20 Sep

ALL YOU NEED IS LOVE

I was diagnosed with a brain tumor in 2013, right in the middle of my medical residency. Before that, I was just going through the motions, making sure I saw enough patients to reach my numbers, graduate, and practice on my own. But on March 13, 2013, my view of medicine changed drastically—and I owe it all to love.

Love diagnosed me, treated me, helped me through the hospitalization, and aids in my recovery to this day. In short, love saved my life. On that day in 2013 when I developed double vision, a prominent, local neurologist obtained the MRI and laboratory work that gave me a diagnosis. Unlike me, he wasn’t merely going through the motions. He loved his craft and it was because of this love that I was diagnosed.

When I needed surgery, the neurologist consulted with a neurosurgeon who performed the 16-hour surgery. What possesses someone to operate for 16 hours? What drove him to wake up every morning before the sun rises to visit me? Only love of his art could motivate him, I believe.

In my initial post-operative phase, I was in the ICU for one week, followed by a month-long stay on the general floor where I received dozens of visitors, including my primary care physician; a rehabilitation doctor; speech, occupational, and physical therapists; a neurologist; an ophthalmologist, and a neuropsychologist.

Many of these visits, especially from the physical therapist, were frustrating. Saying words like bumblebee, or putting pegs in a board did not thrill me. Many times I wanted to skip these appointments, but the love of my wife and two sons always urged me on.

It was the love of my friends that reminded me that I would get better. It was their love that gave me the hope I needed. Now, when I am doing balance exercises at the gym, I close my eyes and picture my friends and family. Their love makes me do that extra exercise; they are the reason I try to recover.

My words may sound cliché, but no matter how I spin it, I can’t get around the fact that love has been the driving force behind this whole journey, from diagnosis to recovery.

As a physician, I hope to use this love in all my encounters. The days of going through the motions are behind me. I realize it is unrealistic to love every one of my future patients. Instead, I will love the art of medicine and the fact that I am fortunate enough to be in a position to help people.

 

speakup_1.jpgChristopher Chiou, MD, practices family medicine in Okemos, MI, where he lives with his wife, who is also a doctor, and two sons. He has recently begun writing about health in various journals.

 http://journals.lww.com/neurologynow/blog/speakup/pages/post.aspx?PostID=72
16 Aug

Supplements

If you are looking for a profound article describing the meaning of life, then read no further, this is not that kind of article.  I was just reminded recently about the idea of supplements.  In fact, one of the EBTS members, Andrew Walker, recently posted, “A nutritionist suggested some supplements to support [the] brain…”  Now before I go on, you might finish this article and think, jeez, does Chris not like supplements?  I want to answer that right from the onset; my response is a little complex, but ultimately the answer is, “I do not know.”  Let me explain.

In medicine, we are trained to be weary of dietary supplements.  The idea behind this is that these supplements are not researched and approved by the FDA.  This does not mean that they are disapproved, it simply means that that particular drug or dietary aid has not been studied.  Numerous supplements like multi-vitamins, glucosamine chondroitin, and melatonin I actually encourage my patients to take.  While these have not been approved by the FDA, they have stood the test of time.  However, for every one of these effective remedies, many more questionable ones exist.  My mind cannot go away from e-cigarettes when mentioning this.  I know they are not technically a supplement, but many of the ideas are the same.  While, the idea of replacing a ‘regular’ cigarette with a device that delivers nicotine in a different way is a good thought, the problem is that we have absolutely no idea what is in them.  For all we know, e-cigarettes could contain trace amounts of rat poison.  Or it could contain some magical compound that stops smoking.  The point is that we have no clue what is in e-cigarettes or supplements; they lack the research needed to know their contents or effectiveness.

So, in the end, my thoughts on supplements is one of uncertainty.  I have been fortunate enough to be on both sides of the conversation: I have both suggested and been advised to take a certain supplement.

My only advice to you is to be your own FDA, and research and study what you are considering to put in your body.  Part of that research may include asking your physician, in hopes that he/she also has studied the supplement in question and can share their findings and thoughts with you.  Your research may include posing a question to a group like the EBTS (like Andrew).

