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Speaker 1:


Matt George:

Dr. Gander do you mind, for those listening, introducing yourself?

Dr. Sarah Gander:

Sure. I'm Dr. Sarah Gander. I'm a general pediatrician in Saint John, New Brunswick. I'm a Johner, I grew

up here. I left for my training to Newfoundland for medicine and to Kingston, Ontario for my pediatrics

residency. And so I came back to Saint John to practice and I've been here ever since.

Matt George:

Thanks for being a part of The Sensory Friendly Solutions Podcast.

Dr. Sarah Gander:

My pleasure, thanks for having me.

Matt George:

As I understand it, you're also in the podcast medium? Is that right?

Dr. Sarah Gander:

My gosh, thank you for the plug. Yeah, I'm the host of the Fac Dev Lounge Podcast for Dalhousie

Medicine New Brunswick, which was kind of awesome because we created it thinking that we needed

another way for faculty to consume faculty development education, just given people's busy schedules

and kids, and distributed education and travel and things. And then lo and behold a global pandemic hits

and so our relevance kind of was even more amplified. So, yay. Yay us for being ready for a pandemic,

the only part of my life that was really for the pandemic.

Matt George:

Right. And we're going to talk a lot about that, but before we get there it really is an incredible medium

to meet people where they are. I think one of the reasons the podcast medium has grown so

significantly is it kind of goes in tandem with the mobility revolution. People are on the go, we're busy.

Now we're all at home, and we're going to talk a lot about that because one of the goals of the podcast

is dealing with this time here and now. But it really does meet people where they are, doesn't it?

Dr. Sarah Gander:

Well, and it doesn't contribute to what I think is some of the harm that's happening now, which is just

basic screen fatigue.

Matt George:


The Trial VDerrs. iSoanrah Gander:

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People get really excited about inviting us or having... They're like, "Oh, we'll do it on Zoom," or, "We'll

do this webinar." And you just sort of think, I don't want to do any of that because I'm Zoomed out. And

so, it's nice to think that maybe you can consume some of the stuff and still accomplish those goals or

that interest but be up for a walk, or be on your treadmill, or be in your car. I guess it's multitasking if

you like that kind of thing.

Matt George:

Yeah. Do you think those... Maybe we're taking more liberties right now in the way that we work and

the way that we consume media. Do you think some of that stays? One of the things that I think will be

important going forward is, do we maintain a better relationship to work following this? Or do we go

right back to where we started?

Dr. Sarah Gander:

Oh wow, what a great question. I think what it's done for me, personally, is made me realize that you

can multitask in a way that serves you. So if I want to be in a call that I know that I'm sort of a passive

listener on a call, and it's at 9:00 and maybe I want to do that walking on my treadmill while I listen, then


Matt George:


Dr. Sarah Gander:

But if it's something that I need to be an active participant in, I think we need to still commit ourselves

to sitting down and focusing, but also taking some pause because it does take a lot out of you to stare at

a screen all day. And so I hope that there's some things built into this world that we start to learn about

that kind of allows us to pause, because the temptation, of course, is to log on to a meeting at 9:00, lot

off at 10:00, log on at 10:00, log off at 11:00. We used to walk between rooms at least and pee, and grab

a drink, and high five your friend in the hallway. But now we could just isolate ourselves all day, some


Matt George:

Yeah, I think you're right. Having said all that, COVID check-in. I have to do a COVID check-in with you.

We're all dealing with this in different ways. First and foremost, yeah it's a health crisis but it's turned

into much more. I think it's the perfect storm. It's been a social crisis, it's been a financial crisis for some,

and it's been a health crisis for many families. So COVID check-in, how you doing, how's the office, give

me the scoop.

Dr. Sarah Gander:

That's nice. Well we're in New Brunswick, so we got off a bit lucky. I do think that the province made

some early, courageous choices and that's probably why, a lot of the reason why we are where we are.

But also I know the frontline people who did a lot of hard work. And so I think that COVID check-in for

me now at this point, because here we are in September, COVID check-in's a bit frustrating right now

because the kids have come back to school and I'm not always convinced that the plans that we to be

applied to everyone necessarily followed perfect logic at times.

