Michael H.: Well, hey, everyone, and welcome to another episode of Doctors Living Deliberately. Thank you so much for joining us today, and of course, welcome to my co host, Dr. Arpita Gupta De Palma. How's it going? 

Arpita: It's going great. How are you doing, Michael Hersh? 

Michael H.: Great. So much enthusiasm from you this morning. 

Michael D.: Maybe its got to do with her guests.

Michael H.: Yes! Well, speaking of our guest, we have a very special guest today, Arpita, and I think you should do the honors of introducing him to our audience. 

Arpita: All right. Well, we have with us today, my amazing husband, but that's not really, I mean, I guess that's probably the best part of him. No, I'm just teasing. But this is Dr. Michael DePalma. He is a board center certified interventional spine physician with the residency training in physical medicine and rehabilitation. He went on to do his fellowship and interventional spine care at the University of Pennsylvania. And I guess the way I would describe this man is a brainiac visionary. He loves to do research. He's got multiple research trials in his medical practice. He went on to, after being the director of the spine center, various different facilities after he graduated, he actually decided to go out and build his own practice, which is Virginia Eye Spine Physicians. And that is where he is the medical director and president. He has a fellowship training program where he trains fellows every year there, the research arm. When I say he's a visionary, I mean that he's always thinking of new ways and to expand his field, new ways to apply the research. And if that wasn't enough, he's now launching this new enterprise in a sense where he is incorporating integrative medicine into his field of practice. And so I'm going to hand it over to him in a sense to say, where did I miss anything? Fill in any gaps? 

Michael D.: I don't know. I feel we have to do a fact checker to make sure all that's accurate because it's sound impressive. 

Michael H.: At some point I'm going to have Arpita write my bio so that hopefully it can sound that impressive when people are talking about the things I've accomplished. Well, that's, I mean, that's amazing. And I know that you are in the process of completing your integrative medicine fellowship. I was wondering, you know, we've talked a little bit about that on this show before. Can you tell us a little bit about integrative medicine and how you got involved with it?

Michael D.: Yeah, it's a good question. I was thinking about that a little bit a second ago and my journey just to back up a step. And we've talked about this before, I recognized that I was in burnout and got connected with professional coaching you and then another coach over about a year's time. I pulled myself through that with some help, but along those lines, I saw what Arpita was going through and how she was evolving, and she actually put me in touch with a few of our colleagues who had completed Andrew Weil Integrative Medicine fellowship program. So I was intrigued,

Arpita: One was actually Dr. Dinsmore, who was on one of our earlier episodes talking about perfectionism. She also completed this fellowship. And I just, I don't mean to cut you off, but you did already, he just actually graduated. So he is completed now that the fellowship, but yeah, go ahead. 

Michael D.: I'm due to graduate next, Well, upcoming, yes, I travel next week to complete that graduation, but yes, I'm at the end of that road. It was a two year fellowship program. I learned a lot. But one of the things I've learned from Dr. Weil was that the body wants to heal. And our role as physicians is to identify the barriers to help identify the barriers to the healing and then guide the patient through steps to achieve healing. And I learned a lot about other areas within integrative medicine, one of which mind body connection which we hear about that stuff through our traditional medical training, but don't get in depth education training in those things and those techniques. So that was one big takeaway. Over this past 2 years.

Michael H.: You were mentioning kind of your path to burnout and kind of getting connected to integrative medicine as as kind of as a modality. But what inspired you? Like, how did you kind of start to integrate it into your life, integrate integrative medicine? And then what made you decide to go ahead and get additional training in it?

Michael D.: I would say I think we all are information seekers. If there's something that's Puzzling we ponder it and then we seek information to explain it and ultimately heal or get through it and 

Arpita: well, I'm going to cut you off because I think if you go back to even before you started coaching, all of this started to transpire when you found out about your dad's diagnosis. That's what I think put you on this path of learning about this a little bit. I mean, I might be wrong, but yeah. It might be interesting for them to understand your story talking about that, like where it came from. 

