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...

Yoga Anywhere - Even in Bed

"If I don't do some kind of practice for 10 minutes before I try to get up in the morning, I might not even make it out of bed. Because of my arthritis pain, the practice makes the difference between shuffling (and praying I don't fall) and walking to the bathroom."

My student told me this yesterday, as she was sharing how happy she is to be able to practice every day and improve her quality of life. Not all of us have this type of motivation for our daily practice. For some of us, the difficulty with maintaining a daily practice is finding time. Once we get up, the demands of family and business appear more important than our own self-care.

The following practice was inspired by an email from a mattress company, Casper, who claims to have the perfect combination of memory and latex foam. They wanted to know what yoga poses could be done in bed, for those of us - like my student above, who need to practice in bed, or those of us who just don't want to leave our comfy havens.

Yoga in bed is a way to support ourselves, before the day begins, so that we suffer less throughout the day. Here are my 10 favorite poses to do in bed. Use pillows and rolled up blankets for props; you'll probably want the covers off once you begin moving around.


1. Resting Butterfly - with and without support

2. Windshield Wipers - move side to side

3. Banana

4. Figure Four

5. Sphinx - 2 options

6. Sleeping Swan

7. Supported Twist

8. Open Sesame - 3 options

9. Toe / Ankle Stretch

10. Seated Pranayama / Meditation

The Questions

Teaching yoga to people with chronic pain or people dealing with a cancer diagnosis affords me a unique opportunity to witness our universal desire to reduce suffering. The most common question asked by all populations is:

"What can I do?"

I decided to take some time to share the different circumstances that give rise to this question. You may find yourself among these, or not. Keep it in mind the next time you encounter someone suffering.

I am just out of surgery to have my cancer removed and I am so scared. I don't want to hurt myself, but I want to get back into my body and feel normal again. What can I do?

I'm in pain. Everything seems to make it worse, but sitting still makes me crazy. What can I do?

In some form or another, I get asked these questions nearly every week. Our bodies were made to move, but what if moving hurts, and what if that sensation is tied to fear? I don't pretend to know what these people are going through. So, more often than not, I say nothing right way. Instead, I breathe. I pause to connect with all my senses and then notice what I feel. I then ask them to do the same. Sometimes, that's all that is needed. They already know what to do and how to do it, and I am only a reminder.

My brain will tell me that hopelessness has an effect on immune system, and that there is always some movement or breathing practice that we can do. The act of doing something - anything - to participate in our own well-being goes a long way towards balancing the situation. I only let my brain tell me this once my heart has checked in, though, because this person may not want to hear it.

My loved one is in a really dark place. His cancer has returned and the outlook isn't good. What can I do?

Knowing when to step in and when to hold space for someone we love is a challenge that everyone in any relationship faces. When caregivers come to me, I usually address the caregiver's issues, because that is who is in front of me. Occasionally, they will ask me about their loved one. Most of the time, I advise them to do as I do: pause, breathe and notice what your heart says. Another way to look at this is to discern the difference between empathy and sympathy. Here is a great 2 minute animation that illustrates Brene Brown's lecture on understanding the difference:

What if my doctors missed something? What if it comes back? What can I do?

My pain is so mild today that I want to tackle everything that I'm not normally up for, but I'm afraid that I'll trigger a pain flare. What can I do?

After checking in with my breath, and asking that person to check in with their breath, I then reflect on what is true in this moment. When I'm working with my own pain, it's the same process: breathe, notice, discern. There are so many stories floating around in our minds and our bodies, and not all of them are true. What's important is to keep checking in, keep noticing what's true in this moment, and then this one. The only thing we can do is live every day with awareness.

Next month, my daughter and I will be taking a service trip to Malawi. ("Voluntourism" has come under fire lately, because there have been many situations that leave the area no better or worse off after the group has left; here is an article about "voluntourism".) The group that is going includes several yoga teachers and students. At our last meeting, one of our leaders asked us to reflect on the Yamas and Niyamas - behaviors listed in the Yoga Sutras, and use them as guidelines as we enter someone else's world. One of the reasons I'm so interested in being involved in this trip is that the leaders took a very service-minded approach in organizing it. At our first meeting, they spoke about how we won't know exactly what we'll be doing to help the village until closer to our departure date, because we want them to tell us what they need, rather than us assuming we know. It struck me that this is the same approach that I use in my work. I don't know what the Malawi people we meet may need. I have some thoughts, for sure, but I'm going with an open heart and the practice of pausing and breathing to see what are the answers to the question what can I do?

