The Drip Room
Matthew Heistan
Adam Korman
Eng 102
30 Mar 19
Mobile IV Therapy: AZ IV Medics
Five years ago I was watching a poor quality "reality" show on tv with my wife. This was a show dedicated to following around a group of wives married to wealthy doctors in Atlanta. One of the ladies was pushing her husband to open a mobile IV business, she spent an entire segment trying to convince her Doctor husband of the viability of the business plan she had created. Essentially, she wanted to offer in home mobile IV therapy. Her focus was people that were hungover. I am a firefighter paramedic, and I have been starting IVs for the past 20 years or so, and it was common practice for us to treat each other with IVs after a rough night, or illness, or heat stress. Our Fire Dept Medical Director had given us approval to do IVs for each other as a way to help with the fluid volume lost when firefighting in the extreme heat of the Arizona summer. I had an epiphany when I saw the people lined up on the couch on the tv show, getting fluids, nausea medicine, and immediately feeling better. I had seen this play out countless times at work, both with our guys in the summer after working hard in the sun, or after a rough night before shift. As you can imagine, getting into 75 pounds of gear and working in 121-degree temperatures can rapidly deplete your fluid volume. I realized then and there that if I could feel ok after a couple bags of fluids, after getting almost to the point of going to the hospital for heat stress, I realized I had a marketable product. My wife is a Type one diabetic, and as a result I had IV supplies at home both to rescue her from low blood glucose by administering dextrose IV, and to lower her blood sugars with fluid administration when she went into diabetic Keto Acidosis. All of our friends and family knowing this would call me for help when they were sick, dehydrated, or like in my wife's case, managing a chronic condition. I figured that if I could find a doctor willing to be our medical director, it would be relatively easy to sell IVs to people. However, I knew nothing about business and wasn't in a place financially to raise the capital to start a business. I started by doing research, countless hours of research online, covering all aspects of starting a business. I started with zero knowledge about any business other than I had owned a personal training business in college, so I was familiar with sales and marketing to a small degree. At that time, only one other place in the valley was open and offering mobile IVs. I reached out to the owner of this business and we hit it off and I decided to go to work for her. This was the start of my business. Unfortunately, my relationship with this person declined after 2 years of working together, she wanted to change the terms of our deal, and I declined her offer and started my own business. In August of 2016, we published a Facebook page and were open for business. We now operate the valleys largest mobile IV therapy business; we treat many different types of people and many common ailments. Our treatment focus currently is on dehydration, migraine headaches, hangovers, flu, athletes, wellness, POTS syndrome, morning sickness, fatigue, oxidative damage to the body, High dose vitamin C, and lastly, we are launching an iPhone app, which will transition us into telemedicine providers.
Dehydration. Everyone has experienced it at some point in your life, whether it was a charley horse cramp in your calf after a day spent in the sun, or a hospitalization after a serious dehydrating illness like diarrhea. Fluid loss is sneaky, your body has a remarkable ability to compensate for volume depletion, as you lose water, your blood vessels constrict to drive up your falling blood pressure, fluid is pulled back into the core and the heart beats faster to help compensate and keep oxygenated blood going to the brain. Have you ever experienced a "head rush" when you changed positions from seated to standing? This feeling is your body compensating, speeding up your heart rate, squeezing your blood vessels, and ultimately keeping you from passing out. This is a clinical finding and is referred to as orthostatic hypotension. This is when your heart rate increases more than 20 beats when standing, and blood pressures fall under 100 systolic, a normal BP is 120/80, with a heart rate of 72. Our dehydrated patients usually have vital signs that reflect what is going on, a heart rate of 100 at rest, and low blood pressures. The biggest culprit for dehydration like this is volume loss from an illness, nausea, vomiting, and diarrhea. The problems arise when the person is unable to rehydrate orally do to the above reasons. Once you have fallen behind on fluid intake, and your body is still processing out the same out of water it normally would, your kidneys control blood pressure and release diuretic hormone, which is why you continue to make urine even when you are dehydrated. Our patient is now clinically dehydrated and can't put back enough fluid to alleviate the dehydration. Here in Arizona we are very familiar with the temperatures being very high all summer long, but our climate is dry all year long and you lose fluid all day every day just to breathing in such a dry climate. The population we see most often with this persistent dehydration is the elderly. They have several co-factors for why they get dehydrated, from the simple lack of fluid