Seeing Light at the End of the Tunnel: 5 Reasons To Be Hopeful During this Corona Crisis, With Dr Dilraj Kalsi of the Hippocrates Lounge

Everyone is talking about mindfulness and meditation nowadays but it’s unclear until you try them what value they may have. Now you can integrate them as a morning boost, evening pick-me-up or nighttime relaxation technique and figure out which form of meditation or mindfulness works for you. There is not just one way to go about so feel free to experiment and find what gives you peace.

As a part of my series about the the things we can do to remain hopeful and support each other during anxious times, I had the pleasure of interviewing Dr Dilraj Kalsi from Hippocrates Lounge.

Dr Dilraj Kalsi is a London-based MD who uses Lifestyle Medicine and Digital Health to empower patients to prevent and reverse illness. He is Founder and Lifestyle Doctor at Hippocrates Lounge; a Lecturer in Digital Health at the University of Warwick; and publishes regularly on Shared Decision-Making with colleagues from the University of Oxford, where he went to medical school. He supports companies to optimize workforce health and productivity (especially currently with remote working), as well as patients with Rheumatoid Arthritis, Diabetes and IBD.

Thank you so much for doing this with us! Our readers would love to “get to know you” a bit better. Can you share with us the backstory about what brought you to your specific career path?

Back in 2015, my mum came to me one morning with swollen, tender, almost purple knuckles that were stiff, especially in the morning. My heart sank as I realized what we were dealing with. I was a 5th year medical student at Oxford and I was on Rheumatology rotations at the time. Rheumatoid Arthritis is an autoimmune condition where the immune system attacks your joints, most commonly in the hands, on both sides of your body, causing swelling and tenderness of the joints with a characteristic stiffness lasting about 30–60 minutes in the mornings and improving over the day. Every patient I had seen on the wards had joint deformities in their hands stopping them even buttoning their shirts. I feared the worst, and mum’s diagnosis was confirmed a few weeks later.

Medical school taught me that RA is a chronic deteriorative condition that will get worse but for which we try to limit flare-ups by using drugs which suppress the immune system. These drugs come with plenty of side effects, and mum was adamant she did not want a lifetime of them. We looked at it as a family and my brother suggested a variation of the Paleo Diet tailored to Autoimmune Disease. Mum saw a nutritionist too and got some supplements. I was extremely skeptical but within 3 weeks her symptoms had calmed right down. Even then her Rheumatologist, who I happened to be on a medschool placement with at the time, gave us a lecture in which he asserted while looking at me that ‘diet plays no role in Rheumatoid Arthritis’. With every blood test her inflammatory markers, anti-CCP levels and Rheumatoid Factor came down. A year later her blood tests were completely normal and after 18 months she was able to eat normally again. In her case no drugs were required. 5 years later she has had no flare-ups and her new Rheumatologist even acknowledges her diet may have reset her gut microbiome, which we now understand to be linked to rheumatological conditions.

As you can imagine this challenged my whole paradigm and understanding of Medicine. I studied Functional and Lifestyle Medicine and went on to found Hippocrates Lounge, to support others in undertaking journeys like mum’s in the fight against chronic illness. Meanwhile I have always had a creative streak, studying Medical Innovation across the US while at medschool and doing a Biodesign course at Oxford. This has given me the foundation to lecture the first generation of Digital Healthcare Scientists at the University of Warwick. Communication is a key facet of what I teach there, and underpins the most satisfying moments I experience as a doctor, hence I continue to publish on Shared Decision-Making with colleagues from Oxford. True Evidence-based Medicine encompasses scientific research, clinical experience and patient values. Shared decisions incorporating patient values are the way to achieve this. All of my work looks to leverage lifestyle change and digital health to empower patients.

Is there a particular book that made a significant impact on you? Can you share a story or explain why it resonated with you so much?

As surprising as it may sound, I’ve never been a big reader. But one of the most inspiring books I’ve read is Blink: The Power of Thinking without Thinking by Malcolm Gladwell. So many anecdotes in that book stand out in my memory with poignant themes that resonate with me even today. For those who have not read Blink, it is about ‘thin slicing’; a concept where we use our intuition or ‘right’ brain to quickly come to (often) correct answers that would have taken our logical ‘left’ brain much longer to compute. A great example in the book is Vic Braden, a tennis coach who always knew when a player would serve a fault but could not explain it. He uses such examples to argue that given time learning a craft we can intuitively understand it more deeply than at a conscious level. Applying that to my work now, many patients intuitively understand contributing factors to their illness, what makes it better and what makes it worse, but cannot always articulate it. Similar to the examples in Blink, the evidence is not always there to back it up but we have an obligation to harness these patient insights so long as they do not compromise safety.

