Seth Horst and Dave Faller sit down with Dr. John Thurston, owner of North Idaho Ketamine and TMS, to discuss a rather novel approach to the treatment of depression, anxiety and PTSD. They answer some of the tough questions regarding the recent rise in use of Ketamine among First Responders and Veterans, how it affects the brain and body, and if Ketamine treatment is safe for everyone. Seth used Ketamine after his retirement from Law Enforcement to help treat symptoms of PTSD, and he shares his personal experience in an attempt to explain what it FEELS like to those who are curious. 

Links:

https://www.northidahoketamine.com/
https://www.voyagefoundation.com/

Sponsor:

This podcast is brought to you by Your North Idaho Agent.  YourNorthIdahoAgent.comOur team is comprised of Former First Responders and Veterans and we have years of experience in all aspects of Real estate purchase and sales. 

We don’t just sell homes- we sell- the north Idaho experience.

Instagram: https://www.instagram.com/your.northidahoagent/
Facebook: https://www.facebook.com/northidahoagent
Youtube: https://www.youtube.com/channel/UCHz9XczupyJ93VRtqfQEW-g

0:00

It’s not just a party drug. Hey, in today’s episode, we’re gonna talk about ketamine and its current uses for PTSD, depression and anxiety treatment. Let’s go north. Idaho is a throwback to a better time in American history, a time when values and characters still mattered, from home school moms, hunters and homesteaders to business owners, veterans and first responders. We are a unique community held together by a common thread, a love of life, liberty and the pursuit of happiness. These are the stories of those who choose to call North Idaho home. Welcome to the north Idaho experience. We’ve got John Thurston with us today from this is gonna be a cool podcast North Idaho, ketamine and TMS. You promised you would tell me what TMS stands for, because I can’t remember, transcranial magnetic stimulation. Okay, the mouthful it is, it’s like, right up your transcranial magnetic stimulation. So we’re going to talk about ketamine today. And it’s not the horse tranquilizer that you’re thinking. It has a lot of uses. I’ve used it myself, so I will share my experience with you. Actually, I used it with John, under his guidance, and so I guess first, can you give us a quick bio on your background and how you got into this? Yeah, I’m a psychiatrist, and got into this after I had my own treatment back in 2019 for me, I kind of categorize people, you know, 40% of people will be the light switch people. So after one treatment, it is this feeling of, Wow, that was amazing. And for me, I was became a little evangelical about it. Right after my first treatment, the world would be a better place if everyone tried this. And since then, I’ve realized that’s not true, you know, but 40% of people will have that experience of feeling like it was very profound right away. And so for me, I was one of those 40% and and that really inspired me to start using it my own practice slowly, and that kind of evolved until I could really devote my career to it. So it’s been a long time coming. What? How is it delivered? Because that’s probably an important thing to touch on, like, what’s the atmosphere, like when someone goes in for Academy treatment. You know what pause that? Why would someone come in for Academy treatment? Yeah, lots of reasons. You know, some people we see everywhere from severe mental illness, meaning people have tried electroconvulsive therapy before they come to us. I mean trying everything before they come and really struggling with depression, anxiety, PTSD, OCD, or bipolar depression. But also we have, I think, people, you know, I don’t, quote, unquote, the worried. Well, what the reality is is pain and suffering is inherent to life, right? We’re all going to grow old, we’re all going to suffer losses, and so pain and suffering is the thing we all have in common. So I think, you know, I call them my psychonaut patients, the patients who maybe have that weekend retreat they do with their buddies once a year, and they go out and they do like LSD or mushrooms. And they’re usually pretty prominent people in our society, oddly enough. And just recently, well, a while ago now, I guess. But one of the patients came in and goes, that was so convenient, and it cracked me up, because with ketamine, you can have a very intense experience, but then you can go home and have dinner with your family, right? So I’m of the camp that you know, you can have a good time, but it can still be therapeutic. Yeah, yeah. So you brought up something electro what? Transcranial magnetic stimulation. So no, there was something I said people would come in, oh, electric ECT, electroconvulsive therapy. Good Lord, I don’t even know what that is, but it sounds Yeah, I would pick ketamine first. Yeah, absolutely. And there was a non inferior study just recently showing that ketamine, this was actually within the last year, showing that ketamine is not inferior to ECT and ECT has always been the gold standard for treatment resistant depression, right? People who can’t kick the depression, we’re talking severe depression, right? Can’t function, can’t, you know, hold down a job or relationships and yeah. So depression is the main reason why people come in is that, would you say would be the majority of people, yeah for that, yeah. And depression can be a symptom of many other things, right? People with trauma or anxiety probably also have depression. And then there’s also things that are depressing in life, like realities, right? I mean, so we also get people with bereavement, people who’ve lost a child, or like, you know, these hardships, and they’re having a hard time shaking it, moving on, or finding the meaningfulness around their suffering. And for so I think I love that phrase of finding meaningfulness in our suffering, yeah, yeah. That’s a good way to look at it. So the lay down the atmosphere for me. I mean, obviously I’ve been there, but what does it look like? How do you deliver the ketamine? Yeah, so set and settings very important, right? I always want people to be prepared that it is an experience. It’s not just come in, get an infusion and feel better, and so set and setting being so important. So during the initial evaluation, getting a tour, but the space, we really try to make it Med Spa kind of like, right? It’s got to be really comfortable, lots of plans, soothing music, the aroma. Therapy, the music you choose is very important. We recommend an eye mask, also developing a mindfulness practice. And so everybody, but we just hired a new person, but, and it’s not required to work with us, but everybody except one person has that ketamine treatment themselves at the office. And I think that’s an important piece, because it is a very powerful experience and just having that. Well, I think the people that work there are also part of the set and setting, right? So the mindset being the mindset you come in with, but then the setting, the environment you’re with, which includes all the people that work there, yeah. So I think, you know, you said you’re a psychiatrist, correct, correct. So, I mean, I’m a big believer in, like, the placebo effect, and the fact that your brain can control way more than you know, we can physically and it can do a lot more. So obviously this has an effect on your mental status and your brain and everything else and how everything works. But for people, you know, we come