Introduction to Dr. Bash

Host: It seems like you’ve done some interventional radiography in your career.

Dr. Bash: I did, yeah. It was part of my neuroradiology training. It was hard on me, though. I couldn’t do it full-time. I did my training, so it was good, but it’s hard on you. You’ve had a spinal cord injury yourself, so you know what it’s like. You’ve lived with it for a long time, and you’re just an amazing person to do what you do.

Host: It’s kind of an amazing feat.

Dr. Bash: Well, I like it. I’m motivated to do it, so that’s why I like to help. My case took seven years to process, and I’ve got a nice training background, so I can help veterans with their problems. It makes me feel good about what I’m doing and helping the next guy in line. I do it independently, ensuring the testing is accurate, and the doctor following me will understand what I’m doing. I also try to cure medicine, so I get testing for various conditions to ensure patients don’t fall through the cracks.

The Importance of Comprehensive Medical Testing

Dr. Bash: I get to look at the case for several hours, whereas the clinic doctor only gets 10 minutes. I can do a whole body analysis and help them medically along with the VA rating schedule. That’s the way it should work. The veteran should be at an advantage because he’s getting a full body analysis and more testing, helping him live longer and be healthier.

Host: That’s good. Veterans are living longer today with weight loss surgeries and things like that, and they’re getting healthier.

Dr. Bash: Yeah, that’s a good deal. Infections can be a serious issue. I had a failed gastric sleeve and almost left the world. One of the staples blew out of my stomach, and I had to have two more corrective surgeries. I spent the majority of last year in the hospital.

Host: Did you bleed or get infected?

Dr. Bash: I had a blowout, and one of the staples blew out. I had surgery, came home, and on the fourth day, I started having stomach pain. It got severe, so we went back to the emergency room. They did a couple of tests and found the issue. They rushed me to the OR and got it cleaned out. Two weeks later, it happened again.

The Challenges of Post-Surgical Complications

Host: Did you have any fever or infection with that?

Dr. Bash: Yes, I was septic and had all kinds of complications. The reason I got septic was because of leakage, as bowel content is not sterile.

Host: How did you manage through all of that?

Dr. Bash: I ran across a very good infectious disease doctor who really helped me. He was very good at what he did and likely saved my life. The surgeon was pretty good too. It was a rough time, and I lost 125 pounds.

Host: That’s always a joke in medicine—just keep getting sicker and sicker until you see the infectious disease doctor. They usually save your life because they go through extensive training.

Dr. Bash: Yes, they do. They’re good doctors.

When to Get an Independent Medical Opinion (IMO)

Host: When do you recommend a veteran get an IMO?

Dr. Bash: I like it right off the bat. I do cases now with patients in service. It’s nice because they have that benefit before discharge, so they can see a VA doctor while in service. If the VA doctor is biased against them, by the time they’re exited from service and go to the VA, they already have two negative reports in the record. I try to get my IMO/IME testing done while they are in service. When the VA doctor rolls in, they already see my IMO/IME, and they have to either disagree or agree with me. If they disagree, they have to be truthful, or they could get in trouble for malpractice. Normally, if my work is well-documented, they will agree with me. This makes the medical board process more straightforward, and by the time they get to the VA for the rating, everything lines up.

The Value of Professional Workup

Dr. Bash: It’s important to have an IMO or IME at any step or level of the process. If there’s a decision that’s negative, you need new evidence, and an IMO/IME can provide that. The BVA will also take new evidence. So, any step where a decision is made, you should consider an IMO/IME to ensure all aspects are considered.

Host: How many IMOs and IMEs have you done?

Dr. Bash: I’ve done about 5,000 patients over 20 years. The average patient has about seven issues, so I’ve probably done around 35,000 to 40,000 issues.

Host: That’s a lot!

Dr. Bash: Yes, I did a lot of them. I used to visit big hospitals every two weeks, seeing about 20 inpatients and doing lots of exams and reports. I’ve got a lot of experience, and I know the pressures the doctors are under in VA hospitals. I don’t use that as an excuse to provide anything less than good care to patients.

Traveling and Examining Patients

Host: Do you still travel a lot, Dr. Bash?

Dr. Bash: I travel some. It slows me down because my files are displaced, and I can’t work as efficiently. But I can be talked into traveling to places to see patients or be an expert witness at a BVA or DRO hearing.

Host: You probably have more success at the BVA level, don’t you?

Dr. Bash: Yes, the BVA judges know my work over 20 years. They know I’m a straight shooter and try to do the best job I can. At the regional office level, it’s more complicated because there are many offices, and the DROs don’t necessarily know me as well as the BVA judges do. But it’s more about the person than the place.

Understanding Spinal Cord Injuries

Host: What are the grades of a spinal cord injury as far as complete and incomplete?

Dr. Bash: Those are interesting terms. Complete doesn’t necessarily mean the cord is cut all the way across. Most of the cords are still intact at some level. Incomplete means you have some residual function below the injury. We’re getting better at using imaging to grade these injuries based on area, volume, and signal changes. Once you have an incomplete injury, you do muscle strength testing, sensory testing, range of motion, vibration, position, and hot/cold testing to understand what’s going on.

Host: It affects every system in your body, even muscle, doesn’t it?

Dr. Bash: Yes, it affects the immune system, bowel, bones (osteoporosis), skin (breakdowns), and even your blood pressure. It complicates things further when patients are on pain meds, which can dull their brains, causing them to miss warning signs like infections.

Host: Do you still drive?

Dr. Bash: Yes, but I’m starting to do less of it. My family doesn’t want to ride with me anymore. I’ll take routes with only right-hand turns to avoid crossing highways. It’s crazy, but it’s safer that way.

Host: Thank you all for listening. That ends this show. Now I’m going to zoom off.