Category Archives: Prevention

Why I Became A Family Doctor

I am a family medicine doctor – but that is only a small part of who I am. Father, husband, photographer, social media guru, writer, singer — these are only a few of the many ways I define myself. But when I am on my deathbed, hopefully many decades from now, and looking back on my life, what will I list as my top accomplishments? What will resonate deep in my heart that I’ve lived a full life? Would it be my career? Actually, yes, this would be partly true. Of course my most satisfying moments will be a legacy of family and children, and I’m happily on that path. I am sure that I won’t find any more joy than surrounding myself with my wife, children and future generations. But regarding a career, I am extremely fortunate that I truly love my job and derive deep satisfaction from my 9-to-5 career. Very few people can say that about their job. Can you? And if you can’t say that, then perhaps you should do what I did – change your career path. It’s never too late.

Becoming a family medicine doctor was a second career for me, a life-changing decision that I made far after my undergraduate years at Columbia University. I never grew up thinking about becoming a doctor. My wonderful parents were very American in their approach to raising their four children – very hands off, letting us all figure out our career paths on our own, no matter how late we were in deciding. I almost wish my parents did have a bit more Chinese “tiger mom” strict parenting style and had guided me with a firmer hand while growing up. But now that’s neither here nor there, and I consider myself a much more well rounded person by becoming a doctor later in life.

Alex at my clinic

My desire to have a career helping people started during my high school days with two pivotal events. The first was my two year stint in Peer Ministry, where I and other students hosted weekend or overnight events and meetings with other teens, from schools across our state of Massachusetts. Our mission was mostly to help other teens cope with typical teenager struggles: parents, relationships, self esteem and the like. During these wonderfully open sessions, I blossomed into a self confident young man, finding deep satisfaction in helping others with their problems.

My second pivotal event occurred during my sophomore year of high school, during a student trip to the poor towns of West Virginia state, filled with old, abandoned coal mines. We helped rebuild homes and also assisted in teaching Bible school to a group of seven year old kids. They were too young to really understand Bible stories, but I had loads of fun dressing up as a cow and crawling around the gymnasium floor, with two dozen adorable kids happily crawling behind me, mooing and ringing their bells. I felt a deep emotional satisfaction bringing joy to those kids, and even right now I can still remember that feeling I had during that all too short week.  A child is a miracle of hope and happiness!

Ever since those two pivotal events in my life, I had tried to find a career that could recreate that deep emotional satisfaction from helping others. In high school I enjoyed and excelled at math and science and was considering becoming an engineer (not a doctor). I also was thinking that if I became skilled at these sciences, I could later become a professor and teach others. So I was thrilled that I got into Columbia University’s College of Engineering, and off I went to New York City. annual tailored health check New York City was an intense new world for me, but I definitely felt like a “country mouse in the city,” overwhelmed by the city’s intensity. It took me a while to find my groove, and I soon realized that my Columbia College friends were having a lot more fun than I was in Engineering. My liberal arts friends filled their days reading classic books, taking in the theatre, and discussing politics. How much more exciting for me! I decided to switch from the Engineering College to the Liberal Arts College, eventually graduating with a Bachelor of Arts in English. I especially loved my senior year, sitting on the great lawn in Central Park and reading Plato and Hunter Thompson in the glorious spring sunlight. It was there at Columbia that I honed my writing skills, mostly focusing on creative writing and drama. I especially loved my senior year when I wrote and acted with a hilarious and talented group of students for a comedy TV show. We called it “The Velveeta Players” because it was so cheesy! (Velveeta is a famous American brand of processed cheese).

