A Pathologist's Journey to Wellness

• Wellness Resources for Pathologists by the Wellness Project Team

Becca Battisfore:

Welcome to the latest edition of the College of American Pathologist’s CAPcast. I'm Becca Battisfore content specialist with the CAP. In this episode, we'll be hearing from Dr. Sathiyamoorthy about her journey to wellness and how she overcame musculoskeletal issues while continuing to practice pathology. While her story is unique, there are aspects that will certainly resonate with other pathologists. So welcome to the podcast, Dr. Sathiyamoorthy. Before we dive in, can you give a brief introduction of your current work and your involvement with the CAP?

Dr. Srividya Sathiyamoorthy:

Thank you. Thank you for having me do this and share my story with my colleagues. So I've been practicing pathology since the last 11 years before which I had completed residency and fellowship training. I currently function as chair of pathology at Northwest Hospital in my hospital, and I am a medical director of clinical chemistry, cytopathology and point-of-care testing. And I also oversee the fine needle aspiration service that we do at Interventional Radiology. I also participate in CAP. I've been active since my residency as a junior member. I served on the CAP checklist committee, and then after going into practice, I started getting more active in the college by participating as a delegate from the Maryland delegation for the House of Delegates. And in that role, I was invited to be part of the Wellness Project team, and I've been doing that recently, I believe, last two years.

Becca Battisfore:

Wow. Great. So let's start at the beginning of your story. Can you share when you first started to notice that there might be some musculoskeletal issues?

Dr. Srividya Sathiyamoorthy:

Right. At that time I was not thinking of it like that, and I was in the middle of my residency, so I just thought of it as related to my overwork with the computer, the keyboard and everything. And so it first started off, I would say in maybe 2008 or nine when I was a resident as a wrist pain. And I went to see a doctor at that time and he suggested that it could be carpal tunnel, and basically he wanted to inject steroids in my joint, and I didn't want anyone injecting anything in my wrist. So I said no. Again, I kind of worked a little bit on my posture while I was typing and it kind of reduced by itself, I would say. And that's how it started. And over time, I would say sometime around 2017 or so, I started developing some elbow pain.

So I had swelling in both my elbows. This was diagnosed as medial epicondylitis, so on both my elbow joints. So again, I went to a different doctor. At this time it was a elbow specialist, and they said that it could be because of my repetitive work that I do. I use a computer, I used microscope, but they did not directly link it to anything more than that. And I was suggested to kind of throw away my phone and go to Bali for three months. So obviously I did not do that. At which point I also started noticing that I have a lot of the stiffness in my neck and my shoulder, and I was always meddling. I mean, not meddling, but putting my hands up in my neck, especially at the end of the day. And it was just something I started living with. It was always with me.

And so I would say by 2018 or so, it started to get slowly worse. At that time, I didn't connect it to the epicondylitis, but I tried acupuncture. This would be, I would say 2019, I went to see an acupuncture specialist, and I did that for six months, and that did give me some relief. Although it was temporary, it didn't go away. But once I stopped the sessions, it started coming back again, like how it was before. And then I also happened to start meditation sometime in 2019, and I realized that meditation was really helping me. And the longer I meditated, 45 minutes, one hour, I would end up with completely painless status, which I had not experienced in, I would say the past five or six years. I was always living with pain. But when I meditated, I realized that it would just go away.

And it was very temporary because at the end of my meditation, I would be completely pain-free, and slowly within a half an hour or so, I'd start my activities and the pain would come back. And so that is how I was until about 2021.

Meanwhile, I also was taking up more responsibility at work. Initially, I started off as anatomic pathologist with being director of microbiology, which went into the COVID period, at which time I was directing micro lab, and we were actively involved in the testing in COVID for our entire system. I was system director for microbiology. And then by 2020, I would say late 2020, I took over as chair of my department here at Northwest Hospital. I have to add that by 2017, I had started taking over this fine needle aspiration service, which was another added responsibility, but it's something I love doing, but it's a different set of muscles I use when I'm doing the fine needle aspiration. I use the ultrasound probe and I'm doing aspiration of patient's thyroid and neck nodules.

So that was added in 2017, and then by 2020, I kind of took over as chair of Northwest because I basically wanted to stay in one hospital before which I was doing 50% at one hospital and 50% at another hospital. And I felt that that might be adding to the stress of it, so I kind of wanted to stay in one place. So I took over as chair at Northwest Hospital, and that's where I've been since 2021.

