Sleep 7–8 hours every night. Getting adequate sleep leads to improved cognitive function, decreased risk of alzheimer’s disease and cardiovascular disease, more energy, stronger immune system, better wound healing, and slower aging, just to name a few. The list of benefits goes on and on and addressing your sleep problems early on could make a world of difference in your long term well-being.
As a part of our series about “How Anyone Can Build Habits For Optimal Wellness, Performance, & Focus”, I had the pleasure of interviewingDr. Matthew Kohler, co-founder of Ospina Medical.
Dr. Matthew Kohler has been a leader in the field of Interventional Pain Medicine in Manhattan since he began his post-doctoral training in 2015. He completed both his residency in Anesthesiology and fellowship in Pain Medicine at the prestigious Columbia University Medical Center, part of New York City’s #1 ranked New York Presbyterian Hospital system. He is double-board certified in Anesthesiology and Pain Medicine through the American Board of Anesthesiology. He has completed advanced certifications in Regenerative Medicine through the Interventional Orthobiologic Foundation and through affiliation with the Regenexx Network. He has also pursued additional training in genomics-based personalized medicine so that he can best optimize his patients’ health and give them the best possible outcomes.
Thank you so much for joining us in this interview series! Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?
Thank you for having me be a part of your interview series! I actually had a pretty eventful childhood in a lot of ways and it’s a little bit challenging to summarize succinctly, but I will definitely do my best here! My roots are in a town called Culpeper, Virginia where I was raised on an 80-acre farm with my parents and my older brother, Mikie. My paternal grandparents also had a farm on the neighboring property and much of my extended family was nearby. This allowed for a really fun childhood playing sports with my brother and cousins, hot air ballooning on weekends (my parents were licensed hot air balloon pilots), and spending time exploring the farm. Unfortunately my father was diagnosed with colon cancer at a very young age and had to undergo surgery and multiple rounds of chemotherapy before eventually passing away in 1991. I was seven years old at that time. My mom raised my brother and I as a single parent for several years before eventually remarrying and moving to Chadds Ford, PA with my step-dad and step-siblings. In October of 1997, when I was thirteen and just a couple months after starting at a new school, I discovered a painful lump on the right side of my neck. I had had Lyme Disease the preceding summer, which my primary care doctor thought was the cause. However, my mom insisted on a biopsy to make a more definitive answer because of her experience with my dad getting a delayed diagnosis. I was brought into the A.I. duPont Hospital for Children in Wilmington, DE to receive the results of the biopsy and was told that I had cancer. In my case, it was Non-Hodgkins Lymphoma. I had enlarged lymph nodes in my chest and neck, but was told that I was in an early stage and that I would have to undergo a chemotherapy protocol that would last about 18 months. As an early adolescent this was obviously a difficult thing to accept, but I was fortunate to have an incredible medical team and supportive family. My cancer was responding very well to the treatments and we continued to push through with optimism and looked forward to the day I completed my chemo. But, before I could finish my chemotherapy, I was again presented with a significant loss. My brother Mikie, who was 3 years older than me, fell asleep at the wheel after dropping his girlfriend off at her house on Valentine’s Day in 1999. Two months later I underwent my last round of chemotherapy. Without a doubt this was the most challenging and defining period of my life, but it gave me a unique perspective and a strong sense of purpose.
What or who inspired you to pursue your career? We’d love to hear the story.
I’m sure the response to the previous question gives you some insight into what inspired me to pursue a career in medicine. Clearly a lot of my childhood was spent in the hospital setting between my dad’s cancer treatments and my own cancer experience. One additional significant contribution to my career choice was that I had an uncle with hemophilia who acquired HIV from a blood transfusion and this was subsequently transferred to his wife. Both of them tragically passed away at a very young age, but I remember spending a lot of time with them in the medical setting as well. The combination of all those experiences gave me a lot of insight into illness and allowed me to fully understand and appreciate the patient experience. I felt that I could truly empathize and sympathize with patients as a healthcare provider. I also always had a passion for science and an interest in working with people, so medicine was really a natural fit for me.
