Life Changing Moments: Discipline and Self Care, with Dr. Alexandra Lukianoff

[1:06] There are times in our lives that change the way we see the world. Navigating these challenges can take insight, trusted confidants, or even a coach. Let’s, explore those moments. In this companion podcast to Rx for Success, we will discover ways to learn and write our own success stories together. I’m Dr. Dale Waxman, a physician coach with MD Coaches, and this is Life-Changing Moments.

[1:34] Music.

[1:41] All of us can recall incidences in our lives that significantly changed its trajectory.

[1:47] Sometimes an event generates a physical challenge that creates an obstacle to forward progress.
My guest today, Dr. Alex Lukianoff, experienced a substantial setback as a result of a car accident and after a 10-month period of multiple surgeries and recovery, recovery, return to her professional path of surgical training, only to have another physical malady, probably related to the same car accident, hinder her forward progress.
Her story of physical recovery and return to medicine is chronicled well in Rx for Success Podcaster No. 157, and I encourage you to take a listen, it’s fascinating.
I invited her on this podcast to further explore the inner recovery that also occurred during, this time and how that has informed her life today.
Alex, despite the setbacks, completed general surgery training, then worked clinically and in leadership positions in wound care, and has recently shifted her focus in addition to wound care onto wellness medicine.
So Alex, welcome to Life-Changing Moments.
Thank you so much. I’m so happy to be here.
Well, you know for people who may not have heard the RX for success podcast, they may be wondering how you’re doing I mean, I’m sure there’s some imaginations going about, you know, if you had 10 months of recovery and then another setback, How are you physically right now?

[3:16] So physically right now, I’m better than I have been probably since my 20s. I you know did.

[3:24] Have definite physical setbacks and I I really, when you have those kind of injuries, you kind of lose faith in your abilities.
You know, you have a different relationship with your physical being.
So I really, I got pretty down for several years, but within the past year, I have given myself time, to increase my fitness and my physical wellbeing in a way that I haven’t done before.
And I can tell you, honestly, I am so much better off for all of it than I think I literally have been since before I went to medical school when I was 30.
So life is pretty good at the moment, especially in that way.
Well, that’s good. And I may wanna pick your brain a little bit more about that because I wanna get into ways that we, sounds like you have been doing a lot of thinking about how do I stay well?
How do I, what are some of the ways in which I can meet the professional demands but also have good self-care.

[4:30] So let’s put a pin in that and come back to that if that’s okay with you. Absolutely. Awesome.
So also for our listeners, could you just tell us what you’re doing right now, professionally what you’re doing right now.
So professionally, I’m still seeing wound care patients up at St. Thomas Midtown at the Craig Center two days a week. I still love wound care. But what I was seeing in that practice is that patients really suffer, especially I think to an extent wound care patients, their malady is not just what you’re seeing, it’s everything else that’s going on with them mentally and physically.
And I could not find psychiatric help for my patients. It would take about nine months to to get them in to see a psychiatrist.
And I could not find anybody to really help with weight loss unless they had certain insurances, certain payers.
So between that and my own journey, I’ve pivoted towards opening a wellness practice.
I call it Taproot Total Wellness, and the name literally came to me in a dream, but it’s so perfect because the way I see it is I’m helping people start from the ground up.
And the taproot is the route that initially goes down into the ground.
You know, you can’t see it from above. So you can’t see the inner work that’s going on and what that represents.
But it’s nourishing the rest of the being until it’s ready to bloom forth.
So I’m starting where I can start, which is with weight loss.

[5:52] And, you know, I’m really doing a full concierge, really supportive, using the tools that I’ve gained over the years.
And I’m doing some skincare and Botox because I think some of that definitely goes together.
It’s also something that I can.
I do on my own right now in a teeny tiny little practice because the ultimate goal is to expand out into a single destination wellness retreat where I’ll have nutritionists and yoga and meditation and hiking trails and horses and you name it.
I just, I want it to be like the Canyon Ranch in Middle Tennessee for people to come and tap into what’s already there and be able to bring it back home with them.

