059. How to Invest in Yourself for Lifelong Health & Productivity with Dr. Robyn Tiger

00:05 Dr. Ann Tsung Are you struggling to advance your career and sacrificing time with your loved ones because of endless to-dos, low energy, and just not enough time in the day? If so, then this podcast is for you. I am your host Dr. Ann Tsung, an ER critical care and space doctor, a peak performance coach, a real estate investor, and a mother of a toddler. I’m here to guide you on mastering your mind and give you the essential skills to achieve peak performance. Welcome to Productivity MD, where you can learn to master your time and achieve the five freedoms in life.

00:52 Hello. Welcome to Productivity MD Podcast, and I am your show host Dr. Ann Tsung. Today we have Dr. Robyn Tiger. She is double-board certified in Diagnostic Radiology and also Lifestyle Medicine. She is the Founder of StressFreeMD. She’s a stress management expert. She focuses on a whole person wellness as well. She’s a podcaster, a coach, and an author. So the reason why I wanted to bring Dr. Robyn Tiger on is because to be productive in life, you want to have the grit to recover. And if you don’t have the grit to recover, this is not going to be sustainable for the rest of your life. And you’ll be sacrificing time with your loved ones as well and sacrificing your health. So I thought that it’s so important for us to talk about our own holistic well-being and recovery. I’ll have Dr. Robyn Tiger introduce herself a little bit more. And also, would you tell us a little bit on why you do what you do currently? So thank you for being on the show.

01:55 Dr. Robyn Tiger Well, thank you. Thank you so much for having me. And, yeah, all these topics are near and dear to my heart. So hello physician colleagues out there listening. So happy to share with you why I’m here and why I do what I do, in that I consider myself a burnout thriver. And I say that with a little chuckle. But the truth is, about 15 years or so ago, I wasn’t so well. I had many, many symptoms and illnesses that our colleagues could not figure out. I thought that none of them were connected. They all seemed very individual. I can list a few of them for you, and maybe you are experiencing some of these things. So migraine, headaches and vomiting. I had terrible tinnitus and vertigo. My gums would just spontaneously bleed, which made no sense to me. Really horrible reflux, gastroesophageal reflux, body pain, poor sleep, poor digestion, abdominal pain when I was eating. I had these really terrible paresthesias where I would lose sensation in my hands, my feet, the left side of my back. I could be cutting up vegetables. I can’t feel the knife. I could be driving a car. I wouldn’t feel the steering wheel. I could be doing a breast biopsy, and I would actually lose sensation of the biopsy gun. That was probably, of all the symptoms, the most scary. Because our doctor brains start to think about neurologic diseases and terrible things, right? And so body-based symptoms were many.

03:42 Then I started to have some bad thoughts. Like, wow, I don’t know if I can really do this anymore. I looked amazing on the outside — great husband, two incredible kids, beautiful home, all the things — but I was essentially dying on the inside. I saw a mental health care professional. I saw lots of specialists. I took lots of pills. I have every lab test, every imaging study. Everything was normal. No one could figure out what’s the matter with me. I just felt like I was circling the drain. And it was a time when people really didn’t talk about these kinds of things. It was really just, who are you to complain, right? Just keep going. You have everything. Don’t be selfish. And all that guilt of even sharing that I wasn’t okay was just weighing me down. I could tell you, Ann, that I had three physician colleagues die from suicide. And it was really, really playing on my mind. I looked at my children. I looked in their eyes, my husband. I’m like, wow. Am I heading in this direction? Is it actually where my life is going? And I do not want that for myself.

04:58 So Western medicine, as amazing as it was, was not what I needed in that moment. I tried it. Sometimes we need Western medicine. We’re Western medicine-trained physicians, but I knew there had to be something more. That’s when I started looking outside the box. I was already training and running long races. I was already eating what I thought was a very helpful dietary pattern. I started hearing more and more about things like yoga, and meditation and then coaching, which I thought yoga and meditation were just eye-rolling events. People were really weird down the hall doing strange things. I said, well, I’ve tried everything else. I’m going to just sign up for this 101 series and see what happens. And so that’s what I did.

