One of my first 11th-hour interventions with a top executive came in 2004 when a high-level hedge fund manager (we’ll call him Dan) just tapped out. He started drinking copious amounts of alcohol and disregarded his job, family and friends. His wife said, “I’ve never seen him like this. He’s like another person.” Millionaires think they’re getting the best treatment from their high-end physicians and they’re not. It’s hard to believe, but it’s a fact.

One of Dan’s best friends and confidants talked him into meeting me so I drove over to his house in St. Petersburg, thinking about Dan’s backstory and how I would approach him. It always goes right back to the line I use often: “Everybody and every body has a story.”

The Intervention

I knocked on the door of his Spanish-style mansion and saw a red Maserati parked next to a black Land Rover in the driveway. The house was on the intercoastal waterway and worth $5 million easy. It’s always just sad when a person attains this level of wealth and hits a brick wall, like an endurance athlete who pushes his metabolism to such extreme levels he almost dies crossing the finish line. I know this well because I was one of those athletes. You could cut my wrists and throat and I would never stop. The “alpha” brain chemistry does not create a healthy mindset and can get men and women into trouble fast. Ironically, the same focus and determination that makes some people successful can also kill them.

Dan’s housekeeper greeted me and walked me to his bedroom. I knocked on the door and he opened it, looking disheveled and like he hadn’t shaved in days. We shook hands and sat down in his workspace, where there was a computer, desk and chairs. He was wearing a dark blue Nike jogging suit, drinking a Scotch and smoking a cigarette. It was 10 am.

Dan asked me if I wanted a Scotch. I assented, thinking, “when in Rome” and hoping to bond with him a bit. This high-level exec wanted to make sure I wasn’t a namby-pamby exercise freak or food Nazi. During this part of my job, I’m a chameleon adapting to conversations within seconds. Many of these folks who run billion-dollar companies think they can get through anything with just a strong will and a “my way or the highway” attitude. They find out soon enough their physicians are lost when they are told time and time again their lab tests are normal and it’s all in their head. The lab work conventional medicine orders really doesn’t tell us much. We should be testing the microbiome and mitochondrial function as well as nutritional and hormonal deficiencies. But I digress.

He said, “So what are you going to do for me?” I smiled and said, “That’s the question, isn’t it?
You cool with talking a bit?” He said, “Sure I’m not going anywhere.”

“Dan, I’ve acquired a unique skill set over the years that allows me to find hidden patterns in a high-stress metabolism that may have been missed by conventional physicians, so I want to hear your story. If you don’t find my questions redundant or boring, let’s drill down together, no rush, ok?”

Dan nodded and lit another cigarette off the one he was smoking. Nicotine is both a relaxant and stimulant and once inhaled can cross the blood brain barrier in eight seconds. This gives a person a sense of calm. I would smoke on the way to emergency calls so when I arrived, I was not jacked up, just in a state of flow.

The Interview

I told Dan that the interview would take about sixty minutes. Most people, if they’re not in severe pain, can handle talking about themselves for sixty minutes. This also allowed a beginning and ending in Dan’s mind, so he could get back to his routine sooner than later.

This was the part where I find the high and low points in Dan’s life. Depending on his honesty, we could uncover the causes of his current symptoms of apathy and depression. He was already taking an antidepressant which just causes people to be numb to the outside world and their responsibilities.

Much like my love of responding to emergency calls when seconds meant life and death, I became addicted to the rush of interventions. I had sixty minutes to meet him where he was and get him to buy into my recommendations.

I had to drill down on what Dan enjoyed. Trust me, it could have been anything from banging hookers to drinking to doing heroin. I’ve seen it all. The stress hormone cortisol caused Dan’s levels of feel-good neurotransmitters (dopamine and serotonin) to tank, so the alcohol and antidepressants were keeping him feeling OK in short intervals.

“Dan, where are you now?”

“Russ, there’s just no point to anything. I did everything right. I provide my family with a good life. My kids go to the best colleges, my wife is at the country club every day and I’m alone to battle this dark cloud alone. They all say they love me but those are just words. My life is drinking and watching porn to get through the day. I’ve been feeling like shit for a year and now I’m at a point where I don’t what to be here anymore.”

