|int| Bridging the Battlefront to Homefront: Dr. Chris Frueh on Confronting Operator Syndrome | Ep 103

When my great grandfather returned from the Spanish-American War, the battle followed him home, casting a long shadow over his daily life. Dr. Chris Frueh joins us to shed light on this very darkness that many veterans confront, known as Operator Syndrome—an affliction that intertwines mental and physical health, leaving a complex legacy of suffering. Through Dr. Frueh's compassionate lens, we navigate these challenges, illustrating the pressing need for holistic support systems for our nation's heroes, and the transformational power of treatment and understanding.

What would it look like if every citizen contributed to national service, bridging gaps and cultivating respect for the shared commitment to our country's welfare? We explore this radical idea, examining how mandatory national service could foster unity and appreciation for those in uniform. By examining global examples and the unique bond among service members, the discussion with Dr. Frueh unveils a provocative vision for a more cohesive society, grounded in the principles of service and sacrifice.

The journey towards healing is rife with hurdles for many veterans, especially those battling the silent aftermath of blast injuries and TBIs. This episode delves into these complex health concerns, from cognitive impairments to sleep disruptions and hormonal imbalances. We highlight the promising horizon of treatments like the stellate ganglion block therapy and the potential of wearable technology in improving sleep and overall well-being. By exploring cutting-edge fitness regimes and the invaluable resources being developed by SEAL Future's health board, we offer a beacon of hope for veterans striving toward recovery and health. Join us for this profound dialogue, featuring Dr. Chris Frueh, to gain a deeper appreciation of the resilience and the ongoing needs of our veterans.

Buy his book on Amazon by clicking here.

Contact Thad - [e-mail]

Thanks for listening!

Episode Transcript

Speaker 1 (00:00):
You're going to look depressed, you're going to feel
depressed, you're not sleeping,you're not able to concentrate,
you have low motivation and thatwas a big thing for him.
I just don't have themotivation I used to have.
He'd stopped working out.
Irritability is a huge problem.
Physical muscle mass starts tochange, working out becomes
really hard and, of course, theeffect on sexual functioning.

(00:22):
So, whoa, that was unexpected.
I didn't see that coming in myearly naive state of working for
the first time, working withoperators.
Once we got that identified andgot that treated he was doing,
you know, there was a hugechange, a huge benefit for him

(00:42):
Also started to realize.
Another unexpected issue was alot of the guys that I worked
with.
I started saying let's getsleep studies done.
My name is.

Speaker 2 (00:54):
Thad David.
I'm a former Marine recon scoutsniper with two deployments to
Iraq.
As a civilian, I've nowfacilitated hundreds of personal
and professional developmenttrainings across the country,
and it struck me recently thatthe same things that help
civilians will also helpveterans succeed in their new
roles as well.
Join me as we define civiliansuccess principles to inspire

(01:14):
veteran victories.
Welcome to another episode.
I'm here today with Dr ChrisFree.
He is the author of a book thatactually launches today, called
Operator Syndrome.
How are you doing, Chris?
I'm doing well.
Thanks for having me, Thad.
Of course I'm so excited.
I know we had gotten contactabout a month ago and just from

(01:36):
our initial conversation I'mvery excited to jump into
several topics that you havegoing on.
And before we even jump intoOperator Syndrome and what that
is, I'd love to just if youcould just give a little
background of what got you intohelping veterans and to this
topic of operator syndrome.
Sure.

Speaker 1 (01:55):
Sure, and it's.
Can I show my book, please do?
Yeah.
So that's the book.
It's not too thick.
You can read it on an airplaneif you wanted to.
My background is clinicalpsychology, so I have a PhD that
I earned in 1992.
And then I wanted to work withveterans.

(02:16):
That's what I wanted to do whenI went to graduate school, so
my dissertation was with Vietnamveterans and my first year out
of school was training, gettingsupervised for licensure, and
then that turned into along-term job at a VA hospital.
So I was in Charleston, southCarolina, at the VA there and

(02:40):
the Medical University of SouthCarolina from 91 to 2006.
And so my time at the VA wasthe first half of that was
completely full-time clinical,working in a PTSD clinic, and
then the second half of it waspart-time clinical and most time
on research.

(03:00):
I started to get NIH andVA-funded research projects.
That took my time.
When I left the VA in 2006, Imoved to the University of
Hawaii and I'm still here branchcampus in Hilo on the Big
Island and I like it here.
But I also had a chance to dosome work in Houston for about

(03:20):
12 years.
So I was running researchprograms at Menninger Clinic,
which is a private psychhospital affiliated with Baylor
College of Medicine, and then Idid that for about a decade,
commuting.
It was a part-time gig, andthen I had the opportunity to
set up a center for veterans,mental health and research

(03:42):
research education at theUniversity of Texas Medical
School in Houston.
So that's my professionalbackground, my childhood
background maybe that's what youwere asking about that kind of
leads into why did I do all thisother stuff?
So as a child, my father was aVietnam veteran.
He was not a combatant, he wasa physician in the Air Force.

(04:05):
But I grew up with that.
You know that, you know kind ofthe shadow of the Vietnam War
hanging over, hanging over thecountry, hanging over my family.
Also, one of my heroes as achild was my great grandfather,
who was alive and he lived to beabout 100.
He died.
I think I was about 14 when hepassed away.
He was also a veteran.

(04:27):
He had fought at the Battle ofSan Juan Hill in Cuba during the
Spanish-American War, so that's1898.
And so as a child, probablyfrom about the age of 10, I
would talk with him about thewar, his experiences in the war
and a pretty profound homecomingexperience that I think shaped

(04:49):
his life going forward andshaped a lot of my thinking
about what we as a country doand don't do for our veterans
Should.

Speaker 2 (04:58):
I tell that story.
I was actually going to ask youif you weren't going to tell it
.
I'm very curious to know.
I mean 1898, you said Yep, 1898.
Well, what was that homecominglike?

Speaker 1 (05:11):
So it was a short war , spanish-american War.
We were in Cuba for about threemonths.
We brought 20,000 or 30,000troops home, pretty much all at
the same time In Cuba.
They had been exposed totropical diseases, they were in
the jungle with the mosquitoes,and so they came home.

(05:33):
They brought, they were, mostof them were sick, they had
malaria, dysentery, whatever,and they were malnourished.
They hadn't been well fed.
The logistics didn't work outvery well for that war.
In fact the logistics were.
I don't know the full story onthat, but the rough riders Teddy
Roosevelt and the rough riders,their horses never even made it

(05:54):
to Cuba, so they were on foot.
These cowboys so-called cowboyswere on foot because their
horses didn't arrive, becausetheir horses didn't arrive.
So what the government did wasthey built a new camp, a base
camp, up on the Montauk Point atthe tip of Long Island, new

(06:16):
York, as a staging area.
So they basically, in a bigrush, they threw this camp
together and they put thousandsof tents and kitchens and it
just became a great big mudfield.
And so they brought thesoldiers home and they
disembarked here and they werebasically put into this
isolation camp to recover andget better, except that the

(06:39):
isolation camp was just adisgrace.
The food was terrible, mud waseverywhere.
It just was not a hygienicplace for men who were very sick
to be.
And it was a national disgrace.
The president of the UnitedStates went up to see it and
view it so it came into the news.
This camp was named CampWyckoff, who, I think Wyckoff,

(07:03):
was the first KIA in theSpanish-American War in Cuba.
So they named the camp afterhim.
So my great-grandfather was verysick.
He was not, you know, he didn'tthink he was going to survive.
He was that sick and a womannamed Mrs Bean came up from New

(07:24):
York City with her carriage andher butler and she brought as
many men as she could fit intoher carriage, I guess it was
five or six men, picked them upat the camp, took them to her
home in New York City she was awealthy woman Took them to her
home and nursed them there forweeks, at risk to herself and

(07:49):
her own family to have these menwith these diseases in her
house.
And she nursed them back tohealth and then got them set up,
gave them money so they couldget home.
My great grandfather was fromMichigan.
He was with the Michiganmilitia.
So he had to get back toMichigan somehow, and so for the
rest of his life he talkedabout her, he talked about the.

(08:12):
He truly believed she'd savedhis life and given him his life
back by helping him get to gethome.

Speaker 2 (08:21):
Did he ever get back?
That's an incredible story.
Did he ever get back in touchwith Ms Bean?

Speaker 1 (08:26):
I don't think so and I don't know anything about her.
It's probably something Ishould put more effort into
learning about.
What I also don't know was didMrs Bean do this on her own, or
was this part of a largermovement of civilians going up
there?
And I suspect there were othercivilians going up there and
bringing men home to care for?

