Veteran TBI treatment with Sam J. Peterson

Dan King: [0:00] Hello, everyone. It's Dan. It is my pleasure today to be joined by Sam J. Peterson, Army Combat Veteran and co-founder of MindSpa. Sam, how are you doing? Sam J. Peterson: [0:09] Doing great, Dan. I'm happy to be on the pod. Fantastic. Dan King: [0:12] It's a pleasure to have you. So tell me, why the bomb squad? Sam J. Peterson: [0:15] Well, you know, I really wanted to get out of my hometown of Spokane, Washington. It's a little podunk town on the eastern side of the state. I originally wanted to you know go airborne ranger i was like oh i want to do i want to i want to be like call of duty i want to go shoot terrorists in the face and then i took the azab and the recruiter was like hey you scored pretty high buddy like you know there's some other options that have bonuses and i was like i also like money so they started showing me all these uh recruiting videos and the first one was uh it was army counterintelligence you know you think spies and they showed me the video and it was like that's just a bunch of dudes in tents looking at screens and next the second one he showed me it was like robots explosions bomb suits like it just hit every single like little action movie button in the very base of my brainstem that i possibly could and uh oh yeah you'll get a fifty thousand dollar bonus like sign me up i'm gonna be the bomb guy and you know didn't happen to mention that uh you know not only is uh eod explosive Warden's Disposal, the hardest academic school in the Department of Defense, with an 85% fail rate, but it also has one of the highest suicide rates in the entire DOD. Dan King: [1:35] Wow. Sam J. Peterson: [1:36] Wow. Dan King: [1:37] So there were a few catches, is what you're saying. Sam J. Peterson: [1:41] Yeah, there were a few catches that no one talked about, but they became obvious the longer I was in the career field because you're constantly exposed to blast trauma. Even the little guys that you don't even think about that barely give you a headache are causing permanent damage to the brain, permanent cumulative damage to the brain. Dan King: [2:00] That is horrible. I'm so sorry you suffered all of that. If you were to kind of summarize and articulate the mental health impacts of working that job, how would you do it? Sam J. Peterson: [2:09] It's such a great environment you're with a very very close-knit team so on one side the mental health impact is that you get this great brotherhood of highly intelligent motivated individuals for the most part that are all there doing you know doing the same mission and there's so much art in being on the bomb squad because you're playing this like spy versus spy game it's super intriguing it's super engaging and it's a lot of fun and it's also very dangerous so It adds a level of focus that you normally just wouldn't get from anywhere. Because if you're down on an IED, guess what? That's the only thing in your world. You are 100% focused, which is awesome. There's nothing like that rush, and it is super fun. The downside is that that cumulative blast exposure has a big impact on your ability to function. From you know developing post-concussive migraines to anxiety to depression which is the most common comorbidity with tbi and that kind of decline it can either happen very very rapidly from like one single event or slowly over time and what that looks like is. Sam J. Peterson: [3:23] Your relationships, especially outside of the profession, just on this slowly but gradually accelerating decline as your brain starts to atrophy from this damage. By the time you get out, I know guys who still struggle to go into crowds who can't be around people whose marriages are falling apart. It's literally because they have a cognitive deficit for their TBI. Dan King: [3:51] It sounds like... you were inspired to address your own TBI as well as the TBI of others. Is that part of the origin story of why you decided to get into the group practice world? Sam J. Peterson: [4:02] Oh, yeah, man. It was nearly taking my own life that was the catalyst for this. But really, my trauma is nothing compared to what happened to some of my friends and some of my mentors. It was actually, to be perfectly honest, and I can say this now because of the way that mental health is moving, but MDMA is what saved my life. And it was that one experience that just, it was like a light switch. Sam J. Peterson: [4:28] Turned my life around in a huge, huge way and started to get me on a positive path because once I had had that experience, I knew that there was a possibility that I could feel better. There was at least something that could give me that glimmer of hope and it did. But what really cemented my drive to be in this field was five months after that experience, one of my mentors, I was the last guy to talk to him at the unit, walks out in his backyard, blows his head off of his three-year-old son in the house and there were no signs there were no symptoms he was we were laughing and joking and talking about the future on the friday before he took his own life and just that connection to the pain that my