05:49 I remember very clearly. I can’t tell you how many cases I read, how many biopsies I did, and procedures. Then I got home, fed my kids, bathe my kids, hand them off to my husband. I went to this very first 101 yoga meditation class. It was 7:30 at night. I had one eye open. I was so tired. Why am I here? After that session, I felt like a new human. I had focus. I had concentration. I wasn’t tired. My body didn’t hurt. I felt calm. And it blew my mind. It was that moment when I said, okay, I need a little bit more research here and see what the heck is going on inside of me to allow me to make that shift. That was the beginning of my understanding of our autonomic nervous system and how imbalanced it can be. Over time, all those symptoms that I shared with you went completely away. And when any of them start to pop up again, I know what to do. So that was the beginning of my transformation and the beginning of my studies to teach our colleagues how to feel better. Because my diagnosis that everyone missed was a whopping case of chronic stress.

07:11 Dr. Ann Tsung It sounds like it’s a chronic fight or flight response, a chronic cortisol elevation leading to all of your symptoms. Then what you found was meditation, yoga put you in that parasympathetic state. And for once, you actually felt calm and not in the fight or flight. Is that essentially a good summary?

07:30 Dr. Robyn Tiger Yeah, I think you’re right. There was all this cortisol, all the cytokines, the inflammatory markers. If we could have done a blood test then, I think I would have been through the roof in my values. I came to understand that, as these symptoms start to dissipate, I started initially practicing myself. And then wanting to learn more, I went into teacher training never thinking I was going to teach anybody anything. Just because my doctor brain was like, this is interesting. I want to understand it better. I want to understand that why and how. It was there that I learned about the field of yoga therapy, which is a three-year certification with the base level of 1,000 hours of training. I thought, well, if I could take these concepts and break them down into ways that our colleagues and others can do them quickly and easily to feel better, that would be amazing.

08:21 So I got certified in yoga therapy and then a certain type of meditation called iRest, which was created for our military originally. Another three years of really understanding a very secular evidence-based type of meditation to help process experiences. Then the body-based tools became what I focused on for about 10 years, becoming expert in body-based tools and education. Then the life coaching, that mindset piece, after experiencing the benefits of thought work and really adding that together so we have a bottom-up and top-down approach to stress prevention and relief. Then I just added that to lifestyle medicine after that. So yeah.

09:08 Dr. Ann Tsung That’s awesome. Yeah, it is definitely very holistic. I can remember when I was doing my critical care fellowship, I felt like I aged the most during that two-year fellowship. I had sores in my mouth and tongue inflammation. Just the sleep was never restorative, pelvic pain that I thought was like ovarian cysts and dysbiosis. So all of that, it’s all gotten better since now Monday time now. But yeah, it’s just crazy how prolonged, especially people who continue to work in the ER or ICU, how prolonged cortisol — the entire shift has like a cortisol elevation — can lead you to these physical symptoms. This is the reason why I want to make sure that the audience understands why it’s important for you to begin now. Because I talk to a lot of my clients. They want to wait until the real estate is done, or this work is done and this is done. Then I can schedule time for self-care, or it’s not even on their — it’s not even on the map at all whatsoever. Could you tell us a little bit of why the clients should care about this now versus later?

10:24 Dr. Robyn Tiger Yeah, that’s a great question. It’s really twofold. Because I get asked this question a lot. “I’m too busy. I don’t have time for that. When I’m on vacation, I’ll feel better.” Right? What? Your two or three weeks a year? Maybe. It takes you three or four days into that where you start to actually feel like you’re in vacation mode. So if I shared with you that you could feel like that every day, wouldn’t you want that? Yeah. So actually, this is twofold. One is because you feel horrible, right? All the things I described, if you’re even experiencing one of them, you feel terrible. And who wants to walk around feeling that way? Who wants to walk around every time you eat, you have abdominal distension, diarrhea, constipation, your body hurts? Who wants to walk around waking up with one eye open counting the minutes until you get to go back to sleep again? Wouldn’t it be amazing to wake up not tired, right?

11:18 So you’re reactive. You’re saying things you wished you could take back. You’re doing things you wish you didn’t, right? Number one is, you just don’t want to feel horrible. You didn’t come this far to only come this far. So that’s number one. Number two is, if you want evidence, the evidence-based literature tells us that chronic stress is the direct cause of most of the chronic diseases in the world — hypertension, adult-onset diabetes, myocardial infarction, stroke, cancer progression and growth. And it even prematurely shortens your lifespan by prematurely shortening your telomeres, the protective ends of your chromosomes that determine how long you live.