(08:48):
But I can't.
I've not been able to findanything in the historical
record, but I'm not confident.
I know where to look.
So if anybody out there islistening, I would be very
curious to know was this a, wasthere sort of a movement to go
up to Camp Wyckoff and bringthose soldiers into private
homes and care for them?

(09:09):
This does kind of bleed intosomething that we'll get into in
our conversations, which isAmerica.
Today we have a much more robustVA system, we have hospitals,
we have better technology, wehave better disease management
and we have all that good stuff,but I think what we don't have

(09:30):
is a civilian society that looksat and sees veterans and
recognizes that they have needs,that many of them are injured,
hurt, sick, I think, to youraverage American.
I think 99% of us who are notveterans don't even know a
veteran, have not even reallythought about veterans, and when

(09:54):
we do, it's thank you for yourservice and glad the VA is there
to take care of you, except theVA can't do everything.
And so I think part of what weare looking at right now for our
nation's veterans is a verydisinterested society.
What's the word?
I'm just not looking, notpaying attention, not interested

(10:18):
.
Indifferent that's the word.
I was struggling with Anindifferent society and an
indifferent society that assumesthe VA is there to take care of
all needs and of course, the VAcan't.
Even if the VA was a perfectorganization which it's not and
people don't even know about theways in which it's not taking

(10:40):
good care of veterans in some ofthe ways that it's not, so
there's just very littleawareness, I think, among most
Americans about our veterans andabout what they experience and
struggle with coming home orcoming out of the service and
with that?

Speaker 2 (10:56):
I mean, what would be your thoughts inside of that?
I mean, do you have a solutionin there, or is that just an
observation?

Speaker 1 (11:02):
Well, it's an observation, that's maybe a
partial assessment of a problem.
I think we have a solution.
Solutions are complicated herebecause the solution requires a
shift in all of society.
And let's put this into thehistorical context.

(11:22):
I mean, america has always hadpeople that stepped forward to
fight our enemies, or you knowthe identified threats If we go
back, you know, to the KingPhilip Indian War, for example
the citizens.
There was no VA, but thecitizens recognized hey, if
we're going to ask our young mento go and fight and risk their
lives, it's on us to take careof them when they come home.

(11:45):
So it was an understoodsocietal debt that was owed and
of course we now pay that debtwith our taxes.
But we're not doing anythingother than just allowing the
government to pull out a littlebit of money from our taxes to
make the VA happen.
Solutions Wow, how many hoursdo we have?

Speaker 2 (12:09):
This might be a different.
I know we're going to talkabout the VA and this might come
up at that point in time, but Iwas just curious.
I didn't know if you hadanything.
Just that was top of mind foryou.

Speaker 1 (12:18):
Yeah, I do.
I have one thought that's top ofmind and people would hate it,
but I think it would solve manyof our problems as a society and
that would be a requirednational service.
And I'm not a policymaker, I'mjust, but I'm also not
spitballing.
This is something I've thoughtabout a lot over the decades and
I think if we had it, you knowand I don't know, I won't speak

(12:41):
to details too much but if everyAmerican at some point had to
give two years of service beforethey were reached the age of I
don't know 28 or 30, maybe youpush that number lower and maybe
that service could be, you know, maybe there would be options,
maybe some people could chooseto go into this military service

(13:02):
, maybe some could go into lawenforcement or firefighting,
maybe there's, maybe there'sother other kinds of service.
But I think, I think, if we wegot more into becoming more of a
service minded country where we, we all understood what it
meant to put on a uniform and dostrenuous, rigorous, important

(13:27):
but also dangerous work, I thinkthat would help unite us more
than we are united, butcertainly it would also, I think
, help develop that appreciationand awareness of the fact that
there are men and women who suitup every day and step into the
fight, step into the arena, soto speak, whether that's law

(13:49):
enforcement, emt, firefightersSome of my work is with first
responders but also, obviously,soldiers.
What do you think about that?

Speaker 2 (14:00):
I think that would be a phenomenal, phenomenal thing.
I was talking to somebody.
He was in town.
I think that would be aphenomenal, phenomenal thing.
I was talking to somebody, wewere, he was in town.
He's a fairly big personalityand he's more of a mentalist and
he was on stage and I was justtalking to him.
He was from Israel and he'sactually getting ready to fly
back to Israel and it was right,it was his flight happened.

(14:23):
He was flying out on a Fridaynight and that night was when
they got attacked.
So I talked to him like sixhours prior oh wow, like man,
what do you?
What are your thoughts abouthaving to serve?
You know, for them, I thinkit's three men must do three
years, women must be two years.
I think that every, everycitizen must serve in the

(14:43):
military.
And he said it's fantastic,they absolutely love it.
And so I don't have anypersonal, obviously, aside from
my own service.
It sounds like it would be agood thing, but just talking to
other countries that do it, itseems to be a very unifying
thing that everybody does theirtime.
They love that, they did theirtime, and then they know that
even the you know the big, likeGal Gadot, who's a huge movie

(15:06):
star here Now.
She served her military time aswell, and it's so.
It doesn't limit them fromdoing what they want to do.
But to your point, it givessome good appreciation, and so I
love it and I think it's agreat idea.

Speaker 1 (15:20):
And since October just a followup on that, since
the atrocity attacks of October7th I started doing a little bit
of work and consultation with agroup of psychiatrists,
psychologists, mental healthexperts, and we're a small I
would say a small internationalgroup a couple of folks from

(15:42):
Australia, a couple from BritainI'm the lone American and a
couple of folks from Australia,a couple from Britain I'm the
lone American and then a handfulof docs from Israel and I've
worked with other doctors fromIsrael and even published some
research on their insuranceprograms for post-terrorism.
So what's really interesting isI'm a civilian, I've never put

(16:03):
on a uniform, I've never servedin the armed forces, but the
Israeli docs have.
So when we're havingconversations about treatments,
working now with some of thefolks not working but talking
with some of the folks that runtheir hyperbaric oxygen therapy
treatment and research programswhat's really cool is you
realize these doctors, they'vebeen there, They've had the

(16:28):
training, they've been onmissions.
One of the psychiatrists was aformer special operations
soldier, and I'm not even sureif the word former is
appropriate, because I thinkthey maintain some ongoing
connection to.
Even after they've done theirthree years they continue to do

(16:50):
things.
So, yeah, it's a completelydifferent thing and, man, we
live in a country that is sodivided right now in America.
Service would, I think, bringus together in that way too,
maybe, and have some benefits.

Speaker 2 (17:04):
I love that loop around.
I was not even thinking on thatlevel of the tie-in, of how
divided we are and how thatwould be a huge unifying
connection because all veteransthat's one thing that every
veteran knows.
I mean, we talk trash abouteach other all the time,
different branches, yet at theend of the day we're here for
each other.
Yep, yeah, yeah.
And it just made me think of.

(17:25):
I'm not a very religious person, so I'm going to mention just
Mormons.
And you know, you see theseindividuals traveling around
town and I was talking to aMormon.
He said now, if he seessomebody out, he'll actually go
out of his way to go help themout.
Just because he's like I'vebeen there, he'll actually go
out of his way to go help themout just because he's like I've

(17:46):
been there and and it just itjust made me think of that
unification that when you, evenwhen you're done with your time,
you see people in the middle ofit, there's just that reaching
in to help, that yearning to gohelp somebody because you've
been there.

Speaker 1 (17:59):
Yeah, so it's a great idea and once a veteran, always
a veteran.
So it's a.
It's a lifelong, life-changingexperience and identity.

Speaker 2 (18:08):
That's fantastic.
Well, thank you for sharing.
I'm glad we went through thatbecause I could definitely see
where it got you very interestedinto supporting veterans and
helping veterans, because itmakes perfect sense.
And so your book OperatorSyndrome.
What is Operator Syndrome?

Speaker 1 (18:25):
Yeah, okay, well, I got to tell a little story on
that just to kind of put this incontext and try to help it make
sense.
So, as a VA clinician, I neverreally we didn't have patients
that came from specialoperations, not in the 90s.
And special operations in the90s was very different from what

(18:47):
it became after the global waron terror.
I mean, we did have GreenBerets, we did have SEALs, of
course, and I know many thatwere active in the decades prior
to the global war on terror,but I didn't have experience
with them personally.
My friend network in Houston Istarted to meet a lot of Navy

(19:10):
SEALs, army SF, some MarineRaiders, and in conversations
with people, one thing I heardover and over again and I'm just
going to kind of pluck out oneindividual who comes to mind who
is a good friend.
His words to me were so hiscontext he was a Navy SEAL.

