“If self-care was important before the pandemic, it has become almost essential in everybody's life today,” says Usha Peri, MD, who is a DaVita medical council member and a SKY breath meditation instructor for the Art of Living Foundation. Listen to this podcast, in which Ryan Weir interviews Dr. Peri on self-care, with a focus on self-care for clinicians and during the pandemic. Dr. Peri discusses what burnout is and how to counteract it, what self-care means to her, how she became interested in the SKY breath meditation technique and why she became an instructor, and what tools she uses to help with her own self-care. During the podcast, she also demonstrates a couple breathing exercises that one can do in less than 5 minutes during a break in the day to unwind and reset before going back to work.

Podcast Transcript:

Ryan (00:40): Hello and welcome to the DaVita Medical Insights podcast. I'm your host Ryan. We're joined on the phone today by Dr. Usha Peri. Dr. Peri is on the medical council of DaVita and is a SKY breath meditation instructor for the Art of Living Foundation. Dr. Peri, how are you doing today?

Dr. Usha Peri (00:57): Great. Thanks, Ryan.

Ryan (00:59): All right. Dr. Peri, we're talking about self-care today and as we all know, there's a pandemic going on. So can you talk about the timing of this topic and why self-care for clinicians is so relevant right now?

Dr. Usha Peri (01:11): Absolutely. Even before the pandemic physicians' burnout rates and health care professionals' burnout rates have been on the rise. Even though this word was coined back in the '70s, it has started becoming much more relevant recently with the rise of regulatory burden, as well as electronic health documentation burden that's being placed on the physician. Now, with the pandemic hitting, all of this has just gone exponentially high. Things are changing quite rapidly and they're asked to keep up with all the changes. As you know, regulations are changing, by the day, sometimes, and our telehealth visits, all of us had to transition to telehealth almost overnight. And the documentation rules around that keep changing as well. At the same time, our patients are also in this uncertain, anxious time. And so their demands on the health care professionals are higher and our ability to deal with the death and the grieving process, all of this is taking a huge toll on the health care professionals. If self-care was important before the pandemic, it has become almost essential in everybody's life today.

Ryan (02:42): Yeah. And especially going months into this pandemic too.

Dr. Usha Peri (02:47): Yes. And not knowing when it's going to end either, Ryan.

Ryan (02:50): Right. Right. So self-care can mean a lot of different things to different people. What does self-care mean to you?

Dr. Usha Peri (02:58): Right. That's a good question. Well, you're right. Anybody, who's human and living actually health care professional or not, is doing self-care in some form and fashion whether they call it that or not, right? All of us that are humans have to eat good food, hopefully, good, nutritious food, drink plenty of water, get a good night's sleep, and if things go well and we have a little extra time on hand, exercise perhaps, or spend some time with nature, walking, listening to music, et cetera. All of that would fall under self-care to me. I mean, that all sounds simple, right? And why do we even need to talk about it? Why podcast? Well, the challenge there is that the increasing demands that we talked about, we as human beings start cutting corners and start cutting into our eating time. What used to be an hour long lunchtime at one point in my own work day has now pretty much disappeared and exists in my car while I'm driving.

Dr. Usha Peri (04:09): What used to be exercise time can go away if you have to catch up with your notes or do other important things for the family. What used to be sleep time can easily disappear, once again, when you're juggling multiple different tasks. And more importantly, if there's stress of negative outcomes, then it takes away your sleep. Even if you're in bed, you're running around not getting good quality sleep. So all of this starts taking a toll on your physical energy levels as well as mental energy levels. And then you slowly start feeling burnt out; emotional exhaustion, depersonalization and compassion fatigue, which is the three components of burnout. So now when we're in this stage, when we moved away from doing our usual things in a happy natural way, on to this vicious downward cycle of burnout, we have to do something extra to get ourselves back up at least to the baseline.

