When Powerful Therapies Miss the Mark

Welcome to Integrative Medicine with Dr. Leland Stillman, the podcast where we explore the best of East and West, old and new, conventional and unconventional, in search of answers to medicine's toughest cases and most difficult problems. This podcast is for informational purposes only. Diagnostics and therapeutics discussed on this podcast may or may not be right for you, so talk to a qualified practitioner before taking action based on what you learn here. If you'd like to become a patient at my practice, go to stillmanmd.com to schedule a complimentary discovery call. Thank you for listening and welcome to today's episode. Hello everyone. Dr. Stillman here, back for another episode. Today I am joined by Dr. Scott. Dr. Scott, thank you for joining me.

Happy to be here, man. Thank you for having me.

And I like to start by asking everyone who they are and where they're from.

Simple questions with lots of potential nuances there, but I would say that My name is Dr. Scott Shirk. I am a board-certified internal medicine physician. I specialize in something called Health Optimization Medicine, which is also a nonprofit organization that I help run. And then I also specialize in something called hyperbaric oxygen therapy, of which, by which, or whatever you wanna describe it. I've been around hyperbaric medicine for a long time. And where I'm from, well, I grew up in New York. I grew up the son of a chiropractor named Dr. Alan Shirk, who's been a chiropractor for over 45 years that Leland Stillman Stillman knows very well from over the years as well. And he was my initial, you know, mentor with all of these things, health and wellness, grew up very alternatively in his practice over those years. Didn't know what allopathic medical school even was. Didn't know it existed until I was actually thinking about going to medical school or going to professional school at the time. And so I grew up very out of the box and decided to go to medical school with the idea of trying to bridge the worlds of allopathic and integrative or, you know, alternative medicine at the time and found myself on a journey creating an integrative practice around hyperbaric medicine initially, and then eventually creating a practice that also included this foundation, which is called Health Optimization Medicine. And then eventually founding some companies and building some additional things to help people around not only clinical work, but also in the world of training and products.

What's your earliest memory that you can link to your ambition to become a physician?

Nobody's asked me that question before. I, it's a good question. It all feels like this sort of collage of growing up in my dad's office, a period of time. We had an office in our home as well. So I remember like running through the office and coming home through from school and running there. But even younger than that, I remember like coloring in the front and playing with bones, bones of like spines. So I have like those early memories. I also have these memories of people coming out of the office and just being so happy. People coming outta my father's office and just being very, just happy that they were like loving my father, like loving him. And they still do now, maybe even more so than they did you know, back in the early days, I don't know, you provided a service for somebody and they were truly grateful for it. And those are some of my earliest memories. And I always liked the interaction. And when I was a little bit older, I would work the front desk of the office and he would pay me under the table in cash. And I was very good at collecting money because I knew it was helping me get to college. And also it was the money he was going to give me that I could use with my friends and go do things. And, but it was during that time I got to really see him inside. The office with other people, just people, and just seeing like the cadence of that. I knew I never wanted to work like he did, meaning that he is a machine. He'll get up in the morning and see patients and he'll only stop when people tell him to stop oftentimes because people won't, you know, won't keep coming after a certain point. But yes, because between 8:00 PM and 5:00 AM, most people have other things to do. But the other hours he would be at the office basically between 5:00 AM and 8:00 PM every single day. And so I know I didn't want to work as hard as he was seeing patients like that. But I also knew that I really had the same kind of ideas where I could really see myself helping people in various ways that I didn't quite understand at the time. But I would say that's the ecosystem that I grew up in that gave me the idea that I really wanted to help people in the ways that I guess I'm helping them now.

What was it about his bedside manner or his way with patients or his treatment approach that you think left people feeling the way that they felt? Other than of course the good adjusting, which goes without saying.

What he was always very good at was giving people his undivided attention and making them feel like he was in the room for at least 2 to 3x more than he actually was. And I took this to hospitalist medicine for a little while, interesting, when I was like working in the hospital, but in a different way. But the idea is going very wide with somebody, creating a space for them very wide, and then going very narrow and sort of getting to what's required very quickly, and then going wide again and getting out kind of thing. So it was like this sort of beautiful symphony Having that as like a bedside manner was super cool to watch because it's like watching NFL players play their games well. It's just like this beautiful up and down every single time. Right. And then navigating the intuition part has been really interesting because he has a very good sense of that. And that wasn't something that I thought really came naturally to me when I was younger. But, you know, over the years with more practice, you get this more intuition of just the nuances of flow and how people are going to move in various directions depending on what you do, the more you do it. Right. And so I think that, that, that was a big part of it as well.

It's funny because I think the way you described that, you know, starting very broad and then zooming in and coming— I don't know if people get this idea, but it's funny you say it. I immediately understand what you mean. When I was a hospitalist, I always tried to leave on a lighthearted note. And I would say I had things like, I had a lot of good ones. One of my favorites was when men wanted to leave the hospital because they always want to leave before their wife thinks they should leave. So I would say, are you ready to leave the hospital? Oh yeah. Have you cleared that with your boss? And they always know exactly who I'm talking about. And they'll be like, ah, and then I know if they've actually talked to her or not. And I said, look, you got to talk to your wife. You got to make sure she's on board because I've made the mistake only once of trying to discharge a gentleman home without his wife's consent. Doesn't end well. Have you ever read or looked into Ted Kaptchuk's work on the placebo effect at Harvard?

