In this episode, I talk about healing trauma and CPTSD with Ketamine Therapy together with guest speaker Dr. Ken Adolph.
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In this episode, I talk about healing trauma and CPTSD with Ketamine Therapy together with guest speaker Dr. Ken Adolph. Join the Think Unbroken Community Coaching Sessions at coaching.thinkunbroken.com
Read my book Think Unbroken for FREE at book.thinkunbroken.com
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Hey, what's up Unbroken Nation. Hope that you were doing well wherever you are in the world.
I'm Michael Anthony author, speaker, coach, and advocate for adult survivors of childhood trauma and you're listening to the Michael Unbroken podcast today.
I am joined by Dr. Ken Adolph- a certified board cardiac anesthesiologist, which I mean, Wow! the amount of effort and work that takes just to get that title plus more importantly the conversation that we're going to be having today around Ketamine Therapy, I'm super excited about this one. Hi, my friend! How are you today?
Dr. Ken: I'm great and thank you again for having me on this. This is going to be very interesting.
Michael: It's my pleasure. First and foremost before we jump in, can you tell everybody a little bit about yourself?
Dr.Ken: Sure. So you stated that I was a cardiac anesthesiologist. That's true. I've been in practice for about 20 years here in Austin, Texas. That's been my primary place of practice is in one hospital and providing care for patients who are undergoing heart surgery. Most people would be out there asking, “Well, how in the world did you get connected to ketamine? And how, you know it, What is the connection?”
Before I get to that, I want you to know and reach out to everyone, that I am a sufferer of generalized anxiety. And so from the beginning of training, I knew that this was going to be a long journey for me. Because of the stress and the anxiety that I was fighting against, I felt alone, I fell silent, ashamed, because I felt like I needed to be Superman. I needed to put a cape on and be everything for everybody at all times. That left me again alone and disconnected. Most of the time that I was in practice, I felt disconnected and I felt on the outside and part of that is my upbringing. I'm sure that most people out there can certainly identify with that. I felt like growing up as an athlete mostly and then suddenly turned the stern of the ship into becoming a student and, you know, eventually a physician.-I really want to make that known to everyone out there that even though, “Wow!” It's a “wow!” It's also doesn't come without a certain amount of stress. And from stress, of course, we know some trauma related to that. Although that's my perception -that's my trauma perception.
Michael: I think about that and it holds true for many people. I mean, not only being under the stages and terms under the lights but in terms of on the stage of the playing field. Also now in academics and academia, being deeply thrust within this thing and expectations are high. I think about stress, anxiety, and depression which often tend to kind of loom within each other. And then you’re often, if you had an experience anything like mine, being dissociated and kind of just having this out-of-body experience commonly. I want to dive into that.
But first, as we kind of head into this, I think 2 things are going to be really important to have as a precursor of this conversation. Ken, 1.) Talk to me about the thing in which ketamine made you curious, and 2.) then to what is ketamine?
Dr.Ken: Okay, first, I'll tell you what's ketamine and then I'll answer how I became interested in it.
Ketamine is actually an anesthetic and is recognized as one of the broadly used anesthetics. It's even used in veterinary medicine around the world and so it's very important to keep it where it is and utilize it in a safe manner. So it was developed because, in World War II, our veterans on the battlefield were dying of morphine overdose. It was a standard dose injection, meaning intramuscular ejection, through the pants and with someone who is of course gravely injured on the battlefield and that was causing respiratory depression. So the same thing that we're seeing now, with deaths with the opioid epidemic that we have in this country, we see deaths related to respiratory depression.
Ketamine was developed so that we did have a safer drug on the battlefield. And so it was called the Buddy Drug. Ketamine increases heart rate, increases blood pressure and it does not decrease respiratory depression, respiratory drive, and so very safe drug because it's an analgesic and does hit the opioid receptor which so does morphine, but it hits a lot of other receptors. So initially it was developed as an anesthetic and it is in its own class - again, it was described as a dissociate. So what I mean is it basically allows your brain to drift off into the unconscious because you no longer have the sensation or the body sensory in place that's coming to your brain. So you can literally perform, you know, small surgical procedures even in the field. Setting an arm that's broken, a shoulder that's dislocated. It's a lot and like I said, a very safe drug used in ERS in Pediatric.
