#102 - 🎖️ Dr. Nicole Dobson MD

Hello Friends 👋

We are so happy to host on the podcast this week retired army colonel and neonatologist: Dr. Nicole Dobson. Dr. Dobson's career is fascinating, and her work with the US military has sent her across the world, from Hawaii to Afghanistan. Daphna and I had a long list of questions for her covering a wide range of topics, including leadership, hierarchy, and how to function in settings with limited resources. We are sure you will enjoy listening to this episode, Dr. Dobson is a remarkable individual with a fascinating career, and it was an honor to chat with her this week.

Have a good Sunday!

If you would like to reach out to Dr. Dobson, she can be contacted by email.

dobsonnr@upmc.edu

Bio: Nicole Radich Dobson, M.D. joined the University of Pittsburgh Medical Center (UPMC) Division of Newborn Medicine in November 2021. She is a professor of pediatrics at the University of Pittsburgh School of Medicine. Dr. Dobson is the director of the UPMC Neonatal-Perinatal Medicine Fellowship Program and the director of simulation education for the Division of Newborn Medicine.

Dr. Dobson earned her Bachelor of Science degree from Lehigh University in Bethlehem, PA and completed medical school at Rutgers-Robert Wood Johnson Medical School in Piscataway, New Jersey, receiving the Academic Achievement Award for graduating first in class. She attended medical school with a 4-year scholarship from the Army Health Professions Scholarship Program. After medical school, she entered Active Duty and completed her General Pediatrics Residency and Neonatal-Perinatal Medicine Fellowship at the National Capital Consortium/Walter Reed Hospital in Bethesda, MD. She held numerous leadership positions during her two-decade military career, including Chief of Neonatology, Tripler Army Medical Center, Hawaii and Medical Director of the Intensive Care Unit at Craig Joint Theater Hospital, Afghanistan. Prior to moving to Pittsburgh in 2021, Dr. Dobson was the Director of the National Capital Consortium Neonatal-Perinatal Medicine Fellowship Program and Professor of Pediatrics at Uniformed Services University, Bethesda, Maryland.

Dr. Dobson’s research interests include the effects of intermittent hypoxia and caffeine therapy on the developing brain. She has published over 20 manuscripts and two textbook chapters, and she has been an invited speaker at regional, national, and international meetings. She serves on the Executive Board of the American SIDS Institute and the American Association of SIDS Prevention Physicians.

The transcript of today's episode can be found below 👇

Ben 0:54

Welcome. Hello, everybody. Welcome back to the incubator podcast. It's Sunday, Daphna. How are you?

Daphna 1:04

I'm doing well. We've had an exciting week with an extra extra episode. And we are so grateful to have on our guest today. So was a big week.

Ben 1:17

Big week for us. If you're not familiar with what Duffner is referring to go back on your timeline, we released a special episode on Wednesday, to announce some of the details of the Delphi conference that we're putting together in March 2023. Tickets are now officially on sale, they are limited. So there's not an infinite number of spots. And we we were doing this to be to provide as much quality control with our conference as possible. So you can find out more about the conference, what it is what it is about whether this is something you want to attend or not on this particular episode, and on the conference website, which is www dot Delphi conference.org. I'm excited about our guest today. And and it's it's, it's it's one of those guests a bit like Dr. Lemons that was recommended to us by a listener. And again, making the case that that we we see every email, everybody can tell you we respond. We just respond to each email either Daphna or myself. Our administrator, Amber Tate does take care of some of the administrative stuff. So if you're calling for like receipts and stuff, she'll she'll take care of that. But I wanted to give a shout out to Matthew Harrell, who is the person who actually suggested that we bring in Dr. Nicole Dobson on the show. So Matt, thank you. Thank you again for making this happen. This was a phenomenal interview. And I think people are going to enjoy this quite a lot. Definitely anything else before I give the audience, Dr. Dobson's bio.

Speaker 1 3:04

Now I think it's time. All right.

Ben 3:07

So Dr. Nicole Dobson joined the University of Pittsburgh Medical Center division of newborn medicine in November 2021. She is a Professor of Pediatrics at the University of Pittsburgh School of MIT School of Medicine. Dr. Dobson is the director of the UPMC neonatal perinatal medicine fellowship program and the director of simulation education for the Division of newborn medicine. Dr. Dobson earned her Bachelors of Science degree from Lehigh Lehigh University. Is that how we say it? Lehigh University, I think so in Bethlehem, Pennsylvania, and completed her medical school at work Rutgers Robert Wood Johnson medical school in Piscataway, New Jersey, receiving the Academic Achievement Award for graduating first in class. She attended medical school with a four year scholarship from the Army Health Professions scholarship program. After medical school, she entered active duty and completed her general pediatrics residency and neonatal perinatal medicine fellowship at the National Capital consortium Walter Reed Hospital in Bethesda, Maryland. She held numerous leadership positions during her two decade military career including chief of neonatology trippler at the Tripler Army Medical Center in Hawaii and Medical Director of the intensive care unit at Craig joint theater Hospital in Afghanistan. Prior to moving to Pittsburgh in 2021. Dr. Dobson was the director of the National Capital consortium neonatal perinatal medicine fellowship program and Professor of Pediatrics at Uniformed Services University in Bethesda, Maryland. Dr. Dobson's research interests include the effects of intermittent hypoxia and caffeine therapy on the developing brain. She has published over 20 manuscript and tech textbook chapters and she has been invited. She has been an invited speaker at regional, national and international meetings. She serves on the executive board of the American SIDS Institute and the American Association of SIDS preventive prevention physicians. She's a fascinating individual And we're very happy and honored to have her on the show. Without further ado, please join us in welcoming to the show, Dr. Nicole Dobson. Dr. Nicole Dobson, thank you so much for being on the show with us today.

Unknown Speaker 5:13

Oh, thank you for inviting me. It's an honor to be here.

Ben 5:16

So let me ask you the first very important question. You're a colonel in the military. So is it Colonel doctor? How do we what do we call you?

Speaker 3 5:27

Well, now I'm retired so so we can we can drop the colonel at least retired from the military so we can drop the colonel title. Nikolas fine. But in the military, it alternated between Colonel or doctor depending on what I was doing. And also, what I needed to get done. There were times better to say Colonel than doctor when I would be calling somebody on.

Daphna 5:49

That makes sense. I feel that in the hospital, even that I have changed my title, depending on who I'm talking. I feel like though, if you've gotten that title that you get to keep it forever.

Unknown Speaker 6:00

I can put retired Colonel documents.

Ben 6:06

I think for many of us, myself included, it is a very foreign concept to be an an army or a military neonatologist. I mean, I think I think for me, if you're talking about an army physician, you think of Normandy, some some medic putting on BandAid on a wounded soldier. And so the concept of being that you love war

Daphna 6:27

movies, Tony,

Ben 6:28

I love. But the idea of I mean, I think the idea of being a military trauma surgeon whatever that that sort of people can can picture that but an army neonatologist can can you tell us a little bit what that is? And how did you get into this?

