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ketamine

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I am NOT an expert in this CH world we live in.  But, we didn't talk about Ketamine that much in the conference, and I am sure there are people on this sight that did not go.  That being said, this shit works for me!  I am using it for shaddows in between my quarterly M regiment(for which I will never go off again after being reminded last year what Kip 9-10 feels like).  Prior to this sight there is nothing I had not tried.  This siight saved my life so I am just throwing something out there that might help.    

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Dosage was a total trial by error!  I have a nasal spray that is 50mg/ml.  2-6 sprays to the right nostril was the prescription.  I found it closer to 10 to 12.  Quite pleasant!  Capable to function.  almost like tv back in the day when channel 12 and 13 were the same show, but it was a different channel.  The world is on 12 you are on 13 but it is HD!  Amazing clarity, no reenty issues and probably less than half an hour of effects.  I have not used it a lot so this is from a handful of efforts.  Failures at first as the dosage I was trying was to low and I didn't know what to expect.  No CH so I figured it worked.  Keep in mind I am CH free with my quarterly M and I use this as a security blanket.  Doc says patient can abort with this stuff!  I had to refill as I realized my script was expired well before I finished it.  I would love to hear success from a sufferer that can abort with it.  My version of "effect" should be taken with a grain of salt... I lean towards the aggressive side.

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My pain doctor said...no fecking way ...when I asked for some. He went on and on about terrible nightmares and horrible side effects.

He is a good doctor and always helps me. This was my first NO from him so I tended to believe him.

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Hi Folks,

I did bring up Ketamine at the Las Vegas conference. Would have liked a more substantive discussion however, but there were time issues!

As some of you know, I do prescribe it on occasion. It is certainly no worse that using opioids and likely better! Yes one must be careful, like with many many things. It will always be a challenge to get it from someone who has NEVER prescribed it before. The US is lucky that it is only a schedule 3 agent, while in Canada it is schedule 1, non starter!

As with other medications, take enough and you are 'out of your tree' (like with Benadryl, alcohol etc) but I generally trust patients to be cautious and give them the benefit of the doubt. I have found that the compounding pharmacies have been helpful and do not look upon me as a dope peddler! Remember the compounding pharmacies are our friend.

It has yet to be determined what long term treatment concerns there would be with ketamine. I suspect it is best used with breaks so the body can loose the tolerance to it.

Desperate situations deserve brave choices and that is how I ended up writing some patients for this. Have to admit as yet no disasters and nobody hated it. All some degree of positive. As yet we still do not know the ideal role it should play.

FYI Very soon, the academic journal HEADACHE will publish a 5,500 word review of mine that covers cannabinoids (not useful here) and hallucinogens for headache. I do mention ketamine positively so that would be something to show a skeptical physician (yes psilocybin mushrooms are covered in a positive way as well).

Cheers,

:)

BostonHeadacheDoc

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With your permission Doctor, I would like to show your post to my pain doc. I sure would want your

blessing beforehand.

By my doctors own admission, he isn't a headache doctor and doesn't see a lot of headache patients. He has gone from occipital nerve blocks, which gave me a weeks reprieve, to occipital facet blocks which give me a month pain free. He burned the facet nerves last month which seems to really do the trick for a longer period. Problem is, it is all temporary.

Just my latest in a long line of attempts to try anything....we all know the drill.

He should be persuaded by your post, if you don't mind.

Dan

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Thanks BostonHeadacheDoc!  :)

Yes, thanks Doc!  :) :) This is great stuff.  Just to be sure, is this the journal, www.headachejournal.org? 

A yearly subscription is kinda pricey, but it appears you can order single issues.  Would you mind posting, or PMing me, the issue number when it comes out? 

Many thanks!

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Sure Dan you can.

RunawaySlim and Dan- just send me a private message with your email and will send the article to you also. For copyright reasons I cannot post it but as I understand the rules I can send it myself to those requesting.

Yes RunawaySlim it is that journal.

BostonHeadacheDoc ;)

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I have been amazed by the Ketamine.  So many doctors seem to be so scared of it, and the more experience and research I do with it makes me not understand why.  Truthfully, I blame Nancy Reagan and her damn drug war, but I tend to blame her for a lot of things.  :)

Ketamine can be psychologically addictive, but it is not physically addictive.  I have taken ketamine at times daily for two weeks straight.  When I stopped I was very surprised to find that the only withdrawal (if you can even call it that) was that I was little cranky for a day or two.  Nothing a bong hit or two couldn't help.  Another thing that is a amazing is it's short duration of action.  Most times the amount I take does not inebriate me much and I can go about my day just fine--when I have had heavy hitters and I go for a higher dose it can be pretty intoxicating but it really only lasts about an hour.  You don't get stupid like alcohol or opiates either--you are very aware of the intoxication and you don't want to do stupid things like drive a car or french kiss your cousin.

