Self-Care for the New Year

Heart failure and heart transplant patients face change and uncertainty. Cardiologist Dr. Anu Lala emphasizes the value of gratitude, mindful language, and affirmations to help. She invites patients to meet life as it is, rather than ruminate on what they wish it was. 

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Transcript

Stephen Calabria: [00:00:00] From the Mount Sinai Health System in New York City, this is Road to Resilience, a podcast about facing adversity. I'm your host, Stephen Calabria, Mount Sinai's, director of podcasting.

With a new year upon us, folks are grappling with ever increasing levels of uncertainty, both in their own lives and in the world at large.

To help walk us through how to deal with this sea of uncertainty. We're joined by Annu Lala MD.

Dr. Lala is a cardiologist at the Mount Sinai Hospital who advises patients on holistic prevention of heart disease. Her practice is committed to providing whole person, integrative health advice, and she remains committed to optimizing heart health and improving patients' lives. We're honored to welcome Dr. Anu Lala to the show.

Dr. Anu Lala, welcome to Road to Resilience. 

Anu Lala: Thank you so much for having me here. I'm so happy. 

Stephen Calabria: Could you tell us a little bit about your role here at Mount Sinai? 

Anu Lala: Yeah, sure. In the conventional sense, I'm a cardiologist. I [00:01:00] specialize in what's known as heart failure, but what I like to call heart function and transplantation.

I also have some leadership roles in education and research and editorial work. I'm one of the co-editors and chief of the Journal of Cardiac Failure, which is the official journal for the Heart Failure Society of America.

Clinically, I care for patients across the spectrum of heart disease, from prevention and early risk, all the way to advanced therapies like heart transplantation and mechanical circulatory support, which are machines that take over for the heart. But most importantly, is the human side of medicine.

I think how people live with illness, how people live with uncertainty and change. And how we can, as healthcare professionals, really support resilience, not just survival. That's where I really love being with people and interacting with people. 

Stephen Calabria: And [00:02:00] what does your typical patient population look like?

Anu Lala: Oh gosh. So it's incredibly diverse. I care for individuals who are really very sick and hospitalized, but also people who are outwardly doing fine yet quietly struggling with fatigue, with stress, with weight changes, with hormonal transitions, with caregiving burdens with things like shortness of breath when they're doing things that they feel like they shouldn't be short of breath doing, like walking up the subway stairs or carrying up the laundry up a flight of stairs.

Many of them are overlapping or have overlapping cardiometabolic emotional social challenges. But what everyone seems to have in common is, they're trying to live full lives while dealing with uncertainty, and I think that's something we can all relate to. 

Stephen Calabria: Absolutely. And the new year often brings [00:03:00] uncertainty. It brings pressure to have resolutions, to have a reset or to reinvent ourselves. From your perspective, what does a healthy reset actually look like, especially for people who already might still be burnt out from last year? 

Anu Lala: Gosh, I've been thinking so much about this, so I'm so happy you asked me that, Stephen. I don't think a healthy reset needs to be a dramatic overhaul. It doesn't have to be a reinvention, especially for people who are already exhausted.

I think a true reset actually means less, not more. It might mean creating a little bit more space mentally, physically for yourself, a little bit more kindness towards yourself.

I feel like what's speaking to me most loudly, and I'm sure this will come up again over the next 45 minutes or so, is just kindness towards ourselves, more acceptance and honesty with what we actually can hold right [00:04:00] now, handle right now. And sometimes I think the healthiest reset is just stopping the resistance to what is.

So accept where we are and then start caring for ourselves from that place. That to me is I think, what 2026 is calling for us to do most. 

Stephen Calabria: Yeah. You've talked about this phenomenon a lot, meeting life as it is, and we talk about this in resilience too, seeing things as they are and not how we wish they were or hope they would be.

How do you think accepting where we are, rather than where we think we should be, can build resilience as we enter the new year? 

Anu Lala: Ugh. I love this. And as I was sharing with you before we started, I love the opportunity to talk about this, because I think resisting what is, is just exhausting. Stress to me, I think Eckhart Tolle said this, stress is not [00:05:00] accepting what is, it's resisting what is.

That's what causes stress, and I think when we're constantly comparing ourselves to these imagined versions of what we should be, I think we drain ourselves of energy that could otherwise support our progress and our healing and our growth.