Speaker 3 6:49

Yes, so like many doctors who end up in the military, I ended up joining us through a program called the Health Professions scholarship or HPSP, that pays for medical school. And I'm going to date myself here a little bit, but I applied to that program before nine 11. And before we were at war, and, you know, my personal goal, besides you know, wanting to serve my country and and give back was I was at the time very interested in infectious disease. And I actually thought I was going to be an infectious disease doctor when I was applying to medical school, and the army had incredible infectious disease programs all over the world. And so I what I envisioned my career as I was applying to medical school was I was going to become an infectious disease specialist and study exotic infectious diseases in Southeast Asia or Africa. And the Army seemed like a great fit for that plus a way to pay for medical school. You know, obviously though, career paths change and as I got into medical school, I decided on pediatrics so then I was like, alright, well, I can do peds ID and then when I got into residency, I was it became I don't really like this as much I like the critical care side and I landed in in a technology but the military, you know, there's the operational side, the combat side of the military. And then there is what we call the you know, sort of the the garrison when you're on you know, when you're at home at your bases. There's two different missions of the medical services. And when we are, you know, at stateside or bases around the world but not at war, we are providing care to not only the active duty military members, but their entire families. The Military Health System is in the US as a socialized medical system that is free access for anybody who's in the military as well as their families. So there's lots of space for pediatrics, peds, subspecialties neonatology because we're doing the whole spectrum of care at military hospitals. So, you know, being in the military, when we are, when we're stationed at our home station or home hospital, for a doctor, you're providing care within your specialty, but then when you are called to deploy to support the troops, you are doing a different type of medicine potentially. And this the army, we like to say the army looks at it as you're either a surgeon who cuts or you're a primary care doctor who does that whole spectrum of everything else. And so for neonatologist, we are the dark, we're in that group of doctors who do everything else. So you know, for

Daphna 9:22

that means like, you know, scary adult medicine, right? It does. Yeah, it

Speaker 3 9:26

does it mean scary adult medicine. You know, I think the important thing to remember the average age of a lot of the troops is, you know, adult still covered under adolescent medicine, though, you know, early, you know, late teens, early 20s. So, there is a lot of adolescent medicine that's involved when you deploy and you're being what we call a general medical officer, which is just taking care of the troops. But then, you know, there's more specialized care as well that needs to get done and because we also we don't only take care of the troops in the war, but we also take care of injured civilians. and supporting troops are actually a fair number of children who ended up in our in the host nation. And I'm particularly talking about Afghanistan and Iraq, since those are the wars that really weren't going on for my entire career that pediatrics was a huge because of how many injured civilians were taken care of.

Ben 10:19

I want to go back to a little part to some part of the of your training that you mentioned, and you specify that you signed up for the military before 2011? Sorry, 911 2001. And my question to you is, the US had been, we've been living in relatively peaceful times. And after you make this commitment, these events unfold and the landscape, the global landscape changes dramatically. How did you process this this drastic shift? I'm assuming that it will, I'm not sure if you were expecting your military career to be relatively smooth based on how the last 30 years had gone by. And now this, this happens, how did you deal with events and how things changed?

Speaker 3 11:09

Yeah, so that it certainly was an interesting processing of events. And I think like many, many young adults, or adults can remember exactly where they were a 911. At the time, the news hit and, and I can remember exactly, I was a pediatric resident on the ward in Walter Reed in Washington, DC, and I was interviewing a patient. And there was a TV on and we literally watched a plane fly into the tower, and it was just, you know, we all sort of stopped and we're like, what just happened, and then the Pentagon got hit. I don't know, for I don't remember the exact timeline. But you know, not, not soon after the Pentagon was hit. And we could actually see the smoke of the fires from the Pentagon. And, and then, you know, we sort of got our first taste of what it meant to be in a masked cow situation when, you know, we got Directorate of, you know, all right, every, you know, nobody's going home until we know how many casualties are coming from the Pentagon, we need to, you know, discharge as many patients as possible. We don't know, you know, what's going to come, but those patients are coming to us, you know, we're the military hospital. And I think, you know, there was a amongst all of us that day realization of WoW, think things are going to change, because, you know, I think we knew that there would be a military response involved. And then, you know, the weeks that followed Afghanistan, and then about six months later, you know, Iraq, started and at the time, I was my now husband, we were residency engaged, and I still remember us talking about, you know, hey, our lives are going to be changing a lot. And shortly after we got married, my husband left for Iraq for nine months. And, you know, it was, it was certainly a big change. I think we all, you know, I also I grew up in New Jersey, not too far from New York, I knew people who were affected by the towers going down and were killed. And, you know, for me, it was an intense feeling of pride to be like, you know, what, I'm gonna be able to be part of this response that, you know, hopefully, it's going to help bring some peace and justice to this. And, you know, certainly things. You know, I don't want to get into much political discussion away, things evolved over the next 20 years. But I think at the time, you know, I started had a lot of pride to be in the military. And I said, you know, what, I'm, I'm, I've joined to help my country, and now is the opportunity to do that.

Ben 13:22

Yeah. And the political response, unfortunately, is not something we have tremendous control over. So I was very curious about your personal experience through this. And, and so you, as we said, in, as you was, we mentioned in your bio, you eventually served as medical director of the NICU, at the Craig joint theater Hospital in Afghanistan, and you tell us a little bit as to how did that happen? How did you get, I guess, offered this opportunity to?

