treat them. You know, I believe that traditional medicine obviously has a place, but I wanted to look at some more natural methods and maybe try to help them before we have to go to traditional medicine. And so I started the clinic during the midst of COVID, of course. And so great timing. I know, right? So but we treat a lot of COVID patients and so it was very helpful. And so we started with just being open, you know, two days a week. We’ve grown now we’ve shifted the days that we’re open to weekdays and now we’re open three days a week and we continue to add services. So we’re located in Ravenna at 128 North Prospect Street. We can be found at my wellness.com. We also can be reached at (330) 839-8078. And we offer a lot of different treatments And so there’s no specific conditions that we treat. We really like to look at the person as a whole, see what kind of symptoms we’re dealing with and talk about where they’re at versus where they want to be and then how we can help get them there.
Nick:
Are you ever like, Nope, can’t help you. This isn’t really something that we can do.
Crystal:
Not really, no. I don’t think I’ve ever had to turn anybody away. I mean, because, you know, we work with a couple of different pharmacies who have made some specialty treatments for us. For instance, we have a mineral blend. We have Vita complex, we have an amino blend. And those are just a few of what we have to offer. But, you know, depending on what their symptoms are magnesium, zinc, vitamin C, those go a long way and they treat a lot of different conditions. And so, you know, we can treat them based off of what their symptoms are, what their lab values are showing and how they’re feeling.
Nick:
Okay, great. Because unfortunately assigned health center sometimes it is that way. Well, someone will come in for a Ketamine infusion and we’ll say no, actually really don’t qualify. But then again, being a nurse anesthetist, some of our treatments are more invasive or more okay, This isn’t like, for example, we send out a postcard about migraines, but we’re not at all A the first place you go to if you have a headache. We’re expecting people who have been to the neurologist and they’ve been to the chiropractor. Nothing is working and then they can come to us and we’ll figure something out for them. So sometimes that is a challenge with what we do, which is sort of generalized but also very specific at times.
Crystal:
Yeah, I mean we’ve had patients who definitely have gone to other providers, they’ve been to different specialists. They’re kind of at their wit’s end with different treatment that hasn’t been effective for them or they’re just tired of taking so many medications every day, you know, or they’ve taken this medication. Now they have this side effect. So sometimes we have those people who are really just looking for something different and then we have people who haven’t. I mean, maybe they’ve been to their PCP but really haven’t been to all the other specialists because they don’t want to go that route. Right. They want to try to do something a little more natural, more holistic.
Nick:
Is there a good way and this might be a rhetorical question. Most of my questions are really as I think of them. But is there a better way for patients to integrate all of their providers into care? Because it’s it sounds amazing like everybody on my team is going to get together and they’re going to have this meeting just about me and we’re going to have all these great ideas. But practically speaking, is there a way that you can connect all of these or is it just not really work?
Crystal:
So it’s definitely not like that where the providers are not meeting and sometimes we’re talking, you know, like I have patients who go to a clinic down south and so they also come and see me. So, you know, on Tuesdays they’re down there on Thursdays they’re with me and they come every week. Most of our patients come every week. Sure. Because we do weekly injections or we do infusions. We do everything in an injection. Infusion because we want that to be in the bioavailable form so that everything we’re giving you your body is able to utilize and put to work in a little bit different from the oral medications. And so, you know, I will call those providers if it’s very specific, you know, like this is what we are doing. Tell me a little bit about what you’re doing. I want to make sure that we’re on the same page and that at the end of the day we’re doing what’s best for the patient. People typically I don’t talk to their PCP’s. I will send over a note of what we’re doing, kind of like a consult note, right? Unless we have specific questions about medications or dosages. I had a patient who I was treating their vitamin D deficiency. The PCP also wanted them to start an oral supplement. So I will make phone calls in those circumstances, you know?
Nick:
Yeah, that makes sense. And for us, what we started doing is almost all of our patients, unless they meet with a therapist first for an intake appointment, we’ll have their PCP or their psychiatrist or their therapist refer them. So that way from the get go we have an idea of how to treat somebody. And it helps too, because that way patients don’t feel like tourists. Like they’re like, okay, everyone is working together. But I think it helps also to be upfront with the patient like, Hey, here’s what we can do together. Here are some things that you’re just going to have to trust us on because we’re the experts in this particular area. So for example, we work a lot with pain management. Oh yeah, there are some pain management places that can do Ketamine infusions and have insurance pay for it. Most of them can’t. And obviously usually it’s a blend of mental health and physical health that we’re dealing with. So a lot of times it’s okay, we need to work in lock step and pain management is notorious for this is exactly what you can take and what you can’t take. So it’s important for us to come alongside them or even I think I was telling you earlier, a lot of times we’ve done our treatments specifically like a day or two before surgery or a day or two after surgery because like you’re saying about COVID, there is these hits to our immune system, to our nervous system unless we’re very intentional. That’s a really good word. Intentional. Yeah, it’s extremely intense, very intelligent, ineligible. We we will miss those opportunities to really impact someone’s health.
