Small Changes Big Impact
Small Changes Big Impact
A teaspoon of wellness makes the medicine go down with Dr. Julia Alleyne
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In studio today, we have Dr. Julia Alleyne, the associate program director of the Academic Fellowship and Graduate Studies program at the University of Toronto Department of Family and Community Medicine. Today, we discussed the importance of wellness and resilience in keeping people healthy.
Visit https://www.wellsense.net/
Recorded April 2, 2020.
Small Changes, Big Impact: a DFCM podcast. I'm your host, Dr. Jeremy Rezmovitz. Our guest today through Zoom is Dr, Julia Alleyne. We'll be discussing how a teaspoon of wellness makes the medicine go down. I hope you enjoy the show. Julia, thank you so much for being on the show today.
Dr. AlleyneOh , thank you Jeremy. It's a pleasure.
Dr. RezmovitzSo tell our listeners what you do in our department.
Dr. AlleyneI've had a few roles. My current role is I'm associate program director with graduate and academic studies. What does that mean? I oversee the family and community medicine master's degrees, the research certificate and our academic fellowship.
Dr. RezmovitzSo you've got free time in your hands, is what you're saying?
Dr. AlleyneWell, we're busy right now because we're doing a lot of converting to distance learning.
Dr. RezmovitzYeah I can imagine.
Dr. AlleyneBut my staff and the instructors have been just fantastic at grasping the concepts quickly.
Dr. RezmovitzYeah, I'm sure there's a lot of work that you guys are undertaking right now that was probably not anticipated to be done in such a short amount of time.
Dr. AlleyneThat's right.
Dr. RezmovitzYeah. So how are you coping right now otherwise? I mean, you've got professional commitments, personal commitments, I'm sure, how has COVID-19 impacted you right now?
Dr. AlleyneYou know, I'm a silver lining person. So I bounce back and forth between the new demands, the restrictions, the worry and the uncertainty. And then looking at, "Oh, I get to know what my cat does during the day" and "Oh , this is a new person who I haven't talked to in a long time or someone who I'm reacquainted with." So I bounce back and forth between them. I've gone through other marathons, so to speak, and I'm treating this the same way that you just have to pace yourself, prepare yourself, you know there's going to be an end. We know that from history - other pandemics have started and ended. And so I'm in my marathon mentality right now.
Dr. RezmovitzSo I think it's really important for all the listeners right now to really get a sense then, of what does your cat do all day?
Dr. AlleyneWell , you have to understand that we adopted her about four months ago. So first of all, I disturb her naps. I didn't realize how much she sleeps during the day. She sleeps a lot. I had no idea what her curiosity was like. If the weather changes, if a windows opened, if there's a noise, she's right there. And the most surprising thing is that she actually likes human contact and she hangs around us. So it's been quite interesting.
Dr. RezmovitzSo that's not very usual for cats.
Dr. AlleyneNo, I think she's a dog underneath it all.
Dr. RezmovitzYeah, I think so. What's her name?
Dr. AlleyneHer name is Yoga.
Dr. RezmovitzYoga. Talking about yoga - how is your physical activity up with all the social distancing and the physical distancing right now?
Dr. AlleyneI wish I had time to do more, but I'll tell you, I'm very lucky. I've got a little gym right in the basement. We live in a townhouse and I have a rooftop terrace. So between the gym and the terrace is four flights of stairs. So that's great. And I've got some opportunity to do yoga or treadmill or spinning bike in the house. But on top of that, I have been trying to get out for a good walk at least four or five times a week. It doesn't happen every day -there's just too much going on. And I'm conscious to only be with my husband when we go for a walk. I think the hardest thing is the sitting . I'm doing a lot more sitting than usual and that I have to be more aware to get up and move. But you know, I'm trying hard and in some ways it's allowed me to schedule it in. Often physical activity gets bumped. And so as I make my day in my routine, I schedule it in.
Dr. RezmovitzIt's interesting as primary care practitioners that we tend to tell our patients "make sure you do your physical activity" and then we don't schedule it in ourselves. So I've definitely been scheduling it in - I feel better after doing it. I just really - it's so necessary now. Now that we've switched the phone calls, it's way easier to schedule it in. Other than the challenge of doing physical activity right now, what other challenges have you identified or - let's put it a different way. How has COVID-19 exposed vulnerabilities in your life right now?
