WEBVTT
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Okay, so welcome to our podcast.
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This is a little bit different today because this podcast is a spin-off of our radio.
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We're talking about health and wellness, we're talking about biohacking, we're talking about mental health.
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And uh Dr.
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Shoule, you are the Phoenix Suns psychiatrist consultant.
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How do we what's your exact title for the Phoenix Suns?
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I am the team licensed mental health professional and the consulting sport and performance psychiatrist.
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And is that uh like do you get a a lot of playtime?
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Like are the players coming in your office like all day?
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I like to say I make myself readily available.
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So then if there are needs, then I'm there to chat with them.
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But yes, I work a lot with players, staff, anyone who needs help within the organization.
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And when you meet with a player, is it mostly like do you do it at the arena or at Footprint Center or at that practice facility in Arcadia?
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Uh really all of the above.
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So I'll meet with them at the practice facility, at the arena before games, at my office, in their home, or virtually.
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So any of those five.
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And is it on the down low, or do the other players know that, oh my God, you're meeting with Brooke today?
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Uh it is on the down low, I would say, mostly, except for like if it's before the games and they just finish warming up on the court and they're like, hey, can I grab a few minutes?
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So we're just sitting out there on the court chatting.
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So that is public, and I only do that when they initiate that publicly.
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Yeah.
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And what about when a player gets traded?
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I always thought like watching the emotional roller coaster or that there would be emotional roller coaster being traded.
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Do they ever continue talking to you even though they're with another team?
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That is such a tough question because clinically we can only practice medicine in the states that we're licensed in and where the patient's located.
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So let's say we trade someone to Memphis.
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Now I'm not licensed there, so I can't continue clinical kind of care with them.
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But what I can do is just be a person and just check in and be like, hey, this was a really tough time.
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We miss you here.
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How's it going?
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And just like be a human with them.
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They can't call you and do service that way?
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They can call me, but again, for that more like casual conversation, it can't venture into like a clinical patient relationship again since I'm not licensed in that state.
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So, how long have you been with the Phoenix Sons?
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I've been with them for three seasons and with the Mercury for two seasons.
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Okay.
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All right.
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So we had like a bunch of things we want to get into, right, Carrie?
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We do.
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We absolutely want to talk about some of the issues in mental health.
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Um, not really as much as um, you know, what you do day in, day out on the on the regular mental health side, but some of the ideas that the players might go to or they might search something on the web that says this is a cool new trend of something that can help me get better.
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So we specifically want to ask you about the use of um ketamine.
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And ketamine is a drug that has become pretty common in the uh mainstream market for people helping to deal with clinical depression, anxiety.
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We know players deal with a lot of performance anxiety, which is why you're helping the team out.
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And what has been your thought process on this new rollout of an old drug?
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Ketamine's been around forever.
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We used it in the emergency rooms to help sedate mostly young children if we were doing an invasive procedure.
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But ketamine has been used now to help people overcome the barriers with depression and with generalized anxiety disorder.
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What are you seeing happening with specifically in the NBA?
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Is there any use or is that a allowed drug for the players?
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And and what has been your take on that?
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Yeah, I think that it's really easy to get caught up in what seems to be the newest fad of things.
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And in the NBA, especially when we have players that are performing at such a high level, it's so critical to make choices and medical interventions based on like the most minimal side effects possible.
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So to me, like that is like the very end of the conversation and should not even really come up because ketamine, just with a general population, can have so many potential side effects.
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So much so that at a place that's doing it well, you're monitored for two hours after a spravado nasal spray.
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So I think that it's something to keep in mind, especially with NBA players and especially in sports psychiatry training, is like what intervention can you have that's evidence-based that has the least amount of side effects possible?
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Can you help the listeners understand more about the drug ketamine itself?
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Because this falls within the psychiatry realm to some extent right now.
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It wasn't originally developed for that, of course.
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It was more of an anesthesia medication.
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But psychiatrists have embodied it and found new applications for it.
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So, what has been some of the literature, what has been some of the medical studies that have been done around this drug and using it on the psychiatry side?
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Yeah, so I think it's been studied for a few different things, some for PTSD, some for depression.
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And recently the FDA, when they approved spravado, they approved it as the nasal spray for depression with an antidepressant, which is interesting because they're not saying you should just go use ketamine without evidence-based pills that are already available.
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They're saying that you can use it in conjunction with antidepressants.
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So, in the study that was done that the FDA had cited in their statement for spravado specifically, it was seen to have superior efficacy when compared to a placebo nasal spray with an antidepressant compared to the spravado plus antidepressant.
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Um, so that did have better efficacy in terms of treating depression.
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Is it in an IV drip?
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The the spravado, so ketamine can be given IV, IM, and then spravato is a nasal spray as well.
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Spravada is ketamine?
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Is S- ketamine, yes.
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As a nasal spray.
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But what you're referencing is most people are actually seeing the clinics pop up as an IV drip.
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Like I talked to a guy yesterday, and I think he's a pretty clean guy.
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And he goes, Oh man, I gotta tell you about this ketamine drip I did.
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He goes, It was amazing.
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It was like I was spinning, I was out of control, it was like I was high, and I don't think this guy drinks or does drugs.
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Then I have another buddy of mine who is a pretty healthy, well, he I mean, he's a fitness guy, and he was like, dude, I gotta tell you, I did ketamine, and it was the crazy, he's done every drug in the world, right?
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And he's like, and this made me never want to do drugs again.
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He was so amazing.
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And I was like, Well, I don't do drugs, so I don't need that feeling.
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And I remember right after that conversation, Carrie, I went to you.
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Carrie's my doctor, by the way, my real doctor.
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And she was like, not the fake.
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She was like, don't stay away from it.
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Then I watched this documentary, and actor David Arquette, uh-huh, who's been on every drug in the world and addicted, he goes for these ketamine treatments and they show the ketamine treatment, and it did not look pleasant seeing what he was going through.
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So now I'm like, this is coming up all the time.
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Why are people doing it?
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Like non-athletes.
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Yeah, I think that people want a quick fix and they want something that will act fast and give them a high when they think it's medically indicated.