from a first responder background, and when you talk about trauma or incidents or things that people can’t let go of, or things that people are struggling with that are leading to difficulty in relationships and everything else. There’s a lot of people in the first responder and military community and veterans that have those type of things. And I’m sure you’ve probably worked with a lot of them. Yeah, absolutely. What’s your Is there any is there any caution to doing anything like this, or having ketamine therapy if you’re still active duty, or anything else like that. Are you talking about, like, from a medical legal like, if somebody worried about losing their job? Or, like, Well, I mean, there could be that, but then also just the fact that you’re going back into more trauma day after day, and those types of things, like, right now, I mean, I’ve left the profession. There’s a lot of things that I have that are built up. And obviously, doing ketamine maybe lets some of those things go. I’m not sure how it all works, but for somebody that’s still involved in a lot of that stuff, and having it daily or weekly or else, is there, is there a huge benefit to do ketamine? Well, I think so. First Responder. So that 40% I was saying another 40% or more, the sunrise people, where it’s like, oh, it’s helping a little, you know. And then 20% of people say, in the general population, will say it was just weird. I don’t think it helped at all, right? But in the first responder population, which usually those folks have complex PTSD, which means, you know, it’s not just one traumatic thing, it’s kind of one damn thing after another, building, a building, right? Shitty situation after shitty situation, you know. And in that demographic, it is really almost 100% of people. The only reason they haven’t had benefit is if they have side effects, which can be nausea, vomiting, can be a deal breaker for some people. So, and I have, you know, theories for why that is, but I think you know when people are in it, it is definitely nice if you can have a day, you know, or ideally the next day, I mean, the next 24 hours following a ketamine infusion. I love the metaphor flipping the snow globe, right? But if we don’t make any other changes in our lives, good chance those snowflakes are gonna fall right back to where they were before. So really treating it as an opportunity, and kind of this time to go to work, which, if you’re, you know, inundated by stress, you have to do like a 24 hour shift the next day, and you’re being trained, you know. And you have to, because there is a hard, you know, as a first responder and military and, you know, other professions too, there’s a hardening process where you kind of have to develop a little bit of toughness so that you can withstand the overwhelming sensations and thoughts that come with you on that work, right? And it is kind of mean by flipping that snow globe, I would say, yeah. There could be some, just some thoughtfulness that would go in to make sure that, hey, you don’t have to jump right back in, right to having to be, you know, on point really intensely. Because I don’t think it would be negative necessarily, but it could be a wasted opportunity. Okay, that makes sense, yeah, yeah. So almost not that it would you would necessarily want to wait until retirement, but like, once you got out of that world, you might have better success with treatment, rather than going right back into it or, or, I guess you’re also looking at it like you’re kind of giving yourself a little bit of a breather, like going on a vacation, mental vacation, yeah. So there’s that the legality side you run into that. Or how’s that work for guys, you know, because there are lots of things that are precluded, like, you cannot take certain drugs, or things like that. I don’t know how it plays into when it’s guided by a doctor, right? Yeah. So I get that question a lot from people who are, you know, in active professions, that they’re concerned about drug tests and all that. And on the standard, like 12 drug screen or whatever, you know, it’s doesn’t show up, ketamine is not tested for. And the half life of ketamine is very short. It’s only 15 minutes for the active drug, and it’s metabolized to our ketamine, but, and they could, you know, test for the R ketamine, but really, within an hour, the active drug, you know, the ketamine, is out of your system or metabolized. So, so the chance of it, even if they were looking for it specifically, to show up on a drug screen, is very low. But then it is prescribed by a doctor. It’s not being used illicitly, right? So there would always be that. But I really always encourage. People to say, you know, it’s nobody else’s business between you and your doctor, right? That’s a HIPAA thing, right? Yeah, exactly. Okay, so setting is important. What’s it like when they go in the room? How’s that set up? And how do you deliver the ketamine? Oh, right. So we’re, we prefer IV infusion, the continuous IV infusion, because you can dial it in, 100% of what we give is 100% of what the person receives. Other routes of administration, like an intramuscular injection, it’s about 93% or some, you know, troches about 30% and then the intranasals between eight and 40% right? You think of, if you swallow some or you’re having a cold, right? What’s going to be absorbed or actually get into your bloodstream, right? So, but then, yeah, coming into the room, the process is you check in, right? Or your first the evaluation, preferably on a different day, day of your ketamine infusion, checking in, and then, so we spend time getting the we have everything you need, but we always encourage people to bring comfort items if they like that, right? So recliner, you sit back, you know, you get the IV placed, going over the treatment for that day, some people like intention setting, you know, everybody’s, you know, kind of different on what they prefer. And then the infusion itself is, you know, you have a little call button around your neck, and you have, we’re monitoring your heart rate, respiration rate, blood pressure, all that in real time. And if somebody wants to bump up, you can hit the button and give a thumbs up during the infusion itself. So that’s cool. Thing about the continuous IV infusion is you can dial in the dose. But also, if it’s going, ooh, this is not what I thought it was. I don’t like this, we turn it off, and then within minutes, you’re coming out of the experience. Is there the experience? Every time I hear, yeah, what does that mean? That’s the name of our brokerage that we just opened, real estate brokerage, the experience, yeah, every time I hear that, I’m like, Oh man, yeah, we picked the right answer, good. So I was a little bit of a med school nerd. What’s the action? How does ketamine work in your system? What is it doing? Yeah. So there’s eight different ways that we know of that it works on in the brain, right? So you can go down a rabbit hole. The thing I find most fascinating about it is how it can shut down the circuit in the brain. We call it the default mode network, but it’s basically the circuit in the brain that’s going when we’re daydreaming, we’re thinking to ourselves. And so a lot of us, we conceptualize the default mode network as being our narrative sense of self. And so when that starts to shut down, I think that’s what can lead to that dissociative effect, right? Most of us are very identified with that narrative, right? I am my inner voice. We