Dr. AlleyneYeah. Well , my brother is a paramedic and he's running the command center for Metro paramedics. And so he did a checkup. He phoned me and I'm a physician and he's a paramedic and he says, "I just want to make sure - have you got a thermometer?" And we moved recently and I can't find the darn thermometer. So I was honest with him, "ah, haven't found it. Got a few more boxes to go through." But actually I did not panic and I thought to myself, "you know what? I know what a fever feels like. I know what the symptoms of a fever are like. I'm not going to worry about this." And then I went online yesterday and there's a couple of online sellers right here in Toronto that now have thermometers . So I think probably it's the vulnerabilities of maybe how prepared you think you are, and then someone asks you a question that throws you off and then you have to regather yourself and say, "let me put this in perspective and is this something I need? Yeah, probably. Okay, let me try next week." So it's that balance between being prepared and not panicking.
Dr. RezmovitzSo there's a lot of uncertainty, actually. I don't know if you've noticed, it's almost oppressive right now.
Dr. AlleyneIt is.
Dr. RezmovitzBetween home , patients , professional commitments , administrative commitments that you might have - how are you dealing with all of that ?
Dr. AlleyneI think in terms of uncertainty - and I'll get a little bit philosophical here - you have to build resilience. That's the best way to deal with uncertainty. And people will say to me, "well, what's resilience?" And you look back on your life when you have actually gone through a difficult challenging time, how you have managed with it. And what we do is we try and find purpose. We try and have confidence in the actions that we're taking minute to minute, hour to hour. We connect with others because we're much more resilient if we connect with others. And we need to take care of ourselves. So that uncertainty, I try and replace with resilience building. We - there's no magic pill for uncertainty and it comes from within us. It comes from our own mindset and our own experience and view of things. That doesn't mean it's always in perspective. So that's where the resilience comes in.
Dr. RezmovitzSo I've been doing a lot of counseling for the last two years, and the three questions that I ask I think align completely with building resilience. They are - number one is what are your strengths? Number two is what are your goals? And number three is how can you use your strengths to achieve your goals, in the service of other people? And starting from a place of strength, looking towards something that you can focus on, and doing it so that you can connect to other people, will definitely help people through this time of uncertainty.
Dr. AlleyneYeah, I like that. And I'll add a little bit of a perspective on that too. I was doing a webinar yesterday with a group of patients - 60 to 70 patients in the group - who were Parkinson and movement disorder patients. And this was actually out of UCLA, but they run it worldwide. And it's difficult for them to give service to others. And so we turned it around that by taking care of themselves, they're actually helping alleviate stress and worry from others who may be worried about them. So I like what you're saying. That purpose that connects us gives us resilience.
Dr. RezmovitzIt does. It does. Now, the other thing that I think connects us is humor. I don't know if you've noticed, but a lot of the anecdotes that you've told here had this theme of humor, right ? Both of us back and forth have been laughing a little bit in the face of this horror that we're - we understand what's going on , but we still have to laugh a little bit. And so recently you've started up a website about - and I'm not aligning completely laughter with wellness , but you have - you set up Wellsense, is that correct?
Dr. AlleyneThat's correct. Yep .
Dr. RezmovitzCan you tell us about Wellsense and its role in our lives right now?
