How to think about chronic health conditions

Tapestry Talk

I’ll be giving a public presentation on “What You Should Know About Diabetes” at the Bonsor Recreation Complex at 7 pm on Wednesday, November 25th. You’ll learn if you are at risk for diabetes and how you can prevent it; how diabetes can affect your heart, circulation, nervous system and brain; and what you would need to know to effectively manage your health and avoid these complications.

To register for this free event, contact Leona Cullen at or (604) 259-4450. This presentation is part of the Burnaby Division of Family Practice’s Empowering Patients public education series.

An important focus of primary care is the management of chronic disease. This includes high blood pressure, diabetes, heart disease and chronic lung disease. The proactive, planned management of these conditions has been shown to reduce complications and hospitalizations, prevent premature death and improve quality of life.

The term, chronic disease carries a negative connotation. I prefer the term chronic condition. After all, each of us shares one chronic condition; it is sexually transmitted, incurable and has a 100% mortality rate. That condition is life.

On good days (and I’m hoping that for you that means most days), you recognize that it’s not all bad. We don’t choose the conditions of our lives and we don’t deserve misfortune, but we can choose to make the most of what we have.

We remain agents of positive change. We can learn and do what we can to maintain the best quality of life so that we can pursue our personal dreams and do what is most meaningful to us.

And we can be agents of positive change by helping others struggling with their own chronic conditions, providing the support that we can and empowering them to be active managers of their own lives.

That’s how I see my role as a family physician. In healthcare, we treat people not medical conditions. We help our patients manage their health in the context of their whole lives. That management has to be tailored to fit the unique life of each individual.

Doctors and nurses have traditionally had the habit of labeling patients with their conditions. They might call the first patient on the OR slate, “the 7:30 gallbladder.” There is a tendency to call people, asthmatics, diabetics or hypertensives.

Patients can label themselves when they are first diagnosed with a chronic condition. A first heart attack can sometimes be a wake-up call to finally quit smoking, start eating a healthy diet, exercise appropriately and reduce other risk factors. Some, however, become demoralized and surrender, seeing themselves as damaged goods on borrowed time.

With a new diagnosis of diabetes, some patients are in denial and fail to make lifestyle changes and monitor their condition while others take on the label of diabetes as a harbinger of impending doom. Those with a balanced approach do best. They accept the diagnosis of this chronic condition as life-preserving and life-enhancing news. They learn what areas of their health require more attention and how lifestyle changes reduce the potential for complications that would otherwise threaten their eyes and kidneys and the circulation to the heart, brain and feet. With knowledge comes power and a greater sense of control.

If you’ve been diagnosed with a chronic condition, ask your family doctor what you need to know and do to take the best care of your health. As part of the Burnaby Division of Family Practice’s Empowering Patients public health education series, we are providing free unbiased information in public presentations and online

Posted in Burnaby Division of Family Practice, Empowering Healthcare, Healthy Living, patient-doctor relationship, Positive Potential, Preventive Health | Tagged , , , | Leave a comment

What you need to know about diabetes


November is Diabetes Awareness Month. So raise your awareness of this common condition by correcting these five common myths.

Myth #1: I don’t need to worry about diabetes.

Diabetes is a very common condition. The prevalence of diabetes in adults over age 20 is 1 in 11, and the incidence of diabetes is expected to increase as the population ages, becomes less active and more obese.

There’s a good chance that you – or someone that you care about – will develop diabetes. That’s why we all need to know more about it.

Myth #2: Diabetes is all about sugar.

Diabetes is a problem with metabolism – how your body converts food into energy. Because glucose is a source of energy for every cell in the body, diabetes has potential effects on multiple organ systems, including the nervous and circulatory systems.

Poorly controlled diabetes is a major cause of heart attacks, strokes, kidney failure, amputations and blindness. A person who has had diabetes for several years is considered by physicians to have the same risk of a heart attack as someone who has established vascular disease.

Poorly controlled diabetes is a common cause of erectile dysfunction. More bad news: Viagra doesn’t work as well for people with diabetes.