think in language. And when that starts to get disrupted and shut down, that’s why a lot of people will talk about ketamine and metaphors, right? It’s hard to, you know, articulate. Say, what was your experience like? Know him and Ha, or use poetry or exit, you know, examples. So, yeah, low doses, people feel relaxed as you go up on the dose, melting into the chair, hovering over your body. Up from there, people can feel like everything and nothing very significant but insignificant in that kind of paradoxical realm, is, I think the sweet spot for a lot of people. I want Dave to do this, so I brought some with I like, I’m so nervous to ever try it, because I am. I’m hypersensitive to everything. So, like, if you give me a child’s dose of Benadryl, I’m out, like, for 48 hours. Man, don’t even I’m just Jacks me up so and everything has been like that. I mean, I’m the guy that like my when I have extreme back pain, I can take two Advil and I’m good. We’ve never taken any drugs, right? No, no. Are you talking about, like, illicitly? No, I’ve never right, none. And you didn’t even start drinking until you were 28 yesterday. Yeah, I’m 29 now. So I don’t like, does that matter? Ketamine is a really weird drug when it comes to dose. And we start logo slow. And it does matter. You know, for you, I would start lower, like we start most people around point seven, milligrams per kilogram. They’ve kind of had a, you know, their average kind of experience, if they’re very naive to any mind altering substances. And maybe we start more at like point 5.6 if somebody has had a lot of psychedelic experiences before, they’re very comfortable with that idea of having a non ordinary state of consciousness. We maybe start them more like one milligram per kilogram of body weight, already tripping. Send them. Yeah, yeah. So yeah. Like, okay, let me touch on my experience, because I’ve done it twice with you, I think. But I have had experience with other psychedelics a long time ago, mushrooms being one of them. So it wasn’t, I mean, it had been, you know, 20 years, probably, but it wasn’t totally foreign for me to step out of that, out of my mind, and have that disassociative feeling, because it’s probably pretty weird, especially as an adult, if you’ve lived your whole life without ever having that, and then having that, it’s, it’s, it’s trippy, and it. Can be a lot to take in. The way I try to explain it to people is like, you’re living your life, and you’re kind of in this rut, not necessarily bad rut, but you’re in this, you know, wagon rut of like this is how things are, and this, you know, experience like this removes you from that, at least for a short period of time, and allows you to look at things differently, where you cannot look at things differently because you’ve been in that rut so long. It’s, it’s like, almost physically impossible without an outside influence, like ketamine. So is this include, I mean, do people typically talk about hallucinations and things? Is this like a modern day peyote that we’re dealing with? Or, like, psychedelics? So, uh, classical psychedelics, like, you know, Ayahuasca, DMT, LSD, psilocybin, all work through the serotonin system, and ketamine works on the NMDA receptor, GABA, glutamate, kind of so it’s a different system in the brain, but the downstream effects can be similar that affecting so we know that the classical psychedelics, or that serotonergic action, can disrupt the default mode network as well, And so ketamine can do that as well, but ketamine has some added benefits, I think, compared to other classic psychedelics. And there’s still a lot of active research. You know, nobody fully understands exactly how all these drugs work. But the part that’s really interesting the brain derived neurotrophic factor, which is endogenous BDNF. We call it brain derived neurotrophic factor, and it’s natural in our in our brains, but ketamine causes that to release in a bigger amount, and so the whole neuroplasticity piece, and that kind of, you know, so that disrupting that default mode network, I think, can lead to that experience you’re talking about. And you did a nice job. People use all kinds of metaphors to try to describe that, right? Very hard to describe, yeah, yeah, but it’s most people find it to be an important experience, and then flooding with that brain derived neurotrophic factor actually causes, you know, neurons in your brain to start sprouting more dendritic spines, which is kind of how neurons that will fire together wire together that whole idea, right? And so the ability to create new patterns of thought, new behaviors, new idea, you know, is increased. So that’s why really treating it to me like an opportunity is important. Yeah, I think it’s hard for me to wrap my mind around like I said, I’ve never had any psychedelics. I’ve never done any drugs, nothing like that. And so to hear he just he’s doing this whole thing. Can I sit in the room with him? I have no idea, like, when, when you’re talking about this experience and these things, I don’t even I’m looking for something tangible. And it sounds like there’s really not a lot of no being tangible in terms of what you’re going to experience, which is, I think hard for me, I’m a control freak. Well, yeah, it’s really hard to explain. Um, I, for me, it’s very visual, you know, but I, but ketamine is interesting, because I could almost pull myself out of it if I wanted to. I almost had to concentrate on not concentrating. That makes no sense. But it was different in like, if you take mushrooms, you’re in it for the ride, like, and it’s gonna be 12 hours till it works out, until you go to sleep and wake up the next day. But with ketamine, it was like, I could relax my body and just like, be in the moment listening to you definitely want to have some good music. Don’t bring death metal and and I could just focus on that music, and then I’m in the ride. But if something happens in the room, like I could, I could kind of pull my I’m still a little loopy, right? But I could kind of pull myself out of it. And that’s kind of like when you were saying that there’s a button that you when you were saying that there’s a button that you can ask for, more or less, like you could do it so you’re not fully you’re not fully conscious or anything else, like you’re aware your surroundings at least. Yeah, absolutely. And you have control over that right of the depth. Every time we talk to you, How was last time? Right? You know, we recommend people to do six treatments over three weeks. I think of it as 21 days, a new habit, so and then putting in a plan around that, right? We talked about the music, the aromatherapy and eye mask. I’m a big on mindful. Mindfulness is a buzzword in mental health, because it works, right? People can get out of their brain into their body in a systematic way. Brain loves the past, loves the future, but to get it to calm down and just be in the moment when the reality is, yeah, this is the only thing that exists me and you, except you watch it out there where, you know, this happened probably earlier, is it we’re not live? Are we? No, okay, good. So, but anyways, yeah, so the moment. But, um, so spending a lot of time developing that mindfulness practice, and then in the ketamine infusion itself, you have cues, you know, if I’m asking myself, What am I doing here? You know, then, oh, yeah, returning to breath. Or, you know, we developed that tool. That’s a key detail, because I did have, like, for