None of us can achieve success without some help along the way. Was there a particular person who you feel gave you the most help or encouragement to be who you are today? Can you share a story about that?
Without a doubt, my mom has been my greatest inspiration. She has been the model of resiliency that helped me to overcome all of the challenges thrown my way at a young age. Everything I went through, she went through and more. She lost her father to a motorcycle accident when she was in college. She then prematurely lost her husband (my father), her brother (my uncle), her son (my brother) and a best friend. Her ability to overcome these immense challenges and dedicate much of her time to helping others while keeping a positive attitude and appreciation for life has been an incredible inspiration for me. She has always kept me grounded and made sure I always looked for the best in others. If she had a friend or family member going through a difficult time she was always the first one to be by their side. If I had a friend that she saw was experiencing something challenging, she always encouraged me to be there for them. Additionally, she never pressured me to do anything specific with my career or major life decisions and always allowed me to pursue my own passions. I feel like that is something that can’t be understated in regards to my growth as an individual.
Can you share the funniest or most interesting mistake that occurred to you in the course of your career? What lesson or take away did you learn from that?
(Some of the details about the patient have been changed in this story)
Something that has had a tremendous impact on how I currently practice occurred during my first year as a Pain Medicine attending. It was the first time I was seeing my own patients and I was eager and excited to find ways to help every one that I saw. In this particular case it was an individual with a pars defect, which is a stress fracture of the lower spine. He had seen a number of physicians for this and had done all of the conservative care measures over several years without any improvement in his low back pain. He wasn’t interested in undergoing surgery for this due to his young age and unclear benefit of surgery in his particular case. The patient had recently moved to New York and came to me to establish care there. He had been under the care of a pain physician in his previous hometown who was prescribing him low dose opioid pain medications to be taken occasionally for flare ups. He was a professional in a stressful field and spent a lot of his time sitting for prolonged periods at a desk which was not tolerable for him at times. After carefully reviewing the patient’s records and speaking with him about the risks and need to minimize their use, I agreed to take over his opioid prescription. When prescribing these medications as a pain physician we are constantly reevaluating the need for them with the patient and using whatever objective information we can to ensure the medications are being taken appropriately. Over the ensuing months the patient seemed to be going through his medications faster than what he had been taking historically and was requesting more pills whenever he came in. He chalked the increased pain levels up to working long hours and stress. Otherwise he seemed to be using the medication appropriately and didn’t have any other signs of opioid abuse or overuse. I never actually increased the medications and instead focused on lifestyle modifications and non-opioid therapies with him to help him manage his low back pain. Several months after I began seeing him as a patient he ended up having an unrelated injury that required urgent surgery and following his discharge from the hospital he was given a slightly increased dose of the pain medications by the in-patient care team. A few days later I had received a call from the hospital informing me that the patient had overdosed and passed away. When one of his friends discovered him they also found that he had large quantities of opioid and benzodiazepine medications purchased from other people stashed in his apartment and appeared to be both selling and abusing the medications. As a young physician this was a gut-wrenching moment for me. I couldn’t fathom how I could have missed that he was misusing the medications I prescribed to help him get through the day and help him function at his job. This was a truly eye-opening experience for me in many ways and it has changed my approach to managing patients dramatically. Obviously opioid medications have had incredibly damaging effects on our society and are not something to be utilized without close medical guidance, but I was convinced, or at least very hopeful, I could avoid having outcomes like this with careful questioning, monitoring and testing. I learned that opioid abuse can be present even in unsuspected situations and that there is no perfect way to control the use of these medications once they are in the hands of the patient. One life lost to medication this way was one life too many. Since that time I’ve dedicated my practice to helping patients in ways to maximize their return to function without the use of harmful medications. This was one of the experiences that really steered me more towards more holistic approaches like regenerative medicine as a means to help patients.
The road to success is hard and requires tremendous dedication. This question is obviously a big one, but what advice would you give to a young person who aspires to follow in your footsteps and emulate your success?
