LETTERHEAD

TO WHOM IT MAY CONCERN:

I first saw XXXX  XXXXX  (Date of Birth: XX/XX/XX) on XXXX X, 2008.   I treated her for reflex sympathetic dystrophy (CRPS / RSD) with a three day series of ketamine infusions, with very good results, on September XX, XX and XX, 2008 and again on November XX, XX and XX, 2008.  My treatment notes are enclosed.  Video recordings of Ms. XXXXX were made before and after treatment and are available for both treatment sessions from Mr. XXXXX.

I was very heartened when our treatment was successful in relieving Ms. XXXX’s RSD symptoms.  She has had the disease for approximately 23 years and that was a significant obstacle to overcome.  All other attempts at treating her pain had failed.

Over 30 years ago, ketamine was approved by the U.S. Food and Drug Administration (FDA) as drug for general anesthesia and for the treatment of breakthrough pain. At the RSD / CRPS Treatment Center in Tampa, Florida, ketamine infusions are administered to treat breakthrough pain, as approved by the FDA. It has been used historically for the treatment of breakthrough pain associated with CRPS / RSD (see Ketamine Infusions, Lubenow, Timothy, MD, Kirkpatrick, Anthony, MD and Friedberg, Barry, MD, online at:

http://www.rsdfoundation.org/en/Ketamine_Treatment.html

Several practitioners in the Philadelphia area are utilizing a low dose ketamine infusion treatment consisting of a series of 50 mg/hr infusions with limited success (Robert Schwartzman, MD; Chairman of Neurology at Drexel University College of Medicine), requiring weeks of treatment in declining frequency. 

We have developed an alternative and highly effective protocol that utilizes an increasing dose of ketamine by IV infusion over a three day period, for 4 hours each day.  While we start the infusion at 60 mg/hr, it is increased to the tolerance of the patient in three stages at 90 mg//hr, 135 mg/hr and 200 mg/hr so that the patient is maintained at the highest ketamine level which can be maintained at a sub-anesthetic level.  The patient is constantly monitored electronically using constant pulse oxygen saturation readings and continuous monitoring of blood pressure and heart rate. In addition, the patient’s level of consciousness is monitored as well.  To further ensure that the patient does not become anesthetized, a series of simple questions (family members, town, where born, pet’s name) are regularly (at least every 10-15 minutes) placed to the patient and the patient’s response dictates whether to maintain, increase or decrease the rate the infusion.

Our patients have derived great benefit from the treatment so they are pain free for the first time in years and they are able to do things they had assumed they would never do again.  We have found that some patients require a booster, generally after 2-3 months or longer, and the pain, if any, which returns is significantly less intense than before treatment. We expect most patients to eventually require no ketamine boosters.

We work closely with national and international specialists in RSD including Dr. Robert Schwartzman. I am Chairman of the Scientific Advisory Committee for the International Research Foundation for RSD / CRPS. Our committee members are listed at the following website:

 http://www.rsdfoundation.org/en/en_sac.html

At this time, to our knowledge, this is the only location in the United States which offers a fully monitored and safely administered increasing dose sub-anesthetic ketamine treatment up to 200 mg/hr. Other governments recognize our increasing dose sub- anesthetic ketamine treatment. For example, the Canadian government provides full reimbursement for this treatment at our Center.

The RSD / CRPS Treatment Center is a licensed Ambulatory Surgical Center that is approved by the Florida Board of Medicine for Level II surgery. The facility is regulated pursuant to the rules of the Board of Medicine as set forth in Rule Chapter 64B8, F.A.C.

Sincerely,

Anthony F. Kirkpatrick, MD, PhD

Medical Director

RSD Treatment Center

ADDENDUM

October 5, 2009

Two well-controlled studies demonstrate the long-tem benefits of outpatient ketamine infusions.

One study is from the Netherlands and the other is from the USA

Learn more ----

http://rsdhealthcare.org/outpatient_ketamine.htm