Tools for Self-Care to Prevent Burnout

Every person, especially healthcare providers, can go through burnout. Dr. Carrie goes through some practical wellbeing tips and tools that helps her deal with stress and prevent burnout.

2:15 - What is the definition of well-being, and what does Dr. Carrie do for well-being?
8:00 - What's Dr. Carrie's calling for doing Medicine?
10:15 - What is functional medicine vs. integrative medicine.
13:00 - How does burnout happen? How do you prevent burnout.
16:00 - Adrenal Fatigue and NeuroEndoMetabolic Stress Response
24:50 - How to deal with Stress - set up boundaries, learn how to say no, breathe
27:25 - Love Rounds
32:08 - Adrenal Fatigue Causes and Testing

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Transcript

Tad Worku: 0:05

I want to introduce you guys to tonight's guest. And I saw you on here, Dr. Lam. I want to start by reading your bio, just to kind of go there, and then we're going to personalize it a little bit. Dr. Lam graduated with a Bachelor of Science in fine arts from Pacific Union College. That's where we met and earned her Doctorate of Medicine degree at Loma Linda. She's board certified in family medicine, and anti aging and regenerative medicine. She has completed her fellowship in anti aging, metabolic and functional medicine and is a graduate of the Institute of functional medicines, applying Functional Medicine and clinical practice course. Her career focus is in primary care, along with functional and integrative medicine, with emphasis on anti aging, lifestyle, medicine and nutrition. She won a Medical Scholarship Award for preventative medicine and is an author of the international best selling books, advanced symptoms of adrenal fatigue syndrome, metabolic approach, and adrenal fatigue syndrome cookbook. She also co founded the land clinic and is the medical director there, and has a wealth of knowledge, but overall, is just a really cool person guys, down to earth, great friend, and just incredibly knowledgeable and willing to kind of share that knowledge. And so that's why I asked you to be a guest tonight. Because, you know, the accessibility to information, I think is what changes things. And so, thank you for being willing to join us tonight and well being Wednesday. Thanks Ted for having me. Absolutely. Before we get into tonight's topic, being that this is well being Wednesday, I want to personalize it a little bit. So what is something that you do to promote your well being?

Dr. Carrie Lam, MD: 2:22

Yeah, so I think I'm really big into wellbeing. So yes, thanks for the intro. I think what really constitutes well being is t mindset, right. I think positivity and looking and being fulfilled in what you do, will also contribute to your well being, like, Do you love what you do? Or do you kind of go to work and you're like, oh, I have to go to work because I have to go to work. So that mindset of, it's not I get to go to work, but I want to, or not, I have to go to work, but I get to go to work, you know. So as for my well being practice, I had quite a few. But I think Sabbath rest, I think is one of the biggest things I can advocate for. I think going through college, going through medical school and residency, I never once studied on Sabbath, the Sabbath day. I think I always set that aside, not only for my upbringing, but just for my sanity, you know, that my brain needs that rest. And so the rest from work also is very important into that God set aside. So I feel like that's very important. For my well being, or else I would go crazy. And I think in medical school, we also have these, what we call golden weekends, which is after finals week, you get two whole days off, you know, compared to just one day. And that was so much what we call it is like you work hard, but you play harder, you know, so something to look forward to. I think that's very important. The other thing that I actually did a lot of is sleep, you would think that, you know, oh, I have so much to do, I should study more, or I need to catch up on everything. I'm gonna sacrifice my sleep but no. If I got less than six hours of sleep, I would just get sick. So I slept at least eight hours. Yes, every night, you know, for my own health, but I think also because your brain needs that sleep to be able to process everything and package it into your memory. And, the healing also comes in the sleep. So unlike so many people who rely on caffeine, because they don't sleep very well, I actually like r rarely drink coffee even, you know through my medical school days, and even now I rarely drink coffee. That's not to say that I don't believe in coffee or things like that. But usually coffee is used as a crutch because you are tired. So how do you prevent yourself from being tired is by, you know, making sure you get enough good sleep, to begin with. Definitely Eating healthy is part of the well being, I think a lot of people know that. Half your plate should be vegetables at every meal. So that's just a general thing that I would say, Setting aside time to do what you love what I love to do, I love to do, I love to hang out with friends and family, church, family and community and I love to do art. And then purpose and fulfillment, I talked about this in the beginning, but finding what fulfills you and what you do daily. For me, maybe it will be helping to heal patients by not only in a physical way, but spiritually too. So that's how I find fulfillment in what I do.