I will say this though, a heavy dose is just weird.  I have done a lot of drugs and the only thing I could compare it to is a really strange nitrous oxide trip.  As a "dissociative" it can "distance" you from things, I don't know how else to put it.  Even when it does not work completely for me and I switch to the big guns like Imitrex, it still seems like a lifesaver.  Sometimes it can take 20 min for a shot of trex to work for me--and anybody with clusters knows that 20 minutes is just to long.  The Ketamine distances me and tones down the pain, making it a hell of a lot easier to wait it out.

So many Doctors are willing to prescribe narcotics that you build tolerance to rapidly for pain, cause physical addiction, constipate the hell out of you, lead to depression and withdrawal...the list of negative effects of the opiates is ridiculous (and yes, I still use them from time to time)  For regular, non cluster pain, the combination of Ketamine and opiates seems to be a much better choice than just regular opiates--mostly because the pain relief is more complete and you can take less of the physically addictive opiates.  When I was having some really painful teeth work done I was going for the hydrocodone and Cannabis mnixture (another great thing that can lower your needed intake of Opiates) and it worked all right but I was still in a good bit of pain.  This seemed like it was eventually causing a cluster which I would take my Ketamine for--and the tooth pain would just disappear.  I don't think the Ketamine alone would do it at the low doses I was using, but it seemed like the combo kicked ass.

Here is a link to "Postoperative Ketamine Can Reduce Morphine Consumption and Nausea"

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2605142/

One study on Intraoperative ketamine showed that

"We have demonstrated that intraoperative preventative ketamine reduces opiate consumption in the acute postoperative

period by 37% in opiate-dependent patients with chronic pain

who are undergoing painful back surgery. In addition, it seems

to reduce pain intensity postoperatively in the PACU and at 6

weeks and to reduce consumption of morphine at the first postoperative visit. The findings of this study add considerably to the

body of literature pertaining to the efficacy of ketamine in preventative NMDA receptor antagonism."

http://ether.stanford.edu/Ortho/Intraoperative%20Ketamine%20Reduces%20Perioperative%20Opiate.pdf

To me, it sounds like if a Cluster patient has tried just about everything and ends up on Opiates, it would be a damn good idea to mix ketamine in there too. 

Another thing about the Nitrous oxide--it is in the same class as Ketamine (NMDA receptor antagonists) so it's not that strange for them to have similarities.  A big thing to be aware of though is that for me they seem to work synergistically.  When I went to the dentist with a cluster I took a good 10 sprays then sat down and had them put the nitrous mask on--within a few minutes it was complete interdimensisional travel.  Many of the specifics are a little fuzzy, but I could see all the dimensions of the verse (as I call it, because the Uni-verse would imply a singular space instead of the infinite unbounding cosmos that I was experiencing) splayed out like a deck of cards being shuffled.  I could see into all the dimensions and I could see that my own dimension, the one where I was having a crown done in a dentist office was going downhill fast.  I knew that if I didn't intervene, everything everywhere was going to dissolve into nothingness.  Then I retreated to being a very small, shy child in the corner of a very dark room.  Part of me was urging this child to DO SOMETHING!  SAVE THE VERSE"  and the little child would reply, "but I'm scared...I don't know if I can" Eventually convinced that every cosmos everywhere was about to be completely annihilated I slowly put the effort into raising my hand. It was like the air was complete thick tar, it might have been the most effort I ever put into anything.  As it slowly got into the air I felt more and more exuberance---"I'm SAVING THE WORLD!" 

About this time was when the dental hygenist looked in and found me sitting calmly with my hand in the air.  She came in and asked me if I was ok--to which I gave no reply and stared at the wall as if I had no idea she was there.  They promptly stopped the nitrous and I came back to earth, aware of the unbelievable beauty and strength of the world, the verse and myself.  I was not aware until a few minutes later that I was in a dentist chair with a couple of worried hygenists looking in at me.  Then I started laughing hilariously and asking them "what the hell just happened"  To which they replied "I have no idea"

The rest of the appointment was kinda rough on me and the dentist, mostly because no one had any idea that I had saved everything everywhere (You're welcome folks, just another day's work :) ) and no one had any idea why I kept erupting into maniacal laughter.

So the lesson is--be real careful with the nitrous ketamine combo--unless of course, you're into that kinda thing.  It was pretty cool.

-Ricardo

BTW--thanks Doc, for all your input.  Your presence on here could make a big difference for the folks that want to try this and are meeting resistance with their doctors.

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Dear BostonHeadacheDoc,

It is wonderful to have a health professional working on our behalf.  Thank you!! 

I would love a copy of your review and will be PMing you if that is okay.  I have migraines but have found the busting, vitamin D regimen and other suggestions found in this website to help far more than any pharmaceutical I had been prescribed to this point. 

I am wondering, too, if Ketamine might be helpful for migraines.  I am thinking yes but am not hopeful that any physician in my area would prescribe this for headaches.  I would like to show your review to my PCP though, maybe, some day, perhaps....

Carlos, I love your posts.  They are consistently well thought out, interesting informative and funny, too.  And hey, thanks for sayving the "verse!"

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