me, it was a roller coaster of anxiety, like, oh, you know what’s happening? Like, the onions, weird. And then, okay, go back to the breath. Or I did the second time I went in. I did have an intention. I don’t remember what it was, but, and I kept returning to that one word, and that helped ground me in the experience, because for me, so I did it right, right after I retired, officially retired as a cop, and I I was definitely dealing with some post traumatic stress from some a lot of things, but one in particular, and so I think I kind of tried to use. Does that healing process to get me out of that rut that I was stuck in. And I say it was pretty beneficial, like when I had visuals. This is very hard to explain, I’ll try, but you know, I could shut my eyes, I’m listening to the music, and it’s a very flowing visual for me. Then there was this Starks space, and I could see it, and it was very dark and flowing. And my immediate thought when I saw that was like fear and anxiety and but then I was able to recognize that, bring it back to the breath like, okay, I can see that it’s not controlling me. It’s not taking over, paying attention to it. I’m not afraid of it. I’m looking at it. And then, you know, over time the flowing would pass like it was almost a physical experience that I could see of anxiety and stress that I was getting rid of, yeah. So there you go, yeah. And that idea of, I mean, that doing, if we can, you know, six over 21 days. So for me, I always use music for mushrooms is my favorite. I try to be consistent. I use raw sage, I crush it up, and I just smell it, and I put my pockets whatever I wear an eye mask. You can still have intense visual stimuli or visual experience, even with no light coming in, just kind of incredible, right? And then read, I just keep it simple, stupid, returning to my breath and and then if I’m going through a funk, I can’t sleep, or whatever it is, and I’m at home, I can do bust out all those tools. I get out my music, from mushrooms, my raw sage. I do some breath work, and then, you know, just pay attention to my breath, and I can actually dissociate without any ketamine now, because I’ve paired each experience with that in the dissociation. You know, what does that mean, right? But I mean, I think for what you’re describing to that idea of experiencing ourselves as something more than the sensations and thoughts that we have, right? So for people who are more spirit, you know, or religious, you know, that kind of connection with their Creator, if people are more agnostic atheist, maybe this feeling like, wow, quantum physics is real, or there’s something going on. I mean, even people who would identify as being secular or atheist or agnostic, I think you know, have to agree that there are things about the universe we don’t understand, right? We can’t connect quantum physics with Newtonian physics. We don’t have the theory of everything, right? There’s things that we don’t know, and that humbleness that comes with that, or through that non ordinary state of consciousness and experiencing ourselves as more than sensations and thoughts. I think most people experience that as a spiritual kind of experience, even if spirituality, you know, they wouldn’t consider themselves a spiritual person, right? I would say, in my personal opinion, is that everybody that gets out of the careers we were in, or the military, I don’t know what other stressful jobs are out there, but I think it’s a good transition. Anybody working at Verizon right now, anybody because they’re in trouble, I think that’s a good way to transition, because otherwise you run the risk of carrying I know so many older retired guys, and it’s like they’re, you know they’re doing, well, sure, some of them, but a lot of them are stuck in those old patterns. And, like, you can’t get out of those old patterns without some kind of outside influence. Maybe you’d get there with, like, Sure, meditation, maybe. But I think something like this is a great tool, and you look at it like a tool. I mean, you don’t have to look at it like you’re doing a recreational drug, for sure, but to kind of help you break out of that pattern and find because that transition from being a first responder or veteran is tough to go into civilian life. It’s freaking hard. You know, we talk to guys all the time that deal with that, and it, you know, took me a solid six months to a year to where I was like, Okay, I’m feeling pretty normal again. I’m not in condition, black, red, whatever, all the time. Now I’m I’m at a normal level. Yeah, that’s awesome. Yeah. So sign up, Dave. Let’s go with your hand. What are some contraindications? What are some like for people? Are there people that you would say, hey, ketamine is not for you? Like, if somebody came in and said, hey, I’m interested in trying this stuff out. Yeah, what is it that you would ask that? Would that, you know, hey, maybe this might not be the right thing for you? Yeah, definitely, if they have any history of psychosis, right? I mean, and you know, the people can become psychotic if they’re sleep deprived, or they’re withdrawing from, you know, whatever, but if it’s in the absence of significant outside stressor, and they’ve had psychotic symptoms, meaning, you know, seeing things other people don’t, or hearing things other people don’t, or the intense paranoia, and that can be a little tricky to distinguish, especially when people a lot of trauma, right? A paranoia can be kind of a symptom of PTSD. So if it’s trauma congruent, that’s not as concerning, but it might also be a reason to start lower, go slower, right? Because, again, loosen, loosen your grip on reality a little bit, right? I mean, that kind of losing sense of self, sense of self dissolving a little bit if somebody is predisposed to a psychotic episode that could worsen it, right? So that’s an important piece. If anybody has history of cystitis. Or definitely, if they have any active, uh, symptoms like a urinary tract infection or things like that, that would be a reason to delay treatment until that’s resolved. Ketamine can be toxic to the endothelial lining of the bladder, so that’s we always ask people how they’re peeing. Keep that in mind for UTIs, yeah. Thanks. Appreciate it. So, okay, it’s such a it’s such a nuanced subject. I think because a lot of guys out there, especially from our world, are like, so strict against, I’m not doing any drugs. Well, it’s unnatural, right? Like I had ketamine on the ambulance. Oh, yeah, right. It’s a controlled substance on the ambulance. I mean, it just came out when I was leaving. Was leaving, but, yeah, you have ketamine. So when you tell me, I mean, it’d be the same thing if I went to you, and you’re like, Hey, I’m gonna give you a bunch of fentanyl. Well, hold on, you give me a bunch of fentanyl. Like, that’s something that I’ve learned is not good for you, right? So hearing ketamine, I mean, right out of the gate, is just has a negative connotation. Or, you know, as a cop, like I never, I don’t think I ever arrested anybody with ketamine. But when I was in high school, I remember kids, the bad kids, right? They were using ketamine. I don’t know how they did it. Never did it, but like going into a K hole, they would call it. And you probably heard that law enforcement now usually have as a negative connotation, right? Yeah, don’t who you know are abusing drugs. If they go into the K hole, they never want to touch it again. And that’s ketamine is used by