You could imagine in veterinary medicine. You wouldn't want to have to control the airway of a giraffe or a horse so that you want to keep them breathing. Most of the time when you see that shot, that's a dart that goes into a tiger, that's ketamine. It will sedate them safely and allow them to continue breathing. So that's kind of ketamine in a nutshell
The connection for me is, of course, I'm familiar with it in the use of it. It's so safe and being that it doesn't decrease heart rate or decreased blood pressure in the cardiac operating room. We need drugs that are cardiac safe and that is a cardiac safe drug because of those things. And so if I have someone who's very ill from a heart standpoint, where their heart isn't pumping or squeezing adequately I can provide an anesthetic upfront that will allow them to be anesthetized safely.
Michael: Can you talk about the differentiation between ketamine in this medical practice versus what I'm used to growing up on the streets being Special K?
Dr. Ken: In the operating room we’re mainly using it for an anesthetic, and it’s really mean. When you need an anesthetic, you need analgesia, you need amnesia or amnestic where you don't remember things. You also needed in a dose where it's going to be again safe. Just like many of the drugs, fentanyl is a drug that's used in the operating room. It does make its way to the street and it's used illicitly but you know, it also can be brought back into looking at it as a therapeutic way of being able to help patients in other ways.
Back in the 90s, they began to recognize - again in the military, that in the Burn Unit, soldiers who were having debridements when they're burned- they have to go through multiple different operations, essentially where they're having this excess burn skin taken from their body. There were a group of patients that were receiving a drug called propofol. You may be familiar with that with Michael Jackson. There's another set of patients who were being anesthetized with ketamine and they would come out of these experiences reliving some of their traumas on the battlefield and being able to process them. That began the thought that “Wow, these guys are having less, you know, PTSD long-term. Maybe there's something that we can look at here.” And so began a process where we started to utilize many different modes. I mean, you know I won't go into detail about the studies but, essentially utilizing ketamine as a dissociative you use that term dissociation. This is a dissociative drug meaning that it allows you to escape the input of your body so that you're just basically free to roam your unconscious.
Michael: What is it about this drug particularly that makes it so ethical in treating things like depression, anxiety, mood disorder, suicidal ideation? Something of that nature. Years ago, I started doing research on ketamine and still to this point have not tried it but I'm incredibly curious about it because you go look at research and white papers, anywhere from Harvard to beyond and everything points to this efficacy rate in the high 80s to even 90% in treating these ailments. What is it about ketamine that is so much different than all the other efforts that we've seen in Pharmacology?
Dr.Ken: I'm going to make a point of being able to answer your question, but I'm going to ask you to remind me on the backend- integration, integration, integration. So we can talk about that after because for me, the molecule affects a receptor, it puts us in a state of mind that allows us to see our life through a new lens. We again have to take that information and reap to begin to process that.
So, to answer your question from a scientific standpoint even in low doses, what ketamine does is it allows our prefrontal cortex and our hippocampus to no longer communicate. So, when we get into the rumination cycles that we do when we are depressed, or when we're anxious, or when we experience trauma, we cannot get out of that loop. Even with suicide and it also applies to eating disorders with you know - body dysmorphia, where we constantly are in this loop where we can't get unstuck. Ketamine allows us to be able to afford just a second. Set aside from the default mode network, I'm not sure if some of your listeners are familiar with that but that is that Loop. The default mode network will turn off when we undergo a ketamine infusion. It's allowing us to be able to one severe that rumination Loop. Allows us to be able to again have moments of gratitude, have moments to realize that our life is important. That we are interconnected in many different ways. And again, ketamine is in these effects are dose-related and we can get into that if you'd like but that's really what ketamine is essentially so powerful in its being able to stop that rumination cycle just for a moment for that hour.
Michael: So effectively, then what is happening is you're looking at a chemical reaction happening through this being administered intravenously?
Dr.Ken: There are several different routes. So intravenously is the way that we do it at ILLUMMA- our clinic here in Austin. But there are other ways you can give it. Intramuscularly for example. For bio-availability, the amount of drug that's available to the brain is very high for IV. It's 99 to 100%. But for IM, it might be 93 to 94 percent. You have the benefits of having IV is that, if a patient has suffered trauma and they're undergoing and reliving or you know, revisiting of that experience, we can turn the infusion down. If they're starting to feel uncomfortable or we see that they're moving around or you know, almost trying to get out of the chair- IM it’s in your body and either having to give another drug to help with that but with IV, it's turning it on or turning it off.
