D.O. or Do Not: The Osteopathic Physician's Journey for Premed & Medical Students

Episode 50: Justin Boge D.O. Anesthesiologist

June 15, 2021 Season 1 Episode 50
D.O. or Do Not: The Osteopathic Physician's Journey for Premed & Medical Students
Episode 50: Justin Boge D.O. Anesthesiologist
Show Notes Transcript

In this episode of D.O. or Do Not, we welcome Dr. Justin Boge.

Dr. Boge did a residency in anesthesiology at UW Madison and a fellowship in pain medicine at Oregon Health and Science University. He is an Air Force veteran who is currently on staff at Gundersen Health System in La Crosse, Wisconsin.  While working part-time in his pain management practice, he is simultaneously furthering his education with a Master of Health Administration through Cornell University.

In this interview, Dr. Boge will tell us how he chose osteopathic medicine and why he decided to pursue extra time as a teaching assistant in osteopathic manipulation while in medical school at Des Moines University. He will talk about his experiences serving in Iraq and how he chose to specialize in anesthesia and pain management. I hope you enjoy his story and journey in being and becoming an osteopathic physician. Thanks for listening!

Hosted by Tiffany Carlson
Edited by Nicholas Buskill

My name is Dr. Ian Storch. I'm a board-certified gastroenterologist and osteopathic physician,

and you are listening to DO or DO NOT. If you are interested in joining our team or

have suggestions or comments, please contact us at DoOrDoNotPodcast.com. Share our link with

your friends and like us on Apple Podcasts, Facebook, Twitter, and Instagram. We hope you

enjoy this episode. Hi, I'm Tiffany Carlson, a second-year osteopathic medical student hailing

from the Midwest, and you're listening to DO or DO NOT. On this episode of DO or DO NOT, we welcome

Dr. Justin Bogie. Dr. Bogie completed a residency in anesthesiology at the University of Wisconsin

Madison and subsequently a fellowship in pain medicine at Oregon Health and Science University

in Portland. He is an Air Force veteran who is currently on staff at Gunderson in La Crosse,

Wisconsin. While working part-time in his pain management practice, he is simultaneously

furthering his education with a master of health administration through Cornell University.

In this interview, Dr. Bogie will tell us how he chose osteopathic medicine and why he decided to

pursue extra time as a teaching assistant in osteopathic manipulation while in medical school

at Des Moines. He will talk about his experiences during his time serving in Iraq and how he chose

anesthesia and pain management as specialties. I hope you enjoy his story and journey in being

and becoming an osteopathic physician. Thanks for listening. Thank you, Dr. Justin Bogie, for joining

us today. I really appreciate your time. You're welcome. I know that you just finished with a

patient and hopped right on to this call. So tell me a little bit about how your normal day looks

like. You know, start in the morning when you wake up. I know we've shared a cup of coffee before so

you know you probably have your coffee and then take us through what your work role and

responsibilities are during a typical or atypical day. Okay, excellent question. Well, I do pain

medicine so I usually wake up at about six in the morning, do all the usual stuff, get out the door

and at work at seven. I run through my patient workload and that can be a full day of seeing

evaluations, new pain patients, and follow-ups or it could consist of doing procedures. I work Monday,

Tuesday, and half day Wednesday because I'm pursuing a master's in healthcare administration

in Cornell and I used a military scholarship to accomplish that. But basically what I do is I go

through my patient census and then I do chart biopsies especially on new pain patients. The

field of pain medicine is similar to or analogous to the island of misfit toys on the famous Rudolph

the Red Nosed Reindeer yearly special. We tend to get patients that other people cannot figure out

and so I like to do a deep chart biopsy so I know what medications have been tried,

what treatments have failed, is there any psychological input that needs to be addressed,

and then I do appropriate medical management or multimodal, multidisciplinary management

where I might get one of my other pain colleagues involved or a different division in our

neuroscience department, maybe a neurologist or physical medicine and rehab specialist.

