Living Better With Yoga Part 1

A regular yoga practice has made my life better, in so many ways. I know that when I’m at my worst, most desperate state, my practice is there. But it doesn’t always look like an asana practice; that is to say, my yoga doesn’t require me to roll out my mat and do several rounds of Sun Salutations. It’s great when I can do that, but practicing something – anything – during those trying times helps me reclaim perspective and clarity.

I have taught yoga in some interested places: adult education centers, elementary schools, corporate conferences, airports, beaches, parks… But the place I find the most use for yoga is in a hospital. I’m sharing here some of my more memorable hospital teaching experiences.

Yoga on the Stanford Hospital Psych Ward

As yoga becomes more well-known to the medical community as a supportive healing tool, more and more hospitals are willing to adopt yoga practices. I received a call to teach yoga to the psychiatric patients at Stanford Hospital a few years back, and I was excited and curious how I could be of service. When I arrived at the hospital for my first class, I realized that the staff was looking at the practice from a purely physical perspective, like another fitness class. As the weekly class continued, much of that changed. The logistics of the class were the most challenging part of teaching there. Yes, the patients had their moments of challenge, too, but for the most part, they remained very open and tried their best to follow along despite heavy medications.

It was here that I began to understand the power of brain chemistry. Asana, meditation, breathing, etc. can only do so much if the brain chemistry balance isn’t right.

I met a woman one week who seemed a bit out of place there. She was so competent and clear-headed that I mistook her for a staff member at first. She followed the breathing, body awareness, movement and relaxation practices with what seemed like ease. The following week, I saw her as soon as I entered the ward and went up to her to invite her to class, but I could tell something was wrong. Her breathing was labored and she couldn’t seem to think clearly enough to get a sentence out. She told me she was afraid to walk to the room for yoga because she was unsteady on her feet. I got her a nurse to escort her and she tried to follow along for the first few minutes of class, but left in tears. (One very nice thing about teaching in a supportive ward is that I knew that her nurse would follow her to be sure she was okay, which let me continue the class without worry.) The following week I returned and she came back to class, much clearer than before. She told me the week prior she had been detoxing from her anti-anxiety medications, which sent her into a panic attack. With her heart and mind racing, not to mention the physical discomfort of withdrawal, she was unable to use her mind to observe and calm her mind.

I believe whole-heartedly in the power of yoga to adjust for chronic conditions, but when the situation turns acute, I respectfully bow to the power of chemistry.

The Yoga Piece to the Chronic Pain Management Puzzle at Kaiser

Several years ago, I was contracted to teach yoga as part of a team of providers working with chronic pain patients at the Santa Clara Kaiser location. The program is run like an intervention, providing patients with tools to learn about their pain, how their brain processes pain, and how to stop the pain cycle. In this program, I am one tool in a multi-disciplined toolbox, which includes medical experts, behavior experts, movement experts and nutrition experts. In addition, the patients support each other in a community of similarly conditioned humans. The yoga practice that I offer them has been honed down quite a bit from what I originally expected them to be able to do. It was clear from the first week of working with these patients that the debilitation, deconditioning and sensory-motor amnesia that occurs with long-term pain (and medications) required a softer, subtler approach. As a teacher, I am constantly asking these patients to say yes when their habit has been to say no, a habit that comes from a deep part of their brains that tells them to stay away from pain. In order to ask them to breathe, track sensation and – possibly – move their bodies, I need to meet them where they are. Before I teach them, I have a “huddle”, a meeting with all the providers who share with me the patients’ mobility, medication and mental issues, as well as giving me their insight on the group as a whole, so that I have some insight about how to approach them most effectively.

Some of the patients have been very resistant to yoga. Some have overcome that and now embrace yoga, while some have not. What’s so impressive about this program is that you don’t have to love all aspects of it. If someone doesn’t like yoga, there are other methods of healing movement. What’s important is that the patients – we humans – stay open, and keep trying.

On a side note: for those of you who many be interested in working with chronic pain, I will be leading a yoga workshop next year, along with one of my colleagues from this Kaiser program. Stay tuned for more details as they are finalized.

Healing Breathing for the Good Samaritan Oncology Patients

This year I began a program at Good Samaritan Hospital in San Jose. I teach breathing practices to cancer patients in their hospital rooms. I was inspired to do this because of so many of my Yoga for Cancer Survivorship students telling me, “I love this practice, but I wish I had started sooner in my recovery.” I thought about what I could offer in those difficult moments, and the breath work was born.

I teach a sequence of breathing that meets the patient where he or she is – most likely in a state of stress, and then steps them through different techniques until the breath is smooth and calm. It takes 5-10 minutes and has fast results. Most patients reported feeling calmer, less nauseated, in less pain or more focused.

