Women In Wellness: Ann Seide of Seide Integrative Health On The Five Lifestyle Tweaks That Will Help Support People’s Journey Towards Better Wellbeing
An Interview With Candice Georgiadis
Resist the urge to measure up to some Instagram image of wellness. Don’t convince yourself that you (or your doctor) failed at making you healthy when you face a devastating diagnosis like cancer or heart disease. It is the nature of being human to become sick and to die: none of us make it out of here alive! Have a provider at your side who brings empathy, compassion, and honesty to your care. It is sometimes in our greatest challenges that we find sources of strength we never knew were possible.
As a part of my series about the women in wellness, I had the pleasure of interviewing Dr. Ann Seide.
Ann Seide, MD, is a former US Navy Lieutenant Commander and board-certified Internist and Integrative Medicine physician with 25 years of experience caring for critically ill patients. Dr. Seide brings her unique skills in mind-body practices, herbal medicine, and a compassion-based communication practice called Council to the bedside, as well as to groups as diverse as police officers and prison inmates. Dr. Seide partners with people seeking wellness, often in the midst of challenging situations. Learn more about her practice at www.seideintegrativehealth.com.
Thank you so much for joining us in this interview series! Our readers would love to “get to know you” better. Can you share your “backstory” with us?
I was raised in the Midwest by remarkable parents who, having never attended university themselves, encouraged me to pursue advanced degrees in zoology, molecular biology and medicine. Their love for each other and the natural world, their respect for marginalized people, and their work ethic all informed the path of my life’s work.
In the US Navy as a doctor, I was privileged to care for active duty and retired veterans. Naval medicine provided a strong foundation of rigorous allopathic training, while allowing me to engage in home visits with patients where I learned the “softer” ways of healing.
Twenty-plus years of practice as a Hospitalist (providing exclusively in-hospital care) brought me face-to-face repeatedly with catastrophic illness. Intimacy with the brevity of life and the importance of presence to this moment led me to deep personal practice which has influenced my medical practice. Whether struggling with the side effects of cancer treatment, or with the heart-wrenching decisions made daily in the ICU, providers need skillful means that extend beyond what conventional medical training affords.
Although I know Western medicine is powerful and effective, I have remained open and curious about other healthcare systems: indigenous healers, traditional Chinese medicine, and herbalism in particular. Being able to view migraine headaches, for instance, from varying perspectives offers up treatment plans that can be far more effective than using Western medicine’s drugs alone. In this example, traditional Chinese medicine might ask a migraine patient about how she expresses emotion and about her menstrual pattern, because a blocked liver meridian is associated with headaches as well as abnormal menstrual blood flow and repressed anger. An indigenous healer might prescribe whole herbs that bring balance to her system, or offer a ceremony in which drumming, smudging, and dancing serve to clear out unwanted influences. Such descriptions often seem “crazy” from a Western perspective, but I find them rich and interesting. Sort of like understanding poetry as an expression of truth, in contrast to factual reporting.
Knowing, however, that not all complementary and alternative forms of medicine are beneficial, I sought out additional training and found the Weil Integrative Medicine Fellowship at the University of Arizona. Focusing on evidence-based therapies, the program emphasizes a healthy dose of skepticism alongside openness and curiosity. This board-certified specialty attracts physicians of all specialties, naturopaths, nurse practitioners, pharmacists, acupuncturists and other allied health professionals, offering me a diverse community with whom I can pose questions and share patient cases. It’s a community that also knows the importance of self-care for those engaged in the caring professions, something of particular importance to me.
In 2013, I lost a dear friend and physician colleague to suicide. Unable to get the help she needed, Shawn left a family and a community of physicians bereft and questioning how this could have happened. She became a touchstone for me as I began to question how we, as providers, might learn better self-care along with being better equipped to care for each other. In 2014, I enrolled in a chaplaincy program at Upaya Institute, focusing my studies on contemplative practices, systems theory and provider wellness. Several years post-divorce, I was in a place personally that quite honestly was not seeking another life-partner, but as fortune would have it I found exactly that! My now-husband, Jared Seide, was also in the chaplaincy program. His focus was on bringing a mindfulness-based dialogic practice called Council to deeply suffering populations, and right away I saw its relevance to burned-out providers of healthcare and first responders. Over the past 8 years, I have been privileged to join Jared in such diverse places as Rwanda, Auschwitz, Bosnia, Bogota, as well as prisons in California, facilitating Councils and seeing how deeply needed this practice of heartfelt speaking and listening is.