Unknown Speaker 13:48

How did you how did you earn the opportunity opportunity? So

Speaker 3 13:51

I actually I recently i Well, actually, it was a couple of years, a few years ago, at at a like a regional fellows conference, I was giving closing remarks and was kind of talking about tips in my career. And my joke was watch out. If you're good, you know, when you're doing something, well, you're going to get opportunities you that you don't necessarily want and you can't say no to. And in the military, you can't always say no, this was certainly one of those scenarios. So I was deploying to Afghanistan as part of a unit that is called a medical error support company that basically goes we have the ability to sort of set up our own our own kind of clinic with lab capabilities, radiology, but the particular mission of our unit at the time was to sort was to fill in holes, you know, gaps in the existing infrastructure that was in eastern Afghanistan. And I was originally tagged to be, you know, general medical officer or primary care doc at a small clinic in the Capitol, but when I got there, there, there was an army surgeon who was in charge of the medical capabilities and you know, was kind of our unit fell under him. And he was talking with all the doctors and he sought me out. And he said, I hear you're a neonatologist. So you have ICU training? I said, Yes. He said, Well, we have a lot of injured kids right now in our ICU. And you know that the team, we don't have a lot of pediatric expertise, expertise. You know, we have a general pediatrician here, but we like to have a, you know, somebody with ICU training and who's come from with peds. I'm like, Well, I can certainly do that. I'm thinking this sounds way better than taking care of adults in the clinic. So I was like, okay, I can do that. So, you know, so that my, you know, Mission got shifted a little bit and I got plugged into the hospital instead of going to this small clinic. And then, about a week after I started, they said, Well, what how do you feel about how to take care of adults? You know, we're starting we're going to the A surge of the summer where we were in Afghanistan, the summer was a heavy fighting time. So there was a lot more casualties. I'm like, Well, you know, I can adapt, I can do this, you know, the military prepares us. So, you know, next thing I know, I'm doing adult ICU care. And then, you know, I still remember this pivotal night on call we used I mean, and it was literally, you know, I used to joke we were I felt like a glorified resident some nights because it really was, you know, the there was a team of medical doctors internists meet plugged in there that we are the ones who, you know, were there kind of 24/7 Taking care of the issues, making vent changes, writing orders, the cert, there's a chief trauma surgeon who sort of ran the show and a whole, like, I don't know, 15 other surgeons, a lot of subspecialty surgeons there that we were sort of coordinating care with. But we were kind of the first call for everything. So it was one of my first nights I was taking call and the trauma, the chief trauma surgeon was the surgeon on call that night and he didn't seem super happy about like, why is there a neonatologist? And you know, I'm taking care of this afghan patient who had been injured and had surgery earlier in the day was just having significant blood pressure issues, you know, we're, you know, as transfusing blood products, managing pressors. And finally at 2am, I called him and I said, This guy needs to go do or he's bleeding somewhere in his abdomen. You know, I just I can't keep his blood pressure up. And, you know, he kind of comes out and is kind of grumpy, you know, they were very slipped up, we are all sleep deprived, because we're so busy, but he's like, alright, I'll go to the or so he takes the guy back to the O R. And about 20 minutes later, a nurse comes to find me and says, you know, Dr. So and so we'd like you in the O R? And I'm like, Oh, no. So I go back to the LR and he's he I walk in and he said, Nicole, you save this guy's life. He's bleeding from a Nick and his renal vein. And you know, you have to scrub and help me, that's the surgeons wife. And he's like, I need somebody to retract.

Unknown Speaker 17:43

That was an apology for being rude.

Speaker 3 17:46

So a couple of days after that, him in the the head army surgeon who was kind of like the the kind of chief medical officer that would the term they would be equivalent to a chief medical officer in a civilian hospital. We were all theirs group us in the doctors lounge, and they just kind of walked in and they said, Okay, we have a new medical director of the NICU, Nicole this or I'm sorry, of the ICU. Nicole, this is your job. And they walked out like that was it? And it was like, okay, yeah. And then it really was, I mean, they were the surgeons were so busy that they've just wanted somebody who could sort of manage all of the medical, you know, medical side, all the doctors, the nurses, the artis kind of all the things that can happen. So the surgeons could really concentrate on operating and, you know, managing patients. So that's how it evolved. And you're in terms of professionally, it was an incredibly rewarding experience, you know, it's working, I'm just an amazing group of people, you know, coming together to, you know, we save many lives, lots of people, you know, we're able to make it back to their families. And it was very rewarding six months. I mean, if it wasn't for, you know, being in the midst of a warzone, and, you know, sometimes concern for our own lives because of shelling plays and other events that happened. It was It was exciting, exciting time.

Daphna 19:08

Yeah, that's I I'm struck by your story, obviously, in many ways. And it struck a chord with me that you have this really unique perspective on war, right, taking care of children of war time casualties, in addition to, you know, the routine childhood problems that you had to care for. And again, politics aside, I wonder like how transformative that experience is to care for children due to wartime casualty.

Speaker 3 19:48

Yeah, it was, you know, I was very happy that we have a policy that we would take care of the children who were injured in the line of fire and not just, you know, not just the children that you know, other, you know, civilians as well, I mean, we would take care of people who are injured in the, in the line of duty. But you know, sometimes those injuries were incredibly severe, you know, like, amputations and monitoring, the hard thing for life alternating and the hard thing for us all, I think to comprehend was, these children and adults were eventually returning to the, you know, host nation, the local medical system, the care that's available, the resources that are available, and also sort of the cultural norms, and, you know, some, you had some of these injuries, the families would not be very accepting of having that child back in their family long term. And, you know, there were some horrible stories of, you know, there was a, you know, a lot of burn victims, particularly young girls who would be burned, where, you know, we would treat them, they would return to their families, and then they would be abandoned by their families, because in it, they, it culturally that, you know, they saw it as well, you know, this, this girl is to form now, we're not going to be able to, to marry her, we're not going to be able to have as part of our culture. And, you know, our, we had, obviously, a very large group of translators who worked with us who would, you know, kind of talk to us about the cultural norms and what's accepted, but it was very hard sometimes when we'd, you know, put a lot of energy and resources into taking care of these children become very attached to them, and, you know, and, and then, you know, wonder what's going to happen to them, when we, you know, either transfer them over to the host nation, medical system, or their, their districts home to their families, and, you know, a lot of the families just didn't have the resources to maybe take them to medical appointments, or, you know, they were lived very far from where medical care was available. So, you know, from that side, it was, it was very, I think it was, it could be very hard. You know, we talked, there would be missions that would go out to remote villages to try to provide medical care, but really, you know, we couldn't offer a whole lot like, you know, we could give some vitamins. And, you know, I mean, a lot of the chronic problems, we would see, we couldn't offer, you know, anything for I remember, you know, evaluating a baby who was, you know, sciatic most, you know, had a significant murmur, I'm sure had some sort of congenital heart disease, but there was absolutely nothing, you know, we could offer I mean, we weren't going to be able to do surgery on this baby. And, you know, the family, you know, the baby was struggling to breathe. And, um, you know, I'm sure that baby probably died shortly after we saw them. But you know, that that was some of the realities. I think that's very hard. Hard for it was very hard for us to process when we are there.

Daphna 22:44

Yeah, I think that's especially difficult when you know, there's theoretically a treatment, you could offer a workup you could do and coming from such a resource, rich, you know, place to go in and feel like, we could we could potentially ask for it. If we were in a different situation, that must be really difficult.

Speaker 3 23:05

It was interesting. We, we spent some time trying to help. One of the missions was helping to rebuild the Afghan medicals system in the valley, we were the coonara Valley region. And I remember there was we had physicians from the Afghan military who would rotate in and work with us, and then also just kind of local, I guess, you know, community physicians, who came in to just do some training and for us to, you know, talk with them. And they asked me to talk to them about neonatal resuscitation and like what we do in the States, and, you know, and it was very interesting, you know, Afghanistan is incredible, when I Afghanistan has incredibly high infant mortality and maternal mortality rate, and just talking, you know, most of the births, there are home births with, you know, really lay midwives, if at all, physicians really aren't involved at all. And, you know, we just kind of talked about some of the basics. I wish, you know, now, helping babies breathe wasn't in existence yet. But gosh, what a great opportunity, it would have been to try to give that as outreach to the lay midwives and things because I think it would have would make a difference there.