Michael: One of the things I'm very curious about is - so if you're in this space and let's say let's pretend for a moment that I have absolutely no idea about anything we've talked about to this point and I'm really not connecting the dots on what ketamine is or does or why it put in an ethic-able in trauma, therapy, or therapy in general - at a high-level if you were to simplify this in two sentences, what does ketamine do in regards to mental health?
Dr.Ken: Okay. So instead of concentrating on the science because sometimes you can get confused, Ketamine just doesn't act like the NMDA receptor and blocks that. I mean, there's we can get into the science of it but to be completely basic and broad. It allows that patient to be able to escape essentially the rumination that they've been undergoing. The narrative that they live on a daily basis and look at their life through a different lens. When they come out of that, they're able to sit with a therapist who has experience with ketamine, who can guide them through being able to know what that experience. It is like being able to say, “Let's look at that experience. Let's look at how you saw that experience or how you re-live that experience”, to be able to guide them.
One of the most important things about ketamine is that it releases something called BDNF- brain-derived neurotrophic factor. So the neurons that we have that are in atrophy, kind of shrivel or shrink like if we think of a tree, some of the neurons that are used in those connections are no longer firing so ketamine wakes them up. We're able to rewire the brain so to speak. When we begin to think more positively where we are able to relive that experience and form new memories so that we can see where our lives are about In a different light. Are you familiar with the term narrative identity?
Michael: Yeah, I am. But for those who are listening, go please feel free.
Dr. Ken: Memory is so important. I think that anybody out there who has lived a life of multiple different traumas or like you said where they've experienced dissociation- to be able to deal with that trauma- knowing that ketamine can be an essential part of breaking the narrative of an individual, it is important to know. What I mean by that is that that experience in anyone's life can form your story. Just like, you asked me or if you asked anybody- to tell me about yourself - if someone starts off with the pain that they're suffering from, that’s inescapable and that they're unable to function in their life, that becomes their narrative and it can affect everything. From dementia to their somatic response and those thoughts. When I say narrative, it becomes who they are and to the core -feeling like a broken person.
Michael: I would have to think part of this is also a reclaim of your body. Like what role does that play? Because as someone who went through, a lot of trauma, and dealt with chronic pain for a very long time, one of the things that I noticed and think was, as my mental health got better, my physical pain started to reduce. It's not that I still don't have physical pain. I have to deal with having chronic health issues, What what role does ketamine play in that?
Dr.Ken: I believe that like you said, you've noticed that in the work that you do, that those physical symptoms are beginning to alleviate. I believe that when we suffer trauma, or when we suffer long-term depression and anxiety, it begins to manifest as physical symptoms. If we do not face it, our we do not deal with it- I call it whack-a-mole. I mean, it happened to me, in my life where my chronic anxiety turned to panic attacks had no idea why they were coming, but it's my brain forcing myself to say, you know, I can't control my heart rate, I become out of control and If you're an anxious person, that's what we deal with. We want to be in control of our lives, and if we don't face our real true emotions, the core wound. I believe that it will manifest as chronic back pain, chronic neck, pain, shoulder pain, fibromyalgia dysautonomia. I don't know if people are familiar out there, where you get dizzy spells. We see all of these things in the clinic where patients come in and they've gone through a battery of tests with multiple different physicians where they see that they have no way of or no answer to their physical symptoms but there really aren't addressing their their their psychological issues.
Michael: Yeah, I mean I literally could not agree with you more and that was my experience too. I had this moment where I noticed I was having 4-5 panic attacks a day, that dawned on me in that moment like “ Wow! You have some shit you need to work on because this is your body and your mind trying to expel the chaos that you're consuming.”
You know for me, speaking as a man, it was just like “ Push it down. Push it down, push it down.” and eventually, you can't push it down anymore. It is a boiling pot, ready to explode. It kind of just destroyed my life for a while because I had to pause and go. What is really happening?
What is the long-term efficacy of ketamine here? What I'm concerned about in the context of this conversation, not fully understanding it, and realizing it to this point is, How does it play on the long-term game? Is this an immediate Quick Fix? Is this something that works for 20 years down the road? You do one IV and you're good to go. Talk to me a little bit more about the long-term impact of usage.