[6:35] Wow, that’s very visionary and that’s awesome. And I wish you well.
And I know you and I chatted just a little bit before.
We’ll likely get to meet each other in person because my daughter lives in the same town that you’re in, Middle Tennessee. So I’m looking forward to watching that journey as it moves forward.
You mentioned that inner work and that’s something that I also heard in that RX for Success podcast with Randy.
And so I wanna kind of go right, get right into that, that particular part of the story.
So for people who didn’t hear the story, you were a surgical resident, you had a spine injury as the result of being rear-ended while in your car, you recovered from that and then you went back to work.
And so what I’d like to do is play a segment from that podcast in which you talk about those first few days back.
So I’m going to go ahead and play that now. He was trying to get my confidence back under me.
So on my second Monday back, we did an esophagectomy and a Whipple in one day, and I think the next day we did another Whipple, and he’s like, see, you’re back.
So that was- That’s a lot of time stooped over an operating table.

[7:56] It absolutely was and I was exhausted, but I had some more tools in the toolbox than I would have had before the accident. I knew better how to take care of myself rather than not take care of myself.

[8:14] So Alex, I’m curious, what were those tools? How were you, what did you learn during that time, that enabled you to take care of yourself and what were those that you employed?

[8:26] So, I think it was a real shift where in the time before accident, B.A., I looked at wellness as the external appearance of it all, like if you’re taking care of yourself, that means you look nice, your clothes fit well, you’re a certain size, and your hair looks good.
And then when I had the accident and I did not know, was my right leg going to work?
Was I going to be able to return to training, I started to realize that the only thing I really could control ever in life was what was going on in between my ears.
And my younger brother was a few steps ahead of me on that and introduced me to some books about Buddhism that had helped him over the years.
So not only did I learn that really the only thing in the world that I can control is what goes on between my ears, it was even a step beyond that where it’s like, okay, I really can’t even control my thoughts, but I can become the observer of my thoughts, and let them pass, let emotions pass, and maintain that soft and peaceful part of myself that had been pretty ravaged over the years.
So, in a way it was a blessing that I even had the accident because it removed me from my life and it really caused me to take stock of what…

[9:53] When you have nothing else, what is really important. And it really is who you are, how you see yourself. And it’s love. It really comes down to love. So I didn’t love myself at that time, before the accident. And I learned a different way of thinking of what that actually means. It’s not about what you accomplish and what you perform. It’s about how you, what energy you give out to the world. So when it came back to training a year prior, if I had.

[10:25] Back pain, or I was tired, I would have told myself I was being weak in some way or selfish, and I would have been hateful to myself. And you can’t live on that. That’s going to burn out.
Those aren’t tools. Those are weapons. So when I came back, and those were some big days. I mean, I don’t know that in my training prior to that, I had done that many hours of surgery on a combination of physically demanding, but really fine work dexterous cases in a 48-hour period.
So I was in pain, for sure, and I was incredibly tired. But I knew instead of trying to to fight through it and stay up and all the bravado things that we do to ourselves.
I knew I needed to go home. I needed to rest. I needed to be kind to myself.
I needed to take the lessons of the day and just sit with them, have some quiet time and give myself credit for what I had done without it being an ego thing.
You know, really taking an inventory of the day and saying these were good things that you did, girl.

[11:39] Yeah, thank you for that. That was really brilliant. That was a lot.
It was a lot. I wonder if we could unpack a little bit of it.
What I’m hearing mostly, Alex, is a mindset shift.
Absolutely. And as a result of really being intensely with yourself during that, during 10 months of recovery.
Yeah, that’s a great way of looking at it.
And I’m sure some listeners are also wondering when you say, so some of those are mindset shift tools, were there any other practices specifically that were helpful to you to continue to access those tools?
Tools and what did you pull out of your back pocket? I don’t know if at that time I really had set practices like I do now.
It was more of just a mental shift, a different way, you know, a little bit of pivot, a one percent change in thinking that has gotten me to where I am now.
And I will be perfectly candid and say I haven’t done this perfectly and I really, I had some very dark years up until maybe the last year and a half where I don’t think I was remembering any of this, but it’s gradually come back in and I’ve been able to be more kind to myself. And now.