I know all about the placebo effect, but not specifically that book.

No, he's done some of the most interesting work on the placebo effect at Harvard's. I can't remember what the The Institute is, and I don't even know if Kapchuk is still publishing. He's technically a DOM, Doctor of Oriental Medicine. I don't remember. Don't quote me on that. But his background's Chinese medicine. And some of the most interesting work I've ever read is just, and you've no doubt familiar with it from your comment, and this is for people listening, is that just having an interaction with a practitioner where you feel seen and heard and understood and listened to has this healing power, which I think is so lost within the insurance framework of, did you check this many boxes? Did you do this many exam points? Which is why people are so— they leave their physician's office so often and they don't feel seen. They don't feel heard. They don't feel like they matter. They feel like they're just somebody, like, take a number, like the deli counter. It's that impersonal. And I think it's something I've noticed everyone in this space of, as you call it, health optimization has that feeling like we have to have this warmth, this empathy, this genuine connection with patients, which I think unfortunately doesn't necessarily permeate the whole profession.

Yeah, it's, it's really difficult, right? Because we have a lot of other things that are trying to divide our time. Like everybody else, we're clinicians, but we're also human and we have families and we have, you know, dogs and we have people that need to go to the school and all these other things. And then, and then if you're working in a realm like in the insurance world, well, I have to do blood pressure checks and I have to do this, or, you know, how do I have any time to talk to my patients? It's very difficult. It's, it's not an easy world to navigate. But I think what it comes down to is that most clinicians didn't get involved in medicine to do administrative tasks. They got involved to hopefully help patients. And not that I'm going to agree with, you know, the majority of how doctors will work with patients anymore, but I know that if they're able to have better conversations, everything's going to get easier and the patient's going to get better despite what they might do. Oftentimes it's kind of funny, right? I know doctors out there that are fantastic communicators. They're not that great at doctors, but they're fantastic communicators. Like they're not bad, but they're not the most up to date on every single thing. Like the new, whatever it might be, but they have much better outcomes than people that are just on the science and like know everything. They tell you all the data. It's not the same. If you're a better communicator, if you have better rapport with your patients, they will do better hands down. And this is what you're talking about placebo because they believe that they're going to get better. My father is a great example of this. He is somebody that will make people believe that they're going to get better. And that's a Big deal. Because if you believe it, it's true. And I had a pathological liar friend tell me this in 7th grade, Leland Stillman. I was like, why do you always lie all the time? Well, if you believe it, it's true. I don't understand that. But of course now I do. But that was one of the most prescient things that almost anybody ever told me.

I told you earlier, I interview people with really interesting stories of incredible recoveries from severe diseases on this podcast for what we call the Stories of Hope, Stories of Healing series. And every single one of them, almost always without my prompting, somehow in the interview drops that they didn't know how they were going to recover, and everyone told them that they weren't, or that it was unlikely, or that it was very uncertain. And yet they always had this irrational belief, and they don't always call it irrational, and maybe it's not irrational, but they sort of had this, this strange, exceptional belief that they were going to get better. And they didn't always know how, and they always had their doubts, but they always link that belief to their success. And so it's so interesting because you can't bottle that, you can't sell it, You have to work to believe that you're going to get the outcome, and it is so hard when you're in the middle of it to keep believing, especially when you're getting negative feedback. You're getting worse, you're having ups and downs, you're having bad days, the therapy's not working, your labs aren't improving. But you know, the common denominator doesn't lie. They all say, I believed. And we joke about it in the practice that we call this gaslighting yourself to success, because it can feel a little bit like that for sure. But gosh darn if it doesn't seem to work.

The opposite's not going to work is what it comes down to, right? If think you're not gonna get better, surprise, it's just not gonna work. Right. So if you're gonna have a conversation with yourself, don't let it be that. That's, and that's what I always say. If you're coming to see me, you don't think you're gonna get better. We gotta do something about that mindset, right?

Yep.

If you're coming to me, no matter what, I'm gonna fight this thing and I get better. It's gonna be something I'm like, calm down, let's relax. And you're gonna get better that way too.

Okay.

But what you're probably finding with these people, Leland Stillman, is not that they're militantly, I'm gonna get better no matter what. Like they have this base grounding. In the capacity of them to heal that does not require this sort of fighting mode, right? Because I think fighting is the wrong way oftentimes to be thinking about these things, right? Because if you think about it, like, I'm going to fight cancer, like, no, no, you're going to recover from cancer because your body's going to be able to recover from it, right? Like, that's the framework that you're telling me you're talking about these people oftentimes. It's not like I fought it with everything I could and then I got through it and 'No, I'm better.' That happens, but that's not really what we're talking about here. That's not the mindset, really, you know?