12:01 So twofold answer. One, you don’t want to feel horrible all the time. You worked so hard to get here. You deserve to feel good every single day. Number two, it’s an investment in your health. Because if you don’t pay attention to your wellness, you will be forced to pay attention to your illness. Okay? I’ll say that again. If you don’t pay attention to your wellness, you’ll be forced to pay attention to your illness. So even if you don’t have any of these chronic illnesses on board right now, you’re just in the roads then if you don’t take care of yourself. Because even though we’re physicians, we are humans too. We get human illnesses just like everyone else. So that’s my twofold response to why it’s so important to take care of yourself now.

12:57 Dr. Ann Tsung Yeah, your health is really your wealth. Your businesses wouldn’t be there if you don’t have your health. That would not be your priority or focus. So we talk a lot about that. And if you don’t do it for yourself, then I would do it for your loved ones. Because, like you said, that reactivity, that lack of patience when you’re in that fight or flight mode, then you could react to your spouse. You could react to your kids. You don’t have patience with them when they don’t act, or you have expectations. You then really lack compassion or understanding for other people when you don’t take care of yourself. So if you don’t do it for yourself now, maybe do it for your loved ones so that you can have a beautiful relationship with them.

13:41 I think what people can’t visualize is maybe like, or they don’t know where to start — can you describe a little bit of what they can expect to see? Or maybe from your prior clients, where did they start? And how long would it take for them to get to a point where they don’t need to get vacation, yet they still feel like they’re on a vacation every day? What can they expect to see other than the physical symptoms may be starting to go away? What can they feel, et cetera so that they can visualize what’s ahead if they make the change now?

14:21 Dr. Robyn Tiger Yeah, so couple of questions embedded in that. To go to how will you feel, the opposite of how I was feeling and the opposite to how you may be feeling now where you have energy. You’re focused, and you have concentration. You’re responsive and not reactive. You can actually take that few second pause before you speak or do something. You’re present. You don’t ask someone their name three times. You don’t look at your watch five times. You can’t remember what you just thought, or heard, or saw. You feel really good when you eat your food, right? Your bowel habits are good. I mean, we know our gut microbiome is everything, right? So we want our digestive system to be in order. Our bodies feel good. We have better posture. We feel alive. Not that we’re just living, but we actually feel alive. There are so many things that would transform, and there are so many ways that you can feel better from however you’re doing that now.

15:30 And so if your question is, “I’m too busy. I don’t have time for this, and how would I even begin,” so as Ann mentioned, I’m a double-board certified in Lifestyle Medicine. I actually have the honor of serving as lead faculty and subject matter expert in Stress Management for the American College of Lifestyle Medicine and, more recently, co-authored the new board review manual that physicians and other health care professionals are actually studying to sit for the boards. I can share with you that if you don’t know what lifestyle medicine is, it’s a newer field of medicine that focuses on the opposite end of the spectrum. So in traditional Western medicine, we have a disease management system. If somebody comes in with a back pain, you might give them a medication or send them for therapy. If somebody comes in with a sleep issue, maybe you give them a pill to help them sleep or send them to a mental health care professional. If somebody comes in with diabetes, you give them medication. If someone comes in with high blood pressure, you give them medication. If somebody comes in with whatever, and so we treat the symptom. We treat the illness. That’s what we were taught in med school, so it’s not your fault.

16:38 But what if I told you that we could get to the root cause of what all these things are coming from, and we could work with the opposite end of the spectrum to prevent, reverse, and sometimes actually treat symptoms, illnesses and diseases through six key pillars? Those pillars are stress management, healthful nutrition, nourishing sleep, exercise, social connection, end risky substances/I add escapes. We focus on these six key pillars which are like six spokes on a wheel, and they all need to be functioning for that wheel to work. We work on all of those pieces. Then the transformation can happen. Then you can prevent, reverse, and sometimes treat your symptoms, illnesses and diseases. And because we’re doctors, and we’re left brainers, and we like things really organized, I make that super easy. We do a quick assessment. We see where you are, and then we just start with one thing at a time. I focus on 1% better every day. That’s it. So we start small. We start to make some small changes, and we start making other small changes and small changes until your whole life is like, wow, I didn’t realize I could feel this good, or I don’t remember the last time I felt this good.