To sit in a circle among people with whom I might not identify, listen to their whole story without feeling the need to agree or disagree, and be able to speak what’s present for me in the moment is a wholly different way of communicating that what we were trained to do in medicine. (Studies show that, on average, physicians listen for a brief 11 seconds before interrupting a patient!) For me, the practice of Council took meditation “off the cushion”; Jared and I often refer to it as “mindfulness 2.0.” The foundational Zen Peacemaker tenets of Not Knowing, Bearing Witness and Loving Action become very real for me in this practice, whether I’m formally training a group of LAPD officers or simply sitting at the bedside of someone diagnosed with stage 4, inoperable cancer.
My practice of Integrative Medicine approaches health from the physical, mental, emotional, and spiritual perspectives. For me, being truly integrated means to leave nothing out…not my rigorous Western medical training, nor my experience as a Council Trainer, nor my interest in other health systems. I invite my patients into the same experience of leaving nothing out, to enter into each encounter curious and willing to explore together what wellness means for them.
Can you share the most interesting story that happened to you since you started your career? What were the main lessons or takeaways from that story?
In 2008, a beloved colleague — orthopedic surgeon Ed Farrar — was struck head on by a car while riding his bicycle in to work. Not far behind was another physician, an anesthesiologist, who quickly realized the severity of Dr. Farrar’s injuries and within minutes an ambulance brought him to the very hospital where he’d been heading to operate. The operating room was alerted, and the crew of nurses, techs, and fellow orthopedists and neurosurgeons were at the ready.
Despite such rapid response, Ed’s spinal cord was severed in the mid-thoracic region, and further injury higher up his spine left everyone uncertain at what level Ed would be paralyzed. Everyone hoped for the best, but feared the worst, especially as the days that Ed remained dependent on a ventilator increased.
My group of Hospitalists staffed the intensive care unit, rotating 12-hour shifts, day and night. There was both a sense of wanting to be assigned to Ed and dreading it. Some doctors, particularly men who previously rode bicycles or kayaked the rapid Wenatchee river along with Ed, found it difficult to care for him. Though most tried to maintain what they felt was “professional distance,” I now see that what they were experiencing was secondary trauma — something I later learned affects first responders, as well as bedside caregivers, and can lead to future ill health, damaged relationships, and even suicide.
I, too, took my turn caring for Ed, and began to notice a pattern. The day shift would make strides one day in weaning his dependence on the ventilator, only to return the next morning to find him sedated and on higher vent support. We blamed the night crew, thinking they would “snow” him with sedatives and then have to turn up the vent.
But on some days, Ed would appear alert, relaxed, and less sedated in the morning, and would require less ventilator support. I eventually realized these days happened following the night when a particular nurse was on and had been assigned to Ed. One of my night shifts covering another floor, I went down to the unit just to visit, and found this nurse giving Ed a deep tissue massage in his shoulders (an area that Ed would often complain caused him a lot of pain). When I asked the nurse what meds he was scheduled to get to help him sleep, she just smiled and said he wouldn’t need any. As I became aware of this, I started to track his use of pain meds the day following, and found a notable decrease the days after his bedtime massage.
Ed had been a loquacious person, but being intubated and hooked up to a ventilator robbed him of the ability to speak. A family member had brought in a child’s Speak & Spell toy, which Ed would use to communicate. It took time, and most often doctors and nurses wanted him to give brief yes/no answers. Anything requiring more than a few words was just too time-consuming. But, on days when I had fewer patients (or could visit outside of when I was on shift), I would spend a couple of hours with Ed, allowing him to laboriously tap out things he wanted to say. I vividly recall one day when he typed, “Former spine surgeon, paralyzed, now needs more…” He never finished this phrase, as he drifted off to sleep, and I’ve over and over again pondered how he might have finished this.
Something even more surprising in these Speak & Spell conversations, was that on those days — similar to the days following his bedtime massage — Ed requested far fewer doses of pain medication. I even remember one day in particular, that his nurse came in to offer pain medication while we were conversing, and he waved her off!
It is these recollections of caring for Ed that make me realize the power of complementary approaches to healthcare. Of how simple touch reduces pain, of the importance of presence and not shying away from the difficulties of caring, of how listening without an agenda provides a space for healing.
