medicine | yoga | wellness | choosing joy

www.shannydo.com Resident physician (PGY-2) on a mission to promote lifestyle modification; it's time to shift the focus from sick care to health maintenance. My motivation is through fun and challenging yoga, weight lifting, nutrition, and research on complementary and alternative medicine. Find me on instagram: shanny_do Email me anything: [email protected]

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You Can't Do That When You're There

"Eating healthy will be impossible when you're a resident. Trust me, I ate well until residency started and then it was all cafeteria food and cookies from the nurse's station."

"Med students never sleep, just expect to deal with that. It's impossible to learn all the material without pulling all nighters on the regular."

"You are absolutely CRAZY for planning your wedding during med school."

"Good luck trying to exercise when you're in medical school, you won't have any time!"

"Good luck trying to exercise during residency, you won't have any time!"

"Say goodbye to friendships and relationships. You're married to medicine now."

"You're starting residency? Hope you know how to sleep walk."

All of the above quotes are real things that have been said to me over the years, and general themes of "warnings" given to people pursuing medicine. With each of these statements it added to my nerves about my upcoming endeavor. You're telling me that not only am I about to start something incredibly challenging for a number of reasons, I'll also lack the ability to enjoy life and take care of myself? While this advice could be heeded as somewhat useful in anticipating inevitable physical and mental hardships (no one should believe balancing career and personal health will be easy) but for the most part, it's all just not true.  I'm sure the same can be said for other jobs or the decision to have children-- there will always be people telling you that your own happiness/health will decline with irreparable circumstances. 

Reflecting back on the past seven (SEVEN?!) years of medical school and residency, I can honestly say that a commitment to a healthy amount of exercise has been the single most important self-care decision I have made.  It's kept me centered, helped me sleep better, and influenced other ways I approach self care.  Some weeks I move in a way that is intense and heart-pumping, while other weeks my approach to exercise is completely restorative and stunted in duration.  Thinking back to my tough weeks as the CCU senior in January, I was doing at-home yoga exclusively, with the majority of the time spent in deep stretches and breath work.  Other weeks when on a lighter schedule I enjoy lifting heavy weights and spending a whole hour in the gym for a workout. As summer emerges I can't help but soak up every ounce of sunshine during long walks outside with my husband.  The point is how and how much has been a fluid adjustment to my circumstances but never completely neglected.  

"The most important patient we have to take care of is the one in the mirror."  -- AMA President Robert Wah, M.D

Certainly sleep was less than optimal some weeks (read: Night Float) and I felt it. But I made it a priority to optimize sleep hygiene and can say that my sleep during residency was vastly better than undergrad days (why did I think it was ok to go out until 2 am, then wake up 4 hours later for rugby conditioning??) Same with nutrition-- during residency I have eaten in a way that best serves my body and healthier than any other period of my life because (you guessed it) it was a priority to me.  

When I look back on med school and residency, the only thing I wish had been tipped in one direction more frequently, was leaning in more to social engagements. It's all a balance of the time you're given in a day, and often sleep was such a great priority that I'd pick it over driving into the city.  I'd stay in my suburb to catch up on research rather than driving up for a Saturday in New York City with friends. That's not to say my social life hasn't been rich with amazing friendships and experiences, but rather carefully chosen to optimize other parts of self care. In hindsight I don't regret these decisions individually, but collectively I know what I'd like to change moving forward (read: more Philly SIPS!) 

That old advice (mostly from barely acquaintances or strangers) creeps up again as fellowship is right around the corner for me.  "First year of fellowship is just crazy, expect to be miserable!" "Yeah good luck doing all that yoga when you're getting hammer paged for consults." "You'll be sleeping less than intern year."  I get it, and appreciate hearing perspectives from others that are a reflection of their observations or experiences. The nerves about starting this next step in training are inevitable-- little bits of imposter syndrome reappear, concerned I won't live up to my own and others' expectations, nervousness mixed with the excitement of opportunity. On top of the concerns related to my work, I get nervous about how this change in training will influence the other parts of my personal world. But I fully believe that once again, the aspects of wellness and life outside work that are important to me, will be maintained.

  I'm writing this here for me AND for you, we can choose to do all the things that make our life feel whole. We can be flexible with the ebbs and flows of work and life so that they're no longer 2 separate entities but rather a constant flow of intention. Priorities happen because we make them happen, it's just knowing what they are. 