18:03 Dr. Ann Tsung Yeah, I think the micro steps, the more habit stacking can make — we talked about, or Tony Robbins actually talked about a two-millimeter shift. And then once you make that two-millimeter shift at this time point, if you can do that now, then in a few years, your entire trajectory is going to be exponentially different than where you would have been. I do remember in my critical care fellowship, I felt like I was living in the haze. It was just like a dream-like state all the time. I couldn’t focus. Like you said, gassy, bloating after eating, all those things. And now it’s like focus, energy. I wake up before the alarm and things like that, which in the past I would have never thought that that would be possible. I actually thought to myself like, so is this what happens when you’re older? Your sleep does just not feel like you slept at all. You just wake up and feeling still tired. Is that what happens when you’re older? Is that even possible? I remember when I was little, I used to be able to wake up and feel great. But not anymore. So I think to the audience, that it is possible for you to make that change now. I wonder what are your thoughts about, or what is your vision about maybe three to five years? Where would you like to — because you’re doing a lot. Podcast, you’re authoring a new book, a show. You do coaching, one-on-one group coaching. Where would you like to see yourself take this in three to five years or so?

19:39 Dr. Robyn Tiger Yeah, my passion is to help as many people as possible. So getting on platforms where I could teach as many people as possible. Of course, our colleagues are my nearest and dearest to my heart. I’ve been asked more recently to help other populations. But I feel that everyone deserves to know what I know, and I almost feel selfish every day holding it in. I just want to shout it from the rooftops, because we didn’t learn any of this in medical school or any training. And even though I’m several decades out of training, I’m still coaching medical students and residents who still aren’t learning this information. So in three to five years, I just hope to be helping thousands and thousands and thousands more people than I currently am on any platform that I can get on to share this information. I want to do it from both ends, which I currently am helping those that are already suffering. Then at the beginning, the prevention of this from happening to begin with, so we can really work from both ends of the spectrum.

20:50 Dr. Ann Tsung And what would you say then if it’s prevention? Like the top three actions or strategies that you can do versus somebody who’s already — we’ll talk about it later — maybe somebody who’s already at burnout, working multiple ER shifts, critical care shifts, and is already reactive with their family? So maybe like from the medical student’s side or a college student’s side who’s not quite burned out, all the way to the ones who are already burned out. Any differences in strategy, and just the top three?

21:20 Dr. Robyn Tiger I would say, the top thousand are your stress management. And I’ll tell you why. Even though we have six key pillars of lifestyle medicine, I feel and I have experienced in my own self, as well as the thousands of clients that I’ve had, that the stress pillar, learning how to prevent and relieve your stress, that’s really the umbrella under with all the other decisions that you make fall. So there is this by directionality. But predominantly, if you are stressed, you are not choosing nourishing foods. Okay? So you are not eating celery and romaine lettuce. You want sugar and fried things and processed things, right? Think about when you’re studying for your exams in college. What is everyone eating?

22:08 Dr. Ann Tsung Monsters.

22:09 Dr. Robyn Tiger Right. Yeah, cookies in the middle of the night, right? So Insomnia Cookies, I know my kids talk about. Then the thing is when you eat that food, you actually feel worse. Research shows that when you eat added sugars, added fats, processed foods and kept with chemicals, you actually have higher anxiety and stress. It ends up in depression. So first of all, when you focus on your stress, you’ll be making more healthful nutrition choices. When you focus on your stress, you’re more apt to sleep better. Okay? So when you are feeling stressed and anxious, you can’t sleep well. And when you wake up and you’re tired, you’re more stressed and anxious. So we want to focus on our stress because it helps us get nourishing sleep.

22:54 When you focus on your stress, you’re more apt to exercise properly. You’re more apt to get the number of minutes per week, as well as the intensity level that the exercise prescription is recommended. Most people don’t even know, even physicians don’t know how much should I be exercising and at what intensity. And when you’re exercising better, then you feel better and you’re less stressed. When you are focusing on your stress, you’re more likely to connect with others. Social connection has been shown to be a key component to our health and well-being. Our own surgeon general even wrote an entire book called Together on it and even issued an advisory for isolation and loneliness, so we will be more likely to connect with other people. And the more connecting with other people, we feel less stressed. And when you focus on your stress, you’re less likely to be over drinking and doing recreational drugs and internet shopping and buying every color of that shirt that you don’t really need, or gambling, or whatever else you’re doing to not feel the thing that you don’t want to feel. Right?

23:59 And so when we see stress as the umbrella and we focus on that component — it’s not even the first three. It’s the first thousand or million, I would say — it’s using tools to relieve it and to prevent it when you know you’re going into a situation ahead of time so that everything else is going to fall into play. Then you’ll have that whole person well-being, and you’ll feel amazing. You’ll increase your longevity, and not only your lifespan but your health span. Research shows that the last 10 to 12 years of your life, you will most likely be ill. Most people are sick in the last decade of their life. And so when you do these things — again, it’s an investment — you can move that healthspan to be closer if not equal to your lifespan.

