Lifestyle Medicine Conference 2017

It’s not everyday you find yourself on the balcony of a beautiful hotel, overlooking the stunning Manly beach, and surrounded by over 400 energetic, passionate individuals.

This weekend I was fortunate enough to connect with these “capable, caring and passionate” individuals. We shared, we experienced and we inspired each other. We discussed topics from behaviour change and psychological medicine, to public and planetary health. We learned about the gut-brain axis, and how to prescribe lifestyle interventions. But more importantly, we walked the walk, and talked the talk.

As a medical doctor, I challenge you to the following. Why not try one, why not try them all?

1. Nutrition
I challenge you to ‘eat the rainbow’. What does this mean? It means eating whole, natural, unprocessed foods. Choose blueberries, red capsicums, green spinach, purple carrots and bright pumpkins. As Michael Pollan put it, “Eat food, not too much, mostly plants”.

2. Exercise
I challenge you to incidental exercise. Take the stairs instead of the escalator or elevator. Carry your luggage instead of dragging it. Get off the bus one stop earlier and walk the rest of the way home. A little bit of exercise, consistently goes a long way. Consistency is key.

3. Smoking
Quit smoking. Is that too hard? Then why not first try to decrease the number of cigarettes you smoke? Is that still too hard? How about buying a Nicotine Replacement Patch and sticking that on? Give it a go, i’m not asking you to do anything that will harm you. Option three also doesn’t mention anything about no smoking either…

4. Alcohol
I like a glass of wine so I would be a hypocrite to ask you to abstain from alcohol. When it comes to alcohol, I believe it all comes down to drinking in moderation. I challenge you to alternate your alcoholic drinks with non-alcoholic drinks.

5. Sleep
I challenge you to a good night’s sleep. Does that sound enticing to you? Studies show that getting sufficient sleep, that is, not too little and not too much can help control your weight. So, what are you waiting for? Get a little shut-eye.

You trust me when I treat your medical conditions, and now I ask you to also trust me when I try to improve your health and wellbeing.

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2017: My Year of Me

This year I decided to take a year off full-time medical clinical work. I had been told multiple times that as a PGY3, it would be risky and extremely difficult to get a job the following year. I had also been told to go ahead and experience other aspects of medicine and life. So I went with the latter and it has been one of the best decisions i’ve made!

So what have I been up to?

1. Research.
Prior to experiencing research this year, I had never really enjoyed doing research. Two research projects later and I am now inspired to do further research in the future and perhaps even a PhD. I believe one of the greatest influencing factors is that i’ve been lucky to have two fantastic research mentors who have provided me with the support and guidance I required.

2. Teaching.
I was fortunate to land an associate teaching role at the medical school I graduated from. Teaching is extremely rewarding and I received fantastic feedback from the students. It taught me skills such as leadership, communication and to be more understanding of individuals.

3. Volunteering.
I followed my passion and it lead me to the Australasian Society of Lifestyle Medicine. I am a strong believer in good health starting from the simple changes we can make such as a healthier diet, increasing our activity levels and stressing less.

4. Locum work.
I was fortunate to obtain a role as a Medical Registrar in a regional hospital in New South Wales. This gave me greater autonomy in decision making and I played a bigger role in patient care. The learning and experience was exceptional. I also met some fantastic doctors and nurses.

5. Personal and professional development courses.
Time is one thing that I am especially thankful for this year. I actually have time to attend courses such as the SPRINGBOARD Women’s Development Course and the BASIC ICU Course – both excellent!

6. Kindness.
When we are extremely busy, working full-time, tired and lacking energy, it can be difficult to give to others, whether that is our time, energy or kindness (and it is understandable!). This year, however, full of energy, I found myself helping an octogenarian find mushroom soup at Coles, walking tourists to their destination and giving up my car space for others. It is a nice feeling to be able to help our community!

7. Family and friends.
I find myself being able to say “yes” to my loved ones more often and being able to give them more of ‘me’. I have time to buy my friends flowers, to home-deliver food to them and bake them goodies.

8. Friday night drinks.
I often avoided Friday night drinks because I was too tired, didn’t want to take time away from the studying that I “should” be doing or had too much to do the next day. However, this year, I have been able to go out a few times and it has actually been extremely enjoyable!