I agree. And one of the best pieces of advice I've ever gotten from my friend Richard Brooke, he said, 'Fall in love with the process. Doesn't matter what it is, fall in love with the process.' The process of being healthy isn't standing atop the podium because you just won triathlon, or you just won some marathon, or you are the best figure competitor in your zip code. It's the 'I showed up at the gym and put in the workout that I knew I needed to do in order to reach the goal.' It also isn't obsessive. It's not 'I went to the gym for 3 and a hours and punished my body into the ground, and I'm not sure I'm going to be able to walk tomorrow. It's, I just did this daily work. I put in, I was consistent. I often share with patients that what's so important about consistency is that it compounds in ways that we don't even see. So 50% of the effort doesn't necessarily mean that you get 50% of the results. And the analogy I'll often draw is that of a penny. If you double a penny every day for 30 days, it's something like $5 million. It's absurd. I mean, it makes your head hurt. You're like, how is it possible that you double a penny 30 times and it's $5 million? That math works out, but it does because the human brain doesn't tend to work in exponential functions. It works in linear functions. If you double a penny every other day, every other day for 30 days, it's like $163, barely enough for 2 people to go out to dinner at a nice restaurant and have a bottle of wine. So $163 results versus $5 million results. It's the difference between did you do the work every day or did you do it every other day? Really fascinating, very important. And part of why I do podcast is I want people to get these little pearls so they come in with the right attitude to whatever clinic they're going to work at or, or be seen at as patients. I want to get the rest of the story here because what I'm really curious about is you came in with this open-mindedness to integrative medicine, but you went into allopathic.

Very rare.

I know one other person like that that I can think of, and I'm sure there's more, but that's how many I know. And I, I know a fair number. I'm really curious, what was your experience of medical school like? And then how did that— in residency, how did you then pick and choose what opportunities you pursued, and then how did you structure your career from there to get to where you are now?

A lot of fun in medical school, man. I gotta tell you, I studied, I went to University of Maryland in Baltimore. And so it was in the city of Baltimore. And I have to say that it was just like being in school, right?

Baltimore was more fun then, wasn't it?

Between the years that I was there in 2003, 2012, where it kind of like it's golden time, a lot of shock, a lot of trauma. That's what I learned about. That's where I learned about hyperbaric medicine actually was in the trauma center there.

Really?

But oh yeah, the other large hyperbaric facility in the basement at shock trauma for Maryland. Oh yeah. Because it's, it's the shock trauma was developed at Maryland because of all the trauma in Baltimore. So you have all the military branches that go actually and train their, you know, their surgeons and ER docs on gunshot wounds in Baltimore. So it was a thing then. It's a thing now. I was there at a good time from a Baltimore perspective, I guess, from a training perspective and for a training perspective too, it was a good place to train for like a lot of crazy things.

Good for you, bad for the gunshot wound victims.

I mean, it's, it's both, right? Like oftentimes, I mean, most of the gun, the gang violence, almost the gunshot wounds is gang violence, right? It's not typically, but people do get caught in the crossfire, of course, all the time. I mean, from a couple years, first couple years of medical school was really just studying and then partying in between studying. So it wasn't really a whole lot different from college except the partying was harder and the studying was harder, you know, in combination. But, but oh yeah, definitely. Yeah. But after that, when medical, when residency really started, or even when the second couple years of medical school, medical school and residency, when I started going in and trying to check out all the different types of specialties and things like that, I got pretty jaded pretty quickly is what it came down to because I was like, okay, this is all the same things that I really don't want to have very much involved with. Like, I don't want to be a surgeon. Not for me. I don't want to scope people every day and night. Not for me. And so, but do I want to be a dermatologist? Ah, you know, that's kind of nice. Like you get to make a whole lot of money and you, and like, do I want to be a radiation oncologist? I don't like radiation. I don't like oncology, but I like making $500,000 a year. That sounds pretty cool. So I got somewhat tantalized by those kinds of things for a little while, but in the end I decided on internal medicine because you really were learning a lot of physiology and pathology, which I thought was interesting. I just recently finally retired from that in this year, actually, Leland Stillman. It took me this long.

Why did you pick hyperbarics and how did that happen?

It started in medical school when I learned about it when I was at the shock trauma center. I saw it being used for things like burns and wounds and trauma, neck fascia, which is a terrible infection that, you know, so I saw it being used in those ways. And then actually, interestingly enough. My father was getting interested in hyperbaric medicine around the same time because he was seeing it being used and starting to use it himself in kids with developmental disorders, with autistic, autistic spectrum disorder, with ADHD, with anoxic brain injury and others. And this is back in like 2000, I don't know, 5 to 7, around that timeframe. So very early on, but seeing some really great benefits. And so I was learning that the amount of research that had been ongoing in other countries was actually quite significant outside the United States in that there was a potential way to bridge the worlds of the conventional and the alternative world using hyperbaric medicine as my kind of fulcrum there as my, as my lead. Also knowing that most people that are involved in hyperbaric medicine at the time were much, much older. They were in their sixties and seventies. And I was the dude that was just coming out of training that had no wrinkles at the time and didn't have any gray hair in their beard and could, and looked like, you know, I was like the new whippersnapper that could learn a lot about hyperbaric medicine very quickly. And create something that was, you know, special and I think impactful in my own niche, you know.