Tad Worku: 6:10

Huge. And I think it's worth noting, right? Sometimes the idea is it's easy to say until you're really busy. Right? So it's so easy to say, Okay, so let's set time aside for this or set time aside for sleep or set time aside for a whole day where you're not going to do anything. And the excuses, well, I'm probably busier than you are, right. But it's very interesting that, you know, with everything that you've gone through, that's busy, right, like starting medical school, residency, you know, all of the things it takes, that is extremely busy. And I think as you enter into these spaces of higher productivity, the rules are more important. I don't think you can function at the highest areas without truly paying attention to those rules, because the burnout will be that much worse. And so I do think it's powerful, just to mention, that it's somebody, it's coming from someone that has been through the busyness and it's not a sacrifice of how much you need to get done. It's actually how you get that stuff done.

Dr. Carrie Lam, MD: 7:36

Right? Yeah, if you make it a priority, you're not going to feel like you're missing out, you know. It actually just relieves you. You have those rules set.

Tad Worku: 7:46

Yeah, that's awesome. So we talked a lot about purpose being a foundation of well being in well being Wednesdays. And so I wanted to ask, just kind of start with a purpose story. You know, I think a lot of people, we've talked about it as students, but a lot of people felt a calling or a family member or something that led them into healthcare or the wanting to serve people. And so being that you currently are the director of your own clinic and started the LAM clinic. Is there a story behind how you ended up in that current role? Or how you ended up in medicine in the first place?

Dr. Carrie Lam, MD: 8:30

Yeah, definitely. I'm one of those people that say I've always wanted to be a doctor, you know, ever since I was young, and it stemmed from my father. He was also a medical doctor who went to Loma Linda. But he ended up actually coming out and doing integrative medicine. He's been doing nutritional coaching, basically, for the past 20 years, all over the telephone, and decided to go the natural route. So even though we've been trained conventionally, with the medical school, and to be an MD and be able to use medications, we decided that our philosophy on health is to get to the root cause. And so seeing him practice and help a lot of different types of people. The people that he's seen is usually people that have gone to seven eight doctors, have not gone to in their answers, really jaded by the medical system and are really desperate for health help, whether it's alternative help or any type of help. And so, having seen him help people, I obviously wanted to come out and you can say, help these people but not only conventionally, but in a whole person type of way. And so just knowing that I went through medical school and residency, knowing that I wanted to come out and have my own clinic to be able to help these type of people, because I could see that in conventional medicine, it's not really possible to do that type of medicine yet. Okay. But hopefully in the future we will be able to. And so if you don't know what functional medicine is, I can just give a quick rundown. So functional medicine is to get to the root cause of why symptoms happen. Medicine, as we know it, now, a lot of times is covering up symptoms, for example, someone has diabetes, and we give them Metformin or pills or insulin to lower their blood sugars. But do we stop to think about why their sugars are high in the first place? Do we take the time to counsel our patients on diet on lifestyle changes, on exercise, which could be what is causing their diabetes in the first place? Correct. And a lot of times this, we go see to a doctor, oh, you have higher sugars, you need to take this pill in order to lower your sugar. And that's more like sweeping the dust under the carpet. So with functional medicine, we try to, you know, get to the root cause what is actually causing the diabetes or any chronic disease? Integrative Medicine is the toolbox, I like to say. You have regular medications are definitely good, like you go to the hospital, because acute care is great. And surgery is great for keeping people alive. But then what about chronic diseases, there are a lot of variety of options that are open to people and to patients, not only medications. There's nutrition, there's natural, there's alternative, there's Eastern, there's Western, there's a lot of different therapies. And so integrative medicine is the toolbox for all of that. Because each patient should be personalized in their treatment and not algorithmized. So I'm really, you know, passionate about ,that when patients come to see you and they have issues, they are a person, and they are not a disease, right. Figuring out what their root cause and how to help each individual person where they're at is, is very important. And then there's also preventive medicine. So we want to focus on health care, it's called health care, it's not called sick care, right, we hear that a lot. And then nowadays, we're doing sick care, because everyone is sick, by the time they come in, they see the doctor or they see the nurses. And so what we should be doing is trying to get people healthy before they're even symptomatic, before they see the doctor, before they get to the hospital. And so at our clinic, we do a lot of elite workups, we really want to make sure that they are healthy, long term. And they age gracefully, you can say that. So it's quality of life. But I also know that burnout is very, very real. And I would say in residency was probably the hardest time for me for finding my meaning in being a doctor or in seeing patients. And a lot of times I would say it's not the person. It's more the system that we're in, right? We are just thrown in and you're expected to meet numbers, you're expected to see these amount of patients and do what the hospital tells you or do what the clinic tells you. And you say like Yes, sir. And you just do it, you know. And so that part of wanting to help people we can lose sight of, very easily. And I can say that if we want to help people, we have to first help ourselves. So when you go on an airplane, they tell you put your mask on first before putting it on your child because if you're not doing well, you won't be able to help them. Same thing as a healthcare provider, you want to make sure that you are personally well, or else you won't be able to take care of the people that you're taking care of. Does that make sense?