Reflections on Teaching Yoga in a Chronic Pain Program

Artwork from:
http://criticalscience.com/chronic-pain-
psychosocial-interventions.html

This population is really limited... Some of them are addicted to prescription narcotics... Some of them have mental health challenges... They could be in a pain flare.

Do you think you can help?

The questions made me pause. Could I help? As I had been taught to do in yoga, I took a deep breath and checked in. I knew I wanted to help, but did I feel like I could be of service? The answer that came back was yes, so I laid out ideas and plans, and my interviewers glanced at each other and smiled at my enthusiasm. I was in a room filled with medical professionals who were redesigning their pain management program and wanted yoga, among other healing modalities, on the menu. I mentioned my own experiences with chronic pain, dating back to when I was a pre-teen, and how yoga had helped me. I was so full of idealism in that interview, and I was totally underprepared for what I was about to undertake. I’m grateful for that idealism, because I might have been scared off if not for it.

On my first day, there were 8-10 people in the room, and their pain was as diverse as them. Some could sit in chairs, and some could only sit for a few minutes; some preferred being on the ground, and some turned green at the thought of getting to the floor and back up again. We had chairs, a few padded mats, a few bolsters and some foam blocks. I had planned a yin yoga sequence, but realized quickly that this was not going to work. I started to worry,

what could I ask these people to do that wouldn’t hurt them?

I went through my yogic toolkit, and realized that all of these people could help themselves through pranayama. Good thing yoga isn’t solely about the body!

What they each had in common was that their nervous systems were stuck in a fight-or-flight mode because of their pain. As Dr. Palermo wrote in her post, pain triggers the stress response, and continual pain leaves the switch to the stress response fixed in the “on” position. My tool for the nervous system is always the breath. They might not all be able to get to the floor, or stand, or sit up, but they could all breathe. So, we started there.

Slowly, I eked out a sequence that supported most, if not all, of them. Together we found options for anyone who experienced pain or struggled to breathe during any part of the practice. I used Kelly McGonical’s book, Yoga for Chronic Pain Relief, as a guide, and I asked them to befriend their bodies and establish a relationship that wasn’t based on fear and pain. We joke about being less of a dictator and more of a coach of our bodies. Over and over, we emphasized – together – that the shape of the pose wasn’t the priority; the attitude, breathing, and observing were what really mattered.

When they weren’t doing yoga with me, they were practicing qi gong, walking or chair dancing, learning about their brains, their emotions, their diet and their habits. The team consists of psychologists, physicians, a pharmacist, a nurse, a Traditional Chinese Medical practitioner, a physical therapist, a Feldenkrais teacher and myself… a very well-rounded and holistic combination of providers.

Over the last year I’ve notices some patterns arise in the hundreds of patients that have come through the program. In the first few weeks, the patients are very fixated on their bodies and their sensations. The questions they ask me are indicative of this perspective: Am I doing this right? Is there a yoga pose for this body part / pain situation?

But at some point, the patients realize that 

it’s not about their body or their pain, but their relationship to both. 

For most people, that realization happens during the third week of the program, but some figure it out right away, while others report back months later that they now understand.

Pain and stress are on one side of a coin, with relaxation and service on the other, and emotions running along the edge of it. The tools that we offer them are mindfulness, compassion, presence, perspective and community; we use these tools to flip that coin from one side to the other. Some of the tools are packaged as yoga, and some are not, but the foundation is all the same.

Announcements:

• Sunday, June 23rd: Lorien will be offering restorative yoga demonstrations as part of Kaiser's Seeds of Hope Cancer Survivor Day. See Events page for info.

Lorien's Healing Yoga for Wellness DVD is out! How to get your very own copy:

• Order from Amazon for $27.95, plus tax and shipping 
• Stop in to Breathe Los Gatos and get it today for $30, plus tax
• Buy it directly from Lorien for $27.19 (tax included, no shipping, you must pick it up in class)
• Coming soon to eBay, Kaiser Santa Clara, local yoga studios and many more...

Fascia, Our Body’s Infrastructure

As a yoga teacher, I get asked many questions about pain. A common one is:

Why does an injury in one part of my body present pain in an entirely different part?

Logic would dictate that the area where you feel pain is the site of the injury or issue, but that doesn't always occur. 

If you’ve never experienced sensation that originates far from where it presents, then try this: open your mouth and place your right hand on your lower jaw bone; slide your jaw into your hand, but resist against it with your hand… and notice where you feel the sensation. Yes, there’s some feeling around the connection of your hand and jaw, but mostly you’ll feel this along the left side – the side where your hand isn’t. Why is that?