I think the tricky part though is, acceptance doesn't have to be passive. In fact, I would argue it's not passive. It doesn't mean giving up. It means starting from truth. I think when we meet life as it is, we free ourselves to make choices that are more aligned, more compassionate, and then also more sustainable.

I think this is where resilience actually begins, and Lord knows that we're all struggling with this, myself and included, but what a beautiful concept to just contemplate, entertain, make space [00:06:00] for.

Stephen Calabria: In cardiology, you've emphasized the power of words. You've mentioned preferring heart function over heart failure.

As people think about New Year's resolutions, how can changing our language, both outwardly and inwardly, help us be more resilient and compassionate with ourselves and with others? 

Anu Lala: I think words matter. We just know that they do, right? Words shape our identity. I think, particularly in healthcare, we are so focused on disease and what's going wrong, rather than focusing on health and what is actually working and going right.

With respect to my specific subspecialty heart failure, I think that there's no more negative word in the English language than failure. When people say, I have failed, or my heart is failing, there's this implication that there is a verdict, there's a finality to it, [00:07:00] and we know that life is a process.

Moving from disease to health is a process. There's no, there doesn't have to be this finality to things. And it also, in my mind at least, gives us this idea that there's no point in trying anymore, that it's over.

And I think, in medicine, we're really trying to be intentional about not defining people by their diagnoses. I think that the same should be true for how we talk to ourselves, and that's how I think you can bridge the two of how I'm obsessed with how much language matters in health also applies to the new year.

I think when we shift language from judging ourselves, oh, I'm lazy. I can't wake up early, I can't journal I find it too hard to meditate to curiosity. This didn't work for me right now, but I'm [00:08:00] entertaining this or I'm hoping that this might work out.

I think just making space rather than creating or using words to make final judgment statements will create space for resilience and, most importantly, for self-compassion. I'm certainly working on that for myself.

I don't know about you, Stephen, but rather than making judgements about, okay, I'm Anu, I am not good about managing my calendar, I am not good about keeping track of things and making to-do lists, et cetera, all of which are probably true, by the way.

But for making space around, I'm working on this, I'm excited about getting better at organization, I'm gonna find individuals to help me be more organized, or whatever it is. What I think just being very intentional about the words we use to describe ourselves and our interactions with others is really important, I think, to how we [00:09:00] perceive life.

Stephen Calabria: And now that we've squared away how we talk to ourselves, what are a few small daily practices that you've seen and you would endorse that you think would make the biggest difference over time? 

Anu Lala: Yeah, I'm certainly not an expert, but I can share my own experience and I can share the experience that I have witnessed of patients that I deeply admire. Doing what we get to do in heart transplantation, where patients are often on the brink of really life and death, we witness the tremendous resilience of the human spirit.

And so, one of the things I love that I saw with a patient that we developed together, it was an individual waiting for transplantation who had been here for a couple of months, had two little kids waiting at home, is, we talked about a daily [00:10:00] inventory of what is working rather than the to-do list, what is not working, what I wanna improve.

It was, in this particular case, it was an individual whose heart wasn't working, but everything else was. This individual was able to breathe, their brain was working, their eyes were working, their nose was working.

Their sense of taste was working, senses were working. Their lungs were working, their kidneys were working, their colon was working, their legs and arms. And this may sound almost too simplistic, but when you focus on what's not working, without contextualizing it within what is working, I think you missed the entire point, 'cause there's so much more working than is not, and so I think being deliberate about what is working is a really simple, profound, and powerful practice.

I've actually started doing that in the morning, making it really simple for myself, and I think that there's [00:11:00] good data to support this kind of practice. Gratitude is associated with lower stress hormones, improved sleep, and even better cardiovascular outcomes in certain studies.

I think the shift from the attention to threat versus sufficiency, what is working, is the groundwork for gratitude and is a foundation for resilience.

And then the second practice, I would say is a brief pause before reacting. It's wonderful to go through this with my kids, 'cause they're learning these practices now in school, which is when you're angry or you're frustrated or you feel that amygdala response to just take one, as my son calls it, who was in fourth grade, one belly breath before reacting.

And that one conscious breath, to me, is a meditation. It's allowing us to respond rather than react. And I think that can be so [00:12:00] profoundly helpful because it allows us to feel like we're more in control.

It allows for our prefrontal cortex to supersede the amygdala response. And I think over time that space, that pause, is where resilience is built. 

Stephen Calabria: Could you talk for a moment about the role of hope, both in life and in practice? I imagine you have to straddle a line between giving patients inspiration but not giving them false hope. Do you see the role of hope as something that's important in your practice ?