anesthesiologists for surgeries, and at anesthesia sized dosing, it’s more of an experience of, wow, an hour went by. Felt like a second, right? Or you’re kind of in and out. I’ve had that before. I’ve had ketamine before for that, yeah, so and so, that’s that whole dose range, right? And just below that dose, and that’s different for everyone. I was gonna say earlier. I mean, we’ve had little old ladies in their 80s, and at the starting point seven makes per gig, they’re like, twiddling their thumbs, going, Wow, I still feel like I could drive home. Am I supposed to be feeling something? And then we’ve had six foot four Marine Corps guys who look like they could flip over a truck at the point seven makes per gig, and they’re going, Wow, that was so intense, right? You know, interesting it is. Everybody’s very different. That’s why we always start low and go slow. So if we know you’re a sensitive guy, that’s me. Nothing wrong with that. All right, yeah, they, they gave it to my son when he broke his arm, and they were setting it in the hospital, and he was, like, 14 at the time. And, you know, I’m like, Okay, I’ve done ketamine. I’m like, it should be fine, buddy. And, but he doesn’t do well with any kind of medication. He’s probably like, you in that regard, like, one ibuprofen, he’s good. And he got done afterwards. And he will never try ketamine, I’m sure of that. Because, like, just because the setting right, he’s like, I could feel everything they were doing, but I couldn’t get out or verbalize anything else. Kind of weird. That sounds awful, yeah? Oh, man. So I don’t know if it’s something about the way his body metabolized, or the dose they gave him, or what, yeah, maybe underdosed, right? I mean, because it’s, yeah, at a high dose, sense of self isn’t dissolving. It’s, you know, being shut out of you know, so you’re unconscious, right? So aware you don’t have memory of the experience, the fact that he remembered the experience means probably was underdosed, and that’s that dose, the K hole range is the dose just below unconsciousness, right where you’re conscious of slipping into unconsciousness, and it’s like you’re going down a black hole, and it feels like you’re gonna die and you’re never gonna come back out. And it’s maybe 5% less than 5% of people find that to be therapeutic. It’s like that complete Ego Death kind of thing. But you have to want to go there, to go there. I did it one time. I never need to do it again. For me, it was just scary. And, you know, I didn’t find the therapeutic value in that, right? So I think, like getting to that, you know, working way up to that paradoxical feeling is usually a sweet spot for dosing. And if you continue to go beyond that, then you start to tiptoe into that K hole range, which, like I said, 90 99% of people probably don’t find that to be too therapeutic, yeah, that feeling of you’re dying, yeah, yeah, right. And then the panic, and yeah, oh boy. So the normal, or the ideal treatment plan, is six sessions in three weeks, ideally, yeah, okay. And then how often would someone need, like, if they got relief from it, how often would they need to redo that? Or, yeah, we do that case by case basis, right? I’d say on average is every three months or so. And even that gets longer and longer in between. So I’ve been at three to six months. I’ll do a booster for quite a while. Sometimes, you know, stress. I mean, for me, I love the metaphor white knuckle driving. So for myself, I start to notice, like all these decisions, I get stressed out with my work, my family and all that stuff and then after ketamine infusion, it just kind of feels like I loosened the hand on the wheel a little bit, and kind of a feeling of Back to Basics for me. I think a lot of people have described this feeling of, wow, why did I care so much about all this crap? I mean, all I got to do is drink water, eat food, sleep, be a nice person. The rest is kind. Of bullshit, you know, back to basics, kind of feeling, yeah, I it left me with a sense of well being that lasted for weeks. But just like, yeah, good, shrug it off. So, going back a little bit, what got you into doing ketamine? Like, I mean, that’s a curiosity and life. I was, I used to do a lot more addiction psychiatry, and I was at an addiction conference, and I met a group of researchers who were studying ketamine, and it’s used for addiction and its effect on the default mode network. And when I started diving into trying to understand the default mode network, that’s when I was like, wow, I gotta try this. That’s fascinating to disrupt my narrative sense of self. That sounds crazy, yeah. And I was also going through a hard time, you know, my wife was still in training. We had our first baby. I just I completed residency in 2017 and so that point, I was a couple years in. But, you know, new baby, wife still in training, and feeling like I was kind of trapped in my job. I was working with addiction and then severe mental illness, like on a pack team, which is very difficult population to work with a lot of trauma coming into you? Well, yeah, yeah, it was. And I kind of also going, what did I do? I don’t want to be a psychiatrist anymore, kind of feeling, you know. And, and then, yeah, ketamine, for me, was helpful in this way of kind of shifting that suffering to going, yeah, the fact that maybe I don’t want to be a psychiatrist anymore. Means maybe I’m a good one, because our medical system is terrible, and mental health is probably the worst part of our medical system. I think a lot of people would agree with that. So you know, our inpatient you’ve ever been on an inpatient psych unit, they’re rough places to be. I’ve dropped a few people off there, but I’ve never been, yeah, not very therapeutic. General. I can’t imagine it. Mental health is one of those subjects that you can’t you have to tread so lightly. There’s some people with some serious mental health issues, and then I think there’s a lot of people that want to believe they have medical health issues, mental health issues, mental health issues. I think there’s a lot of, I don’t want to say copycats, but I think there’s a lot we’ve developed a society where a lot of people want to claim that they have issues. They want to find a way to to justify their actions or how they are. But there’s some people that have some real mental health issues. And it’s, it’s one of those lines that you almost can’t cross to say, like, when somebody says, Hey, I’m having these issues, you can’t say, No, you’re not, like, it’s, it’s a, I think it’s a mixed bag. And so as a as a psychiatrist, I’m wondering, do you see people that that you can look at and that you can evaluate and say, yeah, like, you have some severe PTSD and maybe you don’t know about it, or just the opposite, like people claiming that, oh, man, I have all this trauma and they don’t, or is that something that you can even evaluate for and and say for sure on people? Yeah. I mean, so for diagnosis, right? I mean, you know, there’s a difference between meeting the criteria in the DSM, right? I mean, anybody can memorize that and just say yes, yes, you know, check the box Yes, right? And so what I usually look for, what are conflicts that the person’s having, versus what are deficits that the person has? And, I mean, we could go down the rabbit hole. I mean, it’s kind of a fun, elaborate idea, you know. But basically, you want to try to understand the conflicts and you want to medicate the deficits, right? Okay, so