The one thing that I would advise everyone to do is constant self-evaluation and assessment in all aspects of your life to make sure you are getting the most out of it. Knowing your priorities and just knowing what makes you happy will go a long way in helping to make difficult decisions. In the context of pursuing a career in medicine, there are many steps along the way that give you an opportunity to determine whether it is the right path. It’s important to be self-critical and really assess your own happiness with each progression through your early adult life. Medical training starts in your undergraduate years with pre-med courses and taking the MCATs. After that are the preclinical years of medical school followed by 3rd and 4th year rotations in which you get exposed to each speciality and have an opportunity to get a glimpse of life in that particular field. With each step of the way it’s important to learn as much as you can about the field, what kind of work/life balance you want to have and whether a given career checks all of the boxes for you. Ultimately life is short, so it’s important to make sure you are doing something that is fulfilling and fits your interests, skillset, and passions. For me, Medicine is a truly rewarding career and worth the challenges presented along the way. No matter what career path you choose, that honest self-evaluation and honoring what you want out of life, both personal and professional, is what is most important.
Is there a particular book that made a significant impact on you? Can you share a story or explain why it resonated with you so much?
Change Your Genes, Change Your Life by Dr. Kenneth Pelletier has been very influential in steering my vision for how I want to take care of my patients, and how I want to take care of myself. The book addresses how epigenetics, the science of how we are able to upregulate and downregulate the expression of certain genes with certain interventions, is shaping the future of healthcare. His emphasis is on personalized medicine and health optimization on an individual level by highlighting the ways in which we can compensate for some of our genetic vulnerabilities. This was particularly interesting for me as a cancer survivor looking to live a long, healthy and productive life. But it is also interesting as a medical professional who has undergone traditional training because this was not something that I was ever taught in medical school. Our healthcare system is based on treating diseases and injuries once they are present, and tends to ignore prevention and health maintenance. Maintaining your health is left up to the individual without any guidance from the standard healthcare system. My hope is that this will change on a greater scale over time, but in the meantime I am working to implement ways to provide more personalized care for my patients with painful conditions or injuries through lifestyle education, genomics, and regenerative medicine. This book motivated a major shift in my approach to patient care.
Can you share your favorite “Life Lesson Quote”? Why does that resonate with you so much?
“I think of success as being proud of what I do everyday.”
I heard this quote by Chef Enrique Olvera on the series Chef’s Table at a time when I was already out of training and working in private practice. It immediately resonated with me because there were times when I was frustrated by some of the day to day obstacles of working within the confines of the U.S. healthcare system in a busy Manhattan practice, but it helped me to realize I really am proud of what I do. I get to help people suffering from painful conditions and improve their quality of life to pursue their own passions. I regularly think about this quote and it reminds me of what’s important when making difficult decisions in my career and business. If I’m not proud of what I am doing, I will never feel fully satisfied. This speaks to my primary core value, which is to do everything with integrity, but it also encompasses that I want to be doing something that is forward-thinking, provides a meaningful service to the community, and is mentally, socially, creatively and technically engaging. While I consider helping even one patient feel better a success, if I can check all of the other boxes as well, then I can definitely feel satisfied that I am “successful” at the end of each day.
What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?
At this point, my practice, Ospina Medical, is the “exciting project”. My business partner, Dr. Rajivan Maniam, and I just opened the practice earlier this year with the purpose of creating an innovative practice for patients looking for treatment options other than just medications, steroid injections or surgery. Regenerative Medicine is something that we found to be a great alternative for patients as it provides them an option to heal without harmful side effects or as much significant risk. The reason this is so exciting is that you are actually utilizing your body’s own healing capabilities to treat injuries and pain rather than relying on exogenous chemicals, steroids in many cases, or the tissue trauma associated with surgeries. After working in traditional pain medicine for several years after fellowship training I felt there was more I could offer to patients that were looking for better long-term solutions to their medical conditions. We have done extensive additional training to offer the most evidence-based and precision-focused treatments for a number or conditions of the spine, joints, and musculoskeletal system. I am also doing additional training in genomics-based personalized medicine so that I can better tailor treatment plans for each of my patients. The idea behind this being that by helping an individual find their optimal diet, sleep habits, exercise routines, supplementation strategies, and stress management techniques based on labs, genetics, and lifestyle factors you can greatly impact their health and improve healing.