Becca Battisfore:

Oh, okay. I had a question. You had mentioned that back in 2008, your wrists were hurting and the keyboarding likely had a big impact on that. Did you find that all of these different roles that you were taking on had caused some, being in a different office, in a different chair, different desk set up? Did that cause additional pain that you noticed?

Dr. Srividya Sathiyamoorthy:

The thing is, the pain always used to take a few days to develop. So at any point of time, I could not temporarily relate the pain to some specific thing, but I definitely believe that having a set-up here that was my predecessors were both tall people and I just inherited the furniture and everything. And so I definitely considered that, and some of my colleagues had suggested to think about that also. So ergonomics was something I did think about. Obviously making sudden changes is not going to happen at the same time. I wasn't 100% it was directly related to all that, but I definitely think it was contributing to that with the added responsibilities. And so posture and ergonomics definitely have a role in this. Yeah.

Becca Battisfore:

Right. Yeah. You don't discover it until it's a little too late and then you have to course correct. So I think you took us to 2021 and that's when things started to get worse. Do you want to tell more about that?

Dr. Srividya Sathiyamoorthy:

Sure. So by 2021, I had just started taking over as chair, and it was middle of COVID, and we had a lot of, I would say this was national issues, but it affected every single system. So we had reagent issues, testing, supply issues, and a lot of, I would say even within the hospital operational issues and in general, it was a little stressful period to take over a chair without any previous experience. So it entailed a lot of learning for me, steep learning. And that resulted in me spending long hours at work, sometimes 12 hours, 14 hours. I mean, I had to do it just to be able to keep on top of everything. And so at that time, I would say definitely that one of the hobbies that I did regularly was walking. I love walking, and I used to be a runner before that, but I stopped running around, I would say 10 years ago because of my knees, I started developing arthritis in my left knee.

And so I kind of brought that down and I kept walking. But then during that period, in 2021, there was a period of time I would say where I could not walk. I didn't find time to do that because I would have really long hours, and I have a family, kids at home, although they're a bit grown up at that point, they were in college and high school. So yes, that also added to this, the stress, the lack of exercise, and especially the prolonged sitting, I would say looking at the microscope and multiple screens, as you can imagine, I had two screens. And so all of that contributed to where I was headed, which was in October of 2021, one day, it was Monday evening, I had a long day, and I had actually started working Saturdays for the past few Saturdays. I remember that happening.

And so that was another, I think I was working long and didn't have much of a break. One Monday evening, I went home and all of a sudden I just had this kind of a sudden sharp pain and my right shoulder, and basically my shoulder was just fixed in a static position. And actually at that point I thought it was a dislocation, but I had not had trauma or anything like that. And so I was completely, not only in pain, but very scared as to what was happening to myself. I didn't know what was happening to me. I think at that point, I had started going through these days without even being conscious of my pain. I think I was so used to it. And then at that time, sometimes what happens is you take everything, your work so seriously that you don't realize all the other effects that are going on around you.

And definitely that was happening to me. I was sometimes in a daze. I just needed to get some things done, and I would just hang around at work way after regular business hours. And so that happened on that Monday evening, and I was quite frantic. I didn't know what was happening. I needed to go into either emergency or urgent care, and I called a couple of my colleagues and tried to figure out what's happening. And it did not sound like a fracture or a dislocation because there was no trauma involved. But at that time, I had no idea what was happening. And one of my dear colleagues and co-chairs actually made an exception. He saw me in his office. Basically, he couldn't even do a physical examination of me because I was in so much pain. And so basically he put me through a short course of steroids to see if it was inflammation related, and then he asked for MRIs of the shoulder.

So that's how it happened. And then I was like, this is not shoulder related. I somehow fell deep down. It was not shoulder related, so I kind of requested that he give me an order for a neck MRI also just in case. And he was very gracious. He did that. And so we got our MRIs and the MRI showed that my right shoulder had two foci of large areas of calcified tendinitis.

And so basically I was referred to a pain specialist that is musculoskeletal rehabilitation physician, and the focus was to get some kind of physiotherapy for the shoulder. I have to say here that before I went to the rehabilitation specialist, we had started physiotherapy on the shoulder. We started that thinking, this is a shoulder thing because MRI didn't show any neck changes. And so there was a little bit of narrowing of disc space and everything they said potentially could be contributing. But basically I was told the pathology is in the shoulder, and we started physiotherapy, and that's when it got worse because I was trying to fix the shoulder issues, but this was making it worse because I believe that the issue was not on the shoulder and it was more proximal in the neck.