conflicts usually amenable to therapy, and definitely ketamine. I mean people who are stuck with EMDR. I mean EMDR and ketamine work so well together. I always like, especially first responder or complex PTSD folks, it’s like, is there waving? You know, we’re trying to hire a therapist. So if anybody knows a therapist looking for a spot, we have, hopefully somebody who’s going to come over and start soon. But you know, that was a question I had. Do you guys combine? Do you currently have other therapies? Oh, you were doing that. I mean, I do the best I can, right? But I’m one person, and I can’t be everywhere and all the time. So between, you know, doing the evaluations I meet with every person before their ketamine infusion, you know, and then, okay, now I’m also going to do, you know, therapy with, you know, it’s just a lot. So we are trying to hire another person. When you do that, it’s not while they’re doing ketamine, is it No, just to check in beforehand and then integration afterwards of checking in see on how it’s going, basically. And that’s, it’s not rocket science, but we all need, I think most of us need, a coach, kind of person, right, to hold us accountable, right? How’s it going with those things we talked about during the evaluation? So part of that 90 I do spend 90 minutes to two hours during the initial evaluation. And during that time, it’s hopefully diagnostic, but hopefully therapeutic, and coming up with that plan on how to get the most out of treatment if somebody wants to do it. And so there we’re putting in kind of that plan, and then the rest is really just following through on do we need to make changes to that plan. How’s that plan going? Because a lot of it’s, yeah, the person needs to choose, you know, small things, right? It’s all about small achievable because small, achievable things lead to a big change down the line, right? So you’re trying to set yourself up for success. So there’s an initial evaluation. It’s not come in and sit down and sign up for Academy, drip, right? Yeah. I think that’s kind of what makes us a unique clinic. I think a lot of clinics. Run by, you know, non mental health professionals. It’s more that, right? Do a medical you just fill out a you know, you’re medically cleared, so to speak. So I’m guessing I’m gonna go off on a tangent on testosterone here in a minute. But as a clinic, most of your stuff, I’m guessing, is cash pay. Or do you guys deal with insurance? Does insurance pay for stuff like this. We do only it’s probably five or six months ago, we went, Man, we’re the ringer with medical billers. And we finally got someone who’s amazing, and she’s turned our practice around. So we are what we have is a people have Medicare, they sign an ABN, was an advanced beneficiary agreement. There’s all these rules. And then if they are commercial payers. Then they start in a financial agreement, and it basically saying you’re going to pay the discounted rate. We charge $450 per infusion, and all our prices, you know, our website, whatever. And then we will submit, if the person wants us to to insurance, to try to obtain as much reimbursement as we can. And then we’re able to discount the refund the patient, the difference of what the insurance will pay. So the reason I ask is because, like, you know, we just did a podcast on testosterone, and I just got on TRT about two weeks ago. We were just talking about this before podcast, and it’s been an absolute. I mean, it’s been a game changer for me. It’s all cash pay, right? I can’t you go to you go to a physician. And if you’re between, you know, 290, and 900 they’re like, Yep, you’re good. Like, we’re not, not giving anything for you. And I know pharmaceuticals are out there to make money. I know the pharmacy industry and everything else, like Big Pharma, they want to make money. And it’s deep. And I’m sorry, I mean, it’s funny, the cash pay out of mentor, right? That’s is kind of a little bit derogatory. People don’t realize it, but cash has that undertone of air, you know, we’re doing something under the table, right? Something kind of shady, a dark alley, and give you some testosterone. And insurance, I’m convinced insurance companies kind of created that language because if you’re not taking insurance, you’re taking cash, and therefore you’re doing something unethical. But here’s the thing, like, I feel like Big Pharma is making money off of this, because I feel like there’s a lot of treatments out there, whether it be testosterone, ketamine, whatever else it is out there, that are actually having massive benefits for people, but insurance isn’t covering it, and thus people that even have insurance are forced to pull money out of their pockets. It’s more money just being passed around in the pharmaceutical and it sucks, because I definitely think there can be a benefit to ketamine. I think there’s a benefit to a lot of these other things out there, and you’re finding them at clinics instead that have the research and the everything to back it up, but yet you’re having to pay out of pocket for it because insurance won’t cover it, or they’ll only cover a little bit, when really it’s a better treatment than going to your family physician and them saying, Well, let’s try these medications. Let’s try this and go in on this, this game for months and years, if not, on all these things to try to treat something that’s not actually working the underlying cause. Yeah, super aggravating. I mean, the decisions about somebody’s health care should be between them and their doctor, right? In that it’s dictated by insurance companies, is super painful. You know, yes, if you figure out the solution, I’m feeling it. I think what you’re saying is right about the Big Pharma like trying to or whoever making it feel dirty because they make more money if your regular doctor puts them on SSRIs or whatever else out there, not saying those don’t work, but they’re definitely over prescribed. And I’m sure people are making lots of money, so if they can force the doctor to okay, like her, here you go. Here’s your medication. Well, let’s be honest, there’s no money in Healthy People, right? And if you fix people, if you can make people healthy, then there’s a lack of revenue. So the money is really between people that are not healthy nor dead. There’s no money in dead people, right? It’s the people in between. It’s the people that need something all the time. If you, if you fix somebody, if you do something for them, that’s going to change their life in a positive way, to where they’re not going to need this continual medication, or it’s, it’s changed or altered their mental status, where now they can focus on things, whatever else, and they don’t whatever else, and they don’t have this depression, anxiety, whatever it is. Then you fix them, and you don’t make any more money. So the money’s somewhere in between a healthy person and a dead person. And I feel like that’s kind of where you end up staying when you’re in on insurances and stuff like that. I mean, it’s hard do. On that note, we talked about the insurance What about VA? Do they do? Yeah, we actually get patients coming from Walla, walla Washington to come to our clinic. We’re the only clinic with a veteran cares agreement, yeah. So that’s, you know, it’s a mixed bag, too. I mean, we’re dealing with the VA, and they’re sometimes paying some sometimes, but, you know, because we have a veteran cares agreement, we have to accept assignment. So for veteran, it’s great