Another example in Blink is a study showing that surgeons who spoke to patients with a lower tone of voice tended to be sued more often. We are in an age where we are transitioning from a paternalistic, doctor-led model of care to patient-centred care. We have talked about patient-centred care forever, but to truly practice it we have to communicate all of the risks and benefits of clinical decisions to patients in a way that they can understand them. We can then work together to incorporate their value set and come to aligned decisions.

Moving on to Gladwell’s more recent content, his Basement Tapes: Revisionist History podcast has 2 episodes at the end of season 2 which takes us through the journey of how animal fats were demonized culminating in their removal from McDonalds and other fast foods through to how interrogation of the original study data which supported limitation of animal fat actually shows reducing consumption of it does not alter mortality. This really typifies to me how we have to be honest and clear about how far scientific research goes, especially what we do not know, who it applies to and who it does not. We all need to be willing and able to understand it for ourselves in order to make health decisions that apply to us as individuals.

Ok, thank you for all that. Now let’s move to the main focus of our interview. Many people have become anxious from the dramatic jolts of the news cycle. The fears related to the coronavirus pandemic have heightened a sense of uncertainty, fear, and loneliness. From your perspective can you help our readers to see the “Light at the End of the Tunnel”? Can you share your “5 Reasons To Be Hopeful During this Corona Crisis”? If you can, please share a story or example for each.

Healthcare is actively embracing telehealth, improving access to and convenience of care

The need for physical distancing means that telehealth is being embraced globally like never before. This means that beyond the crisis, healthcare workers who previously felt very uneasy about new ways of working will be adept in using these technologies. This means improved access to care for all patients, as you can video call a doctor anywhere in the world at any time. Moreover doctors will become more aware of tools relevant for their patients and will be able to arm you with the best digital resources for whatever conditions you have. The Cleveland Clinic, for example, with sites in Ohio and Florida, will log over 60,000 telemedicine consults in March, despite previously averaging 3,400 per month. You may think this only applies to younger, tech-savvy patients but Medicare is now covering telemedicine for seniors and many digital health companies like Echo, an app for prescription refills, are one of a number of companies actually reporting their most engaged patients to be over 60:

Usage of Echo by age in March

Hygiene practices are generally good practice and have benefits to the healthcare system

All of the hygiene advice in terms of washing hands, avoiding touching your face and controlling how you sneeze and cough is all good practice for now and beyond the pandemic. A UK nursing colleague of mine said that food poisoning cases are down in her hospital by 50% and it will be down to people improving their hygiene practices, particularly in food preparation. The same advice taken more seriously by the public in the long term can protect whole populations against many conditions, including flu which kills up to 650,000 people globally per year.

Remote working is being actively embraced meaning we can focus on life:work balance and not work:life balance

While the economy is being hit very hard by the crisis, every company is having to embrace remote working. Long before the crisis, Gallup research estimated that 43% did some form of remote work in the US, meaning there is plenty of experience to support it. For employees while there may be job uncertainty there is also the opportunity to optimize life:work balance rather than work:life balance. What I mean by this is that now your life actually centers around you and your home, you can build the lifestyle you want, involving the people you care about most and prioritizing everything you really want to prioritize. All the time you would have spent traveling can now be invested in yourself and your loved ones.

People now have to take ownership of their health, which is important for any condition

As scary a time as it is, there has long been a need for each of us as individuals to better understand our health and healthcare. There are patients who are not ‘activated’ meaning they are very passive in their care and let the clinicians do everything, and there are those who are fully activated, know a great deal about their health and even educate others. Greater activation is linked to better health outcomes. Now we have a burning need to activate, we should take the opportunity to think critically about all of the information we receive about health and learn the skills we need and gather resources we can trust to help us find better answers and determine better actions as a result. These will help us now and in future.