I knew where Dan was. He was unconsciously trying to bump up his dopamine and serotonin. The average porn site visit lasts seven- and one-half minutes. Dan was losing himself in the wave of oxytocin after orgasm. This state of physiological arousal allowed him to forget about his pain, even if it was just for a few minutes. Watching porn is never about sex; it’s about getting high.

“OK,” I said. “I got it, Dan. Understand that being an executive, you really have no tribe. You’re the leader at work and at home and have very little time to just exhale. You’re like many of the elite special forces police and paramedic personnel that go home and feel lost and alienated among people who love them. I’ve been with many men who were in the same place you are now, so just roll with me.”

The Facts

Dan was a fanatic about research and had been spending a lot of time on what was causing his symptoms. He was familiar with the gut-brain connection and this gave me a break because I wouldn’t have to explain why he needed our advanced testing. I could concentrate on explaining why he needed a personalized treatment protocol that’s designed for him and only him.

As Dan and I continued to talk, my words made sense to him. Because I had worked with many people in his situation and had felt the same way myself when I was a paramedic attached to a SWAT team, we started to connect. Dan became more open with me, which allowed me to think while he was talking.

He was consuming a high amount of carbohydrates, which was good because the carbs were keeping his serotonin levels elevated. The same for the alcohol, which is just liquid bread, so I was not going to change his daily routine because he was suicidal at this point.

His treatment had to focus on mood and brain chemistry. It’s a combination of interventional endocrinology, physiology, evolutionary medicine and nutritional and hormonal replacement. This combination could take over five years through the conventional medicine approach of applying sweeping generalizations to the masses.

I had to convince him with thirty minutes left on our talk that I had answers for him before it was too late. There’s almost no difference between my conversation with a high-powered alpha type and getting an addict into detox. (I’ve done both.) Sometimes, I don’t know how hard to come at these alpha types. Do I tell him, “Wake up or die!?” Sometimes, that approach works, other times, people tell me, “Geez, Russ, try some decaf.”

Dan had a yearly appointment with the executive program at the Mayo Clinic, which only looked at basic blood labs and never considered how stress over the years affects thyroid, cortisol, testosterone and growth hormone levels. All these markers affect brain chemistry daily.

Dan hated waiting in physicians’ offices only to hear—as he put it—the same bullshit. “Here, take this drug,” Dan mimicked. “I’m tired of feeling numb. It’s like I’m in a black and white movie.” So that was the ticket with Dan. He hated having his time wasted. My team of physicians, pharmacy and labs could get him answers quickly.

I knew I had very little time to get Dan to feel a bit more energy so he’d know he could get through this. I wanted him to know he was in a hole in the ground, and I jumped in with him because I knew the way out.

And that’s exactly what we did.

Personalized Medicine to the Rescue

Dan and I stayed in touch daily and got his blood labs done right away, which would tell us about his hormone levels. Some of the labs we use requires urine or saliva samples, so we sent test kits to his home. It would take fifteen days to get results back, which would tell me about neurotransmitter and cortisol levels. Meanwhile, Dan’s blood labs returned in a few days and showed that his levels of thyroid hormone and testosterone could be optimized with micro-dosing right away.

When testosterone is elevated, estrogen also increases, along with serotonin. This helps with mood in short order. (A dangerous mistake made by bodybuilders and clients of low-T clinics is taking testosterone with a women’s cancer drug to block estrogen. Men need estrogen, too. Another mistake is taking large injections of testosterone at once instead of using small amounts of cream every day, which parallels natural production more closely.)

Within days, Dan’s mood improved. He called me and speculated that his reaction must be a placebo effect. I told him that we were hitting multiple receptor sites that affect neurotransmitters. Two more days went by and Dan called me laughing. “Where the fuck did you come from, Russ? I’ve been feeling like shit for a year! What the fuck is in this stuff?” Sadly, thousands of psychiatrists across the U.S. will prescribe antidepressants before testing naturally occurring thyroid hormones, testosterone and cortisol. This hurts people.

Well, that was almost fifteen years ago, and my skill set has improved exponentially. I continue to learn new treatment protocols every day. I think about Dan every time I interview a new executive client. I love the challenge of being a metabolic detective. Now I get my highs from elevated feelings of self-worth every time I help someone. I worked on my first patient in 1975. I’ll be 65 this July and all I can say is: BRING IT.