we’re able to provide care to veterans, you know. And if veterans don’t pay anything for treatment, they just need a referral for ketamine treatment from their primary mental health provider at the VA. So the VA does do, oh, that’s good, yeah, yeah. They there was a wonderful psychiatrist, Dr Brown, who’s working at the Spokane VA, and I think he left there, you know, him, No, I just That’s. Best name ever for a doctor, Dr Brown, yeah, yeah. I think that was, I’ve never met him. Just spoken to him on the phone, and he was working really hard to try to get a ketamine program going through the VA, and I think he was unsuccessful at that. And that’s kind of what then triggered, where they kind of granted us this veteran cares agreement, where they will pay for treatment at our clinic. That’s fantastic. So there you go, veterans, if you’re out there, that’s a huge thing, and that’s, and that’s the stuff that you don’t see. I mean, in terms of ketamine clinics, how many are there within 200 300 miles from here, you know, I should probably know that. I don’t know there’s a new clinic who’s a wonderful Johnny Wade is a CRNA that started Kootenai ketamine, and it’s over in Post Falls, near Cabela’s. And so we’ve been, you know, we’ve kind of kicked around how we can collaborate best, because him being a CRNA, me being a psychiatrist. You know, there’s definitely, you know, overlap of skill sets. So, so we’ve met a few times and continue. So it’s fun, most people in the ketamine world, and, no, it’s weird. I mean, when you have a ketamine experience, you’re kind of humbled a little bit. Or, you know, for me, you know, we’ve done enough of them or that, and there’s some evidence of it being an intactogen So that really have empathy or enjoy kind of social interactions a little bit more. But I think a lot of people who have ketamine treatment also feel called to kind of a little bit of a higher mission, to kind of like, wow, we have a potential to be a part of the evolution of human consciousness, right? Which is kind of what the world indeed eats, right? It’s kind of Barbara’s like trying to get along and, you know, yeah. And so among ketamine clinics, especially if there are other people who had ketamine treatments themselves, and they’re very passionate about those treatments. I mean, I had some of the Boise ketamine clinic. The owner there, Nicole Rice, she’s amazing. She’s a psych NP, and also CRNA. She did both, uh, both of them, which is incredible, but just very open with all the knowledge, right? Here’s what I found, here’s what worked for me, here’s what didn’t, you know. So there’s kind of this feeling of we just all need to work together to be able to provide the best treatments we can. And figure out that I feel it should be mandatory that all world leaders and politicians do ketamine or something similar. Yeah, maybe we wouldn’t all be fighting all the time. Pretty cool. I think it would be that’s not Yeah. Do you ever? Do you ever have people that come out of there with a negative experience? Yeah? We do. Okay. We do. Yeah. Let me think about some examples I know, because that’s an important piece of it, right? I can give one from my wife. She probably won’t listen to this anyway. She used it for depression, and I think she did six treatments, but she had, she had one where she got really nauseous and was like, throwing up, yeah, and that was a bummer. So it was a physical response, yep, okay, no, not, yeah, not a mental response, just a physical response. So she had that hanging over. She got past it and went back after and it was resolved, but that was definitely one, yeah, that’s a bummer. If you have that, it is, yeah, and we’ve, you know, learned a lot about that too, and we have multiple ways to treat it, you know, like all the nausea medications now on board that we can use. But yeah, that can still be an issue. If somebody’s already really anxious, like, you know, on the edge of kind of having a panic attack, I usually say, well, we should call it right unless you can find a way to calm down. Maybe it’s not a good treatment, because anytime I’ve learned this the hard way too, like, oh, okay, well, we’ll start the infusion. You’ll just calm down through the infusion doesn’t usually work. A person can still, like, now it’s feeling change, especially they don’t have that experience with any non ordinary states of consciousness, and that can be really scary, and it’s normal. I mean, I still get anxious before every ketamine infusion, and I’ve done a lot, I’m getting anxious just talking about it, right? I mean, you know, because it’s the unknown, right? You’re kind of going, and every time can be very different, yeah, right. And so you’re kind of going, Okay, what’s going to happen today, right? You know? And I’m gonna lean into what’s coming up. And, you know, it’s kind of that lesson in giving up a little control, which is scary for all of us, not, you know, right? So, so that normal anxiety is fine, but if they’re already like, you know, you’re having to hold their hand and do some breath work with them, then, you know, unless we can use some mindfulness practices progressive muscle relaxation or do some stuff to try to get them chilling, we will call it and not because that usually leads to bad experience. That’s like, the problem is that I’m not, I’m not nervous about that. I’m the type person. I’m like, All right, let’s give it a shot. But I’m also very much a critic. You know. I’ve always heard about like, you see these people that get hypnotized, right? Somebody touches them and claps. Next thing, you know, they’re out. I’ve also heard like, you know, it’s not going to work on you if you don’t want you don’t want it to happen. And I’m the type of person, I am a bit of a critic, and I’m wondering how that plays out to something like this, because, right? And I’m resistant to a lot of things. When you get the hero dose, buddy, and you don’t how much you resist, and also knowing that it’s not for everyone, right? You know it’s not, yeah. I mean, I say with first responders, it is disproportionately higher likelihood, yeah, but it’s still Yeah. I mean, we’re all different. Thank goodness. Here’s a good question, addiction. Is there a risk of addiction with ketamine? I would say there’s a risk of addiction with everything you know, but you know most people. Aren’t doctor shopping or using it. I think, I think it is there, and you have to be cognizant of it. We have a few patients over the last like, two and a half years that maybe have been coming in more frequently than I feel like they should, right? You know, usually want to taper off, and if they’re not able to taper off, then we need to figure out a plan of why, right? What’s going on. Me, they’re liking it too much, right? But most people would not want to do it every day. It can be a pleasurable experience, but also exhausting, like, same way people aren’t, you know, using psilocybin usually every day, right, right? So, and then they’re kind of worn out. They need to process it, right? It was kind of intense, yeah. I mean, the experience I had, yeah, I was, I did it, and I was like, it was great. Had well being for a while, and I did not have the feeling like I need to go back and do it again, like it wasn’t an issue at all. And since you were a psychiatrist and focused on addiction as it is, I mean, I’m guessing alcohol, you know, sexual addictions, whatever else it is, is this one of those things that people that have addiction