I like to ask this question because it's always got a good answer. Usually when somebody finds a great therapy that they then fall in love with and dedicate a huge part of their life to, there's a story. There's like one patient where they saw something just amazing happen, or, or a series of patients, or like a, a scenario, like a ward, like a burn ward, let's say, would be a good story for hyperbarics. Was there a case or a moment in your career where you thought, I've really got something here? And what was what was that like and why was it so compelling that you've dedicated now a large part of your life to hyperbarics?

I think there's many ways for me to answer that question actually. And I think it kind of dovetails into like my evolution a little bit. The first case that I saw was somebody with necrotizing fasciitis when I was in that shock trauma ward, my third year of medical school. I don't know if you were still doing Q3 or Q4, 30-hour call when you were training, but I was. So I was at shock trauma. We were on call for 30 hours every 3 nights. For 2 weeks.

Brutal.

It was brutal, right? And so it was very tiring. And my typical residency when I was in my fir— my second and third year of medical school was 30-hour calls every 4 nights. So it wasn't like, you know, this, this every 3 nights was, was hard. But that one neck, neck, neck fascia patient that I saw, she was this morbidly obese lady with neck fascia both on her arms and her legs.

Paint the picture of what neck fascia is for the average person who's never heard of it.

Yeah. So neck fascia is basically, it's called flesh-eating bacteria for a reason. Necrotizing fasciitis is the long-term It looks like your, your skin is actually frying off. Like it looks like it's like slabs of meat for a lack of a better description.

And to me, the scariest, the scariest thing about it is I remember hearing a horror story from the ICU where I trained. The way he told it, it was funny because he was a really funny guy. Ted, I think it was Dr. Ted Sears, if I remember his name correctly. It was this, this case where it's like, there was like a tiny, tiny, like pimple or divot or like skin defect on the heel. And the patient just starts crashing and their vitals are worse and their blood pressure is going down and they're just they're just decompensating very rapidly and everyone's like, what is going on? And it's neck fascia. And the only manifestation on the initial presentation was that tiny little— and so it's a terrifying diagnosis because it is like, it is, it spreads so fast. And a typical course— I hope I'm not stealing your thunder here, but I just—

no, you're good, man. This is good. Yeah.

They like a typical course would be you were having a normal day. All of a sudden you started to feel poorly. You went to the hospital. The next thing you know, you're going to the OR for debridement and your entire leg is being stripped of all your skin. Because it's gone necrotic and it's—

Yeah, it goes through the fascial planes and goes and gets a gas organism. So it just goes fast. And then it causes this toxic shock kind of thing because it's typically strep or a clostridial infection. But in the end, what happens and what I saw is that this lady came in, it looked like she was going to have to get amputated, all 4 of her limbs, all 4. And it was nasty looking. And then I saw her go down and then come back. And instead of her limbs looking like purple and terrible, they were pink again. And she was going to get some debriement. She lost a couple of fingers. She lost a couple of toes. She may have lost one foot, but like in the end, she didn't die, number one. And number two, she had significantly more limbs than she was going to have otherwise. And I was like, what, what just happened to this lady? What did you guys just do?

Yeah.

And I was like, that was all you— you're telling me all you did was give her 100% oxygen for 2 hours at 2.5 atmospheres. And that's what she— that's it. I was like, I gotta learn more. So, I mean, that was one of my major—

that seems like a valuable therapy.

Yeah, seems valuable, right? And you're telling me it's just oxygen under pressure? Like, that's, that's kind of crazy. And so that was like my first story. And then when I started getting into hyperbaric practice and I had a couple really significant improvements. One was, I remember like an insurance-related condition. It was, it was radiation cystitis, a lady that had radiation to her bladder and it was radiation to her uterus because of uterine cancer. And had bladder complications and was having bleeding that just wasn't stopping. And they had tried everything. And then finally hyperbaric therapy stopped her bleeding after like months or even maybe years at that point for having chronic bleeding. I remember that being super cool. And I remember another patient that was a younger— it was a kid that had maybe 3 or 4 ski injuries to his head. So traumatic brain injuries to his head skiing. He was at the point where he wasn't in school. He might've been like, I think he may be like 10 or 12. He wasn't in school, wanted to kill himself. Didn't want to, didn't want to live and had no motivation. And he was doing neurofeedback, not getting a whole lot better. And all of a sudden, like after maybe 10 or 15 hyperbaric sessions, the kid's back in school, no more depression, doing great, great at everything and wants to go back skiing. And we're like, no more skiing, you know, you're done, dude. Like you're done after 3 concussions of skiing, you're done. Right. And like, but like he's back to being like a, like a 12 or 13-year-old kid. Right. The evolution of this is interesting, Leland Stillman, because I also saw people that I thought should get better with hyperbaric therapy, but they didn't. And actually some people get worse initially. Usually it wasn't like long-term they would get worse, but they would get worse in the chamber and not get better. I'm like, well, what, what is going on here? And, and I realized over the years that there was a significant portion of people that were getting into hyperbaric chambers before they were really ready to get into a hyperbaric chamber. And what I mean by that is that there's a significant amount amount of oxygen going into the system when you're using hyperbaric therapy. That's causing what we call stress to the system. Can the system actually tolerate that stress? Number one, the initial stress of it. And then also, what are they going to do with all the stress that you just created? Do you have the capacity to actually— what's neutralizing that stress over time? Now, that stress is what makes hyperbaric therapy work under most circumstances. But I found over the years that if you didn't look at that from a machinery perspective— how well can they make energy? How well can they detox from the energy that they make? How can balance that, that oxidative stress that's created under hyperbaric conditions. If they don't have that capacity, they are not going to do well long-term. They may do actually very poorly initially, and it could be diagnostic in many ways. But I found that if you didn't allow somebody to go through the process of at least optimizing on some level, if they're already very sick, especially then any benefits that you saw, and even initially in the hyperbaric sessions would likely not be something permanent for sure.. And so the evolution for me was like, well, there has to be another way of doing this. And I got to the point where I was going to give a lecture in 2021. It was a virtual lecture. And the title of my lecture was going to be, please do not put them in the chamber. And I got disinvited from this lecture because it was a hyperbaric conference. And so that's not good for anybody's bottom line. Right. And so if you have a therapy You want to use it, right? And that, I don't fault people for that, but it's just, you know, it just means I'm a hammer.

