Transcript disclaimer: This transcript was generated by computer software and may contain errors, omissions, or minor inaccuracies. Please refer to the audio recording for the most accurate version of the conversation.

Kyle Buller: [00:00:00] All right. Hello. Welcome everybody to Psychedelics today. Really excited to have Dr. Michael Bert here, and Peter Albertine here. And this is gonna be a really fun, special episode, um, kind of talking about, uh, a patient’s journey, um, with Ketamine assisted psycho psychotherapy, ALS. Um, so I’ll pass this over to you, Michael.

Kyle Buller: Um, for an introduction, if you can introduce yourself to the audience.

Michael Alpert, M.D.: Hi everyone. My name is Dr. Michael Alpert. I’m a psychiatrist based in the Boston area. I worked previously on the clinical trials of MDMA assisted therapy for PTSD, and I’m currently in private practice in the Boston area doing a combination of medication management talk therapy and ketamine assisted therapy.

Michael Alpert, M.D.: And I’m really looking forward to joining both of you on the podcast today.

Kyle Buller: Yeah, likewise. Thanks for being here. And Peter, we’ll pass it over to you.

Peter Alberding: Well, good [00:01:00] afternoon. I, am Peter Alberding. I live in Boston, or I live in a suburb of Boston. And, uh, I’m 60 years old. In the end of, 2023, I received a diagnosis of ALS.

Kyle Buller: Mm,

Peter Alberding: which, uh, for those who don’t know what ALS is, it’s a neurodegenerative disease, which. Slowly robbed your ability to control voluntary muscle movement and, uh, is a hundred percent fatal. Um, there are limited, very limited treatments available, and, um, as one might imagine that causes a lot of, uh, uh, uh, as Michael has taught me existential angst among other things.

Peter Alberding: And, um, sometime, I don’t know, in March or April or June, something like that, several months into the diagnosis, [00:02:00] I, uh, was interested in pursuing psychedelic therapy to help me address a variety of, uh, you know, emotions and, uh, you know, issues to address around, you know, life and, and, um, and the, you know, the difficult challenge of facing a disease like this and was referred to Michael.

Peter Alberding: Uh, through a, a, a psychiatrist affiliate with MGH. And, um, that’s my brief background.

Kyle Buller: Yeah. Well, thanks for being here and thanks for, again, hopefully sharing your story with us today. Sure. Yeah. Um, Michael, I’m curious, you reached out, um, to pitch this idea, so I wonder if you want to give a little bit of background about, um, yeah.

Kyle Buller: This, this episode from your perspective.

Michael Alpert, M.D.: Sure. Well, over the course of our work together, Pete has shared pretty consistently the desire [00:03:00] to speak more broadly about his experience with others. And it’s overall felt like it’s been a really positive experience going through this ketamine treatment over the past two years or so, and wanting to tell more people about that, wanting to have some kind of a way of ness giving back and.

Michael Alpert, M.D.: I was familiar with the podcast for several years and it seemed like a really great place for both of us to be talking about our experiences working together after having done so now for about two years. Um, so I floated the idea to, uh, Pete, he’d already mentioned that he’d had his own podcast and had been speaking very publicly about having a LS and had talked about what that was like for him, which had me thinking that a podcast might be a good place to do this.

Michael Alpert, M.D.: So thanks Pete for being so open to sharing your experience and Kyle for [00:04:00] interviewing us.

Kyle Buller: Yeah, I’m excited for it. Um, so Pete, maybe let’s dig into a little bit of like your story and how you got started with, um, you know, working with Michael. And I’m kind of curious, was this your first introduction to like using psychedelics as like a treatment?

Kyle Buller: Yeah, psychedelic with ketamine is, you know, we can go back and forth about that definition, but

Peter Alberding: Right. I mean, I guess I had certainly never experienced ketamine, uh, in my life. I have, uh, like a lot of people in younger days, uh, you know, on a recreational basis, done, you know, taking mushrooms and, uh, uh, so had some, it wasn’t naive to, uh, sort of the concept of expanding your mind through chemical intervention, uh, if I may say it that way.

Peter Alberding: But, um, you know, this was, ketamine is a lot, I didn’t know what to expect. It is a very different [00:05:00] experience than, uh, say, you know, psilocybin. Um, and so I, I was, uh, you know, like a lot of people I had read Michael Pollan’s book, uh, what, how to, how to Expand Your Mind or I can’t remember the title of it. Is that Right?

Kyle Buller: How to Change Your

Peter Alberding: Mind, how to Change Your Mind? Sorry. And, um, was curious and, uh, you know, did, did some research, contacted a few people and happened to have a connection to, uh, uh, uh, like a chairman emeritus psychiatrist from MGH who introduced me to Michael. And we probably had, uh, I don’t know, five or six talk sessions before ketamine, you know, became a, you know, do we want to pursue this path?

Peter Alberding: I mean, the way, the reason we got in touch, the reason I, uh, took the step was because I was curious to see if ketamine was a good idea, but I didn’t walk in this office and say, let’s do ketamine [00:06:00] for sure. Uh,

Kyle Buller: what was it about ketamine that, I guess, like piqued your interest were, were you reading any studies about it or hearing other people with their treatment?

Peter Alberding: Uh, good question. I, what the, what the primary issue is. I didn’t want to, I mean, I am aware. Uh, know some folks in the Boston area who are kind of underground, uh, you know, trip guides or whatever you want to call ’em. I was not interested in doing this in a nonclinical setting. Um, and so, you know, unfortunately the, you don’t really have an option, right?

Peter Alberding: It’s ketamine or nothing. MDs are not gonna, aren’t able to work with these other substances. So I would, I would’ve been open to, uh, any, you know, MDMA or mushrooms, but that, that wasn’t an option. And after getting educated on ketamine, I said, let’s, you know, I’d like to, I’d like to try it.

Kyle Buller: And I guess when you were thinking [00:07:00] about, um, reaching out to, to do ketamine, was it, what were you kinda looking for?

Kyle Buller: Was it some of that existential angst or were you looking at it from like a different perspective, whether it was like dealing with a little bit of pain or.

Peter Alberding: Um, well, if you think about, so the, the, the diag, you know, a LS is a very slow progressing disease. And so if I divided it into thirds, the first third is really diagnosis and, and just terror, you know, fear, um, not of the unknown, fear of the known.

Peter Alberding: It is very clear what’s gonna happen to somebody. Maybe not the order in which you lose your function, but you know what the end of the road is leads to the same place. And so that first third is really just getting your arms around this is real and there are some really terrible things that are gonna come [00:08:00] down the chute.

Peter Alberding: And, uh, I think it is prudent to try to wrap your arms around those things as pest as one can, uh, before. They hit. Um, and that, you know, I, again, I just decided I didn’t, I wasn’t seeking out ketamine necessarily. I was seeking out, um, whether to pursue ketamine. You know, it started out as a curiosity and enough curiosity that, um, you know, we went and had several sessions, but it was a, uh, you know, it took a little while to sort of get to the point.

Peter Alberding: I think Michael is appropriately, uh, you know, doesn’t want people walking in his office saying, let’s do ketamine. Um, for all, I presume the obvious reasons. And, uh, and I certainly wasn’t in that frame of mind anyway. Um, so it was more, uh, it had nothing to do with physical pain or anything. It was more just [00:09:00] anxiety, fear, terror, what?

Peter Alberding: However you wanna, all of the above.