(19:34):
He'd been at DEVGRU, the Tier 1unit, very accomplished.
He had the medals.
I did sit with him and gothrough his DD-214 and his
entire folder of militaryrecords.
So and have talked with manyother people, so I'm 100%

(19:55):
confident he was representinghimself, you know, honestly and
with integrity, his service.
His complaint was I don't knowwhat's wrong with me, but I'm
not the same as I used to be andI don't understand it.
I look in the mirror and Idon't see the same face.

(20:16):
And he even described you knowI've put on a little weight, my
jowls have kind of filled out.
He wasn't sleeping very well,he was drinking too much,
drinking a lot, but it was morethan that.
And so you know my 15 years atthe VA treating and studying

(20:36):
PTSD, that you know that's thefirst hypothesis.
So in talking with him I cameto realize he didn't have PTSD.
He didn't have the fear,reactivity, he didn't have the
avoidance of thoughts and cuesand situations and sounds that
maybe activate PTSD symptoms formany people who have PTSD.

(21:01):
He just didn't have it.
So then it's like, well, whatdoes he have?
And, yes, he seemed depressed.
He didn't have any fear, anyproblem talking about his combat
experiences or his training orthe loss of many, many friends.
We started.
I just like I need to do sometrial and error here.
And that's what it became forme trying to help some friends.

(21:24):
It was like let's get bloodtests, let's look at hormones.
That's something mental healthcare essentially never does, we
never really think abouthormones.
I worked in the VA for 15 yearsand I don't ever remember
anybody from my clinic ourclinic being referred to get a
hormone test and I regret that.

(21:47):
I'm not sure how we would havedone that or if that would have
been easy to do when I wasworking in the VA, but anyway,
he had low testosterone, verylow testosterone.
I don't remember his exact ageat the time, let's call it 37
years old.
He had done 17 years in theNavy.

(22:08):
He was a very large man, is avery large man and he had the
testosterone of an elderly man.
So, wow, what does it mean tohave low testosterone?
You're going to look depressed,you're going to feel depressed,
you're not sleeping, you're notable to concentrate, you have
low motivation and that was abig thing for him.

(22:30):
I just don't have themotivation I used to have.
He'd stopped working out.
Irritability is a huge problem.
Physical muscle mass starts tochange, working out becomes
really hard and, of course, theeffect on sexual functioning.
So, whoa, that was unexpected.
I didn't see that coming in myearly naive state of working for

(22:54):
the first time, working withoperators.
Once we got that identified andgot that treated, he was doing.
You know there was a hugechange, a huge benefit for him,
also started to realize very.
Another unexpected issue was alot of the guys that I worked
with I started saying let's getsleep studies done,

(23:17):
polysomnographies, that's whereyou spend the night in a sleep
clinic and we measure brainwaveactivity, breathing, heart
activity, body temperature,movements, eye movements, limb
movements, eye movements, limbmovements.
And most of the guys I know andwork with have sleep apnea,

(23:41):
obstructive sleep apnea, whichyou think of I always think of
as a disorder for middle-agedmen especially who are a little
overweight.
It's something else with theseguys so low testosterone, sleep
apnea.
So let me go back.
You asked what is operatorsyndrome?
I've kind of introduced you tokind of how I my first you know,
kind of awakening or awarenessthat something is going on here.
That's different from what Iwas expecting of operators from

(24:10):
across all branches.
I've worked with operatorsliterally from every branch,
including active duty, includingCanadian SOF and including
private defense contractors.
I've done a lot of work withprivate defense contractors, not
all of whom are operators, butmany of them are or function as
operators in war zones, and thispattern emerges just the same

(24:35):
kind of pattern of injuries andfunctional impairments.
I just started seeing it overand over and over again to the
point where now I sit down withsomebody and once I hear where
they served and what they did, Ihave a pretty good idea of some
of the problems they're likelyto have.
So let's do this and we cancome back.
I'm just going to rip throughthe list of injuries and

(25:01):
illnesses and the point I wantto make is they're all
interconnected.
They cause each other, theymake each other worse.
So traumatic brain injury isthe first.
I want to come back and key onthat in just a moment.
But traumatic brain injury,sleep disturbance, such as
insomnia, obstructive sleepapnea, the hormonal

(25:23):
dysregulation, which istypically low testosterone, but
frequently other hormones aswell Chronic pain in essentially
every joint in the body,headaches, sometimes migraines
that are pretty severe.
Then we have the psychologicalstuff, the depression, the
anxiety, some PTSD, anger.

(25:45):
Anger is a big one.
Hypervigilance is almost like aseparate issue for a lot of
guys.
Hypervigilance is almost like aseparate issue for a lot of
guys, separate from PTSD.
It's just a behavioraladaptation that they've learned
and is deeply ingrained.
It's a reflex, addiction andsubstance abuse, widespread

(26:05):
impairments of perceptualsystems.
So hearing, vision and balanceare all affected and impaired.
Typically Then we get intocognitive impairments.
You know, memory andconcentration are impaired.
Organizational ability just tostay on task with things over
the course of a day or a week isdifficult.
All of this now bleeds intomarriage and parenting and

(26:31):
family, causing problems.
All of this bleeds intomarriage and parenting and
family, causing problems.
All of this bleeds intodifficulty with intimacy, both
physical, sexual intimacy, butalso emotional intimacy.
One thing I hear over and overagain is guys describe a loss of
empathy, loss of kind of anemotional numbing.
They just don't hurt or respondto suffering the way most of us

(26:56):
do.
You have the toxic exposures,all those things that affect
breathing, respiratory illnesses, cancer rates we're seeing high
elevations of cancer rates inthe soft community, the
transition out of the military.
Now we're going to take thatoperator with all these injuries
and impairments and say goodluck to you, go back to the

(27:19):
civilian world after 10 years,15 years, 20 years or more, get
after it there and good luck.
And there are programs thathelp with that.
But, man, that's a challengefor every veteran, whether you
serve two years, a four-yearenlistment or.
But, man, that's a challengefor every veteran, whether you
serve two years, a four-yearenlistment or a career.
It's a challenge.
I don't know how.
I mean it would be a challengefor me if I had to suddenly do

(27:41):
something very different fromwhat I've done my whole
professional life.
And then the last kind of twothings are the existential
concerns.
You know the guilt, the loss,the survivor's guilt, losing
tribe, losing the purpose andmission in life, and you have
all of that put together and wehave a really we have a high
rate of suicide in the SOFcommunity.

(28:04):
I don't know anybody personallywho's died by suicide, but I
hear of a death almost everyweek, a suicide death almost
every week.
And when I talk to guys, verycommonly they will say, yeah,
they've had five, six, eightfriends die by suicide after

(28:24):
they came home after theirmilitary service, after they
finished their contracting workoverseas.
So suicides are a real problemand that's a concern for a lot
of us, something that manypeople don't understand.
And I want to go talk about TBIfor a minute, if I could.

(28:44):
People think of TBIs asconcussions.
You get hit on the head, maybeyou're knocked unconscious,
you've bruised your brain.
You do that enough times,you're going to have long-term
injuries to the brain, andthat's true.
People also don't think aboutthe injuries caused by the toxic
inhalations.
You know, breathing toxic air,not breathing any air, the

(29:09):
diving often leads.
You know combat diving, whetherthat's seals or other branches,
that often.
You know that oxygendeprivation is a form of injury
to the brain.
And then the big one, the onethat we don't really understand
medically and is just nowstarting to get attention, are

(29:31):
blast wave exposures.
So most people don't understandwhat a blast exposure does.
Every explosion sends out aripple, a shock wave, an
invisible wave.
If you're close enough, ifyou're within the radius, that
wave is going to go through you.
It has a shearing effect.
So it goes through the brain,through all the soft tissue in

(29:52):
the body.
In military special operationsand this is true for
conventional also, and I want tocome back and acknowledge that
what I'm talking about isoperator syndrome.
I don't just view it as onlyspecifically people who meet the
formal definition of operator.
I know firefighters, I knowmany Marines who you know with a

(30:18):
couple of pumps to Fallujah,for example, other soldiers in
artillery units and suchAnything that involves
explosions is going to injurethe brain.
So if you have training withbreaching demolitions,
shoulder-fired rockets, evensniper rifles, not even sniper

(30:38):
rifles, even handguns have amicroblast.
So it's a matter of what isyour have a massive amount of

(30:59):
blast exposures, not just fromdeployments but from the
training itself.
So before a SEAL even gets intotheir first platoon, 95% of
them have TBI just from theirtraining exposures.
Conventional forces also aregoing to have some of these
injuries.
They just typically don't havethe same magnitude, the same

(31:21):
number of years, but also theintensity of blast after blast
after blast.
Being in a shoot house,training in for close quarters,
you know CQB is going to, youknow you're in a tight space,
you're breathing, you'rebreathing all the heavy metals,
you're handling the heavy metalsand you're in a very tight,

(31:41):
confined space with the gunshotsand such.
So it's really a profound doseof brain injury that we are
talking about for this community.
There's two other pieces that Ithink are causative, and that's
just simply the high op tempo oftraining.