Because you CAN do that when you're there. Promise :-)

Love,

Shanny DO

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Why Mondays are the BEST Day

If you've ever read my instagram captions, the frequency at which I've pronounced my love for Mondays is probably nauseating at this point. But I really can't help it-- no matter how many people try to create rain clouds on a Monday morning with phrases like "Is it the weekend yet?" "If Monday had a face I would punch it," and other various hate-statements. If we would all be open minded and look around us, you might also join me in my sentiment that the day after Sunday is certainly the best.

When you walk into a space (work place, school, etc.) on a Monday morning, despite maybe less smiles, everyone certainly looks fresh.  Most people did laundry and are wearing one of their favorite shirts, everyone's hygiene is on point because it's the beginning of the week, the lives of others appear more organized and rested. I read somewhere (the source is probably completely invalid but whatever) that most people don't smile until 11:16AM on a Monday. HUH? That's blasphemy. To fix that, it's easy. Unintentionally, I walk into Mondays with handfuls of compliments. And I mean them. Either from noting the beautiful pictures someone posted on social media from whatever they did that weekend, to a congratulations for something because I hadn't seen them since last week, or a compliment on their freshness today. It's surprising to realize how the simplest positive comment can really change someone's day (it surely changes mine.)

  If you have to force yourself to have that kind of positive energy Monday morning, we can all take a token from Shailene Woodley, who's morning routine sounds something like this: 

" The second I wake up, I scream very loudly [sings to the tune of “Good Morning” from Singin’ in the Rain], 'Good morning! Good morning!' And then I scream out, 'Exciting day! Exciting day!' I feel like it completely sets the mood for the whole day." [source]

Another reason Mondays are the best? Productivity. Obviously this doesn't apply if you're in medicine or other profession that requires working weekends, but it's true for the staff and team members with weekday jobs.  When I sit down with care managers and social workers on a Monday, despite any attitude, they're the best at getting. sh*t. done. This likely has to do with the confidence of several more weekdays ahead.  And it's awesome! If you've ever tried to get any type of tedious task done on a Friday, you know it's pretty helpless. The ship has sailed for the day. Like calling in prior authorizations to insurance companies so a patient can get a medication approved. Um, no thank you. You're certain your request will get lost in the abyss of 2 business days before you can harass them again. BUT ON A MONDAY, the work place is your oyster for productivity! Or think about the high-risk patient getting admitted on a Friday evening for chest pain. They should probably at some point get a stress test. You know when that's going to happen? MONDAY.  So this poor patient has to sit in the hospital all weekend waiting for the most productive (and best) day to complete their medical workup.  I'm sure there are several other scenarios in careers outside of medicine, but I'm a one-trick pony and only know this field :-P

On Mondays, everything is open! Aside from national holidays and strange little independent stores, the rest of the world is at your service.  You realized you need to get something done over the weekend (dry cleaning, go to the DMV, schedule a doctor's appointment, etc) but you're infuriated because you can't. You can't even check it off your to-do list that it's at least scheduled! Atrocious, right? BUT, Monday to the rescue.  Sweet voices pick up their office phones letting you know they are back in business despite the short weekend hiatus.  Your clothes can now be cleaned. Your license renewed.  Your dentist appointment locked down.  What a joyous world it is!  See, during residency I never understand when people complain that their 1 day off is during the week. Huh? Do you have any life responsibilities? Have you ever experienced the sheer joy of walking into a DMV where there's no line? I have, and it's beautiful. 10/10 would recommend. 

Mondays are for new beginnings. It doesn't matter what happened last week. Today is a fresh start and the opportunity to make it a great week/month/year.  Mondays are so commonly the day for starting over or trying something new, and even if there's "failure" in that attempt, the motivated energy is contagious. For the simplest example, think about how crowded the gym is on a Monday compared to a Thursday. This is the day to encourage yourself and those around you to finally commit to whatever change you wished to make.  Of course, any other day of the week would be fine, too.. by why not make it a Monday??

The next time you feel like joining in the masses with Monday blues and complaints, remember that they're kind of awesome and should be celebrated. Cheers! Now go smile before 11:16 am and let's get that average pushed up. 

Sincerely,

Shanny DO

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The White Coat Police

A memory came to me today out of nowhere, and I immediately had to write down my honest thoughts regarding it. A while ago, a 3rd year medical student and I were speaking and rather nonchalantly the student says, "You know, back in the day when white coats were actually meant for doctors." I remember being taken aback by the comment and being the non-confrontational type (unless I really know my opinion on something) I let it go and said nothing. But indeed, I have a LOT to say in response to that comment. 

