Patients who visit Crestline Health & Wellness are immediately enveloped into a caring, calm environment. No matter what has been troubling their mind and spirit prior to entering – perhaps crippling anxiety, severe depression or debilitating pain — a weight soon lifts at the notion of healing through the hands of the empathetic team and the miracle of ketamine therapy. Led by Dr. Amy van Elkan with the dedicated assistance of Nurse Ashley Fontaine and Patient Coordinator Hampton Adams, Crestline Health and Wellness is changing and saving the lives of those with treatment-resistant disorders.
“We take care of patients who haven't found relief with traditional antidepressants or with opioids for pain,” Dr. van Elkan noted. “We don’t see first-timers. These patients all have treatment-resistant disorders. Though we don’t know what causes treatment resistance, we do know that only 30% of patients respond to traditional antidepressants, while 75% of patients respond to ketamine therapy.”
Inspiration to open Crestline Health & Wellness was sparked back when Dr. van Elkan was working as an anesthesiologist at a pain specialty practice and saw firsthand the incredible relief ketamine brought to patients who suffered chronic pain. “My inner voice kept telling me there was more that I could do for my patients – with holistic and collaborative medicine,” she explained.
The voice was so insistent that Dr. van Elkan left her position and forged a new path, first researching and developing protocols based on scientific literature about ketamine, then traveling to Texas and New Mexico to visit ketamine clinics since, at the time, none existed in Birmingham. Finally, Crestline Health and Wellness opened in October 2019, the first of its kind in the Magic City. But just a handful of months later, the COVID-19 pandemic hit, and the brand-new practice scrambled to find PPE (personal protective equipment), such as N95 masks and medical-grade sanitizer, in order to continue caring for patients. The clinic saw an uptick of new patients during this time — the isolation and uncertainty brought on by the pandemic led to increased mental health challenges, and it was then that Dr. van Elkan and her staff "fully realized the need for the clinic."
Plans to expand are on the horizon. For now, three treatment rooms and the three staff members, Dr. van Elkan included, are involved with shepherding patients through the delicate process of ketamine therapy. A patient’s first appointment, usually about 2 hours long, involves a thorough discussion of experiences and medical history, as well as risks, benefits and alternatives “to develop an individualized wellness plan.” Before each infusion, patients are to abstain from food and drink for six hours and to refrain from “anything that could alter mood or consciousness,” including unprescribed drugs or violent media. Dr. van Elkan also suggests journaling prior to the appointment to “set goals and intentions for the infusion.”
“Most importantly, we instruct patients to ‘let go’ during their infusions,” she said. “All of this preparation is aimed toward opening themselves to whatever is revealed during the infusion experience.”
The infusion itself involves a tiny catheter inserted painlessly into a vein and a “highly calculated” syringe pump containing an amount of ketamine based on the patient’s weight, plus saline. Infusions are administered for 40 minutes, with most patients feeling differently after about seven minutes – usually “floaty and tingly” and with heightened senses of sight and hearing.
“We give patients a disposable eye shield, dim the lights and encourage their favorite music to create a calming environment,” Dr. van Elkan noted. “For the safety of our patients, we continuously monitor their heart rate, rhythm, blood pressure, and oxygen level. These infusions can be lovely and pleasant, but they can also be challenging. It takes a lot of courage on the part of our patients.”
After the initial appointment, Dr. van Elkan typically sees a patient for at least six more follow-up treatments — about an hour each, without the consult — and most patients report a marked improvement by the third session, though “everyone’s response will differ.”
Most of all, Dr van Elkan and the staff at Crestline Health and Wellness treasure and honor the opportunity to serve patients, many of whom feel they have nowhere else to turn. The depression rate in Alabama, according to Dr. van Elkan, is double the national average, and the rate of suicide in Alabama is higher than average as well. While using ketamine therapy for mental and physical health might be groundbreaking at the local level, it has arrived in time to address “a great need in the community.”
“We cry and laugh with our patients,” Dr. van Elkan mused. “This practice is definitely involving me in my patients’ lives more than I ever thought it would. I'm grateful to not only be a part of their journey to wellness, but to also offer them hope. That alone is a very powerful tool."