Kyle Buller: Yeah. Thanks for sharing that. And Michael, I’m curious, like what’s your approach to ketamine assisted psychotherapy? There’s so many different kind of like schools of thoughts, different routes of administration, like how do you approach this work?

Michael Alpert, M.D.: Well, thinking of it on the kind of higher level like that, I’ve been working with ketamine in a way that’s similar to the way that I worked with MDMA as part of the clinical research studies for PTSD.

Michael Alpert, M.D.: So as Peter was saying, I have several preparatory sessions with people as really a chance for us to get to know each other for the people I’m working with, to become familiar with me, to ask the questions they have about ketamine and for them to have a chance to really share their life story and talk about what they’re hoping to be getting out of it.

Michael Alpert, M.D.: And from my perspective, I want to explain [00:10:00] as much as I can about what are some of the. Um, range of experiences that people can be having with ketamine. Uh, and also really be sure that people are making as informed a decision as possible. And ideally to even have the chance to test out what it’s like being in my office in to some degree of vulnerable space.

Michael Alpert, M.D.: For some people they might even put on eye shades and, uh, wear headphones and listen to a piece of music during one of one or several of the preparatory sessions just to get a sense of what that environment’s like. Um, so I’ll start off with a couple of prep sessions. The actual ketamine sessions themselves.

Michael Alpert, M.D.: I think about them usually in roughly thirds where they’re about three hours long each and ballpark. That first third of the session is what I think of as kind of like a preparatory psychotherapy time where we’ll [00:11:00] talk maybe about what’s coming up for the. Person in the room, what their intentions are, how they’re feeling, how I can help facilitate, uh, the, we transition over to actually using the ketamine, which people might be inside.

Michael Alpert, M.D.: For ballpark, I usually allow about an hour, but some people can be inside for much longer, some a little bit shorter. And then the last part of the session is really a chance for people to begin integrating and processing the experience however they see fit. For some people it might involve using art supplies.

Michael Alpert, M.D.: For many people, it involves us having some time to talk. Uh, some people want to have some period for silence or contemplation or even listening to music. So I really try and follow people’s process and track them where they’re at in the moment. And in terms of how I administer it, I mostly work with intramuscular injection.

Michael Alpert, M.D.: I usually, for you prescribers out there typically start ballpark around [00:12:00] 0.5 m per kg, which for me feels like a. Enough of a dose that people are able to get kind of a sense of what the medicine can do for them. For many people that really feels like it’s a sufficient dose. Um, and we can always adjust up or down in future sessions.

Michael Alpert, M.D.: And I try and frame the first one as in introduction to the medicine and what its effects are like physically and psychologically for you. And thinking of this as part of a multi-session process of us all just figuring out what’s going to be the optimal, not only dosing, but the psychological prep and the, uh, environmental setting that we can be creating.

Michael Alpert, M.D.: In between the ketamine sessions, particularly at the beginning, I really encourage people to have at least a couple of non ketamine follow-ups where we can talk about what that experience was like. And for people like Pete, who I’ve been working with for some period of time, who [00:13:00] also are getting a fair amount of support in other areas in their life, we might eventually get to a cadence where we are just meeting on, say, uh, once every several weeks kind of basis just for the Ketamine sessions.

Michael Alpert, M.D.: And that’s kind of where, uh, Pete and I are at right now. Having worked together now for two years and given all the other things that are going on. And I’d say the approach that I take with it is also really paying a fair amount of attention to this setting, meaning that I am. Curating playlists. I’ve got some singing bowls and wind times in my office that I can use and I’ll even work in essential oils, try and pay a fair amount of attention to the environment in a ways that you’re probably seeing in things like the, uh, maps manual or other, um, psychedelic research protocols.

Kyle Buller: Awesome. Thank you for that. Um, yeah, I love that people are like starting to incorporate [00:14:00] a little bit more singing bolds if they have that background, like the vibration of that probably feels different. And PE you could probably speak to that. Like what is that like to like have that live music element?

Peter Alberding: Uh, you know, the, I knew it was coming the first session. I will say that as I became. You know, I sort of knew how, how things were gonna roll. Uh, it was almost, uh, it, it had a little Pavlovian effect I think in the sense of, you know, you get those, uh, overtones going and it just, I, I, it just sort of sets a mood of, um, uh, I don’t know, serenity or calmness.

Peter Alberding: Uh, and, and like a vibration of energy. I don’t want to sound all, you know, foofy about it, but it’s, it’s, it, it does something. It’s hard to describe what it does, but, um, it’s helpful.

Michael Alpert, M.D.: [00:15:00] Yeah, I really like using the singing bowls in particular, right at the beginning, shortly after I’ve given the injection. I also will say sometimes work with lozenges, but mostly with the injection and the injection.

Michael Alpert, M.D.: The intramuscular injection sets in pretty quickly. So after I’ve gotten that taken care of, then I’ll do the singing bowl for a couple of minutes, multi medicine, starting to kick it, and then it’ll start with the playlist.

Kyle Buller: Yeah, I love that. Yeah, that’s really nice. I used to do like a little repetitive drumming with folks, um, as they, because I would work with lozenges, um, and almost like kind of get somebody in that like relaxed trance state with the drumming beforehand, um, while they’re holding it for like 10, 15 minutes.

Kyle Buller: Right. It’s like just, you know. Um, Pete, I’m kind of curious to like, dive into your experiences a little bit, like Yeah. What were your first couple, uh, academy experiences like?

Peter Alberding: W Yeah, so the, I, you know, I was, uh, in, in terms of [00:16:00] the, you know, the setting intentions, you know, I, we sort of were ready to go and I came in for the first session and I, I, I think I said something to the effect of, I, I don’t really have any intentions.

Peter Alberding: I’m not sure what to expect, and I’m just an open book, and I, I’m just gonna let my brain go where it goes. Um, and I had no idea what the intensity of what was coming my way. Um, so the first session was, was super intense and very positive. And I, I, if I remember the first one correctly in the sequence here, I was very, I was exploring my body basically.

Peter Alberding: I was my first symptom. And when Michael and I first met, it was basically, um. It pretty significant weakness in my left hand, and the rest of me was like, you would, if you, you know, if you were sitting with me, you wouldn’t know I had, there’s anything wrong with me. Um, so it was, [00:17:00] it was relatively mild, but I spent a lot of time sort of like holding my left hand in my right hand and exploring my hand in some detail, and then my forearm and worked up to my shoulder.

Peter Alberding: And, um, I, I, I sort of, uh, would say I went through the seven stages of grief, you know, in, in one session, you know, which is not exactly true, but it’s pretty close. It was, yeah, this is, this isn’t, you really have this disease, um, and, you know, deal with it kind of thing. Uh, was the first session, I think this, and it was so intense that I, after the first session, I wasn’t sure if I was gonna do a second session.

Peter Alberding: Um, and, uh, I thought about it a little bit and I said, well, let’s, let’s, let’s get one on the schedule. And you know, Michael and I talked about it and, um, you know, [00:18:00] let’s assume we’re gonna do it. And the second one I came back for, I, you know, I was a little, I was nervous ’cause it was very uncomfortable, uh, seeding control of, you know, I, I say to people, you, for me, I, I turn into an amoeba, you know, you have, you lose control of, uh, you know, of, of yourself.

Peter Alberding: You’re totally inside your own brain. And, um, you know, that’s a, uh, it’s a little bit unsettling. And the, the second time we, the second session we had, I knew it was coming. And so that, that got me a little nervous. Um, and I think the third session I had, uh. Uh, things went south on me. I, I got, it was, uh, a little scary.