 

22 May

Awareness

For this month, Brain Tumor Awareness Month, I am writing about the issue of awareness and what it truly means to be aware.
The month of May is Brain Tumor Awareness Month, which is one of many months in our society. We have Black History Month, Breast Cancer Month, and LGBT Month, among others.
But what does it mean to be truly aware? I think, too often the reaction to hearing of this month’s observance is, “Really? Interesting.” (In a flippant manner). Or if someone wants to go a step further, the response may be, “Cool! I know someone with Breast Cancer”, or “I know someone Brain Cancer.” But is that true awareness? Is that what is meant when a whole month is devoted to the subject?
I must admit that in medical school, Brain Tumors was a topic that was only taught as part of another topic with maybe 10 minutes of lecture time devoted to the condition. We were taught of only the most deadly Brain Tumor Cancers, numbering maybe 15 afflictions. Prior to my surgery, I had never heard of Epidermoid Brain Tumors. I’m sure Neurology or Neurosurgical specialties study them more in-depth, but even in medical school we did not learn about Brain Tumors in much detail.
Merriam-Webster defines aware as having or showing realization, perception, or knowledge. Simply knowing of Brain Tumor’s existence does not fulfill this definition.
To do this month justice, we ought to delve deeper. For me, this means learning about more than the 15 Brain Tumors taught in my medical school. For many of us in this group, we either have a loved one with an Epidermoid Brain Tumor, or have been diagnosed personally with an Epidermoid Brain Tumor. But I contend that we should take this a step further and try to learn more of Brain Tumors. Take 10 minutes out of your day to read an informative article on the topic. Even though I have been afflicted with a Brain Tumor myself, I am going to devote more time to learning of the condition and its vast implications. But learning of the scientific facts of the condition is not enough; as I mentioned earlier, most of you are incredibly privileged to be, or have someone in your life with this disease, knowing about a topic is more than knowing the facts of it; broaden your knowledge by feeling the experience: ask someone you know about their condition and how it affects their life.
This month, I urge you to take time to learn more. This way, when someone says to you, “Did you know it is Brain Tumor Awareness Month?”, while your reply might be a passing, “yeah”, now you will be more informed.

My hope is that this month does not become a mere side note, but an event that makes you change your realization, perception, and knowledge of the topic.

28 Jan

Fear

Fear is defined by Merriam Webster as to be afraid or apprehensive.[1]  But while we know how to define fear, where does it come from?  The question of fear and its basis is an important one.  But when I thought of it more, the answer became clear: we fear what we do not understand.

One only needs to look at countless examples from our history to see this: before the Wright brothers mastered the art of flight, flying was seen as not only an impossible endeavor, but also one that ensured death; before 1968 it was seen as ludicrous to even attempt an unconventional method for high jumping.  Then came along a man by the name of Dick Fosbury who revolutionized the high jump on the way to winning a Gold Medal.[2]  My point is that difference can lead to a lack of understanding, which begets fear.

I have experienced much of this in my own life: growing up Asian in a primarily white neighborhood led to some (but not many) misunderstandings and fear.  I played tennis growing up and was once asked by an opposing team member, “how I could possibly see the court with my slanted eyes?”  This lack of understanding is amplified now with my current condition as most who come across me are unsure what (or what not) to assume.

For you, does being told that you (or a loved one) have a ‘brain tumor’ scare you?  Perhaps it’s because all we know is that brain tumor = bad.  Maybe if we better understood them our fears would be lessened.  I remember when I received my diagnosis, I was scared; a flood of questions came to my mind: What is an Epidermoid Tumor?  How is it treated?  Does it require surgery?  How long have I had it?  I could list the countless number of questions that came to mind, but the point is not the number of questions, the point is that I was asking myself these questions, a sign of my lack of understanding, which led to my fear.

Thus, in the future, when you find yourself anxiety-ridden over an upcoming (or past) event or happening, try to turn this fear into inquisition, to broaden your understanding.  Hopefully, this will help to quell your angst.