brothers and sisters were dealing with it drove me like nothing else because it made me angry first we were getting pushed psychiatric med after psychiatric med after psychiatric med and nothing was helping. I was like, there's got to be a better way to treat the brain. And it turns out there is. Dan King: [5:32] Thank God for that. So tell me about the beginning part of that journey, searching for something better. What did you do? Sam J. Peterson: [5:39] You know, I went out and tried everything myself. I started a nonprofit called the Evictus Project and we started raising money for vets to get more effective treatments. And so we found ketamine and tried it out. Oh, my God. Holy crap. This is great. It's like the lights are on. I'm home and I'm happy about it. But, you know, after after about 10 weeks or less, the anxiety monkey starts crawling back up your back. You start to get the headaches again. And we're like, OK, that's a great starting point. But it's not the solution we're looking for on its own. Sam J. Peterson: [6:12] And then me and my former co-founder, we tried hydrobaric. And hydrobaric oxygen therapy was fantastic. He got a much greater healing potential from that therapy. But we noticed that we would get, or we would, this happened with us, and it also happened with people we were paying to go through this program we were developing. You would get people that would, they would get like three steps forward. And then after about six months, it's like a step back. Some of their symptoms would start to come back. We're like, okay, cool. We're close, but we don't have the whole picture. And that's when I really got introduced to TMS and to regenerative medicine. I helped develop an internet as a stem cell protocol. And that's really when shit got real. Like, okay, if we put all these things Sam J. Peterson: [6:59] together into a cohesive format, I guarantee that we can help make these people better. And that's how this business was born. That's how the inpatient program that I founded was born, is really bringing these therapies together in a cohesive manner to heal and rewire the brain simultaneously. Dan King: [7:19] A lot of the underlying science behind this one-stop shop that you've created, which by the way is so phenomenal and so unusual, most practices don't evolve this way, right? It's amazing you have this unique origin story, which has contributed to building something beautiful. But help me understand how it is that you, so you're not a trained clinician, you didn't go to university for psychology. How is it, how is it that you've been able to master or at least understand the science in sufficient depth, that you've been able to see how the pieces of this puzzle fit together? Sam J. Peterson: [7:50] That's the thing, Dan. Something that I've learned along the way is that regenerative medicine really isn't taught in medical school. Sam J. Peterson: [8:01] Hyperbaric oxygen therapy is not taught in medical school. I've never heard of any psychiatrist being trained in ketamine in medical school. So, you know, then it became, okay, if I can't go to medical school to learn this, where can I learn it? And it turns out you've just got to read a lot of PubMed. And during COVID, you know, I didn't have this level of knowledge. So I was trying to write a theoretical framework for, like, how all of our treatments work together in a cohesive manner, especially the stem cell treatments that we're still developing. Sam J. Peterson: [8:34] And I had a friend of mine who's also a combat vet, Omar Rutledge, fantastic guy. You know, any clinicians watching will see this guy on the news before too long. He's just brilliant. But he was in the Battle of Fallujah, was a machine gunner in the army, got PTSD and then got out of the army and then got a psychology degree about it. Then he went to Stanford and ran the MRI lab at Stanford, then went to MIT, sold all those possessions and lived in a van so he could afford to go to MIT on a grant and a scholarship just to learn neuroscience to try to fix his own brain. So when COVID happened, everything closed, right? So MIT closed, all the gyms closed in Boston, and he had nowhere to go, nowhere to shower and shave. And I was like, Hey man, like I've got extra room in my condo. You can live in your own bedroom. Like, Hey, I'm going to set up an extra desk and come work with me. And so for, it was about four and a half months, I sat down and was writing this theoretical framework. Sam J. Peterson: [9:39] I would get like maybe like a sentence or two a day in an 18 page document. Right. And he was over my shoulder the entire time, just critiquing the hell out of my writing and how I was delivering this message. Cause you know, the guy, guy works with, with doctors and neurologists, you know, psychiatrists all the time. And he's like, Nope, you're writing too quote colloquially. Like you're not making this point. That's not a primary source. And by the end of it, it just hammered, it hammered this stuff into my skull in a really unique way. And I've been able to leverage that to, you know, communicate effectively about how these treatments