Some of those patients if while I'm doing my exam if I find an osteopathic diagnosis,

a somatic dysfunction, I will chart that and then I'll do a treatment immediately on the spot

and then I will appropriately document that and then treat it. Can you, sorry to interrupt,

but can you just kind of explain what a somatic dysfunction is for our pre-medical students?

Oh sure so it's kind of doctor of osteopathy medical legal ease term for you know I found

a painful area in the body or an area of the body that is not functioning equally to the other area

if that's a hip or a SI joint or maybe a facet joint in the in the back. We do that during an

osteopathic exam which is done with hands touching a patient you know very kind of intense musculoskeletal

exam and then when we find that area go ahead and do some sort of treatment that may be

what some people would be familiar with a chiropractic type of manipulation which is

kind of a high velocity high amplitude kind of puts your arm behind the patient's back and then

do a thrust. If you've never seen an osteopathic manipulative treatment it's similar but sometimes

dissimilar to a chiropractic but that's the best way I would describe you know more of a traditional

back cracking or neck cracking type of treatment but in addition to that you know high velocity

low amplitude or high velocity high amplitude treatment we also do you know myofascial release

treatments massage treatments strain counter strain treatments which is basically short for

shortening the muscle so it can relax you're trying to affect the Golgi apparatus which is

one of those fun words to say and or maybe just some direct massage or distraction or compression

techniques it's really hard to describe the totality of osteopathic therapy in a brief

setting but that's kind of my best attempt. Well thank you for that so you you're able to do that

in the office once you find it and then what kind of other things during the day you're doing that

deep chart dive and then you're going to go see see your patient and do different procedures so

what kind of does the rest of your day look like? One of the areas that my salary is dependent on is

putting needles in people's back and doing injections that other people aren't comfortable

doing so when I do injections we might do epidural steroid injections under fluoroscopy

which basically means you know a military example would be I'm a sniper but I need someone to help

you know give me wind readings and to also visualize the target that's the scout sniper

they work as a team so I have a fluoroscopic assistant or a person from the radiology department

that has a big x-ray machine and then I can see where I am doing an injection to see if I can

give benefit so this is not shotgun but kind of sniper spinal injections and or hip injections

or joint injections to help diagnose and treat a patient's pain condition. Unfortunately in 2020

the general public seems to think MRIs and x-rays make diagnoses but they don't they are

an explanation of a picture of a person at a point in time there is no functional MRI that

points to the homunculus on the brain that tells a pain provider where the source of the pain is we

surmise that from the combination of patient history so doing a chart dive physical exam

unfortunately physical exam is brought with sensitivity and specificity issues and then you

know I look at imaging and I lick my finger pointed into the wind and I make a guess at where I think

the pain is coming from and after we do an injection if the patient responds remarkably

to that injection it's diagnostic and therapeutic if that makes sense. And then so a homunculus some

people might not know it's kind of like where different parts of your body show up in the brain

right? Exactly it's somatosensory cortex in the brain is where all pain is ultimately sensed

and medical students and well if anyone's taking anatomy you learn about it in anatomy training

but basically scientists and physicians before us mapped out what part of the brain certain parts

of our body are sensed in and so I think it was the folks that created duloxetine or

simbolta which is a medication for neuropathic pain and also fibromyalgia but they did a functional

MRI study where they scratched people on the forearm people who had fibromyalgia and people

who didn't and then found the homunculus lit up in the forearm region but with people with fibromyalgia

it lit up exponentially. So it did two things it shows that sometime in the future

we'll have functional MRIs and then I'll be out of the job because we'll know where the pain is

coming from but it also established fibromyalgia is not some sort of super tentorial psychological

only input although there is some input usually in that realm but it is very much a biologic

entity that has been proven objectively with imaging so fibromyalgia is more of a central pain

state but it shows up in the brain as an exaggerated central pain state. Awesome thank you for that

description so you're you're only working two and a half days out of the week and then what are you

doing your full-time student the rest of the week then? Yeah so I was fortunate to apply and utilize

and get accepted with a military scholarship to Cornell University in Ithaca in their master's