You can optimize your entire lifestyle: how you eat, move, think, sleep and relate

There are lots of difficulties about self-isolation and social distancing; however it also presents so many opportunities. Every lifestyle change we’ve left on the backburner because of work we now have the time to implement. Moreover they will all help us to be more productive and deal with the anxiety the corona outbreak evokes. Here are some ideas for you:

Learn to cook and eat healthily daily

Lots of people do not eat well simply because they regularly eat out and do not have the time or interest to cook. Being at home and with restaurant closures it is unsustainable to continuously eat take out (though make sure to support local when you do). Cook from scratch using raw ingredients, do it with whoever you live with to make it easier and try at least one new dish per week. In a week or two you will be into a great healthy eating routine. No one can disrupt it either: it’s not like anyone can invite you out to McDonald’s!

Get daily movement in multiple ways

Given that you are in complete control of your time at home, you can create multiple opportunities to get movement throughout the day. You can go for a morning walk, you can use a desk cycle while working, you can do a yoga workout on the floor or a calisthenics workout in the garage. There are loads of fitness professionals even doing free group workouts online at this time and you can meet some new people in the process.

Practice all those de-stressing techniques you learned but never implemented

Everyone is talking about mindfulness and meditation nowadays but it’s unclear until you try them what value they may have. Now you can integrate them as a morning boost, evening pick-me-up or nighttime relaxation technique and figure out which form of meditation or mindfulness works for you. There is not just one way to go about so feel free to experiment and find what gives you peace.

Keep a regular sleeping pattern for once

There are so few external factors now that you will be able to control your daily routine. You can easily do all the little things that add up to a great night’s sleep. Keep a regular bedtime, create a bedtime routine you can do daily, limit caffeine, get lots of natural light in the day and minimize light exposure at night including screens, try an eye mask and ear plugs if need be.

Reconnect and regularly maintain your relationships

There has never been a better incentive to reconnect. Social media has done many great things to connect us but most of us have pulled away from real connection, hiding behind a WhatsApp message and fearing a call because we might actually have to speak on-the-fly rather than craft our text response. From an evolutionary perspective, we are creatures that rely on social connection, culture and community and that shows in modern research that demonstrates loneliness is as unhealthy as 15 cigarettes per day. Reconnect with your loved ones, call them regularly, ideally by video, and maximize the quality connection you have in that time rather than waiting for the next eventual time you see them.

From your experience or research what are five steps that each of us can take to effectively offer support to those around us who are feeling anxious? Can you explain?

Check in regularly, practice active listening and know who to call

If they have diagnosed anxiety, make sure everyone involved knows a helpline to call in a crisis. If they are undiagnosed and you are concerned, fill a GAD-7 questionnaire with them and if they are moderately anxious or worse, seek medical advice. Safety always comes first and should never be compromised.

Check in with them regularly via call rather than text for more meaningful connection. Use active listening and try to be non-judgmental. The power of silence cannot be underestimated and insights are more powerful when they come from the individual themselves rather than being told to them.

Find their grounding tools for the short and long term

When anxiety takes hold it starts to be a swarm of thoughts that act like an overwhelming vice on your head. People need tools to help ground them and snap them back to reality. A really useful way to do this is to have 3 statements of fact in mind about oneself almost like a mantra. ‘I am intelligent; I am strong; I am kind’.

When they are less overwhelmed you can go further and explain why the statement is true. ‘I went to university; I am intelligent’. The key is to create something that is quickly actionable when they start to feel anxious that is grounded in truth or belief strong enough to overcome the anxiety in the moment.

For the long-term, work to find a daily stress-coping tool that they resonate with. Anything from meditation to mindfulness to music. They need a daily stress reliever to unroot the anxiety in the longer term.

Monitor it using the simplest tools available

Anxiety as a concept might imply a condition and a discrete time frame for it but the reality is that it is very dynamic. As such it is of much more value to understand and monitor it over time. The GAD-7 questionnaire mentioned above is freely available and can be used to diagnose anxiety but also to monitor it.

There are lots of other useful tools available such as Headspace, Calm and Wysa that can help improve mental health and monitor mood. Daylight is another platform currently in the research stage, leveraging digital CBT to manage anxiety. Find a tool that suits the individual you are helping and stick with it for at least a month for it to have impact.

Identify triggers and device strategies to control them, including hysterical information about coronavirus

The most useful aspect of monitoring anxiety is that you can trace back to triggers for when it was worse and develop coping strategies. For most people right now, the anxiety is going to be focused on the coronavirus. The best coping strategies for this are to control the information sources you use. There is a lot of information flying around social media as well as spam on WhatsApp. Limit yourself to trusted resources like the CDC and time box your updates to a maximum of 1 hour per day.