Dr. Usha Peri (05:19): And that extra obviously is something that can recharge and rejuvenate us. And again, in our current society, it would be great if I can get this in the form of a pill. And if not in the form of a pill, something quick, that is not very time consuming, right? So while I was going through this journey in my own life, I stumbled upon this great breathing and meditation technique called the SKY breath medication. This is almost 15 years ago. And initially I used to do it as a hobby that made me feel great. And lately it has become a very essential part of my day. I spend about 20, 25 minutes of my time doing this and it recharges and rejuvenates me very naturally and very automatically.

Ryan (06:10): So you mentioned that self-care isn't something new. It's gotten a lot of news lately but it's been around for a bit and you've been dealing with this subject for a while. So how did you originally get interested in this subject?

Dr. Usha Peri (06:22): Sure. So, like I mentioned, these things happen very naturally but then I am a mother of two kids who are now young adults, 24 and 20. I have held many leadership roles in my company, including the immediate past presidency. And I've seen this company grow from a five employee to a 70 employee company. I'm a medical director on the medical council, married for 28 years. So I've obviously worn many hats. And in the process, just like I mentioned earlier, I've realized that I was cutting into things that are necessary to maintain a healthy body and a healthy mind. So during this time I stumbled upon this breathing technique. And now I come from a tradition of yoga. Growing up and going through medical school in India, I've taken great interest in doing some yoga postures and breath work. And I came here and all of that got lost in the business of daily life.

Dr. Usha Peri (07:25): But then I rediscovered it about 15 years ago. Initially I was doing it for fun but later on, as life caught out and I was juggling all these different things, I realized that this is a great source of energy for me. It's a great source of winding down without having to have a drink of alcohol, which I've never been a big drinker at all but even social alcohol or just to wind down, which I used to do many years ago, at the doctors and parties, I've completely given up. And I realized that yoga, breath work and meditation are just much more powerful in helping relieve, let go of the daily stresses and to recharge and rejuvenate me. And not only am I now combating burnout but I've actually got an extra perk by practicing this which is peak performance. I realized that my mind can dive into the creative, intuitive sites of myself and come up with very beautiful problem solving.

Dr. Usha Peri (08:29): For any problem solving we do need the creative and intuitive sites of our minds and brains active. And I noticed that doing this practice on a regular basis helps me do just that. So I'm actually a very sought after person in whatever field I choose to enter, right? Whether it's as a parent, spouse, at work, wherever I am, I'm considered a cheerful person who brings value. My patients love me because I bring that extra human element to the equation. And I have people who drive many miles across town to come visit with me as well, yeah? And then I realized that this is too beautiful of a tool to keep to myself. That I would love to share it with the world. So that's how I became an instructor five years ago. And now I teach this to youth as well as adults and health care professionals.

Ryan (09:29): Yeah. Can you talk more about the tools that you use to help with your own self-care?

Dr. Usha Peri (09:33): Sure, Ryan. So when I started out I took this workshop, a 10 hour workshop, called the happiness program or living well for health care professionals, which teacher the 20, 25 minutes take home breathing technique called the SKY breath or Sudarshan Kriya. The term that comes from yoga. And what it is it's a very deep involved breath work that allows us to clear up the day to day stresses. And allows us to get into a very meditative mode of mindset that allows me to just then slip into meditation. And meditation to me is effortless. It's not concentration, it's not focused. It's actually the ability to disconnect from our day to day activities.

Dr. Usha Peri (10:24): We use our senses from the time they're up to we go to sleep, especially in this information overload, connected gadgets heavy world today. So that 30 minutes allows me to disconnect from all of that while I'm still awake, not when I'm sleeping and gives me a tool that's physiologically actually allowed for relaxation and disconnection and deep meditation, which is automatically recharging or rejuvenating. So yes, my tools are I do about five minutes of yoga stretches. The postures that are very well known. 20 minutes of the breath work called the SKY breath and followed by a 20 minute meditation. So total about 45 minutes to 50 minutes. That's all. That's how my day starts. And then the rest of the day, I feel like I can face anything that comes my way.

Ryan (11:23): So these breathing techniques that you do is this something, I mean, while we're on the podcast and while people are listening, is this something that we can demonstrate now briefly?