Can you share a story about the biggest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
In 1996, when I was in residency at Portsmouth Naval Hospital rotating through the emergency room, a mother brought in her 4-year-old child who was having an allergic reaction. He had a localized rash, but no signs of airway compromise, and a history of playing outdoors and probably coming into contact with a plant that caused the reaction. Basically, a condition that did not require admission to the hospital, and that could be dealt with at home with some basic allergy medications. I prescribed Benadryl, and some topical creams to ease his itching, and sent them on their way. My shift ended at 7pm, and I went home: at that time, my daughter was @3 years old, and I was pregnant with my son.
The next day I went in for my ER shift, and the doctor in charge pulled me aside. He said that the mother had brought her son back later last evening, beet red all over, agitated, crying, and tachycardic (a fast heart rate). In reviewing my visit earlier in the day, the resident who saw him the second time saw that I had overdosed the Benadryl: I had prescribed an adult dose for a 4-year-old, which caused these symptoms.
I felt my own heart pounding, envisioning what it would be like for this to happen to my own children, and the fear the mother must have experienced. This fear soon expanded, as the ER doctor went on to say how angry she was, and that I should consider what “damage control” I might enact.
At first, I wanted to hide. Once I verified that the child hadn’t been admitted, that he’d been able to go back home after the second visit, I thought perhaps it might be best to just “leave well enough alone.” Being in the military meant we didn’t really have to be concerned about the mother suing; this is a fear more relevant to civilian practice. But the more I pictured my own children, and my own fear of their being injured at the hands of someone else, I knew I couldn’t just walk away, content that no ultimate harm had been done by my actions.
And so I called the mother. She indeed was angry with me, and a little taken aback that I called. I listened as she recounted what had happened the prior evening, resisting the urge to defend myself or try to counter anything she said. I told her I too had children, and couldn’t imagine how scared she must have been. I apologized for my error, and as we continued to talk, I could sense even over the phone that her anger was dissipating. Within a few minutes, she began to describe something else she’d been concerned about regarding her child, and actually asked could she bring him in that day again to see me! This floored me, that after my egregious error she would even consider letting me see her son again.
Over and over again, through the years, this lesson has resonated with me: the importance of remaining present, particularly in difficult situations, not shying away because it is uncomfortable to be with suffering. When I feel my own heart racing, my own dry mouth when considering a tense situation, I recall this brave younger me who made a difficult phone call when she wanted to run away.
Let’s jump to our main focus. When it comes to health and wellness, how is the work you are doing helping to make a bigger impact in the world?
My approach to wellness acknowledges the presence of illness and death not as demons to be fought off, but as omnipresent in a world that continually lives in a state of flux. To be integrated means to leave nothing out, and often this includes accepting parts of ourselves and of the world that we’d rather not admit exist.
When working with an individual, this frequently means seeing someone battling with cancer, or chronic immune disease, and helping them integrate the identity of “being sick” with their aspiration of wellness. In my private practice, in which I work with patients to develop comprehensive, integrated approaches to their health, I do so outside of conventional insurance-based compensation. In doing this, I can provide hour-long visits (more if needed), in which we delve into aspects of their history that almost never come up in a traditional doctor visit. Rather than the appointment being “physician-led,” I turn the reins over to the patient, allowing them to guide what we speak about. This is a radical shift for many people, who have been conditioned to expect that a doctor visit consists of answering directed questions, an examination that involves exposing parts of their body, and perfunctory prescriptions for pills and tests.
It is my hope that, in the future, wellness isn’t something sought after by the wealthy as a way to deny or stave off illness, but is embraced as an approach to maximal health exactly where someone is at the moment. I envision a clinic where patients participate in a membership model, rather than fee for service or HMO-dictated care, where they are encouraged to visit for health-maintaining practices, as well as when they are facing health challenges. Throughout these visits, they would see an integrative physician as well as a nutritionist and additional ancillary providers (like licensed acupuncturists, mental health providers, massage therapists, body workers) for a team approach that is coordinated and evidence-based. And I believe such a center could be central to a community and not set apart from it, incorporating local indigenous practices alongside traditional Western approaches.