OK, thank you for all of that. Let’s now shift to the core focus of our interview. This will be intuitive to you but it will be helpful to spell this out directly. Can you help explain a few reasons why it is so important to create good habits? Can you share a story or give some examples?
Reinforcing good habits and changing bad habits is something that is extremely important as you age. When you are younger you can generally eat unhealthy meals and pull all-nighters and still function at a high level. As you get older your body’s ability to rebound and recover begins to slow down, you start noticing the consequences of a poor diet and lack of sleep, all the while the responsibilities are beginning to pile on. This is why it is critical to form good habits early, because the earlier they become routine the more long-term benefit it will have on your health and your career. The simplest and most impactful habits we can begin to form early in life are good sleep, a healthy diet, and regular exercise. As cliche as that sounds, it is something that most Americans have difficulty with in at least one category. And if even one of those is off, your health, energy and productivity are likely going to suffer.
How have habits played a role in your success? Can you share some success habits that have helped you in your journey?
Having a healthy routine for sleep, diet, exercise, and stress management has really been the foundation that has allowed me to succeed in a demanding profession and start a business while doing so. I definitely work a lot, but I wouldn’t classify myself as a workaholic. I need my downtime and I place a lot of value in having balance in life and making sure I find time to do things that I enjoy each week. Staying social and taking time to explore and create new experiences has been instrumental for me. I think this has also allowed me to get out of my comfort zone. There is so much you can learn about yourself and about others by being curious, traveling, and engaging in new experiences. As a physician this helps me to connect in meaningful ways and better understand all of my patients even though we may be very different.
Another important habit that has played a significant role in my success, specifically as a physician, has been to always listen first. Taking the time to really hear another person’s story will allow you to gain insights about who they are and clear the path for you to connect with them in a more meaningful way. I think this is critical to building trust in a relationship as it will always provide for a more productive dialogue and interaction.
Speaking in general, what is the best way to develop good habits? Conversely, how can one stop bad habits?
Constant self-evaluation and continuing education are critical in developing good habits. Understanding and learning what works best for you is something that takes time and may even change over time. Everyone has different needs, so sometimes there is some trial and error to determining what works best for you and your mind and body. This is an area in which I believe personalized genomics-based medicine can remove a lot of the guesswork and allow people to optimize themselves with less self-experimentation with different diets and exercise routines.
There is a spectrum of severity of bad habits and there is a spectrum of how aggressively one needs to address those bad habits depending on how disruptive they are to productivity or how much they negatively impact others. Sometimes making a small, conservative change is enough to correct it, but at other times more extreme measures or interventions are needed. I think stopping a bad habit takes self-awareness first and foremost. Recognizing that something you are doing is having a detrimental effect on your work or well-being is an important first step. After that recognition, you have to be motivated to change the behavior. A lot of people are aware they have a bad habit, but for some reason they may not be motivated to make a change to improve that behavior. Sometimes a catastrophic event can be the motivator. Like being a long time smoker diagnosed with lung cancer. And sometimes it’s as simple as being educated on why that cigarette you are smoking can be bad. I will say, just like other health issues, it’s better to take a proactive and preventative approach to any behaviors that could be detrimental and address them before they become engrained habits.
Let’s talk about creating good habits in three areas, Wellness, Performance, and Focus. Can you share three good habits that can lead to optimum wellness. Please share a story or example for each.
Achieving optimum wellness is a little different for everybody, but you can definitely generalize that habits pertaining to sleep, diet, and exercise are critical.
- Sleep 7–8 hours every night. Getting adequate sleep leads to improved cognitive function, decreased risk of alzheimer’s disease and cardiovascular disease, more energy, stronger immune system, better wound healing, and slower aging, just to name a few. The list of benefits goes on and on and addressing your sleep problems early on could make a world of difference in your long term well-being.
