Ep. 113 – Unlocking Migraine Relief: A Holistic Approach with Dr. Sui Wong

Adam Rinde (00:00):

Hey everybody. Before we start the podcast, I just want to mention a brief announcement from one of our affiliate sponsors, sapien CE. Today, 75% of healthcare professionals listen to podcasts for educational learning. Turn podcast listening into reflective learning opportunities with Sapien ce, powered by Learner. Plus, it's so great that you can earn CE by just listening to podcasts such as The One Thing podcast. Please check out the link to sapien CE in the show notes, [00:00:30] and by that you'll also help support our podcast efforts. Thank you so much and enjoy this week's episode. Welcome back to the show everyone. This is the One Thing podcast and I'm your host, Adam Rindy. In the One Thing podcast, we're constantly exploring chronic and difficulty treat conditions and asking questions that may budge the needle and help us really understand what the key parameters and key elements [00:01:00] are to move forward towards health and wellbeing.

(01:03):

And today we're humming on a particular pervasive yet misunderstood challenge migraines. It affects a huge percentage of the population and all too often the approach is purely reactive chasing symptoms with medications. But what if we could fundamentally shift the landscape intervening for the cascade of events that lead to an attack? What if we could build [00:01:30] resilience from the ground up, empowering the nervous system to better understand and withstand life's inevitable stressors? That's precisely what we'll be unpacking today with our guest, Dr. Sue Wong, a neurologist out of the UK who is pioneering a more holistic, patient-centered approach to migraine management. She leverages lifestyle interventions and is grounded in top-notch science. We'll be diving into her framework and what it's like [00:02:00] to build that. So whether you're a migraine sufferer or a healthcare professional seeking new tools or simply someone committed to optimizing your brain health and performance, this conversation is packed with actionable information. We're going to discuss it all and more. Welcome, Dr. Shui Wong. Dr. Wong, welcome to the One Thing podcast. It's a delight to be here with you today.

Sui Wong (02:25):

It's such a delight to meet you to end a true privilege. Thank you so much for the invitation, Adam.

Adam Rinde (02:30):

[00:02:30] You're welcome. I'm excited to get started here with talking with you about a lot of different things that you're involved with. I thought we'd first start by really hearing the wide array of work that you do. Yesterday I was doing some research on one of my favorite websites these days, site ai, and I pulled up papers that you've been published as an author or co-author and the work you've [00:03:00] done. And I noticed a trend in some of the work that you do that's involved with clinical medicine, diagnostics, imaging of real significant disease processes of the nervous system in the eye. And then you have this whole other array to that of course we're going to get into. So I was just wondering, can you talk about what that journey's been like being really in the heart of medicine and bringing in all different [00:03:30] tools and aspects to your practice?

Sui Wong (03:33):

Thank you so much. I'm very active in research because of this concept of in order for us to make advances to improve the care that we provide, the people we see in clinic, we really have to move things forward through good quality questions that translates directly to our patient care. So the very much starts from a patient facing point of view, and I love being a doctor. I'm a clinician at heart and I love [00:04:00] the healing and art and science of medicine. So that's how it got going with writing a lot of research papers from my first paper in 2001, it was published so wonderful from writing case reports and case series to bigger observations to bigger research studies. And a lot of it is actually part of collaborative efforts as well. So it's not just me, it's all part of a network of similarly minded scientists [00:04:30] and researchers, clinicians as well.

(04:32):

So to answer your question about how it went to that slight different arc, of course we're here today to talk more about other holistic lifestyle based interventions and that journey complimented very well my clinical role. So I'm a neurologist and also I specialize with vision. So a neuro-ophthalmologist and I work in, I'm very grateful for very high quality institutions and have received really [00:05:00] fantastic top-notch training. And I realize that sometimes the way that we can improve patients' lives and improve the outcome of their disease does not just depend on a prescription of medication or surgery. And it could be other things that improves their wellbeing, improves their brain resilience, and there is evidence to support these practices. But I think the implementation of it can be a bit more difficult because it really requires [00:05:30] the opportunity to talk with the person in front of us to really deliver something that is appropriate for them.

(05:37):

If somebody wants to talk about something else, such as if they're having a chronic disease such as lots of migraines or pain, one of the key things we may talk about could be sleep, but at the first visit that might not be appropriate time to discuss because they may not wish to talk about it, they may wish to talk about the medications that they're currently on, [00:06:00] or there are other things where it just feels like it has to be something more. It has to be some other tablet. Sometimes there is. And part of my training is to know what is at the forefront of the signs. So it all kind of started with the combination of wanting to be there in service of my patients and that also coincided very nicely with my own personal journey. So in my training before we recorded, you talked about how you're very involved with teaching and training, so you will know firsthand [00:06:30] about how stressful it is in our training to become specialists or just becoming providers.

