In this episode, we introduce you to our guest Dr. Nina Ahuja. She is an ophthalmic surgeon who has earned numerous awards for excellence in surgical teaching and contributions to medical education & is also the author of Stress in Medicine. Dr. Ahuja is the Founder of Docs in Leadership, an organization she created to deliver leadership education to medical students, residents, physicians, nurses, nursing students, and fellow healthcare professionals.
Questions for our Guest
Questions below are some we’d like to tackle. We go off-topic all the time so we don’t expect to hit them all. If you have any ideas, please let us know. Looking forward to our conversation!
What made you decide to enter the Medical field? Why did you choose the ophthalmology route’?
You are certified in the emotional intelligence assessment. What is the influence of EI on job burnout and job performance?
“Since emotional processing starts this sequence, learning to understand and manage our emotions is fundamental to managing stress, regardless of the trigger.”
What are the most common issues you see at your clinic and in the OR?
What have you seen as the most damaging comorbidity that affects the eye? Diabetes?
How important is eye health? Most of us take our eye health for granted and see our eye doctor once or twice a year.
What is the most challenging aspect of medical school? Is it the stress, competition, or the amount of knowledge you need to know…?
Your book Stress in Medicine was a best seller on amazon, and I love how it starts with one of Hippocrates’ quotes “Where the art of medicine is loved, there is also a love for humanity. What made you write a book about stress in the medical field?
One common issue that adds to the stress is time management. You’re a very busy person. How do you manage your time now and when you were in school?
Have you dealt with burnout? How can you prevent it?
What is ADMIT, and what made you create it? Can you go into each step?
Adapting
Doing
Measuring
Introspection
Transformation
One of the challenges in the medical field is we are responsible for breaking bad news to families; what advice can you give nurses and future MDs on talking with families?
Your current obsession is to make “Stress in Medicine” required reading for students of all healthcare professional programs upon entry – nursing, MD, EMS, etc. How are you working on this goal?
See what the challenges of the medical field today are by watching this full episode 👇👇👇
TIMESTAMPS:
00:00 – Intro 00:35 – Guest introduction 01:05 – How Dr. Ahuja got into the medical field 02:12 – How emotional stress correlates 03:35 – How emotional intelligence develops 05:28 – Burned-out nurses 10:22 – Explaining the Acronym 16:23 – Eye Health 20:16 – Blue Light 21:51 – Eye Trauma 22:41 – Virtual Eye Care 24:56 – Virtual Reality 25:57 – Dachshund Leadership 29:47 – Common factors in poor leadership 33:47 – Nursing Culture 36:27 – Physician stress 41:57 – De-stressing 43:16 – Wrapping up the show
In this episode, we will discuss stress and anxiety as a nurse. We discuss how to have a well-balanced mental life at work and outside your job. We all get stressed and anxious, it’s nothing that we can completely eliminate, but we can control it. Managing stress and anxiety is all about understanding the feelings, where they are coming from, and adequately reacting to them.
How to Manage Stress and Anxiety in the Workplace
Nursing is one of the most stressful career options out there. It is impossible to explain a nurse’s stress without being there. In nursing school, you have an idea of how nursing will be, but your imagination of a nurse is minimal compared to what it is.
What Stresses Nurses Out?
Workload
The workload is the primary stressor for a nurse. Many states do not have set up patient ratios, meaning if push comes to shove, you can have an extra patient or 2 to manage. Patient care is hard and time-consuming; we also have to chart everything. Short staffing also leads to higher workloads.
Lack of support
One of the main complaints by nurses is a lack of social support from coworkers and higher management. Anxiety is heightened when there is less support. Maintaining a positive and relaxed work environment is hard without someone to talk to.
Working with the sick
This is especially hard in the ICU. The ICU requires working with the sickest people; many die in the ICU, which takes a toll on an individual. Also, we maintain many different medications, which is very stressful when patients crash.
How to Manage Stress at Work
You can’t control everything that happens at work or the environment, but you can find ways to improve it. Try not to focus or change the aspects of the job you cannot; instead, find out what you can influence and learn to react appropriately to a situation.