work. Dan King: [10:17] No student loan was required to get that education program, just providing someone free rent. Sam J. Peterson: [10:22] Well, it's actually just free office space because he, his house was on wheels. Yeah. And that's really, we became super close and, you know, we still, we still collaborate to this day. And as soon as he's done with his PhD program, like it was like, Hey man, And you're going to work with me. We're going to do some amazing things. Dan King: [10:39] Amazing. Amazing. Tell me a bit more about entrepreneurship. So, you know, you create this protocol. You're working with someone super sharp. You get some real scientific rigor under your belt. Why is starting a business the next step? Sam J. Peterson: [10:50] You know, I think starting the business was my next step because it became about access to care. You know, we tried the model of, hey, we're going to do a nonprofit. We're going to ask for donations. and then you know it became such a logistical burden to have you know one person go to five different places for for a treatment protocol you had to deal with you know five different systems of taking payments making sure that someone can show up on time you know get to all these different places it became overwhelming for patients especially tbi patients to have to bounce around i was like man, And then you deal with other business owners who don't necessarily have the same vision or who are not motivated by the same kind of purpose and drive to help people that you are. It just became a, yeah, man, this doesn't make sense to do it any other way. We have to have control over this process and we have to make it easy for people. We have to take down barriers and create more access to care because we knew that there were ways to do this, ways to get people access, but they didn't become clear until we stuck our hands in the muck and got dirty. And then we were able to create things like our TRICARE program and develop things like Patriot Power Up. It was for lack of a better option, I'd have to say. Dan King: [12:13] Okay. Looking back on it, though, if you reflect on your journey a little bit, do you feel you have the soul of an entrepreneur? What are some of the entrepreneurial characteristics you think you bring to the table? Sam J. Peterson: [12:24] Oh man i don't know if i have the soul of an entrepreneur it was just hey this needs to happen because i'll be very frank with you dan when we started this like anxiety was my state for years, you know i would say a is for anxiety b is for bigger anxiety c is for equipment anxiety and i can go all the way to zebra like stepping into a highly regulated field with no experience was like not only daunting, but I have to say, looking back on it, it was kind of stupid, but there was no other choice. It had to be done. And I couldn't see anybody else that was doing it. It just, it was a necessity more than anything and being willing to sit and. With that anxiety and it's not about what it's about who who do i need to bring to the table what degrees have to be in place for you know us to be able to provide these services who can come to this group and bring the pieces that we're missing and as soon as i shifted it to that mindset like the the air started to come back into the room a little bit and started to think about partnerships with individuals who can help move this. Dan King: [13:39] Nothing great is built just on your own, right? You need the right team. And so tell me a little bit about the initial journey of building the business. So how many years has it been and what was your initial revenue and profit for the first company? Sam J. Peterson: [13:53] So MindSpa has been around since 2021, late 2021. We started off just doing telepsychiatry for the first couple of months built up about 200 patients and then got this space here in the Denver tech center. We opened that space in June of 2022. And during our first half a year, we did half a million dollars in revenue with just a few providers. Dan King: [14:27] Amazing. And then for 2023 and 2024, what did the numbers look like? Sam J. Peterson: [14:32] Yeah. In 2024, we did about $1.1 million in revenue. And then in 2023, we did $1.3 million in revenue. This year, I'm targeting three. So we learned a ton of lessons during that initial period. Just we came into this with an expectation of what we thought the proper business model was, and that just immediately got sidewiped. Dan King: [14:59] Yeah. Well, welcome to entrepreneurship. What were you wrong about? Sam J. Peterson: [15:02] I had this vision that we needed a room full of psychiatrists, that psychiatrists were the only way to go and that we didn't need to engage with the mid-levels at all. And could not be more incorrect. And what I have found just as a business owner and as someone who's been around this now for going on a decade, it's really important to have different levels. You have to meet the patient where they are. Some of the patients we get, incredibly complex, difficult to work with. Sam J. Peterson: [15:39] You know, may have signs of like borderline personality disorder, maybe like