Peter Alberding: Um, and, and, uh, not for very long, but maybe a third of it or something, or a fourth of the session was, uh, I was in a dark place and wanted to get out of it. [00:19:00] Um, and, you know, for a variety of reasons, a, that’s a, a good reason to be doing this with a professional. Um, you know, after the first session, I remember saying to Michael, I can’t imagine anybody does this, does ketamine recreationally, I got, just seems insane to me.

Peter Alberding: But, uh, you know, obviously people do. So what do I know? But, um, it, uh, it is helpful to have a professional ’cause Michael sort of pulled me outta the tailspin. Um. Two ways. One, by, by, you know, soothing me or, uh, getting me, uh, redirecting me a little bit and, and two, um, with music. And I’m sure we’ll spend some time talking about the importance of music and the role that, uh, music plays in guiding either guiding or sort of being a leading, uh, indicator of where, where you may want to go and can, [00:20:00] uh, it just plays a big role.

Kyle Buller: Yeah, we should definitely get into to the music part. Um, Michael, I’m kind of curious, like, you know, when you do see somebody kind of like tailspin as Peter’s describing, like what is, like, how do you support somebody through that when you see somebody like really in it.

Michael Alpert, M.D.: That is a great question. Well, something I’ll add before answering that one though was I wanted to mention in terms of uh, Pete’s second session, how different that was from the first one.

Michael Alpert, M.D.: And I remember you coming out of that session feeling like it was incredibly peaceful, blissful, having, being at this state of not feeling stressed and like everything happening with your body was biology and chemistry and just being amazed at the miracle of life. And it’s just amazing. Yeah. It’s just amazing just what [00:21:00] a different head space it was and it really surprised me and hammered home for me, this whole beginner’s mindset of no matter how many people I work with, with ketamine, no matter how many times we work together, even with the same dose, how every one of these experiences is just going to be different and there’s just unique.

Michael Alpert, M.D.: No way to predict it from what, at least from what I can tell. Um, but in terms of having these kinds of, uh, more difficult experiences, I think in that third session, I remember you were feeling like you were in a dark place, kind of on the edge of an abyss almost. And so I put out my hand. Mm-hmm. And, uh, Peter and I had had conversations about the role of supportive and therapeutic touch.

Michael Alpert, M.D.: I’m not a trained body worker, but I had offered as long as we both consented to it before and had clear signals around the use of touch, um, to do something like hold his hand or put a hand [00:22:00] on his shoulder. Um, so I offered for him to hold my hand and when he was. In that kind of dark space, that sort of abyss was just taking my hand and moving it around.

Michael Alpert, M.D.: And there was something I think to that, that seemed to be kind of grounding in the moment. And it seemed like it was able to kind of calm things down a little bit. Uh, the music that we were listening to, I think it was this kind of amorphous sound suite of a couple of different sound bath instruments, but it wasn’t anything particularly melodic or that had any kind of direction.

Michael Alpert, M.D.: And so then we shifted gears on that and I think it ended up helping out with some of those, uh, some of those difficulties. So yeah, I think for me, to the extent that someone’s able to be engaging verbally with expressing themselves asking for something, um, you know, I just try and get a sense of where they’re at.[00:23:00]

Michael Alpert, M.D.: If we’ve talked about some things that might be helpful in terms of grounding them. In those moments, we might try doing something like that. Like in this case, you know, talking about just holding a hand. Um, and then if possible, I’ve noticed, yeah, shifts in the music, just doing some kind of shift in the environment whenever someone’s feeling like they’re in a place that’s really tough or they’re feeling really stuck, can be helpful.

Michael Alpert, M.D.: And something that we’ve talked about is that just because someone’s in a place that might be bringing up a lot of difficult emotions or, um. Difficult memories. It’s not necessarily something to automatically move away from. There’s not necessarily quite as much time for the dialogue around that. With Academy Session, I found as there is with MDMA where someone’s inside, you know, in that for eight hours and we can have some pretty extensive discussions about what’s going to be helpful, you know, and going in and out of [00:24:00] the experience.

Michael Alpert, M.D.: Um, and so I do tend to really go with, um, the side of maybe having a little bit less dialogue around it that I might with a psychedelic that lasted longer. And if someone’s saying that they really want for there to be a shift, and they’ve sat with that, uh, really kind of responding to that as much as I can.

Peter Alberding: And, and I, I think I’m sure that it’s individual for me, like putting fear on top of existing fear was not helpful for me. Right. And yeah. Um, and I, and I think the, uh, it’s not that I, I sort of recall the music. It wasn’t like the music was atonal, but it, there wasn’t a structure to it and the lack of structure, you know, I don’t think the music caused that, but it didn’t help.

Peter Alberding: And the change of music and to say Michael offered his hand, we had discussed [00:25:00] ahead of time, like, Hey, is it, you know, is it okay if I touch it? Like, if you reach your handout, that’ll be a good signal. So, I mean. I was hanging on for dear life and my hand, my hand went out pretty aggressively. Like, uh, save me kind of thing.

Peter Alberding: Um, uh, and, and that, that was helpful.

Kyle Buller: Yeah. And I wonder if you could like, chat a little bit more about like, how that was helpful because, you know, there’s a lot of conversation lately in the psychedelic, uh, world about touch, um, and how sometimes it can be a little controversial, especially with folks that don’t have training, but also hearing from your experience like that was really beneficial and it sounded like that really helped you to get out of a, a pretty dark place in, in a sense.

Kyle Buller: So I wonder if you could like, yeah, yeah, yeah. Talk a little bit about that experience of like maybe asking for a handheld,

Peter Alberding: I mean, I, I, there’s gotta be an enormous amount of trust between clinician and patient, first of all. Um, ’cause I can imagine that, uh, it’s, you know, the, the [00:26:00] patient is in a very vulnerable situation.

Peter Alberding: Um, the, uh. You know, I think we, there were a few occasions where I needed some, some handholding. I mean literally some handholding. And, uh, I, I think it was, uh, you’re not alone. Um, like it was just knowing I’ve got somebody there with me, uh, in that, in that moment and, uh, is, is gonna, you know, hold onto me so to speak.

Peter Alberding: I mean, it’s, it’s almost metaphorical in what, I mean, you are physically holding hands and, and I remember doing a lot of like mo circular movements and Michael would just sort of go with me. Uh, yeah, yeah. A lot of that. Um, so it was reassurance. It was in the combination of, okay, there’s some holding, Michael’s obviously multitasking ’cause he’s working on changing up the, you know, the mojo with the, with the music.

Peter Alberding: Um. [00:27:00] And so I, you know, the other thing about ketamine from my experience is you have no sense of time. And so I can’t tell you if I was in that sort of state of anxiety or fear for two minutes or 15 minutes. I like, it felt like a long time. My guess is it probably wasn’t.

Michael Alpert, M.D.: Yeah. And one other thing I’d wanna add, as, uh, Pete’s talking about how there needs to be this certain degree of trust between client and therapist and, uh, Kyle, you’re bringing up these issues of therapeutic touch. It brings up the issue of, well, what happens if I’m working with someone who does not want any kind of therapeutic touch or does not consent to that as we’re going into the session and what are ways that I’m able to help facilitate if someone were to be.

Michael Alpert, M.D.: Wanting to have [00:28:00] some kind of connection with another person while they’re going through a psychedelic experience. And I’ve had this situation come up of working with people who do not want to have any kind of, um, non-medically necessary touch. I always frame it as thinking of touch in a couple of different categories.