I graduated from Columbia with an English degree and great enthusiasm for my future, but I still wasn’t sure which career path was best for me. I still loved the idea of teaching, but I didn’t feel like a master in any subject enough to teach. I loved to write and edit, but even a Columbia grad needed to start entry level in a publishing house, slowly climbing the career ladder. I moved back home, looking for editorial work in Boston, when my identical twin brother volunteered for a sleep research study at Harvard University School of Medicine, spending 35 days and nights there. He made quite a bit of money doing this, and the doctors were thrilled at the chance to perform sleep deprivation tests on identical twins. So I also volunteered, and we both spent 11 days and nights inside their lab, in separate rooms, completely isolated from all time cues from the outside world, with no windows, TV or radio (this was pre-internet). I was literally poked and prodded every couple hours, constantly monitored with machines and blood tests, saliva samples, video cameras, memory tests and mood scales. Every night they glued a dozen electrodes to my scalp and monitored my brain waves. I found out later that they had us on a 22 hour day, thus cutting away 2 hours a day from normal life and flipping our sleep cycles completely in a week. At the end, to reset us back to normal, they kept us upright in a bed, forcing us to stay awake for around 50 hours using any means possible; we played a lot of cards and sang silly songs. It was all quite surreal and strange and fascinating, and it was my first true foray into medicine. All the lab workers were medical students or doctors, and they loved their work and the science. I was hooked on medicine for the first time! But I still wasn’t ready to become a doctor. It took another year or so, after moving to wonderful San Francisco and still struggling to find a decent editing job, that I again found myself in the medical world. This time I was an editor and desktop publisher for a private medical company deep in the foggy cliffs of the Veterans Administration (VA) Hospital. Again I was surrounded by doctors and medical students doing fascinating research, loving their work, and getting paid well for it. And finally it clicked: I should become a doctor! Medicine was — and still is — the perfect mixture of my skills and desires: I could help people every day, in truly life-changing ways. And as a family doctor, I would never get bored, even forty years later, as every patient would be a new dilemma, with a new story.

I went back to school part time and aced my premedical classes, volunteering at Shriner’s Hospital for Children and other places to get more experience. I vividly remember my first real test: watching a person get open heart surgery. I’ll never forget the surreal sound of a saw cutting open his rib cage, or the smell of his burning flesh from a cautery gun stopping small bleeding, or looking down into his open chest, watching his heart beating. Many people would just pass out at that moment — but I thought, “wow, this is really cool!” Richard Saint Cyr portrait I eventually took the grueling and exhausting MCAT exam and soon got accepted into Saint Louis University’s School of Medicine. I had finally found my calling – and I remain thankful that I pursued this dream. In my life choices, my number one most important decision was asking Joanna to marry me; my second most important was deciding to become a doctor.

Many people ask me why I decided to become a family doctor and not specialize in something like cardiology or neurosurgery. I especially got this question while living in China because almost all doctors specialize there, and there really isn’t even a developed program for primary care doctors in China. Most Chinese people don’t realize that family medicine actually is a specialty, complete with extra training and our own medical exam and certification.

The classic American view of a doctor is of a small town doctor who the community knows and loves dearly, who has delivered generations of babies over their 40 years of practice. A good family doctor is deeply involved in their community’s health, their schools, their public safety. I always loved that classic American image of a doctor, and that’s what I strive for each day in my practice. I see people of all ages, from newborns to the elderly, and I follow them for years. It’s a deeply satisfying career, a true honor to deeply understand a patients’ health and history, and to do all I can to keep them thriving and healthy.

 

(this is an excerpt from my book translated into Chinese. I moved back to the USA last summer and now work at Swedish Bainbridge Island Primary Care Clinic in Washington state.) 

From Beijing to the Boonies: Moving Right Along

I am leaving Beijing.

After ten gloriously exhausting years in China, I, my wife and my two boys are saying goodbye to China — and hello again to the USA, for new adventures in a rural town in the Seattle area, surrounded by blueberry farms, pine forests, wrap-around water views, white-capped mountain ranges — and crystal clear skies, when it’s not raining.

There. I’ve finally announced it. What a relief. I’ve been staring at my blog’s word processor for weeks, trying to write an all-encompassing opus, an uber-elegy to my roller-coaster years here, trying to capture what it all has meant to me. But I threw away all of my early edits. Sometimes they were too preachy, too treacly, or worst of all: boring. So I decided to lower my ambitions here and just put out something — anything, really — mostly because my time here is quickly running out, and I wanted to give my Beijing patients a few weeks to say goodbye to me here in the clinic, as my last day is now less than a month away (the end of July).

So here’s my main point: I wanted to give thanks and express gratitude to all of my Beijing patients over the past ten years. If I don’t see you again this month, it’s been a true pleasure and an honor taking care of you and your families, hearing your stories and sharing my own. I hope I’ve made your lives here in China a bit more healthy and rewarding. And to the millions of readers of this blog and my other publications, I’ve been thrilled and deeply satisfied to share my advice with so many people, especially people across China with my Chinese translations and book.