Myth #3: Diabetes is caused by being overweight or eating too much sugar.

There are two types of diabetes. Type I is insulin-dependent. For some reason, usually related to the immune system, the pancreas no longer produces sufficient insulin. Therefore, type I diabetes requires insulin injections or infusions.

90% of diabetes is type II or insulin-resistant. This is commonly a hereditary condition. You might inherit a tendency for diabetes from your mother or father. As you grow older or gain weight, your cells may become more resistant to the effects of your body’s own insulin. You become glucose intolerant, and carbohydrates, such as rice, pasta and potatoes cause a greater rise in your blood sugars than they normally should.

Not everyone who is overweight or drinks a lot of pop will develop diabetes, but if you have the genes for type II diabetes, gaining weight, getting older and consuming excessive sugar will allow diabetes to manifest.

Myth #4: All diabetics have to take insulin and check their blood sugars many times each day.

People with type I diabetes – because they do not produce enough natural insulin – are dependent on insulin injections or infusions. They have to monitor their blood sugars regularly throughout the day to keep their glucose levels in a safe range.

Most people with type II diabetes do not require insulin with the onset of their condition so they usually do not have the same need for multiple daily glucose testing. There are a variety of oral medications to control type II diabetes. Two essentials are regular exercise and smaller, more frequent meals with low glycemic index foods (carbohydrates that do not cause a sharp rise in blood sugars).

If blood sugars continue to rise with type II diabetes, insulin may be needed.

Myth #5: Everyone with diabetes will get complications.

With the careful management of diabetes, most of the complications of diabetes can be avoided. This requires optimal self-management in which individuals are given the support and education they need to be effective managers of their own health.

In addition to blood sugars, we monitor and manage blood pressure, cholesterol levels, changes in the eyes and kidney function.

I’ll be giving a public presentation on “What You Should Know About Diabetes” at the Bonsor Recreation Complex at 7 pm on Wednesday, November 25th. You’ll learn if you are at risk for diabetes and how you can prevent it; how diabetes can affect your heart, circulation, nervous system and brain; and what you would need to know to effectively manage your health and avoid these complications.

To register for this free event, contact Leona Cullen at or (604) 259-4450. This presentation is part of the Burnaby Division of Family Practice’s Empowering Patients public education series.

Dr. Davidicus Wong is a family physician and his Healthwise columns appear regularly in the Burnaby Now, Royal City Record, Richmond News and Vancouver Courier. For more information about diabetes, talk to your family doctor or check the Canadian Diabetes website

Posted in Burnaby Division of Family Practice, Empowering Healthcare, Healthy Living, Screening Tests, Self-care | Tagged , , , , , | Leave a comment

Mindfully Manage Your Emotions

Nitobe Memorial Garden, UBC (Davidicus Wong)

Do you remember the scene in Disney’s animated movie when Snow White runs screaming through the woods, terrorized by what appear to be evil trees? She awakens in the morning, surrounded by new furry, forest friends.

In real life, we all get lost in the wilderness of our emotions, and those emotions cloud what we are able to see. We may think we know the difference between happiness, sadness, anger and anxiety, but any of us can get caught up and lost in our moods and feelings. We are surprised with where we have wandered.

The conventional approach to life is to seek pleasure and avoid pain. That we believe is the definition of success and the secret to happiness: maximal pleasure and minimal pain.

We preoccupy our thoughts and energy with the pursuit of physical comforts: nice meals, a comfortable home, attractive clothes and a variety of sensual pleasures. We work not only for the necessities of life but to buy the things we crave. We peruse catalogs, search the net and wander through shopping malls to find what we want.

At the same time, we avoid what we don’t like: pain and suffering. When we experience physical pain especially when it becomes chronic, we struggle to fight it – with fear, anger and sadness. This invariably amplifies our suffering.

Likewise, we seek positive emotional experiences: falling in love, happiness and peace, and we react with aversion to negative emotions, such as sadness, grief, anxiety and anger. We might try to suppress or ignore these difficult feelings or struggle to fight them with even greater fear, anger and loathing.