intake, alcohol intake, prescribed diuretics to combat hypertension, poor nutrient intake, lack of electrolyte intake, and lastly dementia. We go to several in-patient memory care facilities and help the residents; these people simply forget to drink due to senile dementia. These patients perk up from being almost catatonic to better than their baseline normal. Another population we treat is children, we go down to age 12 or 100lbs, so we get to see many ill children, kids are a challenge because they may or may not have had an experience with an IV before, we hear horror stories about multiple IV attempts for example. We only will treat children if they want the IV, not the parents. Obviously, we need the parents' consent to treat the child legally, but we will not force a kid to get an IV. Any hint that the kid doesn't want the IV, the appointment is over. In the study "Outpatient Rapid Intravenous Rehydration to Correct Dehydration and Resolve Vomiting in Children with Acute Gastroenteritis." A group of pediatricians compared the effectiveness of Oral rehydration vs IV hydration in children. The study can be summed up as, kids who got IVs, got healthy sooner, required shorter hospital stays, and had better outcomes than the oral hydration group. The patients in the IV group also didn't have any co morbidities for the gastroentersis, they were not dehydrated, experiencing headaches, ect. Oral hydration is inferior to IV hydration. When you drink water, it goes thru the digestive system before entering the blood stream, and based on how well you digest water, you may still be dehydrated while making urine, and drinking water. One of the best feelings you can have as a healthcare provider is when you show up, fix a problem and leave. This is what we are fortunate enough to do with migraine patients.
Many people struggle with severe migraines and they do so in silence, confined to dark rooms, beds, pain, and crushing nausea and vomiting, which in turn makes the migraine worse. We have a drip dedicated to migraines, and I have all of my Rns carry a headlamp so they can start IVs and work in relative darkness for our patients to be comfortable. Our dedicated Headache drip is the non-steroidal anti-inflammatory drug Ketorolac, its effectiveness has been proven in "Randomized Trial of IV Valproate vs Metoclopramide vs Ketorolac for Acute Migraine." As the superior compound. In all areas of measurement, it performed better than Metoclopramide. It is cheap, generic, safe, and well tolerated by most. Our next drug in the cocktail is Zofran, a Nausea medicine that also acts on the brain, we recommend the medicine even if the migraine sufferer is nausea free. They combination of the 2 meds are synergistic. The last ingredient of the Migraine cocktail isn't a drug at all, it's a mineral! Many of us are familiar with soaking in a hot tub of Epsom salts for relief from aches and pains, the mineral Magnesium is the active compound in Epsom salts, and it is also very effective as a smooth muscle relaxant, dilating blood vessels in the brain and the body. In "Efficacy of Intravenous Magnesium Sulfate in the Treatment of Acute Migraine Attacks." The patients reporting to the ER with a complaint of migraine, got a dose of 1 gram of magnesium over 15 minutes, and a control group got plain saline. After 15 minutes had passed, the control group also got 1 gram of magnesium over 15 minutes. All of the patients treated with magnesium reported relief, and all of the patients in the control group that got magnesium after the plain saline, also reported relief. Magnesium is capable of resolving most migraines without out any additional drugs. The synergistic effect of the drugs and the Magnesium treats all the symptoms of the migraine and the underlying causes and resolves it. The liter of fluid that the meds are delivered in also helps the person to rehydrate if needed. Every year the nation is swept by a epidemic of flu, while a inconvenience for some, it can prove deadly if you have a compromised immune system or underlying health problems. We cannot treat the virial flu, but we can treat the symptoms.
We all are familiar with that body ache that announces the fever of the flu, those aches and pains that ultimately become full blown fever and chills. The best tool to treat fever is a NSAID like Tylenol or if the person can't keep it down, IV Ketorolac. The Nausea and vomiting weakens the body, no intake of fluid, no intake of calories to keep the bodies machinery going, some people are very susceptible to nausea, and are unable to eat or drink for several days while the flu rages. We can stop the nausea with our medicine Zofran, and if that isn't sufficient, we can also add Diphenhydramine, which also will help the patient sleep. We typically give our flu patients what is referred to as a "Meyers Cocktail" after Dr Meyers a Naturopathic Doc who came up with the formula. Ours contains B complex 1-6, B12, Vitamin C, Glutathione, Zinc, and Magnesium. This combination with the meds is very effective at shortening the duration and severity of the flu, while the fluids hydrate the patient and also helps to flush the virus from the body, water while not new or exciting has the ability to help the body heal itself. The fluids also make the addition of the anti-virial medications like Tami flu less taxing on the body, reducing side effects and I believe more effective. One of our infrequent but fun calls is a hangover.