9. Romance.
When your life revolved around work, friends, family, work, gym, sleep, study, gym and work, there’s not too much time left over for other aspects of your life. But this year, who knows, maybe things have changed?

10. Travel.
This year I have been on at least 23 plane rides both interstate and internationally. I love traveling as you experience things you wouldn’t usually experience, meet a diverse range of people and learn about different cultures and cities. Which is why I am super excited to go to Europe in just 19 days! I will be there for just under 3 months and I would love any tips and recommendations!

So whether you’re burned out, wanting a change or even feeling a bit directionless with your life, I would recommend some time off. Who knows, you may land yourself your dream job, discover a country you absolutely adore, or even meet mister right! 😉

Dear Patient – Mr MH

I still think about you every now and again.
You were too young to die, too nice to die, too polite to die.
But you left us.

You were so strong, so courageous and so easy to look after.
I looked forward to going into work just to say “hi” to you.

Then one night you decided to leave.
My heart felt heavy, and tears filled my eyes as I watched your wife run out of the room crying, breaking the silence of the night.
I knew it was time.

I listened for your heart and breath sounds for the last time. Nothing.
I looked into your eyes for the last time. No reaction.

May you rest in peace.
Thank you for smiling every time I went into the room despite knowing you were leaving so soon. Too soon.
RIP.

My Peruvian Journal – Lima (Part 1)

For my end of internship year holiday, I decided to jet set to Peru. Why? For various reasons. There are still quite a few countries I have not travelled to, so I had a few options. I asked myself what I wanted to do during my holiday. I knew I wanted a place that was not too cold (crossed Canada off the list) and I knew I had 3 weeks to travel (crossed Asia off the list). I started searching “Bucket list destinations” and Machu Picchu popped up time and time again. Coincidentally, I also have a friend travelling around South America, who was a great push behind me booking my flights. The next thing I knew, I was at a flight centre with my bank card, determined to book my holiday.

Day 1 – 10th Jaunary 2016

Travelling solo is not the most foreign concept to me, but for some reason, waiting at the airport for my delayed flight gave me cold feet. I had flown from Melbourne to Auckland, and now I was waiting for my flight from Auckland to Santiago. It felt as though everyone around me was speaking Spanish. Where were all the English speaking people? Where were all the Caucasians with blonde hair and blue eyes? Or the Asians? The flight ended up being fine – Auckland to Santiago, Santiago to Lima. I even met a lovely New Zealand couple BR and JR. They have invited me over to their Avocado Orchard near Auckland one day (definitely an offer I will take them up on!)

Although the taxi driver spoke minimal English, my airport transfer to San Augustin Executive Hotel in Miraflores was smooth sailing, and I felt safe the entire time. The first evening was spent having dinner at the hotel. I ordered chicken with grilled vegetables and potatoes (over-priced but still decent). They also greeted me with a free Pisco Sour, a Peruvian cocktail made with Pisco, lime juice, sugar, egg white and Bitters. By the time I had arrived, I was tired and it was dark outside. I was not yet comfortable to roam outside in the dark alone. On the plus side, I did meet two lovely employees from the hotel – DM, the Bartender and M, the Bellboy who ended up becoming good friends of mine whilst I was in Lima.

Day 2 – 11th Jaunary 2016

Day 2 was spent exploring Lima with my new friends – RS and his older brother JS. I met RS on the plane ride from Santiago to Lima. He was sitting a few seats away from me on the plane. I overheard him speaking to a lovely old lady, and I was intrigued – I thought to myself, his communication skills screamed out familiarity, something I was longing for. Not long later, I found out he had just finished his medical internship in Melbourne (surprise, surprise, what a small world!)

