It is an honor to be a trusted physician that has impacted many lives through my work in the emergency room, holding hands with those suffering from suicide, anxiety, pain, and other forms of suffering.
As a Navy combat veteran now serving Omaha for the last 7 years, I have seen firsthand the crushing impact of mental health disorders on individuals, families, and our community. Personally, I’ve lost corpsmen to suicide and understand the pain of living with trauma. With conviction in integrity and compassion, I’m devoted to using the latest science based, forward-thinking approaches to help all struggling with these conditions. From writing the workbook “Stress Relief Survival Guide” to creating a free YouTube course teaching how to take immediate steps, I’m passionate about guiding those in need towards a better tomorrow.
Our vision at Waybridge is to create a healing space that offers transformational medicine, celebrating the human spirit and bringing light to people’s paths. Committed to the highest standards of care and safety, we use evidence-based approaches that work. Thank you for your courage to think differently and for trusting us with your care.
With much gratitude,
Leslie Koenig, MD
Ketamine is a safe, effective anesthetic that has been in use worldwide since 1970 and has been listed on the World Health Organization’s Essential Medicines list since 1985. Multiple studies and trials run at Mt. Sinai in New York, Yale and other prestigious universities and hospitals since 1990 have shown that ketamine is exceptionally effective in treating treatment-resistant depression, PTSD, anxiety, suicidal ideation, neuropathic pain, and other related mood disorders. Unlike standard antidepressants like SSRIs, and SNRIs which generally take 4 to 8 weeks to work (if they work at all), ketamine is fast-acting and can sometimes show immediate efficacy after a single intravenous dose. Because of its fast-acting nature, ketamine can be an extremely important tool in preventing suicide and immediately alleviating the suffering caused by major depressive disorder (MDD). More recently, it has also been used to treat neuropathic pain and the symptoms of PTSD. The small doses and method of administration (intravenous infusion) used to treat depression patients differ greatly from those used in hospitals for anesthesia.
Ketamine infusion therapy is the use of ketamine for the treatment of mood disorders and pain conditions, most commonly depression, suicidal ideation, post-traumatic stress disorder (PTSD), and complex regional pain syndrome (CRPS). For the treatment of mood disorders, ketamine therapy involves a series of six infusions at a ketamine infusion center spaced out over 2-3 weeks, with each infusion lasting about one hour. The dissociative effects of ketamine subside quite quickly, with most patients feeling comfortable enough to go home 20-30 minutes after the infusion is complete. For pain conditions, ketamine treatment involves a series of five, higher dose infusions at a ketamine infusion clinic over five days, with each infusion lasting about four hours.
We will not bill your insurance company for payment. This is because the insurance carriers do not predictably pay for this treatment. We will provide you with the necessary forms you would need to submit for reimbursement, but it is unlikely that you will be even partially reimbursed. Ask about how you can apply with our financing partner (CareCredit).
Several alternative forms of ketamine administration, such as oral lozenges, nasal sprays and intramuscular injections, have been offered by some new providers. While some of these may seem attractive at first, NONE of these administrations have a track record of success, and only intravenous (IV) ketamine has been extensively studied over the past 30 years. The data, published in hundreds of research papers from the National Institute of Mental Health and many other prestigious medical centers and universities like Yale and Mt. Sinai, have confirmed IV ketamine’s safety and efficacy in treating a multitude of mood disorders like treatment resistant depression, PTSD, major anxiety, and others. The safety and efficacy of other forms of ketamine delivery, whether oral, nasal, and intramuscular (IM), remain unproven. IV is the only delivery option that is 100% bioavailable.
Most patients report significant improvement by the (3rd) third infusion and more than 80% report remission at the (4th) fourth infusion. In addition, there are some patients that initially become aware of improvement in mood and well-being through loved ones such as a spouse, and this can occur after only one (1) infusion. Some patients want further gains before moving into maintenance and will continue to receive infusions at a frequency of two infusions per week until they reach remission or improvement levels they deem satisfactory. Typically this is achieved by the (6th) sixth infusion. Once patients complete this loading dose protocol they begin the maintenance phase of treatment which is highly patient-specific. As a general rule, patients can expect to return for maintenance infusions about every 4 weeks for the first 12 months following treatment onset.
Patients will usually receive infusion therapy in a private room with constant mechanical monitoring of heart rate, pulse, blood oxygen saturation percentages, and blood pressure. Infusion therapy means an IV will be placed and an appropriate dose of ketamine will be administered over a 40 min time frame or longer. Practitioners are able to see a patients vital signs from the monitors at all times from the nursing station. However, patients will notice that a practitioner will enter the patient treatment room several times during the active phase of the infusion to monitor the depth of sedation and ensure patient comfort. Most patients report a relaxing and peaceful experience. Patients will most likely experience changes in vision and their ability to clearly focus on objects or people, speech will be slurred or slowed, most will have an experience of floating or being disconnected. Patients on average should expect to spend 90 to 120 minutes in the office allowing for the check in procedure, the active phase of infusion, and recovery time. Patients will need a trusted friend or family member to drive you home after your infusion. Patients may drive and return to work the next day. Patients may have a friend or family member in the treatment room during infusion, but this is not necessary.
During the Initial Medical Evaluation, we establish a baseline with digital mood monitoring, and have you complete clinically validated surveys based on your treatment protocol. We define success as 50% improvement based on these scales. We have you complete these questionnaires throughout your initial series of treatments and into the booster phrase.
Often, close friends, loved ones and even coworkers might notice subtle improvements in mood prior to your awareness that the ketamine infusions are beginning to work.
No, IV administration of ketamine has been found to be the most effective. Studies have found that the nasal ketamine sprays and oral medications are not as effective. Oral medication typically gives patients 20-25% of the effective dose, while the nasal sprays typically gives patients 30-50% of the effective dose.
Mon – Fri: 9am – 5pm
Sat: By appointment