Ben 24:12

Yeah. So was there at any point in your service and or in your, I guess, your your tour in Afghanistan? Is that called the tour? Yeah. Tour. Yeah. Was there any, did you have any interactions with the NICU or makeshift NICU environment?

Speaker 3 24:30

I did not at all because we, you know, we we were not in the practice of delivering babies at the military hospitals. And, you know, we would have some infants who would would be injured who would come through for care, but I didn't have any I never left the base to see any, you know, Afghan hospitals or any interaction there. I mean, we were very much things were very active where I was and you didn't leave the base unless unless

Speaker 1 25:00

Sounds like you were very busy. Right? Yeah. And unless you're

Unknown Speaker 25:03

because I mean, it wasn't safe.

Daphna 25:08

So you actually had been? Yeah, I mean, you've actually attended really, and units all over the world. And I wonder, you know, what are the things that you carry with you, you know, regardless of culture or location or, you know, that that, you know, doesn't change across across units?

Speaker 3 25:36

Yeah, I mean, I, you know, I think, from my time in the military, and, you know, obviously, you know, as what I wasn't deployed, I was being a neonatologist, you know, I worked at in Washington, DC, I worked in Hawaii, you know, I think every time you go to a new place, a new unit, you know, you've got to, you know, sort of, there's always nuances in the system, you know, learning learning how things are done there adapting to the system. You know, I think my time in Hawaii was very interesting. Because that in and that's in the state of Hawaii, there's actually three NICUs, one of them is at the military hospital, the other two are within a four mile radius at the Women's capital and Women's and Children's Hospital. And then their Kaiser Permanente has a small NICU on island as well. And, you know, there was a lot of collaboration was incredibly important between the NICUs because we were all almost all of us were full all the time. And we would occasionally take care of civilian patients, and they will take care of our military patients when we were full. And I think, you know, building I think the lesson I talked to my you know, sort of trainees about and advice I'd give is just you know, you need to learn and adapt to your environment, your new environment, and try to identify the strengths and weaknesses that are there and work within that model. And you can always take what you know from one place and apply it to another. That doesn't always work, you've got to figure out the system that you're working in.

Ben 27:03

This episode is proudly sponsored by Wreckit. Me Johnson recommened. Johnson is dedicated to the research and development of nutrition products that help support baby development at every stage, including an extensive Enfamil portfolio for premature and low birth weight infants learn more at HCP dot meet johnson.com. I guess that that it's great that definitely this asked this question because it leads me to what I wanted to ask you, which was, when you're in these scenarios, abroad with limited resources, you adapt by default, because you you know what you don't have, you know, what you do have, and you do the best you can with the resources that you have allocated to you and your team. But in the US, which where we do have a tremendous amount of resources, we often think that the way we're trained to practice medicine is the only way and it's and it's a very high level of excellence where so much support is provided to families, both medical, social, and I am wondering if coming back to the US healthcare system, you've been able to adapt more readily to your patients circumstances, the way you've had to adapt throughout your career in the military, and been able to get out of the rigid system that were being trained as, as residents and fellows, where the way you're trained is the way you practice medicine. And that's medicine, right? There's almost no other form of medicine. I'm curious if, if, as you come back, you see your patients more in a more individual manner and adapt how you allocate your resources to them to fit their needs more.

Speaker 3 28:47

Yeah, you know, that's an interesting question. And I think, you know, the COVID pandemic certainly brought that to light, especially at the beginning of the pandemic, when resources were scarce. And you know, the stories about, you know, ventilators not being available on how do you allocate them, we, you know, we spent a lot of time in the military, thinking about those scenarios training for those scenarios. And when I was deployed, you know, sometimes we were living those scenarios I, we had a day, we ran out of ventilators in our ICU, and then what are we going to do until, you know, luckily, we had a transport team who was coming to pick up some of our sickest patients so that we then would free up ventilators, but you know, those sorts of scenarios come up a lot when you're in resource limited areas. And I think it just gives you a different perspective to help you think outside the box of you know, like, well, maybe, you know, we've got to come up with some creative solutions here. In you know, we, I think spend a lot of time learning how in the military when you're especially deployed in resource limited environments is learning how to make do with what you have and figuring out how to do it. And I remember one of my colleagues and neonatologist who was deployed in Iraq, they have a 32 week infant deliver at their base and you know, They figured out how to rig up a bubble CPAP system. You know, it certainly wasn't supplies that they have, you know, they figured out how to how to Jerry Rig it. So I think it just, it creates a lot of adaptability to, you know, let me figure out how I'm going to do this and creativity and solving things. I mean, I think at the individual patient level, you know, for me, I've now been out of the military for nine months, and transitioning, taking care of a full, you know, civilian population. And there, there are different, you know, different challenges. When I was in the military, everybody had a job, you know, by default, everybody had a job, if they, you know, somebody in the family was active duty, they had resources, they had health insurance. And in the military had a lot of a lot of systems in place to support young families or families where a child has medical problems. And it's been very interesting, you know, for me, as I'm making the shift to the civilian side of seeing some of the challenges these families face, and, you know, and there are, you know, there's a lot of programs in place to support them as well, but you know, helping the families access them. Because I feel, you know, I feel like in the military, some of it was like, there was a little bit of you have to do this, because I'm your, you know, they're the military command would be making sure that a service member is taken care of their families verse, you know, that's not the case on the military, or on the civilian side. And so I am learning to, you know, every case, every individual is different and every family's circumstances different and try to spend the time to learn that

Daphna 31:35

you've touched on it a little bit with this answer about some of the, you know, support systems. And obviously, like, you said, it's, it's kind of, you know, the, in the military hospitals, it's like, universal health care. But what are some other things that you think, again, your I know, you're transitioning to, to this new way of working, but what are some things you think our hospital systems are NICUs can learn, you know, from the, from the military, the way those medical systems are run?

Speaker 3 32:10

That's an interesting, challenging question. You know, I think I think adaptability is very important. You know, I do see, and especially in, you know, very in, in large units, and, you know, sometimes the time it takes to implement change can take a really long time. And it's that way, in the military as well. But I think we, we did, there are times where you can't take, you know, six months to make a change happen. And that, you know, sometimes I think that there has to be more of a push to make, make things happen quickly versus, you know, we need to have 10 meetings about about this, to make this, this change occur. I do feel like in the military that we're taught, you know, and I mean, we didn't do make rash decisions, but that there were certainly times where, you know, and I think about kind of our response to COVID, within, you know, sort of our local hospital and things that we were able to very quickly adapt the night, you know, I don't know if it had to do with, with plans that were already in place, just because of our kind of planning for, you know, sort of these emergency situations. But that is I think, you know, I think that's a frustration people feel with with any system about being trying to make changes, but it can be hard sometimes I

Ben 33:37

want to ask you one more question. One more question about the military, and then we'll move on, I promise, but you

Unknown Speaker 33:45

I have one, then we

Ben 33:47

wanted to find out exactly what what. And you correct me if I'm wrong. The US military has people stationed all around the globe. And they're often station if they're not, if it's not an active war zone, they're there with their families. So if, let's say we have military personnel in I don't know, Korea, Japan, somewhere far, far from the US. And, and and a mother gives birth to a baby prematurely. How does the military deal with that baby, considering that this baby might need to be hospitalized for X number of weeks, slash months? I'm just curious as to what are what is the structure as to what happens to this baby and this family in these circumstances?