Crystal:
Really? We will. And like you were mentioning the COVID, we’ve we’ve seen them during COVID. We’ve seen them after COVID. You know, we do treat acute illnesses as well. So, you know, whether it’s flu or dehydrated, you know, they need to get their electrolytes back in balance, those types of things. But, you know, we’ve treated patients for the last two years consistently with COVID and the immune system. You know, we’ve had a lot of even rare autoimmune conditions, prolidase deficiency, different genetic conditions like that. And so it is very important to keep that immune system in order. And a lot of times we see that the over overdrive, the immune system is kind of over. Right.
Nick:
And a lot of times that looks like an autoimmune deficiency where it looks like their immune system isn’t doing anything, but instead it’s so active, it’s so scared, it’s attacking its own tissues and everything else. And that’s why it seems like every single cold that goes around you’ll get it because it’s sort of like an army is fighting on four different all the fronts. Yeah, absolutely. And I think it’s interesting too, because that often is the challenge of traditional medicine or standard American medicine, whatever you want to call it. They’re not that great at okay, this hit just happened to your system. How can we recalibrate? How can we get you tuned up before you start having all these unexplainable symptoms that you’ll then deal with for years?
Crystal:
Yeah, absolutely. I think, you know, it’s challenging in primary care because, you know, you’re seeing so many patients and you know, you’ve got to be an expert with everything you know, And you know, in certain situations you can refer out to specialists, but in certain situations such as community health, you know, sometimes the patients don’t have insurance and so you cannot refer them out. So you’ve got to kind of learn to be that specialist, you know. So I think that you just sometimes it’s hard to have the the time or the ability to step back and think of everybody as a whole and look at kind of all these different facets, you know, and even just the simple stuff, you know, you get somebody who’s coming in for a cold, you treat the cold and then move on to the next patient. But in all reality, there’s a lot of other aspects that should be considered. And so that is one of the reasons why I started my clinic because I wanted to be able to just really treat everything, spend as much time with the patients as I need to and then treat them each as an individual. Right.
Nick:
Well, that makes a lot of sense and I think that’s something that we see too, that especially with the IV nutrition. So is there a particular blend that you use to start out with or is it just again, very patient specific?
Crystal:
So there are we have about nine different infusions at our clinic. Some of them are very specific. You know, there’s a skin, hair and nail condition, there’s mental health, there’s like an athlete recovery. So we do have, you know, a couple of generally appropriate for everybody infusions. I mean, except for certain medical conditions, you know. Right. Kidney disease, heart disease, those types of things. Obviously, we wouldn’t want to overload your system with fluids. But you know, I do try to customize it based off of what’s going on with the patient. So after we do our initial assessment and we talk about what exact symptoms they’re having. How they’re feeling, what their goals are for care. Then if one of those infusions kind of fit good with what they’re looking to achieve, then that’s perfectly fine. But you know, a lot of times I do customize an infusion for them. So I do have I would say probably my mineral blend is my most favorite because it treats a lot of different conditions. And so we’ve got selenium, zinc, magnesium, even copper glutathione. I mean, there are a lot of different ingredients, but those ones are almost the basis for most of my infusions, you know, because we use them any anywhere from, you know, COVID, the flu, somebody acutely dehydrated. We want to build up their immune system. We want to build up those vitamin C levels, right? We use them in patients who just don’t really have good gut absorption. So they’ve got irritable bowel, inflammatory bowel, you know, ulcerative colitis, Crohn’s. They’re dehydrated chronically or they lack those intrinsic factors to absorb things through the gut. We give it to them intravenously. That way it’s there and they have it. We’ve often we’ve been seeing an influx of people like post gastric bypass or similar surgeries where they have to meet those fluid requirements and they’re just not able to. So they’ve been coming to us for that and Okay.