(06:37):

There is definitely a big difficulty where practitioners or healthcare practitioners would be at risk of burnout of not taking care of themselves and they're taking care of others. And certainly I found myself in that situation where I was working extremely hard, trying to do my best for my patients and really I didn't really have time to cook. I didn't have time to have a proper night's sleep [00:07:00] and I would be dragging, grabbing for the sugary things, grabbing for the ultra processed foods and just trying to just get through. And of course I would be at tip top attention and at my best at work. But then what was left after work was really nothing too much for people. I love family members or even for my own self-care, it would be work and eat something unhealthy and sleep and go back to work. So [00:07:30] because that is not a very fulfilling, holistic approach, and I started to make a slight change with realizing that I wanted to create a better sense of balance.

(07:42):

So it started with a combination of looking at the kind of things I was grabbing for that sense of like, oh, I just need to grab that sugary thing, just give myself that boost to going, oh, actually what am I eating daily? And what about things like yoga, [00:08:00] meditation, physical activity, and broader aspects of that? So that started to impact a lot on my personal life. And also that was something I was sharing with my family because I thought this is tremendous. There is a lot of benefits to all this and there's all this research about it. So what started with me really going really deep is kind of my character. I like to go really deeply to understand something and I go, wow, this is amazing. And then around that time I thought, [00:08:30] if this is so important for myself and my family, why am I not talking to it with my patients?

(08:36):

And of course then I'm aware of the fact that anytime we talk about things with our patients, we have to make sure it's validated and it's certified and various other legislations and also regulations appropriately to make sure that we are delivering things to a certain standard. So that's when I delve into a lifestyle medicine, getting the diploma. So there is an international board of lifestyle [00:09:00] medicine, which is part of the American College of Lifestyle Medicine and also the British Society and there are certifications. So that's how it started for me to bring it in. And over the years I've been delivering this kind of care to my patients in my clinic. So I work in a national health service, which is a public funded service, and we have huge volumes of patients. And I found that this approach was very well received and actually creating group clinics.

(09:27):

So I also deliver group clinics that allow peer [00:09:30] to peer support and discussions of behavior changes or lifestyle interventions that would be suitable, but really coming from the person in front of me talking about something that they feel right to talk about. And of course that evolved further to people saying, oh, if it's so good, why are we not doing more of it? And that's when I realized I needed to talk more about it, which is why I'm so privileged to be on your podcast here. That's the drive for me to write books. So I [00:10:00] write lifestyle, holistic care, self-care books based on the interventions and the lifestyle approaches that benefits our brain health and wellbeing.

Adam Rinde (10:10):

Yeah, I can't wait to hear more about the books as we go today. I'm just going to go into this a little bit further. This is really interesting and I've heard you speak about something that really resonates with me. It's that you're seeing very serious rare diseases most [00:10:30] of the day at this point in your career and your expertise. You're not seeing just basic general neuro-ophthalmology issues, yet you're still integrating this work in your practice because a lot of those conversations are very serious and a lot of times the patients don't feel a lot of hope in those scenarios yet. I've heard you speak about the importance of quality of life and [00:11:00] other outcomes with patients, and I was wondering if you could talk a little bit about that and how lifestyle medicine plays a role in that.

Sui Wong (11:08):

Absolutely. So a lot of clinicians as mentioned, they would be, although they could be rare, some of it could be more common, for example, migraine, but we can talk about that separately. But generally speaking, people come to me, there could be a few things that would be influencing their quality of life and their wellbeing. So for example, if somebody's coming to me with an autoimmune condition such [00:11:30] as myasthenia gravis, so that is one of the conditions I've done a lot of research in, for those who may not recognize that condition, it's a rare neuromuscular condition that is usually autoimmune in nature and it causes weakness of the body and muscles that also include muscle of the eye. So people could get double vision. Sometimes they get problems with swallowing and breathing and of walking and such things. So it can be very, very severe. So of course when people come to me, [00:12:00] they are in an active phase of their autoimmune disease, they need rapid intervention for symptom management and treating the autoimmune condition.

(12:11):

So yes, of course we can think about things that we can use such as corticosteroids or prednisone as you would call it in the United States as an emergency, very rapid introduction. And then there is this really important discussion about how do we avoid the side effects or minimize the side [00:12:30] effects of medications that we give. So the classic thing usually starts off with, for example, in this scenario, the side effects of prednisone could be weight gain, blood sugar dysregulation, problems with the sleep thinning of the bones, reducing the immune system and so forth. A lot of things that we talk about. But then the situation may be that we need to use that medication for its lifesaving intentions. And oftentimes we then talk about when I start talking [00:13:00] about the side effects of prednisone, nobody wants to be on it. So then how do we support them?

(13:06):

So that's where I start talking about, okay, at what stage they talk about physical activity, we talk about the kind of foods they're eating. And what's remarkable is I was seeing a lot of people taking on board that kind of conversation, really, really liking that kind of conversation. And classically, people who take prednisone would gain weight. And I was really surprised when [00:13:30] we start off with this conversation preparing them to start on prednisone and they come back on the next visit, they've implemented the lifestyle changes, they have lost weight because of course it's all about metabolic health that we were working on. And also it continued to improve whilst they want prednisone. So that's one of the example. The other examples could be that if somebody has a chronic condition that leads to worry and anxiety, that they're going to get another attack of their condition.

(13:59):

So for example, it [00:14:00] could be a inflammatory condition like optic neuritis, nerve inflammation. So somebody could have had that and they're worried about could