You are a nail.

Indeed. Right. And so I have always had the benefit mostly to be able to be on that higher level, not higher, but maybe the removed level, which is like, I don't own a clinic. I'm not trying to fill these chambers. Now other people do, and they have to fill these chambers for various reasons. But what if we can work on optimizing somebody's foundational biochemistry, their vitamins, their minerals, their nutrients, their mitochondrial health, their stress. Their lifestyle, all those things for 3 to 6 months before doing hyperbaric therapy. Now, if it's an acute issue, get them in the chamber, educationally throw shit at the wall. That's gonna be optimizing them along the way. And I call it my educationally throwing at the wall strategy, right? But in that framework— Is that trademarked yet? I, I should, right? But I don't have it trademarked. I, but I like that. You guys know all this, this analogy, right? Like you have an educational way of thinking about this and I have a framework that I've developed over the years on how to do this. But if you have time, then use a strategy that's a framework that's going to help people whether they get into a hyperbaric chamber or not. And that's kind of how I approach it now.

That's fascinating. I love that. I think it's so important for— and one of the things you mentioned, right, is that people don't want to talk about when their therapy is not appropriate. And I think that's such a shame because I think they're just thinking about it all wrong. Even if you just look at it from an economics perspective, you know, because I've had my own struggles with this in terms of, okay, well, I want to do this really, really, really well with very high integrity, exceptional outcomes. But how do I do that and balance that with my responsibilities and not give away too much so I don't have quality of life? How do I, how do I communicate the value of what I do? How do I make sure that patients know what they're signing up for? I put a lot of effort and thought into how we structure the way that we onboard patients so that we, we can get the best outcomes and we can serve the people who it's right for us to serve. And that all has made me think that clinicians and business owners don't think about this the right way in this following sense. If there's people who shouldn't go in the tank and you're putting them in the tank and they don't get a good outcome, you're creating negative word of mouth and you're also burning this therapeutic that has tremendous value. They're creating a negative association in their mind. And so really all you need to do is make sure that you identify these people before putting them in the chamber. And instead of thinking, oh, well, this is going to hurt my bottom line, well, no, this is an opportunity for you to serve them in a different way. So you're not—

I appreciate that so much, man. Like, if you tell them that something is not going to work for them, it's a deal, you know? And I think that because they, because it's just not something that they're expecting. Right. And that's a big thing that I found over the years is that it's very much appreciated when I'm like, look, I think hyperbaric therapy can help you at some point, but not right now. Absolutely. And I often say it's like, it's not if, but when. It's not if hyperbaric therapy is going to be helpful, it's going to be when conversation. That's so, so important.

Yeah. It's just a matter of human nature that that's how a lot of people look at it. But at the, at the end of the day. I think it's so important to have the perspective you had just shared, which is let's figure out who needs the tank and who doesn't. And like you said, I mean, I've been really impressed with hyperbarics personally and professionally because it's such a powerful tool. And physiologically, I can't imagine someone whose life, assuming they don't die traumatically in the next 5 minutes, it won't be relevant for. It's that powerful. It's that important. I really think in the coming decades that every home will have a hyperbaric oxygen tank. If it doesn't have one built in, it'll have spot for one that's portable. Because when you do the math on the amount of suffering and misery and death it can postpone, even though it's a $20,000, $30,000, $50,000 device, it saves that much over the lifetime of the device and more, which is part of why I'm— I mean, I'm not surprised, but I am surprised that it's not a bigger part of modern medical practice. It's so promising. I think, and this is part of why I think you guys are You know, like your dad's practice has taken off so much with it. It's so powerful. Just like you shared in those, those cases that really impressed you about its effects.