24:49 Dr. Ann Tsung I think that’s a really great way how you put it. Stress is the number one thing that affects all other aspects of life. If you’re stressed out, like a lot of times, for example, after an ER shift, that’s when I over eat. I don’t overeat on junk anymore. But after ICU shift too, I would overeat on the nuts or my avocados or just keep eating those nuts. It’s healthy, but you just couldn’t stop because that discipline is gone. That capacity of your frontal lobe to make those good executive decisions I feel like was gone after ER shift.

25:29 Dr. Robyn Tiger Well, you know what? And so because our doctor brains seem to understand that even more and unpack it, we know that when you’re not sleeping well and you’re tired, when you’re working like that, it actually causes you to eat 300 more calories the next day. Because it messes up your regulation of your ghrelin and your leptin. That’s your satiety hormone, and the hormone that detects hunger. And so you have less hormonal regulation. And so, on average, you eat 300 more calories the next day.

26:01 Dr. Ann Tsung I can definitely see that. And if I worked or if I’m on the computer planning the things for the next day but somehow a stressful task that needed to be done or some agenda for the following day, I have through just recently been waking up two nights in a row at 3 AM. I couldn’t go back to sleep because of rumination. That’s when I was like, alright, I got to go do my floats because it’s time. It’s too much. Then I just stop doing planning, or plan earlier instead of like eight or nine. But plan earlier like four or five, or this time for meditation, things like that. So I agree. It can really affect you, even though I coach on these things to my clients. But it affects me, and I have to realize that that’s time. Okay. I need to do more. Or, I will do more for self-recovery because right now it’s not enough. So then that goes into my question then. If we’re targeting stress, are there three fundamentals to address in order to decrease stress or three techniques or something like that that you found to be effective with your clients?

27:14 Dr. Robyn Tiger Yes. So again, since we’re docs and we like things really organized and structured, and we like things in three’s lots of times, so I have broken down what I consider to be three categories of stress relief tools. One is breath. We focus on the way we breathe. People are like “I don’t have time for a yoga class. I don’t have time to meditating,” I get you. What’s the least amount of time you have? Lots of people will say 10 or 15 minutes. And so when I teach things, lots of times, it won’t be any longer than that. But the tool that you use can take seconds. Earlier, you said, well, how quickly can someone feel better? In seconds is the answer. Right? Because we just never learned. We learned a lot of anatomy and physiology. But we didn’t learn actually how to work with our own anatomy and physiology, right? And so the category one is breath, like how you’re breathing. Your breath can do four things. It can calm you down. It can wake you up. It can cool you off, and it can warm you. So depending on how you use your breath and whatever situation you’re in, you can create any of those desires.

28:25 So we’re talking about stress. One of the components is calming you down and understanding how to breathe in a way to increase your parasympathetic tone or to decrease your sympathetic tone. Secondly is your body and how do you move your body, movement. And so I teach a very specific type of movement called somatic movement, which I studied in Northern California at the Novato Institute of Somatic Research. What we came to understand is it’s the opposite of stretching. So everyone, try it. Everyone, sit up and pull your shoulders back. You can do it with me, Ann. Pull your shoulders back. Okay. And just go back to how you were. Now pull your shoulders back. Let’s do it again. Then go back to how you were. Then pull your shoulders back. Well, heck, how long do you have? Go back to how you were. We can do this all day, right? And so what we understand is stretching feels amazing. But it doesn’t increase the resting length of your chronically intense muscles. People are like, you have amazing posture. It’s somatic. So understanding a different way of movement, which is the opposite of stretching, helps to increase the resting length of chronically-tensed muscles and gives you space in your body so you feel better.

29:35 The second category is movement. Okay? So both of those so far are body-based, bottom-up. The third category is mind. That’s composed of both body-based and mindset, right? And so I break that down again to a body-based and mindset because we can’t think and feel at the same time. And so I always start with the body and then move to the mind. So with respect to the mind, breaking it down to body-based will be a specific type of meditation. So docs are like, I can’t sit quietly. I’m like, I got you. So everything I have is guided and it’s based again on that meditation created for our military. That the Department of Defense has declared a tier one treatment for chronic pain equivalent to opioids. No joke. And it’s in lots of the veterans, administration hospitals, and in a Walter Reed and being used across the board for our first responders.