If you look back in the history of this symbolic piece of clothing, doctors began wearing them as a distinction from non-science based practitioners (read: quacks.) They purposefully started wearing what laboratory scientists wore: white coats.  It began also representing a symbol of cleanliness for physicians when hygiene largely became recognized as an essential part of medical care. As we've moved closer to the present, scientists and doctors have continued to wear them, as well as several other professions in the healthcare setting.  Pharmacists, nurse practitioners, physician assistants, physical therapists-- these individuals wear them as a representation in their professional involvement in patient care. ESPECIALLY for NPs and PAs who quite literally do the same job as doctors, wearing a white coat maybe should be expected in certain settings.

After this medical student's comment, I remember thinking of other similar attitudes I've overheard.  Doctors report that so many people wearing white coats is "confusing" for patients and the belief that there should be a very clear distinction based on how we dress.  Others believe that they worked hard for that white coat and it should represent all their years of slaving away, not to be diluted by professions that didn't go through similar training. I choose to respectfully and totally disagree with these thoughts.  

Firstly, if your patients are confused and don't know you are their doctor, you're doing something wrong. You're not sitting down and talking to them, explaining to them your role in their care.  Maybe you're not introducing yourself correctly. Either way, what other people wear should have no bearing on your physician-patient relationship.  Secondly, regardless of how many years a physician trained compared to other professions should have no bearing on the importance in patient care, and a white coat shouldn't be the sole thing representing all those years of hard work.  Your expertise and experience, problem-solving abilities, reliability, and bedside manner should speak for all those years, not what you're wearing.  A good physician (and a good PA, NP, pharmacist, etc) should be able to walk into a patient's room, communicate effectively and do their job well, regardless of their attire. 

If a doctor out there is so concerned about the respect that comes with a white coat, I encourage them to reevaluate why they are in this career. Respect is earned, not passed out at a white coat ceremony. If we all do our jobs well, with intellectual curiosity and compassion, it really won't matter how we're identified.

On another note- while I adore my white coat, it's.. kind of gross. I mean really, despite cleaning them regularly I can't compensate for the exposure considering I wear it into every patient's room. C. diff spores and MRSA abundance? Yep, let's be real. We're reaching an understanding that maybe white coats aren't necessary and may actually be a detriment.

So can we just leave them as a symbolic representation of everyone's hard work and stop worrying who "gets" to wear one? This is not Mean Girls. We can all sit together and wear whatever the F we want. 

Love Always, 

Shanny DO

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Happiness to me looks like: waking up from a post-night Float daytime coma to your dog and husband excited that you finally woke up at 6pm 😂• Time for shoe shopping and dinner with @thegweese, another catch-up sleep, and Sunday Whole Foods date with @emilynminer 🤗 allll before heading back into another round of nights! Happy Saturday my dears, home you're making your happiness ❤• (image from @gordonogden) #happiness #liveauthentic #wellness

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Woke up in the afternoon way earlier than my alarm (and you KNOW how I feel about sleep 😴) and tossed and turned, so frustrated I couldn't fall back asleep. Finally got up and trying to make the most of a little extra time-- but will definitely be paying for it at 3am when the pager keeps buzzing 😳 • Back to the basics- I used this book in 1st year of med school and still pull it out for a succinct review on EKGs, especially for rare stuff I don't see every day in my patients. ...But also looking at my @passionplanner just SO excited for Grand Canyon adventures in less than 2 weeks! Life is good. Even on nights, sleep deprived and isolated from society 😂 • (Also, blueberries topped with @califiafarms almond creamer.. and coconut oil coffee make any disgruntled wake up a little more tolerable.). Happy Thursday ❤❤❤ #read #learn #grow

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Relax. All will be well. Everything is figureoutable 😋❤ • I do this often, with small mistakes or uncomfortable interactions with someone. We have this tendency to blow everything out of proportion because we were in our own head. Take a step out, imagine being someone else reacting to the scenario.. and it's likely so minor that it's not even a problem at all. Just some Sunday evening perspective that I need as well 😘• 📸: @wellandgoodnyc #sundays #intentionalliving #relax

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A very important blog post about being an average pre-med ❤

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Feeling like a little kid coming home doing their homework 🤓 eating a snack before dinner 🍎 (that @traderjoeslist mixed but butter though..)• Today is all about completing the little tasks, the ones that nag you when you wake up because you keep putting them off.. and also for reading up and writing case reports. Sounds like a damn good Tuesday 💚 and yes, Harrison's is the holy grail for internal medicine, and I still read my hard copy! 📚• #readmore #goals #medicine