healthcare administration it's an executive program so theoretically one could complete this 18 month

degree while also doing full-time work. I was fortunate enough to secure part-time employment

so I could pursue the other half of my intellectual energy and direct that towards this master's

degree which I've always kind of had an interest in being a physician for so long I've had issues

with administration in the military setting and private practice setting and the adage if you

can't beat them join join them certainly applies to you know kind of my motivation and where I'm

kind of going off in a new intellectual journey or trajectory. Right so you were also in in the

military early on in your career was that something that you always decided that you know I'm going to

be like when did you start becoming interested in medicine and then decide how you wanted to become

a doctor? I grew up in a family that had absolutely no ties to the military I in high school applied

to and was not accepted into the Air Force Academy I had a major knee injury in high school and that

was kind of the kiss of death as far as getting into the Air Force but I always felt I don't know

some internal compulsion or drive to you know be a part of something bigger and better than myself

and after I got accepted into an osteopathic medical school in Des Moines had the financial

aid speech you know which you know scares people straight into the realization that

it's very possible you have a hundred thousand two hundred thousand five hundred thousand dollar

nugget that you you will have to pay over your career. They discuss different options American

Health Service Corps, military were some of the few options to help supplement or pay for that

huge expense and I basically took my letter of acceptance I kind of interviewed a couple of

physicians that were at a hospital I was working at in my hometown of La Crosse I was doing cardiac

rehab and so I found a couple of ex-military doctors and the Air Force doctor told me to do

Air Force the Navy doctor told me to do Air Force the Army doctor told me to do Air Force

which I thought was kind of remarkable you know beggars can't be choosers I applied to all three

branches and it turned out the Air Force accepted me first and so I went with the Air Force and they

paid for medical school. The pound of flesh that they extracted back from me was a four-year active

duty commitment where I was able to deploy to Iraq and be medical director of anesthesia during a very

intense time around 2006 in Balad, Iraq and you had a very nuanced multi-factorial experience

that you know I'm very proud of but yeah that that's kind of the long and short history on how

the military and I had a mutually beneficial symbiotic relationship. Well thank you thank

you for your service and also kind of explaining that there are other options besides loans to

finance a medical school education going back you know prior to getting accepted into Des Moines

how did you become interested in medicine and like pursuing becoming a doctor? I've had a few major

orthopedic injuries that kind of deflected me towards medicine and that was juxtaposed to the

realization that I was I had some talent in math and science so I thought logically how can I wield

those talents you know to have a job that you know kind of forces you into lifelong learning

into lifelong learning and you know medicine was always at the top of that job curiosity list

but when I was in eighth grade I was riding my bike football practice and my football helmet

caught in the back of my bike and I went head over tea kettle into the asphalt and broke my left

humerus rather remarkably compound fracture and then I spent about four weeks in traction

at the Gunderson Clinic Hospital System that I currently am employed at ironically and it was

kind of that time that I kind of saw you know how serious my injury was possibility of amputation

and then you know resolution and healing to the point where I played high school football and

then I played a year of college football but I think that was the biggest deflection having a

major injury that required you know intense coordinated multi-disciplinary multi-dimensional

you know therapy but but you did see kind of how the body heals itself was that also kind of a

crystallizing experience to consider osteopathic medicine or were you pursuing other opportunities

you know the the osteopathic medicine I wasn't really aware at that time it wasn't until after

around college that I learned that there's you know two all there's two ways to get into medical

school osteopathic medical school and allopathic medical school so it was really after my journey

of applying to you know different medical schools that I became aware of you know the osteopathic

you know kind of philosophy and principles I have always kind of had respect for alternative

medical therapies and so I had a master's in exercise physiology before I applied to

osteopathic medical school so I thought it was kind of a natural maybe transition or you know

kind of dovetailed nicely into each other you know my experience with musculoskeletal cause

and effect you know with pain and you know kind of the you know benefit that exercise and certain

exercise prescription can have and you know very many different aspects in a patient's life

psychologically and physiologically so it was really in that journey that I became aware of

osteopathic medicine and then in the hospital I was working in sought out an osteopathic physician

that was working in primary care and you kind of job shadowed and got more excited about that

medical school training and so you did your undergraduate at lacrosse did you apply to

multiple schools or just because Des Moines very close to Wisconsin that was like the main choice

good question I did my undergraduate at University of Madison in Wisconsin I did molecular biology

