Bon Vivant Chic - Life Well Lived

Finding Joy and Purpose in Healthcare: A Chat with Dr. Jay Poonkasem

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Ernestine:

Welcome to Bon Vivant Chic Life Well Lived The podcast for anyone who wants to cut through today's noise and just listen for a few minutes to meaningful conversations on the human experience and the power of connectedness. I'm your host Ernestine Morgan, an advocate for kindness with a passion for showcasing human interest stories that matter. Today. I'm happy to be sitting with Dr. Kirksack Jay Poonkasem, who is board certified in family Medicine, hospice Palliative and integrative medicine. I first met Jay in the early part of my time at Morton Plant Mease Healthcare Foundation. Jay was a USF resident at Turley Family Health Center in Clearwater. Jay has agreed to sit down with me for a friendly conversation. Physicians are always so busy and I'm very grateful he has carved out some time for a nonclinical chat. But I really do wanna include clarity around hospice care versus palliative care, and what is integrative medicine. So let's get started. Please welcome Jay, a well-respected physician in our community with a passion for diving and underwater photography. He travels all over the world to some beautiful, exotic places. Always water around, right. Jay, thanks for sitting down with me today.

Jay:

Thanks Ernestine for having me. It's great to be here with you.

Ernestine:

Can you please share a little about where you grew up and what life was like?

Jay:

I actually grew up in Plant City. So it's basically between Tampa and Lakeland. Went to, elementary school there, went to middle school junior high, and then, I went to, high school in Tampa. Growing up in Plant City was nice. The people there were great. And of course you have the Strawberry Festival there every year. It's known as the, winter Strawberry Capital of the world, oh, is that right? Yeah. So I remember one year my parents had a booth at the Strawberry Festival. We were making, bread art. That was kind of neat actually. I was there at the festival every day. We were selling bread art that we made so it was nice and creative. We were able to go around and what's bread art? We, we were in Thailand one year and we learned how to make bread art and form it. You basically. Make, figurines flowers and things like that. Oh, do you eat it? No, you don't eat it. Oh, you, it's basically for decoration. Okay. Cool. It's, it's made out bread uhhuh, and it's formed into a dough and, and that dough is made into whatever figurines, flowers, roses, whatever, what you want to make. And it's really cool you color it and then.

Ernestine:

Oh, that's neat.

Jay:

We were there, doing that for that one year. That was a lot of fun.

Ernestine:

What are some of the fondest memories you have growing up besides doing the bread art? You sound like you have a very close family.

Jay:

You have a sister, right? Yes, I do. Our, family's very close. One of the fondest memories growing up, I guess it's a bunch of memories just because we were big into music. Growing up, we had a little recording studio in the house. Music was a big part of our lives. I started off playing guitar mostly, and we had our own. Kid band, which was fun. Our parents were in a more of adult band, they would play at parties and things like that. We did the same. We had our kid band and we played a lot of different things and that was a lot of fun. Over time, I started recording things in the recording studio just for fun. Those were good times back then. Oh, that is great. Do you have

Ernestine:

Old videos

Jay:

Yes, we do. My dad sent them to me and I'm like, where did you find these? It was so funny. I looked back, I was like, wow. Oh my gosh.

Ernestine:

You're too young, you didn't know the Partridge Family.

Jay:

Growing up. I've heard about D Partridge Family.

Ernestine:

That's who I grew up with is Partridge Family. Who had the biggest influence on you when you were young?

Jay:

I would've to say. Both of my parents did. I wouldn't be here today where I am without their support. They've been a huge influence in different ways. My dad showed me the value of hard work. My mom, showed us good values. Did a lot of our homework with us and kept the household running they both, were a big influence, in my life,

Ernestine:

what was your very first job and, how did it shape you?