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Dr. Sarah Gander:

So one of the biggest challenges is the alternate days for high school students. And so when you're a

pediatrician and you spend a lot of time trying to get kids to do what they are supposed to do, which is

get up in the morning, and have structure, and go to school, and come home, and do some activities,

that sort of Tetris of their schedule is frankly a nightmare. And it's a nightmare for parents, and it's a

nightmare for teachers, and it's a nightmare for people trying to help people with behavioral disorders

or neurodevelopmental disorders.

Dr. Sarah Gander:

And so the COVID check-in for me now is to try to have compassion for the fact that people are trying to

make the best decisions they can to keep us safe, but also push a little bit to say at what point in a

province that has such a low yield of COVID morbidity do we start to ask ourselves are we doing more

harm than good by overreacting, maybe? But that's a strong word because at the same time people say,

"Well, of course I'd rather overreact and have no COVID."

Matt George:

Yeah, it strikes me... Let's stay there for a minute because it strikes me that that hones in on one of the

goals of this podcast. And one of the goals of this podcast project is to produce content about this world

that's increasingly busy, it's noisy, it's bright, it's overwhelming. You mentioned behavioral disorders or

those who are neuro diverse. I don't think I considered that, the disruption in scheduling and the

disruption in routine that this has caused may be a serious barrier to people being well or families being


Dr. Sarah Gander:

Mm-hmm (affirmative). I think what we know pretty well about the way the brain works is that the brain

really likes habit and then neuropathways and grooves that it becomes familiar with. And in neuro

diverse children, and really anybody, there's a moment where you really thrive optimally with a routine.

And that routine is really, in our society, cycled on the daily. Like this is what we do every day: we get up

in the morning, we have breakfast, or brush our teeth, and [inaudible 00:07:54], go to school, go to

work, whatever.

Dr. Sarah Gander:

I had a patient who I was trying to figure out his high school schedule for him. And if you think of the

month of September and October with holidays and everything it was like, "Okay this week you're going

Monday, Wednesday, Friday. Next week Tuesday Thursday, but the next week there's a holiday so that

week's Tuesday Thursday again."

Matt George:

Oh, boy.

Dr. Sarah Gander:

So there's just no even pattern that the human brain is going to default to in an easy way. And so then

add neuro diversity onto it, add toxic stress and trauma, and poverty, and two working parents, or not

knowing where your next meal comes from, whatever, whatever, a lot of things that our community is a The Trial Version

reality. It's just like how is this going to happen?

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Matt George:

Yeah. We're going to come back to all of that. I know you work a lot in the social determinants of health.

And I want to bring up some of Gabor Mate's work that has radically changed my life personally, and I

know probably a lot of the listeners too. But I want to trace your career arc for a minute. Why a


Dr. Sarah Gander:

Oh, my gosh. I feel like this is a med school interview.

Matt George:

There's a lot less pressure.

Dr. Sarah Gander:

The answer is because I wanted to help people. No, that is the answer because-

Matt George:

Yeah, it is.

Dr. Sarah Gander:

It's funny, I grew up in Saint John. We all have our own challenges in this world and one of my family's

major challenges was... My aunts are like my sisters, just the way the ages work.

Matt George:

Mm-hmm (affirmative).

Dr. Sarah Gander:

My cousin, who felt like a niece or a nephew, passed away from a brain tumor when I was in early


Matt George:


Dr. Sarah Gander:

And so, we have these formative moments where we sort of get inspired by beautiful people. So my

mentors were people, and anybody who's listening who knows pediatricians at Saint John would know

the names like Emile Paras, Wendy Alexander, people like that who just were by the bedside 24/7 back

in those days, and just beautiful people who were wonderful mentors. And so that, and my mom's best

friend is an emerg doc in [inaudible 00:10:22], Pam Walsh, and she's always been the coolest person I

knew. And so I've just adored her.

Dr. Sarah Gander:

So I think mentorship and sort of putting yourself in their shoes, because I don't have any doctors in my

family. Because sometimes that's it, right?

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Matt George:


Dr. Sarah Gander:

Your dad's a doctor, your mom's a doctor, whatever.

Matt George:


Dr. Sarah Gander:

But it was just I think that and I loved the sciences. I always worked with kids and so it just kind of all

came together. And I'm really super silly, I'm weird.