- Healthy Diet and Exercise. I lumped these together because they go hand and hand for me. I’ve adjusted my diet consistently over the years to try to make healthy choices based on calorie needs and nutrient densities of certain foods. More recently I’ve started doing time-restricted feeding most days with a 16 hour fast and 8 hour eating window. This gives my body some time to burn through some of the glycogen stores and glucose to keep my insulin sensitivity optimized. I usually get a workout in during the morning which is towards the end of my fasted period to get some additional benefit. I make a superfood smoothie for lunch around noon and eat a healthy dinner each night. I still allow myself to cheat on the weekends, and even on weekdays occasionally, but generally try to stick to a nutrient diet and avoid overconsumption. For exercise I used to go to the gym in the mornings, but since COVID started I’ve been biking 30 minutes to and from work everyday. This gives me a great chance to get my heartrate up and listen to a podcast or music in the process. Everyone is going to have different needs in regards to diet and exercise, but it’s so important for everyone to find what works for them in their specific circumstances. Small, incremental changes over time are the most sustainable for making long-term improvements in these areas. Trying to rapidly transition to a completely different diet or too aggressive of a workout routine are likely going to make you frustrated and give up.
- Practice Stress Reduction. This is the one that I personally struggle with the most. I’ve read a fair amount about breathing techniques, meditation, positive thinking, expressing gratitude, journaling, and general self-care, but I’ve found these to be some of the most difficult to implement. There is certainly a lot of stress with being a physician and starting a practice in Manhattan during a global pandemic and I think the hardest part of that is just finding time. It feels counterproductive to pause and focus on your breaths when you have endless emails and project deadlines after a long day in the clinic. But, as I’ve made myself practice these techniques more regularly I’ve felt that the biggest benefit they have provided for me is slowing me down to be in the moment, forgetting the mounting stress of the day and focus on being grateful for everything and simply for being alive. The work will get done much more easily when you recognize all the good that comes from it. I always recommend making one small change at a time and transition into things gradually so you have time to physically and mentally adapt to each change before making the next one.
Can you help explain some practices that can be used to develop those habits?
I think that the most important practice for developing good habits is spending time educating yourself on health and performance. Medical training taught me a lot more about disease and illness than it did about wellness, so for me this has meant reading books, blogs and articles, listening to podcasts and lectures, watching documentaries, and talking to experts on these topics. The better you understand your own body and why certain behaviors are important for your health, the more motivated you will be to develop those healthy habits and avoid the bad ones.
Can you share three good habits that can lead to optimal performance at work or sport? Please share a story or example for each.
My three good habits listed above for optimal wellness apply to optimizing performance at work and sport as well.
- Track Your Sleep With an Oura Ring or similar device. This can give you excellent data points on which you can then take action to improve your sleep. Good sleep has such a significant impact on one’s ability to perform at a high level.
- Track Your Diet. Personalized medicine can take some of the guesswork out of what diet is best for each individual, but some trial and error may still be necessary to see how you feel on a particular diet. Some people may respond differently to a diet based on how they process fats and carbohydrates, their microbiome, and the presence of medical conditions such as gluten sensitivity or inflammatory bowel disease. Taking a proactive approach to monitoring your response to various foods will allow you to feel and perform your best as you individualize your diet to your needs.
- Track Your Exercise. This is a great way to make sure you are meeting your fitness goals and helps you stick to a workout schedule.
Can you help explain some practices that can be used to develop those habits?
Using technology to help you track your health goals is something that I have found to be immensely valuable. Wearables such as the Apple Watch, Oura Ring, and Whoop give you a lot of great data that you can then take action on. For example, when I started wearing the Oura Ring I realized just how much late or heavy meals before bed negatively impacted my sleep. This has helped me to change my behaviors to eat lighter dinners and try to give myself at least a couple hours between eating dinner and going to sleep. There are also a lot of apps that can be used to help you optimize your health. Some of the ones I personally like are Inscape for meditation, Lose It for calorie tracking (not necessarily for weight loss), Strava for logging outdoor activities like biking or hiking, and Zero for tracking fasts.