So at which point I started getting worse, and so I stopped everything. I said, no more doctors, no more physical therapist. I don't want any treatment. I need to reassess myself, my situation, why am I getting worse and what is really happening with me? And obviously, I couldn't go to work, so I was off. I couldn't work, I couldn't drive, I could not do my basic activities of the day. And so pretty much I was in a very low point of my life at home and just thinking and assessing and self-evaluating my situation.

Becca Battisfore:

What did you notice started happening then once you had all this time and not as much stress physically on you?

Dr. Srividya Sathiyamoorthy:

Right. I wouldn't say any change was immediate because there was a lot of stress in me because I am going through this whole thing, and I don't know what it is about and how to figure it out, how to fix it. And my whole family is now affected because I'm at home. My husband's kind of taking care of me, and we all don't know what exactly is happening and how do I get back on track with my life. It was definitely a deep point of my life. I mean, when I say deep, deep, but also the lowest point. And what kept me going, I would say at that time was my habit of meditation, which I had started, I would say in 2019. Initially I would do it for pain relief. It would give me relief.

And so I started doing more of it. Even at that time, even before all of this happened with my shoulder, I used to sometimes just go away from my office and meditate for 10 minutes or within my office, I would do it because it would bring back complete relaxation and that would relieve me of the pain. And so I continued to meditate and try to introspect, and I started keeping notes of my pain. I also started looking back into my history and how did this whole thing develop?

Obviously, sometimes you're so immersed in your life and your work, you don't have time to think and put things in perspective. So I took the time to kind of write notes and study myself and see what were the actions I could do, what were the things I could not do. I started doing an extensive literature search on what could be going on with me. And then I started yoga, which as a student, I had yoga as part of my curriculum throughout my elementary, middle, and high school. But I had not continued after that. I let go of the practice. For some reason, I went back to yoga, and even though I couldn't do some of the asanas, I would do yoga because it brought up my, I would say my psyche. It would improve my mood for the day.

So every morning, and sometimes I couldn't sleep in the night, I was worried about what's happening and the pain would not allow me to sleep. So I would watch these yoga videos on YouTube, and I found one simple yoga, and I would just follow along because I knew all the asanas. That helped and my meditation, because that would just kind of calm me down and tell me to think practically, what is the next step? So that'swhat happened. And after a couple of weeks, I said, okay, first I decided I need pain control. And then my doctor had suggested I see that rehabilitation or physiatrist. So I did that. I got an appointment, and in those days it was difficult to get an appointment. So I typed my entire history, like my timeline, and I handed it to him when I went to that appointment.

And then he prescribed me a long-acting painkiller, which I started. And so he said, first, you need pain control, and then we're going to figure out what's happening with you. And so that's what happened. We started pain control, and then I started interviewing different physical therapists. I had stopped my other physical therapy session, so I kind of explained to the physical therapist that I think I'm a special case. It's not a straightforward diagnosis. I don't know what I have, but I need you to be patient with me and willing to work with me and kind of understand my background, my history and everything, and put it all together. And so there was one person who had a lot of experience, like 30 years in physiotherapy, and she was willing to work with me. And basically I took articles to her explaining or looking at what I could have.

By that point, I had kind of started looking at things differently, and I kind of started considering the possibility that this was all neck related and it was related to my work and all of that. So I came up with this kind of possible diagnosis, and I shared some of these articles with my physical therapist who worked with me. She was wonderful. In fact, my first physiotherapist had told me I shouldn't do yoga while going through physical therapy, which in retrospect, I think probably would've been better if I had continued the yoga parallelly. But this person was very much into yoga, and she said, absolutely, you should continue. She had me do the yoga asanas that I'd been doing every day. She cleared me off that. She said, "You should continue them", and very encouraging, and she was willing to look at these. I had some corrective exercise plans from these articles on what I possibly have, and she had all those equipments, and we started working together toward correcting what I possibly had.

And by trial and error, and by observing myself making a lot of notes, I realized, okay, I'm going in the right track. And I had this very encouraging physical therapist with me, and that's how my journey started toward healing.

Becca Battisfore:

Wow. And I think it's very interesting that being a doctor both contributed to those issues at first, but then you have all these skills of having a comprehensive full medical history, taking notes, researching, and that really helped you to get back into that journey of healing. And I think that's just great advice for anyone is to write up your history because we know our own bodies best. So going into a doctor's appointment, sitting down, you might forget something. So writing it all down is, I think such great advice. So by, I think it was May, 2022, you're back at work full time, I think?