When I enter the rooms and ask if they’d like to practice Healing Breathing with me, I know I won’t get everyone to participate. It’s fine with me if they say no right then; I let them know I’ll be on the ward a little while if they change their minds. It’s also fine with me if they tell me the breathing had no affect on them; perhaps I’ve planted a seed for some pranayama practice later. And if they don’t have the concentration to receive it, I’ll limit the practice to the simplest form: watching the breath. That can be enough that day.

These situations and patients have taught me so much. Yoga is a great tool for living better, and it has its limitations, but there is always something we can do. Stay tuned for more installments of Living Better with Yoga...

Power of the Pause

Photo credit: Porsupah

When I sit with my dogs and they stare into my eyes, seeming to will me to understand their needs, I sometimes wonder what they think of us humans, and what they would tell us if they could give us advice. My guess is that they would ask, "Why are you so stressed? Humans are at the top of the food chain, with no natural predators, enough food and plenty of shelter. Why are you so worried all the time?"

Anxiety disorders are the most common mental illness in the U.S., according to the Anxiety and Depression Association of America (ADAA), affecting 18% of the adult population. The problem is that our minds have evolved to the point that they can identify threats that are there, have been there and might be there at some point, but our nervous system responds to all these threats as real, no matter which verbe tense they belong to: present, past or possible future.

I see this most often when my students who have been diagnosed with cancer finish their treatment and are deemed "in remission." Some of them tell me that they suddenly feel unsure, like cancer is stalking them and that any moment their bodies will betray them and cancer will begin to grow again. They walk around with a cloud hovering over them, darkening any moments of happiness with the thought, "how long?"

In reality, it is the mind that is doing the stalking, not cancer.

Catastrophic thoughts beget more catastrophic thoughts. Our minds react like a hamster on an exercise wheel: repeating variations of the same worrisome ideas over and over and never resolving any of the threats. We humans may be on the top of the food chain, but our minds have become our natural predators.

Whenever anyone asks me about mental health treatments, I make my personal opinion clear: I believe in normalizing brain chemistry. For some, that can be accompllished without the presence of medications, but for others, medication is required to bring the brain back into balance, or else the hamster will never even know about the wheel, let alone have the awareness to step off of it.

Once the brain chemistry is normalized, skillful awareness practices must begin for real change to happen.

In yoga philosophy, we learn about the three gunas, or fundamental operating principles. These gunas are called rajas, tamas and sattva. In very simplified terms, rajas is associated with promoting action, change, excitment and passion; tamas is associated with resistance, darkness and idifference; and sattva is associated with promoting harmony, intelligence and balance.

The problem is that we live in a culture that glorifies rajasic lifestyles: work hard, play hard, do more, be more are the messages that innundate our society. We even have the popular quote, "I'll rest when I'm dead." This lifestyle keeps the hamster on the wheel, rather than helping it change the pattern.

So is more rest the answer? For someone with anxiety, the nervous system is said to be in a state of hyperarousal (on the hamster wheel, looking for threats), so rest will not come easy. Finding that balancing practice - the sattvic lifestyle - is vital. Observing and balancing all the sensory inputs can be helpful: food, entertainment, sound, smells, etc., to help balance the nervous system. Yoga offers us many tools to find harmony in our body chemistry, but the simplest tool is the breath.

Photo credit: Driton Avdyli

As a student of my breath, I have found many different states of mind are reflected in my breathing, like the ripples on the surface of a lake. They give me clues to what is going on below. If I stir up the surface, I also stir up the lake. But if I can be patient and let the ripples settle, there is a better chance that what is below will settle. My primary tool to overcoming the predatory pattern of anxious thoughts is breath awareness. No matter how rapidly I breathe, there is always a pause at the top and bottom of my breath; it may be split-second, but it's there.

In my most fearful moments, I tell myself, "You're not dying... You're breathing... Feel that? There is a pause - find it... There... Find it again... There."
When I'm reaching for that next sweet thing to compensate for discomfort, I ask myself, "Is "Have you paused and checked in? Is this really what you want? Wait for the answer... there."
During the dark stories that my mind tells myself, I question, "Is this true? Wait... Does it still feel true after that pause?"

The pause offers me the ability to tap into a more balanced, sattvic state, where I can be less prey to my thoughts. That pause has power.

Lessons From the Intersection

"Would you be interested in teaching stress-relieving yoga to staff in a psychiatric ward?" When I received this question, I immediately said yes. How wonderful, I thought, to support people who are deep in the trenches, dealing with mental illness day after day.

And then the email came that told me the class would be a mix of staff and hand-picked patients.

And when I actually taught the first class, it was all patients with just one staff member, quietly typing away on her COW (computer on wheels).