Nick:
Yeah. And that does go to my previous point of like a lot of times there is a surgery or an incident and if you’re not careful with your health, it can be very difficult for your body. And COVID is the example that most people think of. But obviously before COVID it was known at least I did a lot of research on it, you know, Epstein-Barr virus, mono, there’s a lot of viral infections, a lot of bacterial infections where, you know, being a nurse anesthetist, I see these patients at their very worst and then we assume that they get better. But no, we release them out into the wild. They go back home and a lot of times they have a diminished quality of life and it can be for the rest of their lives because it’s a very critical time to make sure they have the nutrients that they have, the support that they need.
Crystal:
I agree. I agree.
Nick:
So at our clinic I do magnesium B12 1 or 2 other things and we’ve talked before about trying to combine some of what we do. But often my challenge has been with any practice, especially ones like mine or yours, the weakest link is always the least medically researched thing that we do for people. So what what population doesn’t need IV fluids for? For what people would it just be expensive PE where they just got an IV and nothing really happened.
Crystal:
So I mean I think our patients who are absolutely very well, we do have quite a bit of them that come in and they’re really just looking for almost like a detox. You know, they’re eating the right stuff. They’re exercising routinely, they’re feeling good. They don’t have any health conditions and they just maybe once a year, once every six months, you know, they want to have a nice little detox like a myers cocktail or we have one for like an athlete recovery. So you’re very healthy. You’re leading a healthy lifestyle, but you want to be proactive with your health. And so, you know, the infusion that we have is kind of just really enhancing your musculoskeletal system, your immune system, your brain function, your neurological function. So I guess for them, I wouldn’t say it’s not necessary. It’s not something that you need to have every day. But you know, every once in a while, maybe once or twice a year, they do like to do that. I would say those that’s my population who really doesn’t absolutely need it. So if they don’t get it, they’re going to be fine. But if they do get it, I think they would still see those benefits.
Nick:
Well, the advantage, too, although this won’t sound like an advantage to anyone watching, is that it’s a needle poked in your arm. So you’re not going to get it unless you feel better afterwards and it’s going to cost you money because I assume everything that you do is self-pay. Yes. Yep. And I think honestly, some of the most dangerous side effects I’ve seen is when it doesn’t cost the patient money or effort or time because I was on a medicine once where the insurance was paying for it, I had a copay card. I was like, Yeah, let’s do it. You know, I lost 15 pounds, had all these side effects. I was like, It’s not costing me anything. I’ll do this a little bit longer. But I had I had an expensive co-pay like the first side effect. I’ve been like, Nope. Yeah, not worth it. Yeah. So and that’s what we honestly try to do at Ascend. We put barriers for the patients to make sure that they’ll put in the effort that there’s almost an energy transfer of like, okay, here’s your part and then this is what this will do for you.
Crystal:
Absolutely. No, I think that you’re absolutely right. You know, you want to make sure that they’re vested because like you said, it’s you know, those are sometimes the patients that we see in primary care who come in all the time, all the time, they don’t have any co-pays, you know. And so with this and at our clinic, you know, we are private pay most of the time. This kind of stuff is not covered by insurance, although I wish it was. I think as we get to be a more forward thinking country, hopefully that’s something that they can work on. But yeah, so these people are coming in and they’re investing their own money and it’s a lot of money. I mean it’s if you look at it from a larger perspective, it’s not a lot of money compared. Here to what you would pay for the long term health complications that you’re preventing. But you know, an infusion might be anywhere from 100 to $140 and that’s for one infusion, you know. And, you know, people who get these twice a week, depending on specific medical conditions, once a month, once every other month, you know, it kind of varies. But our weight loss programs and our other supplemental programs, you know, they’re all they’re all private pay. So I think and and that brings me to another challenge is that when people don’t see an effect after like a week or two, they’re like, okay, I’m not seeing an effect. You know, I’m not not really sure about this. But, you know, like we were talking previously, this is something that takes time. Health takes time. You know, there’s no magic pill or magic infusion that you’re going to just feel better, you know, unless you’re super dehydrated, of course, then you’re going to feel better right away. But you know, in all reality, you know, your health takes time, you know? Right.