Dr. Srividya Sathiyamoorthy:

Yes. So I started in November, the physical therapy, and after about four or five weeks, I was in a reasonable position to work part-time. So I came back beginning of January '22 part-time, like two days a week, then three days. And by May, 2022, I was back full-time. I mean, it's still a constant journey of recovery. I feel new muscles that I hadn't felt in a long time. So basically what I had was an imbalance of my muscles, some of the muscles because of forward facing work all day. And also because of my ergonomics, my short stature, I was spending a lot of time on the scope and the computer, there's an imbalance between certain muscles. So our anti-gravity muscles, because we are bipedal, we walk on two, our body's more developed to be on fours, so our back muscles are much stronger. Our anterior front muscles are weaker, and when we don't constantly walk, they get weaker.

And so there's an imbalance between the neck muscles, the posterior neck muscles, anterior neck muscles. And there's also an imbalance between our chest muscles, our pectorals, and the trapezius and upper back muscles. So severe imbalance causes shortening of some muscles and overwork and stress and almost inflammation on other muscles. So there's an imbalance. So it's like if you think of ropes, okay, so the ropes are intertwined, but some of the ropes are getting shorter, and the other ropes are longer, but they're overworked. And so it's so complex. It's not a very straightforward, it has a very specific set of exercises for specific muscles. So that was a main challenge there to figure out these things. And I would say it's compounded by layers of injury. So the oldest injury heals last, and then on top of that are caught a lot of nerves and ligaments and our rotator cuff and everything is running in this area of the shoulder joint.

And what happens is when you're sitting for a long time, your shoulder is in a static position for a long time, and some muscles are overused, some are underused. So there's an imbalance. And that affects these results in some calcific, and this is my theory, but I think it makes sense. And so my calcified tendonitis was secondary to all my other things that were going on with my neck and upper body.

Becca Battisfore:

It's a good reminder of the fact that everything is so interconnected in our bodies that it's not just one thing you have to look at. You have to look at the whole picture.

Dr. Srividya Sathiyamoorthy:

I'm so glad you said that because in today's world, you have a shoulder doctor and then you have an elbow doctor, and the elbow doctor doesn't look at your shoulder, and your shoulder doctor doesn't look at your neck. I mean, I might be exaggerating, but what I'm saying is the whole human body is interrelated, and it's not just the muscles and the ligaments. I mean, even the stress affects our posture, which again, in turn affects our energy levels, and that in turn affects the way we sit, the way we keep our neck. Everything is interconnected. So that is one thing I've learned in this journey is that we have to always have an overall balance of our health, and we have to maintain a balance between our physical health, emotional health, and the spiritual health. All of that needs to be in balance for us to work to our full potential.

Becca Battisfore:

Yes. And yeah, you gave a great example too of how yoga and meditation not only provided some physical relief, but psychological as well, and how much that compounds on each other of psychological, physical over and over. And so once you start finding the solutions, how it compounds in a healing way.

Dr. Srividya Sathiyamoorthy:

Those days when I was really in kind of no man's land, I had no idea what was happening with me and what was going to be the future for me, whether even I would be able to go back to work. At that time, doing the yoga every day somehow kept me psychologically up and gave me hope, even though I couldn't see the way I kind of felt, oh, I'm able to do all of these yoga asanas. Even though I can't move my right hand, right shoulder, I'm able to do all of these other things. So maybe my body's okay. I mean, it's just, maybe it's something reversible. It kind of gave me hope that I probably can self-heal.

Becca Battisfore:

Yeah. Wow. Wow, that's really incredible. So that was back in 2022, and now bring me to the present. It's been over a year now since you're back at work full-time. Overall, how are you feeling? And maybe walk through your current wellness routine.

Dr. Srividya Sathiyamoorthy:

Yeah, so yes, it's like you put on your oxygen mask first before helping anyone else. I realized that I cannot fall apart. I mean, I have to take care of myself in order to be able to be a productive human being, to be a good mother, to be a good wife. I mean, in an overall, having a full life, I have to take care of myself. And so I have simplified my life in a lot of ways so that I can free up some time for myself. Just a simple example is I now wear scrubs every day to work. So it's easy, right?

Becca Battisfore:

Oh yes.

Dr. Srividya Sathiyamoorthy:

Every week I have five sets. Every weekend I do my laundry, I fold them and keep them ready. So every day it takes me very minimal amount of time to get ready, because I wake up early in the morning and I meditate for about 45 minutes every morning. And then I move on. I do about half an hour to 40 minutes of yoga, sometimes less, sometimes more, depending on when is my first meeting of the day or when I have to turn up at work. I have actually come up with my own routine that includes, I start with meditation and then yoga asanas. Within the yoga asanas, I have certain sequence of which I follow because I have to start with my neck and relax the muscles there. And then I do the whole full body yoga. I have a sequence that incorporates some of the physical therapist taught workouts.