Michael D.: Yeah. I mean, so my father passed away from Lewy body disease early 19. And so over the several years leading up to that point, just trying to reconcile what the heck is going on and why. And then what are the implications for us, family, and inevitably you'll learn about cellular homeostasis, I promise I'm not going to dork out, and get technical, but just why things go wrong, why there's organ damage, and how can we intervene to head that off. If you look at areas around the world where folks live long, healthy, active lifestyles, it exists. It's not an oasis. And so what are those folks doing? How are they living? What can we learn from those other areas in the world? The benefit ourselves because in America, we're not good at that, right? We, we, we intervene when things go wrong. So anyway, yes that experience going through that with my dad kind of gave me a different focus on how to intervene to promote my, my personal health. And then how do I apply that to my friends and family? And then from there, everything else kind of fell into place, went to the coaching, got involved with the Integrative Medicine Fellowship, and I've learned a lot over the past two years. 

Michael H.: Yeah, it's amazing how life can kind of take us on this journey and you kind of start to kind of pull at a little thread, a loose thread over there, trying to sort something out for yourself. And it just kind of takes you down this path that, that kind of leads to all of the, kind of the transformation that you've seen in your life over the last couple of years. So it really is incredible how that all happens. And so talk to us a little bit about what was involved in your integrative medicine fellowship and kind of what you've done over the last couple of years.

Michael D.: Well, the fellowship is a curriculum. It's well set out. It's largely online, but within that there's there's modules we read through. There's assigned reading in a large textbook. There's videos. About half of the course we had a small group meetings via zoom every other week. And then we had 3 onsite, 3 weekly onsite meetings in Arizona where we came together as a large group and had lectures, didactic small group sessions. And it's really fun. And so you touched upon threads and that's exactly right. It's how I would describe it as well, because the reading, there would be things that would be introduced in the curriculum and that I found interesting that I would explore that further outside or in addition to my, my curriculum. For example heart rate variability, biofeedback, transcutaneous vagus nerve stimulation, pulse electromagnetic field therapy, photobiomodulation, just fascinating things, how to intervene to promote cellular health. But also back to the mind body connection, learning about some of the basic science behind demonstrating the positive impact of those exercises. For example, meditation, it's been shown that inflammatory markers in the bloodstream are reduced as an impact of meditation. Which, I mean, I find that interesting, fascinating because we hear about meditation, kind of know a little bit about it, how you're supposed to do it, but you don't, as a physician, I didn't realize and understand what it was doing at a cellular or system level. And I can start to get my arms around that and embrace a little bit more strongly when I understand better and believe more in it. I think that's also the hour of the mind and our thoughts to affect change at the cellular level exist. And once we start to harness that more effectively, we can use it to our advantage. And I think that also is what folks are doing is blue zones when they are what we might say coherent or they have a balance of path of Vago tone so they're they're not stressed out all the time. Like we might be here in America. We're constantly deluged with information from social media that may or may not be factual, but we believe it. 

Arpita: I think the best way to say it is that, my nerdy husband that I love has figured out that there's actually evidence based scientific data backing what all of these wellness modalities have offered to us. And so for the non believer in meditation or, you know, any of these other therapies, this actually gives backing, like, data to back it up that, yes, there is evidence to show that it does work and how it works. And so I think that was kind of interesting to see as he went through the fellowship where he, you know, he was so immersed in wanting to learn, which he always is, but wanting to learn in a different realm and then apply it even to his field. So, I mean, obviously, like I said, he's an interventional spine physician for 20 plus years. He's been procedurally based working with patients who have back pain and other types of pain and really, I think, was starting to burn out a little bit. Now I'm speaking for you with regards to doing the same thing over and over and over and it being more of a band Aid rather than preventative. And so do you want to speak a little bit about that, about like how this is actually going, how you felt like this would help you with your current patients? And like what your ideas are with that, because it's unusual for somebody who's so subspecialized, you would think to do an integrative medicine fellowship, right? This is something that might also naturally feel fell more on like a general practitioner in a sense. So tell me about, tell us about that. 

Michael D.: Well, yes, I think the perspective for me, so for 21 years and then helping folks get over, get past and move through conditions that represented we'll say in organ damage, disc degenerates, it's injured. It can't heal. And so we don't really have pro healing or regenerative technologies available yet to help repair these, these tissues and organs such as a degenerative disc. And there's a lot of research going on in that area specifically. And we're involved in that research. But, but by and large, we're reacting to conditions after they are present. So how, what can we do to intervene earlier on or in addition to what we are doing to help slow down these progressive degenerative conditions or help prevent them? 