Speaker 3 34:32

Yeah, so the military has contingency planning for that there's actually a very fine, you're

Ben 34:38

not gonna be the right example.

Speaker 3 34:44

Great examples, though, because we have a huge military presence right? In both countries. So there's a small NICU in Okinawa, Japan, and there's a team of neonatologist and nurses and our team I think the units only nine or 10 beds, but their primary mission is a transport mission. And you know, so if there's a baby born at 24 weeks in Korea, they, you know, we will use the host nation medical system, you know if to take care of some of these babies. But you know, depending on the circumstance, how sick the baby is. The other option is that the transport team will fly to pick up that baby and bring them back to the NICU and Okinawa and then eventually they'll end up usually coming to the NICU in Hawaii. So I have a lot of experience with that when I was the medical director at Tripler. Army Medical Center's NICU, because we were only we're coordinating transports all over the Pacific ramp. And then depending on you know, sort of what care is needed long term, that family will be reassigned either to Hawaii or back to the mainland us. Because there is not really the infrastructure in place. Like if that baby a 24, weaker who's going to have you may end up with BPD. And he's to go home and oxygen, there's not the resources for that in Japan or Korea, Guam is another place where we have a pretty big military presence. And then the other thing is making sure that they have the follow up care that they need, you know, in terms of physical therapy, occupational therapy, developmental follow up, that infrastructure is in very, very good within the Military Health System at some of these remote places. So there is a, the military actually has a program called the exceptional family member program or EFMP, that all of our NICU babies, these sort of extremely preterm babies are enrolled in and the idea is that they do everything they can to assign the service member to a place where the family can get the services they need. And, you know, so for our NICU babies, that certainly applies and make sure that they are there. But you know, we do spend, it is interesting, sometimes the amount of of flight time that these babies spend in their first weeks of life, because they may go from Korea to Japan, spend a period of time there, and then end up coming to Hawaii or back to to our military base in San Diego. After there. I think the other thing you know from this story inside is these babies are offering being born at military hospitals where it's just general pediatricians there. So our general our military pediatricians who are training in the residencies really need to be competent in newborn resuscitation and to some extent maintaining stabilizing extremely preterm babies and taking care of them for a period of time until a transport team can get there. And, you know, we would spend a lot of time as sort of the, you know, giving phone advice of okay, we just stabilize this 28 week infant, you know, we're putting in lines, what what else should we be thinking about and doing until the transport team gets here, we would do a lot of phone management that way. And I still remember one of my residency colleagues went to Korea when she finished her residency and that she'd been there like two months and they had a 24 week or deliver, that they ended up I think taking care of for almost 24 to 36 hours before transport team could get there because of weather related issues and things. And yes, she I remember her calling back and she's like, I'm so thankful for all the NICU time I had in residency, I was a fellow at the time, and I was you know, sort of giving her advice on kind of fluids and stuff. And, you know, it was interesting, we had we had a good network to support even though it was around the world.

Daphna 38:19

And makes are just up the interstate transfers seem like no big deal, right?

Speaker 3 38:25

I tell my fellow in Hawaii, like those equations that are on the board, or the calculations on the board, this baby's on 40% oxygen at sea level and altitude, how much oxygen? We actually do that. We do that, like that doctors when we're preparing to fly a cruise, you know, from Hawaii to, you know, to the mainland, or you know, from Okinawa or to Hawaii. And we will also be making decisions like do we need to altitude restrict so that the baby isn't our oxygen doesn't drop as much and, and that has implications because when you altitude restrict the plane can flies as fast and needs more fuel. So it's been it's an interesting, interesting dynamic to balance.

Daphna 39:08

Yeah, including those physics equations. I don't like that at all. I actually have two more questions. I lied. So my first is, you know, medicine is very hierarchical by nature. But that probably pales in comparison to the military. And, you know, there's some discussion that's sometimes the higher hierarchical nature of medicine is, is to a detriment sometimes, and I wonder what your thoughts are

Speaker 3 39:39

on that? Yeah, that is certainly certainly can be an issue within the military because we have to, you know, you sort of have to, to hierarchical structures. We had, you know, the military rank structure and then you have the, you know, the sort of physician hierarchy and I think what I learned early on is very important to remember you know, we Chief our ranks in the military versus time and service, our professional military education and things we've done as a military officer, and it doesn't necessarily translate to who's the expert in the room from a medical side. So, you know, there would be times where yes, I might be a, you know, Colonel, who's, you know, been in the military for 18 years. But the, you know, major who's two ranks below me, but just finished their fellowship training and a subspecialty is really going to be the expert on that particular topic. And recognizing that and accepting that, I think is very important, I think within you know, within our within the military medical corps, I think people that was very easy for people to accept, it would be interesting, sometimes of a dynamic if we were doing some sort of multi, you know, sort of multidisciplinary planning meeting where there were office, military officers from other branches of the service, who maybe didn't quite, you know, understand the way the medical hierarchy worked. And they would be like, Well, why are you know, Doctor doctor, or, you know, Colonel Dobson? Why are you deferring to major so and so on this issue? You know, you outrank them, and I'm, you know, it'd be like, well, you know, respectively, major, so and so is the expert in this field, not be weak from a medical side, and I think that would be very important to, to address. You know, I think there certainly were interesting dynamics in the, you know, the military, it was much more formal, in terms of, you know, people using ranks first names were very rarely used. And there's, I don't know, advantages and disadvantages to that. You know, I think there, there's always there's an interesting, you know, there's there's enlisted, you know, about 70% of the military is enlisted soldiers or airmen and sailors. And then there's the officer ranks, and I think the, there's this opinion in the enlisted ranks, that the officers don't work very hard. And, you know, there's there's all sorts of, you know, kind of bantering and jokes that go back and forth. And I, you know, it, it's interesting over time, but I'll just leave it at that.

Daphna 42:09

That's fair. That's it. So at my last question, then we can move on, because there's so much there's so much that we intend to cover. We have lots of neonatologists and we have neonatal trainees listening, and is it is it too late for them to if they are curious, they want to learn more about joining military service? What's the best way to do that?