30:32 Then now we’ve got the body-based. The top-down will be the life coaching, working with your thoughts. We can’t even tackle those 60,000 thoughts per day until our body is calm and then our mind is calm. Then we can start to work with our thoughts, right? And so those are the three main categories. Then in the rest of that, we focus on our nutrition, and our sleep, and our exercise, and our connection, and our substance use and so on, and our escapes. But just to answer your question, I like to focus on three key components, teach very quick tools that everyone can use, and move on from there.

31:11 Dr. Ann Tsung And so regarding the breath then, I like the categorization. That’s really good. And so regarding the first one, the breath, I’ve been doing the 4-7-8 while breathing. Is that what you recommend, or what do you recommend for people that maybe they’re in a reactive state, they’re in a fight or flight state? What typical breathing patterns do you recommend?

31:34 Dr. Robyn Tiger So 4-7-8 is really for sleep. You’re actually creating a hypercapnic state. You’re increasing your C02. So you don’t want to be doing that during the day because you’ll get sleepy, right? And so what Ann is referring to is that you inhale for four, you pause for seven, and you exhale for eight. Now, those numbers may not work for you. Okay? So you may need to create some other combination where your in is less than your hold, is less than your exhale, right? But the thinking behind that is it’s really for sleep, and you really are focusing on elevating your C02, not to a damaging quantity but to help improve your ability to fall asleep and stay asleep.

32:19 Two key components to breath with respect to our own anatomy and physiology when focusing on stress relief. One is inhale versus exhale. We know from our physiology that when you inhale, that your sympathetic nervous system, heart rate increases. Every time you breathe, your heart rate goes up. Every time you exhale, parasympathetic tone, your heart rate goes down. So when someone says, “Take a deep breath” — everyone do it with me. Take a deep breath. Breathe in. What happens? Everything is up here in your chest, right? So it’s actually your exhale breath we need to focus on. So taking a deep breath doesn’t help. It’s your long exhale, without force, just invitation of lengthening your exhale, which will help drive your heart rate and drive your blood pressure down and allow you to feel calmer.

33:12 So when focusing on breathing to feel calm, one is we want to focus on our exhale. That’s the key to our relaxation response. Secondly is location of breath. So as we just practiced together, if you do with me, you were using your accessory muscles. Everything is up in your chest. And if you remember from your anatomy, your lungs are like a triangle. It’s more narrow at the top, wider at the base. So when you are only breathing at the top, it’s very inefficient. So you have to breathe more times in any given minute to get enough oxygen that you need. You learn to direct our breath into our abdomen using our diaphragm. That increases vagal tone, which calms you down. Then you can take longer breaths which are more efficient, and work less hard. Because more oxygen exchange will be happening in the widest part of your lungs, which are the lowest part of your body. So we focus on breath to feel calm. Again, breaking things down into two components. Exhaling and abdominal breath, breathing low into your body.

34:14 Dr. Ann Tsung Yeah, I don’t think I learned the abdominal distension way or diaphragmatic distension way of breathing until 2017. That’s exactly when I learned it at a Tony Robbins conference at UPW. And instead of breathing up with your chest and shoulders thinking that that’s getting enough expansion. And so do you recommend set of 10 or 5 type of breaths, or a specific ratio, or anything, inhale versus exhale, when people are in that stress state?

34:47 Dr. Robyn Tiger I recommend what feels good for people. It’s very independent of the human. And so when I actually teach people, I do take more time in — I don’t know how many hours we have. I’m only kidding. But I do go into it more detail. I tailor it to the human in front of me and what feels good for them. But I don’t ever say you have to do 10 of these. Someone will not be able to do 10, or they may not feel good. Or if I say you have to exhale for this long, well, that could be too long for someone or too short for someone else. So the key is to focus on lengthening your exhale more than your inhale, seeing how long it can allow that to be without force, just invitation of length, to making sure that the force of your breath coming out is as if a candle is flickering on a birthday cake, but you don’t blow it out. Especially when you teach this, and I always encourage things that work for you to teach it to your family, your kids, your partners, people in your life you care about, your patients, your staff, the person that’s bagging your groceries is stressed out. I mean, I’ve taught this stuff in planes, trains, in automobiles. It’s really amazing to be able to share what feels good for you.