Our conventional approach to life is doomed to fail. That is reality.

There is good and bad in every life, and each of us will experience a daily mixture of pleasant and unpleasant experiences.

If our aspiration is to remain young, active and pain-free forever, we will surely be disappointed; our bodies age and breakdown, we will become ill at some time, and each of us will ultimately die. Accidents can disable us or shorten our lives.

Change – both predictable and unpredictable – is the nature of life and part of being human. It is futile to hold onto all that gives us pleasure. Pain is a part of life, but suffering – to some extent – is optional.

We don’t have to be caught up with the dramatic twists and turns of fortune or get sick on the roller coaster ride of our emotions. With a little wisdom and the application of mindfulness, we can still find peace.

Without mindfulness, we instinctively react to circumstances and get carried away with our emotions. We stab ourselves twice by clinging to negative emotions.

First, we identify with them. We say, “I am depressed”, “I am panicky” or “I am angry” instead of “I am experiencing a feeling of depression, a panic attack or a wave of anger”. By identifying with negative emotions, we add more power to their punch and stay within their reach.

Then we ruminate – repeating and recycling the negative thoughts associated with those emotions. For depression, “Everything is terrible and it’s never going to get better.” For anxiety, “I can’t handle it. I’m overwhelmed.” For anger, “I have a right to be mad, and here are the reasons . . .”

In this way, we linger in the lake of our sorrows or get caught in the quicksand of our own anger.

A mindful approach to difficult emotions is to recognize that it is normal and human to feel a variety of emotions and to notice them change as does everything else in our lives. I use the acronym, ROAR.

Recognize your emotions. What am I feeling? Is it really anger or does something else lie beneath the surface? Fear? Sadness?

Open up and accept your feelings without judgment. Feeling a wave of anger, sadness or fear does not make you a bad person.

Appreciate whatever is arising in your heart. What does it feel like? What does it physically feel like in your body? Think “This is anger or anxiety or sadness” rather than “I am angry, I am anxious, or I am sad.”

Release. Don’t identify, cling to or feed your emotional response. Let it pass through you like a weather system.

Catch and release. Breathe in and breathe out.

That is a key to mindfully managing your emotions.

Nitobe Memorial Garden, UBC (Davidicus Wong)

Dr. Davidicus Wong is a family physician and his Healthwise columns appear regularly in Burnaby Now, Royal City Record, Richmond News and Vancouver Courier. 

Posted in Balance, Emotions, Happiness, Letting Go | Tagged , , , , , , , , , | Leave a comment

Retreating to Mindfulness

Nitobe Memorial Garden, UBC (Davidicus Wong)

If you were on the UBC campus a few weekends ago, you may have seen over a hundred people slowly streaming out of the Asian Centre eyes lowered and placing each step deliberately. This was not the early arrival of zombies for Hallowe’en. I know because I was among them, and I’m very much alive and mindful of that.

We were all there for a weekend meditation retreat led by Diana Winston, director of the UCLA Mindful Awareness Research Center. The book, “Fully Present: The Science, Art, and Practice of Mindfulness” which she co-authored with Susan L. Smalley outlines the scientific evidence and practical application of mindfulness meditation.

At our retreat, organized by the Westcoast Dharma Society, we practiced meditation while standing, walking, eating and sitting (on a chair, meditation bench or a meditation cushion called a zafu). Meditation is the practice of focused attention or concentration. Depending on your practice, you can meditate upon an idea, an image or a mantra, such as the word, Om. In mindfulness meditation, we focus on what arises in the present moment.

When we first learn to meditate while sitting, we focus our concentration on each breath in and each breath out, noting the sound and sensations in different parts of the body. We can then shift our attention to other physical sensations: heat or cold, pressure, tension or pain.