We started our adventure at the Inca and Indian Markets, where we saw several Peruvian scarves, woodwork and souvenirs. RS bought us some Coca Candy to try (it tasted like … anaesthetic?) For lunch, we tried Ceviche, Arroz con Mariscos and Leche de Tigre. All amazingly delicious! They also brought out Chicha Morada, a drink made my boiling purple corn with pineapple, cinnamon, clove and sugar, and Cancha, a toasted corn snack (tasted strange initially, but extremely addictive). Then we visited Hauca Pacllana, an ancient adobe and clay pyramid built by the Lima people between 200 -700 AD for ceremonial and administrative purposes. The weather was hot, and we were dying, but it was a pretty good historical lesson. We later cooled off with Lacuma (famous Peruvian fruit) Frappuccinos at Starbucks. Then there was more walking along the Miraflores Boardwalk (quite beautiful) and exploring Larcoma (an outdoor shopping mall on the beach, overlooking the Pacific Ocean). Lastly, dinner was a large platter of Antichuchos (generally made with beef heart), Chicken, Chips and Grilled Vegetables (or should I say vegetables drenched in oil). One thing I have noticed is Peruvians seem to eat chips, or “Papas fritas” on a daily basis (potatoes are a staple!)

It was sad to part ways with RS and JS. It was such a fun day, and it felt so natural. We laughed, shared stories and joked around as if we had known each other for years. They reminded me of brothers I never had (RS – the teasing, fun brother, and JS – the older, more mature but still awesome brother). They are definitely two people I will keep in touch with and meet up with again!

Day 3 – 12th January 2016

This shall be called the ´Walking Day´. The great thing about travelling alone is that you can do whatever you want and be wherever you want to be whenever. After a delicious Buffet Breakfast (love!), I started my trek along the Pacific Ocean. I had no specific directions, I just knew the general direction I was heading towards. The beauty of this was incidentally stumbling across many tourist attractions, such as the Malecon, Parque de Amor and Real Plaza before finally reaching my destination, Museo Larco. The museum was beautiful, full of artwork, jewels, clay sculptures and rich in history. There was even an “Erotic Room” with art showing different sexual acts – it was definitely a strange experience! I´m not sure whether a long hike in the heat was the best idea, as by the time I had reached the museum, I was exhausted. Nevertheless, I battled on and visited a few more tourist attractions on the way home – Mercado Indios and the Chocolate Museum. I did a total of 39,233 steps and 29.7km that day. My legs and glutes felt so tight and it felt like a great workout, aside from developing Medial Tibial Stress Syndrome.

Day 4 – 13th January 2016

Today I explored Lima Town. But first, I enjoyed my daily pre-breakfast jog and exercise along the Pacific Ocean. It is so beautiful, and you get the cool Pacific breeze early in the morning. It was so refreshing to see the locals out and about, also exercising. I have been told though that Miraflores is a more upper class area, which may explain the healthier, more active and luxurious lifestyle (I have not seen people exercise anywhere else).

In Lima, I visited the Government Palace, San Martin Square, the Lima Cathedral and had a general stroll. Lunch was at a Peruvian Vegetarian place “Afinidad Maravillosa” – it was pretty good value for S/8! It was a very rushed exploration of the city before I had to return to my hotel. The traffic in Lima is pretty shocking, and by the time I reached my hotel, my Tour Van was already waiting, ready to departure – Go, go, go!

I booked a Night Tour for $60 USD (it was quite worth it!) It was a tour for 10 people, but I was the only English speaking tourist. I have noticed many of the tourists in Lima are Spanish speaking – eg: from Brazil and Bolivia. Our first stop was Parque de la Reserva, a magical fountain park. We got to visit 11 out of the 13 different fountains. They had pyramid shaped fountains, rainbow fountains, a tunnel fountain and more – it was very romantic! Then we drove to La Dama Juana, a restaurant in Barranco, the “Bohemian” town. We enjoyed an all you can eat Buffet and a Cultural folk dance show. Some of the foods available included Arroz Con Pollo, Saltado De Pollo, Aji De Gallina, Carapulcra, Seco De Res, Causa Rellena De Pollo and many desserts including Arroz Con Leche and Mazamorra.

Day 5 – 14th January 2016

Today was my last full day in Lima. I went to the zoo, Av Parque de Las Leyendas in San Miguel with my new Peruvian friend, Vanessa. I met her via my new friends GW and NW, a lovely couple from Kansas. (I met Professor GW yesterday at breakfast when he started trying to speak Japanese to me! He was whispering “konnichiwa, konnichiwa”) On the way back from the zoo, we took a bus. What an experience! It was hot, sweaty and a long journey – travelling true Peruvian style (I was exhausted afterwards!)