[12:55] Over about the last year. I’ve really gotten into some good meditation and prayer Practices and I love the concept that you know prayer is your conversation with your higher power But meditation is listening to your higher power.

[13:10] And that has helped me tremendously in some real. I mean my life is not giving me a whole lot of breaks I had torn a meniscus about a year ago requiring knee surgery, well, it was a little bit more than a year ago, it was May of 2022.

[13:27] And then I recovered from that back on my feet, you know, back at work and everything, of course, for months. But then in December, I was having this upper back pain that had gradually gotten worse over a few months, thinking I was just needing to get in better shape and get some physical therapy. I was evaluated and we ended up getting a CT scan because of some of the symptoms.

[13:50] And it turns out I had a 15 by 17 by 20 centimeter tumor in my left upper quadrant.
So this past January, I underwent a major, I mean, major abdominal surgery, same dissection as a Whipple.
Fortunately, I didn’t need any kind of pancreatectomy or any of that, but I mean, the recovery was brutal.
And, you know, once again, I was faced with what, what do I have control over in this situation, not a lot.
So fortunately, I started with some of the prayer and meditation practices just prior to that. And I really, really tapped into that energy over the last six months and life.
I can’t say it’s been easy, but it’s been so much easier than it would have been had I’ve not been able to channel the energy into something more positive to sort of lean into to the wellness practice that I’m growing and to really try and have faith that there’s something.

[14:58] Better out there. I have read a lot of Dr. Wayne Dyer and I really I had this sort of picture in my head that we I mean we certainly are, created from and will disintegrate into an energy source and.

[15:16] I think that’s karma. I think that’s our soul and And Dr. Wayne Dyer put it in words that I didn’t have until I started reading his books in that we are a parenthesis.
Our physical bodies are a parenthesis in the eternity of time and the eternity is the energy and we are a physical representation of that during our time on Earth.
So I started thinking, well, I am carrying this energy now, I’m responsible for it.
So I better start showing it a good time.

[15:47] Music.

[15:52] Hi, I’m Rhonda Crowe, founder and CEO for MD Coaches. Here on Rx for Success, we interview a lot of great medical professionals on how they grew their careers, how they overcame challenges, and how they handle day-to-day work.
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[18:04] One of the things that you said, and there’s a lot of wisdom in all the things that you just said, but one of the things that I think is important and easier maybe for some people, maybe for some people, listeners, to get their head around is this reminding ourselves of that simple piece of what do I have control over?

[18:28] Reminding ourselves, do I have control in this situation? What part do I have control over and then what do I wanna do about that?
What do I wanna do about that? If nothing else, people can take that away and then make some decision about what they do have control over.
Oh, absolutely. And it’s a tough realization at first, but whether you realize it or not, it is what you, it is the only thing you have control over. Right, right.
The other thing that’s coming to mind, I wanna back up just a moment, and that is, is you said earlier something about how, you talked about how previous to the accident, some of the ways that you approached your work ways you approach life. I mean, there’s even this story right after the accident about you You, knowing something was not going well with your body, but you went ahead and did some surgeries.
Anyway, and then after the surgery is when you sought some medical attention and I really wanted to bring that story forward because there are so many physicians who will be able to identify with that and.