Tea House at Nitobe Memorial Garden, UBC (Davidicus Wong)

With further practice, we become aware of thoughts and emotions as they arise. We train our minds to remain in the present moment – rather than getting stuck in the past or projected into the future. We recognize when our minds are carried away in a train of associations or our thoughts snowball out of control, and with practice we remain in the present.

A strong foundation of mindfulness can serve as a safe anchor from which we can experience and manage challenging emotions and physical pain. For example, we can move our awareness and focus back and forth from the anchor of mindful breathing to an area of pain or a difficult emotion, such as sadness, anger or fear.

In walking meditation, we first learned to attend to the sensations in our feet and legs as we took deliberately slow, controlled steps. As we sped up, we noted the subtle changes in our sensations. In standing meditation – a good alternate to sitting when you think you might fall asleep, we recognized that we are in constant motion even as we try to stand still.


In a mindful eating exercise, I shared lunch with my friend and med school classmate, John but we couldn’t talk according to the rules of the retreat. By remaining conscious of each bite of my sandwich, apple and pear and every grape, I noted sensations and subtleties of taste that I normally would have missed. It took me 40 minutes to eat a lunch I would usually wolf down in 10, but my appetite was satisfied with less food. I’ll be recommending slow, mindful eating to all of my patients who are challenged by their hearty appetites.

Though many people think of meditation as something that is done only in solitude while seated on a zafu, mindfulness is meditation in motion. With the deepening of practice, mindfulness becomes the attitude with which we can live every moment of our lives, as we learn and work, talk and relate to others, and experience being alive, having thoughts and feeling emotions.

An insight arises in the practice of mindfulness where the focus of our attention is whatever arises in the present – a moving target. Everything changes and everything is in motion – everything in our world, everything in our selves, including our thoughts, emotions and bodies.

My favourite place for walking meditation was the Nitobe Memorial Garden, a gem of a Japanese garden hidden behind the Asian Centre. It reminded me of the beauty that is all around us every day that we may miss if we are not mindful.

Nitobe Memorial Garden, UBC (Davidicus Wong)

Dr. Davidicus Wong is a family physician and his Healthwise columns appear regularly in the Burnaby Now, Vancouver Courier, Royal City Record and Richmond News. 

Posted in Emotions, Happiness, Healthy Living, Letting Go, Meditation | Tagged , , , , , , , , , , , , | Leave a comment

My Parents’ Stories: The Cycle of Love

Dad's family & home in Cumberland before his birth in 1930

Dad’s family & home in Cumberland before his birth in 1930

My dad was born on Vancouver Island in Cumberland, near Courtney and Comox. When Cumberland had a coalmine, it was one of the largest Chinatowns on the West Coast. My dad lost his father in early childhood. His mother was left with 6 children to raise on her own. But my grandmother’s life was difficult from the start. At age 9, she was sold to a wealthy Chinese family that moved to Vancouver. She worked throughout her childhood and was not taught English. She was married and had her first child at age 14. But my dad remembers her as being very good with her hands, a skilled chef and seamstress. She managed to make ends meet and raise each of her children to be independent.

My dad worked throughout his childhood to support his family, finished school, studied automechanics and worked at Vancouver Motors downtown. He saved enough to study science at UBC and dentistry at McGill. When he talks about his childhood, he never complains about the prejudice he endured or the hardship his family suffered. He talks about wonderful life experiences, his lifelong friends and the kindness of so many people along the way.

The Ng Siblings

The Ng Siblings

My mom was born in the Strathcona neighbourhood of Vancouver. When my mom was 9 years old, she and her 7 siblings were orphaned. Her oldest sisters were teenagers and her youngest brother was still in diapers. There was no extended family to help them. To keep the family together, the oldest sisters decided that they would all work to raise the rest of the family until the youngest finished school. My mom always taught me the value of a good family in which each is responsible for one another, and 76 years later, my aunts, uncles and cousins continue to celebrate the love of family at our annual Boxing Day party.

My parents’ stories could have been told with sadness or bitterness but instead, they are stories of courage, resilience, gratitude and love. The way they told their stories shaped how they lived their lives, related to others and raised our family.