I suppose I could, or should, go into details about why we’re leaving China after ten years. But in general, it’s a very personal decision we’ve made and we’re very happy about the change — but also appreciative of the many opportunities and benefits we’ve had here. Of course if I wanted, I could regurgitate a boilerplate expat-leaving-China catharsis, but I think that genre is a bit tiresome. And besides, I’ve made it very clear in my 600+ blog articles what I’ve struggled with here, and also how I’ve thrived despite the obvious handicaps of living in Beijing. The final tally, for me, is very much a net positive.

So as I wrap things up here, and clearly end this blog in its current form, I am filled with many emotions, most of them positive, which is where I prefer to stay. I’d like share a quote, from a speech I gave two years ago at the opening ceremony for the International School of Beijing’s pollution-free sports dome:

…On a final note, please don’t ever forget just how lucky you are, to be able to go to a school like ISB. What if you were born in China during the Cultural Revolution, with no schools anywhere for 10 years? Your career dreams never would have come true. Or what if you were born just across the street here in the village, and your public school still lets you play outside on bad pollution days?

All of us — adults and parents and students — every day should be thankful for our health, for our families, and that we have the chance to thrive and make our dreams come true.

I bid everyone farewell, finally ending with a few parting words of wisdom from those wise sages Kermit the Frog and Fozzie Bear:

Movin’ right along in search of good times and good news,
With good friends you can’t lose,
This could become a habit!
Opportunity knocks once let’s reach out and grab it (yeah!),
Together we’ll nab it,
We’ll hitchhike, bus or yellow cab it!

seattle-airplane
Buh-bye, Beijing…

Yoga Helps Prevent Heart Disease

 

I’ve written a couple of times about yoga’s health benefits, but I just had to share a brand new study which convincingly shows some great news — yoga may help reduce heart disease as much as moderate exercise! Yes I know, it’s a bit hard to believe, as we always hear that you need moderate exercise — getting out of breath — to prevent heart disease, and most yoga classes don’t provide this cardiac burst. But this review and meta-analysis (published in the European Journal of Preventive Cardiology) reviewed 37 well designed studies called randomized controlled trials (RCTs). Most of these studies compared yoga (usually asana-yoga) to a non-yoga control group, or an exercise control group. In their results, those in the yoga group had significantly lower body mass index, weight, and blood pressure, and improved cholesterol numbers. They also found that the improvements from yoga were essentially equal to improvements from exercise. Even better, many of these studies were performed on people who already had medical issues such as heart disease or diabetes, and the improvements were the same.

There wasn’t an improvement in diabetes numbers such as lower HbA1c, but actually the diabetic patients seemed to get the most benefit in reduction of blood pressure and some other important markers. That’s great news for diabetics who usually are overweight and don’t exercise much, if at all. All of the study’s lab tests are very important biomarkers and risk factors for heart disease, which is the world’s #1 killer. So anything free, fun and non-prescription to help all of us prevent heart disease is a wonderful thing. Yoga definitely fits the bill.

These conclusions are still preliminary, and even the authors say that their findings “are limited by small trial sample sizes, heterogeneity, and moderate quality of RCTs.” But for the great percentage of my clinic patients who are overweight and don’t do any exercise, with many of these above metabolic risk factors, starting yoga is a lot better than continuing to do no exercise.

And this study certainly begs more studies to answer the most obvious, most fascinating question: just how could yoga help our bodies in this way? Does something about yoga’s stress reduction help our immune system in a more profound way even more than cardiac exercise? Stay tuned..

Did Beijing’s Pollution Cause My Asthma?

Now that months have passed and I’m basking in our summer sun, I can safely confess that I had a miserably unhealthy winter.

