Treatment #1 ~  Ketamine conditioning, response and monitoring, assessment of baseline while maintaining appropriate hemodynamic goals within 20% change from baseline 

Treatment #2  ~ increased analgesia with up titration of Ketamine with a goal to decrease baseline complaints for treatment while maintaining appropriate hemodynamic goals within 20% change from baseline 

Treatment #3 ~initiation at higher dose than #2 with up titration of Ketamine with a goal to decrease baseline complaints for treatment while maintaining appropriate hemodynamic goals within 20% change from baseline 

Treatment #4 ~  initiation at higher dose than #3 with up titration of Ketamine with a goal to decrease baseline complaints for treatment while maintaining appropriate hemodynamic goals within 20% change from baseline 

Treatment #5   initiation at higher dose than #4 with up titration of Ketamine with a goal to decrease baseline complaints for treatment while maintaining appropriate hemodynamic goals within 20% change from baseline 

Treatment #6  ~initiation at higher dose than #5 with up titration of Ketamine with a goal to decrease baseline complaints for treatment while maintaining appropriate hemodynamic goals within 20% change from baseline 

Follow Up  ~ start at last therapeutic dose; initiation at higher dose than #3 with up titration of Ketamine with a goal to decrease baseline complaints for treatment while maintaining appropriate hemodynamic goals within 20% change from baseline