Kara Wada, MD: Welcome back everyone to the Becoming Immune Confident Podcast. My name is Dr. Kara Wada. I'm a board certified pediatric and adult allergy immunology lifestyle medicine doc, and we are so excited to talk about all things allergy autoimmunity, anti-inflammatory living and ways to help you Become Immune confident, and competent.
Today I am so excited to welcome a colleague that I have been wanting to connect with and talk with more over the last probably year. Her name is Dr. Singla. She is a triple board certified physician that specializes in pediatric rheumatology and integrative.
Her story is unique because she was diagnosed with rheumatoid arthritis after becoming an attending rheumatologist. We know a few things about that.
And that also caused her to slightly pivot her career. Her pain points both as a patient and a doctor led her to found Rheum to Grow, a private medical practice where she helps children and adolescents with autoimmune conditions achieve faster disease control, less disease flare, less reliance on pharmaceuticals and realistic coping strategies to build resilience in the face of lifelong illnesses.
She lives in Houston, Texas with her husband and her three very active school-aged children. And she not only loves taking care of her patients, but encourages other female physicians to carry out their true passions and avoid burnout and medicine as well.
Thank you so much for joining us.
Saimun Singla, DO: You're welcome. So excited to be her.
Kara Wada, MD: Can you share just a little bit more about, we got the little short snippet of your story, but a little bit more about how you are here today doing what you're doing?
Saimun Singla, DO: I'm excited to be here. I always love connecting with other colleagues that have had similar stories as mine.
Everyone's journey is different, and in mine I had an idea of what my life would look like coming out of residency and fellowship and then real life happens, obviously. What I envisioned in my head was that I'd come out a fellowship, become a clinician educator, publish tons of papers on cool cases.
I was also doing a lot of quality improvement work. I was the director of our division for that. So I had a route I was going and then I got sick. After my second pregnancy, I started having stiffness and fatigue and, really, I thought it was just becoming a new attending rheumatologist. I'm a postpartum, maybe it's all related to breastfeeding. Who knows?
Then I get this diagnosis of rheumatoid arthritis, and it's quite embarrassing actually, when you talk to the doctor and they tell you have this diagnosis that you treat day in and day out, and you missed it in yourself.
Kara Wada, MD: That sounds familiar.
Saimun Singla, DO: I don't know if it was a me issue, like I just decided to ignore it or didn't pay enough attention to it. But things got really real after that because for a while I was just in a lot of denial.
Then I settled into the fact that, you know what? You have this chronic illness that you're gonna have to deal with and it needs to be in the background and the rest of your life will continue. It's not gonna stop me from being normal.
To go from that mindset to actually living that, carrying that out, it takes a lot of work. I realized that the way I was living my life and my goals and what I wanted my patients to feel, I had to take a different path than what I envisioned initially in my head.
I still love educating, I still love the academic side of things but I realized that the way I was practicing medicine was more of a sick model.
That is day in and day out, you ask, "Hi, nice to meet you. I'm Dr. Singla. What's going on? Let's do a physical exam. Let's get these labs. Nothing's wrong with you. Let's move along.'
We're like, "Here, try this medicine. Or here's how we're gonna treat it."
The visits were so directed towards what the problem is and the medical fix for it, which is necessary, obviously. But then you have all this complexity in the background that never got addressed, which was, "How are you handling this illness? Do you know what your triggers are? What are you eating? Do you know that you're at higher risk for things like heart attacks and strokes if you don't do this and this?"
And so there was a lot of education that just couldn't be fit into a six model type visit. That was my first thought of like," Okay, I get what I wanna do, but how am I gonna carry that out?
So two years later that led to me completing another fellowship in integrative medicine and then figuring out how I wanted to apply that to my practice. So then I left a large children's hospital in the summer of 2021 and then opened my practice about a year later in Houston.
Now I've been in private practice for about seven months. It's amazing to have a thought and vision carried out, and I'm actually living it now day to day.
Kara Wada, MD: What would a visit with an integrative pediatric rheumatologist look like?
What would make that different from the typical check-in? I see the adult rheumatologist, all of the things considered
Saimun Singla, DO: From the moment you walk to the moment you leave, things are, it's a very different feeling, first of all. So my goal in creating my environment was a healing environment first and foremost.
So the waiting room is smaller, the visits are longer. It's me and a nurse. We know your name, we know the mom's name, the sibling's name. So as soon as you walk in, we're like, 'Hi Kara. Nice to see you. How are you doing? Let's go right back.' So my nurse will, so right off the bat, you're not, it doesn't have that feeling of sterility, cuz I go to multiple doctor's visits too, right?