Jay:

When I was talking about music earlier, we actually got paid. Starting as a kid. I can't even remember how old we were. I probably started playing. Music probably like nine 10. And then the band we probably started getting paid around there too'cause people thought we were cute. We got four kids, playing music. Hey, we'll hire you guys to play, when the adults are taking the intermission or something like that. But I think what I learned most from there is. It's taking you outta your comfort zone. And you can bring that into current day life because I was a more introvert back then. When you're playing music for people you're forced to be out there, you have to perform. When I had my guitar had that on there, it's like my shield. Right? That's right. So I'd go on stage, we had the guitar and. You just do it. It was good to kind of help you get outta your comfort zone, and put yourself out there. Mm-hmm. And to be more vulnerable and you kind of learn and you roll with it, are you still playing

Ernestine:

now?

Jay:

I was playing music in a band through high school at least. It was even before high school. High school periodically played music in college, but after that it was more studying I recently took up playing the drums a few months ago, so I'm still learning. I dabbled in the drums growing up, but I didn't get my own set to bang on till now. A few months ago, actually, this is crazy. It was after the hurricane rolled through I went to one of my friend's house to charger up, one of my battery packs, and he had a drum set there we just started playing and that was it. Next day. That's awesome. I went out and got myself an electronic drum set.

Ernestine:

And what do your neighbors think? It's

Jay:

actually not bad. I mean, you hear the. Thumping of the bass drum, but for the most part it's electronic, so I have my headphones on. Oh, that's fun. Yeah.

Ernestine:

You've built an amazing practice and reputation in both hospice and palliative care and integrative medicine. Can you explain what the difference between hospice and palliative care are and what is it? Integrative medicine. Very good questions.

Jay:

There's a lot of myths about hospice and palliative medicine. And, one of the things I like to tell people is that, you can think of palliative medicine as this big timeline and hospice fits in the last six months of palliative care, palliative care, you can get that on board at any time, even when you get diagnosed. So there's no timeline on how long you can be on palliative care and, you can be on palliative care and get the support, for many years. You can still get curative treatment. The intent can be to cure and, we're there to help manage symptoms, help manage any pain, discomfort, and really be there to support. Hospice fits in the last six months, all of hospice is considered palliative, but not all palliative care is considered hospice care. Hospice typically is the last six months of life,

Ernestine:

and I've also heard where palliative care can also be applied to chronic illnesses. Diabetes can

Jay:

be COPD. Chronic kidney disease, any type of chronic disease or any illness at all, palliative care can really get involved with, number one, trying to figure out what's important to them. What's your goal? How can we help you get to your goal, with a good quality of life?

Ernestine:

Thanks for clarifying that. Sure. And so what is integrative medicine?

Jay:

Integrative medicine really is looking at the person as a whole. Body, mind, spirit, you take into consideration all those pieces. In medicine, what I found is that we tend to focus a lot on the physicality, the disease process, what's it doing to our bodies, but we don't tend too much into the mental aspects, the mind body connection and the spirituality side of that as well, because that's what makes a whole person. It's not just a disease, it's not just a body, but it's all those combined that makes a person who they are. In integrative medicine, we look at the whole person. I like to look at, the lifestyle aspects. How's nutrition doing? Are you exercising? Are you moving your bodies? How's your stress level doing? Things like that are important as a whole, and there's more to it. We delve into, all of that. The other piece is, we can use different modalities of care. Like in my practice, I'll use acupuncture or auricular therapy. We'll do some manual therapy, as well.

Ernestine:

And what is that seed thing you put in your ear? What is something about the ear, right?

Jay:

Yeah. That's auricular therapy. Basically, you can use acupuncture needles, you can use pellets, you can use seeds. So the ear has, several cranial nerves I like to think about it this way. When I explain it, you can think about the ear as a keyboard to a computer. The brain is the central processing unit of a computer, so when I put needles in or use the pellets or seeds, it's tapping on the keyboard to tell the brain what we want it to do. If we're trying to help with pain, we'll put certain, needles or seeds in, to manage pain in certain areas of the body. It's amazing. It really is. Made a lot of believers outta non-believers.

