Buck Brief - Chris Frueh on 'Operator Syndrome'

University of South Carolina for fifteen years. Left there in two thousand and six, and I've been at the University of Hawaii ever since, and along the way about half you know, quite a bit of my time. For twelve years, I commuted to Houston every month for work, first at Baylor College Medicine and the University of Texas. So my career has been a mixture of clinical work, teaching, and

quite a bit of research. So I have over three hundred scientific publications and all the grants and presentations and all that stuff. But my passion has been working with the special operations community over the last decade or so, and that includes operators from every branch of the US military, including probably maybe several hundred Tier one operators, maybe one hundred Tier one operators. I've worked with people that are

still active duty, no longer active. A lot of the work has also been with private defense contractors, which is an invisible population to Americans because America doesn't know how many people who deployed to Iraq or Afghanistan during the last twenty plus years were not deployed as members of the armed forces but were private defense contractors.

I just couldn't take it anymore. What I didn't love was the bureaucracy of the VA and the politics and the policies, and the harm that I saw the VA was doing too many veterans via their policies, and the poor care and the lack of care that was pretty predominant in many ways. So that's why I left the VA, and a few years later, really just by fortune, good fortune, I made some friends in Houston who were former operators.

One was a Tier one Navy seal who had been on a lot of the big time missions that movies have been made about. And I also met guys from Army and Marines and Air Force while I was there, and so just kind of had a friend circle of former operators. One of the things that was interesting and infusing was they did not seem to have PTSD. And a very common thing that I was hearing initially was, hey, can you help me. I don't know what's wrong. Something is off. I feel different, but I don't know what

it is. And so with my background of PTSD, I thought I had this expertise blah blah blah. Turns out I did not have expertise. Turns out I did not know how to help these guys. So these are my friends, and we're just kind of playing trial and error. Let's get a sleep study, Well, let's get a blood test, and let's look at your hormones. Let's have a conversation. Can I talk to your spouse or your partner and get some information about how you behave, how you think,

how you function, and how you sleep. And it was eye opening, and gradually, over time I kept seeing it was the same pattern of injuries and illnesses over and over and over again. Every guy I met had low testosterone. Hell, how is that possible? Why does a big, strong, thirty seven year old Navy seal who's just a year out, why does he have low testosterone? I didn't understand that. So over the course of time, we began I and some of my colleagues who kind of shared an interest.

We talked with a lot of guys and a lot of listening and a lot of trial and error, but we began to figure some things out. We began to find that we could help guys, and from there it was just a matter of word of mouth, just hey, you help my friend, could you talk you helped me? Could you talk to my friend? Maybe you can help

my friend, and then the friends of friends. So in the last decade, I would say I've come to just organically, I've probably talked to two hundred and fifty three hundred and fifty operators, and then I've also done some forensic work on the side of the defense private defense contractors, so I've worked with I think I've evaluated over two hundred and fifty private defense contractors putting in Defense Base Act insurance claims.

there's you know, paramilitary. You know from your your prior work that the the intelligence agencies have paramilitary and they employ private defense contractors global response, and so that's that's kind of the def I mean, that's kind of the people we're talking about. And then what makes them different from convention? This is something I think most people have no awareness of. Yeah, everybody knows that a Green Beret is cool, he's a badass dude, but nobody really understands

the magnitude of the differences. So what we're talking about is just extensive experience, training and deployments with blasts. Last exposures cause a very unique type of damage to the brain. If you're standing within the radius that explosion is going to pass through the body. It's going to have a sharing effect through all of the soft tissue in the body. You have the incredibly high operational tempo going in and out. There's very little time off, so you do a six

month deployment. On that deployment, you may be running missions twice a week, twice a night. Oftentimes it's nighttime work, not daytime work, so the sleep schedule is shifted and dysregulated. Come home from the employment, and then there's new training evolutions constantly, so there's really very very little downtime. That high operational tempo means our soldiers are living with chronically elevated cortisol and stress hormones flowing through their blood constantly.

The sleep is always jacked up to some extent. Then you have the You have the massive amount of chronic pain on the joints, jumping out a helicopter, repelling out of helicopters, jumping out of perfectly good airplanes, rocking with heavy weight and body armor. Every guy I know who by the time he's thirty, has chronic pain and shoulders, neck, back, knees, elbows, ankles. That adds another burden. So part of how we describe this as allostatic load. Alostatic load is a is a hypothetical.