Dr. Usha Peri (11:34): Absolutely. So I won't be able to demonstrate the SKY breathing. For that you have to come to one of my workshops that I teach and learn. However, there are several breathing techniques that we can learn that can be done throughout the day intermittently, which I also do just to kind of like the reset button on the computer, right? You can pause. Actually we say "take a deep breath," right? It's similar to that. Except when done in a more scientific way, the way yoga has taught it to us over the year, then it has a much more physiologic effect on our body and allows us to reset that brain that's going a hundred miles an hour to give it that needed pause and bring it back to the center, right? So I'm more than happy to demonstrate a couple that everybody actually who's on the podcast can learn and use it throughout the day. Especially when you're feeling a little anxious or things seem chaotic around . Are you're ready for the demonstration, Ryan?

Ryan (12:36): Yes I am. And for any listeners listening to this, is this something they can do while sitting, while standing?

Dr. Usha Peri (12:42): Yeah, ideally it would be best to sit in a quiet corner with your spine erect. So when we start talking about yoga, we're talking about energy. We are energy bodies and we are gathering our energy up and when you're out and about doing our things, our energies are getting scattered and used. So when we are taking a deep breath, we're gathering our energy and we are balancing it. So to do that, just sitting in a quiet corner, closing our eyes, which takes away one of the outward focus, turning it inwards and taking a regular breath in and out, which let's do now. Let's take a regular breath in and out. And the first breath I'll demonstrate is called the straw breath. It's very simple like its name suggest. Take a deep breath through your nostrils and exhale through your mouth. It's like your mouth is now a straw. You're puckering your lips like a straw.

Dr. Usha Peri (13:54): And you're blowing bubbles into the invisible water at the end of the straw like kids do. And now observe how you feel when you're doing it. Just take a couple of minutes to do this on our own and observe what happens in the body and mind.

(Silence)

Dr. Usha Peri (14:23): Taking long, deep breath.

(Silence)

Dr. Usha Peri (15:32): Observing any sensation that you may have in your body, any prospect maybe going through your mind. So put in your full attention on the breath. Breathing out through the closed lip like a straw.

(Silence)

Dr. Usha Peri (15:59): And then we get going with that last breath, relax your breath and continue to sit with your eyes closed

(Silence)

Dr. Usha Peri (16:19): Just observing how your body and mind feel and then when you feel complete, you may open your eyes. And if you're ready, I have one more breath to demonstrate. Ryan, are you ready?

Ryan (16:41): Yeah, let's try the next one.

Dr. Usha Peri (16:43): So this one is called the alternate nostril breath and as the name sounds, it's pretty intuitive. Actually the breath starts with a exhalation. With the breathing out through the left nostril and then automatically we breathe in through the left nostril and the left nostril is closed. We breathe out to the right nostril, breathe in through the right nostril. Close the right and release the left nostril. Then breathe out through the left and breathe in through the left. It's pretty intuitive. Whatever side you exhale, you breathe in, close that side of nostril, release the other and breathe out. And as we do this, once again, no rush, take your time, elongate the breath a little at a time and just watch how your body and mind feels. Okay. So let's get started with the thumb on the right nostril. The left nostril is open. Breathing out through the left, breathing in through the left.

Dr. Usha Peri (18:14): Close the left nostril. Breathe out through the right. Breathe in. Close the right nostril, breathe out, breathe in. Close the left, breathe out through the right, breathe in, now out.

(Silence)

Dr. Usha Peri (18:53): Elongating the breath a little each time.

(Silence)

Dr. Usha Peri (19:16): Feeling the inhaling through your body and the relaxation that you feel.

(Silence)

Dr. Usha Peri (20:02): And then now you're done with that last breath. You may relax your breath and your hands.

(Silence)

Dr. Usha Peri (20:14): And hopefully you're feeling a little bit more relaxed in your body and your mind as well. And you may open your eyes.