Ernestine:

Yeah. I'm sure the body is amazing it really

Jay:

is. And there's probably more we don't know about it.

Ernestine:

Yeah. Every day you hear something new. What are some of the most rewarding moments as a physician?

Jay:

That's a good question. In my world when I first got outta residency, I went into hospice care right away, and people ask me, wow, you're so young right outta residency, why are you going into hospice care? And I looked at it and I said, there's no difference what stage they are in their life. If we're providing good care and quality care and providing them with a quality of life, that's important. I remember I had A-C-O-P-D patient in hospice and this was actually in my integrative medicine clinic for hospice when I worked with them, he had a lot of, pain issues. He had a lot of breathing issues. I worked with him, did acupuncture, different, modalities of treatment with him. And after a few weeks he came in with his wife and we were just sitting there talking and he says, you saved my life. I was taken aback because

Ernestine:

wow.

Jay:

I'm talking to a hospice patient that has a limited life expectancy of less than six months, and he said, I saved his life. And I looked at over his wife. His wife is like You did. And I said, what happened? He said, before I met you, I was in such severe pain, I was taking a lot of, opiate pain medications, but it wasn't helping. After seeing you for a few weeks, my pain level. It started going down and I didn't use as much pain medications. He said before that the pain was so severe and intense and his quality of life was so poor that he thought about ending his own life.

Oh, wow.

Jay:

I was shocked. But relieved at the same time. And, you know, that was one story that popped up into my head. Powerful said. Yeah. What, what's rewarding as being a physician? And just the recent story in the integrative medicine clinic here with BayCare, I had a patient referred to me. She had breast cancer about nine years ago. Had a mastectomy done. She said since that time, nine years ago, she's had such severe chest wall pain, that hasn't been able to be relieved. And she said, I can't do anything in my life anymore. So after we saw her, did a treatment on her. Followed up a week or two later. She said this was the first time in nine years that I was able to walk my dog.

Wow.

Jay:

Was like, wow. I recently just saw her a couple days ago in clinic. She came in with her sister. She's like, look. I am able to go grocery shopping now. I haven't gone grocery shopping in that nine year span. Because my husband did it for me.'cause I was in a lot of pain that she couldn't do anything. And it's moments like this, it's stories like this that I hear from patients that. That drive you. And it's like, wow, we're able to help these people out that are suffering and have a poor quality of life. So in essence, she's like, I have a big mouth and I'm telling everyone about you.

Ernestine:

You mentioned breathing. Yes. And I know you carry a card with you that, explains, if you find yourself in. A difficult situation. You use this practice could you explain, this breathing technique, so that we might all benefit from this?

Jay:

I learned years ago in my integrative medicine fellowship, the 4 7 8 breathing technique one of those things we don't think about until we have a problem. Okay. Like the people with, lung issues, COPD, they know breathing because if they can't breathe, it feels like they're suffering. Conscious breathing is what we're talking about is. Intentionally doing slow, deep breathing, whatever breathing technique you want to do. When you do intentional breathing, it actually stimulates the parasympathetic nervous system. That's the part of our nervous system. That's the resting and digesting. The other part you might hear of is the sympathetic nervous system. That's that fight or flight. Hey, I gotta get outta here. There's a danger there. I gotta get to safety. In our day-to-day lives, we have a lot of stress. Most people have a lot of stress in life, so there's sympathetic nervous systems and overdrive. Chronically, that's not a good thing. Acutely to get out of danger, that's important. But if we're living with that chronic stress. Every day, all day. That's not good for our bodies. Breathing techniques stimulate the resting and digesting part of our nervous system, that parasympathetic nervous system. The 4 7 8 breathing technique, it's a super simple breathing technique that helps to do that. It helps with stress reduction. Anxiety can even do pain if you do it early enough. Okay, so I'm gonna teach you if you wanna learn this. Yes, yes, please. Alright, so it's called 4 7, 8 or a relaxing breath, the four part is inhaling through your nose for a count of four. Seven is holding your breath for a count of seven. Eight is exhaling through your mouth for a count of eight. When we're doing this breathing technique, we want to put the tip of your tongue. At the roof of your mouth, right behind the front teeth. You don't have to push hard. Just lay it up there, okay? Mm-hmm. Okay. And then we breathe through your nose for a count of four. Hold for a count of seven. Out through a mouth for a count of eight. The tongue stays up there the whole time, correct. Okay. So that's the trick. You gotta keep the tongue up. Yeah, the tongue's up there. Okay. So on the exhalation, that's gonna be the most difficult part. When you do the exhalation, you're gonna feel cumbersome at first, but as you practice, it's gonna get easier. 4, 7, 8 is considered one breath. You wanna do a total of four breaths when you start. Okay. The key is doing it at least once a day. And you can use it anytime throughout the day as well. If you feel nervous, anxious, if you're having problems falling asleep, do a set of breathing. I use it when I see a difficult patient or I'm going room to room if I need to balance myself and ground myself, do a quick set of breathing takes less than a minute to do.

