Hello everyone,

I have never written in the forum before but have been around for a long time for many reasons. On May 10th I broke my foot and it never healed. Now of course I have CRSP and because I have severe tendon issues I can't have any of these blocks. I was wondering if they still do the IV Ketamine. I haven't heard much talk about it here on the forum lately. I did call a Dr in Pa today and he said he does it but insurance doesn't cover it, so I called my ins with the codes and they said I am covered. Does anyone know what that's about. Is there an updated list that anyone knows of. I live in Baltimore Md and would love to find one in these parts but will travel to Pa, Nj, Wa or VA. Thanks for all your help with this.

Mary

Hi Mary,
Welcome to the forum but sorry for the reason you are here.
I never did any Ketamine but many in here has so you'll get your answers soon.
I just saw your post and wanted to jump in to welcome you.
Be well....

Hi Mary,
Sorry to hear about your foot. I'm in the same boat with tendons not healing properly in my foot. I'm waiting for ketamine infusions as well. I'm on oral Ketamine but I want to do the bigger doses because it has been a miracle drug for me. What codes did you call insurance with? I have to call mine tomorrow and check.
LittlePaw has an ongoing threaD about the ketamine infusions that is helpful. It should be not too far down on the list! Best of luck & please keep us updated!

Hi Mewsg,

They are still doing ketamine infusions. There are some newer low dose protocols being done in addition to the more well known 5 and 10 day awake procedure which can still be a hefty amount. I am getting it every 2 weeks (though I had a hiatus for vacation and scheduling conflicts). I feel it has helped a lot and is not scarey and with few side effects for little me.

Here is my ketamine thread. I list my doseage, side effects and outcome.
http://neurotalk.psychcentral.com/thread220186.html

There are some CRPS doctors who do ketamine infusions listed here. The list is by no means comprehensive. My doc is not on there. I called pain clinics in Austin and just asked if they gave them. There are a couple in DC for you.
http://crpspartnersinpain.com/crps-physicians/

I am concerned about your foot. May 10th was not very long ago. It sounds like you need some other ortho type help. CRPS is a diagnosis of exclusion and occurring in the absence of another explanation. How can you be freed from CRPS if it is caused by a broken foot that isnt healed? Did you have a non-union fracture? Have you had follow-up imaging? A second opinion? I have heard of multiple cases of non-union not being seeing by one doc then found and treated by another. And what up with tendon tears? Whatever is wrong in your foot needs to be addressed if it can to give you the best chance of getting out of this. Or maybe getting ketamine or something to break the cycle will help healing factors in your foot get back to work on that bone and soft tissue? What have they said?

Sending gentle hugs and thoughts of healing,

Hi Littlepaw,
I'm not sure what you are talking about that I need some other ortho type...I have been seen by 4 separate Drs now and all 4 agree that I have CRPS. I also go to physical therapy. I broke my foot and tore tendons that attach to that bone and it never healed. Now the swelling has gone up my leg. It is very painful, leg and foot. And yes I have had other imaging to see what is going on. The reason I am looking into the ketamine is that I get very sick from most pain meds they make me sick. And I can't have steroid injections because I have very bad tendons all over my body, they tear very easily. I just had 3 tendon repairs in my left hand and in two weeks I will have two repaired in my right hand.
They tell me that we caught the CRSP very early which gives me a good chance of it going away, but I have RA and some other major Autoimmune issues so some Drs aren't so convinced it will get better.
Now about the ketamine. Can anyone tell me if the insurance will pay for it or not. I keep going back and forth that my ins will pay but two Drs in Pa said they won't. Has anyone had the ins actually pay for it. And then there's the oral, I guess it's not as strong as the IV kind. I just got an appt with a pain Dr at Johns Hopkins, we shall see how that goes, I hope I get some relief from the pain soon. Thanks all..
Mary

Mary,

Just trying to help and don't know or remember everyone's history. I didn't see mention of your having seen four docs so could not have possibly known that. New Posters have not always had adequate work-up. I often ask. I asked questions because it sounds terrible that you have a non-healed broken foot and that presents some real challenges. I would expect that hurts like Hell. Obviously it is easier to recover from CRPS with the pain trigger removed. That is not to say it can't get better even with ongoing issues. I have a really jacked up foot with 3 surgeries, a nerve injury and a benign tumor that had to removed and had 2 rounds of radiation to the sole. In spite of all that I am making progress!

Catching it early does make a difference and most people improve over time. Hopefully the ketamine will get you on track to healing. There is much in the literature about it reducing or reversing wind-up phenomenon.

Whether insurance covers is up to each individual carrier and policy AND whether a doc files with insurance for it. Some don't, but you could do it yourself if not. You could maybe look into the two ketamine docs I sent you in DC to see if they file. My insurance has approved covering the infusions though I have a $300 co-pay till I meet deductible. That info is all posted on my ketamine thread.

I am on a United policy. Infusion Procedure codes they cover for me are 96413, 96415, 96374.

With all your autoimmune issues concurrent you might consider asking about IVIG. There is a subset of CRPS who form autoimmune antibodies to adrenergic receptors on their nerves. These people responded well to IVIG in a recent study. Have you tried or considered systemic steroids? Prednisone 10mg 3xdaily for ten days for acute CRPS. This can help knock down swelling and inflammation and supress that hyper immune system. Systemic cortisone does not imperil tendons/ligaments that I know of.

Any talk of prolotherapy on the tendons? Just throwing that out there. Never had it so can't personally recommend...

Sorry you are going through so much. I hope you feel better soon.

Good luck in your journey there are so many helpful people and information on this forum. Sending healing thoughts..

Mewsg,

You mentioned you were having a tendon repair soon. I recommend you read the info on this board re. CRPS and surgery.. You have to be very careful even if the surgery is not on your affected extremity. Are you taking vitamin C yet?

Also, there are a lot of other CRPS treatments besides ketamine. While ketamine is certainly popular right now it is not usually used as a first-line treatment (though it can be). You never know what will work for you so keep you mind open to all options and find a really got PM that knows CRPS. the earlier you are treated the more likely your symptoms will decrease. Those first 3-6 months are important.

Good luck.