Ryan (20:34): Well, I think the analogy you used earlier about a computer restart button, I think that's pretty spot on after those breathing exercises.

Dr. Usha Peri (20:43): Yeah. How long did you breathe, Ryan? Maybe four, five minutes at the most?

Ryan (20:48): Yeah. I'd say so.

Dr. Usha Peri (20:50): Yeah. And so four, five minutes in the middle of the day is not at all hard to find. And I do this in the lunch hour as well. Definitely use a few different breathing techniques from my two toolkit to unwind, reset, eat quickly, and then get back to work.

Ryan (21:10): And can you talk about some of the science behind these breathing techniques?

Dr. Usha Peri (21:15): Sure. Yeah. Yoga is a very ancient science. It's 6,000 years old. And the postures that we talked about, the breath work as well as meditation all have their roots and origins in yoga. And if you notice, Ryan, when we are angry, do you notice any change in your breath?

Ryan (21:36): It gets quicker, right?

Dr. Usha Peri (21:38): Yeah, it gets quicker, faster, and it actually ... If you're really aware, you'll notice it gets hotter because our body temperature goes up. Anger is associated with heat, isn't it?

Ryan (21:50): Yeah.

Dr. Usha Peri (21:50): We talk about a heated argument, right? So yeah. Physiologically the temperature of the breath actually goes up. Now, when you feel sad, how does the breath change? Have you ever noticed it or thought about it?

Ryan (22:06): I think it slows down.

Dr. Usha Peri (22:08): It does. It gets kind of long, slow. And we talk about sighing. So every emotion in our body is associated with a type of breathing. And emotions are what drain our energy as well. If you notice beyond the physical work that's involved, it's the emotional drain that is huge, especially in these days of pandemic. So in order to manage your emotion, have you ever tried telling your mind, "don't get sad, don't get angry"? Have you tried that, Ryan?

Ryan (22:45): I have. And I've gotten mixed results.

Dr. Usha Peri (22:48): Absolutely. For the most part it really doesn't work because it's like, we cannot run and manage our mind with our own mind but we can manage our mind using the breath. That's what the ancient users of yoga, the yogis, have found. And that's why they have actually come up with a repertoire of these breathing techniques, each one with a slightly different effect on our physiology. Now this context, we do not have the time to go into the details but very briefly with a very big overview of the science of breath work is that, normally, when we're in a stress state, which on a day to day basis, we are in a stress state, because there are many deliverables, our sympathetic system is in the overdrive: the fight, flight or fright, which is a new addition of adrenaline and cortisol overdrive, is something that's well known to us as clinicians and we are operating in that mode for the most part.

Dr. Usha Peri (23:55): The breath work puts a break to all of that and activates the vagus nerve in the parasympathetic nervous system and creates better relaxation like we're on the beach right there for us, right? Wherever we're sitting, wherever we're standing, we can bring the beach to us by breathing a few different times in the prescribed format and so that's the science behind the breath and why it actually works for me.

Ryan (24:25): Dr. Peri, where can some of our listeners find more information about this?

Dr. Usha Peri (24:29): Sure. You can go to the artofliving.org which is the main web page for this foundation; artofliving.org. The main webpage. We are in the process of creating a separate page for the health care professionals but there's a lot of information on the breathing techniques and our basic program, the SKY breathe medication program on there. I'm a volunteer faculty for the foundation. This is the largest nonprofit organization that's totally volunteer driven, based off of volunteers like me who found the value in their lives and who give back in the spirit of volunteerism.

Ryan (25:12): That's great. And thank you so much for joining us today on the DaVita Medical Insights podcast to talk about self-care, especially for clinicians and especially during a time like this where there's a pandemic and there's plenty of stressors everywhere. So thank you again for stopping by. That was much appreciated.

Dr. Usha Peri (25:29): Thank you, Ryan, for giving me this opportunity. And hopefully many of you in the audience can take advantage of these techniques that are out there.

Ryan (25:37): Thank you again. And we hope that you'll join us next time on the DaVita Medical Insights Podcast.