To answer that, think of Spider-Man’s costume, a tight second skin with a web design all over it. When he moves, the lines of the webs shift and move with him. Now, picture that web design under your skin, not on top of it. Each line of the webs are connected to each other, so when one spot tightens, tangles or is knotted (as in scar tissue), the rest of the web is affected - and the web is extremely sensitive. 

That web is called fascia, which is a type of connective tissue. These tissues range from light, easily affected “fuzz” to ropey, dense fibers. The following video shows some of the fascia in the forearm.

As the video shows, this web of fascia provides a container for nerves, blood and lymph vessels. When the fascial web contracts, we experience constriction on the nerves, in the blood vessels and the lymphatic system. Too much of this contraction may affect our systems in the following way:

• pain response and coordination
• circulation
• immune system

How do we loosen, untangle or release the adhesions in the fascial body? Massage is one method. Passive resistance through gentle yoga poses can also help, as well as tools that reduce overall stress, such as mindfulness and breathing exercises.

The next time you feel a pain response, ask yourself,

Where does this really come from?

You may be surprised by the answer, or you may not if your "Spidey-sense" is alert!

Announcements:

• Hear Lorien's interview on the Transformational Power of Yoga Telesummit.
• Next Kaiser Restorative Yoga for Cancer Survivorship 6-week series begins June 12 (ends July 24, no class July 3). Call 408-366-4284 to register.
• Tuesday, June 4th: Lorien will be offering gentle yoga demonstrations as part of Stanford's Cancer Survivor Celebration week. See Events page for info.
• Sunday, June 23rd: Lorien will be offering restorative yoga demonstrations as part of Kaiser's Seeds of Hope Cancer Survivor Day. See Events page for info.
• Stay tuned: Lorien's Healing Yoga for Wellness DVD will be out in June...

Stress, Health & Yoga, Part 2

Almost exactly three years ago, I wrote a post about stress. I'm revisiting this topic with more information this time around. On a daily basis, I work with people who are weeding cancer from their bodies, or are learning to manage chronic pain, and the common topic that I always talk about is

stress.

As I mentioned in the 2010 post, stress isn't all that bad. We need stress to grow, but the stress-relaxation responses that are wired into the most ancient parts of our brains were meant to be in balance, like the yin-yang symbol. Once the cycle of stress is complete, we need to

relax,

in order to regain balance. Look closely at these the stress response cycle:

First, our brain perceives a threat, either through our senses (sight, sound, smell, touch, taste) or internally from the brain itself (thought, dream, vision).

Then, our fight or flight response is activated, releasing adrenaline, noradrenaline and cortisol hormones in order to:

• Increase heart rate and breathing for quicker oxygenation of the tissues in support of physical activity
• Release Fats and Glucose into the system to be used for quick energy consumption
• Divert blood flow from non-essential areas of the body (including reproduction, digestion and elimination organs) to muscles and the brain
• Increase perspiration to support physical activity
• Suppress immune system response

All of this is for our own survival, or so our brains and bodies believe.

Finally, when the threat is removed, another chemical called acetylcholine is released, which is a modulator for the nervous system, slowing heart rate and reducing other fight-flight reactions. Adrenaline, noradrenaline and cortisol are used during the physical release, which also expends physical tension, so the system returns to normal.

That's the way it's supposed to work, but the response gets hijacked sometimes, and we end up in

chronic stress,

a place where balance and normalcy don't exist, no matter how hard our brain, nervous system and body tries.

Over time, chronic stress begins to erode our own ability to heal. When cortisol, for example, isn't able to regulate the level of inflammation in the body, we become more susceptible to

Balance Restored: Lorien om-ing on top of a mountain
in Sedona, a very relaxing moment after a long hike

disease. 

If our pain response is triggered, that feeds the stress response, and the chronic stress situation may not be able to sort circuit the pain response, so the two keep feeding each other until we are in

chronic pain.

Which is why I am always talking about stress management!

Whether you are tending to a small patch of cancer or pain weeds in your personal garden, or you are overhauling the entire "back 40", it's important to use the right tools. The correct application or yoga, breathing, chanting, meditation, acupuncture, massage, energy work, diet, mental, emotional and social support can make a big difference in your internal environment and ability to find the necessary balance between stress and relaxation.

Announcements

Please see the Events page for more information about these upcoming special programs:

• Sunday, March 31 (Easter): OM for Peace
• Saturday, April 7 - Sunday April 8: Yin Yoga 14-Hour Immersion
• Saturday, April 7 - Sunday April 8 AND Saturday, April 13 - Sunday April 14: Yin Yoga Teacher Training
• Sunday, April 28: Yin Yoga 1-Day Workshop