And you're like, 'Here's my insurance card, here's my driver's license.' Go take a seat and 30 minutes later you get called back. It's not like that. And I didn't want that for my patient. So I try very hard to bypass the waiting room as much as possible and get pulled straight back. And so my nurse goes in, does her stuff, I go in, start with the same regular stuff, let's go through past medical issues, family history, surgery, what medications are you on, supplements, if you're on anything, what kind of brings you in the same regular, what we call a history initial, the HPI.
The history and physical exam or the intake, and then I do a deep dive at the end of all that. So I'll do, "okay, tell me about what you're eating. Who does the cooking? What type of oils are you using? How, what's your favorite vegetable? What don't you like?" So that's just like the food component.
Then it's okay. Walk me through your evening routine. You finished dinner, then what are we doing? What are we doing after dinner, homework, brushing our teeth? And then how long does it take for you to fall asleep? What are you doing? Are you on your phone? Are you scrolling? Are we on TikTok? Are we having trouble falling asleep? Are you waking up in the middle of the night? Those type of questions.
Then you notice a lot of interesting dynamics come out too, between the parents and what the child thinks is actually happening and what the parent says is happening.
So you're like..
Kara Wada, MD: Sure thing. You uncover some things that...
Saimun Singla, DO: You're like, "Did you know you snore at night? I don't snore." "Yes, you do. "
So I'm like, do we need to look for a sleep study? A lot a of little things come out. Then the biggest thing I like to always focus on also is, " What makes you happy? What are your stressors? And for kids, stress, it might not be the right word, but more like what kind of gets you excited? Is it because it can be good stress or bad stress? So is it friends at school? Is it classwork? Is it an activity? Because sometimes based off of that, you start putting pieces of a bigger puzzle together of what their life looks like and why they might be having certain symptoms.
I also ask about any psychosocial events or that have happened with covid and the pandemic happening. I've noticed a lot of the beginnings of chronic pain shortly after the lockdown then by the time they're seeing me they're in full-fledged, like what we call amplified pain syndrome, where everything hurts them. They've had every MRI under the sun done. Everything is normal. I've been seeing a lot of those kids as well, because these things matter.
So the visit ends up being about 90 minutes to two hours, depending on what all is going on and it does leave an opportunity to unravel and do digging into a person's life to figure out what's happening. Because a lot of times they're seeing me, "Okay, is this juvenile arthritis or not? My child is having a lot of joint pains." And I'll say, "No, the exam looks normal. Your labs are look good, imaging looks good." But then they're still left with, "Okay, then what's causing the pain?"
And so then that's where I help finish the missing pieces as well.
Kara Wada, MD: And it takes a long time to, one, get all of that information. But two, build that trusting relationship when so often folks have had multiple interactions with the healthcare system that maybe have been less than ideal or maybe have been frankly traumatizing.
Saimun Singla, DO: Oh, yes. I see that all the time where me just giving the time to listen to them is therapy. It's like holding space for someone. It's venting. It's like their version of journaling. They're getting it all out and that in itself is very therapeutic for some people. And yes, you're right. It does take time to build that level of comfort. To be like, this is what bothers me. This is who bothers me and to be vulnerable, nobody likes to be vulnerable.
So that's it's hard to create that environment in a regular setting where I was practicing.
Kara Wada, MD: You mean you can't do that in 15 or 20 minutes?
Saimun Singla, DO: I don't, I guess if you fast forward.
Four times speed and talk really fast.
And sometimes it just takes patience like I have to reword things for people to really get to what it is that's bothering them.
Kara Wada, MD: Absolutely. Or when I'm thinking of the classic example and I will many times see folks who've dealt with chronic hives and I may be the third allergist they've seen for chronic hives and the prior doctors, looking through, they gave them great care, but sometimes it is just that time and being able to explain things in a couple different ways where it actually makes sense to the person too and through experience.
Saimun Singla, DO: No, you're right. Because in my head what I think of it is, as in medicine, we're trained to play defense constantly. Like we, okay, this is what's happened and this is what we're gonna do to work it up and this is how we're gonna fix it.
But in my setting, I'd like to think I'm also playing offense because I'm trying to figure out what your triggers are, what's led you to this, and how gonna prevent it. So we have less on doctor's visits and less medical bills and less medicines piling up. Yeah. So it's a, it's a long-term approach mindset.
Because nothing comes nothing that's worth, it's gonna come and fall top of your head like an apple from a tree. It takes work to figure things out it. And so that's the part where I think time and just talking to someone and educating someone is where the visit is very different with me.