Dr. Ken: I think that that's going to be patient-dependent just like anything else. We have patients that come in that are suicidal and the best thing about ketamine is that it's been shown to be effective for extinguishing suicidal ideation within 24 hours. Within an hour of having an infusion that idea or that rumination is gone. That's one end of the spectrum.
We also have the other end of the spectrum which are high functioning. I call high-functioning individuals who are suffering from perfectionism. They have this just unwielding need to succeed and that is keeping them up. They have terrible sleep patterns. They are trying to use Adderall to be highly effective in their lives and then using Ambien or something else at night and they're just completely out of sync. With that spectrum, we have to have a care plan for each individual and have it carried out effectively for each.
What that may look like Is that, for someone who's suicidal we require that they have a psychiatrist, that they have a therapist that they're seeing. We do it on a daily basis initially and then eventually when we start to get out from a month after they finish, let's say 6, which is what we do at the clinic. Two infusions a week for two weeks, and then one infusion a week for another two weeks. And that is just the beginning. Sometimes for those patients where they’ve broken the cycle, they've broken that rumination and now they're doing the deep work where they may be undergoing ketamine assisted psychotherapy, using an oral form. There's also a nasal spray form.
That looks very different than the high-functioning who suddenly may be seized in the middle. Maybe around the third infusion, they go like “Aha! I see what I'm doing to myself”. As they're finishing their series, they're like, “I have such an appreciation for where I am. I have this renewed love for my family. I've noticed that I have broken relationships because of my need to succeed and to be this perfectionist and have this materialistic drive.” They will again have a very much more changing diet using yoga, meditation, integrated practices that are more self-provided.
It’s not that the person that is suicidal may not get there but they need a slower progression through this process. Maybe a year. We even begin to think of changing other things and talk to them about coming down off of medications. I'm not sure how in-depth you've talked about SSRIs how difficult it is for patients to get off of those drugs. Ketamine can help that.
Michael: I don't typically go that route because for me I had just an incredibly awful experience when I was trying pharmacology in my mid-20s and it felt to me like to numb myself would defeat the purpose of trying to put myself in a position to become mentally, astute and healthy. It's something that I'm constantly curious about reading research trying to understand it. I just found for me, it wasn't the right fit whereas other things were non-traditional, you know, from LSD to psilocybin has really played a beautiful role in my healing journey. In regard to the academy, one of the things that I'm immediately curious about is, Does it in any way inhibits the release of cortisol?
Dr. Ken: No, not that I know of I mean it has a cascade of a hundred different things. It mainly is an antagonist at the NMDA receptor, which creates a flood of glutamate into the brain. Not many people know because we hear of serotonin, norepinephrine, dopamine one of the other neurotransmitters but glutamate is really the workhorse in our prefrontal cortex of forming memory. That's why it's so important because it can reform memory. We can rewire our brains because we have the ability to do so. Our brains are fraught with the means to be able to process memories. It is different for everybody and like you said with dissociation, our brains shut off and so those memories will be very different from person to person, even experiencing the same traumatic experience. We've seen that in science and I am also a believer as you are with psychedelic medicine. I mean, ketamine is psychotropic. I'm excited to see psilocybin and MDMA, Ambien, you know as it’s being researched now. I think that it's the future of mental health, you know, as far as care.
Michael: I agree with you and it just makes more sense why this brings this point of looking up the prescription drug pandemic in this country. I mean, it's taken multiple members of my family, including my mother who was addicted to SSRIs, could not get off. Then, you know that story goes and goes and goes. Looking at the impact that it has across this nation. and yet we have these for the most part -naturally, occurring substances, and the environment, in which we live and then being cast a shadow because they can't be controlled by pharmaceutical companies. Why is ketamine not more readily available as an instantaneous treatment in these scenarios?