Michael Alpert, M.D.: You have the, um, the kind of touch of me checking vital signs or me keeping someone from falling while they’re walking, that I consider as one category, which is separate from something like supportive touch, uh, holding someone’s hand or therapeutic touch of say, you know, doing body work if I were a, uh, trained body worker.

Michael Alpert, M.D.: Um, but in situations where you have someone saying that they. Do not want supportive touch. What I’ve done is during some of the prep sessions, we might, um, come up with ways that they’re able to feel the presence of another person, but without physical contact. And that can mean things like, um, putting say a pillow on [00:29:00] their stomach and then, uh, kind of pressing down with that or else, uh, using say a tuning fork on, uh, their forehead.

Michael Alpert, M.D.: Um, or you know, even some people will have like a cord or a rope that they might pull on, or like a towel they might pull on one end and I pull on the other. Uh, there’s all kinds of ways of feeling like another person is there and recognizing the presence of another person even without there, uh, being any kind of physical contact.

Michael Alpert, M.D.: And so I think there’s lots of ways that people can have. Those needs met while also respecting any kind of, uh, protectors or boundaries that they, um, for whatever reason, uh, make clear during the, uh, preparatory sessions.

Kyle Buller: Yeah. Really great points there. Thank you. Um, and maybe forgot to mention this before we hit the record button, but I would love Yeah, feel free to, like, also, [00:30:00] I think you guys know each other really well, so it’d also I think, be interesting to hear you guys like Yeah. If there’s questions or comments that come up, um, just even kind of like riff off each other a little bit there.

Peter Alberding: Well, uh, so I, one thing that was on my mind is sort of Michael in the intro said, you know, to thanking me for being willing to do this and try to help people, the impetus for that was that I was very open, you know, I am a patient at, uh. Heal center at at Mass General, which is a world renowned, uh, multidisciplinary, a LS clinic.

Peter Alberding: And my doctor is a very well known, like internationally well known. These people are excellent. It’s top shelf, um, care. And I was very open with them about the ketamine therapy that I was doing as a, this has been enormously helpful to me and uh, you know, you should know that I think that it would be helpful for others.[00:31:00]

Peter Alberding: And it was interesting that they, uh, acknowledge what I was saying and maybe engage for a minute, but I could sort of tell they just didn’t wanna go there ’cause they didn’t. It’s just outta their universe of things they think about. And that, that’s what kind of prompted me thinking, you know, I’m gonna, uh, I’m gonna evangelize a little bit.

Peter Alberding: I, I ke I don’t think ketamine is appropriate for everybody who has some trauma that they’re dealing with, but I think it could be helpful to a lot of people, and it surprises me how little, um, sort of mental health, uh, discussion there is in an a LS clinic like that. Uh, it’s, it’s, you know, sort of medical and, uh, uh, you know, assessing the rate of disease and talking about clinical trials and, and all that.

Peter Alberding: But basically there was no discussion of, you know, psychiatric treatment or mental health treatment. And, [00:32:00] you know, just in general, nevermind, um. You know, psychedelic treatment. And so that just got me thinking like, wow, maybe more people, this just needs to get out there. I think it needs to be better.

Peter Alberding: Understood. I think there’s a stigma associated with, you know, just the word ketamine. Um, among other things,

Kyle Buller: I think you kind of highlight that like mind body split, you know, which, you know, makes sense. You know, I think medicine does things really well in that degree of like, you know, really focusing on like, how do we treat the disease, right?

Kyle Buller: But like, maybe they’re missing the whole psychological psychiatric portion of it, which is also having a big impact on you as well. Um, and it’s like, yeah, how do we bridge that gap a little bit more? And, um, yeah. I’m kind of curious, like what has been your jour, your healing journey there with, um, with ketamine more from that psychological, um, perspective that you would want doctors and therapists to, to know [00:33:00] about?

Peter Alberding: Yeah. Uh, so I would say that the. So I’m, I’m, uh, a little beyond two years from diagnosis and two years and four or five months from symptom onset. The typical life expectancy of a somebody diagnosed with a LS is two to four years, and I’m pretty confident I’m will be right in the middle of that, uh, bell curve, uh, would be my guess.

Peter Alberding: And there are sort of three phases in my mind. Phase one is just the, uh, the fear of what’s coming. And I suppose you could just stick your head in the sand and say, I don’t wanna know anything about this disease, and just let things come. That’s not my approach. And, um, so I’m pretty, uh, clear-eyed, have been pretty clear-eyed about what’s coming.

Peter Alberding: So the first third is just the angst and fear of what’s going to happen. The second phase is the things that we’re, you were afraid of happening. [00:34:00] Are now happening. And so when Michael and I first met, I had left hand weakness since then, my left hand is non-functional. My right hand is maybe 30%. Like I can move my thumb.

Peter Alberding: Um, I spend a lot of time in a wheelchair. I could still shuffle along with a rollator. I have a feeding tube. Uh, I need non-invasive breathing support. Um, my voice is, you know, weakened considerably. So it, uh, but that’s pretty, you know, a lot of things have happened in a relatively short time. And so the phase two is really the, uh, the, the things you’ve been afraid of are now happening.

Peter Alberding: And, uh, you have to get comfortable with them somehow. And now I’m in phase three, which is sort of the, there’s no more, there’s no more intervention. There’s no more, there’s nothing more that I am going to do. Uh. Treatment [00:35:00] wise, I participated in a clinical study, sort of the, the, the G tube, the feeding tube was the last thing, uh, last step.

Peter Alberding: I was, I am willing to take from an intervention standpoint. So now it’s, you know, I continue to decline, but it’s more getting comfortable with, you know, my life is gonna end. And, uh, I can’t tell you when I, I could narrow it down pretty closely. Uh, and that I wanna have some agency over how that happens.

Peter Alberding: And in each phase, ketamine has helped me, um, address head on in, in ways that I don’t think would, uh, be able to do with just talk therapy. I mean, it’s just, it’s your, your, your mind. It’s just amazing to me what a chemical can do. To, uh, get your brain [00:36:00] to, you know, see things just radically differently and come to grips with them.

Peter Alberding: So I, I sort of described to people who are curious, you know, obviously not clinical folks, but you know, whatever friends or people that are wanna hear about the experiences, um, that you, you don’t really know. Uh, I just lost my train of thought. You don’t know where your mind is gonna, is gonna go. Um, oh, I remember where I was going.

Peter Alberding: Is that the, I think you, you get a lot done with talk therapy. Um, I think there are lots of things that you, it would take years and years and years and maybe you’d get to them and talk therapy and, and adding ketamine to the mix accelerates the, the process. It felt that way for me, um, of. Because I don’t have a lot of time to, yeah.

Peter Alberding: I don’t have 10 years to sort these things out, first of all. Um, but it just, it, uh, it accelerates the timeline, uh, [00:37:00] or it accelerated my timeline of come into grips with, you know, very difficult reality.

Kyle Buller: Yeah. Thank you for being so open and honest about that. And as you’re sharing that it could like kind of just like put myself in and say like, what would I feel if I was going through something like that?

Kyle Buller: And kind of feel a little bit of that heaviness. And it just gets me thinking around just like drug policy of like having, you know, medicines available. I mean, we’re talking about ketamine at least schedule three, but thinking about like psilocybin and some of these other molecules of like just saying no, like you can’t have access to that.