(32:05):
Evolutions are constant anddeployments.
So train for a year and a half,do a six-month deployment.
Come back to the us train.
I mean there's differentcadence tempos but the op tempo
is high and on and ondeployments.
You know a lot of these, a lotof operators?
They're just, they're runningand gunning every night with

(32:27):
kinetic missions.
So now you have sleepdisruption, not not enough sleep
deprivation.
Plus you have the circadiandisruption of traveling back and
forth to different placesaround the world, also a lot of
night work, night training,night missions.
So the sleep really gets jackedup and I think I'll take a

(32:51):
breath here.
That's, that's operatorsyndrome.
I view it as a framework.
It's not a diagnosis, it's aframework understanding that
these are all of the domainsthat we need to be assessing and
looking at, and I would saythat's true.
You know, that kind of thatwhole systems approach is true
for all veterans, for all firstresponders, for all firefighters
and law enforcement.
We should be evaluating each ofthese domains.

Speaker 2 (33:16):
Well, one thing that and it made me think of it I
want to ask you, because yousaid that there's not a ton of
information on it right now, butwith that almost like a
shockwave, because I rememberone of the things that we talked
about oftentimes in sniperschool was just how, when the
body takes an impact from abullet, the bullet goes through,

(33:38):
but the secondary impact is thewave that it sends through the
body and essentially it jars allthe organs around it.
So even the bullet goingthrough, obviously that's one
point of impact.
But it talked about how muchdamage and obviously that's a
big force, a big blunt hit.
But what you're saying is,without the penetration of a

(33:58):
bullet, being close to theexplosion or any blast, anything
like that, it's sending thesame shockwave through or
similar.

Speaker 1 (34:07):
Where is your head in relation to your rifle?
Right on the rifle, right there, yeah, right there, yeah Right
there.
Shoulder-fired rocket If you'redoing anything with Carl
Gustavs, a lot of guys refer tothose as their favorite sidearm,
but that's right there.
I've talked with guys that wereinstructors for shoulder-fired

(34:30):
rockets and they're standing ona field with a student on either
side of them and they'restanding out there all day with
these things going off and atthe end of the day they are
nauseous and woozy and theywobble home and they feel sick
for days afterwards and then thenext day they get up and do it
again, perhaps days afterwards.

Speaker 2 (34:53):
And then the next day they get up and do it again.
Perhaps I remember this one wewere over in Iraq and we had
just a ton, a huge cache of justold military Iraqi, just a
bunch of explosive devices, justdifferent things, and we
brought them out into this fieldand strapped them with
explosives and just slowly, andwe have videos of these just

(35:15):
massive mushroom clouds going upin the sky, and that's one in
particular that just made methink of of the many times of
just, but we didn't, we didn'teven think of it.
How did they discover?
This was a thing and I know yousaid it's a very, fairly new
thing that they're exploring,but I mean, how did we discover
it and what?
I know?
You said it's a fairly newthing that they're exploring,
but how did we discover it andwhat do we know about?

Speaker 1 (35:33):
it.
You know, what do we know aboutit?
Well, there was a.
So at some point along the way,I just tuned into it, just from
discussions these guys weredescribing to me.
Yeah, this is how it feltafterwards I felt sick, I felt
dizzy, I vomited or I feltnauseous.
I was sick for five days aftersome very close explosions and

(35:57):
events.
I tuned into it probably adecade ago, just from talking
with guys, just from hearingtheir descriptions.
There's a famous paper that waspublished in 2016, so eight
years ago now, years ago now bya pathologist, daniel Pearl,

(36:17):
pathologist at Walter Reed, andthis was his team.
He's the last author in thepaper, but that usually means
the senior author, and he kindof followed a similar pattern of
just kind of like hypothesisand tinkering around as Bennett
Amalu did when he discovered thepattern of injuries from
concussions.
So Bennett Amalu was probablymost many people don't know, but

(36:39):
he was the subject of the movieConcussion.
He was a pathologist who wasbringing brains home and
dissecting them, slicing them inhis kitchen, staining the
slides, and he identified thesetau proteins that had built up
in the brains of people who'dhad a lot of concussions so
boxers, football players, soccerplayers, et cetera, and he

(37:02):
called that chronic traumaticencephalopathy, and that's what
we refer to that as those areimpact force injuries.
What Daniel Pearl did was hefollowed a similar methodology,
but the brains didn't show thesame tau protein buildup.
Instead, what they showed wasand it took different approaches

(37:25):
and different types of stains,but what they found, which they
associated with the blastexposures, was a pattern of
scarring in the glial cells ofthe brain.
The glial cells are not theneurons, so they're not the
messenger cells.
Neurons send the messages.
The glial cells, they're likethe infrastructure for the

(37:48):
neurons.
They hold them in place, theyinsulate them, they clean, you
know, they haul out the wasteproducts from the neurons.
So they're very important andthey have a pattern of scarring
caused by the shearing effectsof blast exposures.
That 2016 paper was essentiallya series of case reports.
Patient number one in his casereport was a and I won't say

(38:14):
names, but it was a retired NavySEAL who'd been at the Tier 1
unit for many years, widelyliked, widely respected, admired
by his peers.
I know many guys that looked upto him and served with him and
looked up to him, and I know hiswife, I know his widow.
So about a year or two after heretired he shot himself.

(38:37):
He died by suicide.
He shot himself in the chestand his wife arranged for his
brain to be sent up to WalterReed, to the pathology lab up
there.
And she worked with you know,daniel Pearl worked with her and
the others who formed this caseseries.
So he very meticulouslydocumented the levels of blast

(38:59):
exposures.
So that's the paper where wefirst really scientifically
started to go okay, what we'vesuspected is real.
These are physiological,serious injuries that are
occurring in the brain thatdon't show up on an MRI.
They don't show up easily onany of the testing that we can

(39:22):
do while somebody's alive.
But now we know there's reallysomething there.
Pearl and his team gave it aname.
They named it InterfaceAstroglial Scarring scarring in
the glial cells.

Speaker 2 (39:40):
That's absolutely fascinating that all of this
stuff got connected.
It's pretty amazing, but itseems like this invisible ghost
that you couldn't like.
There's no way to check mybrain right now.
Right, If I wanted to say whatdoes my brain look like?

Speaker 1 (39:57):
I mean we can test for a lot of the cascade effects
.
We can look for those.
So I could ask you questionsabout your cognitive functioning
, about headaches, lowtestosterone and sleep apnea are
probably injuries caused by TBI, at least in part.
The TBI is going to affectspeech you might have slurred

(40:21):
words.
It's certainly going to affectthings like balance and
equilibrium.
A lot of guys have vertigo-likesymptoms, other things.
I mean we know that a TBIaffects sleep, it impairs sleep.
It's harder to sleep with a TBI, which really sucks, because
sleep is the best thing to heala TBI.

(40:43):
So you get this catch-22, whichcan be a vicious cycle, and
what we're trying to do now froma treatment perspective is
switch that cycle around.
If I can help you sleep better,that's going to be good for
your brain and, by the way.
So I've just spouted off here awhole lot of bad news, but I

(41:06):
want to make the point.
There's good news.
We have treatments, we can findways to treat everything on
this list, and so I have seenpeople operators radically
recover and heal and turn theirturn their, improve their
functioning and their, their,and reduce, reduce the suffering

(41:28):
.

Speaker 2 (41:29):
What would be the and I would imagine every patient
would be very different in thetreatment diagnosis.
What are some common treatmentsthat you've seen used?
Just I'm imagining people.
I'm curious to know.

Speaker 1 (41:42):
Yeah Well, the first thing I tell everybody and this
is perhaps relevant to you aswell get your hormones checked.
That's a low-hanging fruit.
That's just a simple blood drawlab test, and then you have a
conversation at that point aboutwhat the data show and what to
do about it.
Another low-hanging fruit is asleep study.