Tad Worku: 14:09

Yeah, and that's powerful. And I think, honestly, that's the basis of wellbeing Wednesday, if you're gonna step into the field, and a system that might not be fully ready to promote well being and I think unfortunately, we've seen that over the last several years. It's a tough system to be in and, and it's there for a purpose, but when, when out of whack it can create its own issues. And I think it's, you know, someone put in the chat inspirational. It is inspirational because, you know, as a nursing model, it's like Whole Person Care, seeing a person as a whole. And we hear that a lot and then sometimes we see something that's a little bit different, which can also contribute to a little bit of burnout or compassion fatigue, which is, hey, I came into this profession to help people. And I don't know if I'm really helping people. At the same time, I feel like my health is worse than when I started. So, I think it's inspirational to hear, you know, and hopefully that the, system of, of healthcare with, you know, funding models and changes in structures of how you pay for health, healthcare, promotes more of that preventative model and more of the whole person then just patchwork. So that's super inspiring. So I want to get into, okay, so that's kind of the macro view of, what you're doing and the philosophy or philosophy behind, you know, medical care and preventative care and, functional integrative medicine. And I wanted to focus on what I would add, maybe it's an assumption, I'll let you correct me if it is. But Adrenal Fatigue Syndrome is one of your, clinics expertise. You guys have written internationally acclaimed material books on that subject. And it's really connected to the concept of stress and adrenal fatigue syndrome. And so I wanted to spend kind of a little bit of time connecting those two topics, and really, you know, getting into your expertise in this because, everybody on in this, in this room, or on this call on this virtual room, is going to be in a constant, stressful environment, right? Healthcare is a constant stressor, each student probably feels like they're under an immense amount of stress already just, with school and studying for exams and not having enough time for anything. And so stress is this inevitable part of life, but probably more heightened in this group and a group of healthcare workers than anything else? And so, like, just to build a foundation of this, what is adrenal fatigue? And then Part B of that question would be, what's the relationship between stress and adrenal fatigue?