Dr.Ken: Well, it is first of all because it's a schedule three drug and it can be used as an off-label you know for what we're doing. So there's nothing illegal about it and it's not underground. Obviously, it is the one. You know, that we have that can produce these experiences that are similar to psilocybin similar to LSD that allow patients to again experience their subconscious. I truly think that the difference between ketamine and those compounds that you talked about is that ketamine allows you to experience these things subconsciously like in a dream state and it allows your brain to process them. The way that our brains are allowed to take in the information. And so oftentimes when I wake up after an infusion I just feel light and less triggered and I mean it's a freeing feeling and so you know it's again further out that I get you to know we've been open for two years and I've been receiving. Ketamine infusion is probably about every eight weeks from my initial series and it is always a reprogramming. It's a reset and I really feel like right now utilizing something that like ketamine, which is not covered by insurance companies because we don't have the ability to go and do the large studies with ketamine, it's an old drug. And like you said, we don't need to get into conspiracy theories about that, but there's a reason why J&J was able to twist the drug on its axis and then come out with spur Votto, which is ketamine in In a different state and so you can go to your psychiatrist asked for spur. Votto it's covered under your insurance company but it still ends up being hundreds of dollars per visit and it's not as effective. It's not as strong and it seems to have fallen off the edge of the table therefore for the effectiveness of the treatment. And so, you know, like you we the crazy thing is that right now we're looking At 80 percent of the companies that were in the development and research of mental health medications, no longer are putting that money into it because I believe they know what is coming and what's coming in the Psychedelic movement?
Michael: Yeah and Portland just legalized pretty much most psychedelics and you know that's going to roll out and eventually like we have Cannabis stores, we will have psilocybin. Open stores. And, you know, I think about the impact that's had in my own life, you know, doing these almost heroic doses of psilocybin. Having these associative memories placed in the boxes that they need to go. Thus removing them from my shoulders, feels very much similar to the experience that I think one may have with ketamine.
Dr. Ken: Yeah. Well, and I think you're right, and I think that what's important to remember is that ketamine when we provide it, Ivy, we have someone in the room with the patient at all time. They're in a recliner. They have an eye mask on. They have a noise you know binaural beats or just noise canceling music and they're monitored the entire time. Heart rate blood pressure pulse oximetry, which is oxygenation and so patients. Feel safe. And this experience is going to spill over eventually when we have Scylla. Reiben and MDMA at our disposal for clinical use, we're going to have to coddle it and utilize it in a clinical way, which again, I'm like you, I've experienced many different psychedelics and in those States. It's more of a feeling with friends or Outdoors or it feels more shamanistic and ceremonial than in a clinical setting. And so, I would say that in our Clinic, we try to provide that space for each patient to be able to experience it on their own without any communication. We allow them to be in a state of dissociation and not disturb them. That's for mental health providers. Who are familiar with it because, in low doses, you can do some fantastic work. Ketamine-assisted psychotherapy. but it takes a psychotherapist to be able to do that or someone who is is trained to be able to provide that service.
Michael: Yeah, and I think about my own experience and psychedelics the most impact, I believe that they ever had was when I was in a sensory deprivation tank floating by myself for like 4, to 6 hours. Yeah. And just having these deep dives into my subconscious and, and looking at all these members, literally like the Matrix that time, where I was like diving into these moments, reframing them, reprocessing them getting where they needed to go, and then coming out. And then having these conversations with With my VIN therapist about the impact of it.
One of the things as we start to wrap up here as you mention integration, and I believe that is without question. One of the most important things that you can do in any healing Journey when it comes to mental health. Ailments, what does that mean in the context of ketamine?
Dr. Ken: What I believe is that it has to be again individualized to the patient if it's trauma, as you know, EMDR combined with ketamine, Really, if they can go to their EMDR therapist within 24 hours, fantastic work. We see huge benefits and results in patients, who are plugged into? Those therapists ahead of time. It's really we have also another and you know we're in covid. And so we touched and reached out to a company called being true to you and they have ketamine assisted psychotherapists who can provide That therapy just telemed or, you know, Zoom calls and to be able to help those patients. Be able to work through and get their integration that way which I think has been very beneficial for us because it provides something that, you know, we don't have a lot of those providers available here in Austin. And so being able to do it remotely at, you know, again immediately after having an infusion has been very beneficial. For other patients, I think it's anything from gardening to journaling if you know writing is amazing, as far as being able to spill your thoughts out onto a page, you know, and seeing what your progression is because your thought process changes over periods of time and be able to go back and read where those where you were. There's a sense of gratitude for being able to know that I've made you know, tremendous progress.