Ask for help
One of the best things you can do when you are stressed and anxious is to ask for help. When you are running around, and a nurse asks, “Can I help you?” it’s ok to say yes. If you need help with a boost or a turn, don’t delay it or do it yourself. Just ask someone for help.
Talk with your coworkers
You are opening the room for conversation. You’re socializing with your coworkers, which makes it easier to ask for future help and work together. How many times did your shift improve after you talked to a nurse, conversed with a nurse, and joked with your coworker? Communication goes a long way.
Bonding with your peers is the best way to break a great work environment. The key to teamwork is good communication.
There will be a time when you feel comfortable enough to share emotions. There will be days when you will see a coworker cry, and you’ll be there to comfort them.
Improve your time management
The number one stressor for nurses is nursing itself, it can be mentally and physically draining. If you feel you are always chasing time, that will stress you greatly. Your shift always gets easier when you have a plan.
You should always mentally plan your shift. If you are forgetful, then the first thing you should do after the report and a quick glance at your patient is to write down what and when you will be doing for the next 12 hours.
Life is happening for you instead of to you.
Get your home life figured out
The last thing a nurse wants to deal with is a nurse who talks about how bad they have it outside work. Always so busy, never have time for anything, always sleeping in, and can’t get anything figured out. You have to enjoy life to be happy. We are not saying that you need to be happy all the time it is healthy to go through cycles of emotions. All emotions need to be expressed.
Health
You need to eat a well-balanced diet most of the time. Nutrition plays a crucial role in mental and physical health. You’ll get mediocre results if you do not feed your body optimally. Headaches, bloating, and cramps can all stem from your diet. How can you be happy and successful when dealing with all those physical issues? It takes your mind off things you should be doing.
Exercise is essential as well. It doesn’t matter what workouts you do. They all promote blood flow to your brain and organs. Many people don’t understand that consistently working out contributes to more than just your physical appearance. It builds structure, routine, and mental strength.
Time management
The same issues nurses have in the hospital stem from their daily life or vice versa. If you’re always chasing time, you either need better planning skills or you’re taking on too much at once. If you’re the person who crams a lot in one day and then gets sad because you didn’t accomplish everything, you need to drop your workload. Tomorrow will come, but you are in the present.
Feeling stressed at work? Learn how to manage it in this episode 😎👇
TIMESTAMPS:
00:00 – Intro 00:20 – Cup of Nurses and Dat Loud mugs plug-in 01:13 – Topic Intro 01:44 – Being a nurse is stressful 03:20 – 3 Most Common Causes of Stress Among Nurses 03:30 – Workload 07:32 – Lack of Support 12:13 – Working with sick patients 20:16 – Ask for help 24:10 – Talk to your co-workers 26:55 – Time management 34:38 – Have a routine 37:00 – Sit Down with Yourself 41:20 – Wrapping up 41:44 – End of show
In today’s episode, we are going to talk about the most common vasopressors we use in the ICU. Those being norepinephrine, epinephrine, phenylephrine, vasopressin, and dopamine.
Vasopressors
Vasopressors are a powerful class of drugs that induce vasoconstriction, they elevate mean arterial pressure (MAP). Vasopressors differ from inotropes, inotropes increase cardiac contractility. Keep in mind that many drugs have both vasopressor and inotropic effects.
Vasopressors are a group of medicines that contract (tighten) blood vessels and raise blood pressure.
They’re used to treat severe low blood pressure, especially in a critical care setting.
When blood pressure is continuously low it can lead to organ damage and even death.
Most commonly used on patients who are in shock, undergoing surgery, or during an emergency.
Located primarily in the skin and GU tract and ultimately decrease blood flow to these organs when activated.
Activation of these receptors will result in vasoconstriction and an increase in peripheral vascular resistance and systemic arterial blood pressure.
Alpha 2 adrenergic receptors
Contribute both to control of sympathetic tone and to local and regional blood flow in the peripheral vasculature.
Sits alongside the more plentiful α1-adrenergic receptor.