Dr. Carrie Lam, MD: 17:27

Yeah, great questions. So stress, we know, affects our whole body a lot. I will start off by saying that Adrenal Fatigue is not a medical diagnosis, meaning it's not recognized by the majority of the medical community. But if you go into the integrative and functional world, everyone knows what Adrenal Fatigue is. So what does it sound like? your adrenals are tired, right? So what happens when your body undergoes stress? The stress response? We know now, primarily, most people know about the HPA axis, we call it the hypothalamus, pituitary gland and the adrenal gland. So well, let's say you see a tiger, what your brain does the hypothalamus produces is corticotropin releasing hormone to tell the pituitary gland to produce adrenal cortical tropic hormone ACTH, which tells your adrenals okay, you need to put out epinephrine and norepinephrine. If this is like an acute stress. Epinephrine and norepinephrine, as you know, is there to really ramp you up. It's adrenaline. And so you're there to run away from that tiger. So it compresses all your blood vessels, it gets your heart pumping really quickly. And that's stress response. And then your body over time says, well, I don't need this long term. Because imagine if your heart was pumping all the time really fast that would not be good for your health. So your adrenals release cortisol. Cortisol is there as an anti-inflammatory hormone in order to reduce that stressful response that epinephrine can produce over time. If you think what is cortisol, it's basically steroids and steroids are anti inflammatory, right? So like, you think, oOh, someone has asthma, I give them steroids to reduce inflammation. That's what cortisol is in your body, the steroid to help reduce inflammation that stress causes. And so over time, let's say it's not just you see, tiger, but your boss is yelling at you, and not only one time, but every day, or you're studying for tests. And it's not just one time it's every day. So the stress tends to just accumulate, even perceived stress accumulate in your body to release more and more cortisol. And over time, we call it adrenal fatigue, because we've seen in saliva tests that the cortisol actually drops your output. Your adrenals output of cortisol just gets tired over time, and doesn't want to produce cortisol. Kind of like how in diabetes, your pancreas doesn't want to produce insulin anymore. And so what are the collection of symptoms in the name fatigue, right? Adrenal Fatigue, you can feel really tired, chronically, you can have hormone imbalances, whether it's in women like PMS, or you can have heart palpitations, if it's affecting your cardionomic system, you can have weight gain, or weight loss, if it's even worse. You can have a lot of gut issues. So a lot of these symptoms can be very vague. But that's where I come in to this neuroendometabolic stress response. Now, I know that, you know, stress does not only affect your adrenals, but it affects your whole body. When you take that test, when you're about to ask that girl out, you get butterflies in your stomach, right? So stress also affects your gut, because cortisol can make your gut a little knotted up, okay. So I like to see that stress is broken down. It affects both the neuro the endocrine, which is the neuro is the brain and the nervous system. Endocrine is hormones. And it also affects your metabolic side, which is your energetic, your detoxification, and also your inflammation circuit. So I've actually come up with this model of six different circuits that stress affects,and depending how stress affects your body, it can actually affect the different parts, and you can have different types of symptoms that come out. And so the question is, yes, stress does affect the human body, and it affects so many different types of ways, right? And how do we help it And, and that will be a lot of different things. And so Adrenal Fatigue is not a medical diagnosis. But, chronic fatigue can be a medical diagnosis. Chronic fatigue basically means that you've had fatigue for more than six months, that's how you can diagnose chronic fatigue. And if you've had like lightheadedness, when you bend down and come up too quickly, or if you have decreased exercise tolerance. I see a lot of patients with adrenal fatigue, they can have brain fog, they can have sugar changes, meaning after you eat, you get hungry again, really quickly. You can have low libido, you know, mood changes, gut changes. And so if you do, you know, you definitely want to be cognizant of it. In the beginning, it might just be one cup of coffee, you're like, I'm tired, I wake up tired, I'm gonna drink coffee. And then over time, you're like, okay, one cup is not enough, I need two cups, I need three cups, or I started having palpitations, or I start being really tired despite drinking the coffee. Then you kind of have to dig a little deeper, if there's something underlying all of these things. Stress is a big one. That makes sense?

Tad Worku: 23:39

Absolutely. And so here's, here's my follow up question to that. You know, we're all going to be in a stressful environment. So everybody's going to operate within this stressful environment. And I think that's one of the reasons why, like you talked about at the very beginning. Balance being such an important thing. Sleep being such an important thing, a day off being such an important thing. And one of the things I always say is don't do extra shifts ever, like never. For extra money, make your out a side hustle that is not in the hospital. But I truly believe that. But for a group of people that are going to be for the majority of their careers, you know, potentially sleep deprived and on night shift or potentially in these stressful environments. Is it doomed to the negative impact of stress? Or is there a protective mechanism against the negative health impacts of stress for this adrenal fatigue?