I applied to multiple medical schools all MD got accepted was on the waiting list and a couple of

MD schools got into Grenada MD school and was considering moving to Grenada and it was at that

time one of the osteopathic physicians in the hospital I was working at you know kind of took

me inside and said have you considered osteopathic medical school and so that realization and then

again in conjunction with a master's degree from UW lacrosse and exercise physiology cardiac rehab

kind of really pointed me in the direction of applying to osteopathic medical schools and I am

a midwesterner so I did apply to mainly all of the Midwest schools because at the time I had

recently just gotten married and I had two twin boys identical twin boys so I had I needed to

maximize my social equity which is mainly in the Midwest in and around the lacrosse area

so you had two little baby boys that I've heard are grown and successfully launched in the world

so congratulations but what kind of other things besides balancing family life did you do at Des

Moines I really liked osteopathic manipulative medicine it was kind of an extra class you know

the the osteopathic and MD medical school follows the similar pattern you know the first year a lot

of the hardcore sciences anatomy physiology second year you start doing systems and then third and

fourth year you do your clinicals we have osteopathic manipulative therapy first and second

year and then you're left to do it on your own during your third and fourth year clinicals

after my first year I just fell in love with it I thought it was you know ancient wisdom

that you know could be you know helpful there has been some studies to validate when you touch a

patient there's a dopamine release there's also oxytocin release which is important for the patient

physician relationship patients who like their physicians are infamously less likely to sue

are infamously less likely to sue their physician even if something wrong happens

and that's the physician's fault and and plus you know as a physician we have a very sacred

responsibility you know to try to help our patients do things maybe they normally don't want to do or

not interested in doing and if you have a strong rapport with that patient it's it's infinitely

easier to get them to do what's in their best interest and so you were a TA like a teaching

assistant for the osteopathic department then yes so after the second year because I liked it so

much became a teaching assistant to help kind of get other people excited about you know kind of

the wisdom that is osteopathic treatment I think there's some medical students that kind of poopooed

in you know yeah I'll get through this class but really what I want to do is plastic surgery or

dermatology or something you know but I would submit you know there isn't there is an ancient

wisdom and there are many pearls in the the training and experience of osteopathic medicine

and I think that time investment the minimal time investment that I placed in it has rewarded me

infinitely I get to see patients for a full history and physical and if I do some OMT on them you know

I get to bill you know a little bit extra and you know it's a way to kind of set me apart from some

of my other colleagues it's it's similar to being you know acupuncture trained or I think it's an

alternative medicine skill set that you know manipulation has borne out some validity and

you know acute pain states at least in back pain and whatnot and you know I just think it's a it's

an opportunity that you can use or lose but you know it it can benefit in my mind almost any

physician in any specialty if they choose to invest in that skill set oh now when you were

at Des Moines was this just an extra thing and you graduated in four years or did your TA time

tack on some additional time at Des Moines I know it didn't tie in an additional time some medical

students if they want to just go into osteopathic manipulotherapy which I think is a separate

separate specialty they do an extra year so instead of four years of medical school do they

do five years but no I didn't do that I just did I spent extra time my second year teaching

osteopathic and manipulative therapy thanks so now you're in pain management now but when you

were at Des Moines were there any teachers or friends that kind of inspired you when you were

deciding what your specialty was going to be I was really gearing towards family practice and

we had a very good instructor at Des Moines Dr. David Bosler he was very excited about

manipulation and he was very skilled and I think that that really helped inspire other

others to go into that field and I kind of wanted to be a old town country doc that you know would

see people and then had another skill that could offer manipulation unfortunately I did a rotation

in anesthesia and I became instantly hooked by the procedures I became instantly hooked by you