Kara Wada, MD: My parents always love, they love sayings, but one of the sayings, they would say time and time again, " An ounce of prevention is worth a pound of cure." And it's so true but then the reality is our human brains sometimes take a crisis to put us back on track and looking for myself, that has been the case.
Saimun Singla, DO: It's true. No, you're totally right. No one grows up with the mindset that let me practice breathing techniques every night. So when the time comes and I need to actually practice it, my body automatically knows what to do and it won't be so stressed. We don't have that mindset. We're just a very reactive society and we're very absolutely instant gratification and social media, Netflix. My kids saw commercials on a regular TV channel once and they were like what is this?
Kara Wada, MD: Can't we fast forward this? Like, why can't we see more Bluey? Or whatever.
Saimun Singla, DO: Yeah. They're like, let's get back to what, what we wanna do and I'm like, guys, it's 30 seconds.
Kara Wada, MD: Back in my day we had to sit through all these commercials, but that's how we found out, that we were supposed to be eating dunkaroos and other stuff, too.
I wanna go back to that idea of reactive and so then the counter to that responsive and how does that look different?
Saimun Singla, DO: Well, the counter to that is being proactive about things, right?
And you're right, sometimes it does take you to get really sick or things just aren't going the way you want it to go, to be like, we've gotta do something different. And I will say the majority of the patients that come to me are like that. They've tried everything. Nothing is helping.
They're like, please, can you help me? And usually it's an education when it comes to the world of chronic pain, for example. No one has taken the time to sit down and explain, this is what the neural circuits are doing. The pain that you're feeling is real. I'm not dismissing you at all.
Think of a habit. Think of a habit loop. The how are we gonna break it basically? So it's the education that counts.
But, reactivity is one of those things that is just so human nature. That it's hard to teach someone. Hey, be like this and not like this. It's one of those things that it takes life experiences for you to realize why it's more important to be proactive rather than reactive.
Down to the simplest things, right? If someone says something mean to us, your initial reaction is to be like, would you say, what did you know? Rather than being like, let me count to 10 and then craft my response.
Kara Wada, MD: And sometime, one of the things that I have been working on this year is for instance, reacting to my phone.
Like I, I get like a little alert and like right now my, the nurse in the office is like helping me. I had to do my yearly TV test, like getting that situated. Yeah. But turning off some of those alerts, setting systems in place building routines and habits so that our brain default is more in line what's gonna serve us as opposed to not.
Saimun Singla, DO: Yes. I, and that, that's, first of all, it's hard to teach children that because adults struggle with it.
Kara Wada, MD: Yeah. I'm edging on 40, so taking a minute.
Saimun Singla, DO: Exactly. But I start trickling those thoughts in there, because it's really important to realize that's a thing, like being reactive versus proactive.
There are consequences to being one way versus the other. And I just paint stories and give examples to children of you're right, look at us constantly wanting to check our phone at a stoplight when you're driving. More and more people when they're at the front of the line and it's a green light, you have to honk because they're on their phone.
Majority of the time that's becoming a more and more common thing, so we're wiring our brains to act like this. In order for us to unwire it, we have to first realize that being reactive is not a great thing. Being reactive in certain situations, don't get me wrong.
It needs to serve a purpose. Social media is a perfect example. Our phones, I've even had to do that in my practice. I have to time block my life, like from this time and this time I'm gonna do this. And if something interferes within that time block while I'm trying to do a podcast, I need to do my best to ignore an email, a phone call, a bing, a ping, whatever it is.
And I think the more we practice it, the stronger it gets. So it's simple but difficult.
Kara Wada, MD: And that, that's the reality with so many of the things that come up within, for instance, the lifestyle elements of hearing for ourselves, our patients with chronic illness, the things that are tried and true, eating more vegetables. Getting the movement, these different things. We've all heard them before. Likely it's the implementation and really fostering that routine use of them that's where we all tend to struggle.
Saimun Singla, DO: I agree. Because we all know you're right. Good things that are good for us, we should be doing. So then why aren't we doing it? Why aren't we going to bed and not scrolling? Why aren't we watching binging on Netflix for three hours before going to bed? These are all habits that we know. I think it's more of creating a game plan in order to fight it, be like, okay, so when this happens, you have to like actively visualize yourself doing what it is that you wanna do and then carry it out and then practice it every single day. When you have a plan in your head of what it is that you want to do, it's easier to do it.