Speaker 3 42:34

Yeah, so, you know, I think it's, there's lots of most of the doctors from the military are, you know, come through the program, I mentioned of us many scholarships for medical school, but they're also payback programs where that you can join, like the military reserves, any of the branches of the military, and they'll help pay back loans you know, for time in the reserves, and, you know, I think it's never it's, I mean, there is an absolute too late in terms of age, I think it's 40 now, but I'm not 100% Sure you have to be under a certain age of when they would would consider to to recruit you I mean, you have to obviously meet basic physical fitness standards to be in the military. You know, there's there are other requirements you have to meet the requirements to join the military. But you know, if people are interested, I would encourage you to reach out to a military physician to talk about it they can you know, then connect you to recruiters. The landscape is very different now than when I joined 20 But it's more than 26 I guess years ago when I when I joined for medical school I mean the landscape is very different there's you know, a lot of downsizing kind of trying to do caught you know, cost containment just the same way I think all of health systems are so you know, I don't is you know, the need right now for neonatologist. Is it the same that it was 15 years ago, there's there's probably, you know, less of a lesson yet military neonatologist and there was 15 or 20 years ago, you know, but there's still a need, I think the important thing to remember is you're not going to join the military necessarily to be a neonatologist, you're going to, you know, more be prepared to be doing general medical officer duties. I know, for a lot of people, it's pretty scary. Yeah. I mean, the military does have, you know, trainings to get you prepared to do that. But you definitely have to step outside your comfort zone.

Daphna 44:23

But I wonder that, I guess brings us to our next point about people who are interested in in reinventing themselves in your region, reinventing yourself as you call it, your second career, I guess. Tell us a little bit about that. And how did you make the decision and what's it been like to to make that pretty dramatic change?

Speaker 3 44:47

Yeah, so you know, the military. The military is interesting, because at 30 After 30 years on active duty, you're actually us you're you have to leave, and it's just you know, an expectation they want to keep a younger hell See are for health healthier, you know, military force. So that is, you know, across the board, 30 years on active duty, you're asked to leave so, and at 20, once you've served for 20 years, you can actually retire from the military with retirement benefits, I never thought I would stay as long as I did. It was just, you know, a certain sort of the circumstances that worked out, I ended up meeting my husband in the military. And, you know, once we were, you know, we got married, it was sort of became joint decisions. But for us at the 21 year point, you know, our young or oldest child was in about he was in seventh grade about start eighth grade. And, you know, we started thinking about, we don't want to have to move again, or it'd be nice to be in in one place for him to go through high school and not have to worry about moving. We were do and we've been in in our current assignment for at the time for years. And we knew that we had basically one more year and they would like we move to the military with like, we move us. So we decided that point, it was time, time to move on to next opportunities, and we started looking for civilian jobs. And it is it's an interesting opportunity, because to some extent, it is a Okay, I'm going to restart, what type of job do I want to look for, you know, where am I going to end up and it was a little bit more challenging for my circumstances, many people because, you know, my husband was also looking for a position. And we, he was, he was actually the one that was heavily recruited to Pittsburgh, he's a pediatric cardiologist and had a great opportunity at the Heart and Vascular Institute at UPMC. So, you know, I joke I came along as the trailing spouse.

Unknown Speaker 46:35

You know, I really, they really lucked out didn't.

Speaker 3 46:39

I was not, you know, at the time, when I came, I was was, you know, mainly a clinical neonatologist. I was, you know, point eight, five FTE clinical, I mean, that that was what I was going to end up doing. But you know, when once you get here, opportunities came up, there were some changes within the division and the program director, spot was becoming available, and they decided to do an internal search. And, you know, I had five years experience as program director on the military side, I really enjoyed it. I, you know, I joked when I retired that I'm like, alright, this, you know, I'm, I've done this now, you know, I don't know if I want to do all the accreditation paperwork, but I, you know, found a couple months, I've been not doing it, I really missed it. So I applied for the position and was offered it. So I took over in February as the program director. And it's, you know, a lot of the job is the same as it was in the military. There's lots of paperwork involved. You know, I have a great group of fellows, though, and it's very rewarding to be back in that position. You know, I think, just like the military, you know, now I've been here for nine months, I'm getting all sorts of opportunities. And, you know, Hey, would you be willing to interest in doing that, willing to do this? And, you know, I learned long ago, you got to know when to say no, and like, you know, is this something I really want to do? Let me think about how this is going to help me get to my, my next next step. And or is this an opportunity that Well, I don't know how this is going to fit in? Maybe I should try it out and see. So I think that's universal across the board versus my, you know, from my military career versus my civilian career, you just have to, you know, kind of weigh the opportunities that come up and decide what's worth doing next.

Ben 48:17

Is there a difference in the leadership style between Dr. Dobson in the military and Dr. Dobson, the program director at UPMC?

Speaker 3 48:27

I don't know if I've been doing this long enough to have a good answer for you. I mean, I will say it, you know, when we talk about those two hierarchies in the military, you know, I definitely had would have fellows, it was not uncommon in the military for fellows not to train directly through from residency to fellowship that they would serve a, what we would call a utilization towards a general pediatrician or sometimes as a general medical officer before coming back to fellowship. So there was a US I found, especially for those trainees that they were very formal, there's a lot of hierarchy would some of them still call me Dr. Dobson, they will not call me by my first name. And I'm sure if they listen to this podcast, they are going to have a good chuckle right now. But, you know, I think, and I was very happy when I came to UPMC that it was a very collegial environment that, you know, fellows and attendees were very much on a first name basis, you know, so that I was fine adapting to that, but, you know, I do laugh that I still have, you know, some of my former fellows in the military who are now attendings who still call me Doctor because because of the hierarchy

Ben 49:34

let me ask you a question. There's there's a very frustrating experience for fellows in this current generation that we hear the stories of the older generation telling us how it was so much tougher in my days and this and that and they make it sound like it was almost active duty you know, like it was so bad you guys have it so easy. And and there's this idea that fellows today's and trainees are being too cold rolled and and it's too easy for them? Well, you've had tremendous a wealth of experience. And I would like to get your perspective on the state of training for fellows and residents these days. And, and and what your perception is on the amount of work and on the responsibilities that is placed on trainees today. And especially when you compare that to the context of the military, where there's a lot of kids, that's there's a lot of things that stakes in when you're in the military, obviously, and there's trial by fire. There's components of safety, there's components of resources that sometimes we don't have to deal with in training, but I'm just wondering, what is your outlook on on the environment in which fellows are being trained today? Do you think it is too late? Do you think it is could be harder? What? I'm curious to hear your thoughts? I don't think there's a right or wrong answer either way.