(42:02):
Every veteran should get asleep study.
Every veteran should get asleep study at some point, and
then maybe even periodically.
So those are two assessments.

Speaker 2 (42:13):
Yeah, it just made me think of and feel silly to ask,
but I want to ask you know myGarmin fitness?
Watch right here how accurateare those as far as?
Because it gives me a sleepscore every night.
Are they pretty accurate?
Not accurate.

Speaker 1 (42:28):
Yeah, that's, that's that's.
I'm glad you asked that.
That's a, that's a.
That's a good question and it'sa really cool topic.
I would encourage everybody towear a fitness wearable OK, not
to track your workouts per se,but to track your sleep.
They're pretty reliable.
They're all pretty reliable andyou can get insights that I

(42:50):
think are really meaningful.
I went through a process aboutfour years ago where I think I
wore five or six wearables allat the same time for a month.

Speaker 2 (42:59):
I totally nerded out, I think.

Speaker 1 (43:00):
I wore five or six wearables all at the same time
for a month.
I totally nerded out.
I had the Apple Watch, the OuraRing, the Whoop, fitbit, suunto
, I think I had a Garmin that'sthe one I probably missed and so
I played with all of them andeventually settled on the Whoop.
I don't know that any of themare any better than the others.
The Whoop seemed to be the bestat that time.

(43:21):
Also, what I like about theWhoop is it doesn't have a
display, it's just a strap.
You have to actually pick upyour phone and look at the app
so it doesn't bother you all daylong.

Speaker 2 (43:30):
It's notifying you of everything that's happening.

Speaker 1 (43:33):
Yeah, it doesn't matter and for a while I was
wearing it and really trackingmy sleep and I noticed some
abnormalities.
I went and got my own sleepstudy based on what I was seeing
, and it was like wow, so Ilearned some really important
things about my sleep.
What I encourage people totrack is how many hours of sleep

(43:54):
are you getting?
How many times are you wakingup in the night?
How many times are you wakingup in the night?
Because that constant waking upis characteristic of periodic
limb movement disorder, it'scharacteristic of sleep apnea
and probably some other things,and we know it really messes up
the quality of your sleep.
And then you want to see howmuch time in REM and slow wave

(44:20):
are you getting, and you alsocan get these great insights
into what helps you sleep betterand what sleep does for you.
Sleep is everything.
Sleep is one of the mostimportant things to get right in
life.
We know so much more aboutsleep now than we used to know,
including that there's a veryimportant system, the lymphatic

(44:42):
system, in our brain, that whenwe're in certain levels of sleep
, our brain is being cleaned orcleaning out the toxins in sleep
, and if we don't sleep, thosetoxins don't get carried out.

Speaker 2 (44:56):
What is the optimal baseline?
I know you said how many timesyou're waking up, what is your
room sleep, but just if we wereto throw out a number, how many
hours should someone be gettingevery night of sleep?
I?

Speaker 1 (45:07):
don't think there's an exact formula that works for
all of us, but I think seven toeight hours of sleep a night is
probably a typical need.
Some people need more, somepeople need less.
For combining the REM and theslow wave sleep, I think two and
a half to three hours a nightis probably good.

(45:28):
You probably want to try to bereaching that.
You also can get insights intothings that harm your sleep.
So I don't know about theGarmin, but some of the
wearables.
You get a little journal eachday to complete so you can log

(45:56):
how much alcohol you had, whatyour exercise was, what time you
ate your last meal, what timeyou ate your first meal of the
day.
You can program other things.
You can customize this to setup you know anything you want to
track and then you start to getinsights.
After about three months youstart to get insights of hey,
this, this behavior is enhancingyour sleep or this behavior is
impairing your sleep.
So it can assist with sleephygiene.

Speaker 2 (46:14):
Well, and I have some questions about that too,
because I did some training thatI want, and.
But I want to circle back justbefore we even go into that,
because I can also hear people.
One common thing that I hearjust with people in general,
even non-veterans just thereseems to be almost this proud Uh
well, I, I only need threehours of sleep every night and
I'm good I got.
Just that's all I need.

(46:34):
Um, what thoughts do you havefor anybody thinking that I only
need X number of sleeps and Ifunction?

Speaker 1 (46:41):
you know, three, four hours of sleep and I'm
functioning, yeah, Uh, the oldWarren Zevon song I'll sleep
when I'm dead is something thatyou hear.
Um, and that's a mentality wehave.
Like, yeah, as you say, we'realmost proud.
I work a hundred hours a weekand I only sleep three out three
hours a night.
Um, there are people that thatworks for.

(47:06):
My grandmother only needed abouttwo or three hours of sleep at
night.
She would stay up and readafter everybody else went to bed
and then she would get up atfour in the morning and have
breakfast ready and fresh breadbaked and everything in the
morning.
When you came down, that's allshe needed.
That's very, very rare.
Most of us need the seven oreight hours of sleep.
I thought I was good with fiveor six hours.

(47:30):
I went through a long period ofmy adult life Before I moved to
Hawaii.
I was typically sleeping fiveor six hours and I worked long
hours.
When I moved to Hawaii, five orsix hours and I worked, you
know, long hours.
When I moved to Hawaii,something weird happened.
I got here and realized that Iarrived here the day like the
end of July, thinking August 1stwas my you know, was my

(47:53):
employment date.
So I check into the universityon August 1st and, I'm told,
come back in two weeks.
There's really nothing going onuntil classes start or
orientation starts in a coupleof weeks.
So suddenly I had two weeks onmy hand with nothing to do, no
to-do list, maybe a few emails aday, maybe a few projects I was

(48:14):
working on from papers and such, but not much, and with nothing
to wake me up, no pressingneeds.
I was sleeping 12 hours a dayfor those two weeks.
It shocked me.
I'd just go to bed and have noreason to get up.
The next morning, and it was 12hours later, I'd wake up and

(48:35):
gradually, over the course ofthose two weeks it just
naturally came down to abouteight or nine, and then a few
weeks after that, once I gotworking again, it came down to
the probably a healthy seven oreight hours of sleep.

Speaker 2 (48:49):
Interesting.

Speaker 1 (48:50):
So my body was like ah, a chance to catch up, and
that's probably what it wasdoing.

Speaker 2 (48:58):
So what would be the indicators then?
Because you mentioned yourgrandmother, who obviously got
by with very little sleep andyou obviously had this timeframe
that you got to sleep and yourbody did.
But what would be theindicators for somebody that,
let's say, that somebody issleeping four hours a night,
feeling like they're good?
Yeah, but there might be someindicators that are happening
daily, whether frustrations,irritability, anything like that

(49:20):
, that somebody could look for,that that might be a reason to
get more sleep.

Speaker 1 (49:25):
Yeah, well, my grandmother had the time to
sleep.
She just couldn't sleep morethan that.
So that's one indicator.
Another is how do you feel?
How are you functioning duringthe day?
A lot of times people go onvacation and they notice they
sleep quite a bit more.
That's probably a clue thatyou're behind, that you're not
getting enough sleep.

(49:46):
I never really took vacationslike that very often, so I never
got that lesson until 2006.
The other piece is a lot of theresearch on sleep has been done
so in the last decade.
I mean, we know more aboutsleep than we knew 10 years ago.
We know much more about, whilewe're sleeping, our body's
healing itself.

(50:06):
It's making sense of the daythat just happened.
Our brain is consolidatingmemories and thoughts, and it's
even problem solving creativitythat are happening.
Plus, we're recovering.
We're healing If we're sick.
That's where a lot of ourhealing takes place but also our
circadian rhythms.
What we need to remember issleep is part of a 24-hour cycle

(50:31):
.
While we're sleeping, ourmetabolism is regulating itself.
Our hormones are going throughan important balancing act at
that point.
Testosterone is.
A lot of our testosterone isproduced while we're asleep,
right?
So if you're not sleeping, yeah,if you're not sleeping, your

(50:52):
brain's not being taken care of.
You're going to put on weightbecause you're metabolic
Functioning is impaired.
I mean literally, weight gainis an outcome of sleep
deprivation.
Weight gain and all themetabolic problems that go with
that are are are common sideeffects of sleep deprivation as

(51:12):
our hormonal disruptions.

Speaker 2 (51:14):
So I love how I mean those things are clearly linked.
And those were the first twothat you mentioned earlier.
The low hanging fruit go getyour hormones checked, just do
hanging fruit, Go get yourhormones checked, Just do that.
And then get your sleep checked, which is obviously what got us
down this.
And I love how it comes rightback to the hormonal Just
getting that checked out,because that's a, that's a big
thing.