some sprinklings of a schizoaffective disorder. Those are very difficult patients. They require that higher level of care from a psychiatrist. Then you have, you know, there's a large swath of the patient population that doesn't require that. They're just looking to not feel the way that they're feeling. They've been stuck in a depressive cycle, an anxious cycle, or they have a traumatic brain injury, and they're just looking to feel better. And that's between the upper and lower quartiles of the patient population. And for the most part, those are non-complex cases. Those are fairly simple to deal with. And I don't want anybody to say that mental health is simple because it is complex, but they're easier patients. And then you have, you know, on the bottom, you have people that are coming in for, you know, ADHD coaching. And that's all they really need. Dan King: [16:37] So when you think about the different tools in your toolkit, if I'm hearing you correctly, you know, if you think about psychiatrists who are the most expensive providers, right? When a pair looks at a psychiatrist, it just costs them more. You're thinking carefully about how do I allocate just the right amount of resource? Or in other words, how do I deploy no more than is necessary to solve the problem? We want to solve the problem, of course, for the patient. That's, you know, objective number one. But if we overdeploy resources, it's bad for the system. Is that kind of what you're getting at? Sam J. Peterson: [17:07] Oh, absolutely. I've seen it now. Practices that try to, you know, really come in and they're overloaded on the top side with psychiatrists. And if they don't have, especially new folks coming into a market, if you don't have a robust, you know, marketing system and pathways for patients to get to some of your other services like TMS or ketamine, if you don't have those pathways established and those patient pipelines established, you're going to flounder and fail because you're paying, you know, anywhere from $350,000 to $500,000 just in salaries for one provider. Tack another 20% onto that for payroll taxes and you're like, holy crap, i've got i'm over half a million dollars just walking out of my practice just in salaries in one person like that that hurts it hurts bad and if you were to do that three times okay now you're looking at over over a million and a half dollars potentially walking out the door just for three providers in order for that to be profitable at all those providers like they have to have their entire management schedule like full and they have to be on top of their notes so you can bill properly, there have to be very few errors in their billing. Or all of a sudden, you trip one of those levels with the insuring companies and that claw is coming for you. And it doesn't take more than one or two of those before you're done. Dan King: [18:31] So is your practice, is the majority of your revenue, is it coming from insurers? Is it self-pay? How do you think about your payer mix? Sam J. Peterson: [18:41] Yeah, payer mix, I would say right now we're about, call it 70-30, and looking to expand our cash pay offerings. I would love to be 50-50, personally. Just because there's so many risks with dealing with insurance companies. There's so many systematic pitfalls. Perfect example. We have a wonderful TRICARE program. So, you know, individuals can come in and we have a wonderful package for people who do TMS with TRICARE. But, you know, that was a huge revenue source for us, you know, these past couple years. Sam J. Peterson: [19:18] And since TriCare West switched over from HealthNet to TriWest, that entire system has been in this state of flux. It took us, you know, 67 days to get our first remit from January 1. Like that kind of thing can just, just that structural, you know, reshuffling can absolutely wreak havoc on your business. So, you know, one of the things that I've learned is like, you know, just like if you're investing, diversification is your best protection against market volatility. Yes. There is so much volatility built in to this insurance system. It is almost manufactured. So you as a business owner have to be very wary of that. If your eggs are all in one basket, it doesn't matter which company it is, Cigna, Aetna, Blue Cross Blue Shield, United, TriCare, TriWest, VA. Sam J. Peterson: [20:18] At some point within the next one to two years, one of your primary baskets is going to get turned over. It statistically will happen, whether it's through an audit, a reshuffle, an issue with capitalization, a government restructuring. That basket will get turned over. And if you are not prepared for that rainy day, you will get very, very wet. Dan King: [20:39] And specifically for listeners who may not be familiar with what happened with HealthNet, can you give us just the basics about what happened there as an example? Sam J. Peterson: [20:46] I mean, you know, every couple of years, the TRICARE contract, because TRICARE is a government program, it's not an insurance company, so they subcontract with insurance companies to be the arbiters of this program, and HealthNet's time was