It's not a specific it doesn't refer to anything specific, but it's a hypothetical construct that refers to the entire dose of everything that is on a soldier's back for the course of their career. And that's another thing that's different. Most operators have careers that are ten years long or fifteen or twenty. Very few of them are doing a four year enlistment and then being out. In fact, that's

almost notheard of. So it's not just that they have maybe a magnitude of blast exposures that's ten thousand times more than a conventional soldier in one given year, but they're doing that for twenty years maybe, So you just have an incredible burden on the entire body. Then you talk about then you have the toxic exposures. Are soldiers in the Special Forces and we're seeing this now. It's

just emerging the high rates of cancer and respiratory illnesses. Yes, we know burn pits are a thing, and those have affected soldiers from all branches who deployed, But it's not the burn pits that are really hammering the community of Special Operations it's the radiological materials, the biological materials. It's the the many doses of vaccines and shots that they've received, how much anthrax Us as a has a Navy seal

received by the end of his career. Then you have the you just have the mystery things that are out there wandering around a field, wandering around an airfield in some other country. I won't say, I won't name countries, but countries around Afghanistan where old Soviet military bases were, and they're there for weeks months. I've talked to soldiers, contractors who spent year at these places. They're describing green ponds floating in the dirt. What's that? What's going on there?

One of the gentlemen that I met, who that I know, who was one of these places, describes how he developed type one diabetes, Type one, type one diabetes.

a pacemaker for. And he, you know, he just can't get his blood pressure regulated. He's on he's been diagnosed with Parkinson's disease. He's concerned about, you know, sometimes several doctors have told him he has als. Doctors themselves can't figure out what's going on with a lot of our

a lot of our guys. And then if you take that to the VA and kind of go back and think about what I said about leaving the VA, I think part of what I want to say to the folks and part of the message is the VA is completely missing the boat.

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Goldgroup dot com slash free. That's Oxford gooldgroup, dot com, slash free. Okay, Chris, so you've studied this, You've identified there's a problem. You try to bring the problem to the VA and to people in the government that should be helping our military and our warriors and what's been going on.

The VA is a large bureaucracy healthcare organization. They are set up to serve the vast majority of veterans, ninety five percent of whom, including those who deployed, were not necessarily combatants, and if they were combatants for the most part, they were not doing the same thing as the one to three percent of those who fought most of the war and saw the heaviest combat and saw the constant stressors, allostatic load, and the high operational tempo that they went through.

What the VA does is the VA is very good at hitting the PTSD easy button. You served in a rock boomy PTSD, that's PTSD. We have so far over diagnosed PTSD. I mean, it's just it's a crime and shame to be honest. The problem that operators have is they don't really have PTSD. I mean, they may have some of the symptoms, but they don't have the fear reactivity. They don't have they don't show the same type of avoidance of triggers and cues that you see with you know,

typical PTSD. What operators do have is massive traumatic brain injuries. They have low testosterone and other hormonal dysregulation. They have sleep dysregulation and insomnia. But they also many of them, maybe eighty ninety percent of the guys that I've worked with, have sleep apnea. Even when they're in their late thirties

early forties, they're developing sleep apnea. So put that together with the chronic pain, the cognitive problems, and the headaches that go with TBI, many of them have the other some of the other classic symptoms of TBI, low poor balance, blurry vision, they all pretty much all have ringing in their ears and other perceptual system impairments vision, hearing, balance. Think about how that ripples out to their family, how that ripples out to their community, their work, and then

there's nobody that understands them. They go to see a doctor and a doctor will say, oh, I've never seen anything like this. I don't know what to tell you. And in modern medicine, we have the problem of the fragmentation of care. So a veteran goes to the VA or any healthcare system, they're going to see one dock for their sleep, another doc for pain, another if they're lucky, another doc for urology if they're lucky. But these docks rarely talk to each other, so they're not They're just

not getting what they need. My conversations with people who work for VA, work for SOCOM, work for DoD, and I want to be clear, I'm not affiliated with any of these organizations. I'm a complete outsider. There's no reason they should listen to me necessarily. But what I hear over and over again is well, we already got programs for everything. They will say, we can't build special programs

for special operations because that's not social justice. And I've heard this argument over and over again, it's not socially just to build special programs for operators. In my response to that, and I'll I'll try not to drop any f bombs here is in medicine, we need to treat the injuries that people have. So if you have a group of people with unique injuries, they need unique care. They need care that is specifically contextually tailored for their needs.