It started in November with my first ever broken bone, a silly bike-vs-oil-patch accident which broke my clavicle and brought me surprisingly distressing pain for more than a month. But far worse was when I was diagnosed with asthma last December and needed two inhalers to breathe better. It started insidiously, when I began to wake up deep in the night with achy chest pains. I initially thought it was just rib bruising from my bike tumble, but then I also started feeling short of breath. One morning I woke up suddenly gasping for air, and I finally went to a colleague at my clinic. My chest x-ray was normal but I took a breathing test which showed my lung function only 60% of normal, and she said I probably had asthma. I’ll never forget those moments after taking those first two puffs of albuterol: in just a few minutes, that elephant-like pressure on my chest for a month quickly lifted away, and I filled my lungs with precious, polluted Beijing air, its acrid smell never tasting sweeter.

So I was fairly certain I had asthma. And while I was incredibly relieved to feel better, I was shocked and disturbed by my diagnosis. It’s not common at all for adults to suddenly get asthma, and of course my overwhelming thought was to blame it on air pollution. Finally, after eight years in Beijing, gasping through multiple airpocalypses, and despite all of my obsessive attempts to shield myself from air pollution, I believed the inevitable had caught up to me. I felt like a fool for ever thinking I could avoid pollution’s long-term health effects. All of my blogging about masks and purifiers; my TEDx talk about healthy living in China; my book discussing healthy lifestyles in China — all of it suddenly felt like sugar-coated wishful thinking, and my rose-tinted glasses finally shattered to reveal the truly ashen hues of my city’s “yellow fog”.

I felt trapped, helpless against the choking evil oozing invisibly and inexorably through window and door cracks, always finding a new hole after my frantically plugging another one. Anxiety filled my days, distracting me at work and home. I was no longer fully present with my family, my patients. I frantically retested all my air purifiers, added one in my office, and upgraded from N95 to N99 masks for my bike commute. Incense at our home during meditation suddenly devolved from a relaxing tool to an anxiety-provoking source of PM2.5. I even considered the previously unappealing but blindingly obvious “cure”: fleeing from China.

 

I didn’t take it very well, as you can see. “Disease produces much selfishness”, as Samuel Johnson once said. “A man in pain is looking after ease.” I even wrote a long blog article about my new illness and its profound impact on my life here, chronicling my desperate attempts to shield myself from pollution. I felt a massive release of catharsis after finishing the final draft, satisfied that it perfectly captured my state. And then I held off publishing it so I could revise later.

Now, a few months later, I’m relieved I never published that article, because what was diagnosed as asthma is now completely gone, for many months already. And now I know that my symptoms may well have had nothing to do with China’s air pollution — it had all been an infection, the sort one likely could contract anywhere in the world.

A stunning turn of events led to this discovery. I actually had been feeling much better after a few weeks with my inhalers and steroids, but mid-February I started again to get wheezy, along with very strange and seemingly disconnected symptoms such as muscle aches and frequent headaches. Then the night aches came back, and on Chinese New Years Eve I woke up gasping for breath yet again, this time with fever and headache. So instead of preparing dumplings and watching the annual TV gala, my family spent much of the night with me in my hospital’s emergency room. There I was diagnosed with an atypical pneumonia and started on antibiotics. Seven days later, all of my symptoms were gone — including the symptoms of asthma. I haven’t touched an inhaler since then.

Antibiotics kill bacteria. So as this medicine completely cured not only my pneumonia but also my supposed asthma, it’s apparent now that I had been walking around for months with a bacterial infection in my lungs, causing all of my symptoms from the chest pains at night all the way up to the more traditional pneumonia symptoms at the end — including my wheezing and asthma.

Looking back, it certainly wasn’t an illogical assumption for me and my colleagues initially to blame air pollution, as my initial symptoms had none of the typical features of a pneumonia infection. And the evidence is quite strong that air pollution can worsen asthma — but there’s actually less clear proof that it can cause new asthma in an otherwise healthy person like myself. Yes, many studies do show an increase in hospital admissions for pneumonia during pollution spikes, so perhaps from this indirect pathway, air pollution was still partly to blame for my illness — although last winter’s air pollution was in fact much better than previous winters.

As I now reflect on those rough months, I’m disturbed how I was far too ready to play the popular “blame China” game. It’s such an ingrained reflex for Beijingers, both foreign and local, to complain about our many environmental troubles. Scandalous stories are so common that we’re hard to shock and easy to believe the worst. So of course, it seemed totally natural to me, my colleagues and my friends to think that air pollution caused my suspected asthma. But we were wrong.