And so for example, I've started to incorporate these things into my current practice. Tumeric, for example, is a wonderful wonderful botanical. It has potent anti inflammatory properties. So I start talking about these things to patients, and they are very receptive and welcoming to these ideas. And what was interesting to learn in this fellowship is that I can't remember the exact percentage, but maybe it's close to two thirds of folks in this country seek and spend money annually on what are called cam therapy. So complimentary alternative medicine therapies. And so people are looking for non traditional therapies. And so they need legitimate guides, physicians, professionals to help them sort that out. 

So I've started, it's challenging as you guys know, to, to roll this into a traditional medicine practice, but I'm working on a different avenue for getting folks that sort of information. But, but yeah, I started to think more full circle and actually starting to experience some of these things myself personally. I look for answers to, to the questions I have. Because backing up again, I was, I am healthy, but I mean, I was not overweight would work out regularly, eat healthy, wasn't a smoker, but yet I developed these symptoms during burnout that didn't make sense to me. I'm like, but what is going on? Brain fog, fatigue, just angry, anxious musculoskeletal aches and pains, and just feeling like crud. But despite that, still being productive on a professional level routinely, and so that just wasn't part of my fabric to feel these symptoms and have them, so it didn't make sense to me. And so that, I started learning more about the impact of thoughts And being able to more effectively manage stress, starting with the mind and understanding better how that affects changes at the cellular level. That was all fascinating. And so again, now, the word I chose earlier was harness those exercises interventions for my benefit. So now the next step will be to put that together in program to help my patients. Yeah. 

Arpita: And I think I'm just going to add, like, part of what we don't recognize and we've touched on this on our other episodes is that we kind of get in our rat race routine, right? Our day to day lives start happening and we, you know, we get out of residency, we get out of training, we start with our family, if we haven't already, we find our houses, get our, like, job settled, attending level, and then we just keep going, going, going, and what happens is Oh, at least what we found is that you kind of get sucked in. You don't even realize and you're not living presently. You're living, but you're not living with intention. You're not living with actually experiencing the present moment and experiencing your day to day. You're just going from work to home, from work to home. And that's just not true living. And so, but we don't realize that the discontent comes with that. And it takes sometimes a full halt, some sort of event to make you realize that this isn't really how I wanted to live like, is this all it is. Is this all we're going to have? And the answer is, yes, if you don't want to be intentional, if you don't say, hey, something needs to change, but it could be also very much so, no, this doesn't really make sense. I have everything that I want. I've got the house, the family, the kids, the job, the, the practice whatever it is, but I'm not content. I'm not happy. And that makes you wonder why? Like, why am I not happy? And I think that's oftentimes the incentive and the kind of the igniter for let me consider what's going on right now so I can make a change. 

So I think that was, we were fortunate. I mean, again, all of this started for us with COVID. I mean, and we go back to that. It was a full stop halt for us literally because the practice shut down everything. And so we had the moment there forced upon us to pause. But that was where we were able to reflect and say, we have everything and we're not happy. So what are we going to change? Because this is not how I want to continue for another 10, 15 years until I retire, you know? And we, again, going back to your arrival fallacy, when I retire, it's going to be great. Well, you know what? If you feel like shit and your body is like totally crapped out and you've like burned yourself to the ground, you're not going to be able to enjoy the retirement.

Michael D.: Or you have a chronic condition that limits or restricts the quality of life. 

Arpita: Yeah, 

Michael H.: I think the other thing I'm going to highlight is, you know, our, our traditional medical training, right, focuses on, as you were mentioning, kind of the things that have been researched and studied and best practices and even some of those, as we know, are, are kind of assumptions about what we think. probably is the best, even though maybe there's not a ton of research underlying those guidelines. And I think a lot of those guidelines are you know, consistently updated as we do gain new and additional information. But the truth is the things that you are talking about in terms of meditation and health through nutritious eating and exercise, these are not new ideas. And these, you know, traditional ways of maintaining health date back millennia, right? And so the fact that we are now just learning how to incorporate some of these practices into traditional allopathic medicine It's about time, right?