to something, whether it be medications, whether it be something psychological, whatever else is this, something that can help them with that? I think so. Yeah. I mean, there’s some evidence that shows it can. It’s been, I mean, yeah, like, I heard about it at that addiction conference, right? I think it’s all about, yeah, the intentions that are going along with it. Got it. But we have had, I say alcohol is the biggest responder, and the other ones have been a mixed bag, like people are struggling with, you know, the stimulants, cocaine, methamphetamines, maybe those are the ones that maybe the least amount of response, as far as but alcohol, by far, has been the one where we say, Man, I just don’t, don’t have that craving. Or I was at a party and I was like, I said, it was easier to say, No, I think it can lower the one of my friends, colleague, he wouldn’t mind me mentioning his name. He’s a wonderful man. John Reese. He’s a used to be a lawyer. Still is a lawyer, but he works at North Idaho College, teaches classes there about drugs and law and all kinds of things. But he had a good way of saying how it can lower the activation energy, you know, like we’re thinking about, or even like saying no to alcohol at a party, right? There’s that kind of build up like, oh, I still kind of want it or, you know, but kind of that tension that can build versus it just being like, easier to go, Well, no thanks, you know. Or it can lower that, you know, I want to go for a run. I should work out all that shooting on our club being should upon right, and should on ourselves, wear ourselves out just thinking about the thing we should be doing instead of just like, I should just f and do it. A lot of people say ketamine can kind of lower that activation energy. That’s pretty cool. You have 14 chairs to put together when we get back. He’s not lying. Yeah, we’ll swing by the office first. Yeah. No, you know that. And that’s something you know. I was talking to you before this about going on testosterone. That was one of the main things that happened. And I don’t know how, if that has any bridge whatsoever, but I know like I was telling him I started TRT two weeks ago, and the two biggest changes that I had that nobody has talked about to me when I was asking, you know, I’ve asked a ton of people for three years. I’ve asked him everybody, oh, it’s exhausting, yeah. One is my cravings and alcohol. So this is like, the second drink that I’ve had in two weeks. I mean, we had, we had a get together with our team the other night, and he was giving me our time. He’s like, Yeah, just drinking water. We’re all having something, no craving for it, and it was the weirdest thing, man, I’ve had this complete shift in my diet. I describe myself as a trash panda. Yeah. I mean, when my my kids, my family, go to, you know, my wife will go to, you know, Maverick, and she’ll go to get, you know, we’re gonna go get some treats, and my Grammy, like, two or three Milky Ways, I’ll just slam those things, like, I’ll just, you know, I’ll just eat, like the crappiest food. I can eat a bag of anything. They have to hide stuff from me in the house. I’ve had no desires, no cravings for bad foods, sugars, alcohol, any processed foods. I literally want meat and like fruits and veg. It’s the weirdest thing, awesome. And I don’t know like not that that has anything to do with ketamine, but, I mean, it was the same type of thing as cravings are all of a sudden gone out. Hormones are just an enigma, right? I mean, they actually go into every cell, and they float right through the cell membranes and affect the nucleus and so how proteins are made. I mean hormones, as we know. I mean they can affect every part of our body and our physiology. And so, I mean, I think again, even endocrinologists are still with hormones. It’s like scratching the tip of the iceberg and understanding exactly how they affect all of our systems. Yeah. Uh, what are good resources if people want to learn more about ketamine, do you have, like, any good books you can recommend, or podcast or other than this one, or things like that. Yeah. I mean, I the voyage Foundation is a nonprofit organization that me and a couple of people started, and it’s got some resources there, some links to some articles and made a book called The ketamine journey manual. So it’s kind of like how to get the most out of ketamine treatment, right? Um. Um, and then our website, North Idaho ketamine.com, I will, I will link both of those. The Voyage foundation is that, is that the URL, voyage Foundation, without the the on the front of it is the URL, and it’s north Idaho ketamine, yep, dude, I freaking love it. We were just talking about changing our name today on a few different things, and whether or not to do Idaho experience versus North Idaho. Everybody has North Idaho. I love it, yeah, yeah. It’s such a different world up there. Yeah? Rep, where we North Idaho? Ketamine, very cool. Yeah. Are you guys on social media as well? That’s probably not the kind of thing you would we might be, yeah, we have, I say that a lot, yeah. Somebody does it, yeah, I’m not on there. But you know, our Shania is a new person that’s helping us out with reception, and she’s become our new patient engagement specialist. Cool. I don’t know what that means. You know, she’s been helping out with all that. It’s important to have that Okay, so those are excellent resources. I know people out there will have lots of questions. Dave and I are always accessible to answer these questions. Like I have tried ketamine. Dave is going to take another team budget. That’s fine. I will pay to see that. Dave, yes, only if I can sit there and hold your hand. Are you sweating? I’m game. But yeah. So if you guys have questions, drop them in the comments. You can always reach out to me and Dave, we can talk it out. I’m tired of hearing Dave talk about testosterone, honestly. So if he talks about ketamine, I’m curious about it. It blew my mind. Yeah, yeah. I’ve been on it, like, a year and a half now, somewhere it’s changed. Like I said over I don’t know, 75% of men I see coming are on it. I mean, it’s very common, yep, very common. Yeah. So we will link the both those websites in the show notes. You guys can grab that North Idaho, ketamine and EMS. They are right in downtown Coeur d’Alene, easy to find. John, thank you. Oh, it’s great pleasure. Thank you. That was cool. Very informative. Awesome. It’s a good topic to talk about, mental health. Dave and I are always touching on it. Super important. Cool. Yeah, thank you guys. We’ll catch you on the next one. Thanks. This podcast is brought to you by your North Idaho agent. We are a full service Real Estate Team serving all of North Idaho. Our team is comprised of former first responders and veterans, and we have years of experience in all aspects of real estate, purchase and sales, compare land to new builds, condos, commercial and resell. We have your back to ensure a safe, smooth and profitable transaction. Be sure to subscribe to our real estate YouTube channel called the North Idaho experience, and check out our website at your North Idaho agent.com it’s an excellent resource to learn more about North Idaho. So if you’re looking to move right now or 12 months from now, give us a call, text or email. We don’t just sell homes, we sell the North Idaho experience. Thank you for listening. If you enjoyed this podcast, the greatest compliment you can pay us is to like, subscribe and share you.