Nick:
And there are cases where you can speed up the process. But there’s also been other times where it’s like, no, that was too high of a dose of Ketamine or maybe we need to do transcranial magnetic stimulation. Well, actually that’s not a good example because that one’s really hard to get insurance to pay for. So if the insurance is willing to cover it, you really you really need it. Yeah. So and that’s another way that, you know, again, there’s some barriers that although it’s annoying for us as providers, it actually does serve a purpose of making sure that the right patients get it. It’s getting so it doesn’t make sense. And for us too, we do deal with a lot of pots, a lot of autoimmune disorders. But what do we do when when there’s someone who’s trying to pay too much attention to their health? I mean, this is rare. This isn’t very common. But the type of person who might watch this show for 30 minutes might also be the type of person that’s trying too hard, that’s trying to biohack themselves to perfection. So how do we have reasonable expectations while at the same time making sure that no one strays into the type of areas where they could actually hurt themselves trying to get better? And I’m talking about myself too. I’ve also taken some supplements where it’s like all my hair is falling out, but that’s fine. I can do this. I’m here to get better, right? It’s just like a reaction of my body. And over time, as I put in the work, we’ll drill down to the root cause and we’re going to do great. So Well, it’s almost like a self torture sometimes. It is.
Crystal:
Almost. And I think people think that they’re doing well, but you’re really doing yourself an injustice because, you know, I think just some of those basic principles like eating a healthy diet, leading an active lifestyle, exercising routinely, you know, having a purpose for your mental health, for your physical health, having a good routine, good sleep hygiene. You know, a lot of times, you know, there are people who I’ve said, you know, I don’t think that you need that. You know, you you appear to be very healthy. And maybe we look at this maybe we scale it back a little bit. You know, let’s just do some simplified basic interventions, you know, because not everybody needs to have routine infusions, you know, So I think just being honest with them like, listen, you know, you really don’t need that. And you know, this is what the potential outcome is going to be. This is potentially how much money you’re going to have to spend. And people still will will do that, you know. Right. But I think just being honest with them and letting them know that you don’t need it, you know, you want to you don’t want your immune system to be overactive because that’s, you know, just as dangerous as not having an active immune system. So I think just education I’ve always found that if you can just educate them on their really what’s going on or what’s not going on, then they’ll trust you, you know? And so if you can develop that rapport, I think nine times out of ten they will listen to you and take your advice.
Nick:
And because we’re not these large practices, it is more of a partnership between the patient provider. You know, we have our psychiatrist, Dr. Molina, nurse practitioners, therapists, and often I will go to recommending therapy. Obviously it’s easier because we have therapists at my clinic, but I think it’s also really important. Well, let’s get down to the the mental causes of it as well. Not in a way that says it’s all in your head. Sure. But the worst thing that can happen is that you’re going to waste an hour of your time in a copay talking to somebody about your problems. So it’s that’s part of the issue too, is like how can we go with the the intervention that’s the least likely to to hurt you as you’re trying to get you better because you know we do a lot of antidepressants at us and they work well but often that’s a month that’s an extra month that you’re depressed. If it doesn’t work, that’s an expensive medicine that your insurance pretended to pay. And then afterwards they’re like, No, we’re not really paying.
Crystal:
Gotta love insurance. So I think if you get the patients on board and just are honest with them about what the expectations are, you know they will listen.
Nick:
That makes a lot of sense. And in some cases you we already touched on this a little bit, but especially about IVs since we both do a lot of IV infusions, obviously the Ketamine IV, but just over the last few years I’ve done a lot more with injections. Obviously no one gets likes getting a shot, but it’s still less painful than. An IED in your arm. I have one patient in particular where we used to do 500mg of ketamine for complex regional pain syndrome. We do that over four hours once a month, and now she’ll come in for about 30 minutes and we’ll do a 10th of that dose in her arm. And it works just the same. And I have no idea why. To be honest, it doesn’t make I mean, part of it’s the way that ketamine works as an NMDA antagonist and as a drug that works on multiple receptors. It does work to shift the nervous system and in some cases even the immune system. But why is it that injections work so well sometimes for patients where just taking a supplement that you got off Amazon? Yeah.
Crystal:
Well, so there’s a couple avenues to that question. So there are a lot of supplements out there. There are a lot of companies out there and not all of them are going to be the best for you, you know, because a lot of these things are not FDA regulated. It’s hard to know exactly what’s in them. Should the ingredients be on the label? Absolutely. But, you know, there are a lot more that are becoming regulated by the FDA. And so everything has to clearly be spelled out on the label. So that’s an important avenue to look at for the patients. The reason that we like to give them in the injections is because, you know, your body doesn’t have to go through that hard work of converting it, metabolizing it, the first pass effect, all of that good stuff. So I often find too, that even if somebody is coming in and they are well and they’re on supplements, they’re taking like 5 or 10 supplements a day, that means they’re taking a pill every day. And you know, whether that’s making your stomach upset or you just don’t want to have to have that burden every day of taking pills, you know, we can give you a shot once a week and that’s your dose for the whole week. And so, you know, that is just a better quality of life for them, you know, and then they feel better. They don’t have anything in the stomach to worry about having to eat naughty, you know, all of that stuff.