And there's a really great book by James, was it James? Clear Atomic Habits. Oh, yeah. Atomic Habits. Yep. That's outlines that and tells you down to the nitty gritty of how you can do these things, yeah, I love that. But you have to have the motivation also. That's part of it.
Like it has to be meaningful to you to make that change.
Kara Wada, MD: Oh, absolutely. So what, let's talk a little bit more about the integrative piece of care that comes into what you're doing.
What does that look like? What sorts of things might you recommend to a patient?
Saimun Singla, DO: So it really, that's, I pull the integrative recommendations based off the history. So that's why the questions about the diet, the stress, the sleep, the physical movement, those are really critical pillars of integrative medicine. Things like, They have symptoms of constipation.
Let's say a patient has that and they don't wanna take MiraLax or for whatever reason they don't wanna take regular medications, that's fine. But here are some other things from maybe Ayurveda that has been taught that works for people is, are there randomized placebo controlled trials saying that ginger water with a little bit of cayenne pepper and lemon.
Is gonna help with your constipation? No, this is just anecdotal that's been around for thousands and thousands of years from a culture that's not ours and it's worked for other people. So let's try it. There are other complimentary...
Kara Wada, MD: minimal risk for harm too, correct?
Saimun Singla, DO: Yes. With minimal risk for harm.
I am not saying, let's go on a detox. Let's kill parasites. Let's do mold testing. I don't do any of that, especially in children. Because there's enough evidence for the conditions I treat to say that there's utility in doing that. So then if there's no utility, it's a waste of money, blood, everything, specimens for us.
So let's stick to what we know and see what works. We go from there. I'm open-minded, but I'm also very scientific in terms of this is probably why something like this does shouldn't apply, and the risk benefit of something like this. The risk is low, so let's try it like the Ayurvedic tea concoction.
Why not? Or even acupuncture. There's data. Now there's actually more data for acupuncture and certain musculoskeletal types of complaints where I'd be like, let's do this. Let's try it. Even the vitamin D for migraines, riboflavin, magnesium, cocuten. There's trials enough, promising enough with minimal harm based on the dose and the brand and stuff that you're taking to say, let's try it because.
Nothing else has really helped you and this is why you're here. And see how you do. So we have the. The pharmaceutical kind of stuff going on, where I'm recommending the various supplements indicated for conditions we have. Mind body component also is very important for certain types of pain processing, right?
So breath work I teach alternate nostril breathing, abdominal breathing. For little ones. We do bubble, I mean like the blowing the yeah. Thin wheels, blowing bubbles. We do puffer fish breathing techniques. So based, it's really tailored based on what the condition is, how old a child is, and also how willing it is or how likely it is that they're gonna do this stuff that I'm recommending.
Some kids like more of a app type thing on their phone, so they like to listen to stories. Some kids like to color or journal, so I try to incorporate that if that helps them. Especially when it comes to chronic illnesses. So if you're trying to. Deal with the long term condition.
Building that resilience is really key because at some point they're gonna be graduating from me onto the adult side. Yeah. And they need, they're not gonna be walking in with mommy and daddy to go over the past medical history and stuff. So that's my part of my job is to make sure they're geared up for that.
So I, I do give quizzes, like literally hand A, B, C, D, E, pick a answer, write the name of your medications and doses. So I gear them up for the adult side through adolescence doing that.
Kara Wada, MD: That's awesome. That, and I will say that has always been an area that's been near and dear to my heart is a med peds and there are, I've had a couple of instances, the last six to nine months where it just went so smoothly with a couple of patients that were incredibly medically complex. And it's really cool to see the systems like getting into a place to do that because for so long it was just this they show up and you don't know nothing and they may not know, but like in these these two instances which we had my one patient on the podcast to talk about this, but we had a conversation with the doc before it. I had documentation and labs and everything, but also the patient was empowered in their own story to be able to share that, to know to take on and that is just as important.
Saimun Singla, DO: It is, and I don't care if you're spelling all your meds wrong, it doesn't matter to me. It, what matters to me is that you know what the medication is what it's doing for you, what it, how it makes you feel, what are the side effects for certain biologics.
You're supposed to hold it if you're sick. So do they know those key things about the medicine? So I know I'm not looking for perfection. I'm just looking for, do you know the overall gist of what we're doing and why we're doing.
Kara Wada, MD: And it's important cuz if you're out traveling and end up sick, like you may not have access to.
Saimun Singla, DO: So what do you do? You're left to your own devices, and the only way that's gonna be successful is if someone has taught you how to be like that. How to think like me, how, what would I do? Like I'm a patient and a physician, so if I'm in a situation where I'm flaring what do I need to have on me if I'm not next to my pharmacy or things like that.