Dr. AlleyneWell, Wellsense has deep roots, but what happened recently is that as we started to come into the March 5th, 6th date and people realized they're going to be working from home, cases became confirmed, and Canada all of a sudden woke up that COVID was here. On Facebook, I posted an inspirational message and I got good feedback - lots of response. Well, the next day I posted really about taking care of yourself , about having a routine, what circadian rhythms are all about. And I posted the next day about sleep and if we in fact don't have the sleep we need, we don't have strong immune systems. Well, this idea of connecting wellness with evidence-based science, but with a common sense approach was finding an audience. And so I made a commitment to Facebook friends that I would do a post every day until we were through this. Now at that time we thought we were into weeks, now we're into months. And by about the end of one week, I realized that I needed to do it on a website so that it was public and so that so many others could benefit from it and share it. And the term Wellsense - truth be told, I had already coined that business and registered it with Canada Revenue Agency five years ago because I had always been interested in this idea of evidence-based wellness with a common sense approach. And that goes back to a lot of roots of work that I've done in wellness. But last fall , a woman from Canadian Revenue Agency called me and she said, "you know, you have submitted for five years, zero income, zero expenses. Do you really have a business?" And I was honest with it and I said, "I have a business idea but I have not turned it into anything and I have to find the right place for it. Give me another year" - because they have the right to say, "this is not a business, we're shutting you down." So that was November and when COVID hit, and when I started to try my messages and when I saw there was a response, I thought, "get the website up, get the blog up, we'll see what happens to it." My hope is, is that there's an opportunity for online courses and opportunity for seminars, but it's really about people versus patients. It's trying to optimize health so that we all take care of ourselves. And that's our partnership with the healthcare system. So I now am finding that I'm addicted to it. I'm writing every day. The responses I'm getting are phenomenal in terms of personal anecdotes about people's lives and what a message or a post might mean . And these are brief posts. We've got some website analytics. It takes about a minute to read a post that that's what we're seeing. So people are taking a minute of their day and it's sustaining them. Maybe two or three hours, maybe for another 24 hours. But it's helping even if it's a small amount.
Dr. RezmovitzSo what you're saying is there's life sustaining wellness through your website?
Dr. AlleyneI hope so. You know, maybe it's optimism, maybe it's reality. There's nothing wrong with realistic optimism. But -
Dr. RezmovitzAre you one of the few people that's saying thank God for COVID-19?
Dr. AlleyneNo, I wouldn't say that. I would say that the opportunity has shown the need and it's the need that I'm trying to respond to.
Dr. RezmovitzSo does the website have different areas that people can look at for wellness?
Dr. AlleyneYeah. I've started some tags - and believe me, I'm talking this tech stuff like I know it, but you know, I'm learning fast. So every day I post, and then I've started to organize them by tags. So fitness, mindset, nutrition, lifestyle - there's some others in there, but it's that type of tags that someone could look and say, "well, let me look at all the fitness blogs" and get them.
Dr. RezmovitzSo that's why I'm asking this - to get a sense for the analytics. Is there any tag that's more popular than the other ones?
Dr. AlleyneMindset is the most popular. And the best post to date was resilience. If you look at the number of viewers - the site has been up for 10 days now. We've had 2100 visits to the site and interestingly, we've had 1400 repeat visits , which means people are coming back. We have countries - certainly Canada's number one, US is second, then we go to the Caribbean, Australia, Germany. So I don't actually know how it's spreading - and I hate to use that word right now.
Dr. RezmovitzIt's viral problems. I don't know if you know how viral spreading works, but you know, one person tells one or two people and those two people tell two people and then, you know, eventually you get a pandemic.
Dr. AlleyneRight?
Dr. RezmovitzYeah. That's the way it works. I've learned that recently. So. Okay, well that's awesome. I'm so glad that you're able to provide this. Hopefully you'll be able to link to our website and tell people to listen to the podcast, but if they're already at your website, then maybe they're getting it.
Dr. AlleyneYeah, no, we will. And you know, the interesting thing, Jeremy - I don't know if you're interested in sort of some of the roots of this, but it's kind of neat how the Wellsense idea developed .
Dr. RezmovitzTell me about it.
Dr. AlleyneSo I originally trained as a physiotherapist, so there was a natural inclination to look at exercise and for years in addition to treating medical conditions with exercise and physical means, I would do community fitness classes as a leader - designing classes. So that really got me into the exercises medicine piece. But then over the years , I became quite involved in sports, sport medicine as a team physician for Skate Canada, for Canadian gymnastics and was privileged to be on five Canadian Olympic teams and then Chief Medical Officer for the Toronto 2015 Pan-Am Para Pa-Am Games. Well roundabout 2006 after the Torino Olympics, we had a debrief and we were asked how did we think medical services went? And there was a lot of chatter and I was rather quiet. And once the chatter died down, I said, "we ran a great m ass unit, but we're missing the wellness boat. We are not helping the athletes and the mission staff be their best. We're doing the reactive treatment of patching them up." Believe it or not, this took about two years for this idea to really sink in. And we did a survey of athletes a nd we looked at what we could provide. And we found in our survey that 75% of our Olympic team athletes, coaches, mission staff, did not sleep well during the Olympics. We found that 13 out of 16 of the male water polo players do yoga e veryday, but didn't do it during t he Olympics. So we found a lot of interesting information that helped us design a wellness plan a nd w ellness program. And what I did is I took the medicine wheel and the meaning behind the medicine wheel that in order to have balance you have to be able to be aware and nurture f our areas: your physical health, your intellectual health, your emotional health and your spiritual health. And so we designed our supplies, our staff skills, our interventions around the medicine wheel. And the concept was that you check in and balance and we'll give you a place to make it easy to do that, but we'll give you strategies to take with you t oo. And so we took that, wellness concept t o Beijing. And we took it to Vancouver. And when I was Chief Medical Officer for the Canadian team in London, we took it to London and the Canadian Olympic team continues to use it. But it was that idea that i f this helps our top athletes at the most stressful point in their careers, why can't it do something everyone? And why can't I turn it in to the everyday person's wellness message?