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You all know I believe that weight loss should never be the main goal, but rather a side effect of living well & healthy. Weight loss is the (sort of not really) easy part, but it's the maintenance with which most people struggle. Even with a well designed "maintenance intervention" as described here, with education on behavior modification, frequent phone calls, etc, not all these patients maintained there weight loss. Don't get discouraged. Maybe in your lifestyle intervention you gained muscle? Maybe your health has improved, even if your weight went back up! If you are living better every day, you will reap benefits regardless. It's clear in this study that even with the best resources of behavior modification and frequent check-ins, maintenance of weight loss is HARD. It's not just you and you shouldn't get discouraged. Focus on the bigger picture of the great life improvements you've made through lifestyle intervention. ❤• Think I might make "preventive medicine literature highlight" a routine weekly thing on here, anybody interested?? I can post pretty yoga pictures, and food ideas.. and white coat posts, but there's inspiration there without much education. That was my original intent when I started using social media. Hope you'll continue to enjoy and learn from these posts as well. Happy Tuesday!! 🤓💙• Cc: @fitmedchick, the queen of preventive medicine!!• #education #preventivemedicine #choosehealthy

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By popular request, hope you enjoy going through a typical day while on elective ❤

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Good morning darlings ☀️ This is Part One of #dayoff and it's going to epic. To be honest, my empathy is waning on this rotation for all the typical reasons that residency fatigue happens: long hours, change in sleep cycle, high acuity, emotional patient/family encounters, deaths, etc. The intensity of residency training is alarming sometimes, and I hope just by sharing that even someone like me who optimizes self-care and wellbeing can feel this way, it helps a person out there feel less alone. • When you do get that day off-- optimize. Do EXACTLY what you feel like (nothing more, nothing less.) For me this includes exercise, coffee, being outside, and just a little academic reading because I genuinely enjoy it, not because I have to. Remember that self care is not a luxury but a requirement in order to do your job well. Love you all. Share with me what your ideal day off routine is!! So fun 😍❤• #selfcare #coffee #choosejoy (at Saxbys Coffee)

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I know it seems like such a small problem (ok, so our kids drink soda! Who cares!) but this may just be the root of our devastating chronic disease burden. I'm still convinced we can and WILL do better with persistent education and readily available options. Just a few conversations with kids and their parents could make a tremendous difference for our overall health as a nation ❤🏥 • (Figure is from NHANES briefing presented on CDS's website>)• #kidshealth #pediatrics #sweetenough

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You already know- it's my priority in promoting good sleep hygiene before ANY other lifestyle interventions (why change your diet & start exercising if you'll be perpetually exhausted?) Sooo when I'm all sleep-deprived from this erratic schedule, I feel like a fraud 😋 No really- this week of nights was rough on my sleep hygiene and I'm definitely feeling it.. and can't believe I'll be transitioning back to days tomorrow 🏥😴 There will be times when life/career/family get in the way of your health, but we have to constantly remember that self-care is essential if we want to be our best for each of these priorities. • Adequate sleep is not optional -- it's required for good heart health, mental health, stress levels, weight maintenance, reduced risk of accidents (and the list goes on.) Until you can honestly say you feel well rested, other health changes are a lower priority. • {check out an older blog post I did on sleep for help with sleep hygiene-- link in bio!} & Happy Friday everyone, may you be well rested and relaxed 😘❤ #sleepmore #tgif #shuteye

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Sunday morning playing catch up for the week's lifestyle medicine research, and this one's for my weekend warriors 🤓🤓🤓• "During some 9 years' follow-up, 8800 participants died, including 2800 from cardiovascular disease (CVD) and 2500 from cancer. Compared with inactive adults, insufficiently active adults and weekend warriors had significant risk reductions in all-cause mortality (about 30%) and CVD mortality (about 40%); regularly active adults had slightly greater risk reductions. Reductions in cancer mortality ranged from 14% for insufficiently active adults to 21% for regularly active adults."• You don't have to be an athlete to reap the benefits of exercise. Move more every damn day. Your body and soul and family will thank you ❤• #evidencebased #medicine #exercise

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If it's sunny.. we out here! ☀️🌤• Resident wellness at it's finest-- so simple, just 20 minutes of yoga because the sun agreed with us and we're feeling rejuvenated 🏥 Change starts with the simple agreement to try 🙏🏻 Can't wait for the next impromptu session!• #yoga #wellness #weouthere (at Einstein Medical Center)

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