A: Hi everyone. Welcome back to the podcast. I am Amanda.
K: And I'm Kendra.
A: And we are excited today to introduce you to Dr. Cecilia Miñano. She's joining us today to talk about all things mind-body connection, particularly gut health. I met Cecilia in coach training and knew you would love her. She is the cutest. That's off script, but still. She's a gastroenterologist by trade. And so she sees and compassionately treats the chronic abdominal pain patients that sometimes are very frustrating for us in the ED because we don't have a whole lot to offer. And so, not only is she gonna help us learn more about our own gut issues (which I have them), but possibly also how we can better help our patients when we don't have a lot in our tool box.
So disclaimer, we are all doctors, but we're not your doctor. So this is for educational purposes only, and you always need to talk with your doctor before you start any sort of medication or treatment. So welcome, Cecilia. Thank you for joining us.
C: Thank you for having me. So lovely to chat with you all.
K: We are excited to have you. This is definitely something that we struggle with in the emergency department when it's not a clear cut diagnosis or we've seen this patient multiple times for the same complaint. I am very excited to hear what you have to say. So to start out, tell us a little bit about yourself. Who you are, your training, family story, what got you into coaching, et cetera.
C: Yes, thank you. So I am Dr. Cecilia Miñano. I am a gastroenterologist for over 15 years. I'm currently in private practice here in New Jersey. I have an amazing, supportive family of a stay-at-home dad/husband named Ed and our three human children and fur-baby named Jedi. And my journey to where I came from is: we're immigrants from Peru. I grew up in a single family household. I will say, before I get into like my training, a little bit about my background is that I…I will say I grew up in a difficult household. A lot of challenges, trauma, history. The beauty of that is that even though it was like a very chaotic setting for myself, I gravitated to education. And I think that was sort of my saving grace, that within an uncontrollable situation, I was able to have control and excel in school.
And for many years it served me. I graduated, not at the top of my class, but definitely the top 5%. I went on to go to Boston University for college. I graduated in three years. I then did a year of AmeriCorps, and I then opted to do a Master's in Public Health at Tulane University. I think my idea at that time was that I wanted to be like a grant writer for nonprofits, but I really missed that, like, human connection. I always had a desire to help people. And so, at that point I decided, you know, I'm gonna be all in on medicine. I thankfully got into University of California-Davis, where I'm a California resident from a young age. And then I matched into NYU for residency, and I completed my training at Yale in Connecticut for my Fellowship.
And I will say, as I look back on my journey, I do think that having had that difficult childhood did help propel me to success, but in many ways it was also like a double-edged sword. And now through coaching I can look back on it and appreciate the different modalities that it gave me. But what it also did with medical training is that, as a young child, I learned to compartmentalize a lot of my feelings. Because even though I had an amazing mother who worked hard and provided for us, emotionally she was just not available for us. And even the history we had, there was never a time to like really process that stuff.
And I bring this up only because I want to show your audience a little bit about how impactful coaching can be. Because when I came to coaching was at the height of the pandemic, and I had had such control of my life through education, working so hard, and it all fell apart when this monster called Covid hit. I had lost part of my income because, as you know, elective cases were canceled. I was going into hospitals feeling unprepared from a protection standpoint and an emotional standpoint. My husband at the time was very overweight, and I was very worried for his health. So after working long days, I would then also go out to the grocery store to pick up the groceries. I was changing three times a day, and I was crying and anxious beyond my wits end. And thankfully, I had gone to a wellness conference two years prior to that. And I had met a surgeon who had told me about coaching, and I'm so thankful that in the midst of this crisis for myself, I contacted her and I said, “Hey, can you tell me more about coaching?” And it was almost like I needed her permission to tell me to go all in on this, because honestly I had never paused to give myself the gift of, like, therapy or anything until that moment. And I knew that I needed to reach out for help.
And then just to fast forward (and Amanda knows this cuz we've been working together in a sort of small group) but the power of coaching is that I have had an absentee father for most of my life. And it's through my journey of coaching, of my own healing and compassion, that I was able to then extend that to my father. And unfortunately, he passed away last month. But my joy is that in his last chapter, I showed up with such love and compassion for him. And I'm so proud that, if I get nothing else from coaching, I've healed an amazing relationship. And I, I carry that with myself. Then it gives me such compassion for when I treat clients in coaching and my own patients. Because I've been there. I've had my own traumas, and you can still be so successful and still find joy every day. Even though you've had these bumps in the road.