Dr. RezmovitzThat's very interesting. So we published an article at the CFP and their blog called "I've stopped telling my patients to exercise" , and looking at the term training instead of exercising. You know, as physicians, we sometimes willy nilly say, "Oh, you need to diet and exercise" without actually giving people goals and focusing on goals and getting people to that point. It's because we really have a role sometimes to play as coaches. And we focused on four pillars in the article: we talked about mental health, physical health, eating and sleeping. Because if they're all connected. You know, everything that you're saying - the medicine wheel, the spiritual journey, the emotional - not journey, sorry , the spiritual component, the mental, emotional component, physical and intellectual - they're all connected. You know, if your sleep is impacted, we know that your mental health is going to be impacted. Your eating maybe impacted. It may then get your physical health to be off a little bit too , right? So we know that all of this stuff is interconnected. Same as exercise is medicine, food is medicine, right? And so we need to do this for everyday people, not just Olympic athletes. And the question is how do we get people to start doing this - not just during a difficult times? How do we get them to create a routine so that when difficult times happen, they can rely on the routine to get them out of the difficult times? To ground them to say, "you know what, I am grateful for all the things that I have and I'm going to do these things that have kept me sane during the easier times", right? "But now during this famine, during this pandemic, during this crisis, I'm going to keep doing those things", right? Look at the water polo players who didn't do their routine during the most stressful times of their life .
Dr. AlleyneYeah. So that's human nature, isn't it? How do we do that? So my thought about that is that we need cueing and we need support. What's cueing? I can enjoy exercise, but unless there's a cue for me to do it three days from now, I might not do it. So that cues - internal or external, we start with external cues. In wellness, those external cues are often symbolic plants, a picture a meditation, a song, a music - it's something that cues us. And I use a technique called window sill wellness, where I ask someone to declutter a window sill and to put a few things there that represent their motivation and what they want to be and how they want to take care of themselves. And as I say , maybe it's a plant, maybe it's a stone, maybe it's something that triggers a memory. But a window is a place where you go to a couple of times a day - whether you're opening the curtain, whether you're looking out at the weather, and that becomes your cue . "Yep. Got to take care of myself today. Yep . Going to do that today." So I think we have to recognize that the cueing is needed, and then the support, which is reinforcement and praise and I feel better and someone tells me, "isn't that great?" And we start to get better at internalizing, but we have to start with the external first. External cues and support, and then we get internal cues and we feel the gratification ourselves.
Dr. RezmovitzSo I have to tell you at the beginning of this interview, there's no way that I would have ever predicted that I was going to talk about quality improvement. Really.
Dr. AlleyneYes. It's true.
Dr. RezmovitzIt's true, right? And so there was - I'd never thought for a second I'd say, "Hey, do you know about W Edwards Deming as the father of modern QI?" And I would talk to you about the greatest theory - the most profound theory you've ever heard in your life. Do you know about this theory?
Dr. AlleyneTell me, Jeremy.
Dr. RezmovitzIt's called about the - it's called the theory of profound knowledge. That's what he named his theory. I think it's pretty funny. I think that you're calling - it's a little egotistical. You know, the theory of profound knowledge.
Dr. AlleyneIt gets your attention.