Beta 1 adrenergic receptors
Located near the SA node, AV node, and cardiac myocytes (make up the heart muscle).
Activation causes an increased heart rate (chronotropic effect), automaticity, and contractility (inotropic effect).
Beta 2 adrenergic receptors
Located in the tissues of the GI tract, bronchi, uterus, pancreas, striated muscle (cardiac), blood vessels, coronary arteries, and hepatic artery.
Activation causes smooth muscle relaxation, vasodilation and increases perfusion, and increased cardiac contractility.
Dopamine receptors
Present throughout the body, dopamine is a precursor to epinephrine and norepinephrine
Activation causes vasodilation, increased myocardial contraction, and increases cardiac output without changing heart rate
Depending on the size of the extravasation, bring 5 to 10 mg of phentolamine to the bedside. This will need to be reconstituted and further diluted to 0.5 mg/mL in normal saline. Treatment of the extravasation will involve the nurse administering the phentolamine intradermally around the site of the extravasation.
Phenylephrine
NEO-SYNEPHRINE hydrochloride produces vasoconstriction that lasts longer than that of epinephrine. Its action on the heart contrasts sharply with that of epinephrine and ephedrine, in that it slows the heart rate and increases the stroke output, producing no disturbance in the rhythm of the pulse. Phenylephrine is a powerful postsynaptic alpha-receptor stimulant with little effect on the beta receptors of the heart.
Effects
Neo causes a rise in systolic and diastolic pressures.
Reflex bradycardia that can be blocked by atropine.
Cardiac output is slightly decreased and peripheral resistance is considerably increased. Circulation time is slightly prolonged, and venous pressure is slightly increased.
Most vascular beds are constricted leading to renal splanchnic, cutaneous, and limb blood flow reduction but coronary blood flow is increased.
Pulmonary vessels are constricted, and pulmonary arterial pressure is raised.
Uses
Severe hypotension
Septic shock
Cardiogenic shock
Situations where levo causes tachyarrhythmias
The drug is a powerful vasoconstrictor with properties very similar to norepinephrine but almost completely lacking the chronotropic and inotropic actions on the heart that norepinephrine provides.
The majority of norepinephrine effects are going to lead to an activation of the alpha 1, alpha 2, and beta 1 receptors. Levophed functions as a peripheral vasoconstrictor (alpha-adrenergic action) and as an inotropic stimulator of the heart and dilator of coronary arteries (beta-adrenergic action)
Effects
Increases heart rate
Increase BP through an increase in cardiac output and systemic vascular resistance.
Vasoconstriction of arteries and veins (alpha 1 and alpha 2)
Increase in heart contractility (beta 1 mediated).
Increases blood flow to skeletal muscle.
Reduces blood flow to the gastrointestinal system.
Inhibits voiding of the bladder and gastrointestinal motility.
Stimulates alpha 1 and 2, and beta 1, and 2 adrenergic receptors. Epinephrine is usually given as a last resort drip or pushed during a code. It has the shortest half-life of all the vasopressors.
Effects
Relaxation of the smooth muscle of the bronchial tree
(increasing myocardial oxygen consumption)
Increased heart rate and contractility (beta 1)
Vasoconstriction in most arteries and veins (alpha 1 and 2)
Low concentrations cause vasodilation of muscle and liver vasculature (Beta 2)
High concentrations cause vasoconstriction (alpha mediated)
Cardiac output is increased but with a small change in MAP due to a decrease in systemic vascular resistance (Beta 2 mediated)
Vasopressin doesn’t act on the same receptors as the prior pressors. Vasopressin is a peptide hormone that acts on 2 major sites, V1 which is the blood vessels and V2 are the kidneys.
Effects
V1 is responsible for the constriction of blood vessels through an increase in systemic vascular resistance leading to an increase in MAP
V2 is responsible for regulating extracellular fluid volume. Activation causes fluid reabsorption leading to an increase in blood volume causing an increase in MAP.