up. TriWest took it over. And taking over, you know, an entire half of the country from a patient perspective is a ton of logistical and administrative burden. That administrative burden got put from one team who had three years of experience doing it to another team that had no experience working within that system so it's been a little bit of a shit show from from our perspective and it's also been from the patient's perspective you know they're they're getting their shit together but it's taken a while i know everybody's working hard over there but. Dan King: [21:37] These system-wide changes have implications for everyone. There's no question. So good on you, kind of sticking with it. Dan King: [21:44] Turning to your services. So you were talking earlier about this unconventional protocol that you built, right? You're really building a one-stop shop. We've got TMS, we've got ketamine, we've got HBOT. So what role do each of those play? If you were to, in as simple a way as you can, how would you articulate the role that each of them plays in the healing journey? Sam J. Peterson: [22:05] So in a very broad perspective, what we're doing is downregulating inflammation and rewiring the brain. We are healing and rewiring the brain simultaneously using a multimodal approach. So we'll start with ketamine. We use ketamine on the front line of this for several reasons. One, it downregulates inflammation in the brain. Two, it increases neuroplasticity. So it's going to make things like therapy and TMS more effective. These studies show us that this is the case. So it also really, I do believe ketamine, especially when it's done correctly, and when I say correctly, I mean properly resourcing your patients as they're going through these experiences, and that's a little bit of podcasts, when it's done correctly, you can drastically take the volume down on the veracity of the symptoms your patients are experiencing because of that downregulation and inflammation. So example, we treat a lot of TBI patients. A lot of these guys come in, they're having headaches all the time. Like we're talking anywhere from three to five post-concussive migraine a week sometimes. Sam J. Peterson: [23:13] And with the administration of ketamine at the proper doses, we're able to take those symptoms completely off the table in most cases, very, very rapidly. So within a week, all of a sudden, they go from having a headache every day to not. And they're clear. They're able to make decisions. They're not as reactionary. And the best part is you get an amazing amount of patient buy-in. So they go, okay, oh shit, man. All right. I've been to 17 doctors in the last five years. No one's been able to make the headaches go away and you just did. Tell me more. You go, perfect. Step into room number two. We're going to the next phase. And for us, the next phase of that is the combination of transcranial magnetic stimulation and hyperbaric oxygen therapy. So with TMS, I'm sure as most people are aware, you're using an MRI coil, a magnet, to create a magnetic field under the surface of the scalp, depending on which machine you use. You know, that can be anywhere from a half a centimeter to three centimeters under the surface of the scalp. Sam J. Peterson: [24:11] And it's influencing neurons to cluster more densely in a network. So, you know, when we're treating, you know, depression, dorsolateral prefrontal cortex, the other side of the head for anxiety. And when you can combine those two together, you can treat anxious depression very, very effectively. Or you could use like the Brainsway machine. The H7 coil is indicated for anxious depression. So you're reinforcing the prefrontal cortex and giving this person back more executive functioning. And with ketamine, it happens faster because you've just increased neuroplasticity, upregulated BDNF. So now we're rewiring faster. We've got that inflammation down-regulated. Now we throw in the hyperbaric, and this is where things get really fun. You know, one of the things that depression, anxiety, PTSD, and TBI all have in common is they are highly inflammatory to the brain. So what happens in the brain when it's inflamed? So the blood vessels in our brain are very, very small. They're so small that in some places, a single red blood cell can pass through at a time. Sam J. Peterson: [25:19] And it doesn't take a whole lot of inflammation before, boom, like you're completely cut off. And the cells on the other side of that blood vessel that are cut off can't create energy in the way that they normally do through cellular respiration. They have to switch over to anaerobic glycolysis. That is how cancer cells make energy. It's also highly inflammatory and waste producing to the cells around it. Sam J. Peterson: [25:42] So you're in a situation if you've been you know had chronic ptsd chronic tbi depression anxiety where your brain is inflamed it's not making enough energy and it's continuing to get more and more inflamed as time goes on and that eventually affects neural connectivity and your cells start to kind of retract it's called dendritic pruning so with hyperbaric we're bathing the