Matt George:


Dr. Sarah Gander:

My med student just said that actually before she left she was like, "Pediatricians are really weird."

Matt George:

Just as a group you're just unique?

Dr. Sarah Gander:

Yeah, exactly.

Matt George:

I feel the need to give a shout out to healthcare workers like you during this time. I have a mother who

has been in a hospital her entire life. I think it's 30 plus years now on the job, is probably going to wrap it

up pretty soon. But in this moment when everybody else went inside, for example I am a technology

entrepreneur what can I say about working on the frontlines. My mom's in the hospital every day and

seemingly is all too willing to be there. So shout out to you and all the healthcare workers that are

working right now. I know we've done well, but we are in flu season so let's wait and see.

Dr. Sarah Gander:

That's right, get your flu shot.

Matt George:

Yeah. Sarah, can I put you on the spot for a minute and read something that you wrote?

Dr. Sarah Gander:

Oh my God, yes. Sure.

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Matt George:

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Dr. Sarah Gander:

You won me over when you put my name and Gabor Mate's name in the same podcast.

Matt George:

Well, I'm putting you on the same rung for the sake of this show and hopefully you see yourself in that

light because you do the same work.

Matt George:

So you wrote this, and this was from the Amplify East website. You said, "When I started working I was

nervous I was going to do the wrong thing for patients; prescribe the wrong medication, make the

wrong diagnosis. After a couple years and some key mentorships," which you mentioned, "I started to

be afraid I was not going to do the right thing for patients; give medications instead of asking the right

questions, make a diagnosis instead of listening. That is when I found social pediatrics." Do you

remember saying that?

Dr. Sarah Gander:


Matt George:

Does it still ring true?

Dr. Sarah Gander:

Yeah, it's absolutely true. I'm glad that does ring true to me, because it is true. The system spends a lot

of time and energy on compartmentalizing things so we can understand them. So, "This group of

symptoms or this presentation means this, and this is what we call this." And that's what we get trained

for, and that's what makes us be able to understand things. Again, the brain likes simplicity, it likes being

able to put things in a box. It feels the safest there. But when you get some experience with this work I

really think where the magic happens is when if people could care less about what it's called and more

about a person and what their strengths and challenges are. This world speaks a lot about how are we

going to build resilience in our kids and in our teens, and why do we have all this anxiety and depression

and things. And I get lots of referrals for, do they have anxiety, do they have depression? And it's like

well, they have a lot of feelings and symptoms and behaviors-

Matt George:

Right, and the world is hard.

Dr. Sarah Gander:

And yeah, what are we going to do about it is what I care about.

Matt George:

Yeah, I'm wracking my brain trying to think about what it must be like in this moment, encountering all

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those things which fit perfectly in the themes and the goals of the podcast. And one of the books that I

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read recently in prep for learning this material was Gabor Mate's, When the Body Says No talking about

how it's not just an illness, it's so much more than that. We carry trauma, whether it's from our

childhood or whatever. And one of the references for this podcast is as of June 2020, the word sensory

overload was being searched over 40,000 times a month on Google. And that might not seem like a big

number but that's a 50% increase in the past year according to Google trends. Are you seeing that in

your work? Because it might be an intangible number, but a 50% increase of sensory overload meaning

I'm overwhelmed by the word right now, 50% in a year. Are you seeing that reflected in the work that

you do? You mentioned anxiety, you mentioned things like depression. Is it true? It's not just one thing,

it's a whole suite of things affecting all of us?

Dr. Sarah Gander:

I don't just see it at work, I see it at home. My kids were home for months with my mom, their dad, and

frankly, YouTube. We spend a lot of energy trying to get them outside and do all the things. And they do,

ride their bikes and they went to some camps and stuff, but there was more screen time than there had

been before. And we don't usually have the news going and stuff, but I think the number one thing

when people come, and they don't always believe me at first, is that if you're feeling like you have

sensory overload, then look at the things that were built to overload our senses: video games, YouTube,

television, not a walk in the woods. And it sounds cheesy, but that sensory overload isn't overload, it's

sensory, well what's the word, forest bathing. That's a healing type of sensory stimulation.