Speaker 1 (51:34):
And a problem, a problem with modern health care
in the West, certainly in the US, is that we divide all these
things into fragments.
We fragment these things, wedon't put them together.
So what I would say is sleep iscritically important for your
brain, for your endocrine system, your hormones, for your

(51:56):
psychological functioning.
So now we've learned thatturning the phone off doesn't
turn the signals coming into thecomputer.
Sorry, that's all.
Sleep is so important.
What I tell folks prioritizeyour sleep, do everything it
takes to get your sleep dialedin, and other things will start

(52:17):
to fall in line.
You will feel better, therewill be improvements.
There will be improvements,there will be functional
improvements.
In fact, I believe this sostrongly that the first draft of
the Operator Syndrome paper was, you know, in a very rough form
, was like a three-page documentthat I started writing as I was

(52:37):
learning and I would add thingsto it as I went and I used it
as an educational tool.
I would give it to the guys andthe gals I was consulting to as
a hey, I want you to read thisand we're going to talk our way
through it, and the title of itwas the Operator's Sleep Manual.
It wasn't a PTSD, it wasn't aTBI thing, it was I want to help

(53:02):
you sleep better becausethere's stigma around some
things.
There's no stigma around goodsleep.
So everybody I talked to waslike, yeah, I would love to
sleep better, help me with that,and boom.
And so getting each of thesethings addressed, each of the
different domains of operatorsyndrome addressed, is important

(53:24):
.
If you prioritize your sleep,you're addressing the other
things, all the other things.
And good sleep also means goodsleep hygiene.
You got to have the righthabits.
If you're going to bed andyou've got a TV on, you've got
lights on.
If you're laying in bed lookingat your phone for an hour
before you try to close youreyes, you're sabotaging your

(53:47):
sleep with that.
So sleep habits are reallyimportant too.

Speaker 2 (53:52):
That's one thing that I read this book.
It was a long, long time ago,long, long time ago.
I think it was like Eat, sleep,sex, something like that, but
it had this huge thing of no TVin the bedroom, and I've always
what's that?

Speaker 1 (54:09):
Your bed is for those two things right, yep, and
that's it.

Speaker 2 (54:16):
That's one hard, fast thing.
I'm not going to have a TV inthe bedroom, it's just I don't
want it.
It's if I'm going to, if I needto watch TV, I can go to the
living room.
Yeah, um, it was the thing Iwas going to ask you about too,
and I know we went down this.
But I've been fascinated withit because my watch never
allowed me to get.
I never allowed me and nevertracked me.
I were always low 80s you knowthe scale of one to 100 and even

(54:42):
on a good night's sleep where Iwake up feeling good, I was
like man.

Speaker 1 (54:44):
What does 90s feel?

Speaker 2 (54:44):
like, and I was training for this big race and
just for two months I cut outmost meat, all booze, all sweets
and for the first time I washitting 98 sleep scores, 97
sleep scores, I mean it was.
It was insane to just cut thosethings out.
Obviously, the heavy workoutswere still there, but then the

(55:04):
moment I reintroduced all thatstuff, it was just right back to
mid eighties, which feelingfine, but that was definitely a
link for me that I found, and Ithink everybody's different.
I encourage everybody to dotheir own, you know, try it, see
what, see what something mightbe doing to impact your sleep,
but it was fascinating for me,yeah, yeah.
So what is?

(55:25):
And as we do this, I love thethis introduction of operator
syndrome and just deep dive intoit.
And I know you mentioned thatit's different from PTSD, but a
lot of these things seem similar.
So what would be the differentdefinition of somebody listening
saying this is PTSD, this isoperator syndrome?

Speaker 1 (55:46):
Well, I would say PTSD falls under the umbrella,
can fall under the umbrella ofoperator syndrome.
Okay, core feature.
I mean, what is PTSD?
There's a whole conversationright there.
I'll give a simple thought onit and we can always come back.
Ptsd is anxiety plus depression, plus some very specific fear

(56:10):
reactivity symptoms or fearreactivity reactions and
avoidance along with that, andso it's very much a
psychological, psychiatricdisorder.
It doesn't mean you havechronic pain.
It doesn't mean you have sleepapnea.
It doesn't mean you havehormonal disruptions.
It doesn't mean you have TBI.

(56:32):
So all of these physiologicalthings are there and they're
separate and different frompsychiatric disorder.
I do believe psychiatricdisorders are also physiological
injuries at the cellular level,at the molecular level I think
we've.
So you want to get intotreatment?

(56:53):
We could talk about treatment.

Speaker 2 (56:55):
Of operator syndrome.

Speaker 1 (56:56):
Of operator syndrome, yeah, but I know we're going to
Of operator, syndrome Ofoperator syndrome.

Speaker 2 (56:59):
Yeah, but I know we're going to.

Speaker 1 (57:00):
Let's start with PTSD and psychiatric disorders.
We treat with counseling,psychotherapy and psychiatric
medications.
Typically, those are thetraditional treatments.
That's what most people, mostveterans, are going to get from
a VA, from the VA with this, butthere's so many other things

(57:24):
that we can and should be doing.

Speaker 2 (57:25):
So let me pause, and you were about to you were going
to say something Well, no, Ihave a ton of questions for you.
I was actually going to see ifwe could just do a whole nother
content piece on PTSD, andthat's where I was
distinguishing between them,because I I have a ton of
thoughts and questions that Iwant to really, really dive into
, because I have some ownpersonal thoughts that I would
love your expertise on, becauseI don't have the 25 years plus

(57:48):
experience in this realm thatyou do.
So I'd love to unpack some ofthat as well, and it's just a
totally separate episode, ifyou're okay with that.

Speaker 1 (57:56):
Absolutely, absolutely, definitely a chapter
two or a chapter chapter threeto our conversation.

Speaker 2 (58:02):
Oh yeah, well, I'm excited to dive into it.
This has been just fascinatingto hear about operator syndrome
and I love what you've, whatyou've put together with it.

Speaker 1 (58:11):
So.
So in modern medicine we arefragmented.
Your endocrinologist isprobably never going to have a
conversation with yourpsychotherapist, your
neurologist for your headachesand your TBI is probably never
going to be talking with yoursocial worker or your
psychiatrist.

(58:32):
We just don't have enoughintegration in our system.
Part of my perspective here isyou need to think about operator
syndrome.
These things all go together.
These symptoms, operatorsyndrome, these things all go
together.
These symptoms, theseimpairments, they all go
together.
They all affect one another.
Problems in one area makeproblems in other areas worse

(58:52):
and we should be thinking abouttreating them kind of all at
once.
So I say to you get yourhormones checked, get a sleep
study, sure, get a consult withbehavioral medicine.
Maybe talk to a psychologist.
Psychotherapy and psychiatricmedications are worth
considering, but it doesn't stopthere.

(59:15):
There's other things.
So, and I'm assuming we're nowgetting the sleep apnea and the
hormones treated with whatevermedical treatments those require
, but let's get a stellateganglion block therapy.
That's one of the first thingsI'm going to recommend.
Stellate ganglion block therapyis a treatment I recommend

(59:35):
pretty much to everybody withanxiety and PTSD and insomnia,
pretty much to everybody withanxiety and PTSD and insomnia.
What it is.
It's a very safe, veryeffective treatment.
We've been neurologists havebeen using it for about 100
years now, since the 1920s, totreat certain types of headaches
cluster headaches.
The treatment involvestargeting the central, the

(59:59):
sympathetic nervous system.
That's what the stellateganglion block is and we've used
this treatment since the 1920s.
About a decade ago a couple ofneurologists working at Fort
Bragg noticed that when theytreated soldiers' headaches,
their anxiety symptoms, ptsdsymptoms, got better and they
started sleeping better.

(01:00:19):
They started being more presentwith their family because they
were more relaxed.
The treatment involvesessentially it's a one-time
outpatient procedure that justtakes a few minutes.
The stellate ganglion nerveruns centers, a collection of
nerves that runs down ourcentral nervous system, and they
can access this at the neck.
So they go in at the side ofthe neck into the spinal column.

(01:00:43):
They inject just a little bitof medication into this nerve.
It has pretty much an immediateand profound effect of reducing
the physiological arousal ofanxiety.
So people feel calm and relaxedright away.
It is safe.
There's only one side effecttypically, which is a little
face drooping.