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And so it's a high?
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It's like it's like a like what I can't speak to that.
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I've never tried it, nor have I had my patients try it because I don't recommend it.
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But I just go back, I'm so conservative in how I practice, but I just go back to like evidence-based medicine.
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There's so many other options we could try before we even start talking about some of these other things, including things that are more studied, like TMS or ECT for very severe treatment-resistant depression.
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So, sure, there's some utility possibly, and maybe if you do it in the right setting, but I have never referred a single one of my patients to go get ketamine.
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Is it an NBA thing?
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Are people in the NBA doing ketamine, or is it just no people in the NBA are not doing ketamine?
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Okay, well that's that's good news.
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We're making progress.
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Yeah, and psilocybin as well as a prohibited substance in the NBA.
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So for people who don't know what psilocybin is, yes, that is like magic mushrooms.
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Oh banned.
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Also banned.
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But marijuana not banned.
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Marijuana not banned, synthetic marijuana banned.
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What's what's that?
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What's the difference?
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So I'm not a marijuana expert because I'm also anti-marijuana.
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So I'm not the person to ask about the synthetic synthetically manufactured versus deriving it from the plant.
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Like when you go to these uh places everywhere that sell it, that's normal marijuana, like the plant behind you, Carrie?
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No, I'm just kidding.
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Like synthetic, you know, that's not gummies, that's not a good idea.
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No, no, no.
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I know he's talking about synthetically manufactured, pharmaceutically manufactured.
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Yeah, they're they're chemically making it.
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So the normal marijuana is legal in the NBA?
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So I wouldn't say it's legal, it's not on their prohibited substance list.
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Because there is a very well-known NBA player that was pushing this and talked about doing it all the time.
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In fact, I have two sons that play basketball, and I didn't want them to watch that clip because you know they're very uh what's the word looking for?
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Uh affected or they influenced by players in the NBA and things that they do.
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If so-and-so's got a pair of shoes, they want that shoe.
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Uh if they see a very well-known player that might play for the Suns, talking about doing smoking weed before and after games.
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In fact, there's one player on the Suns that I heard, he's not on the Suns anymore.
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Um, there was lots of complaints about him that I from the from the people I knew because he wasn't training hard, he wasn't working hard, and they said he smoked weed all the time.
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Like to me, that seems like a big side effect because isn't marijuana a depressant?
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Well, people react differently to marijuana.
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Some people it makes them extremely anxious, paranoid, jittery, and for others, it can just make them totally apathetic.
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Neither of those good.
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Yeah, neither good.
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So why do players want to smoke that stuff?
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So then there's there's no benefit to being a better athlete on it, is there?
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Well, I think that people think that in the short term it can help with anxiety and depression.
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So, yes, that may be true in the short term, but there was a study I just read this morning actually that when they looked at uh marijuana use in PTSD, in the short term it was seen to have some benefit possibly, but in the long term, for long-term users, there was no benefit and they just developed a greater dependence on it.
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The other interesting thing to note, too, in terms of young players or teens that are non-athletes, is that the American Psychiatric Society actually put out a statement about marijuana in adolescence because if you use before the age of 25 when your brain's fully myelinated, it can have uh lasting effects on your frontal lobe, um, which kind of develops like your executive functioning, how you make decisions, your impulsivity.
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So it can actually have negative effects on your frontal lobe development with marijuana use before age 25.
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And then you see these players playing great, getting$100 million contracts, and one of the things they talk about is smoking marijuana, kind of bums me out as a dad.
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You know what I mean?
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Yeah.
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Um, so I'm gonna shift gears on a couple things if that's cool.
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We're just gonna jump around, right?
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Be all over the place.
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So I've been looking for someone in your field for a long time for personal use for my I have three boys, two of them are basketball player athletes, and um my middle son who plays basketball in Hawaii, uh, we would go when he was in the AAU program, we would go on these long drives, and I was always listening to some a book or something motivational.
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And I landed on a book written by a sports psychiatrist or psychologist, I'm not sure.
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And I thought it was one of the most amazing books I've ever read in this field.
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So you're the only other person I've talked to in this field outside of this guy who I've never talked to.
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I tried to track him down and I believe he passed away.
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And I now I can't remember his name, but the book is called Mind Gym.
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Okay.
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Have you heard of it?
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I have not heard of that book, but I've heard the term mind gym actually used in Formula One medicine.
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So they developed a physical gym and obviously for physical strength and conditioning, and then a mind gym that's just as big as the physical gym.
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So Formula One Medicine has a physical gym and a mind gym.
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And in the mind gym, they have different modalities that are available, like you know, um things that can help your mental resilience, cold plunge, um, mindfulness, practice, meditation, things like that.
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So that's where I've heard the term mind gym.
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Oh, well, if you get a chance, the guy, the guy was in Arizona, like he was this guy that had he had the cardinals and he had um all the baseball teams.
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He was the the football player cardinal guy, and he was the guy for a lot of the all the spring training teams that came here.
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And he would tell all these stories about working with players mentally, like how um you know, you hear like the secret.
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Like, I think the forward of the book is by um Alex Rodriguez.
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And he says, he goes every night when he was in high school, he'd go to bed, he'd lay in bed, look at the ceiling, and say, I hit the ball hard, I hit the ball hard, I hit the ball hard.
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And he had his batting average, he would say his batting average loud over and over and over again.
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And then the guy goes on to be, you know, World Series champion and gets all this stuff, and so that he's in the book.
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A couple of football players from the Cardinals are in the book about having a positive mindset and manifestation.
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And like, where are you on that?
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I think that's so critical.
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So, in a lot of the mental skills training for athletes of all sports is that positive, they call it positive self-talk.
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So it's like affirmations, habit building.
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I think like to that habit building is so important for these players that you know, there's so many NBA players or just basketball players that are great athletes.
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But what makes like the LeBron James, Steph Curry's, what makes them different, is also that mental resilience and that kind of immediate decision-making ability in a game.