Anu Lala: Oh yeah, for sure. I think what is most challenging for most. Certainly me and for the patients that I have the privilege of caring for, is uncertainty, right? I think uncertainty is a product of the natural impulse of the mind.

[00:13:00] The mind is naturally programmed, so to speak, to worry about the future or regret the past, and then. We lose the beauty of the present moment, the power of the present moment, and one of the easiest things to anchor us in the present moment is gratitude.

Now you might say what does gratitude have to do with hope? I think that hope, optimism, and gratitude are all connected, because when you are focused, just like we said previously on what is working.

Then A, you're anchored in the present moment, and your shift in mindset happens in the recognition that so much is working in the present moment. That if it's working in the present moment, maybe there's a possibility that it will work in the future as well.

And so I think that this helps us grapple with [00:14:00] uncertainty. My mom always used to say, and still says, growing up, it actually makes me kind of teary, where she says God or the universe, or whatever higher power you believe in, has always taken care of you thus far.

Why would he stop now? That this was always a way for me to shift my focus from worrying about the future to being like, in this moment so much is working, why wouldn't it work moving forward?

And I think that's where I think, invite hope and optimism to have its place and take its seat. And I think, oftentimes patients will say how do I know this will work? How do I know I'll stay alive? How do I know I'll survive this surgery?

Or when will I get a heart transplant? What will the outcome be? I'm very honest and I say, I don't know. I don't have those answers. But what we can do is focus our attention on the now. And right now, we're breathing.

Right now, there are so many things working, and I think that present moment [00:15:00] awareness reduces anxiety, it reduces rumination, and uncertainty stops feeling like a threat and starts potentially feeling more like an open space. And that's something I love practicing. 

Stephen Calabria: You talk about this uncertainty. Is there a particular patient that you've encountered that stands out in terms of their approach to dealing with this kind of uncertainty? 

Anu Lala: Yeah, I think there's so many. I feel like I am the luckiest person in the world in that I get to learn from these patients. And I think going back to what we were just talking about. One patient right now I can think of, who is practicing situational gratitude rather than just forced optimism, in the sense that for this given individual, there are multiple organs at stake.

She doesn't know [00:16:00] what the outcome will be, whether she will be someone who will eventually get more than one transplant for more than one organ. But what this individual is able to do is focus on what's happening today and what they're grateful for today.

So you can see there's a repeated theme here, but I'm seeing it every day and it's a really beautiful reminder. For example, seeing this individual over the past couple of weeks, I've heard things like, today I got to talk to my family.

Today I walked a little further. Today, I'm still here. I love that a lot of patients will say that to me. I'll say, how are you doing? They'll say, I'm still here. And that, I think, is such a beautiful, simple recognition of how much there is to be grateful for in the moment.

So they're not minimizing the difficulty, but they're able to contextualize it. And I think this practice is not passive, but it actually gives them strength. I think gratitude is that stabilizing force that allows them to fully engage with the treatment, with the [00:17:00] decisions, and with life without being consumed. 

Stephen Calabria: You've also spoken about integrating emotional and spiritual wellbeing into medical care. As we set intentions for a new year, how important do you think it is to align our physical health goals with our emotional and spiritual needs? And how do you even do that? 

Anu Lala: Oh my goodness. That's the billion dollar question. We know that chronic stress and emotional dysregulation are associated with greater degrees of inflammation, metabolic dysfunction, cardiovascular disease, poor quote, unquote, adherence to health behaviors that are positive.

And I think when our goals ignore our emotional and spiritual needs, the nervous system remains in this threatened state, this fight or flight state that we always hear about, and that's when change becomes unsustainable, I think when our [00:18:00] goals are aligned.

So when movement, we say exercise, that sometimes feels like a burden to other people, but movement, any movement is good, right? When movement supports joy and they're so connected.

Movement allows for our body to secrete natural positive hormones called endorphins, When nutrition supports energy, when rest supports calm, then the body's more receptive. And I often tell patients and really tells my, tell myself as well, that it's your body's physiology follows your sense or perception of safety.

And so emotional and spiritual alignment creates that safety, and then the body responds accordingly and responds favorably. So practically, now you're getting into the nitty gritty, right? Practically, what does that mean?

I think it means that movement is a [00:19:00] non-negotiable. Movement that you enjoy might need to be prioritized over forcing a regimen. So if that means that you wanna go dancing instead of running for two miles, do it.