A lotus flower blooms over several days, rising out of the
dirtiest water at dawn and sinking back down at sundown

I was warned to not touch the patients or let them touch me, and I was told that there may be some outburst during class, which is why a staff member would be with me the entire time. I grew a little apprehensive after hearing this. We had limited props and space; originally, we had discussed holding the classes in a secluded courtyard, but the logistics of that idea were too great a hurdle to overcome. I did find a room with a door that could be closed to shut out the hospital traffic and noise - to some degree. Once I did that, I found myself alone in the room with the patients. But by that time, I had begun to see them without any fear. Most of them were very spacey from the medications they were on; occasionally, they interrupted the class with questions, laughter, tears, stories, songs, jumping jacks, karate kicks and other behaviors that arise when our mental filters disappear. In between it all, we breathed, stretched, moved a little and relaxed (somewhat) quietly.

I learned three priceless lessons from teaching this class over the past year:

empathy,
humility and
non-attachment.

Don't I know you?

A funny thing happened as I returned week after week: I started to recognize people. Not in the way you might think, because I rarely saw the same person more than once or twice. I started recognizing the people I had seen only once. I thought, I think I know him, or, I've probably passed her on the street at some point, or, have I taught him yoga, or, I might be related to her.

"I never thought I'd find myself in a place like this," a patient told me once. "But I could feel my life slipping away and I was afraid it would only get worse." I knew that feeling. I had been there at times. A darkness that's insatiable, as the Indigo Girls phrased it in their song, "Closer to Fine." I had felt that darkness at times, the pull of the black hole that covers me in a silent blanket and simultaneously loudly chants over and over in my mind to just be still and let myself be replaced by all the pain, sorrow and suffering. Or the too-bright confusion of overstimulating days when anxiety and fear make leaving the house an unsurmountable challenge... Something always pulled me back from those days, though. Family, friends, humor, stubbornness. Yoga brought me even more tools, and as I balanced my emotions more and more, yoga helped me experience less and less of these dark days.

An expression kept forming in my mind as I left the ward: there but for the grace of god go I. For these patients, this treatment, this practice, this situation was what was pulling them back.

Deep Bows to the Teacher

Once, I attempted to help a woman who was really struggling; she told me she thought she was having a panic attack, and I could see that she was shaking, her breath was stuttering and she was wobbly on her feet. She was the only one who showed up to class that day, so we talked and walked a little as I attempted to get her to breathe a little deeper. After a few minutes, she left. When I saw her again, some weeks later, she was a different person - calm, steady on her feet and easily communicative. She told me she had been going through withdrawal from her anti-anxiety medication (ironically) the last time I saw her. She was so much better when I saw her the second time and I knew I had nothing to do with it, although she was very grateful that I had tried to help. I attribute yoga for changing so much about my life, but there are limits. No amount of breathing or standing poses or mantras would help her that day, just patience. Even yoga has its limits, and sometimes life is the guru. Namaste, Life.

Letting go

If I am honest about my thoughts when I first received the invitation to teach this class, I will say that my ego perked right up. You want me to teach this challenging class? Well, of course! Who else is "qualified", but me? (My ego sounds like a 10-year old, or a Steve Martin Saturday Night Live skit, depending on the situation.) But when my 10-year old ego stepped onto the ward and started to lead the class, we both quickly realized that she wasn't going to last. With regular interruptions from the staff (the original space was right out in the open) and no eye contact from the patients, my ego felt deprived of respect and attention and soon slunk away. There were classes where I felt like it was a waste of time for me to come, and that the staff only saw my class as a mild distraction for their patients. But then I remembered that it wasn't about me and if just one patient gained some insight about their breath or their tension, it was more than worth it. I challenged myself to walk the find line between caring for the patients and letting go of any results from my teaching. The patients came and went. Sometimes they stayed for the whole class... sometimes they didn't. Sometimes they followed my instructions... sometimes they made up their own. Sometimes they met me with disdain, fear or apathy... sometimes they smiled and relaxed. As my teacher, Tias Little, once said, "To live at the intersection of radical okay-ness and discernment, that is life's challenge."

Occasionally, we lose our way from that intersection, and we teeter dangerously off the edge. I'm so honored that I was able to share what I know about yoga, and that the patients were able to share what they know about living.

Announcements

• Please see my previous post about schedule changes coming in September.
• Sunday, September 15: Basics of Pranayama and Chanting; this 1-day workshop is at Mind-Body Zone in Fremont; see the Events page for more information.
• Share my blog with others, and invite them to sign up. This is one of the best ways I have to get news out to you all!
• Remember, if you can't make it to class, you can always pop in my DVD, Healing Yoga for Wellness, available online at www.amazon.com and www.eBay.com, and in stores at Breathe Los Gatos, Pacific Healing Arts, Cancer CAREpoint resource center and Kaiser Mind-Body-Wellness center.