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So, how can you hone in both the mental skills part of things and the physical skills is partly by doing things like that, that positive self-talk, um verbal affirmations, guided and visual imagery, those all play a big role in really differentiating those that excel.
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So you say a visual imagery, what exactly do you mean?
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Like you have an example?
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Yeah, so an example would be like a five-minute guided thing, maybe talking about imagine yourself in the locker room, you're just about to go out on the court, you can feel the positive energy of your teammates, you see yourself taking your first shot, and it's literally guiding them through a positive and a successful encounter in the game.
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Is that something you say to the guys on the suns if you're talking to them?
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That's one modality I use for those that are interested in pregame kind of guided imagery.
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Yeah.
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Yeah, because I would tell my sons, I'd be like, visualize, visualize.
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Like when you go to bed at night, you see you walking on the court, you see the ball going in, you see, you see everything ahead of time.
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And then I watch this documentary called In Search of Greatness.
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If you get a chance to see that, it's amazing too, because that's where, like, you have Tom Brady, the greatest quarterback of all time, excuse me, the greatest quarterback of all time, and he at that combine where they measure you, he's the worst performing ever, right?
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Now he's the greatest quarterback of all time.
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But at this combine place, he was the slowest, he was the most out of shape, but he's the greatest quarterback of all time.
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So the documentary goes on to say we measure things because we can measure them.
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I was talking to you about this the other day.
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Yeah, I was like, because it's like, you know, just because you went to Stanford doesn't mean you're the best doctor in the world, right?
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So here's Tom Brady, who uh is the best quarterback of all time.
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Um, why is he so great?
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What is it?
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And he talks about motivation.
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Same with Muhammad Ali, same with Jerry Rice.
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He's like, Jerry Rice said he would go to bed and throw a football in bed every night, every night, and visualize every single game before the game happened the next day.
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He had it all in his head.
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He knew because he saw everything.
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So did Michael Jordan.
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So I feel though there's gotta be something to that.
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Yeah, and what's really interesting too is like at what point does it become unproductive?
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Like I um talk a lot about with people unproductive versus productive anxiety.
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And a productive anxiety is something you could do something about.
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So, like, oh, I'm worried about my SAT score.
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Okay, well, you could study more.
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Whereas an unproductive anxiety is, oh, I'm worried I'm gonna get cut from the team.
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Well, there's nothing you can really do about that worry, and it's it's derailing your performance.
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So I think it's important for people to change their worries into productive worries and then act instead of just sitting with the worry.
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Oh, that's good.
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That's really good.
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How about athletes that uh suffer an injury coming back from an injury?
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That's a mental game.
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It is, yeah, a lot.
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Because, you know, especially at the start of a season, for example, let's say you get a big injury, you've mentally prepared all summer to be able to get back out on the court and potentially win a championship, and now you get a season-ending injury.
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That's devastating to a lot of athletes.
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It's devastating, and that what if is still in the back.
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They know they have a weak link in their armor, right?
00:16:29.200 --> 00:16:35.600
They're gonna go out, but in the back of their head, they're constantly trying to battle this issue of what if I go down again?
00:16:36.080 --> 00:16:41.440
And it's even though physically we tell them you're 100% back, you're 110% back, you're even better than you were.
00:16:41.600 --> 00:16:44.720
They go out there and they play as if that injury is still there.
00:16:45.039 --> 00:16:48.559
And that's a well-documented issue with players coming back.
00:16:48.879 --> 00:17:06.400
And that's something that I think definitely psychiatry gets more actively involved in to try and help them work through the anxiety the performance anxiety because that's where it shows coming back off an injury and teaching them how to act as if, you know, you're talking about throwing the football a hundred times, you know, and envisioning the game.
00:17:06.799 --> 00:17:11.920
We're trying to tell them to go back out and act in their mind as if that injury never occurred.
00:17:12.319 --> 00:17:14.559
Because they keep replaying the injury over and over again.
00:17:14.960 --> 00:17:18.160
Yeah, like my kids, uh my son who was hurt, he won't watch.
00:17:18.240 --> 00:17:21.920
You know, there's a couple of famous injuries on video of ball players, right?
00:17:22.319 --> 00:17:25.200
Paul George broke his leg and he's like, Oh, oh, check it out.
00:17:25.279 --> 00:17:26.079
Paul George broke his leg.
00:17:26.240 --> 00:17:27.920
I don't want to see that, I don't want that in my head.
00:17:28.319 --> 00:17:28.480
Right?
00:17:28.640 --> 00:17:32.160
But so you're saying so you you train like you never had it.
00:17:32.559 --> 00:17:34.160
Pretend you never had that, you never had the injury.
00:17:34.559 --> 00:17:37.039
You have to get them to train as if they never had it.
00:17:37.119 --> 00:17:40.960
And that's the hard obstacle because it's it's really deeply imprinted.
00:17:41.039 --> 00:17:43.359
It's a form of PTSD almost for that player.
00:17:43.759 --> 00:17:51.039
So you've got to find a way to overcome that and really get them to believe they truly are intact, they are uninjured at this point.
00:17:51.200 --> 00:17:55.039
They may actually even be stronger than how they went, you know, how they got injured in the first time.
00:17:55.279 --> 00:17:55.759
That's what I heard.
00:17:55.839 --> 00:17:56.799
Have you been to her facility?
00:17:57.039 --> 00:17:58.000
I have, it's beautiful.
00:17:59.359 --> 00:18:05.039
Like the athletes that go there, like I think you go to a hyperbaric chamber like she has at Venice Air, and you come out better.
00:18:05.200 --> 00:18:06.640
Yeah, you know, to keep doing it.
00:18:06.720 --> 00:18:10.559
And I I watched this documentary on this hockey player, Connor McDavid.
00:18:10.960 --> 00:18:11.359
Did you watch it?
00:18:11.680 --> 00:18:11.920
I did.
00:18:12.079 --> 00:18:12.559
Yep, yeah.
00:18:12.960 --> 00:18:15.359
So this dude tore everything.
00:18:16.000 --> 00:18:16.640
Everything.
00:18:16.960 --> 00:18:18.720
And they were gonna have him have surgery.