[1] https://www.merriam-webster.com/dictionary/fear

[2] https://www.dickfosbury.com/

01 Jan

Reflections

At this time of the year, with January 1st here, I feel it is both an appropriate and vital time to think about what it means to reflect. If you were to ask a 10 year old what reflection is, they might say it is the image produced when you look into a mirror (or glass or still water). The truth is that (besides that being one of the definitions of the word) they would not be too far from what I discuss here; when I think about reflection, I do not think about a physical image that is produced when looking on a certain material, but a less tangible ideal where our past actions and occurrences are pondered. The thought of a physical image that details how we look upon an object (whether it be a mirror or a window) does not stray too far from this existential meaning; in both one sees oneself in their true form.

When I think back to this year, I recall the countless interactions I had; from the cashier at a local grocery store to ones with my close friends. I know what I meant by my actions and words, but were they received differently, I ponder. How has my diagnosis of an Epidermoid Brain Tumor affect my life? Even though the diagnosis and subsequent surgery was back in 2013, I still often wonder questions about it. While I am also thankful that I am able to write for you through the EBTS, I often ask myself if the topics of my pieces are appropriate ones: would different topics be a better read for you? You’ll find that this process of reflection often generates more questions. Don’t let this discourage you, this process should create questions. The art of reflection is a process, not a magic trick, where you instantaneously emerge an improved human being; asking questions is not only an initial step, but also one that happens in the middle of it.

Reflection is how we grow. If Steve Jobs did not reflect on his past successes and failures, would the Apple technology be where it is today? If Albert Einstein simply accepted a half-hearted Theory of Relativity, this concept would likely be a lost one today. The point is not that reflection will always produce an iPhone, or time-space continuum theories, but that reflection is crucial for our progression, as both a human race and individually as people.

So during this time of year, take some time to pause and reflect on your past; whether it be a new brain tumor diagnosis, or perhaps a short interaction with an acquaintance, take time to ask yourself, ‘how did this affect me? Could I have handled it differently? Have I or the people around me changed because of it?’

The art of reflection is an important one that is vital to both us as individuals and the human race as a whole. Use this time of year to reflect. Most importantly, have a safe and Happy New Year!

20 Oct

Miracles

I had a thought today about society’s feelings towards the idea of miracles. I also recently watched a television program that discussed the topic. In this program an interesting question was posed: “What is a miracle?” How do we, as a society, define miracles? Many (or most) religions are centered around figures that performed miraculous ‘acts’; Jesus walked on water and Moses parted the Red Sea. But is this how we define a miracle? Webster defines a miracle as “a very amazing or unusual event, thing, or achievement.” Even though this encapsulates the acts of Jesus and Moses; are miracles solely limited to acts such as these? I am reminded of a fact we are taught in medicine, most lung cancers are due to smoking, but most smokers do not get lung cancer. The idea is the same with these miracles: these acts by prophets are miracles, but not all miracles are performed by prophets. Delving even a layer deeper, as I asked of you in the beginning of this piece, what defines a miracle? I believe that miracles happen to us every day. When you open your eyes after waking, or hear the birds singing their song; to me this is a miracle.
 Why ask this question? As a society we value these miraculous events as a sign of intervention from God. Many religions are based on these events; thus the importance of exploring this topic further is paramount to an understanding of religion and our society as a whole. But are we limiting ourselves when we define miracles like this? To me, after studying the human body, every single heartbeat, every breath we take is “an amazing event, thing or achievement.” Instead of looking in obscure places for these events, I think we need not look further than our daily lives for examples of personal miracles, and events for which we feel grateful and in awe.
As I said earlier, in my studies of the human body, how every cell in our body serves a function of our existence is a miracle to me. But this definition is not only limited to human physiology. Several years ago I contacted the Epidermoid Brain Tumor Society hoping to become a member. Instead, I came into contact with Linda Frevert and Fay Powell; not only did they graciously allow me to become a member, but they also asked that I write a column for the group. To me, countless numbers of personal miracles occurred with this: firstly, allowing me to be part of this group with all of your amazing stories has been surreal. Next, allowing me to share my thoughts with you has been an incredible experience. These are my personal miracles, and I feel truly blessed.
Please do not misconstrue my words, I am by no means trying to degrade or put these acts into question – endless literature and theologians focus on this; I am simply questioning our definition of the word. What I am questioning is the limitation we produce when we define miracles as some magical act. To me,  miracles are more common than we believe. Divine intervention still always has a hand in its occurrence.
05 Aug