Speaker 3 50:54

Yeah. Oh, man, that's, there's a lot there to unpack that question. I mean, I, you know, and I'm going to, I trained before, there were duty hours, at least my residency and part of my fellowship, you know, and I think, something that I, you know, learned from the military, and I actually do a fair number of, you know, military pilots aviation, where they have incredibly strict rules about, you know, sort of flight time and hours on job and the importance of rest. And, you know, the mistakes that can happen with fatigue, and people can die, and, you know, in the military, and, you know, I think about, you know, flying on airplanes, you know, some of our like, you know, getting to the war zone and the, you know, 15 hours, you know, a flying that, you know, you don't want a pilot who's who's tired and going to make mistakes. And I think they have good, you know, there's good reasons for those work hours. And I think the ACGME had very good reasons to put work hours into effect in, in training in medicine, and then making that, you know, because everyone always refers to the safety of the aviation industry. And I think, you know, the military has adapted a lot of that, you know, for kind of, you know, assessing for fatigue. And I think, when we think about our trainees, you know, there is a point where you're so fatigued that you are not, you're not learning and you're not potentially providing safe patient care. You know, I think the the prot, you know, the challenge that is going on, is not necessarily with how we're training our trees, but I think how we are taking care of ourselves as military or I'm sorry, as neonatology staff and the hours that we work and are willing to work that, you know, we have work hours when we're in training, and then we become attendings and all that goes out the window. And, you know, I think my division is struggling right now with like, what is the right answer to that, though, you know, because you have, you know, so many babies that need to be rounded on a day you need cautious, they need to be covered. And, you know, we have an option of Do you want to take, you know, we have you have to take X number of calls in a year, do you want to take them when you're on service and work a 30 hour shift? Or do you not want to take them when you're on service? And, you know, we have the option of how we want to handle that. You know, but I think there and, you know, there's been a lot of publications, recently looking at, you know, what is the work structure, what is a reasonable, you know, sort of, you know, number, number of hours work to get what's safe for our patients. And I think when we think about how we're training, I, I think the the restrictions that are in place are reasonable right now. Because there is a point where, you know, you're so fatigued, you're not getting an educational benefit, but we need to balance with that is how are we working once we become staff? And, you know, I think a lot of people will say, well, once your staff, your more experienced, so, you know, it's okay to work that 30 hours, because you know, you're not going to make the same mistakes you might make if you're new at this, but I don't know if that's necessarily the case, you know, there's not an A exception, you know, for pilots that Okay, now that you've been a pilot for 15 years, you don't have to now follow the same rules, because you're more experienced, you're not going to make those mistakes.

Ben 54:11

I'm so happy to hear you say that.

Speaker 3 54:13

There's a lot that needs to be to be done in that in that area.

Ben 54:18

Yeah, because I still think there's there's this again, this this, this cliche about the military, that military personnel are the prime example of pushing the boundaries and always overachieving. And I'm happy to hear you code these examples where the military says no, the way to actually perform at the best level is to put some of these restrictions so that you don't get in a place where you're vulnerable to mistakes. I think this is I'm very happy to hear that. I'm very happy to hear that.

Speaker 3 54:44

I mean, I think, you know, the important thing to remember and I think, you know, we apply that to what we do as attendings, you know, maybe working a three hour shift that sometimes you do have to push through, you know, and I think about circumstances like you know, when you know When with you know, deployments when your unit is under attack, you may have casualties rolling in for 30 hours that you need to take care of, and you're not going to have the opportunity to rest during that time. You know, I think the way the joke at the military is you sleep when you can, if that's on, you know, the floor of, you know, of a bunker at three 3pm You take a nap, because you just never know when you're gonna have an opportunity to sleep again. I mean, I think that is true. But you know, we don't I think everybody recommends that's not or, you know, recognize that's not sustainable for, you know, months on end, we, you know, that you can do that for, you know, 3648 hours, but you can't keep that going for weeks and weeks and weeks, there has to be kind of some downtime.

Ben 55:43

Yeah, and not normalizing. That is key. I mean, I think in Florida, we, we have something similar where when hurricane season comes around, and the hurricane is coming, we have these pre post during shifts, where you have to be in the hospital for 72 hours, where you just have these rotating shifts. And, and like you said, These are exceptional circumstances, they are limited in scope and time. And eventually you go back to a more healthy lifestyle. So yeah, definitely. Go ahead.

Daphna 56:11

Yeah, no, I think you touched on something also, especially for I mean, you're right, that is when you become a neonatologist, and this is the rest of your life. Right? How long are you willing to continue to work that way, but you touched on something important, which is, you know, in training, like we there's good learning theory about how much you can actually learn? If you're sleep deprived? And so are we are we robbing trainees of of of a good learning experience? If we don't have some of those duty hours in place? Obviously, I think the flip side is then how do we optimize those experiences that are lost? When we have less duty hours? And I think simulation is one of your interest? And I wonder, maybe there's some things we can learn from the way the military does simulation, and even in our own units, to help to help optimize some of those last experiences?

Speaker 3 57:17

Yeah, I mean, I think it's, you know, it's very individual to each sort of program and place, you know, sort of what, what, you know, procedural and, you know, with simulation, really talking a lot about kind of procedural experience of what's available, you know, because I know, that's certainly a concern with with limb, you know, limitation to work hours and felt, you know, trainees aren't just getting as much experience as they used to, you know, I think if you're at a high volume place, that may not necessarily be the issue, because, you know, in a 24 hour shift, the fellow may still be getting two or three intubations. And, and, you know, a couple of LBW resuscitations a chest tube and things that they're having that experience. But yeah, simulation does play, you know, I think a big role. And, you know, we, I mean, I feel like when I talk to program directors across the country, I think everybody is, you know, is adopting simulation to some degree into their curriculums and, you know, simulating rare procedures. And I don't think it's just really for trainees, I think we need to also think about it for you know, our attendings are advanced practice providers to, you know, maintain skills for those, you know, low frequency high risk procedures. And, you know, I think from the military side, that's we would, when we talk about thinking about simulation of, you know, sort of practicing wartime environments, you want to, you know, practice things that aren't going to happen often, but we need to be prepared for it. And simulation plays a role as well, in that.

Ben 58:45

I have to get in my last question, because I want to, I've been wanting to ask you this, obviously, from the beginning of the interview, but we are very conscious these days about work life balance, and making sure that we're maintaining, like, I think, technology, I'm blaming technology, but technology has really broken down the barrier between work and home, right? I mean, it used to be that you literally left work, you got home, and it was it was difficult to reach somebody once they got home. I mean, you had like the phone, but that was it. And today with our cell phones with our computer, we're all doing work outside work hours at home, and it's hard to maintain work life balance. I am wondering, what are the things you've learned through your path as through your career in the military, having a husband in the military having children, how do you maintain some sense of balance in all these activities that you're juggling? That are very stressful, obviously. And, and so I'm curious to see if you have any tips for us as to how we can balance our lives and, and make sure that we don't go crazy.