I have personally collated some key information and resources available via a WhatsApp line, including a self-triage tool, a symptom monitor, infographics I have made on COVID-19 and social distancing and the WHO WhatsApp line for real-time updates. These combined with your own government updates is enough to keep you informed and updated without being overwhelmed.

Do daily activities together, especially healthy ones

There are multiple daily opportunities to improve yours and others mental states that are worth taking advantage of:

• Eating well can improve your mental state
• Long term mental health issues create chemical imbalances in the brain, hence many antidepressants act by increasing the effect of the hormone serotonin. Eating well creates an environment that your brain can recover from these imbalances. Our brains love healthy fats so you can try minimising complex carbohydrates and getting more oily fish and avocado to start with. Cooking with others and sharing delicious recipes to support each other will make this more sustainable.
• Buddy up for workouts and challenges
• Even if you are not together you can share workouts with friends and challenge each other. Exercise increases brain-derived neurotrophic factor, a brain signal that increases the formation of new connections between cells.
• Do some group learning together
• There are loads of fitness, yoga and meditation experts doing free online sessions on Instagram and Facebook. Find one you like and join in. You might even find a community you both gel with. Better yet, you can tackle stress together head on with a course like this.
• You can socialize pretty much anything
• If you like playing or listening to music, share that with friends who enjoy the same. If you enjoy video games, play online together. If you like board games, you can even try Houseparty.

What are the best resources you would suggest to a person who is feeling anxious?

1. Access to local mental health services including a crisis line in case of emergency
2. GAD-7 questionnaire for self-diagnosis and monitoring
3. This stress management course to understand stress, how to manage it and its opposite (flow) and how to get there
4. Apps such as Headspace, Calm, Wysa and Daylight for self-monitoring and self-management
5. Trusted coronavirus resources such as the CDC or as collated here

Can you please give us your favorite “Life Lesson Quote”? Do you have a story about how that was relevant in your life?

“Every cloud has a silver lining”, you may just not be able to see it yet. In my experience, there is no negative experience I have had that in retrospect has not had some sort of positive silver lining. We need to maintain this perspective to get through the pandemic.

My own example would be a research grant proposal I have been working on for months has come to a halt like all non-essential research in favour of focusing on coronavirus. In actuality what this means for the project is that we can take our time, rather than rushing to the grant deadline, to understand the relevant patient groups, establish stronger relationships with our research partners and define very clearly the project plan so we are in the best position possible to make the most of the project when we get to it.

Do not get me wrong, there are definitely times when it is not clear what the silver lining could be; but I have found that those instances work themselves out over time. Life has a funny way of nudging you towards where you need to be through whatever challenges you are given.

You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

Empowering every individual to understand and take ownership of their health. People need to be given the resources to really understand the risks, benefits and implications of all of their health decisions. Health needs to be taught like Maths, Literacy and Science as a default. But not just health facts. We have to be willing to be nuanced, accepting the gray areas for what they are but giving people the tools to navigate them and come to their own decisions.

To me this is the path to deepening our understanding of long-term illness such that we can better manage, prevent and reverse it. Patients have a depth of understanding and experience of their disease individually that we as clinicians lack insight into. The more we can bridge that gap the greater opportunity there is to benefit individuals through personalized medicine and populations through shared learnings.

What is the best way our readers can follow you online?

The best place to follow all of my activities is via my website, where you can read my blog and sign up for regular updates. You can also follow me on Twitter, Instagram and Facebook.

Thank you for these fantastic insights. We wish you only continued success in your great work!

About the Author:

Dr. Ely Weinschneider is a Licensed Clinical Psychologist based in New Jersey. Dr. Ely specializes in adolescent and adult psychotherapy, parenting, couples therapy, geriatric therapy, and mood and anxiety disorders. He also has a strong clinical interest in Positive Psychology and Personal Growth and Achievement, and often makes that an integral focus of treatment. An authority on how to have successful relationships, Dr. Ely has written, lectured and presented nationally to audiences of parents, couples, educators, mental health professionals, clergy, businesses, physicians and healthcare policymakers on subjects such as: effective parenting, raising emotionally intelligent children, motivation, bullying prevention and education, managing loss and grief, spirituality, relationship building, stress management, and developing healthy living habits. Dr. Ely also writes a regular, nationally syndicated column about the importance of “being present with your children”. When not busy with all of the above, Dr. Ely works hard at practicing what he preaches, raising his adorable brood (which includes a set of twins and a set of triplets!) together with his wife in Toms River, New Jersey.