Dr. Sarah Gander:

So I think even Canadian Pediatrics Society has said, "One of the number one things to combat the

anxiety and stress of this odd time in COVID is to turn off the news." Because I think we all know that

not only is it sensory overload, it's confusing, and it's conflicting, and it's fear mongering, and it's fake.

And so not only are we inputting something external, now we have this whole internal confusion that

doesn't even make sense to us, right?

Matt George:


Dr. Sarah Gander:

So why would we watch this? It's garbage.

Matt George:

It's strange that in this time, especially in regards to COVID, it seems like it's actually worse to go and get

more of it. Everybody wants to understand what's happening and they want to know what's going on in

the community health-wise so they can protect themselves and their families, but going to seek out

more information and getting on the screen more, it seems like its' actually hurting us.

Dr. Sarah Gander:

And then let alone the rabbit holes of the internet that if you thought about it or have participated in a

kind of reading or documentary about social media, is built to actually maintain that dopamine hit of

sensory overload and create your own altered reality, actually. And so a lot of the depression and

anxiety we see, when you really unpack it, has to do with the fact that people are really conflicted with

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trying to live in this actual reality, which in Saint John New Brunswick is what it is. You've got these

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things you can do when you can't go out to the mall or you can't travel. Then, wow discover Rockwood

Park, discover the Irving Nature Park. Find somebody who wants to go to the trails in Sussex. We're a

beautiful province. Or you can dive into the internet and be socially isolated and then just not even be

able to balance that with any amount of healing or relationships or reality, basically, I think.

Dr. Sarah Gander:

Does that sound dramatic? I don't mean to be anti AI or something, I just think that the social isolation

of COVID has really doubled down on people, youth especially, just existing in these altered realities.

Matt George:

It's funny because at the end of the episode that we're doing on this podcast we're highlighting some

innovation in the sense friendly world or we're giving a real world tactic, a real tool to go and address

these things for yourself if they work for you. On Netflix, one of their banner documentaries right now is

called The Social Dilemma. I don't know if you've seen it yet, but it's going to freak you out. And it's the

people who built these things that were designed to give us these sensory overloads, these dopamine

hits, telling you not to use them. So they've since left. For example the designer of the Like button on

Facebook participates. And they tell you why these things were designed; they're designed to hold and

steal your attention.

Matt George:

So you can say that as a fact and not sound like Chicken Little because every single one of us has been

feeling that inside of our bodies. We might not have the words for it, but we're all feeling it and I'm sure

you, your family, and your patients feel a little bit of that too in 2020 right now.

Dr. Sarah Gander:

I get irritated when we sit down at the dinner table and my son... it's kind of like, "How was your day?"

And he says, "It was good." And he says, "You know what happened with so and so?" And I'm like, "No,

what? Who's so and so? What are you even talking about, you don't go anywhere?" And then I find out

that it's like a YouTuber or something. And I'm just like, oh God who cares? And you don't want to

dismiss what they're bringing to the table, literally I guess, because they're just trying to interact with

you. He's seven, but I couldn't care less what his YouTuber did on his Minecraft video, could not care

less except for that he cares and so therefore I need to care.

Dr. Sarah Gander:

But now I feel like I have to teach him social skills when he goes out to real people, because he sees so

few real people during COVID. So I would say to him and coach him, and he's a lovely... He's fine, and

he's a good kid, and he's very social in a lot of ways, but it was like, "Eddie when you go see this person,

you could say to them how are you today?" I had to social skill him all of a sudden again because he

would talk about Minecraft or something and I'm like, "Okay, if you're going to tell your grandmother

about Minecraft, this is how you tee it up. It's a game, you build things, everything's a square.

Sometimes you get sword that have powers. I don't know, but you have to tee it up, because if you start

out in the middle you've lost people."

Matt George:

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Dr. Sarah Gander:

So that's just a funny exercise that I never thought I'd really have to do.

Matt George:


Dr. Sarah Gander:

And I think that that would be even harder if people already found social skills a challenge.

Matt George:

Yeah, no doubt. Let's talk for a minute about the social determinants of health. Do you think a lot about

things like the effect of poverty on youth? Being well seems like a very complex thing, doesn't it?

Although maybe it could be quite simple as well. And we're going to talk about some of your strategies

on how you reduce the noise of this current era at the end, but talk for a minute about your work in the

social determinants of health and your focus there.