The science of why the hangover makes you so sick is simple, alcohol dehydrates your body, depletes vitamin B1 Thiamine, interferes with glucose metabolism, causes nausea, vomiting, and headache. The end product of ethanol metabolism in people is an Aldehyde compound, and is one of the big reasons you feel terrible after drinking. Our Hangover bag is the headache medicine, the nausea medicine, b complex vitamins, and the antioxidant Glutathione. Glutathione is an amazing antioxidant and occurs endogenously in all people. In fact, the absence of Glutathione is one of the hallmarks of multiple sclerosis, people with MS don't produce it. It is critical to your liver health and is how you body removes wastes from the blood stream. It has been studied for use in the case of acute ethanol intoxication, "Enhancement by Glutathione Depletion of Ethanol-induced Acute Hepatotoxicity in Vitro and in Vivo." The research in this study proved the relationship between alcohol intoxication and liver damage, and how it can be mitigated by administration of Glutathione. Livers that are damaged by Ethanol can't make enough glutathione, and consequently have lower glutathione levels. Our hangover bag is very effective and typically works immediately. We also have the privilege of helping people with chronic conditions.
I met my first botched gastric sleeve patient a couple years ago, this person had weight loss surgery and it was very effective, too effective in fact. The surgery was preformed incorrectly, and the patient couldn't eat or drink enough to stay healthy and had been in and out of the hospital weekly for several months, all just to get IV fluids and sent home. We were able to treat her weekly until she was able to get her surgery redone, and after her revision, she no longer needed us, but her story isn't unique. We have treated a large number of people with similar stories, weight loss surgery or cancer removal and now they are unable to drink enough fluids or absorb enough fluids from the remainder of the digestive system. Another chronic condition we see often is POTs, or Postural Orthostatic Tachycardia Syndrome. Potsies as they call themselves, can't maintain a good fluid balance and as a result have syncopal or feinting episodes, all the time. They also have sustained tachycardia that is refractive to meds, the only thing that helps these people is IV fluids. We have been able to keep many people out of the hospital and get them back to more normal life. We also treat athletes, of all types from amateurs to professionals.
One of the earliest UFC fighters Don "the predator" Fry was a former ASU wrestler and firefighter for the town of Sierra Vista. Don being a paramedic knew he could rehydrate in between fights and come back out to the cage and fight at peak performance immediately again. In those days, a UFC fighter would fight 3 times in one night in a tournament format. Don's victory over a visibly tired and exhausted opponent in UFC 3 was all it took to add IV therapy to the arsenal of all MMA fighters, and until they were banned 3 years ago, I gave countless IVs to fighter friends. Athletes preform the best when they are hydrated, everyone from any endurance race will tell you the importance of hydration in a long race like the iron man or a marathon. You simply can't rehydrate fast enough or completely like you can with an IV. We host pre and post-Race IV parties around all the major runs in the valley. If the pros get IVs, and they all do, then why would it be any different for recreational athletes? We are one of the only IV companies that will treat expecting moms.
Many mothers are familiar with crippling "morning sickness" that lasts the duration of the day and sometimes the duration of the entire pregnancy. Several years ago, the manufacture of the nausea drug Zofran changed the dosage guidelines and restricted it's use to after the first trimester, and we follow those precautions. We still are able to give the patient fluids and if they are past 12 weeks pregnant, we can give the nausea medicine as well. We also can offer expecting moms the antihistamine as it is pregnancy safe and reduces nausea and promotes sleep. Prior to offering this service, the women would be forced to go to a ER to get hydrated, doctors typically don't carry supplies for IV therapy or have Rns skilled in starting IVs, and Urgent cares typically don't preform treatments of any kind, let alone IV therapy with vitamins, and medicine. A hospital is a dangerous place, the very sickest and most infectious people are in the hospital, the exposure to these community acquired illnesses can be traced back to the healthcare setting and include many virulent illnesses and the current boogeyman, Drug resistant Staph or MRSA. Hospitals are not for well people, and any exposure to a expecting mother is an unnecessary risk. Many people call or message us to help them with chronic fatigue, and we have the answer.