K: That is an amazing testimony, Cecilia. Thank you so much for sharing. And that journey is probably something that maybe, at least one, I would say probably multiple listeners for this podcast really needed to hear. So thank you for your courage and bravery, and thank you for your vulnerability to show that on today's show. So as a gastroenterologist, tell us a little bit more about that mind-gut connection.
C: Yeah, so the mind-gut connection, also called the gut-brain axis, is a really sophisticated system of bidirectional communication between our central nervous system and our enteric nervous system, which is also called our second brain. And what I love about it is that it's communicating at a conscious and mainly at a subconscious level. So how we're thinking about the world, what our nervous system is perceiving with the world, signals from our own body, is creating these signal pathways. And it's affecting us from our central nervous system down to our gut and affecting how we digest food, how we absorb nutrients, the peristalsis of it. It's even affecting, like, the diversity of our microbiome. There's numerous studies now that show that the microbiome is linked to conditions such as depression, anxiety, and even Alzheimer's. And I think it's like a catapult for ongoing research that we're gonna learn a lot more.
In addition to that, the gut and all the signals that we feel then send these different signals, then, backward, which affects our vagus nerve and that gets interpreted in our brain, particularly in our hippocampus, which is associated with memory and emotions. And that amygdala, which is that danger signal. And so we may not realize it, but we're in a constant sort of state of sensing the environment, sensing our own sensation, sensing each other. And the beauty of that is that when so much seems out of our control, we still have a part of us that we can control. And that's how, sort of, we respond to certain external or even internal factors.
What I want to teach about is the autonomic nervous system, which I'm sure we've all learned about in medical school, but that encompasses our enteric nervous system (again, the gut system), and then the sympathetic and parasympathetic system. So I like to teach about this because, throughout our day, we're in the different stages of this autonomic nervous system, and it's really important to try to hone in on this.
So the first state, which we all know is our sympathetic nervous system. So that's our fight and flight response. That's where we're releasing, like, hormones like cortisol, those neurotransmitters like epinephrine and norepinephrine. They're really helpful when we're, like, perceiving a danger or we're in real danger, right? We're sending blood flow to that heart and lungs and muscles to get out of there. But unfortunately what happens when we're sort of bathing in this high stress or chronically stressed state- or that sympathetic drive- is that it's inhibiting our digestive system. It's not allowing for appropriate peristalsis or movement of the gut. It's not allowing for nutrient absorption. It's inhibiting, like, mucus secretion, which you know, clears toxins, protects our intestinal lining and helps with elimination. It's also negatively impacting our immune system and endocrine system and the microbiome.
So, I like to highlight that because a lot of people are searching for the next, sort of like, supplement or diet to follow or medication. And while that's all good, these are factors that, you know, you see your doctor every three months. Your nutritionist, you know, every few weeks. But what are you doing on a day-to-day basis? And that's sort of the role I wanna fill, is how can I help you to build up your own resiliency to know what state you're in, and to bring it back down to the parasympathetic response.
So I didn't talk too much about that, but basically the parasympathetic response is the second branch of that autonomic nervous. And that's where we're in that calm state, and we're optimizing our digestion, right? We're sending those parasympathetic, vagus nerve signals to our gut to promote that absorption, that healing, that repair, that breakdown of foods. It's allowing for us to absorb those short-chain fatty acids, which are protective for our neurologic system. And it has two, sort of, arms to it. The ventral part is that sort of one that promotes the digestive tract, but then there's the dorsal part, which is when your nervous system perceives something so overwhelming that it can't fight or flight. So then it goes into this collapse state. And that shows up also by inhibiting our nervous system.
So what I like to offer clients is that throughout the day, maybe do two to three times a day tracking your nervous system. Do you tend to live in a sympathetic fight-or-flight response? So then when you, if you notice that, then how do you expect your digestive tract to work optimally to move your bowels when you're constantly, like, agitated or upset?