00:18:19.119 --> 00:18:24.559
He didn't want to do the surgery, so he went in a hyperbaric every day, two hours for 45 days straight.
00:18:24.720 --> 00:18:24.880
Wow.
00:18:25.039 --> 00:18:29.599
And then he did his MRIs, and you just see the ligaments all starting to get back together again, right?
00:18:29.920 --> 00:18:30.400
That's crazy.
00:18:30.480 --> 00:18:30.880
Also, Pep.
00:18:31.279 --> 00:18:34.559
He started surgery, yeah, and came back to do have his best season ever.
00:18:35.119 --> 00:18:37.839
Yeah, he signed a hundred million dollar deal at 23 years old after his injury.
00:18:38.079 --> 00:18:38.720
That's amazing.
00:18:38.960 --> 00:18:46.559
One thing that I'm trying to bring in more to light is that there's, you know, there's so many physical indicators of when you can get back to your sport, right?
00:18:46.640 --> 00:18:53.200
Like you go through physical therapy and they look for certain markers and uh mobility and measures and force and strength.
00:18:53.279 --> 00:18:58.720
Um, but one thing that is just starting to be introduced is psychological readiness to return to play.
00:18:58.880 --> 00:19:10.559
So that's a big thing in sports psychiatry world that I've been diving more into recently is what measures are there to validate or or measure your psychological readiness to return?
00:19:10.720 --> 00:19:22.319
And what I've found is that kind of dividing injuries based on length of injury, so like, okay, if your injury timeline is one to two weeks, it's not as detrimental as like a four to eight week or a 12 to 16 week.
00:19:22.480 --> 00:19:42.799
And so, what are questions that we can ask that are validated and studied that measure your confidence and resilience and confidence in yourself to get back out on the court, and not using that as prohibitive, like, oh, your score was a 40 out of 100, you can't go back, but using that as an indicator of where are the weak areas, like what would get you from a 40 to a 50 in confidence?
00:19:42.960 --> 00:19:50.000
Because if we can identify those steps, then we'll have a a better likelihood of you being more successful when you get back out on the court.
00:19:50.319 --> 00:19:52.480
So you have that already, or you're working on that?
00:19:52.720 --> 00:19:54.720
Uh we have implemented that already this year.
00:19:54.960 --> 00:19:59.200
So like what are some questions you asked to find out if they're okay mentally to come back on the court after an injury?
00:19:59.440 --> 00:19:59.519
Yeah.
00:20:00.160 --> 00:20:05.440
Like um how confident are you to take your shot that you normally take on a scale of one to a hundred?
00:20:05.839 --> 00:20:06.720
But will they be honest with you?
00:20:08.160 --> 00:20:10.000
I think they'd be like, Yeah, 100%, 100%, 100%.
00:20:10.400 --> 00:20:12.160
But really, how do you know you're getting it?
00:20:12.240 --> 00:20:20.160
Well, I think I I always like um say ahead of time like your score is not going to determine if you're gonna get back out on the court or not.
00:20:20.319 --> 00:20:23.200
The physical rehab side of things is going to determine that.
00:20:23.440 --> 00:20:27.039
So like let's just have real conversation and this stays internal.
00:20:27.200 --> 00:20:32.640
So any conversations I have with players or really anyone um is confidential.
00:20:32.799 --> 00:20:41.920
So if they talk to me and can be honest, it could help their performance if I can help them identify some areas where they're still feeling uncomfortable and work towards those.
00:20:42.240 --> 00:20:47.200
So let's say I had a uh hurt uh oblique, tore my oblique, and now I'm ready to come.
00:20:47.279 --> 00:20:48.160
I feel like I'm ready to come back.
00:20:48.240 --> 00:20:50.319
Like how what how do you what would you ask me?
00:20:50.640 --> 00:20:58.079
Yeah, so the goal is that every week during your rehab, that we would be checking in and going through that same seven question scale.
00:20:58.319 --> 00:21:00.720
And so so then I could measure your progress.
00:21:00.880 --> 00:21:03.359
It's not just like, okay, you're ready to go back out on the court.
00:21:03.440 --> 00:21:04.319
What's your measure today?
00:21:04.720 --> 00:21:15.440
You would give him homework, essentially goal-targeted direction that would help him go back and kind of revisit why he's hesitating, feeling anxiety towards going back.
00:21:15.680 --> 00:21:20.240
It would help you guide exactly what modality, if you will, that you're gonna give him to work on.
00:21:20.640 --> 00:21:29.359
For goal setting, I like to try and get them to set their own goals first before I I never want to try and tell someone what I think their goal should be.
00:21:29.440 --> 00:21:31.599
So I just try and work with them on goal setting.
00:21:31.759 --> 00:21:35.759
I just facilitate their mental exercise of setting goals for themselves.
00:21:36.240 --> 00:21:46.960
Have you ever had a player that you worked with where the physical medicine team said, okay, they're ready to go back, let's push them back out there, and you've had to pull back and say, he's not ready to go, he's gonna get reinjured.
00:21:47.119 --> 00:21:48.160
Has that ever been a problem?
00:21:48.559 --> 00:21:53.200
Not yet, because the psychological readiness to return, we've just implemented this season.
00:21:53.519 --> 00:21:53.759
Okay.
00:21:54.400 --> 00:21:56.079
And it's quite early in the season still.
00:21:56.400 --> 00:22:00.559
So how how how can you walk us through how you became the team psychiatrist for the Phoenix Suns?
00:22:00.720 --> 00:22:03.279
Like was it it was a job opening posted on the internet.
00:22:03.440 --> 00:22:04.960
Oh no, I don't LinkedIn.
00:22:05.440 --> 00:22:06.160
I'm just wondering how that works.
00:22:06.559 --> 00:22:17.359
What's interesting is that the league mandated this, I think back in 2019, either 2018 or 19, that teams had to have both a consulting psychiatrist and a licensed mental health professional.
00:22:17.599 --> 00:22:26.480
And that could be no, so that could be a social worker, it could be a psychologist, um, but then regardless, they had to also have a consulting psychiatrist.