When I am facilitating Council, or training a group of police officers in the impact of stress on their physical, mental, and emotional health, I am also in the presence of deep suffering that cannot be avoided. Some of these officers work homicide or are battling the effects of gang violence, and the decades of secondary trauma can lead to early death from cardiovascular disease, diabetes, and stroke or even suicide. Three years ago, I helped my husband develop a six-month training program for police called POWER (Police Officer Wellness Empathy and Resilience) that his non-profit organization, Center for Council, has brought to officers in Los Angeles and Jacksonville, FL. It has been deeply rewarding for me to not only develop the program, but to also be involved in offering these workshops “on the ground.” We invited officers from LAPD who had completed the POWER program to a day in which they spoke of the impact of the program on their lives. It was powerful to hear in their words how valuable this training was for them, their families and their colleagues; you can check out the video of this conversation here.
Whether interacting with one person to help them improve their own personal health, or with a group of first responders in a training, I am often aware of countless others in the room. They are the ripple effect; people I may never meet but who will benefit from the impact of my work here and now.
Can you share your top five “lifestyle tweaks” that you believe will help support people’s journey towards better wellbeing? Please give an example or story for each.
To be “well” often challenges us to re-frame our state of mind and to change some basic daily practices, realizing that some might offer restoration to a state of health, while others may simply offer support during difficult times or insurmountable crises. With this in mind, I offer these 5 approaches.
- Nutrition: By this I mean to include everything you take in that might nourish you. This includes what you eat, but also what you intentionally listen to, look at, feel and smell. What images in your day are toxic? What words do you speak (which fall first upon your own ears) that cause more harm than good? How might you cultivate an environment in your home that is nourishing, so that you venture into the world more resourced and better equipped to weather the daily stressors?
- Just Breathe. Intentional breathing is the most basic, readily available, effective tool by which you can interrupt your stress response. Our brains are wired to pay attention to changes in breathing pattern above all other signals received, both internal and external. With daily breathing practices you can reset your autonomic nervous system to be healthier. Two of my favorite practices to teach are “5-count” and “4–7–8 breathing” (see this link in which I teach these and the science behind them). In the video of LAPD officers talking about the benefits of using breathing to be mindful, Officer Lyndon B. said it well: “…something about the mindset of being present, for whatever reason, slowed the game down, which allow[ed} me to think quicker.”
- Sleep: My husband will tell you that I am a great lover of sleep. A full 8 to 9 hours a night is a necessity for me, and less than that not only leaves me cranky the next day, it will often lead to a migraine headache. What used to be thought of as a time in which we “shut off” our daytime, productive self (and thus, in a fast-moving corporate world, something to sacrifice in order to gain more time to work), sleep is something researchers are realizing is necessary for overall health. In a study published last month, obese patients who slept less than 6.5 hours a night were placed in 2 groups: a control group of subjects who did not alter their sleep, and an experimental group in which participants increased their sleep time to 8.5 hours. With no other difference between the groups, those who slept longer lost more weight and took in fewer calories each day. I am also heartened by the image of sleep “washing out” the accumulated tau protein that accumulates during the day, leaving my brain clean the following morning and, I hope, reducing my risk of dementia.
- Not Knowing: Here we venture into how my spiritual practice affects my work. One of my Zen teachers, Bernie Glassman, framed the three tenets of the Zen Peacemaker practice as: Not Knowing, Bearing Witness, and Loving Action Arising. The first of these, Not Knowing, is something I think anyone can benefit from, and you don’t have to wear black robes and sit immobile on a zafu cushion. It simply means letting go of what you think you know. It isn’t being uninformed or ignorant. Rather, Not Knowing includes seeking out all that you can on a subject, learning as much as you can, and then letting go of it. In my practice as a physician, it means learning all I can about physiology, chemistry, anatomy, as well as all there is to know about a particular patient (their labs, history, medications), but when I sit down with that person, I intend to let go of what I think I know. There’s a saying in Zen, attributed to Shunryo Suzuki, that goes, “In the beginner’s mind there are many possibilities, but in the expert’s mind there are few.” Of course, that patient needs for me to be as robustly educated as I can be, and they also need me to be open to the many possibilities of the beginner.
- Gratitude: My mother was a great proponent of counting your blessings. She truly lived this, even to the point of expressing gratitude for life’s challenges and for things that had been lost. (She would often say, when my father expressed sadness over the loss of things or of relationships, “Don’t be sad it’s gone, be grateful that it happened.”) Researchers now know that gratitude isn’t just a nice platitude. Intentionally practicing gratitude yields measurable beneficial effects on heart rate variability and on the brain itself, where regions associated with attention and decision-making increase in size and connectivity. During the most recent POWER training with the Jacksonville Sheriff’s Office, I hooked up one officer to a heart rate monitor during a brief gratitude practice to demonstrate the effects of practicing gratitude on his physiology. We projected the read out on a screen in real time. The visible shift in his heart rate variability from an incoherent to a coherent pattern was striking, showing how quickly physiology changes in response to emotion. For the sake of your own health, as well as those around you, make gratitude an intentional practice every day!