[19:45] What it’s that all about for us anyway?
Well I think part of it is how I was raised like I’ve always had this side that has been looking towards the, metaphysical and the energy and I think I was like 17 when I read the road less traveled and it started to open that up to me. But I was raised by, you know, World War Two era parents. And I was truly raised to believe that there’s nothing in life that you can’t fix by working harder. And that was, I mean, that’s as much a part of my DNA as my eye color. So yeah, I just thought, first of all, you can’t be a trauma patient. You know, that’s, that’s the other guys, that’s not you. So show up because that’s what we do. We show up for work and operate because that’s what we do. We operate. I mean, I’m sure there was an element of strength in there, but it was really, just denial of what was really going on. And then there was no denying it when I was dragging my foot home. And it was actually one of the senior surgeons who, there’s foul language involved, but she was down at one end of the OR, I was down at the other end, and she could see me, just how I was walking. And I thought I was pulling it off fine, like, I’ll just go home and take an Advil and sleep it off. But she’s like, Lukianoff, what the F is going on with you?

[21:11] But in a caring way, which I think outside of surgery, you can understand that she meant, care in those words. I’m like, I’m fine, I’m fine, I’m going home. And I did go home. And I don’t even know how I drove because I had a stick shift, but I was literally like walking circles around my living room in so much pain that I couldn’t sit, I couldn’t lay down. I was just kind of pacing, like what do I do? And for very unusual of my mother to have heard my voice on the phone and say.

[21:46] Something is really wrong here and she just drove up.
Very unusual for her.
She said, I think she probably called me Daisy, because that’s what she often calls me, Daisy, I think we need to go to the emergency room. It’s like, that is crazy talk, who goes to the emergency room? Not me. So ultimately, yeah, I managed my own trauma. And it was my friend who admitted me and sure enough, there was there was a real injury there. And I was even though I knew I was in terrible pain, I was still surprised that there was a real injury. And that there There was really something that needed to be fixed. So I mean, it’s just a mental block and you know The very idea that you wouldn’t, Show up for work when you’re in your chief your surgery. It just became a completely foreign foreign concept an idea, Are there some lessons to impart to people in?
Medical training or medical profession or any profession for that matter that are, Are prone to that same kind of denial and same kind of work ethic, That’s kind of sacrificial of your own your own health.

[22:54] Yeah, and I’m still learning it and it’s still challenging, but I would say in, Your personal and professional life. Let somebody else take care of you. I, And we cannot be our own physicians, you know, it’s just it doesn’t work that way way. And it’s hard. You have to let yourself be a little vulnerable and a little human.
And it’s not easy. But you have to let other people take care of you. You have to trust in the training that they’ve had to do the right things on your behalf. And that is so contrary to the autonomy and the captain of our ships that we want to be. But life is team sport and you got to let other people play on your team.
So that’s one level, which is being willing to allow others to be helpful to you.
The other piece was just sort of this, you know, for your family, and I’m sure there’s a lot of other families, where there’s, you know, you need to be, like, ready to go into the ICU before you miss school, you know, that kind of thinking.
How do we, what do we do with that when, you know, with that work ethic, like, just suck.

[24:08] It up and go? How do you learn to pay attention to signals that are not to be minimized?
I think it was actually my neurosurgeon who, he gave me guardrails at first, which really, helped in that if you ever have symptoms that are severe or disabling, go to the emergency room.
And then if you have symptoms that last more than three days, get a doctor.
So I think in a way, that was the first time in my life, I was really taught some kind of guardrails around self-care, because prior to that, it was like, take care of it and show up, you know?
So I think in a way, I’ve been able to apply that to other areas of my life.
Like if you’re really so stressed out that you’re losing productivity in spite of trying, like you have to give yourself some rest.

[25:06] If you’re processing the same thoughts over and over again because you’re so stressed, you’ve got to talk to a friend.
You’ve got to take a step back, go take a walk, do something, but powering through all of these things, is just not the answer.
You know, I’ve always worked with mentors in life, so if we could get ourselves some self-care mentors out there, I think we’d be a lot healthier and ultimately more productive and better at what we do.
There’s this challenge of those of us who are working, especially with physicians in this, like you, and working with people around well-being, wellness.
There is this cultural norm that we come last.