Noise

I recently saw a great movie (titled ‘Race”) and one scene from it really struck me and persisted in my mind. Let me describe the scene to you: it is a movie about the track and field athlete Jesse Owens. Near the beginning of the movie Jesse is in college in the middle of a training session with the football team watching. One of these players makes a racist comment towards Jesse, clearly flustering him. The track coach notices this and in the next scene confronts Jesse about this. However, while confronting Jesse about this he deliberately riles up the football team and coach, in an effort to teach Jesse a lesson on the importance of focus; there is a poignant moment where all the football players are yelling, while the coach implores Jesse to focus on him, that “All of this is just noise. You are going to hear a lot of this in the years to come, you need to learn to block it out and focus!” The scene ends with Jesse focusing on his coach while successfully blocking out the other ‘distractions’. To make this point clear, the football players and coach can be seen yelling while no sound comes from their mouths.

This made me think of the concept of noise. This is not a new concept as many writers have referred to the idea of noise and the importance of shutting out noise in an effort to focus on the task at hand. Since my surgery the importance of being able to focus on the task at hand while blocking out all other ‘noise’ has become even more relevant. I find that the more I try to multitask the more mistakes that occur. I have learned that instead of trying to accomplish too much at once, it is better to get one task done well rather than two or three done shoddily. In sport this is easier, as the ‘noise’ is usually more tangible: whether it be crowd ‘input’, or your opponent is attempting to throw you off your game by ‘talking trash’. Don’t get me wrong, blocking out this noise can be difficult. I am simply saying that in sport, identifying this ‘noise’ is easier. But this isn’t only relevant to sports, it is applicable to life in general. Many of us have been diagnosed with a brain tumor showing us the fragile nature of our minds. I implore you to put your efforts into one goal, instead of being distracted by “noise.” Forget about that noise, it can only serve to distract you and delay you from your goals.

08 May

Mothers

Because today is a day we honor our mothers, I have done much thinking about the importance of loved ones like our mothers and the importance of having a day like this; yes, the cynical side of me thought this is an artificial holiday created by card and flower companies in a ruse to make money. Then I realized so what if it’s a contrived holiday? Does my mind’s perceived origins of it mean that its aim is disingenuous? The answer is no; the holiday may fall on the second Sunday for arbitrary and questionable reasons, but we embrace it because mothers truly do deserve a holiday to recognize all they do for us.

In my life, I am lucky enough to have 2 mother figures. The first is my actual mother (a true red if you read my last piece), and I also have my wife, the mother of our 2 sons. (I failed to include my older sister in to this group as she is a mother of three). Each of these figures brighten my life, albeit in different ways. My mom only wants what is best for me, and will stop at nothing to make sure I receive the best of everything. I hate to use the term ‘Tiger mom’, but this is a woman who practiced as an Emergency Department physician and put her children through Yale, Harvard, and Tufts. Not only that, but she encouraged and supported my sister and me in our paths to medicine, with my older sister being an Emergency Department physician and me being a Family Practice doctor. She also wholeheartedly supported my younger sister’s less “conventional” choice of working in the financial sector. As hard as I may try not to call her a ‘Tiger mom”, this perfectly describes her.

My wife is different; she is more passive than my mother; but don’t be mistaken, this passiveness does not mean she has accomplished any less in her life. She graduated with a degree in Psychology from Harvard, and now practices as a Family Physician in Michigan and somehow manages to be an amazing mother while working on a full-time basis. Their mothering styles are different; the best example I can give is that if something were standing in the way of what either I or my sons needed, my mom would have no problem stepping on some toes to get what was needed. My wife, on the other hand, would make sure not to step on anyone’s toes but would still succeed at obtaining what was needed. Neither way is better, actually in both cases they get what they desire. I realized in thinking of the importance of them in my life that a day devoted to their appreciation is not enough. If I could I’d treat every day as if it were Mother’s Day to thank them for everything they do.

mom 1But this is only the brief description of my story and the importance these mother figures play in my life. There are almost 7.5 billion people on this planet; and every one of them has or had a mother. So my story, and the importance of the mother figures in my life is one of 7.5 billion. So call your mother today and tell her 2 things:
1. How much you love her
2. How lucky you are to have her in your life