00:22:26.720 --> 00:22:34.720
So us and two other teams are the only teams that actually have the psychiatrist in both roles that does the therapy and the med management.
00:22:34.960 --> 00:22:45.920
Most other teams have uh like a therapist and psychologist because I think in a lot of um areas the consulting psychiatrist is affiliated with whatever the team sponsor is.
00:22:46.000 --> 00:22:47.839
So, like in town here, it's Banner Health.
00:22:48.000 --> 00:22:54.640
So um out in Utah, like the University of Utah is the consulting psychiatrist, but they have their own in-house person.
00:22:54.880 --> 00:23:01.759
So here we're unique in that I provide both and I'm in private practice and have the time to really dedicate to both.
00:23:02.079 --> 00:23:07.359
So when you go to work, you go to your private practice or do you get up and you go to footprint center or you go to the practice facility?
00:23:07.599 --> 00:23:09.359
I get up and I go to the practice facility.
00:23:09.440 --> 00:23:12.000
I'm there until about one o'clock and then I'll go to my office.
00:23:12.240 --> 00:23:13.200
But you get there at what time?
00:23:13.359 --> 00:23:14.400
I get there around 8 a.m.
00:23:14.720 --> 00:23:15.920
And literally you get there at 8 a.m.
00:23:16.000 --> 00:23:17.119
and like there's someone at your door.
00:23:17.279 --> 00:23:18.079
I need to talk to you.
00:23:18.319 --> 00:23:19.200
It's so strange.
00:23:19.359 --> 00:23:21.519
Like I I try and explain this to people all the time.
00:23:21.599 --> 00:23:27.920
I'm like, okay, so I get there and like I'll go up in the breakfast area and I'll just sit and work and make myself available.
00:23:28.079 --> 00:23:34.000
Because the number one thing with professional athletes and on any team, any sport, is familiarity.
00:23:34.160 --> 00:23:39.839
Like I think what people forget is that these guys' lives and women are really isolating.
00:23:40.000 --> 00:23:48.160
Like they are constantly worried about um motives of people, friendships, like who can they trust, who just wants money from them.
00:23:48.400 --> 00:23:51.839
I'd hate to have my salary posted online, so I'm sure they hate that.
00:23:52.000 --> 00:23:57.680
Like they're they are constantly getting badgered by people wanting something from them.
00:23:57.920 --> 00:24:09.200
So I think like it took me a season and a half just to make myself like known that I was trustworthy and not there to tattle on them or tell the the organization what issues they had.
00:24:09.359 --> 00:24:14.640
So I think it took a lot of time just to even get buy-in of like this is a confidential resource.
00:24:14.960 --> 00:24:16.240
Did you watch Ted Lasso?
00:24:16.480 --> 00:24:16.720
I did.
00:24:16.960 --> 00:24:19.680
Okay, you remember how Ted would have these anxiety panic attacks?
00:24:20.160 --> 00:24:20.960
Is that a real thing?
00:24:21.119 --> 00:24:22.319
Like, have you had players have that?
00:24:22.480 --> 00:24:23.359
Like, how would you describe it?
00:24:23.440 --> 00:24:30.960
He was carrying he's on the soccer field and he's the du he's the coach, and all of a sudden he just had to freeze up and leave, right?
00:24:31.119 --> 00:24:31.519
Yeah.
00:24:32.640 --> 00:24:33.440
Does that happen in real life?
00:24:33.680 --> 00:24:35.839
I think typically it it does happen in real life.
00:24:35.920 --> 00:24:37.279
I would say it's just situational.
00:24:37.440 --> 00:24:39.920
Like it may happen in the locker room before a game.
00:24:40.000 --> 00:24:41.359
I'm not saying that happens here.
00:24:41.440 --> 00:24:47.519
I've just heard that this happens that you know, before a game is incredibly stressful or after a loss.
00:24:47.759 --> 00:24:51.119
I think typically during a game, people are pretty locked in and focused.
00:24:51.359 --> 00:24:53.839
So after a game, you sometimes have to meet with a player?
00:24:54.079 --> 00:24:56.960
A player wants to meet with you at 11 o'clock at night because the game's over at 10 30.
00:24:57.200 --> 00:25:04.000
I've had phone calls late in the evening just to talk about things or decompress, you know, not just players, but people throughout an organization.
00:25:04.319 --> 00:25:06.000
So they have access to you all day?
00:25:06.160 --> 00:25:06.400
Yes.
00:25:07.039 --> 00:25:09.039
They call you at 11 o'clock at night, you pick up.
00:25:09.279 --> 00:25:11.119
Luckily, that doesn't happen too often.
00:25:11.200 --> 00:25:15.519
I think the latest call I've ever gotten and it wasn't even related to sports was 10 30.
00:25:15.680 --> 00:25:15.839
Oh.
00:25:16.480 --> 00:25:17.200
And I did pick up.
00:25:17.519 --> 00:25:23.440
Like I was at the game the other night and it was like over at 10, and and or some of those games start at 8, and they're over late.
00:25:23.519 --> 00:25:26.960
And I would think after like my son had a game of scrimmage last week.
00:25:27.039 --> 00:25:29.279
Um, of course, he's in Hawaii, so he's three hours behind.
00:25:29.359 --> 00:25:32.799
But I went to bed, woke up in the morning, he was like, I played terrible.
00:25:33.279 --> 00:25:36.400
Um, and he just he just got very emotional.
00:25:36.480 --> 00:25:39.680
And I wish I was there for him, but it was late, it was midnight at one o'clock.
00:25:39.839 --> 00:25:42.079
And then a half hour later, he's like, It's okay.
00:25:42.160 --> 00:25:44.559
I'm just gonna have to work harder, is what he said, right?
00:25:44.799 --> 00:25:45.920
45 minutes later.
00:25:46.079 --> 00:25:51.759
So I felt like if he had access to someone like you, or yeah, I'd feel bad I wasn't there to take it.
00:25:51.839 --> 00:25:52.960
But he was fine the next day.
00:25:53.119 --> 00:25:55.519
But sometimes I think, do they call you like that?