Then GW invited me to lunch with himself, his wife and the Stephen Hawking´s Group, a group for women with physical disabilities. Some women suffered from Post Polio Syndrome, a condition I find quite rare in Australia. Whilst enjoying Pardos Chicken, we discussed issues such as public transport difficulty for people with disabilities and joked around about meeting Stephen Hawking. I really enjoyed the catch up, or should I say “meet”, and it truly planted a seed for ongoing thought. How do those in wheelchairs catch buses with no wheelchair access, that barely come to a stop for able passengers to jump on and off?

Day 6 – 15th January 2016

Flight from Lima to Cuzco to Puerto Maldonado. Welcome to the Amazon Jungle… to be continued …

Don’t eat the marshmallow … yet!

For Christmas this year, my housemate, P gave me the book “Don’t eat the marshmallow… yet!” by Joachim de Posada and Ellen Singer. I loved it. It was a short and simple book and I managed to finish it during the Christmas break (26th Dec – 28th Dec 2015).

I loved that it was mind stimulating and full of positivity and success. That’s what I want to become, a young successful person.

A question that was asked was – “What am I willing to do today in order to become successful tomorrow?”

What is success? The definition of success varies upon individuals. Currently, if I were to continue being successful, these are the things that define it for me:

1. Living a happy and healthy lifestyle. This includes the ability to exercise when I want to, having access to delicious and healthy food, having a balanced lifestyle between work and play, and having “me” time.
2. Spending quality time with my family and doing things to help improve their lives. I’ve been fortunate enough to do more of this during the Christmas break. Little things such as going for a walk with my mum and sister, sharing Christmas lunch with the extended family and giving mum a massage all strengthen the family bond.
3. Enriching my friend’s lives and bringing happiness and laughter to them. I have really enjoyed sharing stories and experiences with my best friend JN. I feel really fortunate to have such amazing friends.  
4. Enjoying work and learning how to become a better doctor each day. I am thankful to work with wonderful nurses, to have an amazing cointern, to have a likeable registrar, to improve the health of my patients, and to have the ability to continue learning great medicine.
5.  The ability to learn. Education is so important, and I feel so grateful to continue learning each day, whether it’s from medical textbooks, self-help books or about people’s lives.

Finally, I think this book is so easy to read, and such a great read that I will send it to my friend, V in Malaysia. I hope he also passes on the book of wisdom. (I plan to pass it on to V. I hope V passes it on to someone else, I hope someone else passes it on and so forth… and I hope to eventually get the book back with people’s names of who it’s been passed on to… wouldn’t that be cool!)

The Importance of Teamwork

I am currently doing my surgical rotation in a rural town 1.5hrs away from Melbourne. It’s busy, tiring and sometimes I do feel a little underappreciated. I wake up at 6am to reach the hospital before 7am, and I leave work after 6pm, when i’m scheduled to finish at 4:30pm. Despite all of this, I am able to laugh each day, feel partially energised and socially connected. All of this is due to my wonderful co-intern, MK. A co-intern is an equal,  a colleague you work with. You share the workload on the wards, cover each other on half days and remind each other about tutorials and meetings. A co-intern can be good, bad or amazing. Fortunately for me, I have an amazing co-intern who keeps me sane until I get to drive back to Melbourne again. It is not until you are put in these situations that you really appreciate the little simple things. Ten things I appreciate about my co-intern: 1. It is so great to be able to walk to and from work with you. I am surprised that we still have so much to talk about during these 5 minute walks despite living together and working together all day. 2. I enjoy planning our lunches and dinners, and the wonderful salads we will one day make. 3. I am thankful for the lunch breaks we share together. Taking that extra 20-30 minutes to just stop for a while really makes a big difference to your stress levels. 4. I like how we can rely on each other for reminders to submit patients for meetings or reminders about tutorials and meetings. 5. I look forward to going to the gym with you each night and sweating out all the day’s stress and tension. Despite the burn and pain, it is so much more enjoyable with you. 6. The stories we share and debriefing moments are irreplaceable. Enough said. 7. I appreciate the much needed coffee and drink deliveries. 8. I love love love our teamwork approach despite being on different teams. It actually makes taking half days possible. (SO much more evident when you weren’t around) 9. I find it extremely nice that we share the workload towards the end of the day so that we can leave work at the same time. You have no idea how nice it feels. 10. Lastly, I appreciate that you are just such an easy going person and I really enjoy your company. Take notes future interns. Be this person for your co-intern and they shall reciprocate. MOOD: Appreciative and thankful.