Dopamine
Dopamine is a precursor of norepinephrine and stimulates norepinephrine release. At low doses, dopamine stimulates the heart and decreases systemic vascular resistance. At high doses, dopamine’s vasodilation effect becomes vasoconstriction as lower affinity α-receptors bind to the dopamine. Dopamine also binds to D1 receptors in the kidney, producing vasodilation.
Effects
Stimulates both adrenergic and dopaminergic receptors.
Lower doses
Mainly dopaminergic stimulating producing renal and mesenteric vasodilation.
Higher doses
Both dopaminergic and beta1-adrenergic stimulating and produce cardiac stimulation and renal vasodilation.
In this episode, we will be talking about 7 lifestyle changes for 2021 to boost your immune system and overall improve your well-being. This episode couldn’t have been in a better time, with a global pandemic and the start of the new year.
As you kick off 2021, reflect on the past year and set goals for yourself. I think the lockdown was a great teacher for many, whether it’s about your health or career.
The key to 2021 success will require a mindset shift, not empty New Year’s promises. Don’t waste this upcoming year with stagnation. Take this new chapter as a way to grow and develop yourself as a person.
Since we are in a global pandemic and the government nor the masks won’t save us from illness, it’s time to do our part in society and strengthen our immune health.
There are several dietary and lifestyle changes to incorporate which may strengthen your body’s natural defenses and help you fight harmful pathogens or disease-causing microbes.
1. Getting enough sleep
What happens if you don’t sleep enough? Not getting enough sleep weakens the immune system. It also lowers your sex drive, lose your focus, ages your skin, and leads to weight gain. Lack of sleep is making us fat, sick, inflamed, and imbalanced [1].
In fact, according to the CDC, more than one-third of Americans don’t get enough sleep. If you find yourself in the one-third category, it’s time to realize that the first thing you should do is focus on sleep.
We’d all love to be the sleepless hustler who works like a maniac and pushes hard at the gym. We go out on weekends and always feel great after only five hours of sleep.
Newsflash: This person doesn’t exist, and if you know someone like this, they’re heading for burnout. Your brain does allow you to feel sleepy sometimes. Blocking that feeling with caffeine will short-circuit the warning signs of sleep deprivation [2].
These include:
Yawning
Moodiness
Fatigue
Irritability
Depressed mood
Difficulty learning new concepts
Forgetfulness
Inability to concentrate
Lack of motivation
Clumsiness
Reduced sex drive
Lack of Sleep Weakens the Immune System
In a study of 164 healthy adults, those who slept fewer than 6 hours each night were more likely to catch a cold. It is in comparison to those who slept 6 hours or more each night. Short sleep duration = susceptibility to infectious illness.
The participants tracked sleep using wrist actigraphy for 7 consecutive days. They were quarantined and given nasal drops containing the rhinovirus. After that, the participants were observed over 5 days [3].
Sleep deprivation may decrease the production of protein cytokines and antibodies. How much sleep do you need to bolster your immune system?
The optimal amount of sleep for most adults is seven to eight hours of good sleep each night. Teenagers need nine to 10 hours of sleep. School-aged children may need 10 or more hours of sleep.
Sleep and Vaccines
Studies have shown that sleep improves the effects of vaccines. It also demonstrates sleep’s benefits for adaptive immunity [4].
Vaccines work by introducing a weakened or deactivated antigen to the body. This will then trigger an immune response. In this way, immunizations teach the immune system to recognize the antigen. It also attacks that antigen.
Sleep is an important factor that helps determine the effectiveness of vaccines [5]. Studies show that when a person doesn’t sleep after a vaccination weakens their immune. This comes from the studies of vaccines for hepatitis and swine flu. In some cases, this reduces the vaccine’s protection and may even need a second dose of the vaccine.
Trouble sleeping?
If you’re having trouble sleeping, try limiting screen time for an hour before bed. The blue light emitted from your phone, TV, and computer may disrupt your circadian rhythm. It is your body’s natural wake-sleep cycle. Other sleep hygiene tips can be darkening, using a sleep mask, and going to bed at the same time every night.
2. Stay hydrated
Hydration doesn’t protect you from germs and viruses. But preventing dehydration is important to your health.