know seeing anesthesia providers with patients and patients scared because they're going to go

under and you know I heard a physician say you know I'm I'm your guardian angel my only job is

to watch over you and that just that just clicked with me I think anesthesia is like the Rodney

danger field of specialties we really don't get a lot of respect because our patients don't remember

what we do but I can tell you you know starting an IV talking to a person touching their hand

maybe giving them a little benzodiazepine I used to be a bartender I like seeing patients

comfortable and relaxed and I like to alleviate fear and you know that's you know maybe a part

of why I went into medicine but anesthesia it harmonized with some of my you know internal

motivations to relieve pain relief suffering psychologically or you know physiologically tell

me about like so you said you were a bartender tell me some of the things that you learned

doing that job that has kind of carried on while you're taking care of your patients today

well it forces you to to comfortably and easily have elevator conversations right

the social intelligence ability to start up a conversation or get a patient engaged this is

really important in starting and maintaining rapport with patients being able to find something

that you have in common and then kind of amplify or exploit that to create a trusting relationship

again it's I don't know of any job in the world where you get 30 40 minutes to see a patient and

then convince them to do things they are just not interested in doing and so you know working in the

service industry I've done everything from short order cooking to bartending having interpersonal

skills and the ability to have conversation you know with different personality types

has certainly been an asset in my career yeah definitely like having that personality and

being able to establish a rapport with your patients to help them get better so you you're

an anesthesiologist now actually in pain management so what did applying to residencies look like for

you oh god it was a typewriter I'm dating myself I think it was a typewriter it certainly wasn't

centralized I looked at different anesthesia programs throughout the country there are ones

that have better reputations than others I was mainly interested in how they worked the residents

there are some residency programs where you know you see turnover rates residents leaving first or

second year that's a bad sign that would be a bad sign with any job interview additionally or if they

overworked and took advantage of residency help I mean it should be no epiphany for me to to say

that residents are very profitable to hospitals the government itself pays over a hundred thousand

dollars per resident per year for education and I think after the first year I think some of the

medical data has shown that residents far exceed you know they become so efficient at doing certain

types of medical care and off loading other physicians they they more than pay for themselves

and so knowing that there are certain residency programs that exploit and overwork their residents

and there are some that give them plenty of time to study for boards you know have a fairly

fairly reasonable work-life balance and my my research pointed me towards University of Wisconsin

Madison and their anesthesia residency they had a high pass rate first time on the anesthesia boards

meeting and talking with some of the residents they loved their instructors they loved the time

that they had off they weren't overly utilized for call and so that was ultimately and they had a

good reputation that University of Wisconsin started the first anesthesia residency program

for physicians in the world so that's you know kind of a a nice history from that program but

during my anesthesia residency I did a pain rotation where we did a celiac plexus block

on a patient who had pancreatic cancer which is a very painful cancer and a celiac plexus block in

brief is placing a needle in an uncomfortable part of the body just anterior to the aorta

and then blocking or numbing a confluence of nerves that gives visceral innervation

to the abdominal region cool cliff clave in fact celiac plexus blocks in patients with pancreatic

cancer have been shown to increase their survivability so they get a little bit longer

life with a little bit less pain which I think is a nice ability to transition but that's kind

of when I got stuck on pain medicine I saw a remarkable instant relief of a patient who was

suffering from cancer pain and they were able to decrease their opioids and have some sort of

cognition and meaningful conversation with their relatives before they transitioned

that's a pretty powerful story and how you can impact patients lives through you know learning

very difficult procedures and being trusted with that early on in your residency program

so madison you know state capitol wisconsin big institution did you look at other schools for

like to apply for residency or like once you did that research you're you know full speed ahead

going to madison full speed ahead going to madison one of the main reasons i picked madison i did a

rotation in anesthesia at the gunnarsen clinic ironically the place i'm working at now and i

rotated with a family friend who did anesthesia his name was steve carlyle one of his brothers

kevin and i went to high school together so and he really took me under his wing i was a