My mom’s love for me was unconditional. She saw the best and expected the best of me. At first, I thought I had to be a top student and athlete like my brother to earn my parents’ love, but I eventually realized their love came with no conditions. I would always be loved and accepted just as I was.

My mom’s circle of concern continued to expand throughout her life. She had many friends and was involved in helping others in her United Church and community. She would go out of her way to make a positive difference in the lives of other people with not so random everyday acts of kindness.

When she died unexpectedly from a cardiac arrest 12 years ago, I was overwhelmed with grief, but over time I realized that my mother’s greatest gift was still with me. It was her love, compassion and kindness. I could never give back all the love that my mom had given me, but I was already giving it out and giving it forward. I realized that what I feel towards my own children is the same love my mother gave to me, and if I teach them well, that same love will be given to others beyond my own lifetime. My mother’s greatest legacy was of love. This legacy of love belongs to every one of us.


60% of our bodies is made up of water. It’s in each of our cells and in our circulation, but we don’t own that water. We consume it in our food and drink, we lose it through perspiration and elimination.

In school, we studied the Water Cycle. Water evaporates, condenses into clouds, precipitates as snow or rain, freezes, thaws, flows into rivers, lakes and oceans, continuously cycling around the globe. It belongs to no one. It belongs to everyone.

I see our selves as vessels of love and we are part of the Love Cycle. We receive love from many people throughout our lives – friends, family, teachers, coaches, ministers, nurses, doctors and other health care providers – and it comes in many forms including the random kindness of strangers. It doesn’t always come unconditionally – it comes in many imperfect and human forms because we are imperfect and human, but still we receive love from infinite sources.

Love is not a finite resource. It is in us to give, and the giving of love does not diminish us but connects us and makes us stronger.

Posted in Compassion, Coping with Loss, Letting Go, Love | Tagged , , , , , , | 1 Comment

Write Your Own Life Story


As children, we are asked, “What do you want to be when you grow up?” and when we are young, we make our plans. Life intervenes.

People come and go into our lives; relationships change and end.

We make decisions based on who we are and what we know at the time we make them, but we cannot always foresee the consequences. Accidents happen, and illness arises.

Change is constant, unremitting and unavoidable – just like aging, but unlike aging, it is not so predictable. Many young adults see the randomness in their lives, and for many, this is discouraging.

Some of my patients with the wisdom of years look back on their lives with a different view. Though even more people have entered and exited their lives, which have taken ever more unpredictable turns, they discover greater meaning.

Upon thoughtful review, the events of our lives fall into place and create a coherent narrative. Seemingly random events, meetings and even difficulties, take on greater meaning as they led to the lives were meant to live.

I chose the specialty of Family Practice – or it chose me, I simply answered its call – when I fell in love with the stories shared by patients. As medical students, when we take a history, we learn about family relationships, the pivotal points in every life, the triumphs, the tragedies and the disasters; and ultimately, how each person made sense of the unfolding of their lives.

Most people have to rely on reality TV, soap operas and romance novels to be privy to the intimate details of other people’s lives. With deep listening to real life stories, we learn empathy. Understanding the suffering that others endure, we develop compassion.

In an English Literature course, my professor told us that a comedy typically ends with a marriage and a tragedy with a funeral. If this was the case with real life, every one of our lives is ultimately a tragedy, and indeed that’s how a lot of people see their lives: after a certain age – 40, 50 or 60 – it’s a downhill ride to senescence.

I soon recognized that the happiest of my patients told their life stories quite differently. They accepted the same illnesses, accidents and losses in life but also recognized with gratitude the gifts that they had received – aspects of their health that continued to thrive, good fortune that came when most needed, and most importantly, love and kindness shared – particularly from family and friends who had passed on.

If tomorrow you met a friend you had not seen since early childhood, how would you tell your life story? How you reflect upon the past – what you regret and what you appreciate; how you judge others and judge yourself – can impact your happiness in the present and how you continue to see and live your life. Is there another way to tell your story?