So there is very little doubt in my mind as a gastroenterologist, I see the mind body connection present in my clinic every single day. And I've heard it said before, and I love it, the GI tract is the window to the soul, right? So, so there's so many ways that the mind body connection shows up in our clinics every single day, and we are ill prepared by traditional allopathic medicine to manage a lot of these issues. And so when we can lean into how does meditation improve symptoms? How does thought work improve symptoms? How does nutrition improve symptoms? I mean, it all seems, of course. Of course, we should be leaning into these other areas. 

And I think the other thing that you touched on, which 100%, Patients don't necessarily want to take a medicine and they are interested in what are some other ways of managing my symptoms and helping me to feel better. And I love how kind of you are beginning to incorporate and learning to incorporate all of these to just allopathic medicine in a way that suits your patients. Can you tell us a little bit about, you were kind of touching on your plans for kind of how you see incorporating integrative medicine into your traditional practice. Can you tell us about that? 

Michael D.: Sure. Yeah. So back, back to your point a second ago, folks, either they're not interested in a pharmaceutical where they have concerns, or they've been on 1 or 2 or 3 of them without really a lot of success. And so they're curious about other therapies other ways. So I started to incorporate these things into my current traditional medical practice, but then quickly realizing and kind of had an idea that I would need to do this but I need to go in a little bit different direction to have time and really have the capacity to spend meaningful time with patients to guide them through a program to improve their quality of life. And so I incorporated Integrated medicine practice. It's integrated medicine, lifestyle medicine, maybe eventually some functional medicine And it's called Connected Coherence MD And the website is close to being in launch phase 

Arpita: It might be launched by the time this airs. We'll see. It might be almost 

Michael H.: you can drop the website link. If you want people to check back. 

Michael D.: we might have to include that and shouldn't 

Arpita: you put your website is just saying with your website is 

Michael D.: connectedcoherence.com 

Arpita: but maybe I need to coach you on this a little bit. 

Michael D.: No, no, it's just. I don't want to like pitch it in the folks going to look for like, what's this guy talking about? It's not there. Well, yes, it's not there yet, but it will be and that, you know, that's pause for a second. That's a slight reflection of my perfectionism where I want it to be buttoned up tight before I launch it to the world. Well, I want 

Michael H.: What Arpita and I just did, we motivated you to get it done. 

Michael D.: Yes, now the world knows, they're waiting. What the hell is this guy waiting on? One of my integrated medicine fellowship co fellows made the comment last year at this meeting when we got together that if by the time you launch it, you're not embarrassed by it, you waited too long. So inevitably it's going to launch. And, and I'll make additional tweaks, but so I'm working on this program that I'll offer to patients through connected coherence MD. It's probably going to be a six month program, telehealth based actually, so it can work one on one with folks like we're doing now in a video chat platform, HIPAA compliant and I'm excited about it because it's gonna be one on one. There's gonna be no third party payer dictating what we do or what's gonna be covered and what's not or why? Because of the current medical model, healthcare delivery medical model is not conducive to really what, what we need as patients. And I'll act as their expert guide, to guide them through the process to a better quality of life. And this will be the initial program. I have ideas for subsequent programs, one of which will incorporate probably gut health things like the impact of gut dysbiosis. And I don't want to get too technical, but it's fascinating to understand how much of a driver gut health is on everything else. Cognitive function, musculoskeletal system, some of the aches and pains, insulin resistance that we might develop can be a reflection of gut health. So anyway, that was a long winded, I mean, did I even answer your question, Mike? 

Arpita: You did. I, well, I think he did, didn't he? Yes, he did. Okay. I have a question about this though. Like, yes, you're launching this program. It sounds amazing. The six month program, they get to work with you one on one, they like undivided your attention. That's it. Nobody else. Which is very hard, honestly, to get nowadays, I think, but if you had to look at your program and all the little, I know you've got like gadgets, I call them gadgets and things that you like to like, you know, tell us quickly, what do you think is the most impactful piece of your program? And I mean in terms of development for yourself, even like that, you've utilized that you felt the most transition. 