Kyle Buller: Yeah. When you know people are actually suffering and, and going through really intense things where it could be really helpful to deal with a lot of the emotional and psychological components of, of a disease like this. Like it’s gotta be terrifying.

Peter Alberding: Well yeah, and this is off topic, but um, you know, medical assistance and dying is another thing that’s nuts that, I mean, in [00:38:00] Massachusetts.

Peter Alberding: There is no medical assistance in dying and, and denying somebody agency who is going to die, um, strikes me as, uh, backwards. But that’s a conversation for, in a different forum. Um.

Kyle Buller: Yeah, I, I think just being able to have agency over our own, our own life is, is so important.

Peter Alberding: Yeah.

Kyle Buller: I forget what they ended up doing with that whole right of Right to Try act that got passed, which gave potential access to Schedule two substances.

Kyle Buller: I believe that were still going through clinical trial for folks with like terminal illness. So theoretically, like, you know, you could get access with like a doctor’s note for psilocybin, but again, I forget what happened to that bill. But, you know, I think it, it should totally be, you know, available for folks.

Michael Alpert, M.D.: I mean, this is something that really came up with the MDMA clinical trials. There was technically an expanded access program that was supposed to, [00:39:00] um, make. MDMA assisted psychotherapy available to people with PTSD, prior to FDA approval, but only, I think there was only something like 50 spots made available in that, which is a drop in the bucket.

Michael Alpert, M.D.: So I think it really speaks to, uh, not just having on paper these policies like right to try or expanded access, but actually having, uh, policies that allow for numbers that are large enough and, um, processes that are straightforward enough that people can actually access these treatments, um,

Michael Alpert, M.D.: under a limited circumstances. And especially for things that are, uh, pretty far along in clinical trials, even if they’re currently, uh, schedule one substances.

Kyle Buller: Peter, I’m, I’m kind of curious, um, if you’re open to exploring like your relationship to death, um, and like, you know, it’s pretty interesting that. [00:40:00] Did like a comparative analysis number of years ago, comparing like a lot of the substances to like, near death experiences. And I always thought psilocybin or DMT or Fami, EEO would be up there, but it’s actually Ketamine that ranked the highest.

Kyle Buller: Um, and I I’m curious if that has helped like your, your death anxiety or your relationship to death of like, going through this treatment?

Peter Alberding: Not, yeah. I, I would say it’s not only has it helped, uh, it’s, I am not afraid to die, um, which is a bold thing for me to say. I’ve, I guess probably a lot of people have a fear of death.

Peter Alberding: I, I have always had a fear of death, you know, since I was an adult for no particular reason. Just, uh, um, well, and there was, there was actually one session in particular where I was, uh, in a. Like in a poster bed lying down. I, I was off kilter. It wasn’t like, uh, flat on the ground, but it was, uh, I was in a weird position and there were, [00:41:00] I was in a dark room with some lighting, um, dim lighting, and there were sil silhouettes around the bed.

Peter Alberding: And the, the silhouettes were, you know, family and loved ones and close friends. None of the silhouettes were specific people, but that’s who the silhouettes represented. And I was dying. I, this was literally, I, I was at home and it was, you know, it was the end of my life and I was dying in bed and I remember kind of laughing in a joyous way and like blurting out.

Peter Alberding: I’m sure Michael has this in his notes, blurting out, this is great and, and this is how I wanna die. And, and it was pleasant. And ever since that experience, uh, um, you know, I, I don’t wanna die. Uh, I don’t wanna accelerate my demise. I have some lines in the sand that [00:42:00] will lead me to the conclusion that the quality of my life is no longer, uh, sufficient to continue with it.

Peter Alberding: Um, and that, that, uh, I mean, there were a bunch of experiences that led to that. I, you know, I don’t think I would’ve gotten to that without the prior experiences. Um, is, is my sense. I, you know, who knows. But that, that they, they kind of, they built the sessions of built on each other, um, for the most part.

Peter Alberding: And, and, uh, that one kind of got me over the. I, you know, over the hump or I, I don’t know how to describe it just got me to a point of, okay, this is gonna happen and I, you know, there’s either something pleasant on the other side or there isn’t. Um, and I’m gonna find out and, uh, you know, it is what it [00:43:00] is, you know, for lack of a better way to phrase it.

Peter Alberding: And, um, I’m, I’m good with it, which I, you know, I think if you try to put yourself in the position of thinking about having a diagnosis like a LS

Peter Alberding: I’m, anybody who just sort of does the hypothetical, what was the, what if this was me? Uh, uh, you’d say I, um, I’d be scared. I, you know, I don’t know what I would do, but I certainly fear would be one, a big one. And, uh, I can confirm that that is, that is certainly part of the process. And then it’s like, well, what do you, okay, now, you know, now what?

Peter Alberding: Um, ’cause sitting around being afraid every day actually doesn’t move the ball forward in terms of addressing these things. And that’s, that’s sort of the process I went through. Michael, you were about to say something and I kept

Michael Alpert, M.D.: Yeah, I was, I was just thinking as you were talking about this, about, uh, well first of all, that [00:44:00] session in particular, how it was almost like this way of experiencing, at least from my perspective, it seemed like this way of experiencing this really feared thing, your, your death, but in a way that actually felt so supported and joyful and almost happy and, um.

Michael Alpert, M.D.: Something that came up in that session that’s come up in a couple of others is just all of the, uh, people in your life who care about you, who love you, who you feel so close with, and just feeling like they were really present with you, um, in that moment. Um, and then just being able to have this experience of this really feared thing, but in a way that actually felt almost blissful or happy and really connected with other people.

Michael Alpert, M.D.: It’s almost it, from my perspective, it seemed like being able to imagine dying in a radically different way than you had been almost, um, was kind of my read for [00:45:00] that. Um, and you know, just how in so many other sessions, kind of to what you’re talking about, each one’s built on each other and on the others, and, um, each one’s been a unique experience, but how.

Michael Alpert, M.D.: At each stage of this disease’s progression, it’s like those experiences are tapping into some of these fears. Like there’s been, there were some earlier sessions, um, where it was like your head was still there and then your body’s just kind of melting in and that, you know, the idea of the body melting away, especially just, you know, given how important your body’s been to you for, you know, so much of your life, you know, sports, music, it’s, everything has just involved.

Michael Alpert, M.D.: It. Just having this experience of the body melting away and having that actually be something that you felt pretty good about and pretty pleasant about how that was

Peter Alberding: almost mirrored well, and that was, that was in the [00:46:00] context of me. Thinking a lot about, you know, quality of life issues and kind of,

Michael Alpert, M.D.: yeah,

Peter Alberding: what’s, what, you know, how far can you go, kind of thing.

Peter Alberding: And I had a, um, a guy I was pretty good friends with who, who had a LS and passed away a year ago November, who chose to, he, he lived for about seven years, but by, you know, a little bit, very similar progression as mine. Uh, both where it started and the rate at which it got worse. And it was right around year three and a half or so, year four, where he was, IM like immobilized.

Peter Alberding: He had no function other than he could move his eyes and, you know, type with his eyeballs. And he got me thinking about, and this guy was full of joy, loved, you know, wanted to be alive, you know, under all circumstances. And he got me [00:47:00] thinking about the possibility of, you know, continuing for as long as you can.

Peter Alberding: And in that context, I had this session where, I mean, I describe it as if you see like a time lapse of a, of a, you know, an animal or a, you know, body decomposing into the earth. Um, not in a morbid way, just in a biological way. And I, my body decomposed in the earth and all that was above ground was my head.