00:25:55.680 --> 00:25:57.839
Like I just they're driving home, man.
00:25:57.920 --> 00:25:59.519
I don't know what what did I do wrong?
00:26:00.000 --> 00:26:05.119
So to me, I I would see that almost like as a failure of my role if they needed to do that.
00:26:05.200 --> 00:26:11.839
Because my goal is to give them the skills and the tools that they can kind of like process it themselves.
00:26:12.000 --> 00:26:14.559
And I feel like if they can't, I haven't done my job.
00:26:14.880 --> 00:26:20.480
So get specific, what what's something like like what tell us like how what's a something you give them a tool?
00:26:20.640 --> 00:26:23.200
What's a tool that we can give somebody watching this right now?
00:26:23.440 --> 00:26:27.680
Yeah, I think some tools are like uh mindfulness kind of breathing exercises.
00:26:27.839 --> 00:26:33.039
So if someone is having a panic attack, they're now having physical manifestations of their anxiety, right?
00:26:33.119 --> 00:26:34.960
They're getting short of breath, palpitations.
00:26:35.119 --> 00:26:39.839
Sometimes they show up in the ER to their outpatient physician saying that I'm dying.
00:26:40.000 --> 00:27:00.480
Um, and so one goal of like some biofeedback exercises of deep breathing, like box breathing, where you breathe in for four seconds, hold it for four seconds, breathe out for four seconds, is getting that physiological response to get your body to slow the F down because you are just really ramped up and hyped up and can't calm down.
00:27:00.640 --> 00:27:05.599
So I think just those kind of tools they should try and institute first before calling me.
00:27:05.759 --> 00:27:08.640
Because we were talking about this the other day of like setting boundaries.
00:27:08.799 --> 00:27:11.359
So both her and I practice concierge medicine.
00:27:11.599 --> 00:27:15.599
And one of the questions I get a lot, and I'm sure you do too, is oh, do you get called at 2 a.m.?
00:27:16.000 --> 00:27:16.240
Always.
00:27:16.319 --> 00:27:16.480
Yeah.
00:27:16.720 --> 00:27:20.960
Everybody swears everybody must call me all night long because they have my cell phone, and it's so not true.
00:27:21.200 --> 00:27:21.440
Right.
00:27:21.519 --> 00:27:22.400
It is so not true.
00:27:22.480 --> 00:27:32.400
And I feel like our job to be good physicians is to give our patients tools to work through things themselves, whether it be for physical medicine or mental health care.
00:27:32.559 --> 00:27:35.200
And then if things are bad, of course call us.
00:27:35.359 --> 00:27:43.759
But I think it it would be a disservice to people if I was just like their lifeline that they needed to just call and I was the only fix, if that makes sense.
00:27:43.920 --> 00:27:44.079
Yeah.
00:27:44.480 --> 00:27:46.720
I think the family members end up being the lifeline.
00:27:46.799 --> 00:27:50.720
So I wanted to ask you, do you also help with mental health for the family members?
00:27:50.799 --> 00:27:52.799
Is that part of the extension of your services?
00:27:53.200 --> 00:27:54.720
I do, but in my private practice.
00:27:54.799 --> 00:27:58.720
So someone, of course, is that's a family member is is welcome to come see me.
00:27:58.880 --> 00:28:02.160
It's just done outside of the building in my own private practice.
00:28:02.720 --> 00:28:06.480
Would you say that you've met with every player on the Suns?
00:28:06.880 --> 00:28:16.160
I can't say for certain whether I have met with every player or not, but I will say that um it is a requirement just like physical health to get clearance at the start.
00:28:16.720 --> 00:28:18.160
And is that how long is that session?
00:28:18.480 --> 00:28:18.960
I can't say.
00:28:19.200 --> 00:28:21.039
You can't say no, those are all way too specific.
00:28:21.519 --> 00:28:26.240
Would you say that the players on the Phoenix Suns, if they saw you at a grocery store, they would know who you are?
00:28:26.640 --> 00:28:27.759
Yeah, I mean I would hope so.
00:28:27.839 --> 00:28:30.480
I see I am at the practice facility like three days a week.
00:28:30.559 --> 00:28:32.079
So I would hope that they would know who I am.
00:28:32.319 --> 00:28:34.240
But would they say hi to you or are they not allowed to say hi to you?
00:28:34.480 --> 00:28:35.440
I think they would say hi.
00:28:35.599 --> 00:28:35.759
Yeah.
00:28:36.000 --> 00:28:38.240
So that means every player knows who you are.
00:28:38.559 --> 00:28:41.440
But not because I mean that's she sits in the cafeteria.
00:28:42.400 --> 00:28:43.839
We're late in the cafeteria over there.
00:28:44.480 --> 00:28:47.920
Yeah, but for the first season and a half, I think it was like, who is she?
00:28:48.079 --> 00:28:48.799
Why is she here?
00:28:48.960 --> 00:28:50.880
And so it just takes time and buy-in.
00:28:51.200 --> 00:28:52.160
What about for you?
00:28:52.400 --> 00:28:58.559
Like when the new owners came in, did you think you were secure or did you go through anxiety going, oh man, they're getting rid of everybody?
00:28:58.880 --> 00:28:59.680
That's a good question.
00:28:59.839 --> 00:29:05.119
I think I was more so focused on helping everyone else during the transition that I didn't really think about me.
00:29:05.279 --> 00:29:10.799
And I think the reason that I didn't think about that too is because I have a private practice and that wasn't my sole job.
00:29:11.119 --> 00:29:11.279
Right.
00:29:11.359 --> 00:29:11.519
Yeah.
00:29:11.680 --> 00:29:11.839
Okay.
00:29:12.079 --> 00:29:17.680
But it is it's like sometimes I feel like in my career that there's a lot of parallels with basketball with the NBA.
00:29:17.839 --> 00:29:23.599
It's kind of like with uh I I would assume players do they get freaky or nervous about being traded?
00:29:23.759 --> 00:29:27.279
And if they do, do they come to you and they say, the rumors are they're gonna trade me?