My unpublished article thus has transformed both in tone and intent. No longer a simplistic screed, it’s become a more nuanced debate on environmental risks versus epigenetic predestination. But more importantly, it has become — at least for me — a cautionary tale about a person’s unpredictable reactions to pain and illness and the vulnerabilities it exposes. During my most serious illnesses ever, I was anxious and needy, retreating into a shell of survival. I was desperately searching to find some meaning, some positive outcome to my unexpected sickness. Looking back, I am a bit disappointed in myself, for reacting so negatively to what was honestly a not-so-serious diagnosis, especially in comparison to so much of the suffering I see in my own patients in clinic. I found that my emotional reserves in the face of illness weren’t as deep as I had hoped.

But from this humbling, grounding experience I have found more than a few positive sprouts, and thus the entire ordeal has proven to be an unexpected blessing. I now have a deeper compassion for others with illness, and I understand how a person’s perception of their illness is perhaps even more important for a doctor to “heal” than the actual illness. I’m more aware than ever of the deep connections between mind and body, between physical and mental health, both intertwined and inseparable.

I also I never want to be so unprepared again for pain and illness, and I continue to reflect how I can improve whatever inner strengths I may need in reserve, even on a spiritual level. As The New York Times columnist David Brooks says in his new book, “The Road to Character”, suffering “drags you deeper into yourself.” And as I now again revel in the pure joy of my wife and playing along with our two miraculous sons, I am filled with gratitude at everyone’s good health, now knowing how fleeting that can last.

 

This article was edited and translated by Jonathan Ansfield and Ke Xu originally for the New York Times Chinese edition, published there in my health column at http://cn.nytstyle.com/living/20150612/tc12healthblog

Fatherhood, Year Two

As I celebrate my second father’s day as a dad, I’ve been thinking more and more about my own father, who died over ten years ago. When I travel back home to Boston I always drive down the spartan Cape Cod highway to the Veterans Cemetery. I will sit on the crisply cut grass by his gravestone, admiring the blue skies, soaking up the sun and feeling the breeze through the trees. I’ll update him about my wild adventures in China, but I think he already knows.  I know he and my Alex would get along swimmingly, and I’m sure he’s as proud of me as he’d always been. And then I choke down that ache of longing, dust off his stone and make the lonely drive back, wishing he were still here.

As I remember my dad, I think about the importance of fatherhood and how signally important it is for me to raise my children as best I can. My father did the best he could, a very typical father at the time, focused more on providing than nurturing. Somehow he worked three jobs to provide for his wife and four children under the age of five. We four have used our parent’s relaxed, unconditional love as bedrock to develop our own life path and rhythm. Some took a longer time to figure out that path, including me, but as a late bloomer I’m pretty darn happy with what I’ve already accomplished in my life.

 

AlexDadClinic

As I now think about fatherhood and the differences not just between American generations but also cultures in China and the USA, I find research on fatherhood quite fascinating. I recently read last winter’s CDC National Health Statistics Report, Fathers’ Involvement With Their Children, reviewing the amount of time that fathers spend with their children. I found it reassuring that most American fathers were quite hands-on, a more modern approach than in my father’s time. Among fathers living with children younger than five, 98% played with their children, 90% bathed, dressed or diapered them, and 60% read to them at least several times a week. These numbers have increased from their earlier 2002 survey. I fit into this hands-on dad category, and it’s a very conscious decision on my part. My career path at this time absolutely is secondary to ensuring that my children’s first years are as nurtured and guided as they can.

Now that I’ve immersed in Chinese culture for almost a decade, and especially now as a first time father, I’ve wondered more and more whether I can combine Eastern with Western “best practices” of fatherhood, such as I’ve tried to do with medicine. But are there any true differences, or are they just superficial anecdotes from my limited viewpoint here in our first tier economic bubble of Beijing? And if there are true differences, is either “better” than the other?

twins_second_birthday

I found a couple of excellent review articles to shed light on this, including Parenting and fatherhood in urban China—a sociological perspective  from 2009 and Fathers in Chinese culture: from stern disciplinarians to involved parents, from last year. They both have similar points: the incredible changes in Chinese society over the last half century have also affected fatherhood. Both articles mention how it’s impossible to generalize about one stereotypical “Chinese dad” because parenting in China differs between economic groups and regions, as well as urban versus rural fathers. But they agree that the traditional Confucian-infused emphasis on total subservience to daddy (filial piety) has mellowed to a more nuanced fatherhood. Some studies commented on the increasing amount of dads (and moms) who take on roles as friends with their child, partly due to the one child policy. Also, many homes are now a nuclear family of two parents and one child, and no longer the traditional three generations living together (san dai tong tang), which may lead to more father-child intimacy. One Shanghai study from 2003 revealed how the more educated fathers were more involved with domestic chores and playing with their children.