Peter Alberding: And I remember laughing and saying, wow, you know, you can live a productive life with a functioning brain. Um, now my thinking on that has subsequently evolved. ’cause that’s, that is not a path that I would choose, that, I won’t choose that it’s, but those are obviously individual decisions. It was like, that was fascinating.

Peter Alberding: And I never in a million years, would that have been something that popped through, you know, went through my [00:48:00] brain that I experienced, you know, inside my brain with the absence, you know, in the absence of, you know, medical, uh, assistance. And it was, it was, you know, Michael, how many sessions have I done?

Peter Alberding: I’m not sure. 12 or 14 maybe. You know, I was, you may not know off the top of your head. It’s not, it’s a lot. I, you know, you, you’ve done,

Michael Alpert, M.D.: you’ve done a fair amount ball, I’d say ballpark. About a dozen,

Peter Alberding: yeah. Or so at this point. So that, that’s would be my guess. So let’s, let’s say it’s a dozen, I would say seven or eight have been, you know, sort of profound experiences and, uh, you know, four or so, were just.

Peter Alberding: Like, you know, no magic happened. I, I, you know, a lot of, uh, interesting stuff happened, but I didn’t really walk away with any insights or, [00:49:00] you know, that I, that, you know, we’re lasting. And to me that was okay. ’cause I, I remember, you know, every time we have a session, Michael and I have a conversation, should we keep doing this?

Peter Alberding: And, um, there might have been two in a row where there’s sort of, nothing profound happened. And I said, look, honestly, the, if I just do ketamine and it’s just escapism, and I, I spend a couple hours not thinking, you know, not even thinking about the, my condition, um, that’s therapeutic in and of itself. And, uh, and so, you know, not, I just, it’s, my point is not every session is, uh.

Peter Alberding: You know, God shows up and has a conversation with you. You know, I mean, it’s, they’re just not every time, you just don’t have a profound experience every time. But I had a lot of profound experiences.

Kyle Buller: I think that’s an important reminder even for folks that like always [00:50:00] wanna focus on like the mystical or big experiences.

Kyle Buller: I was trying to create a presentation a while ago for a conference when the mystical takes a vacation. Um, and it’s just like, you know, as you’re saying, like sometimes that rest is just as important just to tune out, to not think about what’s going on, right? Like when your life might just be like overridden by fear and anxiety to just get that space to finally rest is therapeutic.

Kyle Buller: So I really appreciate you kind of like highlighting that. ’cause I think when we talk about psychedelics, people are always want like, the really big experiences and, and that’s where, you know, a lot of the, the nuggets are, which to some degree is true, right? But I think there’s also the golden nuggets there when you’re able to just rest and,

Peter Alberding: yeah, and I think I went into, I’ve gone into every session, you know, sort of with no expectations of what’s gonna happen.

Peter Alberding: Michael and I talk about. You know, I, we will have conversations about what’s on my mind, but what’s on my mind is not necessarily, [00:51:00] not necessarily gonna have anything to do with what happens. Uh, you know, when the ketamine hits my brain, sometimes it does. Plenty of times it doesn’t.

Michael Alpert, M.D.: Yeah. And I’m just thinking as you’re talking about, uh, having a co a couple of these sessions that just really felt like a way of taking a break from everything else that’s going on and the value of those.

Michael Alpert, M.D.: You know, that’s something that I really try and take into a lot of the psychedelic work that I’ve been doing, uh, with, certainly with Ketamine, and also to an extent with some of the MDMA studies I was working on, um, where sure, there’s a ton of value that people can get out of these big mystical experiences coming face-to-face with death, all or some higher beings.

Michael Alpert, M.D.: There’s also a ton. That I think we really need to value in just having a chance for pure appreciation of beauty, escape, [00:52:00] joy, relaxation, all these qualities that can really come up. And the way that’s really influenced my work in the way I’ve approached it, um, since I started working with psychedelics is trying to take the music a little bit less self seriously than I had.

Michael Alpert, M.D.: And you know, I, Pete and I have talked a fair bit about the music that he’s listened to, the stuff that he likes. You know, I think there’s a lot of principles that I have tried to keep in mind when creating playlists, um, especially with someone who’s new to psychedelics, really trying to avoid lyrics in any languages that someone might understand, uh, curating a certain arc, um, what have you with that.

Michael Alpert, M.D.: And then there’s also really a time and plays for throwing in a song that. I think just might be really fun to listen to, uh, both for me and for, uh, the person who’s, uh, having the session. And I think some of the best moments in the Ketamine work that Pete and I have done together have [00:53:00] been when I’ve just put on like a Grateful Dead or Beatles song.

Peter Alberding: Yeah. I mean the, the the, um, uh, is it here, there and everywhere? Is that the Beatles song that Yeah. So there was one session where he opened. Yeah. Yeah. That and across the

Michael Alpert, M.D.: universe. Yeah.

Peter Alberding: And like he, Michael is a, is a, I I’ve come out of, uh, ketamine, uh, you know, journey a couple times that, dude, you are brilliant.

Peter Alberding: ’cause he’s, he’s throw, he’s either thrown a curve ball that was perfect. And I, I think a fair amount of time, it’s an audible, it’s not like he’s actively. Uh, making some choices. Uh, uh, most of the time it’s a set playlist, but not always. I, it is my sense and, and the, like that Beatles tone that it’s, that we started with because he, he’ll, we’ll talk about, you know, what, what’s, what kind of mode do you wanna be in today?

Peter Alberding: And I’m pretty consistent with [00:54:00] pleasant and relaxed and happy, you know, upbeat and, um, you know, starting a session with that song. Just, just set the, set the tone. I think it’s helpful that we share a similar interest in music at at least you, you understand what, you know, what I enjoy and the, you know, the types of instruments I prefer to hear.

Peter Alberding: And I’m gonna go out on a limb and say, you’re pretty good at that, among people that have different musical interests. And it is a, a, uh, I don’t wanna put a percentage on it, but like. The musical, the music aspect of a session is of significant importance, um, in how, uh, the experience is in any, in any given session.

Peter Alberding: I mean, um, some of those sessions where it was just, uh, well, you mentioned one earlier. I just, [00:55:00] I I spent the whole session amazed at the un unlikeliness of us even being on the planet, right? You can think back and say, well, you know, 10 generations ago somebody didn’t die of the bubonic plague, which, you know, and, and here we are, I mean, just the amaz amazement of human life, which, you know, what could sound like, you know, some guy who smokes some pot and is, you know, pontificating.

Peter Alberding: But it, it was powerful. And the, you know, just the spending some time contemplating the universe. Um,

Peter Alberding: may sound silly to some, but when you’re facing some, what I’m facing for me, uh, is not so silly. Um, so I, you know, each person’s individual, but things that might sound a little [00:56:00] esoteric or out there when you’re talking about, you know, uh, the end of life, um, has a little broader, uh, applicability.

Kyle Buller: That appreciation, right.

Peter Alberding: Yeah.

Kyle Buller: It’s just like,

Peter Alberding: because I, I’ve been focusing on, I’m sorry to interrupt the

Kyle Buller: Yeah.

Peter Alberding: And my wife and I have talked a lot about this, and we are really focused on instead of the sadness associated with my demise, which obviously exists and, and there’s, there’s plenty of that, but let’s focus on. The joy of the life we have and our experiences and you know, we have three adult children who are doing great and what we’ve created, and it is a heck of a lot better and healthier to focus on those positives, to get in the right mindset, to be accepting of what’s coming.