(01:01:03):
That only lasts for three orfour hours typically and then
that goes away.
The medication will eventuallywear off, but that might be
three, six, 12 months down theroad.
So it provides significantrelief for a long period of time
and during that time, duringbefore the medication wears off

(01:01:25):
you're relaxing, you're sleepingbetter.
Hopefully, you're developingother habits, you're working on
other treatments, othertherapies.
This is just a great way to getstarted on a healing and
recovery, on a journey.
You can go back and have itrepeated, so it's not like just
a one-time only thing.
You can get it done every year.
I just I recommend it prettymuch to everybody.

(01:01:48):
We're also.
One more benefit to it is thatwe think this is a hypothesis
that's being tested now in someclinical trials that it also
stimulates neurogenerativity,that it helps your brain grow
and develop new neurons,dendrites, connections and
pathways.

(01:02:08):
So it's good for the brain.

Speaker 2 (01:02:11):
And there's no side effects other than the droopy
face for three to four hours,and then that goes away.
That's about it.

Speaker 1 (01:02:18):
And like everything in medicine, it doesn't work for
everybody, but 85% to 90% ofpeople get an immediate and
profound benefit from it.

Speaker 2 (01:02:26):
So if it I mean because anxiety that seems to be
, I know it's a common term thatgets thrown around If somebody,
even not a veteran, with justgeneral anxiety, is this
something that would help them?
Yes, absolutely.
So where would somebody go toget something?
Let's say that I wanted to goget this done, just to try it
out.

Speaker 1 (01:02:45):
Well that's, it's actually an easy.
It's an easy service to.
It's an easy treatment to find,believe it or not.
Okay, the catch is it's notprovided by psychologists,
social workers or psychiatrists.
It's not provided by people whoare traditionally thought of as
mental health providers.
So it may be a businessdisruptor.

(01:03:06):
That's probably one of thereasons that many people don't
even know about it.
It's a treatment that'sprovided by neurologists and
anesthesiologists.
So you can go and you can justdo a Google search for your
hometown.
You can look for pain clinics.
Most pain clinics providestellate ganglion block.

(01:03:27):
You also can just Google, youknow, put in a search engine
stellate ganglion blocktreatment and you will find
clinics.
Usually, health insurance willcover it If you're paying out of
pocket.
It's probably somewhere from,probably in the in the
neighborhood of 15, 12, $1,500.
So it's not.

(01:03:48):
It's not a super expensivemedical treatment.

Speaker 2 (01:03:52):
Well, but it's that.
I mean it seems like a wonderdrug.
I mean, if it's that good it'sa very effective treatment.

Speaker 1 (01:03:58):
Yep, I don't know why we are not widely providing it
to people with, you know, PTSD,anxiety and insomnia related to
that.
Does the VA provide?

Speaker 2 (01:04:08):
it.

Speaker 1 (01:04:10):
Some VAs do on a limited basis from what I've
heard.
Okay, and I didn't VA, so Idon't know about any.
You know policies but buttypically I hear from guys they
say no, our VA doesn't provideit.
Some have been able to persuadetheir local VA to allow them to
go get it in the community, acommunity clinic.

Speaker 2 (01:04:30):
Would there be a side effect?
Because I don't know that Ihave anxiety or not.
I don't know if I feel like I'mon the fence and I was like you
know what.
I'm just want to go see whathappens.
Would there be a side effectfor me in the middle there?

Speaker 1 (01:04:46):
I'm not a fan of trying a treatment just for the
heck of it Any treatment, but ifyou experience high levels of
physiological arousal, which weoften think of as anxiety, it
could be.
Irritability is another thing.
Irritability and anxiety aretightly closely related for most

(01:05:08):
, for many people, okay.
So irritability is probablyanother symptom that's going to
be helped by a stellate ganglionblock.

Speaker 2 (01:05:16):
I think my kids probably want me to go yeah.

Speaker 1 (01:05:24):
I've recommended it frequently to couples who are
having trouble and, you know,conflict and anxiety and
irritability affecting theirrelationship, because oftentimes
if one person in the house hasanxiety, the other person is
going to have anxiety.
So instead of a couple'smassage, I've recommended a

(01:05:46):
couple's S SGB treatment forinteresting Many, many of the
couples I know.

Speaker 2 (01:05:53):
I'm going to.
I'm excited to look into this.
I think that's fascinating.
It seems like really feels toogood to be true, and I think you
mentioned that.

Speaker 1 (01:05:59):
Business disruptor and I know that's a big thing.
Anything that's going to takemoney away from somebody else
tends to get, unfortunately,pushed aside.
As an industry mental healthindustry we have our lane and

(01:06:22):
most people stay in their lane.
They provide therapy and theyprovide psychiatric medications.
They don't provide SGB.
We don't typically evaluatehormones.
We have a good treatment inketamine infusion therapy.
That's another treatment Irecommend, but it's not a
frontline treatment because it'scostly.
So insurance companies willprovide ketamine infusion

(01:06:46):
therapy, but only after othertreatments have been tried and
failed, and those othertreatments are psychiatric
medications.
If you have a depressivedisorder and you've tried Prozac
and you've tried Lexapro andthose didn't help, now the
insurance companies mightapprove for you to have ketamine

(01:07:07):
infusion therapy, which is FDAapproved as a treatment for
depression.
Also, side note, some of usthink that stela ganglion and
ketamine work well together, butthere's a symbiotic
relationship if you do them bothin the same week or the same
month.
And some of us also think thatketamine has a healing effect on

(01:07:29):
the brain, that it stimulatesneurogenerativity.

Speaker 2 (01:07:35):
I've got both these written down.
I'm excited to jump in and justexplore them, because I have
not heard of either one of these.
Okay, it seemed prettyfascinating.

Speaker 1 (01:07:45):
And then we can talk about hyperbaric oxygen therapy,
other psychedelic medications.
You know, do some work withsome of the groups that are
doing ibogaine and 5-MeO-DMTwith.
You know phenomenal results andoutcomes, that disequilibrium

(01:08:10):
that's common in TBI.
There's vestibular therapy,which is literally a form of
physical therapy for yourvestibular system.
It's not a medication treatment.
You sit in a chair that movesand turns in different ways and
it's reorienting the fineparticles in your inner ear.
That's another treatment that Irefer people to with really
good success.

(01:08:31):
And on the pain side of things,the chronic pain in the joints,
there are regenerative medicineclinics using fairly new
treatments stem cells, exomes,peptides great effect in
reducing joint pain.
We also can change the way wework out.

(01:08:53):
Weights, free weights, bodyweights, pull-ups, push-ups,
squats all of these put amassive burden on your ligaments
, your joints, ligaments andtendons because they work
against your strength curve.
What do you mean as a staticweight?

(01:09:13):
The weight doesn't change whenyou move it, but your strength
curve does change.
So think about a bench press ora chest press.
You've got the bar close toyour chest as you push out.
That first part of the motionis the hardest part.
That's where you're likely toneed a spotter.
That's where your joints arebeing overburdened as you push

(01:09:38):
that bar away from your body.
As you go through that range ofmotion, your strength is
greater out here than it is whenit's early in the motion.
So repetitively over the yearswe're injuring our joints doing
that.
What I recommend is stop usingat a certain point, at a certain

(01:09:59):
age.
We're training for a differentmission.
You're training to be a fatherand a grandfather and a husband
and have a long life of mobilitywith your family.
You're no longer training for acombat deployment like you were
in the past.
So it's a different mission,different training.
What I recommend is using bands,variable resistance bands, the

(01:10:22):
kind that come with a bar, aplate that you stand on that you
thread it under.
The bands are big, thick, flatrubber bands, essentially not
the tubes.
Flat rubber bands those you canget as much intensity as you
would with free weights, exceptthat they work with your
strength curve when you're atthe start of your motion, the

(01:10:44):
point where the free weights putall that compression on your
joints With bands.
That's the easiest part of themotion because the band isn't
stretched yet as you go out awayfrom you know, further into
that range of motion.
As your strength curve goes up,so does the resistance.
The farther you stretch theband, the greater the resistance

(01:11:07):
, so it's matching your strengthcurve.
I started doing thisexclusively about two and a half
years ago and gradually all ofmy joint pain disappeared.
It just took about six months,but it just gradually
disappeared.

Speaker 2 (01:11:26):
Do you still do all the common same workouts that
the average person listeningwould be doing?
I mean, and just replacing,instead of doing a dumbbell curl
, doing it with a band curl, soeverything's done with a band.
And that's what I mean sameworkout just with a band.