Our immune system is dependent on the nutrients in our bloodstream. And our bloodstream is composed of water! If we don’t have enough water, we cannot transport nutrients to each organ system.
Staying well-hydrated is also very important for detoxification pathways. It increases lymphatic draining in our body. And makes sure we are clearing out any foreign invaders and other waste materials. Dehydration can contribute to muscle tension, headaches, low serotonin production, and digestive issues.
The easy rule of thumb for how much water to drink is the smallest of half of your body weight in ounces of water. This means that if you weigh 150 pounds, you need to drink at least 75 ounces of water daily. If you drink a cup of coffee – drink an extra 1 cup of water.
3. Eat more whole plant foods
An astounding 70 to 80 percent of your immune system resides in your gut. The immune system is separated from the 100 trillion microbes of your gut microbiome by a single layer of cells a fraction of the width of a strand of hair. The two are in constant communication.
A strong microbiome empowers the neighboring immune cells for optimal function. The foods that are highest in fiber are whole plant foods, including vegetables, fruits, whole grains, legumes, nuts, and seeds.
Instead of focusing on a single micronutrient, like vitamin C, it’s important to eat a wide variety since they contain different vitamins, minerals, antioxidants, and phytochemicals that work in synergy.
These whole foods also contain antioxidants that decrease inflammation by combatting unstable compounds called free radicals, which can cause inflammation when they build up in your body at high levels. Chronic inflammation is linked to numerous health conditions, including heart disease, Alzheimer’s, and certain cancers.
4. Exercise more
Improvements in immunity due to regular exercise of moderate intensity may be due to reductions in inflammation, maintenance of thymic mass, alterations in the composition of “older” and “younger” immune cells, enhanced immunosurveillance, and/or the improvement of psychological stress. Indeed, exercise is a powerful behavioral intervention that has the potential to improve the immune [6].
We do not know exactly if or how exercise increases your immunity to certain illnesses. There are several theories. However, none of these theories have been proven. Some of these theories are:
Physical activity may help flush bacteria out of the lungs and airways. This may reduce your chance of getting a cold, flu, or other illness.
Exercise causes a change in antibodies and white blood cells (WBC). WBCs are the body’s immune system cells that fight disease. These antibodies or WBCs circulate more rapidly, so they can detect illnesses earlier than they might have before. However, no one knows whether these changes help prevent infections.
The brief rise in body temperature during and right after exercise may prevent bacteria from growing. This temperature rise may help the body fight infection better. (This is similar to what happens when you have a fever.)
Exercise slows down the release of stress hormones. Some stress increases the chance of illness. Lower stress hormones may protect against illness.
5. Limit added sugars
Many experts say that sugar is one of the most harmful substances we can ingest. Take a look at Western culture, where obesity and diabetes are on the rise.
According to the American Heart Association, the limit for added sugar should be no more than six teaspoons of sugar for women and nine teaspoons for men (One teaspoon is 5g). In the United States, the average person consumes more than 126 grams of sugar per day!
Sucrose is the scientific name for sugar. Plants naturally make sucrose through photosynthesis. The sucrose molecule is made up of two parts: glucose and fructose. Fructose is not needed.
Fructose can only be metabolized in the liver; any excess is converted into fat, which is then stored in the liver. A prevalent form of fructose is high fructose corn syrup.
A big impact at that – immune function decreases for hours after sugar is consumed. A research study was done by Loma Linda University in which participants were fed different forms of sugar and found that the effectiveness of white blood cells (our immune cells that fight infection) decreased up to 50% after 1-2 hours of eating sugar, lasting up to five hours!
6. Eating more fermented foods or taking a probiotic supplement
Fermentation is an ancient technique of preserving food. Fermented foods are rich in beneficial probiotics and have been associated with a range of health benefits — from better digestion to stronger immunity. These foods include yogurt, sauerkraut, kimchi, and kefir.
Research suggests that a flourishing network of gut bacteria can help your immune cells differentiate between normal, healthy cells and harmful invader organisms [7].
A systematic review provides evidence from a number of good-quality Respiratory tract infections that probiotics reduce the duration of illness in otherwise healthy children and adults.