35:51 But again, what you do is maybe different than someone else. So just the overall general concept is: longer exhale than inhale, a slow force dancing birthday candle on a cake. And in terms of how many, it’s until you feel better. You may be able to take two or three and you’re like, okay, I got this. Maybe you need more. When you first start, you’re going to be in your head about it. You’re thinking a lot. So initially, you’re going to be thinking a lot about it until it becomes more natural. And when it becomes more natural, you will be doing less. I always say that we need to create that neuroplasticity. So you practice when you’re feeling okay. You practice when you’re driving in the car. You practice when you’re walking your dog. You practice when you’re emptying the dishwasher, you’re folding your laundry, you’re sitting watching TV. You practice in between our cases, like whatever you’re doing. You are building up your default network so that when you do need to pull these tools out, they’re like, okay, I got you. And they can work right away and work quickly because you created those new neural pathways.

36:57 Dr. Ann Tsung Got it. So just remembering the general principles, for those of you guys listening, doing more diaphragmatic abdominal breathing so that you’re breathing, inhaling using your diaphragm and your abdomen, and then just focusing on the exhale that is longer than your inhale, whatever that feels good for you. Practice it during the times where you’re not stressed so that during the times of stress, you remember how to do it. Then for the second part of the body-based, is there something that’s actionable that people can do right after this episode?

37:29 Dr. Robyn Tiger Yes, because I get this question all the time. I love what you’re talking about. How can I get started? I actually have four free videos on my website, and they’re all only five minutes each. I know you have five minutes. Because if you scroll on your phone, you’re doing that for more than five minutes, right? And so I know. I made them intentionally really short. So it’s actually 20 minutes of content. There’s four different videos. One is a common breathing tool. One is a neck and shoulder release through that somatic movement I described. The third one is a short guided meditation, and the fourth one is a mindset shift. So you’re getting the body-based and mindset bottom-up, top-down approach in those four videos. So you can go right on to stressfreeMD.net website. And I’ll send them right to your inbox.

38:15 Dr. Ann Tsung Oh, wow. That’s awesome. So that basically addresses the next two, or, yeah, the body-based and then the meditation you’re talking about, then up to the mind, the life coaching that you’re talking about. Okay. Awesome. So everybody, go to stressfreemd.com and check out those four videos.

38:30 Dr. Robyn Tiger .net.

38:32 Dr. Ann Tsung .net. Thank you for clarifying. Okay, .net. And if you just take one action after this, it could just be breathing or just go into the website, sign up for those videos, just schedule in those non-negotiable times for yourself so that you can start feeling better now instead of waiting. I had a client. I mean, somebody I was talking to earlier, she’s like, well, I think if I can focus more on learning real estate, I can be more productive in real estate, then I’ll free up more time for myself to care for my health. So it’s right now. It’s right now. So thank you so much. I know we talked a lot today about so many different modalities, techniques, even the way to organize things. Are there any takeaways or major points that you really want the audience to learn from this episode?

39:27 Dr. Robyn Tiger Well, first, you may be thinking, “I should know this stuff. I’m a doctor.” You might have some shame right now, and you’re feeling like you’re shitting all over yourself. “I should know this stuff. I should be doing this. I should be teaching it.” And so I’m here to tell you to wipe that shit off. Okay? You don’t know it. You don’t know what you don’t know. Okay? And so you weren’t taught these things. I learned all of this because of my own experience in wanting to heal myself. Then I just share it with the world. So today is a new day. Today is not too late. I don’t care how old you are. I am 58 years young. I feel great. 58 feels great. Okay? So you’re not too old, okay? And it’s not too late. No matter, whether you’re just starting out, or you’re several decades in or you’re retired, every day is a new day.

40:17 The second thing is that, as I mentioned, I frequently get, “Well, I don’t even know where to begin.” Just start by starting. I’ve made it easy for you. Just go to the stressfreemd.net website. Even if you do nothing else, then these four tools, or even just choosing one, you will feel better. I invite you to try them on for size. The reason I create so many different ways to feel better is because we’re all wired a little bit differently. Some people are more visual learners. Some people are tactile learners, and some people are auditory learners. Some people like to write things down, and so on. So really finding different ways to meet you where you are, where you like to learn, and where you will have the greatest experience.

41:01 Thirdly, if you are someone who’s really suffering, and you’re really in a dark place right now, please know that you can get help. I’m inviting you to get help. If anyone’s listening and you’re having dark thoughts, and you are in a place where you’re wondering if you don’t want to be here anymore, I’m sharing this with you. I’ve lost three colleagues. I have been there myself. It turned my life around, but I got help. And I want you to get help, too. So I’m just putting it out there. Please, please pay attention to how you’re feeling. If you know someone that needs help, please encourage them to get help as well. There’s nothing wrong with it.