Dr. Sarah Gander:

Well, it's complex and it's simple. It's complex because it's people and they come from all different walks

of life with all different experiences. But what's simple is what's the evidence for me, and that's that

putting money in people's pockets makes them less poor. And so we need policies that put money in

people's pockets. And there's good evidence that says that they spend it on the right things. There's still

a pervasive attitude that there's the deserving poor and the undeserving poor, and that's the bootstraps

argument. "Well I had to work for..." And it's just that mantra should be gone with the dodo. People are

poor because people in privilege put them in that position and that's my belief. Not in a malicious way

that I made somebody poor, but culturally whether it be with systemic racism, whether it be with the

wage divide, whether it be poor taxation policies, whatever it might be. So that's the complexity, is that

the policies and the stuff that we choose to do as a province and as a nation is what puts our citizens in

the position they're in, and I believe that strongly.

Dr. Sarah Gander:

The thing about any level of deserving, which I don't believe in anyway, is how could you ever say that

about a child? And so then you get into the human rights of people. And in this province at least, the

minute that you're born, that baby has as many rights as you or I. And we have really no good

mechanism to make sure that those needs and rights are met. I've met families who are homeless. And

to have homelessness in this country is absurd. We just don't need to. To have food insecurity is absurd.

We know what the solution is to a lot of these things, but it's the big things that need to change to do it.

Dr. Sarah Gander:

So how does that translate to me and my practice? Not to mention the underlying trauma and toxic

stress that Gabor Mate's work talks about and the adverse childhood experiences. That's one big whole

thing that actually changes your neurons as well, changes your genetics even. But then there's just the

ability to deal with your day to day. So we were talking earlier about how do you keep your schedule

straight when you go all these random days to wherever when you're worried about putting food on the

table? The Trial Version

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Matt George:

Mm-hmm (affirmative).

Dr. Sarah Gander:

How do you go to a physician to fill a prescription and know that if you pay whatever it costs for that

medication, this bill is not going to get paid this month.

Dr. Sarah Gander:

We had a huge win in this country in the last week which was the Cambie case ruling came out of BC,

which preserves our commitment to a public healthcare system, which says a public private two tiered

system will not improve wait lists, that wait lists are not caused by the public system, and that people

should not be given care based on their ability to pay.

Dr. Sarah Gander:

And so when all of a sudden we say to, because this is a sensory overload type of podcast, when we say

"Yes, you can come to the doctor to get a diagnosis of autism, but if you want to see an occupational

therapist, or a speech language pathologist, or get a sensory dyad, or have a behavioral interventionist

you need to pay $125 an hour, then there's some serious unfinished business with Medicare there.

Matt George:

Right. How are we dividing care based on economic boundaries? A mentor of mine and someone you're

probably connected to as well, actually. I won't name them, but does a lot of work in this space and he

said to me in a similar fashion about the bootstraps argument, "We should improve ourselves, sure. But

when is someone who is sleeping rough supposed to do their resume? Is that before or after they find

somewhere they sleep that night?" And so these things kind of get crystallized in your mind, as you say.

We're putting wellness... We're putting the boundary lines of wellness within the boundary lines of

economic status. And I know you think a lot more about this than I do, but you put it really well that

those are really big challenges.

Dr. Sarah Gander:

They're challenges, but we just had an election here. And so it was a very important platform for me to

make my decision to vote, but also the type of candidates I would back, which are all over the map to be

honest, because there's some beautiful people in all the parties who get it. And there's some people

who don't. And the people who get it I really just pray are the ones that understand that people deserve

to be treated with dignity, people deserve to be met where they're at. And so when you have some

simple policies like the assistance formulary will only cover the birth control pill and not your IUD, well

then yeah how are you going to remember to take your pill? On your bedside table that doesn't exist in

the shelter?

Dr. Sarah Gander:

There's just things that are such low hanging fruit for me, which sounds righteous I guess in a way,

because there are big complex problems that have to do with a lot of economic stuff I don't know a

thing about. But people first, and you have to hear their voice. I think we make a lot of decisions for

people without them at the table. And so we need to find a way to do that in an un-tokenizing way or The Trial Version

non-tokenizing way and really make space for that.

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