And then once I finish that, I do some weights for upper body. And then I do my home gym, which is, you're probably familiar with it, but it's just a set of ropes that you put on your door and you use your body weight to tone your muscles. So I do my upper body workout with my home gym. After all that, I try to do about 15, 20 minutes of walking. All of that happens most mornings before I go to work. So then shower and go to work. So if I miss one day here or there, it's okay. But in general, if I do not do my daily routine, like you said, it compounds the pain, it gets worse.

And then I've simplified my office. I have only one monitor now, and we are in the process of redoing my furniture. But I do have a standing desk, which I stand maybe an hour or two every day. I try to take breaks during the day, a couple of hours on the scope, but I walk for 10 or 15 minutes. Everybody in the department knows that I'm going out to get my steps so they know where I am. So it's just part of that. And I definitely limit my day length of my day. I do not let it get carried away. I mean, anything can be done on the next day unless it's an emergency. So that's my policy. I do have a strong cutoff time for the number of hours I put in a day. And so that's just become now my routine, basically simple life. Do not neglect your physical health. That's my thing.

Becca Battisfore:

Right, yes. That's such great advice, especially the analogy of the oxygen mask, putting it on first so that then you can do your job as partner, parent, and pathologist, the three Ps. And I like how you have such a set routine that you do most of the time, like you said, not necessarily every day can you do it, but most of the time, and you know that works for you know your body, well, that that's what it needs, what it doesn't need your limits. And I think everyone can benefit from knowing that we can find that out ourselves. And so is there anything that other pathologists can do to prevent future issues such as the ones you have experienced?

Dr. Srividya Sathiyamoorthy:

Sure. Definitely know your limitations. One of the things that contributes here is I'm very short. I'm five one point something, and I add a 0.5 to that. So I'm very short. And at that time, I didn't have that awareness about your posture. And a lot of times you are a new employee, kind of don't want to make a lot of fuss. You adjust with whatever you have and things like that. But you should be aware of yourself. And so practice, go over the ergonomics, don't take it lightly. And now there's much more awareness about ergonomics, especially in sedentary work style. Whether you are a pathologist or you're an IT professional or you are a meditator who gives guided meditations all day, you're sitting on the chair for a prolonged amount of time. Our body wasn't made to sit on the chair. And when you sit, it's the worst thing for us.

And if you do sit, make sure your postures is good and you're taking breaks during the day and listen to your body, is what I would say. If your body is speaking to you, listen to it. Do not ignore. And the other thing I would say is in today's healthcare, you're not going to get a lot of face-to-face time with a physician. I'm sorry, I'm a physician saying this, but on the other hand, we have the entire Google and internet at our disposal. So you can find out any kind of information that you would like as long as you're looking in the right place. So be aware of yourself and seek help and do not ignore signals from the body. I would say a couple of years ago, me sharing such a personal story might be unthinkable, but now I feel like it might help somebody because a lot of us do have neck pain and shoulder pain.

We do not share, or we just kind of say, "Oh, it's just me. I'm getting old", or whatever. Part of it is, it might be true, but a lot of it does have to do with our work. And so I feel bringing awareness to that is not, I would say, incorrect because radiologists, issues with ergonomics is well known in most departments most hospitals, radiologists automatically get a standing desk. So I think as pathologists, we have to speak up for our profession. We also have to help our upcoming pathologists, right? So spread the word and kind of be good to each other. That's all I would say.

Becca Battisfore:

Yes, that's great. Yes, be your own advocate, not only for your own self, but for your fellow pathologists or medical professionals. I think that's great.

Dr. Srividya Sathiyamoorthy:

I want to add that for those of you who might be interested in the meditation and upper body workout that I practice every day in the upcoming College of American Pathologists annual meeting this next October as part of the Wellness Lounge and the Wellness Project team offerings, I plan to give very brief previews of Heartfulness meditation techniques and also a short upper body workout that is geared to a pathologist's workday. So I hope to see some of you in our wellness lounge next month.

Becca Battisfore:

So I want to thank you again for joining the podcast to talk about your experiences. I know it'll benefit so many people to hear what you went through, and hopefully they don't have to go through it because they've heard your story. And I want to thank you all for listening to this CAPcast. For more information about the CAP, visit cap.org.

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