Hook Me Up: Are Infusion Clinics for You?
Chicago residents have a new way of curing a hangover or flu: getting an Infusion.
Since its grand opening in the Windy City on Dec. 15, revive, a “hydration clinic” staffed by surgeon Dr. Jack Dybis, D.O., and emergency room nurses, provides intravenous (Infusion) fluids to help healthy people recover from mild to moderate dehydration. While that might seem like a limited clientele, Dybis says quite a few of us are actually at risk of getting dehydrated: people with hangovers, those sniffling through severe colds and flu, elite athletes, and globe-trotting travelers worn out by jet lag. And revive isn’t the only outlet ready to serve your hydrating needs. Commercial Infusion treatment facilities resembling spas, including Revivme, run by board-certified ER physicians in Miami‘s South Beach, and Hangover Heaven in Las Vegas, which doles out Infusion and non-Infusion relief from a bus and is run by a board-certified anesthesiologist, are also gaining customers. But experts question whether people should pay for Infusion treatments, which have risks and may not be more effective than less expensive home remedies.
So how do you know if you’re a candidate for a drip? Potential customers at revive fill out a medical history and mention any past surgeries or preexisting conditions. In Dybis’s office, they describe their current symptoms, which typically include headache, dry mouth, nausea, vomiting, and inability to sleep, and answer questions about how much water they drink a day and how often they urinate. (They may also be asked to describe the color of their urine, since darker fluid is a sign of dehydration.)
Then a nurse may start a line: cold and flu sufferers get hooked up to an Infusion that contains a Lactated Ringer’s solution, which contains a basic recipe of essential nutrients such as potassium and sodium, along with vitamin C and vitamin B complex, which, Dybis claims, provides an “energy boost.” Hangover sufferers get the same treatment, plus doses of Toradol (ketorolac), essentially a super ibuprofen, and Zofran (ondansetron), an anti-nausea drug typically prescribed to chemotherapy patients. Dybis starts with half the normal doses usually provided for hospital patients and increases the amount if and when necessary.
Clients are then escorted to one of revive‘s lounge areas where they amuse themselves for up to an hour to complete their drip. They can choose between a dimly-lit, secluded room if they want to lie down; a conference room with Wi-Fi if they want to work; or a living room where they can gab with others getting the Infusion treatment and watch cable TV or movies. Soon there will be a section for VIP clients such as professional athletes. All treatments cost $99 and are not covered by insurance plans.
So far, the clinic has seen more than 150 patients (you can read Yelp reviews here). Most have been bogged down by flu, such as a woman who had vomited 10 times the day before and one man who was bedridden and missed three days of work. Many, however, go to revive after over-indulging, such as one young man who was hungover after his birthday celebration and needed to be alert for an important LSAT class, and a businessman who was feeling poorly after celebrating a deal with clients. Not surprisingly, revive was packed on New Year’s Day with people who were worn out from the previous night’s festivities.
Dybis is a general and trauma surgeon at NorthShore University HealthSystems and was inspired to start the clinic after his grandmother was repeatedly admitted to the hospital for complications from dehydration. He wondered whether dehydration could be treated just as well outside of an emergency room and plans to use the clinic to research this idea. A 2007 study published in the Annals of Epidemiology showed that dehydration admissions cost hospitals $5.5 billion, and Dybis argues that providing a less expensive and more convenient way to treat this relatively common symptom could lead to health care savings. He also says many of his patients, who do not have health insurance or access to a physician, would not get treated and may develop more severe symptoms that could require more intensive care.
“I’m trying to bring a hospital treatment to the general public,” he says. “This is exactly what you would get if you go into an emergency room.” He has even given the Infusion treatment to himself once or twice when he felt a cold or flu coming on. “You can sit home, sip Gatorade, suck it up and let time take its course,” he says of the way most people try to ward off oncoming colds or cope with hangovers. “But if you have something to do, we offer you a chance to get back your day and be productive. It’s really about how much your time is worth.”
But not all experts feel the same way, warning that patients who are not sick enough to go to an emergency room do not need to receive an emergency room treatment.
“If a person is capable of drinking liquids by mouth there is no reason for an Infusion,” says Dr. Gail D’Onofrio, Chief of the Emergency Department at Yale-New Haven Hospital and Chair of the Department of Emergency Medicine at Yale University School of Medicine. “There’s absolutely no evidence that giving drugs by an Infusion is any different than giving them by a gastrointestinal tract.” ER doctors administer fluids intravenously to people who have very little saliva in their mouths, who aren’t urinating every couple of hours, or can’t keep fluids down for more than six hours — as well as people who are in an unconscious state.
Dybis says that one revive patient who felt so much better after the treatment announced plans to come back as often as two or three times a month. But experts warn that Infusions have risks, too.