As a leader, you likely experience times when you are in a state of Flow. Flow has been described as a pleasurable mental state that occurs when you do something that you are skilled at, that is challenging, and that is meaningful. Can you share some ideas from your experience about how we can achieve a state of Flow more often in our lives?
For me this state of Flow occurs most commonly when I am performing procedures. The physical and technical aspects of the procedure combined with the mental focus required forces you to get into the zone. However, it can occur with other tasks I enjoy as well, like creating art or cooking. Time stands still, worries slip away, and physical aches disappear. When I was younger I always liked to draw and play sports and video games. I partially attribute those hobbies to allowing me to become proficient in my visuospatial and technical skills to do procedures. Being an interventional pain specialist gives me the outlet and opportunity to get into that technical, task-driven flow state on a daily basis, and that is a big part of what I love about my job. When we find things that induce a state of flow for us, I think we should be encouraged to pursue those and similar activities. I do think that practice, training, and experience in a given task can help to achieve a flow state more easily, but I definitely think that being challenged makes it even easier to become totally present in the moment. The one other thing I will add is that I believe staying healthy and active will allow us to maintain a sharper mental acuity and better physical capabilities to encourage flow states more readily.
Ok, we are nearly done. You are a person of great influence. If you could inspire a movement that would bring the most amount of good for the greatest number of people, what would that be? You never know what your idea can trigger.
I think going in line with my interests it would have to be to find a way to help everyone access the education and resources necessary for them to take ownership of their own health and longevity. As a whole, we are very good at treating disease in the U.S. healthcare system, however there is not a good foundation in place for helping to prevent it. Chronic disease not only significantly deteriorates the quality of life of those affected by it, but it has a massive economic impact as well. Heart disease, stroke, cancer, diabetes, tooth decay, obesity, arthritis, and Alzheimer’s Disease are all health conditions that can be prevented, reversed, or managed early on to minimize the effect they have on the individual’s functionality, lost wages, and healthcare costs. I think that by putting an emphasis on the importance of diet, exercise, and sleep, as well as unhealthy behaviors to avoid, much of the chronic disease epidemic we are experiencing can be addressed. The other important aspect to this is to find ways to make healthy foods, exercise facilities, and preventive medicine specialists affordable and readily accessible, and conversely, to find ways to make it more challenging to access unhealthy foods and behaviors. We all have the right to make our own choices regarding what we eat and do, but many people do not realize that the collective sum of all of our unhealthy decisions contributes to approximately 90% of the 3.5 trillion dollars toll on our economy each year. By collectively taking care of ourselves and others we can actually make our nation a much better place for everyone.
We are very blessed that some of the biggest names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US, whom you would love to have a private breakfast or lunch with, and why? He or she might just see this, especially if we both tag them 🙂
I would love the opportunity to grab a meal with Twitter and Square CEO Jack Dorsey, though it would probably have to be dinner because I heard that he usually skips breakfast and lunch. I have a lot of respect for him as a young and very successful CEO, and from my limited personal knowledge of him, he seems to have similar values, takes his health seriously, and takes a proactive approach to social justice and philanthropy. As a young business owner interested in making a positive impact in the community myself, I think there is a tremendous amount I could learn from him and his experience. Of the billionaires, CEOs, and thought leaders in the world, he is the one I feel I would be able to connect with the most on a personal level. From what I have read and heard from his interviews he seems to be very genuine and authentic and I think we have some similar interests. I’d also love to talk to him about his evolving wellness habits, as he practices a lot of what I preach to my patients in regards to some fundamental health habits. Some specific examples he has commented on are intermittent fasting, staying active, meditating daily, using saunas and ice baths, tracking his sleep, and using a standing desk.
How can our readers further follow your work online?
Instagram: @dr.kohler and @ospinamedical
Facebook: @mkohlermd and @ospinamedical
Thank you for these really excellent insights, and we greatly appreciate the time you spent with this. We wish you continued success.