second year medical student and he let me do arterial lines central lines i did a cervical

plexus nerve block i mean i he had me hook line and sinker on anesthesia and and this is kind of

like a little side pearl you know if you hook up with a person that really takes interest in you

as a you know a medical student there's a high likelihood that you will go into that specialty

and you know i just i was really grateful because i was going through a tough time in my life

at that point when i was applying to residency i was going through a divorce and then twin boys

and so i really wanted to stay in the midwest close to madison because my twin boys were

living in demoine at the time and so i was very appreciative that i had someone take interest in

me dr steve carlyle went to university of madison for anesthesia residency and knew some of the

people there and so it was kind of one-stop shopping for me it seemed like providence

and so if providence is uh you know turning its head towards you you should probably

not look away and so i'm very grateful that certain people took time out of their professional lives

to deflect me in the right direction and you know as as a response to that you know my karma

full circle i bend over backwards to anyone nursing people who want to go into pa people

who want to go into medical school i bend over backwards to help those people go into the healing

arts because i think that's i think it's the one of the most noble jobs you can go into is

relieving people's you know sickness and suffering so you went to madison and but

you were still on a air force scholarship how did that work you know once you completed your

residency and you know you didn't really actually have to look for your first job

no you know the good and the bad and the ugly of military scholarships is this the good is

they pay for the medical school the bad can be let's say you really want to do anesthesia

but the air force is like eh we don't need anesthesia this year so that you know they

do kind of a collective sentence of how many people that they have that are that have active

duty commitments and if a bunch are about to mature and to separate then they go okay we

need 15 more anesthesiologists and then the likelihood of the military allowing you to do

your specialty is high but if the military does not need an anesthesiologist or a urologist at

that time and this is important for any listener to know the military kind of owns you and they will

say you're going to be a general practitioner for four years which in the air force sometimes can

be great because if you get you know hooked up with you know a bunch of f-22 pilots you're going

to have a nice lifestyle but it is a general practice you know commitment and depending on

how many years of medical school they pay for in my case it was four so i had a four-year commitment

i did not have to pay a penalty for doing a pain medicine subspecialty but with the air force i had

to ask permission to go into anesthesia and they gave it to me and then i had to ask permission

and i had to compete with another couple of active duty air force anesthesiologists for the pain

medicine fellowship and then once i finished the pain medicine fellowship i went to the

mothership for air force medicine and that was wilford hall in san antonio texas where i did a

four-year active duty payback for my hpsp scholarship that the air force gave me

so you mentioned earlier would you mind kind of telling us about your experience during the

surge in iraq as a pain manager sure sure very surreal let me paint the picture of iraq i didn't

see one cloud i saw one bird try to fly into the sky and it went from the solid phase to the gaseous

phase it just sublimated no i'm just joking every day was 120 degrees and i never saw a cloud that

was a big culture shock i remember walking to the tent hospital in balad iraq for one of my first

shifts and the sirens went on and we we had had we're under a mortar attack that was a very

surreal kind of experience because it you know it really told me i was in a war zone i knew i was

in a war zone but really didn't know i was in a war zone until you know someone was throwing you

know more mortars at us fortunately the insurgents weren't too good at doing mortars so it was more

like they would get lucky but they didn't have very much precision balad air force base was

saddam hussein's former air force academy equivalent and so that was of course a

prime piece of real estate for the united states to take over and so we ran the whole hospital

and different other sections of the military ran the base but it was an enclosed base we had a

swimming pool we had a level one we were the only level one trauma center in the whole theater so

it wasn't in bagdad they had sent patients to us because we had neurosurgeons in our group but we

had two shifts day shifts and night shift i was director of the anesthesia department we had

i think five anesthesiologists and then i think 10 certified nurse anesthetists and then we did

primarily trauma anesthesia so you know you could be sitting on the base or eating some food and

then pagers go off and then everyone sprints to the tent hospital because we have people coming

in on you know medical black hawk helicopters that are in dire straits this was kind of right

after the fallujah uprising so you know you can't see what explosions do to the human body in the