Ernestine:

That's terrific. I'm learning how to meditate. I think I might. Use this tool to get into that meditative state.

Jay:

You can definitely do that. Meditation, depending on the type of meditation serves different purposes, but the breathing will definitely get into that state of mind.

Ernestine:

Oh, that's terrific. Thank you so much For sharing that with us. Have there been any. Pivotal moments or decisions that really changed the course of your life?

Jay:

That's a challenging one. so what I would say is thinking back, I never thought I would be in the hospice and palliative medicine world, and outta residency it just happened. It just happened. I was talking to one of my friends, in the physician lounge one day and he's like, Hey Jay, what do you wanna do with yourself? I go, I don't know, but I do want to incorporate all the integrative medicine that I know, the acupuncture, all these things. Prior to being a physician or going to med school, I went to massage therapy school. Oh, you did? So I'm still a licensed massage therapist in Florida. Oh, that's awesome. I wanna incorporate all these things that I've learned over the years. Into whatever I do. And he's like, Hey, why don't you talk to our medical director for hospice? I went to talk to him and he told us, Hey, we're building a new inpatient facility and you can use all the integrative medicine there you want. I said, sign me up.

Ernestine:

Yeah, that's

Jay:

Yeah. So they were really open to being able to use these different modalities. And that's the rest of its history at that point.

Ernestine:

That's terrific. You have a clinic now? That is open one day a week now. One day a week. Mm-hmm.

Jay:

Most of my time, I'm doing palliative medicine consults at the hospital. The clinic's, on Wednesdays., It's limited, but it's effective oh, that's great. It's a good break in the middle of the week. To change gears a little bit to

Ernestine:

You are still young, we're really in the middle of your career, right? Mm-hmm. But I wondered. Are there, any lessons about family and relationships that you would pass along to medical students or physicians just starting out? Yeah, I think

Jay:

balance is the key. Just looking back and knowing some of the people that I've known I know early on we're focused on our careers, but you have to focus on the whole balance of you. And that can fit into anything, any profession at all, is that you really have to have that balance., If you start focusing on one thing too much, it's gonna disrupt that, life of yours. So if you have family, if you have kids, whatever it might be, you may be spending too much time and career, in my time with hospice. And even palliative medicine patients that I see, I've never had a patient come to me and say they wish they worked more in their life. Most of the people I see that are dying say we wish we could do it again and not work as hard as we did, and spent more time on the important things in life. The important thing in life is individual. So everyone has their own, thoughts of what's important to them and what makes them happy. You gotta find that and then keep the balance. You can still excel in your work and career and all aspects, but you gotta come back to center at some point in time. I think that would be one of the most important things I would, tell, med students or young physicians coming out, is keep that balance. And remember why you went into medicine. And I think that will keep you going. There's a lot of pressures out there and things out there that, are limiting physicians in a way and handcuffing, in certain practices.

Ernestine:

What do you think is the secret to a fulfilling and happy life?