 

with_3_kids

So is there a “better” way of fathering, gleaned from an East-West comparison? Actually no, I can’t really say that there is an obvious difference now — not anymore. But what does seem clear from the literature is that the old-fashioned fatherhood approaches from both cultures — distant and stern, provider and not nurturer — wasn’t the best way. A 2006 review from the U.S. Children’s Bureau makes clear the large body of evidence which shows how more emotionally involved and affectionate fathers, especially at younger ages, raise children who develop a higher IQ, better social connections, better grades and fewer behavior problems.

So I will continue to practice my own quirky fatherhood style, and I personally much prefer the more modern authoritative style versus the older authoritarian model based on Confucian principles. I agree with Confucius that “the father guides the son” — but let’s not forget about daughters, of course. I also agree when he says, “as a father, he rests in kindness.” There’s another famous Confucian quote, “in filial piety, there is nothing greater than reverential awe of one’s father.” Well, I can immediately think of at least a handful of things that are greater than that: growing up self confident; having a core of integrity; showing automatic respect and politeness to all others — I could easily go on.

GandpaAlex

 

Do I want my son to lovingly gaze on his hero-dad for eternity? Of course I do. But I’ll settle for respect, honest conversations and warm affection into his teen years and adulthood. I suppose ending phone calls always with an “I love you, dad” also would be really cool. I can’t control that, but I certainly will always be telling him I love him, at any age, no matter how uncomfortable it makes him, and no matter what he’s done.

I already know I will have a perfect Fathers Day 2014, with Alex at 16 months. We will do our usual routine of me holding him in the baby carrier while I make breakfast, then we all walk along the tree-lined streets to our child development center where he will joyfully play, tumble and laugh with half a dozen other toddlers. Afterwards, we will all take well-deserved afternoon siestas. I can’t think of a better way to spend that or any other Sunday. Well, actually I can — I wish his grandpa were here, in person and not just in spirit.

AlexMeBookSigning

My First Book: A Journey To Good Health in China

《美国医生谈:我在中国的高水平健康生活》A Journey To Good Health in China:  An American Physician's PerspectiveI’ve had a wonderfully interesting ride here in China these last seven years, but having a book published is definitely one of the highlights. So I’m thrilled to announce that next month I will have my first book published, in Chinese. Called《美国医生谈:我在中国的高水平健康生活》A Journey To Good Health in China:  An American Physician’s Perspective, it’s a translated collection of many of my blog articles along with some new articles, personal stories and photos.

It’s an exciting honor to have this opportunity to connect with more people in China, as my Chinese simply isn’t fluent enough. I’m deeply thankful to my publishers and editors for getting all of this together.

We are still finalizing the publication dates, but here’s a bit more information from the publisher, on Douban:

*关注中国最热点的健康话题,国内第一部直指空气污染的大众图书;大篇幅解读你不得不担心的食品安全问题;无条件告知只有医生知道的健康秘籍!

*美国在华最权威的全科医生根据在中国居住近10年的经验写成,只针对中国,绝对接地气!他在中国结婚生子,在中国行医,对中国感情很深,写的都是对中国人最有益而中国人不知道的健康建议!

*无论屌丝还是土豪,都需要认真读一读这本书,都可以轻松摆脱目前的健康困恼,在中国过上欧美式的高水平健康生活!

*作者圣西睿智,美国人,中国通。和睦家医院著名医生;崔玉涛和冀连梅的同事;中央电视台国际频道的做客嘉宾;《纽约时报》针对中国环境和中国人健康问题的专栏作家;中国最有名的英文健康杂志BeijingKids著名撰稿人;《母子健康》杂志特约作者。巨多光环集于一身,绝对健康权威保证,比舒肤佳都让人放心!