Together we weave the tapestry of our lives. It is our shared story and work of art. We are given a canvas and paints – the raw materials and circumstances of our lives. As we live our lives and relate to one another, we build upon what others have built and experience a life intricately connected with the rest of the world. Together we weave a tapestry of inconceivable complexity and beauty that continues to exist beyond our individual lives. This is the art of living . . . a work of art.

Who writes your life story? From this moment forward, will you accept your calling to be an agent of positive change in the writing of your own life story?

Posted in Coping with Loss, Empowering Healthcare, Grace, Growth, Happiness, Healthy Living, Letting Go | Tagged , , , , , , | Leave a comment

The Power to Change Your Brain


Instead of buying a new computer or smart phone when your old one can’t keep up with your needs, wouldn’t it be great if it had the limitless ability to upgrade its own hardware and software to meet the demands of the moment?

Your own brain already has this ability.

At birth, we are born with approximately 86 billion neurons and as they die, one by one, they are not replaced.

This has lead to the common assumption that our brains and therefore our capacity for thinking and remembering decline throughout adulthood. Associated with this assumption is the belief that we are less capable of change as we age. That’s the way the majority of adults think and behave. With time, we get stuck in habits of behaviour and thought; it gets harder to change our routine and how we see ourselves.

Although the actual of number of neurons (nerve cells) does not increase with age, up to adulthood, the human brain can increase to five times its size at birth. The increase in volume is due to myelination (the outer insulation of nerve fibres) and the growth of connections (or synapses) between neurons.

The principle of “use it or lose it” applies to your brain as well as your body. We know muscles that aren’t challenged will atrophy and become weaker. If we don’t move through a full range of motion, we become stiff, and if we limit our activity, we lose our agility and balance.

How your brain adapts and evolves over a lifetime, depends on how you use it because the brain is capable of creating new synapses (connections between neurons) at any age. Frequently used connections are reinforced and become stronger and more efficient. Seldom used connections are lost.

This creates habits of thought, which beget habits of behaviour and habits of feeling.

If we reinforce habits of drinking, smoking or using drugs when we are stressed or in response to particular situations, those habits become more entrenched over time as we strengthen the corresponding synaptic connections.

But if we stop the cycle, try out a new and healthier pattern of behaviour, and repeat that pattern repeatedly over time, we can reinforce an alternate neural pathway. The more we travel along this new connection of neurons, the more we strengthen the synapses until we have adopted the new and healthier habit.

The same principle applies to how we think about our selves, others and our world. It’s simpler and more efficient to hold onto assumptions and beliefs about others and our world, but too often it doesn’t keep up with the reality of change.

If we think of ourselves as being stuck in our ways, addicted to our attachments or incapable of positive change, we will live this self-fulfilling prophecy. Too often we limit our capacity for growth and happiness by our prejudices and unexamined assumptions; we see only evidence to reinforce our beliefs and are blind to evidence that show them to be false.

Certain patterns of thought reinforce particular emotional states, and once in these states, those patterns are reinforced. Thoughts focussed on negativity, judgment, blame and hopelessness reinforce feelings of anger and sadness. Thoughts of appreciation, personal empowerment and a positive purpose beget happiness.

With a healthy brain that can literally change itself, each of us is capable of positive change. Which free upgrades will you choose?

At 7 pm on Tuesday, September 22nd, I’ll be speaking on Emotional Wellness at the Bob Prittie Metrotown Library in Burnaby. I’ll talk about the key emotional health skills we all need to cope with life’s ups and downs; managing stress, difficult thoughts and feelings; recognizing the symptoms of stress, anxiety, depression, mood and other psychological conditions; and where to find help.

This free presentation is provided by the Burnaby Public Library in collaboration with the Burnaby Division of Family Practice as part of our Empowering Patients public health education series. As space is limited, please register by calling (604) 436-5400 or online

Posted in Emotions, Empowering Healthcare, Growth, Happiness, Healthy Living | Tagged , , , , , , , | Leave a comment