Nick:
So which way is it best to do first, let’s try this as an injection and if it works well, maybe you can eventually get to an oral supplement. Or do you do the opposite where let’s just start with like some generic version of this and if you see any benefit, then maybe we’ll go to an injection and see the.
Crystal:
I always start with the injections because nine times out of ten the patients have already tried some of these orals before they’ve come to us. And so we’re either not at the therapeutic doses or we’re just not treating the right symptoms with the right ingredients. And so I will always start with the injections. Sometimes we do blood work if they don’t have any or if there are certain things that I’m curious about that we need to know those kind of magnesium, potassium, those real fine ranges. But I always start with the injections and then depending on where those levels fall, we monitor them throughout treatment for vitamin D, for example. You know, we do a weekly injection and then once we get to a certain level, okay, well, we can take it a step back now we can look at maintenance. We can go to every other week, you know, every three weeks. And then once we get to a certain point, we do need to start the oral supplementation just to maintain that right.
Nick:
And do you find issues with any ratios of minerals? For example, in Orthomolecular medicine, which is alternative medicine, they do a lot of hair mineral analysis and there’s a lot of controversy over whether or not it does anything. How can you tell actually you need more copper or you don’t need that much zinc?
Crystal:
Well, so depending on what their symptoms are, you know, for instance, endometriosis, we use that you know, I had women coming to me who were just in severe pain all the time, back pain, cramping, you know, difficulties with their menses, anemic like women who were facing hysterectomy, you know, who have been through everything, tried everything, and they’re kind of at their wit’s end. You know, the magnesium, the mineral blend works amazing for that. So typically there are a couple of specialty blends that I would use and they would come in once a week for about, I would say 6 to 10 weeks. And then, you know, we could get them down to maybe having to take an ibuprofen once a month during that cycle time. But no hysterectomy, no other medications. We’re not eating ibuprofen like candy. Their quality of life is amazing. And so, you know, and then those women kind of just go out into the world and they’ll let me know when they need me again, you know, should they be on oral supplementation to try to maintain those levels? I would recommend that. Are all of them? No. You know, but that that is just a remarkable way of improving their quality of life without having to perform a major surgical operation, you know.
Nick:
To to our point of like try whatever is the least invasive and taking out organs is as invasive as.
Crystal:
You, which is why, you know, it’s hard for me to understand why this type of stuff isn’t covered by insurance yet because it’s kind of, you know, the backbones of stuff like this that prevents those further complications and more expenses to the health care system. So I think everything is in the works, though.
Nick:
Yeah. And if you look at the data, it’s usually hysterectomy cholecystectomies where they take your gallbladder out and hernia surgeries are some of the ones that when they look at the data it’s like, nope, you could have kept that. That’s perfectly fine. Nobody needed to operate on you. But that is the risk. Like when you go to a specialist, a lot of times it’s not that they’re corrupt, but they’re here to take things out of your body. So if there’s a reasonable reason to take something out of your body. And you’re okay with it. That’s what’s going to happen. So just something that we all need to be aware of. So and you also do some work as primary care. As I mentioned earlier, we have.
Crystal:
A little bit different of a model. We do direct primary care, so it’s like a membership based primary care. So you have an annual membership, then you get a certain amount of visits included with that certain amount of labs, blood work included. With that, you have access to the provider whenever you need it. I mean within a reasonable time frame, you know, they can we manage your medications. It’s basically like I don’t want to say it’s concierge medicine, but it but it is you just have a good relationship with your provider. You’re not waiting in the waiting rooms. You’re not not being able to get in to get care if you’re sick. You know, you have that direct relationship with your health care provider. Great.
Nick:
And again for ASCEND Health Center, for those of you who this is the first show you’ve ever watched and it could be the last because I’m not always all that innovative and interesting as I speak but Ascend health center we do some pain management with Ketamine infusions. Mostly we focus on treatment resistant anxiety and depression. We have a psychologist, therapist, psychiatrist, nurse practitioners and again, the important thing is to find the specialists that can help you. It doesn’t help when you go from doctor to doctor to doctor or from nurse practitioner to nurse anesthetist. You need to find a home and find people who will listen to you, work with you, but also know what’s best for you so that it is a partnership. So thanks again for watching the Ascend Health Show.
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