I've talked to patients, one more thing is that I've talked to patients that feel like a month out, or two months out that they feel as though they're slipping or that, they're that they're, you know, feeling like they're going back. And, and I say, well, go back and think to revisit those that place that you were when you first came into the clinic. And right now, you don't have kids, I mean in your system because an infusion the infusion is gone and we can you know, utilize something called a lozenge or trochee and it's a smaller dose. It's somebody that a patient can be prescribed when we're trying to help them through the most difficult aspects of say, you know, depression or anxiety at post-infusion, where they're doing the work and they are maybe the next day feeling much the difference and said, there's no ketamine in their bodies. It's Not like an SSRI where it's long-acting and it's changing your brain architecture for the worst. It's actually reforming those neural connections so that it reminds patients that that's the difference because patients that come to us with SSRIs. They're automatically thinking that it's related to the drug and negatively. Does that make sense?
Michael: Yeah, absolutely. And I think that's such a point. I'm glad you brought that up because it and again it's going to be different for everyone. I would be remiss if I didn't step into asking you about the power of gratitude in your life. One, I see the poster behind you but also you've mentioned gratitude in your own life, a few times. And I'm a proponent sign me up. I think it's so incredibly necessary. Even if your life isn't as great as you think it is, I believe that there's still always something to be thankful for what role does that play in your life?
Dr. Ken: It's a wake-up and I have a practice of reading. I'm not sure if you're familiar with the daily stoic, or stoicism, or Ryan Holiday. He, he wrote a great book, and it’s broken down into 365 quotes. Essentially evolved the great stoic philosophers, and that's where I start because it's it really. It's an empowering way to put a positive, it e in your life right out of and I start with, you know, my health and then I go to my family at two sons have a wonderful partner in life and in my business. She is just an absolute godsend to me because I know that when I'm struggling, she is my pillar and I just have such gratitude for someone else in my life that shares the same philosophy and that is, you know, Oh, and I teach my son's every time that we sit down to have dinner. That's part of an everybody has to go around and talk about what they're thankful for in that day. And, you know, I think that that's where we need to sit at least temporarily because when, you know, as you know, with the stoics, we can only control what we think and how we feel. No one else is going to be able to take that from me.
Michael: Yeah, I love that. I mean, I resonate with that in such a real intrinsic way. Ken, this has been an absolutely amazing conversation. Before I ask you my last question, tell everybody where they can find you.
Dr.Ken: So the clinic is ILLUMMA, it's two L's and two M’send. So it's Illumma.com or @illumma on Instagram, so we have lots of great quotes and explanations. They can go to our website which is filled with articles and studies and information as to how ketamine works. How an infusion looks and it goes into much more detail and you know we answer every question, every reach out, whether they're in Austin or if they're you know in another country because you know we're a believer in the grassroots explanation and development of these therapies
Michael: Beautiful. Beautiful and Ken my last question for you is, what does it mean to you to be unbroken?
Dr.Ken: I believe that unbroken to me is resilience. It's standing in a place where you know that you've been through absolute hell. Your armor may be battered but you're standing tall. Your sword is sheathed -not unsheathed, and you are ready to face the day because you've been through everything and you're ready for life.
Michael: Man, that's beautiful. Literally, have goosebumps! If you could see, man I love that! I resonate again. Ken amazing conversation. Unbroken Nation, please check out ILLUMMA. Follow, Like Subscribe, Leave a comment and a review.
Until next time my friend...
Dr. Ken Adolph is a Board Certified Cardiac Anesthesiologist and medical director of Illumma, as well as a member of the American Society of Ketamine Physicians.
Dr. Adolph was born and raised in New Orleans and received a Bachelor of Science and MD from Louisiana State University. Ken completed his residency and cardiac fellowship in Anesthesia at the renowned Emory University in Atlanta. In 1998, Dr. Adolph moved to Austin, Texas to open the, now nationally recognized, Heart Hospital of Austin where he has spent over two decades caring for patients and building a practice with CV Anesthesiology, PA. Health and wellness have always been paramount to Ken in his personal and professional life with a strong interest in mental health and the effects of trauma on the human experience.
Through his own struggles with anxiety, he understands what a significant impact mindset can have on one’s interpretation of the world. Using his unique training and his empathetic and compassionate mindset, Dr. Adolph is committed to improving the lives of patients. During his free time, he’s on his mountain bike, catching fish on the Texas coast or touring the country with his two boys and his girlfriend in their Airstream.