It's really honing into that so you can sort of pause and say, “Okay, I'm recognizing right now I'm in a fight or flight response. What can I do to help optimize myself? All right, I going to choose to take a few deep breaths. I'm gonna engage my vagus nerve to bring me back into that parasympathetic state.”
And I love to teach my clients to do this before eating, right? As we know with medicine, it's, like, gobbled down in five minutes. But what I've learned in this process of coaching is that if you don't give yourself the time, no one's gonna give it to you. So unless there's like a, in the ER, like a STEMI or, or you know, your colleague can't, you know, spend a few minutes covering you. Like take a few deep breaths before you're gonna bite into that sandwich, right? Engage that vagus nerve. Because when you're doing that, you're allowing that peristalsis, that absorption of those nutrients, right? Drink in the water to sort of help to dilute that and help to promote that breakdown.
A: Oh my gosh, you're gonna help so many people, Cecilia.
L: Yeah, like me. That's amazing.
A: Yeah. To like, on purpose, activate. That's, oh wow. You're gonna do so many good things. So in addition to mindset work, you know, which we talk a lot about on the podcast, you teach somatic processing is key also. Can you tell us more about somatic processing?
C: Yeah. So before I get that, I do want to touch on the mind work. I know you guys do it a lot. But I just wanna highlight. No, we'll, I'll do both. I just wanna highlight that, especially with chronic gut issues, we tend to look at the world as black or white. When it's going well, we're good, and otherwise we're like, “My body's broken. I'm never gonna get better.” And unfortunately when we're in that state, we're amplifying that sympathetic nervous system.
We are creating more fear in our body, and that's then creating more pain. So even though you may have a dull sensation of, like, a discomfort per se, when you believe that you're broken, when you believe that something catastrophic is gonna happen, you're now amplifying the volume of that sensation. And that is then perpetuating and creating more fear.
So it's a fear pain cycle. So my job is, from a mind and body perspective. So from the mind, it's like how do we reframe that thinking from believing that my body is broken? Where are there areas of your body that are good? Right? If your belly is not great, like is your heart good? Is your lungs? Is your mind good? Like let's also focus on those areas and how can we open up those beliefs that like, not that my body's broken, but that I'm on this journey. I'm learning to trust myself. I'm learning to process my emotions, right? It's a different feeling you get when you change how you believe about your body and yourself.
So a lot of this is rewiring, as we talk about neuroplasticity, changing how you look at things. And I know with chronic conditions, I'm dealing with my own chronic ankle injury that it's been a six month journey. And listen, I've been in this work for a long time, and I still have moments where at the end of the day, I just can't keep going. And I get hopeless and, like, this is never gonna get better. And then I remind myself, okay, I'm in a sympathetic state. Let me give some compassion. And as I take deep breaths, I remind myself that I am whole, that I am healing, that I'm on a journey. And it's through that breathwork and reframing my thinking that I'm able to then shift back into my own parasympathetic state.
So, to somatic processing. So soma is your body, right? Processing is really just being present with yourself, being embodied. What is your body currently sensing and experiencing? Right? If you’re currently in a state of agitation or stress, I want people to recognize what state am I in, and really be curious with your body. Okay? ‘Right now frustration for me is showing up as a dry mouth. I'm feeling palpitations in my chest, I'm feeling my heart racing.’ So we release the judgment of it and just really go into descriptive words about what we're feeling. And as we do that, we learn to take deep breaths. What you're doing is: a) you're reframing your thinking, but you're also b) re-engaging that vagus nerve and bringing that, like, offline sympathetic or collapsed state back into that parasympathetic state.
And you'll notice that maybe the sensation of tightness as you breathe is lessening, right? It doesn't mean it's gonna go away, but now it's more tolerable. And so it's really pausing and letting go of the story of what this means, of what is the next step of, if my future, am I gonna be disabled? Am I gonna lose my job? And you're really just being mindful and present. And with that, I help clients uncover what are the resiliency toolkit within themselves that help them. So, for example, when you're dealing with, like, chronic pain, what are different things you can implement in your life that sort of help to bring comfort to you? Do you need to put a pillow on your head? Do you need to listen to music? Do you need to journal while you're doing sensations? Do you need to incorporate more movement into your life? So, we sort of go into the moment, and then from there, we try different techniques. Like, maybe you need to put your hands out and, like, physically create a boundary. Maybe there's issues with setting boundaries. So we embody that.