Don't hold yourself to these strict patterns that you may not enjoy because there is something to be said for the joy in movement as well, if that makes sense. I think framing nutrition as nourishment rather than restriction is also really important.

Thinking about those healthy choices that you actually enjoy is important. And I think then when we are emotionally, spiritually, and physically aligned, health is not a chore. It's like being in a relationship with yourself.

Having a little space and I think when we're in healthy relationships with ourselves, I think we have access to the best version of [00:20:00] ourselves.

Stephen Calabria: Stress and anxiety can often spike at the beginning of the year. People feel a pressure to reinvent themselves.

They see people in their social media feeds who appear to be absolutely crushing life, and they may even face new financial or professional pressures. From what you've observed clinically and professionally, what are some effective ways to calm the nervous system when life feels overwhelming?

Anu Lala: In its simplest form and I'm just, again, I'm sharing from my own experience and from what I'm also learning because this is such a passion of mine, slowing our breath is the fastest way to calm the nervous system.

Even just two minutes of slow breathing where we focus on longer exhalations. It activates our parasympathetic nervous system or the calming response, and this can lower our heart rate.

It [00:21:00] can also, over time, lower stress markers. I like a particular pattern of breathing, which is called the 4 7 8 breathing, where you inhale, and this can be 6, 7, 8. You can do a box breathing, whatever it is you decide to do.

I think focusing on the exhalation being longer than the inhalation is really important. Beyond that, I'd say two things, one of which we've already spoken about, which is practicing gratitude.

I can share with you one thing I do with my kids at night, which I love, is I say my three thank yous. And this can be like, I was thankful the sun came out. I really enjoyed my lunch today, and I'm grateful that I'm putting you down to bed right now.

And then my son does it. My daughter does it, even my husband and initially, begrudgingly, now does it without even putting up a fight. And I think it doesn't erase stress, but it softens our body's reaction to it.

And then the third thing I would say is reducing comparison, especially in [00:22:00] today's world. I'm still working on this. I think we all will. But social comparison, especially through social media like you mentioned, Stephen, it can increase our anxiety, depression.

I think limiting our exposure, even temporarily, can be profoundly regulating. I'm continuing to work on this. With this comes self-compassion, self-acceptance, of course, but even being aware of it, "okay, I'm comparing myself right now," offers a little space between your mind's judgment, the act of comparison and reality, and just even that space of observing yourself is a step in the right direction.

Stephen Calabria: So you spoke of the role of joy and breathing techniques, and I want to talk for a moment about laughter. So a friend who has a teenager just had a new baby and I asked him, what did you learn the first time around that you're using now?

And he said, I learned that it's easier to go [00:23:00] from crying to laughing than it is to go from crying to not crying. And I'm curious if you have observed any physiological improvements in people who have incorporated humor or reincorporated humor and laughter into their lives.

And if so, if that is indeed a route to feeling better, what do you think are the best ways for folks to do that? 

Anu Lala: I love this question. Thank you for bringing this up. I think laughter is not frivolous at all. I think it is the greatest form of medicine. I think it's one of the fastest ways for us to remind. Our nervous system, that we are safe, that we are connected, and that we are here in the present moment.

I think sometimes people, when they're burnt out, they think that resilience means getting more serious. It's, I need to be more regimented, more [00:24:00] disciplined. And oftentimes the most resilient thing that we can do is allow for lightness and laughter allows for that space.

And that space, I think, changes how you breathe and how you think and how you respond, in general. And we can all look at our own examples to know that this is true. Laughter naturally changes our breathing.

Those longer and irregular exhalations can help downshift the stress response, reduce tension. It allows for connection. It's like social glue, if you will. And I think social connection, we've heard this from the prior Surgeon General is one of the most consistent predictors of wellbeing and longevity.

I think, a laughter practice is something I've been contemplating a lot. Like how do I do that? So one is to watch short clips that make you laugh reliably. And I do this regularly and I just, I really enjoy it.

I think texting a [00:25:00] friend for a one line joy check-in or sending it. So if I see a funny clip, then I'll send it to someone immediately. So I'll share in that laughter. So then it doubles the effect that it has on me.

And then something we, we do as a family is like, Hey, share one of the funniest things that happened to you today. And it's small. It sounds small, but it could be like a nervous system signal to be more conscious and aware about, situations and signals that life is not just stress and it's not just tasks and pressure, but there are these moments of lightness that come about.