10 Apr

Colors

Hi everyone! I wanted to thank you all for being patient with me during my hiatus. It has been many months since I last wrote an article for you.

puzzle-headOne of the reasons I have not produced anything for you is that for the past several months I have been back in the clinic seeing patients, completing a portion of my family medicine residency training. As part of this training, once a month we have a 2½ hour seminar as part of our behavioral medicine curriculum. During this time we discuss a wide array of topics ranging from bipolar disorder to child abuse, all with the aim of improving our communication skills, and hopefully help us become more empathic physicians. One of the past sessions we were treated to a fascinating lecture on a less well known personality classification scheme. Most of us have heard of the Myers – Briggs test, where after an extensive set of questions, spanning many hours, you are given a set of 4 letters denoting your personality type. For example, you might be told that you are an ‘ESTJ’ meaning you are an Extrovert, Sensing, Thinking, and Judgment type. While I think this can be a helpful schema, my issue with it is the time required to take the test. During our session, rather than the Myers-Briggs test, we were given a different and much shorter personality test (it literally took me 7 minutes to complete) and based on the results were given a color that matched your personality type. I have included a copy of this questionnaire below, I encourage you to try it:

Personal Style Inventory
Robert W. Russell, Portland, Oregon
Used by permission

Each line below lists two contrasting traits. Your task is to divide seven points between the two statements on each line to reflect the balance of how each best describes you. Points may be divided in any way you wish, but both sides together must add up to seven. Give high points to the description that describes you well, while giving the other side low points. Do the same on each line for Part 1 and Part 2.  For example, people who see themselves as quick in the way they handle things might fill out the first line like this:

************************************************************************ 

 5  Likes a fast pace.                    or                2  Likes a slower, more deliberate pace
part 1 quiz
part 2 quiz
Scoring Instructions

Add up the total number of points for each column (A, B, 1, 2). the columns (A/B and 1/2) with the highest points determine your color.  For example:

A ‘red’ is a very assertive person, a type A personality.
A ‘green’ is very task oriented, they are the thinkers.
A ‘blue’ is very compassionate and detail oriented.
A ‘yellow’ is more of an introvert, and always follows the rules.

I have also included a copy of the interpretation sheet and what the various colors mean:

The Four Basic Styles

A-1 RED

TASK ORIENTED. FOCUSED ON RESULTS. EXERTS STRONG INFLUENCE IN GETTING THINGS DONE. ASSERTIVE IN EXPRESSION OF IDEAS. PREFERS BEING IN CHARGE. HAS STRONG OPINIONS.

COMMON STRENGTHS: Determined, decision maker, efficient, gets results, direct, takes charge, responsible, leadership qualities, risk taker, alert to opportunities, challenging limitations.

POTENTIAL WEAKNESSES: Dominating, unsympathetic, demanding, critical, superior, harsh, impatient, dictatorial.

A-2 BLUE

PEOPLE ORIENTED, EXPRESSES OPINIONS AND EMOTIONS EASILY. IS VERY ACTIVE AND MOVES AT A LIVELY PACE. PREFERS STRONG INTERACTION WITH PEIOPLE. USUALLY HAS MANY INTERESTS. TENDS TO BE IMAGE CONSCIOUS.

COMMON STRENGTHS: Personable, stimulating, enthusiastic, dramatic, inspiring, innovative, articulate, concern for the welfare of others. Looks for ways to be helpful, friendly, tries to avoid being a burden to others, warmhearted.

POTENTIAL WEAKNESSES: Opinionated, excitable, phony, flighty, reactionary, exaggerates, showoff, pushover, bleeding hearts, doormats, too social.

B-1 GREEN

DATA ORIENTED, LIKES THINGS TO BE WELL ORGANIZED AND THOUGHT OUT. PREFERS SPECIFIC PROJECTS AND ACTIVITIES THAT CAN BE SYSTEMATICALLY WORKED ON. ENJOYS PUTTING STRUCTURE TO IDEAS. THOROUGH AND CAREFUL ABOUT DETAILS.

COMMON STRENGTHS: Industrious, persistent, serious, vigilant, orderly, rational, methodical, factual, thorough, planners, thinkers, analyzers.

POTENTIAL WEAKNESSES: Indecisive, picky, withdrawn, data-bound, uncommunicative, critical, unsympathetic, analysis-paralysis.