It's the best, and the best case scenario, it's used in the context of an integrative, functional, foundational kind of practice. And that you have a practice like that, Leland Stillman. I have a practice like that, which is, you know, focused on optimizing the machinery that's required for you to make energy and detox effectively. Like, what is metabolic health really? It's really that right there, which is, can you make energy? Can you detox from the energy you make? Everything else is either causing that issue there or will get better if you fix it. Right. And so in the end, that's how I think about it. And if you think about hyperbaric therapy in that context, you are going to be just fine. But if you think about, oh, hyperbaric therapy is going to be good for my migraines, or hyperbaric therapy is going to be good for my, you know, my mild cognitive impairment with it, the answer is maybe, but it is going to be so much more optimal if you think about things in this kind of context. And that's the framework that I always have. I have tons of people that still reach out to me for hypobaric therapy only and they say, hey, doc, I'd love to talk to you about hyperbaric therapy for my cancer, for my migraines or whatever. I'm like, yeah, well, who's your integrative oncologist? What are you doing about your migraines? Right? Because hyperbaric therapy, like if you throw it in the context of everything else is going to be great, but in the context of just doing it for that particular condition without the foundation is likely going to be missing a big part of how to help you heal long-term.

Have you written a book about this yet?

So the short answer is no, but the long answer is yes. Because, um, because you know what I, what I did back during the pandemic, what I was, I wrote everything down that I did in practice. Right. I was like, what is my framework? Right. That, that's been, I have it all written down. I just haven't published it.

How long have you been in practice now?

Uh, well, I've, so I finished medical school in 2010. Oh, it's going to have been about what, 15 years? Um, it's almost been 20 years ahead of me. Yeah. So I've been seeing, I've seen patients since 2003 or 4 since medical school. So it's been almost, it's been 20 years of clinical practices, as I like to say at this point. Um, and so So, but the framework that I developed for hyperbaric medicine is something I'm very proud of actually. It's something that I haven't published a lot on. I've done some talks on it over the years, but the, the framework is very simple. It's basically that if you have time, then you should use a framework on how to think about when is the best time to use hyperbaric therapy. The smokescreen to all that is that it doesn't even matter if you get into a chamber, if you do the other stuff, you're gonna do great too. Right. Which is optimizing on all the levels that you already know, but it's just the framework that I use, like, right. Laboratory analysis, diet and supplementation, other technologies that might be helpful, other practitioners that might be helpful. How are you going to surveil things over time? And then of course the hyperbaric experience itself, right? And then all the practices that you're always going to be thinking about to dial down whatever it might be, your nervous system and other things. And so it's really just like a 7-pronged approach and then dynamically working with hyperbaric therapy and not just thinking that one protocol is going to be the same for everybody. Hmm.

Agreed.

It's not rocket science, but it's something that I've felt that I've kind of just stumbled into over the years as the way that really works.

It's funny you say that. It reminds me of an Osler quote. Are you a fan of Osler quotes?

I don't know Osler quotes, but I know Osler.

He said something like, medicine is an art of probability and a science of uncertainty. And I love that about it. Yeah. And it's something I share with patients because they're like, what is the protocol? Like, we have some of the protocols that are one size fits all, but all of you are, and I like to joke, I like to say this jokingly, right? All of you, each of you is a special snowflake and you all fall and you all melt in your own special way. So We can't, there's not just one protocol. We have to tailor all of this to you. And some of it is intuition. You know, this patient makes me nervous. I'm going to give them a lower dose of X or Y because I don't think they'll tolerate it as well. Sometimes I don't even know why. I just get that feeling right through the Zoom call or whatever.

Your spidey sense.

Yeah, exactly. And I so appreciate this thinking on your part because I really see this happening in the landscape, modern landscape of digital marketing of patients are being so aggressively marketed to this therapy, that therapy, this device, that device. I think it's very important for physicians to prescribe judiciously. And I really care in my practice about making what we're doing sustainable, because I think what I've seen happen is people will sort of— it's like they sprint out of the gate and they're gassed after 100 meters and they're not better. They're not well, they're not at their goal. And whether they've run out of time or money or energy or attention, then they just stall out and they're unhappy. And they often, I find, feel very— they actually will get disillusioned if the clinician is like, well, you got to do all the things at the same time. Time because they feel like overwhelmed. And they'll often come to me saying, I went to this doctor, they put me on 20 supplements, I feel worse, I'm having all these weird reactions, I can't get in to see them again, what do I do? Right? And we'll use like 5 to 10 supplements as sort of a rule to try and get best results because I don't often find that people respond well to more than that. That's not a hard and fast— we've got certainly plenty of patients where we're more aggressive, but that's just like what I've found. And I think that What I see happening is there's this like cheapening of the doctor-patient relationship going on as people are inundated with like direct-to-consumer labs, direct-to-consumer HBOT, direct-to-consumer everything. There's this lack of appreciation for— there's such value in working with a clinician who really cares and who really wants to get you the best results and to work within your lifestyle, budget, and all these other things, taking into account the whole person. It's one thing I've seen definitely have— it's like people will spend a lot of money on their wellness and the financial stress will end up creating more disease than they had in the first place.

For sure.