Not to mention many fermented foods are rich in vitamin C, iron, and zinc — all of which are proven to contribute to a stronger immune system.
7. Manage your stress levels
Managing your stress levels and anxiety is key to your immune system. Evidence is tracing the pathways of the mind-body connection. For example, chronic feelings of loneliness can help to predict health status – may be because lonely people have more psychological stress or experience it more intensely and that stress, in turn, tamps down immunity [8].
Short-term stress can enhance the acquisition and/or expression of immunoprotective (wound healing, vaccination, anti-infectious agent, anti-tumor) or immuno-pathological (pro-inflammatory, autoimmune) responses.
In contrast, chronic stress can suppress protective immune responses and/or exacerbate pathological immune responses.
Activities that may help you manage your stress include meditation, exercise, journaling, and yoga.
In Conclusion
These healthy lifestyle practices can lessen the intensity and duration of your symptoms when you do catch a bug. Getting sick and getting better is part of a healthy life. The more you can build up that memory of different viruses, the more likely your sickness is to be uneventful.
Get to know more about boosting our immune system by watching the full video of Ep. 91 here 👇👇👇
TIMESTAMPS:
00:00 – Intro 00:10 – Welcome to the show 00:53 – Today’s episode 02:05 – No empty promises for the new year 03:55 – Lockdown benefits 07:08 – Get Enough Sleep 18:13 – Staying Hydrated 23:47 – Eating More Whole Food 29:40 – Exercise More 34:38 – Limiting Added Sugars 41:15 – Eating more fermented foods or taking probiotics 45:08 – Managing Your Stress Levels 52:06 – Conclusion 52:40 – End of show
In this episode, we are going to cover self-care, burnout, and mental health.
Aleksandra Zubek is currently in a clinical psychology counseling internship. We discuss Mental health, self-care, depression, and burnout during COVID.
1 in 5 U.S. adults experience mental illness each year
1 in 20 U.S. adults experience serious mental illness each year
1 in 6 U.S. youth aged 6-17 experience a mental health disorder each year
50% of all lifetime mental illness begins by age 14, and 75% by age 24
Suicide is the 2nd leading cause of death among people aged 10-34
These are some of the questions we answer with Aleks
What is burnout?
What is self-care?
Why do you think people see it as selfish? Is it selfish?
Because if your cup isn’t full, you can’t give more.
How can we promote our self-care during covid? What can people do?
Ever thought about what you do for yourself that makes you feel good?
Whether it’s going to do a face mask, reading a fun novel, or going on a 10-minute walk.
How can someone figure out what makes them feel good? Let’s take, for example, someone with depression that just can’t find something to be happy about. How can they find that spark, or how can we help them find it?
Drug overdoses were on the rise in 2020; where can they stem from?
Annual prevalence among U.S. adults, by condition, top 3. Can we touch upon each? What they are, their symptoms, whos at risk, how it develops, best approaches?
Anxiety Disorders: 19.1% (estimated 48 million people)
Major Depressive Episode: 7.8% (19.4 million people)
Posttraumatic Stress Disorder: 3.6% (estimated 9 million people)
Depression
Learn more about your mental health by watching the full video here 👇👇👇
TIMESTAMPS:
00:00 – Intro 00:18 – Welcome to the show 00:43 – Guest Intro 01:17 – What is Burnout? 02:45 – Asking patients what is one good thing they can do for themselves today 03:33 – Signs That You’re Burnout 04:43 – Can burnout lead to depression? 09:00 – Talking to patients over Zoom or video calls 11:20 – Long-term consequences of the pandemic on our mental health 18:39 – In what ways can nurses promote self-care to prevent burnout? 22:23 – Compassion Fatigue 27:22 – Are people seeking drugs more now than before? 29:50 – How to help people who are in isolation? 32:30 – What would it be if we could change something in the mental health department? 36:30 – Favorite psychologist – Irvin Yalom 40:34 – Mimicking behaviors 43:00 – Tips to decrease anxiety/depression 44:20 – Wrapping up the show 44:44 – End of show
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