B-2 YELLOW

SUPPORT ORIENTED. STAYS OUT OF THE LIMELIGHT. LIKES BEING PART OF CORDIAL AND FRIENDLY GROUPS. HIGH CONCERN FOR GOOD RELATIONSHIPS. SEEKS STABILITY AND PREDICTABILITY.

COMMON STRENGTHS: Flexible, cooperative, supportive, friendly, willing, dependable, personable, sincere, helpful, team player.

POTENTIAL WEAKNESSES: Conforming, retiring, overly sensitive, dependent, unpredictable, wishy-washy, hides true feelings, sarcastic, chameleon, the “company man/woman”. 

Personally, before this lecture I despised personality tests; I hated the idea of being labeled and I also frequently find flaws in their findings. Yes, that’s true about me I will think, but this is definitely not like me. This test was different though, while yes it did label me as a certain personality, it was also incredibly accurate. Every bullet point that described my personality, my ‘color’ was true.

But what was the purpose of this test? For us, it helped us better understand ourselves and others, and hopefully will aid us in our interactions with colleagues and patients. But why should that exclusively help physicians? All of us have our color, knowing it will not only help us become more self-aware people, but it will also help us better understand others and where they are coming from. For us, even though we share the commonality of either suffering from Epidermoid Tumors or having a loved one afflicted with the condition, we are all individuals, different people with different personalities. It is impossible for any personality test to be 100% accurate, they are simply aimed at classifying your personality with few errors. For me the accuracy of this test was striking, with such little preparation time. More importantly, it highlighted to me the importance of self-awareness and how all of our interactions with others can be made better with this understanding. Take the test, find out what color you are. What color would you label your loved ones? Are there certain colors you are drawn to? For me, I turned out to be a ‘yellow’ with my wife being ‘green’. But I realized that a team filled with either yellows or reds would not make an effective team – you need diversity in colors to make a good team. Tell me what color you are, and what color your loved ones are.

16 Nov

LOVE

In reflecting on my experience with this tumor, I kept coming back to the idea that love played an integral role both in my diagnosis and recovery.  I realize I am not alone in knowing the importance of love.  Perhaps, it was a loved one who implored you to see a physician to obtain a diagnosis; maybe your loved one makes sure to attend all of your appointments; love and support can be as simple as holding your hand during difficult times.

Clipboard01For me, I remember first trying to leave my wife out of the situation, believing being tough meant being a lone ranger; in reality, there really is no such thing as a ‘lone ranger’, even the Lone Ranger needed help (from Tonto).  When I realized that the diagnosis was a grim one, I had to telephone my wife to have her by my side when I received the diagnosis.  When I was waking up from my anesthesia after my 16-hour surgery, the first person I apparently called for was my older sister.  When I was transferred to the ICU I remember holding my younger sister’s hand.  My mother spent every night with me in my month and a half long stay in the hospital.

Why do I tell you this?  Why is this relevant?  I am like anyone else, and when the chips were down and I was shoved into a corner, I instinctively called for loved ones.  Like I said, I am like everyone else; my nature to want loved ones by as I faced difficult situations is an instinct that we all share.  I then thought of the idea of love, and its role in my ordeal: I realized that love not only got me a diagnosis, but it has also helped me through my recovery.  The neurologist who diagnosed me reached his conclusion out of love; love for the art and skill of his profession.  I was promptly seen at the University of Michigan because those who loved me quickly called and found the top neurosurgeon in the area. Every card, every visit, which brightened my day was done out of love.

With health issues like epidermoid brain tumors, we all need loved ones to help us traverse this terrain.  Whether you are a ‘wait and watch’ patient or have upcoming surgery scheduled, the idea of love is how we get through this.  Even though the thought of love may immediately place your mind in the realm of the traditional sense of the word, love can come in many forms; yes love of a fellow human is the more ‘traditional’ thinking behind the emotion, but we can (and do) love more than just people—we love places, arts, and professions too.

I do not tell you this to tell you how lucky I am to have those around me who love me, but to remind you that every relationship you forge, every loved one is a person you should cherish.  It’s easy to be with a loved one during times of joy, but remember it is those same people that will also be there when you are down.