Dr. Carrie Lam, MD: 24:50

Yeah, you definitely want to tackle the root cause, right, but there are ways of dealing with stress. Like you said, not signing up for extra shifts or learning how to set up your boundaries. A lot of times we are such go getters, we can't say no, I know that's me. But people with adrenal fatigue are usually type A personalities They're successful, because they burn themselves out, you know, always saying yes, always people pleasing. So there are tools like learning how to say no. For me, it's my husband, he really helps me basically say, no, you can't do or so maybe that's an accountability person for you. Or one tool that I use is like, oh, I'm sorry, I already have something on my calendar. And it's the word something so I'm not lying, because there's only something on my calendar. So learning to satisfy your time and your boundaries, hey, is this a priority? Do I need to do this now, is part of the stress management. As you go into the hospital and as you see patients and as we become very busy, it is going to be stressful, right? But what are some of the tools that you can take with you, even when you are busy and stressed. So one, stress response is breathing exercises. As we know the HPA axis is more of a sympathetic response, sympathetic, meaning fight or flight. Okay? And then how do we help the parasympathetic out with the rest and digest? The best way is breathing exercises and what kind of breathing you got to be careful because even deep breathing can stimulate someone, I've seen that. So it's more of a calm 70% of a breath, abdominal breathing, where you actually get the abdomen out, you're bringing the diaphragm down, because that's where your vagal nerve lies very close to your diaphragm. So when you're moving that you're focusing on your breath, you're meditating or having some mindfulness even in between patients. That's one way that you can kind of clear and set your purpose and your intention and also bring your parasympathetic nervous system up. So you're not always in that overdrive, that HPA Axis overdrive. Another tip that I really enjoyed, or you can say was helpful when I was in residency was love rounds. Have you guys talked about love rounds before? It was started by Dr. Will Alexander and, Dr. Harvey Elder. And so love round is where you would pick one patient a week, to set aside maybe 30 minutes, or an hour of your time to just sit down and talk to them, as a person, get to know them, see who they are, and what brings them joy, or what are they famous for. And so us as a family medicine residency team with pick one inpatient person to actually go and talk to you for 30 minutes. You can imagine we're so busy all day, but we literally set aside, it'd be like, one hour of our time, basically. We have one person go sit by their bedside, and we talked to them. And Dr. Will Alexander always loves to open with what are you famous for? Right? And the patient's like, Well, what do you mean, I'm here in the hospital? And but no, we want to get to know you, we'd say, hey, we're here to just talk to you and, and love you as a person. And it not only brings so much meaning to patients, but also to the team to know that the person that you're treating has a family, has a dog at home that they're missing or something, you know, or five cats and, they are very proud of what they've done or their 60 year marriage or something because then they just light up. They're a whole different person. t They're not just a patient in a hospital gown in the hospital for an acute reason. So that really changed my daily flow, in that I would be looking hey, is there a patient that I can directly impact every day or every week? Because in day to day in the flow of things, we get busy. We tend not to think of them as patients anymore. We just say okay, all this patient is here for. So it was very good to ground me. And if you, as nursing students, you have time, so don't say you don't have time, okay? So everyone can make time, find that one person, that one patient that you can impact that you can just sit down and talk to. And you'll be surprised how much meaning you can bring. Not only to them, but to yourself. The way we also did it, we offered prayer at the end, we would ask them if they would be willing to and 99% of the time, they would say yes, you know, and really appreciate it. So I became comfortable with praying with patients just from doing love rounds. I thought that was like, one of the best trainings that I got, because I don't think you will get that anywhere else, but in Loma Linda. So I'm very grateful to them all.