Michael D.: That's tough. It's like, what's your favorite movie? Well, I have probably 5 favorite movies. So what I have enjoyed is over the past, it's probably been 3 and a half years now. I've experienced the impact of these different therapies and devices and use biomarkers and metrics to measure them. And I've noticed interval improvement with each one over time. So now my program is a compilation of all of them. So I can't, it's hard to tease out one specifically. Like I noticed impact improvement with heart rate variability bio feedback. And then when I started, there's nerve stimulation incremental improvement, and there's other things too. So it's kind of hard to pinpoint 1 individual thing. So I think really to answer the question would be the whole program itself and stepping someone through. And I think what will be most rewarding and satisfying, probably obviously is acting as the guide and seeing a patient from beginning to end, hopefully hearing and seeing their expression of gratitude and appreciation, but just seeing them feel better. And so at that point, they're gonna be what we would say more coherent, more grounded, more resilient, happier, much like we all want to be. We just want to have a enjoyable, satisfying quality of life and reconnect with what's meaningful to us. That's one of the key objectives, help my patients reconnect with what's meaningful to them. And that, that can vary. So for some, it's playing with the grandkids. For others, it's playing golf. For others, it's art or just being relatively pain free. Did I answer your question? 

Arpita: You did. I think it makes sense. I 

Michael H.: think the key here is the connection, right? Like the clients that you're going to have, the people that you're going to be able to interact with, they're going to get a chance to interact with a physician who maybe they don't have that ability to connect with the person that is providing them care on that level one to one without like somebody staring at the clock the whole time, just trying to get to the next room. And also, you know, reconnecting with themselves, right? Because I think sometimes when we are, as Arpita was alluding to earlier, kind of stuck in the rat race and just kind of moving through life, we lose that connection even to ourselves and we never pause to take a moment and try to figure out like what's going on for me. And so for you to provide that opportunity for the people that you're working with to connect with you and reconnect with themselves, I think that's a phenomenal opportunity. And I think this is, this sounds amazing. 

Michael D.: And I was deliberate with choosing the name of the practice, Connected Coherence. So If you look back at the Blue Zones, one of the nine features of all the ,five Blue Zones is social connectedness and social connectedness, which also includes the family, like the elders live with or close by to younger generations. And then the coherence, that we won't, there'll be a whole nother podcast episode about coherence. What is that? But coherence can promote cellular homeostasis and the regenerative efforts of the body rather than being in a sympathetic overdrive state where it's fight or flight all the time and we're constantly running and we're not, we're not resting, digesting and healing.

Arpita: I think one of the most important things here, just even to start is just to give yourself the opportunity to have an open mind. A lot of people, like you mentioned, are already considering this and want this. They're like, actively looking for it and then there's honestly people like me on the other spectrum when he started telling me about this five years ago for even before any of the training, official training started, super skeptic and I kept telling people I know he's giving me supplements and helping me with things, but if I ever die, you need to check him out because he's giving me all these pills and it's, it's not all just about the pills. It's like all the other modalities, like he mentioned, like the, you know, the vagus nerve stem and stuff. And I slowly started implementing them and started recognizing, yeah, it does actually make a difference. So I would just put out there have an open mind and consider it. If this is something that you feel you want to get back to living an intentional life and just being happy and feeling better. 

Michael H.: I can't believe we got this far into the episode and have not yet talked about the skepticism. I think that's amazing and I'm so glad you brought it up. Because I think that that is something that is a major. Aspect that holds physicians back from learning more about integrative medicine and it potentially could be something that holds patients back from exploring it. And so, you know, what else do you have to say about the skepticism with regard to integrative medicine? Do you have any, any words of wisdom for people that are, are maybe unsure?

Michael D.: So looking inward at myself, I really truly honestly was not ever skeptical. I was curious, but I also thought, well, I'm focused on this right now. I'm gonna continue and then when I'm ready, I'll look into this further. And I was always exposed to coaching and then the integrated medicine fellowship program via my wife and her colleagues. But I do think you touched upon a key point here, Mike, across the board, this traditional medicines, traditional medicine trained physicians. We're not exposed to integrated medicine as much now that that can vary depending on your institution. Like, I think at a higher state, for example, they have a department of integrated health and so there is a program there. But it's different than what we're exposed to and trained in throughout our careers. And if it's different, we're not sure what to make of it. And we have some built in skepticism rather than curiosity. And that might underscore our mindset as well. If we approach it with curiosity, you might realize there's a lot to learn rather than pushing away something that's just different. 