Speaker 1 (01:11:41):
I have a workout system I use that works every
major muscle group in the bodyyeah, okay.
Plus, they're more efficientbecause you can go to full
failure without any risk of harm, without a spotter.
So you can go to full failureand then you can continue doing
partial reps until you can'tmove the bar anymore.

(01:12:03):
So that's what I do, and then Ijust do one set per body part.

Speaker 2 (01:12:07):
Wow, I never thought about that's what I do, and then
I just do one set per body part.
Wow, I never thought about that.
I don't know.
I've been working out for 25years and I've never, never
considered that, never heardthat.
As far as the strength curve,and it makes perfect sense, like
it, just it makes perfect sense.
So, wow, I love that.
Can you still bulk up?
I mean, if somebody wanted tostay bulky, just that's the next

(01:12:30):
question I have that comes tomind.

Speaker 1 (01:12:32):
Yes, I've bulked up.
Okay, I'm now 60 and I'vebulked up in the last three
years since I've been doing this.
Wow, I stopped doing pull-upsand push-ups and squats.
I just stopped all that,switched 100% over to bands and,
yeah, I did bulk up.

Speaker 2 (01:12:51):
I have bulked up.
That's fascinating.
I'm thinking about now my gymmembership.
Somebody's gym membership couldjust disappear.
That's right.

Speaker 1 (01:13:03):
I'm not trying to advertise somebody else's
business, but I use the.
There's a guy named JohnJaquish who is a PhD
kinesiologist, who's done a lotof the research on this and he's
kind of developed his own.
Well, he has developed his ownsystem and his own product,
which is called X3.
And that's what I use, and he'swritten a book so you can get

(01:13:25):
the book.
I think the book is titledsomething like lifting weights
as a waste of time.
Okay, and I do travel with mysystem.
It fits in my carry on bag, sowhen I'm on the road it's with
me.
I do my workouts in the hotelroom.

Speaker 2 (01:13:41):
Well, I find that's.
I travel weekly for work andit's always like this rabbit out
of a hat type of thing iswhat's the gym?
What's the gym going to looklike?
Because I'll, they'll have this.
I went to one just a coupleweeks ago.
They had this amazing gym inthe picture and then I like 4 30
in the morning, I stroll intothe gym, I open it up and it's
just this empty room.
Where is everything?

Speaker 1 (01:14:05):
the equipment used to be yeah yeah, this.
This system has been amazingfor me, and I've recommended it
to other people who've used itwith really good results.

Speaker 2 (01:14:16):
I appreciate it.
I'm going to check this out.
So one thing and as we start towrap this up too, because we
talked about sleep, but onething that I've done and that I
don't do it every night.
I don't do it if I feel like Iwant to get a heavy sleep.
They now have kind of like theyhave the pre-workout.
You know, before you go workout you can take a pre-workout

(01:14:36):
kind of get you all caffeinatedand pumped up which.
I've removed all of that.
I don't use any of thoseanymore, but I do.
They have basically a pre-sleepmix.
Have you seen those?
Anything like that?

Speaker 1 (01:14:50):
Yeah.

Speaker 2 (01:14:51):
Slumber is mountain ops and my buddy gave it to me
once.
He's like, take this, if you'reawake in 30 minutes, I'll be
impressed, and just talk about adeep night's sleep.
What is in the product?
This one has some melatonin anda few other things that I did
not research it fully.

(01:15:12):
So another reason why I'masking you what thoughts you
have about just taking anythinglike sleep aids, anything like
that, yeah.

Speaker 1 (01:15:20):
Sleep aids are well.
Sleep medications like Lunestaand Ambien are going to
radically change you might sleep, but they're going to radically
change the architecture of yoursleep, okay, the time you spend
in REM and slow-wave sleep.
So while they may be okay touse on the short term, those are

(01:15:41):
not good for your sleep longterm Got it.
And that's true of almosteverything that would be a
prescription medication forsleep.
There are some antidepressants,like trazodone, that seem to be
pretty good long-term sleepaids for people with really
severe insomnia.
Melatonin is helpful.

(01:16:01):
When I was in the 90s, when Ifirst started working in the VA,
the most commonly prescribedsleep aid we used that our
psychiatrists used wasdiphenhydramine, benadryl Okay,
you can get it over the counter50 milligrams, 25.
I don't use that anymore.
I used to use it when Itraveled for the first few

(01:16:23):
nights.
It works for about half of us.
It doesn't seem to work foreverybody, but it seems to be
pretty effective for half.
Some people will sleep, butthey wake up kind of groggy in
the morning.
If we're talking supplements,probably there are a number of
supplements that are actuallyhealthy for our sleep.
I put magnesium at the top ofthat list.

Speaker 2 (01:16:44):
I know these supplement companies.
It seems to be popping up thisone in particular that I take up
.
I take it.
I just need I know that I haveto get at least six hours, like
if at four and a half I'll wakeup groggy, but at six or more
and I'll wake up, just I feellike a champion and I'll take it
every night.
For I mean again, I don't likesleeping that deep when I with

(01:17:06):
my kids are in the house, but ifit's on the road and I'm
feeling like I would need tomake sure I get some sleep, um,
for whatever reason, it's seemsto work great, but I didn't know
any experience with it.

Speaker 1 (01:17:18):
Yeah, um, there's.
There's a number of pretty goodproducts out there that that
use um use meaningfulsupplementation Compounds.
Dr Kirk Parsley.
He has a sleep formula that Iknow a lot of team guys, a lot
of SEALs use.
He's a former SEAL but also anMD, so I would mention his.

(01:17:42):
Some people use Cortisol Calm,a product called Cortisol Calm.
It had good effects with that.
Just simply taking 200milligrams of magnesium an hour
or two before bedtime is helpful, and most of us have
deficiencies of magnesium so webenefit from it anyway, but

(01:18:03):
taking closer to bedtime canhelp us sleep.
Interesting.

Speaker 2 (01:18:08):
Well, I really appreciate you taking the time.
I'm excited.
I know we have another coupleof conversations coming up and
I'm really excited to dive intothis.
This has been a fascinatingvery, very fun conversation.
As we do this.
I know the big thing that Ireally want to make sure is just
yes, thank you for holding upyour book one more time.
It is out today.
If you're listening to thispodcast, no-transcript, and that

(01:18:58):
was just the word that Iremembered, so it was a
different context, but it justmade me think of this thing I
read recently that Edison wastalking about with the light
bulb and that people werereferencing for him he's like
man, this is it like we're,we're done inventing, and he's
like we're not, we're juststarting, like we're not even we

(01:19:19):
haven't even started yet.
And he back referenced thethinking that he's like I put
together four different people's.
You know level of thinking thatgot the light bulb and that's
what gets us to the next step,and so it just made me think of
all the work that you have doneis what brought you to where you
are now, and then that abilityto find that.

(01:19:40):
So it just thank you for allyou've done for veterans and all
you continue to do.

Speaker 1 (01:19:46):
Thank you and let me add to that.
Let me just reinforce yourpoint.
I'm still learning and mylearning curve has been really
steep the last decade.
I'm there.
I have a lot of fellowtravelers, so there's other
doctors, there's other nurses,there's other neurologists and
physiatrists and occupationaltherapists and nutritionists

(01:20:08):
that I'm learning from and we'relearning from each other.
We're coming together.
So one place you, anybody, cannow go and I want to.
Really this is something I wishI had said earlier the SEAL
Future Foundation, which is afoundation only for SEALs.
Their health program is builtaround the construct of operator

(01:20:32):
syndrome.
But we've put together aneducational website that is just
launching, like right now.
It just went live I think itwent live on March 22nd, so just
a few days and anybody can goto that website.
They can read about operatorsyndrome, they can read about
the different treatments thatare available, the different

(01:20:52):
assessments that are available.
All of this is in my book, butthis website is a living
document and it was put togetherby a multidisciplinary group of
us.
So we have 15 of us that haveformed a health board of
advisors for SEAL Future, and sowe've written this educational

(01:21:14):
material and over the next yearor so.
We're going to be adding shortvideos and other educational
materials for it and we want itto be there for the entire
veteran and respondercommunities, it's not just for
SEALs.
So what we're doing for theSEALs, we're putting up there to
be educational for everybody.

Speaker 2 (01:21:34):
I just wrote that down.
I'm going to jump on that justto go grab some of those
resources right away, and I'mexcited to get your book.
Thank you so much.

Speaker 1 (01:21:43):
I'm excited for our next conversation.

Speaker 2 (01:21:45):
I'm looking forward to it, Chris.
Thank you.

Speaker 1 (01:21:46):
All right, thank you.