And so I think those are natural ways to bring more laughter into our lives. And to answer your question, so to speak, do I think it's important? One hundred percent. I'm happy that you asked this, 'cause I'll be a little bit more deliberate in my day to day about looking for laughter and trying to share it and also experience it myself.

Stephen Calabria: Moving on to purpose, having a sense of purpose. When life feels [00:26:00] uncertain or heavy, how can people reconnect with a sense of purpose, especially at the start of a new chapter, like a new year?

Anu Lala: Oof, yeah. I find this question, "what is my purpose?" not helpful, personally? I think it's probably the most important question we can ask ourselves, but it's sometimes just, at least for me, so overwhelming that I find it more anxiety provoking than calming and grounding.

But what I do find helpful is, what feels meaningful right now? And I think that's more digestible for me. And purpose in the moment could be caring for someone tending to my own health. It could be something as simple as this podcast right now.

Just talking to you right now feels [00:27:00] meaningful to me. We're talking about meaningful questions and hopefully listeners will feel like our conversation is meaningful. And so this gives me purpose right now.

And I think that there's space that is allowed in changing the question of what is my purpose in life to what feels meaningful right now. So this is something that helps me personally.

Psychologically, I think we've known for a long time that having purpose is linked to better mental health, to longevity, to even cardiovascular outcomes in some studies, but it doesn't always have to be so grand.

And I struggle with this personally, but purpose I think, is revealed to us when we stop resisting where we are. We start engaging and aligning with what is, I think that is our most profound purpose.

And so I think a new year is not this mandate to [00:28:00] redefine your life in these massive grand ways, but it's an invitation maybe to notice where life is asking for your attention. And that might be an a reframe that's more palatable. For some, certainly for myself. 

Stephen Calabria: Finally, if you could offer one guiding thought or intention for listeners as they step into this new year, what would it be and why?

Anu Lala: I've often thought about this line. We used to do in a yoga class I used to take years ago which was, let go, let it go. And that felt like it was pressure, ironically for me. Like it was something that I needed to do, but I liked this, the reframing of it.

Just let it be and we could all break into song now. Let it be, allows for acceptance. I think it's an act of deep self-compassion. It [00:29:00] allows us to stop fighting reality, so to speak, or resisting what is, like we've talked about, and create space for acceptance to flow in.

And I think from acceptance, we are naturally going to be more clear about what life is asking of us. And I think when we align ourselves with what is, we gain direction and purpose, and I think that is the place from which all positive change happens.

My one take home would be to practice the line, and I'm gonna do it two more, just let it be.

Stephen Calabria: Last question insofar as you're comfortable sharing it. What are your New Year's resolutions?

Anu Lala: Huh, i've been thinking so much about this. My New Year's resolution is, I've got a practical one and a more kind of abstract, [00:30:00] philosophical one. The practical one is, i'm working on getting to bed earlier so I can get a good night's sleep.

I feel like I don't get enough sleep and I think we're learning so much about how sleep is just so integral to our health broadly. And then as a cardiologist, we know it's linked even to cardiovascular outcomes.

So I'm working on creating routines where I will be naturally inclined to get into bed earlier. And with more regularity. And then, the more abstract one is to, practice more self-compassion and acceptance.

In concrete ways, I like affirmations a lot, and so I've, printed out some affirmations that I actually say with our kids. I can share them now if you'd like in a, in total vulnerability. But what we say before we sleep is, I am safe. I am protected, I am healthy, and I am healed.

[00:31:00] Divine wisdom guides me to make the right decisions at the right time. I have everything I need and everything I want. The universe loves me. I'm always in the right place at the right time, and thank you because I know everything is working out. And so it is. 

Stephen Calabria: Dr. Anu Lala, thank you so much for being on Road to Resilience. 

Anu Lala: Thank you so much for having me. Happy New Year.

Stephen Calabria: Thanks again to Dr. Anu Lala for her time and expertise. That's all for this episode of Road to Resilience. If you enjoyed it, please rate, review, and subscribe to our podcast on Apple Podcasts, Spotify, or wherever you get your podcasts.

Want to get in touch with the show or suggest an idea for a future episode? Email us at podcast@mountsinai.org. Road to Resilience is a production of the Mount Sinai Health System. It's produced by me, Stephen Calabria, and our executive producer Lucia Lee.

From all of us here at Mount [00:32:00] Sinai, thanks for listening, and happy New Year.