[25:54] And the patients come first. And so even taking that step of saying, this chatter that continues to go on in my mind, and I’m still doing the same old thing and I’m getting the same results.
That’s tough to break through and say, maybe there’s another option here. It’s painful, yeah.
Do you wanna say more about that? Well, I’ve been using the two analogies of you can’t pour from an empty cup and if your plane is crashing, you have to put your own ear mask on first.
So, you know, adopting that into your personal life is harder because it feels selfish.

[26:37] And in the true definition of the word, it is about the self, but you cannot give what you want to give to people if you’re not taking care of yourself first.
So whether or not it becomes, you know, it starts from an internal or an external locus, you’ve got to find your way there.
If you truly want to show up for the people in your life that you want to show up for in the way you want to show up for them, whether that’s patients or friends or family or whomever, You know, you’re not going to achieve the goals in the way that you want to if you’re not taking care of your own machinery, if we want to go with that analogy.
If the, you know, spiritual and emotional doesn’t fit the, you know, the narrative going on inside, then the machinery narrative hopefully does.

[27:26] You know, one of the things I’m thinking about as you’re talking is, we also, you and I probably We both have experiences in our life, especially in the medical environment, where what you just said, we actually have lots of evidence that that’s not necessarily true, because we did work and we did power through things.
What’s not there, though, is that that’s not ultimately sustainable.
I think everybody can agree on that.
At some point, you just run out. You just can’t do it. You can’t do it.
And so I think that’s the message that I hope that we’re getting closer and closer to, our early trainees and that.

[28:05] Alex, I wonder if we could turn to more sort of contemporary.
You mentioned earlier, there’s been some, you’ve had a lot of challenges, especially the one that you just mentioned most recently, a very, very difficult physical challenge.
You mentioned the word, there’s been a lot of dark times, and that you also are feeling like you’re back on track with respect to your wellness.
Most of us, once we adopt wellness, and we haven’t been doing that for most of our lives, are going to fall off the wagon.
And so, I’m wondering if you have something in your story about how you got back on, what allowed that to happen and what suggestions you have? Yeah I think it was just a constellation of things coming together. I was I was sick of feeling the way I was feeling and I knew deep down that things weren’t as I wanted them to be myself or you know the way I was interacting with the world and you know when I went to have this knee surgery a year ago something had happened with my company that had me really upset on my way into surgery and I’m like I shouldn’t need to be thinking about this right now. So my younger brother on that moment in that moment said you know what you need to find a way to be your own boss. So that’s where some of it started to shift and it was just sometimes it’s It’s just simple words, simple concept that.

[29:33] It kept circling, cycling through my brain. And I was, my initial reaction was like, I can’t do that.
I’m a, I’m a physician. I mean, who cares? I can’t do that. And, but my brain wouldn’t let it go.
So it gradually over the next few months became wellness. I could do that. I want to help.

[29:52] You know, this is, this is great. And I want to become an expert of it in my own life.
So it was cart and horse happening kind of at the same time and some of it is I made in my diet and what I was eating I made big changes quickly but you know it gave me results and I felt so much better within a few weeks that it was kind of easy to maintain those changes but for exercise it was painful and And that’s where the 1% changes came in, where I have a field at the end of my neighborhood that’s only about a half mile walk around trip. And I was struggling with knee and back pain, even to do that. But I just kept showing up and trying to listen to myself, you know, what, what is good pain? What is bad pain? You know, the neurosurgeon definitely helped me with those parameters.
Nothing was ever disabling. I was increasing my conditioning. So in a year’s time, I’ve gone from barely being able to walk half a mile and I couldn’t touch my toes when I was trying to do do yoga to now I basically have a daily yoga practice and.

[31:05] Starting to train for a half marathon for next May. Wow. Holy moly.
So, but really I am being literal when I say I could barely walk five minutes a year ago without an ache or a pain.
My cardiovascular health wasn’t there. I was winded. Walking, what now, would be like way less than my resting pace. So I.

[31:27] Think it’s easy to lose momentum.
And one thing that I think I heard over and over again was, you can’t rely on motivation.