If you could start a movement that would bring the most amount of wellness to the most amount of people, what would that be?
I believe that the POWER training for first responders, and the sister program I helped Center for Council develop for healthcare workers (CARE — Compassion Attunement & Resiliency Education for providers), have the potential to revolutionize policing and healthcare. Alongside Jared, I am committed to continuing to do this work, and develop “train the trainer” models that allow this work to impact police training and healthcare education on a broad scale. If we can improve the health of those tasked with caring for all of us in our times of need and crisis, the impact across society will be immeasurably beneficial.
What are your “5 Things I Wish Someone Told Me Before I Started” and why?
Having begun my path to being a physician over 30 years ago, most advice that might have been given prior to that bears little relevance to today’s healthcare system! I might reframe the question and offer “5 Things Everyone Who Needs Healthcare Should Know.”
- Having excellent healthcare insurance does not guarantee you’ll get good care. In fact, sometimes having insurance makes it more difficult! Consider the wait times for pre-authorization of procedures or medications. Or how the list of doctors you can see is limited by your insurance carrier. Sometimes patients with even “the best” insurance coverage are outright denied care. Our insurance system does not prioritize what care people need, nor is it created to support doctors in taking care of people. As we look to the future of how individuals spend their healthcare dollars, I believe we are going to see models that minimize payouts for insurance, and leave cash in patients’ pockets to spend on care that is truly tailored to their needs.
- Don’t pick your doctor from a “Best Doctors” list in a magazine. Or from anyone’s list, for that matter. Make your first visit one in which you “get to know” your potential partner in healthcare. Even a 15-minute conversation will give you a sense of fit, and whether this relationship is one that is going to benefit you.
- Know that being healthy often requires change. Change in diet, change in mindset, and willingness to let go of what you thought you knew when new information comes to light.
- Realize that #3 applies to your healthcare provider as well! Medicine is a constantly changing field, and what we knew 30, or 5, or even 1 year ago may no longer be correct. Partnering with a physician who not only stays up-to-date on current research, but also is willing to admit what they don’t know (and then look for the answers with you) will serve you far better than an inflexible “expert.”
- Resist the urge to measure up to some Instagram image of wellness. Don’t convince yourself that you (or your doctor) failed at making you healthy when you face a devastating diagnosis like cancer or heart disease. It is the nature of being human to become sick and to die: none of us make it out of here alive! Have a provider at your side who brings empathy, compassion, and honesty to your care. It is sometimes in our greatest challenges that we find sources of strength we never knew were possible.
Sustainability, veganism, mental health and environmental changes are big topics at the moment. Which one of these causes is dearest to you, and why?
The topic of sustainability resonates deeply for me. I have long felt that the push to make more, do more, be more, have more is a recipe for misery. Nowhere in nature do we see unmitigated growth without there also being death; in fact, life is only possible because other things die. I am a huge proponent of regenerative farming. A winding, 20-minute drive from my home brings me to Apricot Lane Farms (location of the award-winning documentary Biggest Little Farm), where Molly and John Chester proclaim that they are in the business of making dirt. The basis of healthy herbs, fruit, animals, and ultimately the humans who both eat and care for them starts in the rich soil, which is composed not only of seeds of things to be, but also of fungi and bacteria whose job it is to break down the dead into nutrients. Rich, compost-y soil even releases compounds that, when inhaled, mimic chemicals in our brains that act as antidepressants! (Explaining why my mother often pronounced a day spent gardening as “the best day of her life”). I look upon the farm (and my own little home garden) as living metaphors for my own health, my relationships, and how I practice medicine. Sustainability to me means having enough, practicing gratitude for all that shows up (even the parts I don’t like), and being mindful of what I give back in response to what I take.
What is the best way our readers can follow you online?
www.seideintegrativehealth.com
www.linkedin.com/in/annseidemd
Thank you for these fantastic insights!
Women In Wellness: Ann Seide of Seide Integrative Health On The Five Lifestyle Tweaks That Will… was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.