00:29:27.440 --> 00:29:30.400
Like I've heard rumors about my job and it makes me sick to my stomach.
00:29:30.480 --> 00:29:32.960
And my wife's like, that's not gonna happen.
00:29:33.039 --> 00:29:35.039
Get it out of your head, you can't control that, right?
00:29:35.279 --> 00:29:35.440
Yeah.
00:29:35.599 --> 00:29:46.000
I would say like that there's certain peak times of anxiety throughout the season, playoffs, trade deadlines, all of that I think are high anxiety times just because of the uncertainty.
00:29:46.079 --> 00:29:52.640
Um, but unfortunately, it's a part of the business, and I think people just know that they just hope to be playing somewhere.
00:29:52.799 --> 00:29:53.119
Yeah.
00:29:53.680 --> 00:29:57.279
And do you ever have you ever been like, thank God they trade that guy?
00:29:57.839 --> 00:30:00.559
I like I really enjoy meeting every single person.
00:30:00.720 --> 00:30:03.279
I think they each bring a different flavor to the team.
00:30:03.440 --> 00:30:04.640
So I have not had that thought.
00:30:05.039 --> 00:30:08.240
So you don't go to anything but the coaches, that guy with number 25.
00:30:08.880 --> 00:30:11.279
So we keep we keep talking about the male players.
00:30:11.359 --> 00:30:14.799
Let's talk about the female players because you also work with the Phoenix Mercury.
00:30:15.200 --> 00:30:19.200
So do you see a big difference between WNBA and NBA?
00:30:19.839 --> 00:30:32.000
Yeah, I'd say just on a broad scale, I feel like the WNBA is is still getting accustomed to having mental health services because it was brought on a little bit later, I believe, than the NBA.
00:30:32.160 --> 00:30:36.079
I think one or two seasons later, um, if I can remember correctly.
00:30:36.240 --> 00:30:39.839
But I think that um the gender dynamic is interesting.
00:30:40.079 --> 00:30:45.440
So I think some teams really vibe with a female um mental health person.
00:30:45.680 --> 00:30:47.279
I think other teams prefer a male.
00:30:47.359 --> 00:30:49.359
It really depends on the team culture.
00:30:49.519 --> 00:31:01.039
So I think that's an interesting dynamic I've seen is is like I think sometimes the male players more like to seek a female um provider versus the female players might prefer a male.
00:31:01.440 --> 00:31:05.519
Do you think the stressors are the same between the two for gender dynamics?
00:31:05.839 --> 00:31:11.200
Or do the women bring do they have a added level of stress that the men don't have to carry?
00:31:11.759 --> 00:31:13.519
I think there are different levels of stress.
00:31:13.680 --> 00:31:24.240
I think that there's a lot of viewers and people in attendance and and sponsorship money at stake and things like that for the men on a smaller scale for the women.
00:31:24.480 --> 00:31:31.920
But I think that there's just different types of stressors because it almost throws me back to thinking of like 20 girls in a sorority in college.
00:31:32.000 --> 00:31:37.119
And I think that the it can present difficulty and high tensions at times.
00:31:37.680 --> 00:31:40.400
You know, I brought up Ted Lasso, he had a psychiatrist too, remember?
00:31:40.880 --> 00:31:44.079
Is it is that what it's like, a session, like he the session he had?
00:31:44.319 --> 00:31:45.039
I don't think so.
00:31:45.440 --> 00:31:46.000
It's not like that.
00:31:46.160 --> 00:31:47.359
I don't think it's made for TV.
00:31:47.440 --> 00:31:48.160
Yeah, it's made for TV.
00:31:48.240 --> 00:31:57.359
I know, but it makes it seem like like he comes in, sits out her office, they talk, you know, he breaks down, cries a little bit, or he gets up, then he right, then he calls her every once in a while.
00:31:57.680 --> 00:31:59.119
That would be if I had an office.
00:31:59.200 --> 00:32:02.319
I've had to get creative then there and I use a patio.
00:32:02.640 --> 00:32:04.880
So a private patio with four chairs.
00:32:04.960 --> 00:32:05.039
Yeah.
00:32:05.440 --> 00:32:08.400
Do you go on the trips with them when they play uh in another city?
00:32:08.640 --> 00:32:09.119
A few times.
00:32:09.279 --> 00:32:14.480
Last season I was traveling up until I hit about 34 weeks pregnant, and then I decided to stay home.
00:32:14.559 --> 00:32:24.480
Uh so I traveled through January or December of last season, and then for this season, I just traveled for the preseason trip and the first regular season trip.
00:32:24.880 --> 00:32:27.039
How important is sleep for mental health?
00:32:27.440 --> 00:32:28.079
So important.
00:32:28.240 --> 00:32:29.279
I mean, for everyone.
00:32:29.359 --> 00:32:40.880
I think anywhere from pregnant women experiencing mental health crises that are trying to not precipitate a manic episode if they have a history of bipolar disorder, sleep is so protective.
00:32:40.960 --> 00:32:42.319
And same for athletes.
00:32:42.400 --> 00:32:47.359
Like your body needs to recover both physically and then your mind needs to recover mentally.
00:32:47.440 --> 00:32:48.400
So you need good sleep.
00:32:48.640 --> 00:32:50.079
So what's a good amount of sleep?
00:32:50.319 --> 00:32:51.680
I think it depends on the person.
00:32:51.839 --> 00:32:53.039
I think it's really difficult.
00:32:53.200 --> 00:33:01.680
Like I can probably thrive at about seven hours of sleep, and my husband, up until he got his CPAP, needed like nine to ten hours of sleep.
00:33:02.079 --> 00:33:03.200
I have a CPAP.
00:33:03.359 --> 00:33:03.599
Yeah.
00:33:04.079 --> 00:33:05.680
So wait, was he snoring and keeping you up?
00:33:05.839 --> 00:33:07.839
He was snoring and then he would stop breathing.
00:33:07.920 --> 00:33:12.400
And then I thought he had narcolepsy because he was sleepy in the afternoons, and he had all of it.
00:33:12.480 --> 00:33:14.640
So and how long has he had the CPAP?