Jay:

I'll go back to balance. I think really that's, the key, to happy life and to make sure you wake up every day and you're doing what you wanna do. Finances are important, so you have to have a career that can support your, desires and wishes after that, you wanna make sure that you still are enjoying it. And again, keep that balance because you don't wanna get so wrapped up in your career that you forget other important things. If careers are important, go ahead, dump it all in there. It's individualized, but, I believe balance is gonna be the key, to happiness overall.

Ernestine:

The way you balance your life. You have this hobby, which is diving

Jay:

Scuba diving. But, but I do enjoy photography. When I go, I used to enjoy photography on land and I said, Hey. Let's try this underwater. It's way more difficult underwater. Your

Ernestine:

photographs are amazing. A lot of underwater creatures. Yeah. And you have an aquarium where you Yes. Like you have these. Kind of things, right? Yeah,

Jay:

I just set up a new, seahorse tank, I bought seven Seahorses They're fun. They're time suck.'cause every time I feed them I just watch'em and just mesmerized at,'cause they snick kind of have this sucking, movement when they're eating. So it was like, wow, I'm just sitting there staring at him. But it must

Ernestine:

be meditative or therapeutic,

Jay:

right? It's, I start watching him and I get mesmerized and I just keep staring and I'm like, oh, I have to go. Oh my gosh. So they're fun.

Ernestine:

Oh, that's great. What would you say keeps you inspired or motivated daily? Because the work you do is really hard. It is very emotional. And you're dealing with not only the patient, but the family.

Jay:

I try to keep in mind that making a difference for people is what drives me like you said, what I do is challenging. It's not for everyone because you're in situations where they're emotionally charged and a lot of the situations they're not happy per se, right? Because the outcomes that we want aren't happening. We're in there in the most emotionally and vulnerable times for the patients and families. You're having these deep conversations, this is your only chance to have these conversations, and do it well. If I can help someone get a better quality of life or have a peaceful passing, to me that's important. Oftentimes people say, oh, we don't want you. They're like, well, I get that it might sound scary because we have a misconception of what you do. Mm-hmm. But I can give you comfort. I can bring some peace. I can bring some quality of life to you and your family. So that's what keeps me going.

Ernestine:

We are blessed to have you in our community, that's for sure. Appreciate

Jay:

that. It's been a great community to be a part of, It is, isn't it? Yeah, it really is.

Ernestine:

Yeah. We actually first met when, you had applied for a grant for a program we were trying to launch at Turley Family Health Center in Clearwater. And, you've really. Done some terrific work

Jay:

think it really has come full circle. From the initial grant when I was in residency and now with the Cancer grant, that you were a part of too. So it's been awesome.

Ernestine:

I've been in the philanthropic world for quite some time and philanthropy means different things to different people for sure. Each individual has their own perception, or take on philanthropy. What does philanthropy mean to you?

Jay:

Philanthropy to me, is the simple thing, is just giving back and it's giving back in whatever way you're giving back. Whether it's time, whether it's money, whether it's services, it's giving something of you to someone that doesn't have or not able to have. Me, what I'd mostly do is. Give away my services for free.

Ernestine:

Well, that's very altruistic.

Jay:

Yeah, I'll see friends or family and, we'll go over I tend to have my auricular therapy things. I'll have the seeds in my pocket or something. I'll take those out and start working on people. Our team members at the hospital, they'll come knocking on the door or send me a text. I need a seed. I'm like, come on by.

Ernestine:

That's wonderful. This has been great. Such a wonderful, conversation and our time has been terrific.

Jay:

Appreciate you inviting me for this.

Ernestine:

Thanks, Jay. You're welcome. Ernestine. Thanks for listening to Bon Vivant Chic Life Well Lived. I hope you'll tune in for more meaningful stories on the human experience and share with family and friends. All the episodes are available on Spotify Buzz Sprout, Apple and on my website, bonvivantchic.com. Till next time, remember, every day is a gift. Live it. Kindness matters.