Speaker 3 59:47

Yeah, I'm still struggling with that. I feel like you know, I think early on when I was a resident and fellow and you know, I had this idea before I had kids that okay, you know, I'm gonna figure out this 5050 be split and make it work. And then, you know, once we had kids, I realized, you know, 5050, every week isn't going to happen. And you know, especially for me as a neonatologist, where you know, when you're on service, those weeks are incredibly busy. You know, I very quickly learned that, okay, I've got to adapt that, you know, weeks, when I have heavy political responsibility, my, my balance is going to be more towards work versus weeks, when I'm not on service, I can maybe, you know, try to balance out a little bit more with my family. And very quickly, I realized I needed a village to help raise my kids, and I could not do this alone. And, you know, so I think that's, you know, recognizing that it's okay to ask for help, and, you know, seek that help. My husband and I have been incredibly fortunate that our parents have been incredibly supportive. And, I mean, literally, through our deployments, you know, we had grandparents around to help with the kids almost all the time. And, you know, that was huge for us, you know, for other families, you know, it's a nanny and au pair, I mean, whatever you need to, I think you need to help with that. And, you know, I think for me, I had an impression, I could do it all, I'm like, I'm gonna do all this, I'm gonna manage all this. And it was almost it was, it was hard to be like, Okay, I gotta admit, I can't do this. But, you know, I like to just tell me, it's okay to say you can't do this. And it's okay to ask for help. And, you know, I mean, we, as I said, we were just fortunate that we were able to really have a lot of family support and help, really, over the 20 years, 21 years were in the military, that we had that to help us manage our kids in our careers. And, you know, now my kids are 10, and 14, so they're a little bit more independent. And, you know, there's different challenges now, it's just getting them

Ben 1:01:42

to stay home for an hour by themselves.

Speaker 3 1:01:46

And be home alone a little bit. And, yeah, they're actually even figuring out how to get around on their own. I don't know, they're gonna, probably soon and then it'll be you know, but I think, you know, that's, that's a big thing of kind of the work life balance. I mean, I, I agree that technology is just is, is challenging, that you always feel connected to work and, you know, your email comes to your phone. You know, I just try when I, you know, we have designated time, you know, like this is when we're having dinner as a family, we're spending time together just to set my phone aside as much as possible. I feel now that you know, all my call is in house, I feel like it's much easier to do that, versus, you know, my husband, who wouldn't, you know, he'll be on call from home. So there'll be, you know, dealing with that a little bit more, but it is it's hard. It's, it's a non starter? Yeah. And I don't know, both my kids have already told us, they're like, we're never going into medicine, you guys. Right. So I don't know, if we address this, see what happens. I've heard that from a lot of my colleagues who's gonna say the same thing?

Daphna 1:02:47

Well, we've talked a lot about the different phases of your career, but we would be remiss if we didn't mention that you're, you know, also prolific researcher, and in fact, a co investigator of a major NIC he grant. So maybe it's for closing out the show, you can tell us a little bit about what to look forward to as papers.

Speaker 3 1:03:10

My research career is a whole nother you know, sort of a story about reinventing yourself because I thought I was gonna do basic, I thought I wanted to be a basic science researcher. And I thought that's what I was was going to do. And I did fill out my fellowship research was basic science. And actually, my first couple of years out of training, I was starting to build my own little lab, I had an internal grant was starting to get things going. And then the needs of the military took me away from that. But you know, in the long run, it worked out. I, I ended up kind of falling into a collaboration, I had given a talk about the effects of caffeine. And could there be intrinsic neuroprotective effects on the brain shortly after the cap trial results were published, and Dr. Karl hunt happened, who's now become a longtime mentor and friend was at that talk, and he came to me afterwards and said, You know, I'm part of a group that's, you know, considering doing a study of, you know, trying to investigate, Are there benefits to extend a caffeine would you be interested in joining that group? And through that group, I've just, I've met an amazing group of people outside of the military and, you know, made some great connections. And, you know, we've spent about a decade accumulating the preliminary data for NIH grant that got funded in 2017. So we're looking at it taking extremely preterm babies who are now convalescing in the NICU and ready to stop their clinical caffeine and seeing Are there benefits to extending caffeine now to 42 weeks postmenstrual age over, you know, stopping it when we routinely would that kind of 34 to 35 weeks, so we are

Daphna 1:04:44

abduction. It's a discussion I had on sign out this morning.

Speaker 3 1:04:48

You're actively enrolling. COVID put it you know, COVID derailed enrollment a lot. So we actually we were supposed to be wrapping up the study this year, but we have a new cluster extension for one year to try to hopefully I don't know if we're going to reach our enrollment goals, but we're trying hard. And you know, hopefully the results will, then you know, the next, probably, if we finish enrollment in 2023, probably early 2024. Will, you know, by the time we're done analyzing data, and I think the Moca trial from the new nano network, which is looking at extending caffeine and a slightly different kind of more mature population, and for different reasons, but that will probably be wrapping up around the same time. So hopefully, in the next five years or so we'll have more data to help us answer that question about, you know, when should we be stopping caffeine? Are there benefits to extend a treatment?

Ben 1:05:40

I think that's something that many people don't realize that the 34 week cut off is just because that's what the that's what the cap trial had had used, you know, there was no, there's not really there was not really their intention to study that part. But it became part of routine practice. So I've always, I'm always interested to see how these things sort of seep into the dogma when in truth, it was never really, even the author's never intended to make that the norm. So it's always very interesting. Yeah. And I don't know, you know, I

Speaker 3 1:06:08

think some of it, you know, obviously, from a developmental standpoint, you know, the franc apnea is a resolving around that time. And I think everybody thinks about, well, caffeine is for the central apnea, you know, and so that's why people that rationale, we're going to stop caffeine around this point. But there's still a lot of that, you know, those immature breathing patterns that caffeine helps to stabilize. So,

Ben 1:06:27

theoretically, it makes a lot of sense. You're absolutely right. I mean, if you started at 34, you get for that seven day coverage, I guess, in that 35. Technically, you should you should grow out of these apnea times. Yeah. Well, Dr. Dobson, it's, it's an honor to have you on the show, you set the bar very high. So I just, you're an inspiration, because of all the things you do and because of how genuine you are in your approach. So so thank you for your service. Thank you for everything that you represent. It's really been an honor to talk to you today. Yeah, well, thank you

Speaker 3 1:07:01

very much. It's been an honor to be a guest. And if anybody wants to talk about life in the military, please feel free to reach out to me via email. I'm always happy to talk about my experiences and career.

Ben 1:07:10

We'll share your email on the episode page and we'll be sure to connect anybody who has any interest to you via email, so feel free to reach out to the to the incubator. Alright guys, thank you very much. Thanks. Thank you for listening to the incubator podcast. If you liked this episode, please leave us a review on Apple podcast or the Apple podcast website. You can find other episodes of the show on Apple podcasts, Spotify, Google podcasts, or the podcast app of your choice. We would love to hear from you. So feel free to send us questions, comments or suggestions to our email address, Nicu podcast@gmail.com. You can also message the show on Instagram or Twitter, at NICU podcast or through our website at WWW dot d dash incubator that org This podcast is intended to be purely for entertainment and informational purposes and should not be construed as medical advice. If you have any medical concerns. Please see your primary care professional. Thank you

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