41:42 Dr. Ann Tsung Yeah, I think very recently, just a few weeks ago, there was a colleague of a friend who had committed suicide. It’s a physician. It’s more common than you think, and it’s somebody that you often actually don’t know. This is common in the military as well. So how can people reach out to you if they want more help? Can you describe a little bit about what you offer in terms of coaching and resources on podcasts? And what’s up and coming as well?

42:11 Dr. Robyn Tiger Yeah, and you mentioned suicide. I’ve been getting more and more requests for workshops on suicide prevention and relief from hospital systems, organizations that have lost physicians to suicide. So that is becoming even more and more about what I’m doing, and even with a colleague of mine, Dr. Jonathan Fisher. So if that’s something that you’re interested in, you can reach out to me for that as well. And yes, on the stressfreemd.net website, as I mentioned, I know you will learn differently. You’d like things differently, different types of modalities of learning. There’s online programs on demand. There’s my podcast, The StressFreeMD Podcast. You can set up a free chat. I’m happy to talk with you. We’ve got the free videos.

42:56 I do one-on-one coaching. I do group coaching. I’ve got multiple retreats. Retreats that are coming up would be, the first one is next month actually in Sedona. I’m not sure when this is being released. I am presenting with Dr. Kelly Casperson. She is the You Are Not Broken podcaster and book and urologist and sexual health expert. So we have an exclusive women’s retreat for midlife and sexual health happening in Sedona in March. Then I’ve got a retreat with Dr. Melissa Sundermann. We have lifestyle medicine that we’re having in Africa Safari. That’s happening in January of 2025, if you’re interested in that. So lots of ways to learn, lots of ways to work with me. We can work together. I’m here to answer any questions that you have.

43:47 Dr. Ann Tsung Anything about the up-and-coming book you’re writing or the shows?

43:51 Dr. Robyn Tiger Oh, yeah, thank you for reminding me. I have so many wonderful things happening that I’m just so blessed and so grateful. I am writing a book. The book is going to be due to come out this fall. Stay tuned. It’s called Feeling Stressed is Optional. The book is very unique. It has not only typical text content, but there will be audio and video files for you to practice along with me, handouts, downloadable handouts and worksheets, and CME. And just to mention, all of my offerings have CME. Anything you do with me, you get CME — whether it’s coaching, whether it’s my programs, whether it’s my podcast, whether it’s workshops, whether it’s my book. All of that is included. So thank you for reminding me, Ann. So the book will be coming out this fall. I’m just finishing the last couple chapters now.

44:49 Then I have a new show called The Doctor Moms. I was asked to create a show for a very prominent streaming platform. Jane Velez-Mitchell is a newscaster in LA. She has UnchainedTV. She heard myself and Dr. Melissa Sundermann, my lifestyle medicine colleague, present last year in New York. She asked us to develop a show where we could teach health and well-being tips to everyone. And so we actually just recorded our first few episodes over the weekend, and that will be going live very soon. So stay tuned for The Doctor Moms show.

45:27 Dr. Ann Tsung Oh, that’s really awesome. Thank you for sharing that. So what about social media? Can people find you? How would they see what you have, other than the podcast?

45:38 Dr. Robyn Tiger Yes, so I’m Dr. Robyn Tiger on LinkedIn and on Facebook. On Instagram, I’m @stressfreemd. Then we have a new Instagram called @thedocmoms where our show will be posted.

45:51 Dr. Ann Tsung Okay. Awesome. Thank you so much again for sharing all the resources. So for the audience, if you just go to one website, get the resources or book a call. Just search for anything. Or just breathe right now maybe after this episode. I think that would be a starting point for you to make that two-millimeter shift to get onto a different trajectory in terms of how you can feel. If you feel great, then you can be productive in other aspects of life. For Productivity MD, we don’t focus on being productive on just your business or your medicine. It’s about being productive in peak performance with fulfillment. So Dr. Robyn Tiger, thank you so much for being on the show. This has been a wonderful treat for the audience. And for the audience, thank you for being present with us. Everything you’ve shared, we will put it in the show notes at Productivity MD. So thank you again, Dr. Tiger.

46:45 Dr. Robyn Tiger It’s been an honor. Thank you so much for having me.

46:47 Dr. Ann Tsung All right. And for everybody listening, just remember that everything we need is within us now. Thank you.

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