And just to give an example of one thing that I've heard over and over again, and this is a story that I've heard so many times that you know, I certainly believe it is. An operator goes into the VA, they're referred to mental health, They meet their social worker or their psychologist or what whoever their therapist is for the first time, and they start talking and their therapist has never heard the kinds of things that they're now hearing for the first time, and frequently they break out

crying and sobbing. And so I've heard this many times, and operators tell me, Yeah, I had one appointment ten minutes in. My therap is just sobbing into her hands and into tissues, and I just like, I'm sorry, I get up and I walk out because what else am I going to do?

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also an injury perspective. I just go through some of the treatments and then I'll talk about kind of how we can put them together and some of the foundations that are just doing phenomenal work out there. First off, you know the basics. Yes, it's worth considering psychotherapy. Many guys might benefit from psychiatric medications such as anti depressants. What we don't want to do is load them up

on three or four or five psychiatric medications. Which is what I commonly see, and that's a common complaint about when guys have tried the VA. But there's treatments that the VA doesn't typically provide, and but that they're out there. So say gang block therapy, that's one of the things I start with. Go get a steal gangly block therapy. It's a safe, one time medical procedure. We've been using

it in medicine for over one hundred years. It's provided not by mental health professionals, but by psychiatry and neurology. It was a treatment for chronic headaches and certain types of headaches. But about ten fifteen years ago, a couple of neurologists at Fort Bragg working with soldiers noticed that when they treated a soldiers headache that their anxiety went down and they started to sleep better immediately, like that

night or the next day. And so since then Sean mulvaney Jim Lynch have done some have done a number of randomized clinical control medical trials. Others have two and shown that it's a very effective treatment for reducing the anxiety and insomnia that goes along with PTSD, but general anxiety you know, as a rule, So this is a great place to start because it just brings the volume of that anxiety down. Now that isn't necessarily going to

last forever. It's a treatment that involves injecting a little bit of lytocane or novacane into the stelic ganglian nerve. This can be accessed on the side of the neck. It goes down our central nervous system. It's the sympathetic nervous system, the fight or flight. So we're just we're just dialing it down. That's what the treatment does. This benefit lasts for anywhere from two months to over a year.

Typically a lot of guys never even notice it when it wears off because they're doing other things that are really helpful. Ketamine infusion is a four to eight sessions of ketamine infusions are are very powerful treatment, and I and others have a hypothesis that combining the stelate and the ketamine in the same week or the same month,

that they're symbiotic with each other. And we think they help not just with the anxiety and the depression and the know the mood and cognitive functioning, but that they help regenerate. They help stimulate nerve regeneration in the brain, so they're actually healing the brain. We are using very

effectively a lot of regenerative medicine techniques. Now this is my thing, so I probably won't say too much about it, but the soldiers that we refer to some of these regenerative medicine clinics where they they use stem cells and exomes and peptides really reduce the chronic joint pain, which is a game changer. If you're living with chronic chronic joint pain all the time at a high level, to have that lifted off of you really profoundly changes your life for the better.

They one of the early things is hormones. So getting tested, getting a full panel of endocrine panel of to look at hormones, testosterone, estrogen, human growth hormone, thyroid and every single and the rest of them, and getting that treated early on is important. And that doesn't mean testosterone replacement therapy necessarily, but it does mean a number of things that can be targeted to improve the production of testosterone.

And so seal future, we'll talk to the guy make the referrals and we've we've developed a large referral network and then they'll pay for it.

the community. Each chapter in the book provides they're kind of like short magazine articles, so you can bounce around if depression is your primary issue, or addiction or existential issues, guilt, shame, loss, loss of tribe, Each chapter touches on one of the components of the syndrome, and there's there's treatment, there's then the third part of the book is about treatments and interventions,

including lifestyle, because lifestyles are a big part of it. Well, you know, we need to change the way we eat and sleep, and health practices like cold plunge, hot sawna, bathing, those kinds of things can can make a profound difference. The other thing about my book, which I want to say, is I didn't write the whole book. I had a lot of help I was. I kind of went through it the other day. What I did is each chapter starts with two to five quotes from real people, operators

and spouses. There are a handful of quotes from care providers or scientists who work with the community. So in the book are the voice of over forty operators are represented in there, and their names and their units, not their specific units, but the branches and the type of unit that they were in. So I wanted the book to be it's essentially an airport read for an operator can pick it up, read chapter one and be like, okay, wow, now I have a sense of some things, and I didn't know.