[31:38] You know, discipline has to kick in where motivation lags. And, you know, discipline, I think I had a cold relationship with it when I was younger, like that meant things had to be severe and militant and prescriptive. But really, discipline is the ultimate form of self love.
It’s the way in which we take care of ourselves. And it’s it’s showing up for yourself.
There is discipline in listening to your body’s cues, and there is discipline in taking care of your mental health. There is discipline in remembering to show up for your yoga, your meditation, and your prayer. So yeah, discipline is not a cold prescription like I used to think it was. It’s a, like I said, it’s the highest form of self-love, I think. There is so much wisdom and inspiration in what you just said. And I don’t know if you have anything left in there, but I want to invite you as we’re kind of closing out the conversation. Is there anything that I haven’t asked you about within this realm that you are thinking about that you’d like to impart to our listeners?

[32:47] Wow, that’s a big question. I think I just like to encourage people, you can change.
Your whole life can change for the better, for the worse, but you always have a choice in how you see it and how you respond to any of the changes that are going on.

[33:10] And you know, I was raised Catholic. I really lost faith.
I lost faith more in the church than I did in, you know, Jesus’ teaching, the Buddhist teaching. They’re pretty similar in a lot of ways.
So I called myself a Jibudist for a while, but I didn’t have any practice.
I had a certain amount of faith in spirituality, but no practice.
And it’s really in getting back into daily reflections, prayer, you know, finding a way to engage in your spirituality on the regular that I think has been one of the biggest mental shifts and one of the biggest blessings in my life.
So it’s a very different relationship than I had with spirituality or the church when I was certainly when I was growing up.

[33:54] But man, I think it’s saving my life, so don’t be afraid of the spiritual realm, people.
Really nice, nice ending words for us, in addition to all the other great wisdom that you’ve imparted here today.
So Dr. Alex Lukianoff, thank you so much for being on Life-Changing Moments, and I look forward to hearing how you are growing that vision that you have for yourself in middle Tennessee and bringing that forward to the rest of the country as well.
Oh, well, thank you so much for that. You’ll have to come by and visit. I will.
Thank you again. Thank you, Dale. Throughout this conversation with Alex, I kept thinking of this quote attributed to to psychiatrist and Holocaust survivor, Viktor Frankl.
Between stimulus and response, there is a space.

[34:52] In that space is our power to choose our response. In our response lies our growth and our freedom.
Through a few of her life experiences around physical health, Alex was forced to not only slow down, but to be still.
In that stillness, she experienced that space that Frankl talked about and realized the only thing she or any of us can control is what and how we choose to respond to what we have or what life deals to us.
As Alex put it, the only thing I could control was between my ears.
Well this is sage advice and it is definitely easier to say than it is to practice, especially so when we have so much stimulus to respond to.
Though difficult, Alex does gift us a roadmap to cultivate a sense of self-empowerment and well-being.
So here are my takeaways from Dr. Lukianoff. 1.
Frequently examine, especially in times of frustration, what you have control over and what you do not have control over.
Once that is clear, make decisions only about the things that you do have control over.

[36:03] 2. For those of us who are caregivers, we cannot pour from an empty cup. Though many of us have had life experiences that contradict that adage, continuing to give without some sort of self-restoration is just unsustainable, and it’s a significant contributor to compassion fatigue and burnout. Number three, one can’t rely on motivation alone. Discipline has to kick in where motivation lags. Discipline is the ultimate form of self-love. It is how we take care of ourselves. Use discipline also to listen to your body’s cues and in remembering how to show up for the things that keep us healthy. And number four, don’t be afraid to explore the spiritual world. Well, I really enjoyed Dr. Lukianov’s perspective and the wisdom she shared as a result of her life experiences. If, while listening, you found yourself identifying with some of the same challenges she faced before her accident, consider coaching from one of the physician coaches at MD Coaches. We’re there to help. So, for more information, please contact us at mymdcoaches.com. Thank you for listening and be well.