“Infusion fluids are a drug, and just like any drug, there’s a proper dosage for different clinical conditions,” says Dr. David Ross, a Colorado Springs physician who has been practicing emergency medicine since 1992. “Any time someone puts a needle in your vein, there’s a possibility of infection and a risk of a clot forming in the vein. You could develop thrombophlebitis [inflammation of the vein], and it’s possible to get an infection at the site that can spread to the heart, which is called endocarditis.” Dybis says that only three out of revive’s 150 patients have developed bruising after the Infusion.
Doctors who treat dehydration say that while the ketorolac and ondansetron in revive‘s hangover remedy may help people to feel better — alleviating the muscle aches and nausea, respectively — the drugs have serious side effects as well. Ross says he avoids prescribing ketorolac because of the risk of kidney damage. And other physicians questioned the appropriateness of routinely administering such powerful, expensive Infusion drugs to healthy people who can take cheaper, oral alternatives like Tylenol and Motrin to relieve their hangover symptoms.
“This is like using a bulldozer to do something that you can do with a shovel,” says D’Onofrio. “People could have allergies to these medications that they don’t even know about, and when you’re giving these drugs intravenously, you’re going to compound that and cause adverse effects that never needed to happen — both from the drugs and from the Infusion itself.”
Dr. Arthur Caplan, bioethicist and head of the Division of Medical Ethics at New York University Langone Medical Center, says the Infusion treatment may not work for everyone if it has not been tested in certain high-risk groups that could show up to the clinic, such as the elderly, people who are obese, diabetics, and those with circulatory problems. Dybis says the medical review he conducts is designed to rule out these patients and that he will not treat people with severe medical problems. For instance, he refused to treat man with a history of a kidney transplant who had not taken his immunosuppressants or antihypertensive drugs the morning he came in for an Infusion treatment. He also sent a personal friend, who had high blood pressure and a severe headache and asked for an Infusion, to the emergency room because he was worried that the symptoms could be a sign of a more serious condition such as a stroke or brain aneurysm.
And that raises another concern that doctors have about the clinics. If someone is seriously ill and isn’t aware that they may have a serious condition that requires immediate medical attention, they shouldn’t be spending time cycling through an Infusion clinic first. “You wouldn’t want people to spend an extra hour in a hydration clinic when what they’re having is not a typical hangover,” says Dr. Mark Morocco, an ER physician at the Ronald Reagan UCLA Medical Center. “If there’s something about your hangover that is different than your usual hangover, or something about your flu that is different from flu you had in the past, you have to go to an ER. Almost every day, we see people who think they have stomach flu, but instead have appendicitis — which is potentially life-threatening — or an atypical presentation of a common problem, like a heart attack.”
Then there is the more behavioral reason against treating hangovers with Infusions. As painful as hangovers may be, they are the body’s natural way of telling you not to drink so much, and the hurt should act as a built-in deterrent to finding yourself in the same state too often. A quick fix like revive‘s 60-minute hangover treatment may mitigate that effect. “If you take that natural mechanism away, you increase the risk of developing alcohol use problems,” says Dr. Daniel Lieberman, a professor of psychiatry and behavioral sciences at George Washington University, who is affiliated with its Alcohol & Substance Abuse Clinic. “If [revive] evaluates for alcohol disorders and gets people into treatment, that would be a true medical approach.” Dybis says it’s too soon to tell whether potential alcoholics might be using the clinic as a quick-fix drip since it has been open for less than a month, but if the same person was coming in repeatedly for the hangover remedy, he says he would counsel them. And, he argues, the Infusion drips aren’t likely playing a major role in alcoholism. “Not being open is not going to keep people from drinking,” he says. “I can’t control what people do.”
It’s also possible that the improvements the clinic’s customers report have more to do with the placebo effect than any significant medical benefit aside from rehydration. Revive‘s treatment “might just make people feel better because they are going to a doctor and getting an Infusion,” says Dr. John Kelly, associate director of the Massachusetts General Hospital (MGH) Center for Addiction Medicine and associate professor of psychiatry at Harvard Medical School. “No one has come up with a cure for hangovers other than not drinking the night before.”
The main concern about the Infusion clinics, however, center around the fact that the risks — from the needle and possible infection, as well as from complications from the procedure — are not worth the small benefits, which most experts say over-the-counter pain medications or some rest and chicken soup can provide as well. There isn’t enough scientific data or randomized, controlled trials to prove revive‘s intervention is a better option for treating dehydration from cold, flu, and hangovers than these remedies. “There are a lot of things we do in society to make us feel better, from massages to mood lighting to comfy chairs, but there’s a clear break between things that are offered for convenience and comfort and treatment for a medical problem that needs to be diagnosed,” says Morocco.