Medical Leadership Development Seminar 2014

During my days off work, I tend to do a lot of cleaning. Today as I was cleaning my room, I came across some notes that I scribbled down from a leadership seminar I attended last year.

Here are some words from some very wise doctors:

1. Listen to the quiet people who don’t shout out first as their ideas may be better than the loud voices.
– Just because people don’t state their opinions, it does not mean they don’t have opinions

2. Accept criticism and review it when you are not angry.
– I particularly like the ‘review it when you are not angry’ part. Emotion can play a major role in your thinking and understanding. I have found that it is best to respond to criticism when your emotions do not take over.

3. “It’s amazing how much you can get done when you don’t care who gets the credit”
– This is true of many team situations. Currently I am working in the Emergency Department. Instead of just working by yourself, it is also important to see whether your colleagues need help. For example: in a resuscitation situation, you require more than one set of hands. When we come and work together, it will result in much better outcomes for the patient and it will be much more rewarding for ourselves.

4. Identify good qualities in others and adopt those qualities for yourself.
– There is always room for improvement, right?

5. Find yourself a mentor. Or five.
– A mentor is someone you can turn to for advice, someone you share special moments with, someone you look up to.

Back to cleaning now. Happy Tuesday.

Dear patient #1

Initially when I saw your presenting complaint, I was a little nervous as I have not had too much experience managing arrhythmias, especially in a patient post total thyroidectomy for thyroid cancer. However, I am so glad I did put my name against yours because I got to spend some special moments with someone so lovely.

As soon as I walked into the cubicle and introduced myself you said “you’re so young and beautiful”. I was caught a little off guard, but at the same time I felt really flattered. I gave you a little smile and continued on with my usual history taking. I noticed your story to be so organised and you were so insightful about your condition, which made my job a lot easier. You taught me about the cancer and different therapies you had received. Not long after, I found out you were a GP in your home country.

When you left, you gave me a big hug and left me with nothing but positive feelings, which kept me cheerful throughout the night. And I thank you for this. I thank you for not only passing on wisdom about your condition and journey, but also for being a kind-hearted human being who was interested in knowing about me too. You were polite, warm and caring, something that I did not expect from a patient.

Thank you for the memories and touch of kindness I will not forget.

New Project: How to Win Friends and Influence People

I’m sure many of you have heard of the book “How to Win Friends and Influence People” by Dale Carnegie. I was actually introduced to it about 6-7 years ago whilst at a lecture. Shamefully, I have to admit that it has taken me 6-7 years to pick it up and start reading it, and I am glad I have.

Being the enthusiastic, yet slightly rebellious person I am, I decided to flip through the book and start on page 66, Part 2, Chapter 2: ‘A simple way to make a good first impression’. Basically the whole chapter was on smiling, something I naturally love to do.

Reflecting back on smiles, there are many different types of smiles. There is the heartwarming smile, the insincere grin, the i-smile-because-someone-told-me-to, and the list goes on. I remember about 5-6 years ago I taught a friend about Smiles # 1-3 (I made them up by the way, but it stuck). Smile #1 was the little smile, with your mouth closed. Smile #2 was a smile showing your teeth. And Smile # 3 (my favourite) was the smile where your whole face smiles with you – yours eyes smile, your cheeks puff up and you’re so excited that you almost jump out of your chair.

So back to my ‘new project’. I have decided to read a chapter every day, or a chapter every couple of days (depending on work commitments) and write about my experience putting the methods of ‘How to Win Friends and Influence People’ into practice.

I practiced Part 2 Chapter 2 yesterday, and it actually worked! Blog post about that coming soon.