united states because there's no equivalent training so you know it's a challenge to anesthesia

providers and surgeons most of us were young and just out of our training and you know seeing

kinetic explosive trauma to human beings is you know challenging mentally physically and psychologically

to top it off the surgical units that we were in were kind of hardened little metal boxes that had

air conditioning units but in the middle of the day when temperatures outside would be 130 140

they wouldn't keep up so we did anesthesia basically in a sauna and we would have to you

know regularly broken out or people would have to bring in gatorade for us so it was surreal but

you know reactionary and met the mission and you accomplished the mission with the you know services

and you know materials that you had but to this day i just don't like saunas i just i i can't

stand the feeling of having you know kind of a slippery slimy layer of sweat on my body

it does not sound fun and i think there's actually a picture of you floating around the internet

frying an egg out there as well yeah i want to show my sons how hot it was so there's a little

bit of history behind that because that that picture isn't entirely truthful first of all

try getting a raw egg from a government employee on a military base you know they just i had to

really tell them i was going to use this egg and throw it on the cement and watch it cook so i

could tell my boys how hot it was and not ingest it and you know get some e coli and then you know

the health food worker person would be in trouble but basically i i got two eggs so egg one was you

know the 1.0 version cracked it put it on the cement and then i just watched it and it really

started drying more than cooking so i took the second egg cracked it put it on a plate put it

in the microwave to kind of get it going a little bit then i took that egg and put it on the ground

and and then we took the picture so so it's like so you were able i mean even in the midst of you

know hot horrific conditions you're taking care of american men and women and the civilian

populations you you sort of found that work-life balance there as well to send things back to your

sons yeah yeah we had even though all the other nato countries had the ability to have alcohol

and you know that's a whole nother sidebar the ability for primates and humans to alter their

consciousness in stressful states you know i think is important but because we are the united states

we followed muslim law and so we would we would enjoy non-alcoholic libations i think saint poly

girl non-alcoholic was like three bucks a case so i always bought that and we'd put those in

refrigerators but you know the anesthesia and the surgical staff we would socialize there was a

swimming pool on base that was manned by lifeguards from the united states that made like a hundred

thousand dollars a year because they were being a lifeguard in a war zone which i thought was just

awesome but you know that there are definitely worse places in iraq that we could have been

but it was it was an interesting juxtaposition of super intense horror and trauma and you know

and then weaved in with i'm going to go to the swimming pool we also had a movie theater with

a balcony so i remember seeing talladega nights which today and to date is one of my favorite

movies because it made me laugh so hard and you know what a gift of having a gregarious you know

paralytic laugh in the midst of such horror but yeah we tried to make as much of a work-life

balance as we could you know under the conditions that we were exposed to for sure so besides being

you know an anesthesiologist in a hot box can you tell us a little bit about what has made you

successful like what is your superpower i would say my ability to create rapport with my patients

i think it is a accumulation and summation of my prior work history prior successes and failures

and and one thing i kind of pride myself on i've taken extra classes in motivational interviewing

which is basically a technique it's not like being yoda or you know like cia social engineering but

in kind of a way it is you know like i i alluded to before we have a very short period of time

of trying to convince a person to trust what you're saying and then to to act on you know

recommendations that maybe the patient isn't otherwise interested in and i think that's one

of my superpowers the ability to meet a person talk to and find a common thread exploit that

common thread for the interest of the patient and so you mentioned before like establishing that

rapport and you know and the and the power of human touch and the you know the physician's

touch and the ability to help heal the body so do you have any final thoughts on osteopathic

manipulative medicine and how you incorporate it till today oh sure well uh you know like here's a

great example saw a guy yesterday did a nerve block on him he's got some instability in his

lumbar spine so i'm sending him to a neurosurgeon for surgical solution he's got true instability

i just reviewed with him because i have had shingles and i suffer from post-traumatic

neuralgia that was a gift that iraq gave me i had shingles in iraq left-sided like t78 dermatome

it could have been worse it could have been in the face but anyway uh so this gentleman