Having that sensitivity and that understanding is, I think, very important. And working within the constraints of the patient's life, that's what I feel is, is at the heart of that relationship. And I really care about us bringing that back to medicine because I think it's really been, been ground out of it by the insurance companies, the hospital administrators, the HMOs, all of that.

Yeah. Yeah. It's tough as a doctor to maintain that presence and that engagement because you just want to get done with one thing so you get to the next. It's very difficult and it's something I've had to reprogram in myself over the years and I'm still working on that just because of all the years as a hospitalist and all the years of just trying to get my work done so I could go home and do something else, you know? And so, um, it's, it's not easy, but I do very much acknowledge and appreciate the doctors that are doing their best and it's not easy. Oh yeah. But I see great— saw, I worked with some amazing hospitalists. I'm like, you guys are great. You really love what you do. Yeah. Like you really care.. It's, it shows, right? And like, there's really great doctors in all the realms of all of these things. So it's not like, you know, one single population of doctors is just not doing it. Like it's, it's, but it's really difficult to maintain that. I have one of the guys I work with, I remember he's a hospitalist at one of the hospitals I was recently, was, I was previously working at recently. He just called it, it's like a meat grinder. Like that's what he felt like. He's like, I'm just at a meat grinder. I grind 'em in, I grind 'em out. You know, he was a great hospitalist, right?

Yeah.

He was really good at what he did, you know? And so. So I think the key for me, when I think about being a clinician and also working with or starting companies that are trying to help people, it's like, like from my hyperbaric company, the, the One Based Health company, I'm always telling them, I want to hear when we don't recommend something to somebody. I don't want to hear when we do, right? Like, I want to hear when we don't think it's the right thing to do, because that's the ethos that I want to go by. Like, I don't want to go by like, everybody needs a hyperbaric chamber. No, right? Not everybody needs a hyperbaric gym. Like it's expensive, right? Like maybe they should go see somebody else. Maybe they, you know, maybe they should go, should go do an ayahuasca journey in Peru first. That's gonna be better for them than getting a, getting a hyperbaric chamber.

That's what you should do. Your thoughts on, your thoughts on psychedelics would probably be a whole nother episode.

Exactly. So, but that's, I'm just giving an example that spend your money where it's required now, and that might not be. And so that's, that's the ethos that I always run with the companies that, that I help, help, you know, help run now. It's like, what are we doing to help people? Right. And making sure that that's always is the primary driver, not revenue. I mean, I know that's hard for my, my CEOs don't always like me, but like, that's what I'm, my goal always is what's the best thing that we can do for the person because the long-term, that's going to be the better strategy. No doubt about it. Like you said earlier, right?

And I think that's something that's lost on a lot of entrepreneurs in health and wellness who aren't clinicians. They don't understand that once as a physician, you've gained somebody's trust, if you burn them, it's over. They will not come back to see you. They will not send you their friends and family. They will not promote you on their social media. It's over. And you only get that once and you, it takes a lot to earn. And what's interesting about that to me is that the time horizon there is insane. When, when you think about this, like I'm taking care of families, I'm seeing their children. I might be their doctor for their entire life. I might die before they, these kids do. I mean, I statistically I will.

Yeah.

Some of them are that young. Right. And the point there is like, Like, you're thinking about short money, you're thinking about like sales today. What is wrong with you? We're talking about 10, 20, 30, 40, 50, 60 years. If you have one family that doubles every generation for 60 years, which is like maybe one clinician's working lifespan if they start early, and like I intend to work into my 80s, I'm sure, uh, that's 2 generations of a family. And so, and I see this happening with like private equity that takes over healthcare companies. They'll just turn them into these terrible, like, how can we squeeze as much juice out of this orange as possible? I'm like, you're ruining this product in this service that is so good. So I'm glad that you're championing that because yeah, the CEOs and the people who come in as administrators don't often get that. But when you, when you really try to serve people well, I've just seen it come back because people are, they're really hurting for that right now is what I see. The, the country doctor who you could trust, he was your neighbor, he was your friend, he was a community leader. He's basically been driven out of practice by these big organizations. And so the few of us who that, that carry that forward, whether it's like you and building companies or me and building a practice and you've got it your own micropractice.

Right.

But it's very small compared to the, from what I understand.

For sure. Yeah. It's not a big practice. I keep it small.

Yeah.

I keep it small.

Yeah.

Yeah. But I think that the other piece of that is just keeping my toes in clinical practice is very, very important to me for that reason. Right. Like I, I don't, I understand why people stop. I am very busy and some days I do not want to see patients because I'm just so busy doing everything else. But when I do, I'm very happy that I did because is I know that I'm providing value and it's not just that I'm giving value. I get tons of value back, right? It's like, it's very bidirectional here. And so I think it's very important for me. And I think that, you know, I do see this very often when clinicians stop doing clinical work, they lose that, they lose it very quickly too. And they forget what it's like somehow very quickly oftentimes to feel like what it, what it feels like to actually be with people and doing it. And I know it's not for everybody. Like, I totally understand that. And, but for me, I feel like it's a big part of how I can I can help give value to the companies that I help run is by being a clinician. And so I know that, and that also, I feel like there's more of a pulse of what's going on, that you can't just give one protocol, like you said, for everybody and like be the influencer says, yeah, this is my sleep stack, have fun. And then you and I are like, no, none of that's going to work for you. Sorry.