Dr. RezmovitzIt does. And so, I taught a course through the Dalla Lana School of Public Health and the Graduate Studies program on leading change in population health. And we talk about the theory of profound knowledge as the basis and the foundation for making change. And so one of - the first step in making change is appreciation of the system. And so I look at it as double edged . There's appreciating the system and understanding what's working, what isn't working, how the system works, but there's also understanding how to put energy and work into the system, appreciating it - praise, support. Because that's the only way a system is going to continue.
Dr. AlleyneTo flourish. Yep.
Dr. RezmovitzEvery system without praise or support will diminish. It just doesn't work like that. You need to appreciate the system. That's the first step in quality improvement and I think we lose that sometimes. I don't think people realize how important physical, emotional and mental support is in trying to maintain our wellness. You know, it's interesting, but right now as frontline family docs in the community, the thing we need most right now is PPE - personal protective equipment. And we're not talking about a lot. We need masks, we need gloves, and we understand the dire need for personal protective equipment in hospitals and longterm care facilities for our paramedics, for FirstLine responders, police officers, fire - but you know what? We're also doing stuff in the community where it turns out there are more conditions and diseases other than COVID-19 that you still need support for. And we're seeing people, we just don't want to put ourselves at risk and put our patients at risk in case we've caught something and were asymptomatic during this period. And so if we could find a way to support our primary care physicians with personal protective equipment, I think it would go a really long way to raising the - what's the term I'm looking for here? You know, which - I can't think of it. It's off the top of my head, a tip of my tongue here - raising the morale of what's going on, right. Because if we have the actual physical support then we'll be resilient. We'll just go and do our job.
Dr. AlleyneYeah. And I think if I go upstream from that - because I agree with you, that is absolutely what's needed at this time. If I go upstream and I can help people understand that their immune systems function better if they sleep well, eat well and exercise. If I could help them understand that they won't be as susceptible, distressed and anxiety [sic] - if they have perspective and resilience, that's a way of reducing healthcare visits. And that's a way of helping people to I think, as I say, become better partners in this fight because part of what we have to do is stay out of the healthcare system to make way for those who urgently need it. And so, we've really got so many roles to make this work and really to reduce lost lives. Like that's what the goal is, is to reduce the loss of life. And that is everything from our frontline workers and protective equipment to following guidelines and keeping ourselves well. And people say, "well, I need to do more", but that's gigantic. If you can be one less visit in our healthcare system right now, that's terribly important.
Dr. RezmovitzYeah, it's true. I mean the WHO put out a statement recently that you're only supposed to watch I think six or seven episodes at a time when you binge watch now on Netflix, right? So just six or seven, that's it, right? You're always supposed to be sedentary for six or seven hours, right? That's it - per day. Right? So we really need to - I'm kidding, obviously. I don't think the WHO really cares about - I guess they do from a sedentary standpoint. But it really - if we can really stay well during this period and limit the amount of visits that are going on right now, then maybe we won't have the straw that breaks the camel's back, right? That's where we really - we've got to flatten the straw. Is that a new term that we're coining today? Flatten the straw so the camel doesn't die? Any who. Any last words for our listeners today?
Dr. AlleyneWell, I think that I'm going to go back to laughter. You know, you mentioned laughter. I wrote a blog on laughter. With every one I write, I'm reading and researching too. And we've had an enjoyable back and forth today. And that laughter makes me feel better. And I think that that's the message to get out to people is take, for example, at mealtime , turn off the news. Have your meal with music, with conversation, with a joke, with laughter. And we'll all start to feel better. And if we can get back to that human connection, even virtually , I think that's what I'd like to leave with our listeners is to try a bit of wellness. It goes a long way.
Dr. RezmovitzIt does. Wellness does go - I think, what do they say? How does the expression go? A teaspoon of wellness makes the medicine go down?
Dr. AlleyneThere we go.
Dr. RezmovitzYeah. So I think that's what we're going to call this episode today: a teaspoon of wellness makes the medicine go down with Dr. Julia Alleyne. Julia, thank you so much for being on the podcast today and I hope you have a great day.
Dr. AlleyneThank you, Jeremy. And you too, and thank you for your work on this. It's a great, great episode for people. It's a great series for people. Thank you.
Dr. RezmovitzThanks. This podcast was made possible through the support of the Department of Family and Community Medicine at the University of Toronto. Special thanks to Allison Mullin, Brian Da Silva and the whole podcast committee. Thanks for tuning in. See you next time.