smoker he's already had you know his carotid arteries worked on he's at high risk for

covet pneumonia and shingles so i'm like you know and and the nice thing about the gunnarsen

health system we have epic emr electronic medical record system and it has kind of like a little

summation in the bottom right hand corner that says preventative medicine this guy needs this

this this and this so i'm just like hey talk to me about your pneumonia vaccine when's the last

time you got that and he's like oh yeah i'm due for one i gotta talk to my primary care doc about

that and then and i said you know how about the flu shot do you get that every year oh yeah i

should get that and i i said it's available now try to get it as soon as possible there's really

no penalty for getting it early it probably you know gives you an advantage and then we finally

ended up talking about the new varicella for shingles vaccine which is much more efficacious

and so i just kind of put a little seed in his brain to bring that up to his primary care doc

but that is you know i don't know you know osteopathy we were kind of taught as you know

more holistic and whatnot i think that holistic mentality has bled down because i see my medical

doctor friends doing that also and it's bled down into you know certain electronic medical records

so you know i'm kind of seeing stuff that was maybe less popular from the md side when i was

going to medical school but it certainly is more pervasive now but i would say that's i think it's

an advantage for osteopathic students because that concept is promoted early and often and i

think it's true wisdom you know always thinking of even though i sub-specialize in pain and that's

not my realm i still treat the whole patient and i try to be as holistic in my recommendations

as possible so you really enjoy being a pain medicine doctor from the brief time that we've

spent today would you go back and pick something else and if you would or maybe you wouldn't but

would you try something else now if you had the time well my dad did radiation physics so i

thought radiation oncology would be a really cool or hematology oncology again i don't know why i

pick some of the most broken human beings but that's kind of what pain medicine is i i think

maybe if i did cancer treatment in any way shape or form that would that was something that i've

always kind of wondered about i love doing procedures i love manipulating you know needles

in parts of the human body to relieve suffering that sounds kind of sadistic but another area

that sometimes i you know kind of looked at invariably is interventional radiology i think

some of the procedures and some of the treatments that they do are also kind of cool there isn't as

much patient you know long-term patient interaction per se in that specialty but again i love doing

procedures as as much as i like having the human interaction i like doing procedures

technical procedures thank you so we're just about out of time today and i know you got to get back

to your busy schedule so thanks so much for taking some time to speak with us on the do or do not

podcast so leaving us you've mentioned some really great mentors you know your dad dr carlyle what

throughout your whole journey becoming and being an osteopathic physician what was the best piece

of advice that you've gotten throughout this journey that you always think back on and then

you try to pass on to others live within your means and you always be wealthy the problem with

medicine as we go without for so long and it's the nature of our career to work longer than 40 hour

work weeks i would try to set your lifestyle so that you're always wealthy even if you work full

time in a big city that doesn't pay as much because you want to be in your family and friends

or you want to work part-time and pursue other areas but you know there's kind of a pandemic

or epidemic maybe of physician burnout and i think it is because you know we go for so long and then

when we get out of the starting gate we buy a big house buy a couple of big cars and now you have a

monthly payment you have to come up with whether you like your job or not and having some sort of

financial freedom to you know remove your stake and go somewhere else you know psychologically is

healthy there are i don't know what the statistics are on how many jobs people change out of residency

but out of the military you know it's been studied and most people don't stay in the same job

right after they get out of the military so what i assume probably similar with you know medical

students or i mean residents out of residency but i would plan my life accordingly to that wisdom

live within your means and you'll always be wealthy and really protect the work life balance so your

career doesn't cause a divorce or a family you know a lifelong family dysfunction really good

wisdom for our listeners especially we also have a an earlier podcast that we kind of talk about

finances with dr stork and the white coat investor so thank you for just mentioning the importance

and i think you're living it right now because you're working part-time having time for your

family and then also pursuing further education so thanks again for your service and sharing

your story with our listeners we we really appreciate your time oh thank you as uh it

was a pleasure i appreciate it this concludes our episode of do or do not send all inquiries

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