Kyle Buller: Do you think you would be able, [00:57:00] oh, sorry. You can go Michael. I was gonna say, do you think you, you would be able to appreciate those small little moments without like, you know, working with Michael and doing therapy and ketamine? Or do you feel like that fear and anxiety would continue to be debilitating in a way?

Kyle Buller: I,

Peter Alberding: I personally, I think it, you know, debilitating might be overstating it. I wasn’t, the fear and anxiety that I had was not debilitating. I was working in just, you know, sort of stuffing it in a, stuffing that stuff in a file cabinet. Um, reasonably well. I, I wouldn’t say I’m a particularly introspective person in my life, and I was highly confident that if I didn’t go into that file cabinet and start dealing with it, uh, it was gonna come back and bite me in the ass at some point.

Peter Alberding: Uh, and I thought I was prudent to try to avoid that, um, because I, I just think it’s hard to, it would be very difficult to be facing the end of your life and not [00:58:00] having processed of, you know, all of these issues.

Michael Alpert, M.D.: Yeah. I’m just thinking about how, and some of the, especially some of the earlier sessions, you know, you’ve talked about really feeling a need to, um, almost kind of hold, hold it together, put on a brave face and kind of get through, um, and kind of really be strong as you’re facing this and almost wanting to do that for other people and.

Michael Alpert, M.D.: Yeah, it’s really felt, at least from my end, like it’s been a value experience getting to, uh, talk about all of the range of things that are coming up for you. Um, the gratitude, the acceptance, and also some of the things I feel more, uh, vulnerable. Um,

Peter Alberding: and I, you know, I realized one of the things I realized a little early on was even if I want to be, woe is me or mad at the world or whatever, you [00:59:00] know, I’ve got lots of people close to me and they’re gonna need some leadership from the person who’s being right.

Peter Alberding: If I’m walking around with a dark cloud over my head all the time, um, you know, that’s not only is that not that good for me, but it’s really not helpful for others. And so I’ve, I’ve, part of my style is there’s a fair amount of morbid humor that, um, comes outta my mouth from time to time, which, uh. Uh, it’s, you know, part of my way of dealing with it, but I, I just don’t think any of this I would be in a far worse, I mean, I’m not even in a bad spot actually now I’m, I’m in a good spot, but I, I, I would not be in the spot I’m in without having the, um, I, I just, I’m not a huge talk therapy guy.

Peter Alberding: I just, I don’t really feel like I have that much to think, like, to talk about necessarily. But the combination of, of talk [01:00:00] therapy and, you know, I, I use the euphemism, you know, medical intervention or whatever medicinal intervention, um, is, is, is a mixture that brought it outta me, for sure.

Kyle Buller: How important has those, like integration sessions been for you?

Peter Alberding: Meaning, uh,

Peter Alberding: guess like the after the academy experience or the, the in-between sessions?

Kyle Buller: Yeah, the in between sessions.

Peter Alberding: We did, uh, you know, we had, I dunno, four or five talk sessions before Ketamine come into play. And then I think we did, uh, into three or four integration sessions. Does that sound right, Michael?

Peter Alberding: Something like that. Something like that, yeah. Yeah. We just, I, I think Michael and I had a particularly good rapport and, and we also had really good sessions after the ketamine. You know, I sort of came out of the Ketamine experience.

Michael Alpert, M.D.: Yeah. Like in that last hour,

Peter Alberding: in the [01:01:00] last hour. Um, and so we, it didn’t take that long to get to a point of Michael was comfortable and I was comfortable that the integration sessions were, uh, I, I, there was, I was doing sufficient self integrion so that when we, I got back for the next session, we could, you know, we would talk about it and I was, I would’ve done.

Peter Alberding: I sort of left it up to Michael to say, Leslie, you know, I’m happy to do these, uh, integration sessions. I don’t know that we need to, but I’ll, you know, I’ll let you be my, I mean, he’s been my guide the whole time.

Michael Alpert, M.D.: Yeah. I, I try and, uh, individualize it, especially after having had a couple of ketamine sessions, um, you know, for a number of factors.

Michael Alpert, M.D.: Um, it felt reasonable for us to, at this point, be in a cadence of just meeting for the ketamine sessions themselves. You know, in addition to the psychological piece, there’s also the logistical one, the fact that there was a number [01:02:00] of other appointments and things that you were going to Yeah, yeah.

Michael Alpert, M.D.: Wanting to be, you know, everything wrapping up work, spending time with your family and feeling, if you were feeling in putting all this together, like. The integration sessions either were not necessarily helpful or possibly even taking away from some of these other things that were going to be really important and meaningful for you.

Michael Alpert, M.D.: Um, I didn’t have a strong need to push that. Um, but we do always have time before and after the dosing to really process that. And especially right afterwards, the lines are open if there’s something that’s coming up and we need to chat.

Peter Alberding: I think if someone is maybe in a deeper crisis situation, I’m sure it’s you probably you’d push a little harder to have integration sessions.

Peter Alberding: Mm-hmm. Right? Mm-hmm. And, but I think most of our ketamine sessions we’re probably 90 minutes in, in a talk session before we even get to the ketamine. We are. Yeah. Seems to me we spend a [01:03:00] lot of time on, uh, at our appointments.

Michael Alpert, M.D.: Yeah. We do a fair amount of talking and I think you’re usually inside for about 40 minutes or so.

Michael Alpert, M.D.: Yeah. It’s been pretty consistent. Yeah. Um, we’ll do a like. We’ll do an initial dose and then maybe, uh, like 15 milligram booster, about 15 minutes in or so. And with that, you’ve been pretty consistently waking up after 40 minutes, so that at least there’s the time relief for talking. Yeah. Um, and more recently, the frame has shifted a bit where, um, I’m now going over to, uh, Peter’s house and administering it, um, for, uh, you know, a number of reasons, which has, um, you know, shifted, I mean, can, can’t drive, and I’m not, I just

Peter Alberding: physically,

Michael Alpert, M.D.: uh, yeah.

Peter Alberding: The ability to get to Michael’s office is, uh, isn’t really there. I mean, I,

Michael Alpert, M.D.: yeah. And so we had like one session with, uh, Peter’s wife and, um, yeah. Now the, it’s shifted a bit how we’re doing the work.

Peter Alberding: Yeah, yeah. Yeah. [01:04:00]

Kyle Buller: Have you noticed a difference between doing it in the office versus your home?

Peter Alberding: Well, so the, the first time we did it at. At at home Lynn. Lynn was there, correct? Yeah. Yeah. So I mean, we were married for 33 years. We met in college, like, you know, we, we’d been known each other for a long time. Um, and she sort of sat by my side and I held her hand and I, I stroked her hair and told her I loved her and apologized for being sick.

Peter Alberding: I mean, it was a, I, I cried. It was, it was quite emotional for me. Uh, interestingly, it wasn’t that emotional for her. ’cause you, you know, you’re not, she was just sitting next to me, but didn’t really, you know, nobody would know what’s going on in the, in the person’s brain. Um, and so that was pretty powerful.

Peter Alberding: It was comfortable to be at home. Otherwise it’s, you know, you, you’ve got eye shades on. [01:05:00] You’re listening to music. I, it could be, you know, you could be, I, for me, I think, I feel like I could be anywhere. My, you know, like in the, in the, uh, the most recent session. I mean, this was pretty interesting as, ’cause I’ve never, I’ve always been comfortable lay down and, you know, sort of ready to go when it’s time.