The biggest health complaint most working professionals report is fatigue, chronic, mind numbing fatigue. There is some controversy about the existence of adrenal fatigue and it's treatment. The way I approach the wellness demographic is very conservative, we help people replace the potential missing vitamins and trace minerals that can lead to decreases in perceived energy level and cognitive functioning. Our energy drip contains vitamin b12 or cyano cobalamin, and it also has the trace minerals Methionine, Inositol, and Choline or MIC. This compound is critical to your body's ability to power itself and tap into the stored body fat, metabolize that stored energy and burn fat. Some popular diets lack red meat, vegetarians, vegans, and others all are b12 deficient from a lack of b12 in the diet. We can reverse this and get the patient to a higher level of b12 supplementation than can be achieved by oral vitamins. When we inject someone with 1000mcg of B12, we are sure they are going to receive that dose at the cellular level, when you take b vitamins, they are water soluble so they must be taken with water, any not used are excreted and not maintained in the body. We also include B complex, which is a blend of b1, b2, b3, b4, b5, b6 all are used for energy metabolism and growth and repair. Typically, the effect of a liter of fluid with all of the B vitamins in it, can elevate mood, energy, cognitive functioning, and promote deep sleep. Another popular Vitamin infusion is Vitamin C, high dose vitamin C is superior to oral as it doesn't cause gastric upset, and consequently higher doses can be given. We can give up to 5 grams of vitamin C & when it is combined with zinc, the additive effect is very synergistic. Naturopathic doctors give vitamin C for everything and its use is broad, but we have found it very effective with zinc for stopping illness, and to promote healing. Many cancer survivors swear that the high dose infusions of C can cure cancer. I have seen people who should be dead, thriving with just vitamin C. I have also seen it fail and people who could have benefited from allopathic medicine, decline its use and ultimately pass away. One of my favorite patients ever was a High dose C patient, she got it from us over 12 months, her tumor was stage 4 in her breast, it was visible to the naked eye, as she got the infusions, you could see the tumor shrink. Our treatments absolutely gave her more time with her family. A big trend right now in public safety is trying to divert people out of the emergency medical system, people who have acute complaints but don't need to go to the hospital. This program in the valley is referred to as Community Paramedicine.
The goal of Community paramedicine is to keep the emergency medical system free of people who are not seriously ill. It surprises people when the topic of abuse of the 911 system is brought up, most people never have to use 911 or to give any thought to the resources that are poised around the clock to help. Unfortunately, the vast majority of people who call 911 do so for non-emergency calls for help, this puts a strain on limited resources. All of the valley fire departments have implemented various programs to divert non-emergency calls for help to other service providers. For example, at the fire dept we give out taxi vouchers for people who just want a ride somewhere. One of the biggest movements in the fire service right now is community paramedicine, this is a pilot program where a team of paramedics go out to the homes of people who call 911 frequently and help divert them to other areas for services, for example, we help people get their prescriptions filled by a mail order pharmacy so they can stay home and don't have to travel to the drug store. These types of programs are covered by Medicare and are eligible for reimbursement by insurance. My long term goal is to privatize community paramedicine and make transform my IV business into a full featured private health care provider, and to have all the patients seen by a doctor via telemedicine. Telemedicine is the wave of the future, and is revolutionizing healthcare.
Works Cited
Demirkaya, Şeref, and Okay Vural. "Efficacy of Intravenous Magnesium Sulfate in the Treatment of Acute Migraine Attacks." Headache the Journel of Head and Face Pain. American Headache Society
Friedman, Benjamin W., Leonid Garber, Andrew Yoon, Clemencia Solorzano Solorzano, Andrew Wollowitz, David Esses, Polly E. Bijur, and E. John Gallagher. "Randomized Trial of IV Valproate vs Metoclopramide vs Ketorolac for Acute Migraine." Neurology.org. American Academy of Neurologists
Higuchi, Kurose H., Higuchi S. Miura, H. Saito, N. Watanabe, R. Hokari, M. Hirokawa, M. Takashi, S. Zeki, T. Nakamura, H. Ebinuma, S. Kato, and H. Ishi. "Oxidative Stress‐mediated Apoptosis of Hepatocytes Exposed to Acute Ethanol Intoxication." American Association for the Study of Liver Diseases. American Association for the Study of Liver Diseases
Reid, Samuel R., and William Bonadio. "Outpatient Rapid Intravenous Rehydration to Correct Dehydration and Resolve Vomiting in Children With Acute Gastroenteritis." NeuroImage. Academic Press
Strubelt, O., M. Younes, and R. Pentz. "Enhancement by Glutathione Depletion of Ethanol-induced Acute Hepatotoxicity in Vitro and in Vivo." Science Direct .com. Elsevier