Totally agree. And I, you know, I have noticed that as well. You know, the doctors who turn influencers only, no naming names here, but it becomes very clear from their prose, their writing, the way that they write about clinical medicine, that they're not seeing patients anymore. And it does a lot of harm, frankly, in, in, to patients. Because frequently, I've said this before, I'll say it again, in clinical practice, you're either busy getting good or you're busy getting famous. And it's a really interesting, interesting balance because it, you know, I know docs who are really good, but they, they don't have enough, they're not famous enough to have their own practice. They're actually still working in the hospital, which isn't a bad thing. It's just an interesting dichotomy, right? Where you, you have some of the most loud vocal well-followed, influential people who are making very mediocre to downright terrible recommendations. Not all the time, but frequently. It'll happen. What happens in the practice is they'll put something out and it will get this kind of like zeitgeist on social media. And the patients are coming in and they're like, hey, Dr. Stillman, did you see that thing that so-and-so? I'm like, yes, I did. I know that.

Yeah. There's a couple of people that I just know as soon as it goes out, I'm like, ah, crap. I'm going to get like, and I'm sure you're the same way because you're like, like, this just happened, I just heard this, like, and I listen to certain people, again, I won't name names where I get like the downloads from a couple of my trusted friends or whatever. I'm like, okay, what did this person talk about this time that I'm gonna have to, like, I'm gonna have to talk about, or I'm gonna have to deal with, right? That's just the nature of trying to navigate information. It's not easy as a consumer of information to find good stuff. So that's why I think it's so important to find a provider that you trust, right? And they don't have to be an MD. They can It could be a health coach. I doesn't really matter to me because you just have to find somebody you trust and that is consistent and that is there with you. Right. I think that's, those are the most important pieces. Everything else would be nice icing on the cake, many things, but that's the base for everybody.

Yeah. So much more we could unpack and maybe for part 2.

Yeah, I know.

Right. So any closing thoughts? Where can people get in touch with you? Follow your work? What are your companies that you've alluded to over the course of this podcast?

Final thoughts is that I, I really do feel that there has been and continues to be a sea change in the world of clinicians wanting to have more of these kinds of relationships with their patients. So if you're out there and going, my clinician just doesn't listen to me and I can't find— there is a way, just keep looking. You will find somebody that you, you will resonate with at some point.

Well, you train practitioners. Do you maintain a directory, Dr. Scher?

We have a nonprofit organization. It's called Health Optimization Medicine and Practice, or HOMMHOPE for short. And actually Leland Stillman Stillman's been on our podcast. It's called the Smarter, Not Harder Podcast. And we have a clinician registry where if you're interested, you can go online and find somebody that's been trained in our, in our program. And, and it's a, it's a foundational framework that we use that I think is very robust. Okay. So you might find a clinician with us. That would be great. You're welcome to go to hommhope.org. And if you find somebody that works fantastic, I would love that. But that's not necessary. You can find somebody else, you know, within a, maybe somebody locally that you you really trust. It just, it sometimes can take some time. And as a clinician, if you're listening, I hope this has been helpful as a framework to think about. We all evolve. Like everybody in theory, we're constantly changing and I'm, my clinical practice is constantly changing. I'm constantly learning.

Yeah.

But also just the longer you're in practice, the better you're going to get at this. Like if you're new at practice, it's not easy to understand this sort of intuitive Spidey sense of things, but over time you will, you know, it reminds me of my favorite quote about experts.

An expert is someone who's made all of the mistakes possible within a very narrow field.

There you go. I love that.

Yeah. Niels Bohr, quantum physicist, said that. It's one of my favorite quotes.

I recognize that one. That's a good one. And so I think my final thoughts are just, just enjoy the moment, everybody. That's all we got here. Like, and just, and know that you can enjoy the moment while also working to be better in the future. So whatever that might be. And so for me, my clinical practice, where you want to find me, drscottsher.com is my website. So it's D-R-S-C-O-T-T-S-H-E-R.com. That's where I have my clinical and consulting for hyperbarics. That's where I have my health optimization practice. That's where you can find my companies, one called OneBase Health, which is a company that does work in hyperbaric medicine, but also integration of devices and software that all is kind of working together in this ecosystem that I'm really excited about to help people work better and, and personalize their protocols. And then we have a company called Transcriptions. I have a company called Transcriptions that is a, it's a, it's a product development company that works to help people right now along their path to optimizing their health with sleep, immune system optimization, energy, using things like methylene blue and cool things that downregulate the nervous system. Not ayahuasca. We don't use that because that's not legal, but other cool things that are legal and optimal. And so you can check that out at transcriptions.com and onebasehealth.com too.

There's so much more we could do for part 2, 3, 4, 5, whatever, but I'm sure we'll get around to it.

Yes. I know we're both busy, so I'm glad to hang out, man. It's been fun.

Yeah. Thank you for joining us and everyone. Thank you for listening. We look forward to seeing you on the next episode.