So I have a lot of different tools I use because, especially as I discussed with trauma, for us who've had difficult upbringings or difficult experiences. It's very hard to sometimes get into the empowering thoughts that serve us. We're so hijacked by our sympathetic nervous system that we can't access that. So the only way to break that is to go into the present moment. Sometimes it's like even a simple grounding exercise, right? I'm gonna sit on my chair here and really feel the support of it. I'm gonna feel, like, the support against my spine. Oh, I'm noticing that a pillow behind me, it gives me a little bit more support. These are things that are nurturing to your body and help you break free from that overdrive of the nervous system.
A: That's amazing. I didn't realize until I did my Integrative Medicine fellowship just how many common illnesses have a mind component that's very well known, very well documented. In my own particular case, asthma, you know, very much associated with anxiety kind of stuff. And then so many, you know, IBS, lots of different things that I wasn't aware of until, you know, recently. So along those lines, if you were an ER doc, and you had a patient who had already had CAT scans, multiple. Let's just assume multiple CAT scans, multiple ultrasounds, but keeps coming in with that, you know, abdominal pain. That's the chief complaint, abdominal pain, and like, maybe they've even seen GI, you know what I mean? What if you were that ER doc, or, I'm sure that it happens in primary care a lot too. What would be like, if you could script an ideal approach, what does that look like?
C: I think this is a very challenging area. I think emergency room, I would say, obviously is not the most equipped because you're really in a more of an acute setting. And I do think patients tend to use that in abundance when they don't either have an established primary care or for whatever reason. I think it's hard because pain is so complex, so you could examine a patient and it's, like, very tender, and it's hard to argue to not do imaging because you could potentially miss something critical.
But what I would offer is that with the primary carers, it's that, you know, people like this probably need to be seen a little more frequently so that you're catching things before it escalates. And I think within the ER setting, just recognizing that our nervous system sort of feed off each other in energy. And for patients, just being in that setting is very, you know, activating. It can be traumatizing hearing all the bells and whistles, and on top of that, they have their own fears and anxieties.
So I think definitely if you're in a rush and having to rule out things and just be in there briefly. But if you had a moment later maybe trying to connect with that patient and just reassuring them, okay, this has been found. And then, I would love it if the ER, instead of like TV with news that's very activating, had a little bit of more mindfulness stuff like quiet music, things that are very soothing to our nervous system. And I would love it if the medical student could come in and like, “all right, we're, while we're waiting, let's, like, practice a few mindfulness things. Let's like take some deep breaths. Let's do it together.” And in that way, maybe the amplification of that chest pain or the belly pain, we can try to lessen the intensity of it.
And even upon checkout, right, we give handouts on, like, abdominal pain. We've ruled out all these things, but I would love it if we had some tools for patients of, okay, while you're waiting for this, what are three things that you can do to help calm your nervous system? Let's practice, like, five minutes of walking outside. Pet your animal, right? Connect with an old friend. Take some deep breaths. I want us to start to gravitate to helping our nervous system because we do feed off each other. We are interconnected, whether we know it or not.
And I also wanna empower patients that you do have things within your control. Like your doctor appointment's not gonna be for three more weeks. So what are some things that you can do while you're waiting, while the medicine's kicking in, right, that are gonna help you to not feel these sensations as profoundly?
L: I love that too. Yeah, that, that is just amazing. So many things that I never thought about. I honestly, I know that the way I show up for my patients affects their outcome in some way. But I never thought about our nervous systems reacting to each other in that way. So very, that's really helpful for me to think about.
C: Yeah, I think especially with chronic pain, when you've had a difficult upbringing or experiences, your amygdala is very primed to going into that fight or flight state. So like, for example, like an ambulance can be very activating for people and all the bells and whistles. And patients are sort of at the mercy of the setting. So being a voice of a compassionate listener and bringing your own soma that's more relaxing can help to bring their nervous system down a little. There's so much power even in those five minutes.