But I think too many of us still would benefit if we would let the skepticism pass through, put it aside and approach it with curiosity and just ask some questions. I mean, inherently, we all want to learn. We're information seekers. So why not run with that and and learn as much as possible about integrated medicine and how can be beneficial? So I would just say to everyone out there put the guard down. 

Michael H.: Like the be skeptical about being skeptical and and your advice to be curious I think is excellent advice and we could all learn so much by withholding judgment and just being curious. Learn so much about each other but also learn so much about ourselves in the process. So I am sure that people are going to want to learn more about you and your program. You've already dropped your website link, which is www. Connected coherence md. com. And how else can, can people connect with you if they want to learn more about what you're doing?

Arpita: He's on LinkedIn. Let me help him out here.

Michael D.: So I'll be honest, I'm not very active with social media. And that's that's on purpose, partly because I don't have the bandwidth. But then secondly, I think that's one of the things we have to kind of handle better at a social level, because frankly, that's also kind of a Truman show. Like we're, we're presented with things that we think are reality when in, in essence, they aren't, they're just something that someone else wants us to believe or think. Okay. But the impact is that we're now supercharged about something rather than being present and more coherent. Anyway, she's going to tell you, I guess, how to get ahold of me.

Arpita: So, yes, as he said, he is really a very good example of somebody who's not on social media too much, but he does have a LinkedIn profile, which I will slowly encourage him to put his stuff out there on that. But I think, honestly, people want to get in touch with you about this program. It's the website www. connected coherence, md. com. If you don't see it, if you get that 404 error, just keep checking back. It should be out pretty soon. And there should be a link in there to get on his email list. And you'll be hearing from him that way. 

Michael D.: So the two comments I want to reserve for the closure, one is, and this kind of comes back to what you're maybe brought up a moment ago, To those out there who are listening, who found interest in this podcast and are listening, I would just, I would encourage you to not wait. So a positive impact for me personally going through coaching and where I'm at now compared to where I was years ago is my interpersonal skills and my relationships with folks around me are healthier now. And there's gonna be folks in our lives who aren't around forever and you lose the opportunity to have a strong relationship with someone. You just want to be in the best position to do that. And so I would say, don't hesitate. Don't wait. Do it for yourself and those who are important to you to get help with coaching or integrative health, integrative medicine. There's no reason I wish I'd have done this decades earlier, 

Arpita: And it happened exactly when you were supposed to have it happen. Sure. Okay. 

Michael D.: Secondly, second comment is hats off to you too. I, I know from being in this household that what you guys did with this podcast, this series was a heavy lift. And you did it, you know funded by your own pockets for the benefit of others. I think it also for your benefit as well. So job well done. And this is just the beginning. I know things are going to change and evolve, but, but look at what you got accomplished. You've got the conversation shifted to these key topics and just thank you for doing that and, and nice work doing it.

Michael H.: That's amazing. We really appreciate that. I'll, you know, I'll let Arpita speak for herself because she gets to sit next to you and give you a hug. But that really means so much to us. And it has been an interesting year, and it's great foreshadowing for next week's episode, but thank you. That means so much. Really appreciate it. Welcome. 

Arpita: Yeah. There you go. Every single time you bring this guy on, you make somebody cry, so maybe this is the last time he's on this. 

Michael D.: Oh, yeah. Well I guess so. 

Arpita: I just have to go out to a breakfast right after this. Let me just go redo my makeup. Okay. Anyway, thank you. That was very sweet. I appreciate that. All right. Well, guys, amazing. Another amazing episode. Thank you for sharing your insight with our audience and giving them hopefully a perspective to consider. Thank you, Michael Hersh for joining us and honoring us and helping ask some amazing questions again today. 

Michael H.: Thank you to all of you for tuning in this week, and we will see you next time on Doctors Living Deliberately. Take care, everybody. Bye bye. Bye.