Tad Worku: 31:05

That's incredible. You know, I knew about will Alexander, but I don't think I had heard of it as the love rounds. But in the emergency department, that's the one thing that kept me from getting jaded. I was sitting down whenever I could and asking people, their stories, and it brings a thread of humanity into a place where there's a lack of it, a lot of times. It reminds you of your own humanity. So it's very interesting. That's, amazing advice. Those three things are huge. So, let's go through the chat. You have a lot of people thinking they have adrenal fatigue syndrome. And then I want to go back to the first one. Could not wanting to socialize or leave the house if remote working be a symptom of adrenal fatigue as well?

Dr. Carrie Lam, MD: 32:06

Well, so I would say many people deal with Adrenal Fatigue just depends on the stages, of where you are, because there's four different stages In the beginning, yes, you could have the wanting to stay home not wanting to leave house, it's more that might be just a mood issue, okay. But it's always good to get down to the underlying cause. Because I always look at, you know, whether it's depression or anxiety or any neural issues, I feel like those are symptoms. Okay, I'm depressed, how's the depression and actual diagnosis, when it's actually a symptom of something underlying. Whether it's, you know, serotonin imbalance or a gut imbalance, or maybe your hormones are off. I always try to see what the root cause of those mood issues would be. Okay. And then, basically, adrenal fatigue, like I said, it's more symptomatic diagnosis, but there is testing to be done if you're interested. They're not usually covered by insurance. It's a saliva test. And so the saliva cortisol test, is what I would usually do for just getting a baseline look at how your adrenal function is. Because it tests your saliva four times throughout the day. So when you wake up, at noon, at 6pm, and at night time, because you kind of want to see the whole curve on how your adrenals are producing cortisol, not just a one time blood in the morning. In conventional world, a lot of times they see the cortisol, it's either gonna be super high or super low, and you only have two adrenal diagnoses, which is the Cushing's or Addison's and there's nothing in between. And that's where adrenal fatigue kind of falls under. It's that in between that stress affects, so it's not only just the extremes. So what I do, yes, we see a lot of people that are on the outskirts of the bell curve. We're not just the 95%. But we do see people like that at Lam clinic. I Yeah. Todd was talking about how we can change the system, right? Because it's the system sometimes that we get burned out in. And so that's why I chose to open my own clinic. Lam Clinic we're located in Tustin, Orange County, so not too far. And II decided to open my clinic to be able to change the future of medicine right. I decided as a functional medicine provider not only to take cash patients, but to take insurance patients, because I want to be able to provide a model where functional medicine, integrative medicine can be for every, every clinic out there or every hospital out there, in that we should be focusing on prevention, and how do we change the whole system is by really producing this model and keeping patients healthy. And, yeah, if you're interested, you know, look us up, and you can always, you know, contact me. You can give them my contact if you want, and come out to our clinic, if you want to be patient, or if you want to learn. I think, yes, education is key, so read as much as you can, as healthcare provider and, you know, take care of yourselves. I think that's very, very key to that's what we're all here to do.

Tad Worku: 35:47

Thank you so much. I have to think about the amount that can change if you put these things into practice before you're burned out. There's such a difference in, you know, everybody sits in that classroom the first day, and you're only inspired, right? You're like, I can't wait to go help people. I can't wait to go change people. And then everybody works with that one healthcare provider that's like, how did they turn into that? And most likely, they were one of the people that was sitting in the classroom inspired on day one. So I think, it's so important to protect it, and understand that there's a science behind. If you burn, if you don't take care of yourself, if you don't rest, if you don't sleep, if you don't do that, and you just, go, go, go, there's a science behind what will happen. It's not random, it's not haphazard, there's a systematic way that your body will respond. And I think with everybody being in healthcare and wanting to help people, you know, you're patient zero. So really putting these tools into place for yourself will allow you to take care exponentially more people than you would if you just got burned out. So thank you for the information. Thank you for dropping knowledge and just truly changing medicine and changing the world. It's a privilege to call you a friend so thanks for being a part of it.

Dr. Carrie Lam, MD: 37:27

Thank you for having me. I wish everybody a blessed night

Unknown: 37:39

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