L: Yeah. Thank you so much for that. So can we just hand out your business card to our patients? I feel like that would be helpful to some of these guys. But you have a new group coaching program coming in this year. 2023. Tell us about.
C: Yeah, so I'm currently doing one-on-one coaching, but I'm obviously filling up. So I'm gonna be expanding to group coaching probably in February. But basically it's a 12-week program where we discuss creating, like, safety. As I mentioned, trauma is a big component of, especially chronic pain, and, like, these gut brain disorders. So really helping people find their grounding because, as you know, we can get activated at different times. A bad coworker, a child, and we're back into that fight or flight response. So it's really helping us to come back down to that parasympathetic. We teach about how to process emotions, how to create boundaries. Sometimes we're so overworked in giving to everyone that we don't have any time for ourselves. We talk about, like, even planning ahead. People who have like gut issues particularly have to plan when they're going out and what the bathroom's gonna look like. And there's a lot of shame and guilt with that. And it's like how do we shed some of that so that we can optimize ourselves for success?
Because we know that connection mitigates trauma, and there's a lot of trauma history or unprocessed emotions that we have to address. And then I end it with, like, “What are your tools for resiliency that are gonna help carry you forward, right?” So for some people, ways to bring you back into that parasympathetic is, like, walking or connecting with a friend. Movement. Tai Chi. So we go into different ways that you can work to calm your nervous system. And it- obviously, with all these, no one size fits all. So we give lots of resources so that you can pick and choose what works for you.
L: That's awesome. I love that. I think all of this is fascinating to me because I grew up in a traumatic environment as well. So I have celiac and ankylosing spondylitis, so two gut related issues. And I, you know, went years without realizing anything was related. And no one else in my family has these things. So it's just, it's just so fascinating what our brains can do to our bodies. Just so interesting, and I love that you're focusing on this. So thank you. I know this is gonna make such a huge difference for so many people. So how do people contact you?
C: Yeah, so my website is ceciliaminanomd.com. And that's probably the best way they can set up a free consultation call with me and get on my email list and hear about my group or one-on-one program. And thank you. And what I, the last thing I wanna highlight is that even though I'm a gastroenterologist, obviously I believe in medicine. I wanna work in conjunction with your doctors, right? I'm not here to say like, stop the medicine and let's just focus on your like sympathetic and nervous system. We sort of work simultaneously, right? I'm helping empower you within your own body, or soma, how to reframe thinking. But we're gonna also allow the medicine to take its course, the diet to take its course. It's all like complimentary.
L: Yeah, that's great.
A: I have a question. Is there an ideal patient, like is there somebody who you see frequently? I mean, not patient: client. Like how does somebody know if they need your program?
C: I think if you are dealing with any sort of chronic illness, I am happy to assist. But I think if on a daily or frequent, you know, weekly basis you're plagued by some sort of symptom or sensation, I think these services are very valuable. Sometimes these are signals from our body of some unmet need. It's not always necessarily a structural issue, which our medical profession’s excellent at ruling out. So I think if there's any question, just hop on a call with me, and we can discuss it. But so I do do the gut issues, but I'm also dealing with my own ankle and chronic pain. So I also am happy to work with those people. And I also still do burnout because, like I said, my journey has been through my own burnout story. And there is hope. I just wanna say like we've had difficult upbringings, we have chronic illnesses. That doesn't mean we don't continue to search and hope and advocate for ourselves.
L: Absolutely. Absolutely. Do you have any other closing thoughts for us?
C: No, thank you. I'm so excited to bring this new way of thinking to the ER group here. And I do think there is an unmet need for you guys who are then discharging patients, and I'm happy to help work with you guys.
K Well, we have sure enjoyed this time, and we wanna welcome you to the Burnout Survivor Club. You're duly initiated today. We're self-proclaimed burnout survivors. But thank you so much, Dr. Miñano. This has been fantastic. I know it has resonated with so many out there that not only have struggled with chronic illness or chronic pain, but also struggled to find hope. And I think the bottom line here is you have just opened up a window of hope for someone that I know, just listening to this podcast, will definitely reach out. But I just know that you have given hope. And whether or not they work with you or not, you definitely have resounded that message today. So thank you, thank you, thank you. We honor you for being on the show today and for sharing all the goodness that you have today.
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