brain in oxygen we're allowing your brain to create more atp on a cellular level because all of this other shit it takes a lot of energy healing and rewiring takes a lot of energy and we have a rate limiting factor for getting oxygen to our brain and it's our lungs so if we can accelerate that rate limiting factor we can provide the body with a lot more energy and it just so happens that, It looks like this stuff really heals and rewires much faster. Dan King: [26:38] How long does the whole protocol typically take? What are the range of times? Sam J. Peterson: [26:43] It depends, and it depends mostly on the rate that we're able to charge for TMS. Insurance companies will only pay us for one treatment a day, which is absolutely asinine. The science has proven that we can do far more in a day. Accelerated TMS, all the work from Stanford on the SAINT protocol has shown us that that we do not need to do one treatment a day because we're limited by you know getting getting a full series of tms in it can take seven weeks if i didn't have to do that if i didn't have to wait we could do this entire protocol in 20 business days two zero 20 like literally one one month of working days um yeah and that's because we can do we can do hyperbaric oxygen therapy multiple times a day. You do ketamine, you only need six sessions of ketamine. That's what the science shows. This is kind of a proper series. And then you're trying to get 30 to 36 TMS sessions in that window as well. And as long as you're not limited by that insurance barrier, you're good to go. You can do this very fast. Dan King: [27:49] So self-pay, if you have self-pay patients and you're saying 30% of practice is self-pay, and I know this protocol isn't what you're doing for everyone, but for those patients that are doing the protocol and their self-pay, you can deliver those results. Sam J. Peterson: [28:01] Yeah. We, we have seen incredible results in a very short window of time. Dan King: [28:06] Unbelievable. Sam J. Peterson: [28:07] It's believable. I can show you the graphs. Yeah. I can show you the, I can show you the neuropsych assessments and you know what the really cool thing is, I'm obviously really passionate about traumatic brain injuries just because of all of the impact it's had on my life, both with my dad's TBI and with my former career field. But man, when you look at the executive functioning scores of someone who's had TBI that's gone through this protocol, we typically see, especially in the more acute cases that have had like post-concussive migraines, we typically see an increase in executive function around 100 to 150% after 45 days of this treatment. And that's when doing it TMS once a day, 150%. Like, you don't care about that anywhere. Dan King: [28:53] No, you do not. Wow. You know, we could go on for a long time. And sadly, as we come towards the end of our time together, we'd love to hear about your broader vision. So you built this cool business, you know, you're doing about 1.3. Dan King: [29:05] You're having an enormous, enormous impact on patients' lives. Where do you go from here? What's the bigger vision? Sam J. Peterson: [29:11] Yeah, I mean, the next step from here for us is scaling up to more clinical spaces. My goal is to redefine how mental health is treated in this country by creating access to more effective mental health care. So, you know, this is clinic number one. I'm looking to do clinic number two in Colorado Springs. And then I want to scale this to outside of every single military base and potentially every major city if we can get the VA on board. Dan King: [29:41] Well, that's a whole conversation for another time. As you often say, a podcast in itself about how to achieve that. But what a phenomenal beginning, Sam. What an incredible journey and what a beautiful example of creating so much agency from such a rough situation, right? You've improved your own life so immensely and and have dug into the science to really really understand how you can improve the lives of others and and you've got a good business to boot so what what could go wrong right Sam J. Peterson: [30:06] Well don't say that because let me tell you man it's you know it's easy to paint a rosy picture two and a half you know two and a half three years in but dude, this shit is hard especially when you don't have a background in it like drinking it's like drinking throw a fire hose it's firing razor blades at you sometimes so you know it's not to discourage anybody from like trying this out but man i'll tell you one thing they don't tell you about starting your own mental health practice is how bad it is for your mental health when you're first starting now it gets better but like as an entrepreneur like the number one skill you have to have a grit like you have to be able to just stare into the void and keep walking yeah no. Dan King: [30:52] One ever said you didn't need resilience to do this. So you definitely have it in spades, Sam. So thank you so much for sharing this really, really inspiring journey that you've had. Can't wait to see how it all unfolds. Sam J. Peterson: [31:05] Oh, thanks, Dan. Appreciate that.