00:33:14.880 --> 00:33:17.839
He's had it now for a year and a half, and it changed his life.
00:33:18.079 --> 00:33:18.319
Right?
00:33:18.480 --> 00:33:18.720
Yes.
00:33:18.880 --> 00:33:19.839
I love my CPAP.
00:33:20.319 --> 00:33:21.519
But does he get marks on his face?
00:33:21.599 --> 00:33:22.000
I got marks.
00:33:22.480 --> 00:33:23.279
He has a nasal pillow.
00:33:24.000 --> 00:33:24.880
I can't stand those.
00:33:24.960 --> 00:33:25.119
Yeah.
00:33:26.000 --> 00:33:26.960
So you have your own concoction.
00:33:27.200 --> 00:33:27.599
Yeah, I do.
00:33:27.680 --> 00:33:33.920
I have I've rigged up something, but I I I think I wish I would have focused more on sleep earlier in my career.
00:33:34.400 --> 00:33:36.079
Because I was working on four hours sleep.
00:33:36.240 --> 00:33:36.559
Oh my god.
00:33:36.799 --> 00:33:37.680
I just thought that was the way to do it.
00:33:37.759 --> 00:33:46.799
And up until actually up until I started training or working, having Carrie be my doctor, where she told me to get the aura ring, and I became obsessed with monitoring my sleep.
00:33:46.960 --> 00:33:51.519
Now everybody in my family has the aura ring, and we compete to see who has better sleep.
00:33:52.720 --> 00:33:53.359
And it's great.
00:33:53.519 --> 00:33:56.799
And then it's like, you know, because you can you can see everybody's sleep.
00:33:56.880 --> 00:33:58.720
It's like, so what happen what happened last night?
00:33:59.039 --> 00:34:03.119
And oh, it was my roommate's birthday, and we went out, or I had it studied for a final.
00:34:03.359 --> 00:34:07.519
So it's it's really it's or my youngest son sneaks out to go see a girl.
00:34:07.680 --> 00:34:10.239
We're like, why is your sleep score at seven?
00:34:10.639 --> 00:34:11.679
Or ring outed him.
00:34:11.760 --> 00:34:12.559
Yeah, it's pretty cool.
00:34:13.039 --> 00:34:15.920
So how much sleep do you get now after living at four hours?
00:34:16.400 --> 00:34:19.119
Now I've pushed it six and a half, sometimes seven.
00:34:19.360 --> 00:34:19.679
Okay.
00:34:19.840 --> 00:34:20.159
Right?
00:34:20.320 --> 00:34:23.360
For it which I wish I would have discovered this 15, 20 years ago.
00:34:23.519 --> 00:34:24.239
It's crazy.
00:34:24.400 --> 00:34:27.039
And I feel better, but I'm still shooting for eight.
00:34:27.119 --> 00:34:30.719
And I and I really it's it's almost like I But eight, but eight's not a real number.
00:34:31.199 --> 00:34:31.840
We've talked about that.
00:34:32.000 --> 00:34:36.159
No, I mean eight is just it's kind of that rumor that everybody needs to have eight hours.
00:34:36.239 --> 00:34:42.559
And just like Brooke was saying, it's so dependent on the different individual, their chronotype, and their sleep algorithm.00:34:42.719 --> 00:34:45.519
So for some people, four hours is actually adequate.00:34:45.599 --> 00:34:51.679
What we discovered with you is four hours was far from adequate for the restroom recovery, for the REM and the deep stage that you needed.00:34:51.840 --> 00:34:52.400
It just didn't work.00:34:52.719 --> 00:34:56.400
Well, it was like it's like the so on no sleep, I was miserable, right?00:34:56.639 --> 00:35:00.880
So now I'm trying to get a little bit more sleep, and I started we went to we got stem cells.00:35:00.960 --> 00:35:02.400
We went to Mexico and got stem cells.00:35:02.719 --> 00:35:10.400
And I feel like I'm operating at a whole different level with stem cells, which I just can't imagine what I'd be like without stem cells and a little sleep.00:35:10.639 --> 00:35:11.360
Do you know what I'm saying?00:35:11.599 --> 00:35:12.639
I mean, it's crazy.00:35:12.960 --> 00:35:16.320
What did you notice the biggest difference with stem cells?00:35:16.960 --> 00:35:21.119
I just feel like uh uh like I don't take naps anymore.00:35:21.360 --> 00:35:22.960
Like I'm just moving all the time.00:35:23.119 --> 00:35:24.559
I'm just I feel more creative.00:35:24.719 --> 00:35:29.199
I feel mental alertness versus physical exhaustion.00:35:29.360 --> 00:35:33.280
You we experience mental exhaustion a lot of times in our careers, you know.00:35:33.440 --> 00:35:38.400
Um, and the mental exhaustion actually is one of the things that you notice goes away, which is weird.00:35:38.880 --> 00:35:41.760
I find myself being simple because I'm getting better sleep.00:35:41.840 --> 00:35:48.480
I find myself being like more kind to people, more willing to uh I think I have resting bitch face, you know what I mean?00:35:48.719 --> 00:35:52.400
So when I walk up and down the hallways at work, people would be like, Oh, he's the jerk.00:35:52.480 --> 00:35:53.679
And I'd be like, Why would they say that?00:35:53.760 --> 00:35:55.199
But I think it's because I was always so tired.00:35:55.679 --> 00:36:01.039
So now I find myself working well with other departments at the radio station and other people.00:36:01.440 --> 00:36:02.320
Increase tolerance.00:36:02.559 --> 00:36:04.559
Well, that's yeah, that's such that's a great way of putting it.00:36:04.639 --> 00:36:09.039
Because I used to be like, Yeah, no, no, get out of here.00:36:09.199 --> 00:36:11.840
Now I'm a little bit boy, that's such a great way.00:36:12.880 --> 00:36:27.519
But we one of the things we do notice after stem cells, because so many people who get stem cells also have aura ring tracking, and you can track with a whoop, it's not just an aura exclusive deal, but we notice that their deep sleep and their REM sleep actually increases percentage-wise.00:3