Peter Alberding: And in the last, I don’t know, six or eight weeks, my breathing has, uh, declined, you know, considerably that like, if I lay flat on a floor, I, I might suffocate if I didn’t have breathing assistance. And so I need to be at an angle. But, uh, before the last session, I was just in some, some respiratory distress and I was a little stressed and like, I think Michael had the syringe, like ready to go and I, I hit the, hit the abort button like three or four times.

Peter Alberding: I said, you know, I’m sorry, I need a minute. And had to crank up my ventilation, uh, device to get my [01:06:00] breathing back on track. And so I was really, I was worried about having. You know, respiratory, uh, and, you know, you get, they, they, it’s a vicious cycle if you start having a respiratory distress. ’cause that distress just gets, increases the respiratory distress.

Peter Alberding: And I struck me as, uh, problematic to be in some respiratory distress while on ketamine. Um, so there are some unique aspects to, uh, Michael coming here so I can be tilted up. Um, and obviously have my machine, you know, at my side and, uh, you know, helping me, um, just get through the session.

Kyle Buller: You bring up like an interesting point.

Kyle Buller: And Michael, I’m curious like, is there a point where, you know, we know Ketamine is, has a pretty decent safety profile used in the hospital all the time. Is there a point where like, you know, the [01:07:00] disease is at a certain point where it feels risky to possibly use ketamine?

Michael Alpert, M.D.: I mean, the, the short answer is there’s always going to be some sort of risk involved with, uh, dosing someone with ketamine.

Michael Alpert, M.D.: Um, you know, it can have, um, a number of different effects. Uh, there’s a very small but non-zero chance of laryngospasm. Uh, you have the blood pressure effect, any number of other things that can be coming up. Um, what I would say with that is if it seemed like, um, say Pete’s. Medical profile had, uh, shifted significantly to the point that say you, you know, were having, uh, real trouble, um, uh, uh, very real, uh, trouble getting the oxygen that you’re needing even without ketamine on board.

Michael Alpert, M.D.: Um, I’d probably be having a discussion with, um, PCP, maybe having a care [01:08:00] team meeting just for us to be reassessing what the risks were in that situation. So short answer is everybody’s going to be different. That said, it is, uh, something that I have worked with and many other people have, uh, worked with, with patients who are in hospice settings.

Michael Alpert, M.D.: And, um, there’s, uh, many hospice providers who, um, will work with ketamine as a form of pain control. So. I wouldn’t say that there is any say all or nothing, and each case is just going to be individualized. But especially for something like this, we’re going to wanna be thinking, uh, through things on an ongoing basis.

Kyle Buller: Oh, you’re muted there. Oh,

Michael Alpert, M.D.: Pete, Pete.

Peter Alberding: Yeah. No, I was telling my wife that the doorbell is about to ring. Um, well, I can assure you that the thought has occurred to me also, that there’s potentially some, uh, you know, some risk, uh, as, in addition to Michael thinking about it, the one, uh, consideration that [01:09:00] I’ve had is the, the, the non-invasive ventilation unit that I have is like, if I, if I stop breathing and this thing is attached to me, it’s gonna blow enough air into my lungs to keep me breathing.

Peter Alberding: Um, so there’s a significant, uh, sort of safety valve associated with having my BiPAP machine, you know. Running and attached. Uh, just from my perspective, I, I know that, um, and, you know, that’s, that’s part of the reason I wear it, but it’s a pretty sophisticated device that’s not just blowing the same amount of air every time.

Peter Alberding: It responds to what’s what, how my, what my respiration is in terms of how hard it’s going to fill my lungs up. Um, which is not me thinking of a moment from a unique circumstance. I, most people are not dealing with my, the disease that I have. But

Michael Alpert, M.D.: yeah, I was just thinking of a moment in one of our earlier [01:10:00] sessions where you were very still on the sofa in my office and it was this moment of almost experiencing a deathlike stillness.

Michael Alpert, M.D.: And I remember from my perspective, just watching you being a little bit nervous, and then you started breathing and then you told me afterwards in the integration that you were thinking, oh no, here’s this, uh, you know, six, five dead guy on my, so five, you know, Michael’s probably gonna be getting worried.

Michael Alpert, M.D.: I gotta take a couple of breaths. Um, so, you know, this being something that’s kind of been an ongoing part of our, uh, work together.

Peter Alberding: Yeah, that was funny. Yeah.

Michael Alpert, M.D.: Just

Peter Alberding: in that vein, the, uh, the time where I was, I was envisioning dying and the silhouettes around the bed. I remember saying to myself sort of at the end of like, don’t die actually.

Peter Alberding: Now you’re on ketamine, so don’t die. ’cause Michael’s gonna have a problem on his hands among other things, uh, which is part of the dark humor. [01:11:00]

Kyle Buller: Which is probably needed at times. Right.

Peter Alberding: I think if you can’t laugh about some things, it’s far worse.

Kyle Buller: Yeah. Yeah. All right. Well, I actually see we’re a little bit over time and this, uh, interview just flew by.

Kyle Buller: So, um, Peter, I just really appreciate you and your time and for sharing your story. I feel like this is gonna be really helpful for a lot of people listening that, you know, maybe they’re going through it, family members, um, just getting some insight. And Michael, thank you as well for, um, you know, sharing all your insights and, and pitching this idea.

Kyle Buller: So I would love to wrap up with some closing thoughts. Um, and Michael, since you just went off mute, maybe we’ll pass it over to you if you have any like, closing thoughts to, to wrap up.

Michael Alpert, M.D.: Sure. Well, first of all, I wanna thank both of you for, uh, doing this interview and, uh, it’s been such a privilege to be able to accompany Pete on this journey over the past couple of years.

Michael Alpert, M.D.: And I’m hoping that in the course of. Our work together. And also in the course [01:12:00] of doing this podcast, it’ll get people to really, seriously consider what role, not only ketamine can be playing, but ketamine assisted psychotherapy that really pays attention to the role of things like, uh, music talk therapy, the preparation, all of these other aspects that have just been so influential to the work that we’ve been doing together, and take these seriously as we’re thinking about what it means to be incorporating Ketamine, uh, into mental health context and more specifically psychedelics into, uh, western medicine at this point in time.

Peter Alberding: Well, my pleasure to be on with both you guys. Um, I, uh, my attitude is I, I would like the, you know, whatever the traditional medical community or however you wanna phrase that to particularly people dealing with like critical life, you know, life ending illnesses to, uh. Be knowledgeable about ketamine [01:13:00] and how beneficial it can be to, for many people.

Peter Alberding: Uh, you know, I don’t know that it’s right for everybody or not right for everybody. I, but I would encourage anybody who’s dealing just from, from a existential angst standpoint, I think there are many other applications for, for academy treatment. But as far as I’m concerned or my, you know, my specific situation, uh, I would encourage anybody to at least get educated and consider how it might be helpful.

Peter Alberding: Um, because it has had enormous, enormous, I’ve had enormous benefits from it that, um, I’m grateful that I found Michael. Frankly, I, I’d be in a far different situation, um, uh, in the absence of the relationship that we’ve developed.

Kyle Buller: I am glad that you found Michael as well and were able to start this journey.

Kyle Buller: So yeah, thank you again both and Peter, thank you for your [01:14:00] very vulnerable and, and shares with us today. It’s been been a real blessing. Yeah.