That's what I've tried to instill in my patients. To me that is part of the integrative approach because it's not just, here's your medicine. It's not like a directive thing. And they're the passive recipient of my medical care. They need to be 100% in it, just like me, right? Like I'm all for team patient, X, Y, Z, but you need to be for yourself as well and that's part of it.
Kara Wada, MD: It's that partnership that you're describing.
Saimun Singla, DO: Awesome. How else do you relate? Like sometimes I relate to my patients very easily because of my diagnosis and that I will say that makes my job a lot easier, especially for a lot of patients who have fear of using biologics and immune suppressing medications.
And first I assess like kind of what is your fear? What is the worst case scenario in your head? That's usually like a weight off of their chest of this is my worst fear.
Cancer or like there's something bad is gonna happen, right? And I'm like let me tell you what my thought process is and also I'm on these meds too.
So you can't argue with the fact that I am taking these meds and I am very well aware of the risks. But I'm also well aware of the benefits and what would happen if I wasn't on these medications. So I think that relatability definitely helps. So it's not like a you versus me type thing.
Kara Wada, MD: It's let's do this together. It's cheesy, but I say it all the time. Teamwork makes the dream work.
Saimun Singla, DO: Totally. Totally. It's not like my success is gonna be dependent on everybody else around me and saying, my patient success is gonna be dependent on their skin in the game and everything that I've taught them.
Kara Wada, MD: Oh, so good. So if people would like to come see you, where do you see patients?
Saimun Singla, DO: So I am in Houston, Texas. I do pediatric integrative rheumatology consults. That's like my number one thing, my, my love, right? Combining the worlds of integrative medicine and pediatric rheumatology. They can see me through telemedicine or in person.
Because rheumatology, the physical exam is slightly important. Very important. Just a little bit right?
So I like to do in-person at least once a year. Say you don't live in Houston or you're not within driving distance of Houston. I'd like to see you at least once a year, and then we can do telemedicine based on how well you're doing. If you are out of state, it's very case by case dependent.
If you have a pediatric rheumatologist, then I can work with, I'm happy to do the integrative medicine consult component of the visit and kind of try to tie everything together. If you have interest in seeing me always go ahead and go to my website.
I have a book now link at the top and you can of type in what it is that you wanna be seen for and then we can review the, your case and go from there.
Kara Wada, MD: Awesome. And can you share what your website is?
Saimun Singla, DO: Yes. It's www.rheumtogrowtx.com. So that's R H E U M and then t o G r O w tx.com.
Kara Wada, MD: Awesome.
We'll make sure that is linked in the show notes along with your Instagram and your Facebook. You are always posting really helpful educational posts, things that we can actually go out and try. I learned so much.
Saimun Singla, DO: Thank you. Oh, thank you. Likewise. You too. You too. I'm like such a fan. Fangirling.
Kara Wada, MD: Mutually fangirling. I have been wrapping up episodes the last couple months by just asking to you, what does it mean to Become Immune Confident?
Saimun Singla, DO: I like that question. To me, becoming immune confident is multifaceted.
So first part is being aware of what it is that you have and how it plays into the rest of your life.
So it's the awareness of your condition. The medications you're on. What does your now look like? What does your one year look like? What does the future potentially look like for you?
So that way you can navigate kind of the ups and downs. So your expectation in your head is not, everything's always gonna be groovy if I take this medication. It's that even if I'm on this medication, things might not go the way I want it to, and it's that mental resilience. I think that's important to really build. Not easy. It takes work. Mindset stuff always takes work. So to me, that's being Immune Confident.
Kara Wada, MD: Oh, awesome. Thank you. Thank you. Thank you, Dr. Singla. Like I said, in the show notes, we'll link to your website and all the social so everyone can make sure to learn and connect and hopefully come see you if they're able.
Saimun Singla, DO: Yes. Thank you so much for having me. Thank you.
Kara Wada, MD: Hey, everyone. I am going to ask you once again to go into Apple podcasts and submit a review of the podcast for me.
But first I'm going to share a review from Dr Lex RX.
"Dr Wada's unique perspective is amazing considering she's both an auto-immune patient and physician. Her experience, expertise and insight make this podcast so valuable. Keep them coming."
One other from Amanda Katherine.
"Wow. So informative. Thank you for bringing more attention to autoimmune diseases. Each podcast is so informative and well thought out. Very impressed with all that you do."
Thank you so much, Dr Lex Rx and Amanda Katherine. I really appreciate the feedback and the review.
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