5 Ways to Make Hospitals Better

I’m happy to present this guest post by Ben Gerber, the author of Minimalist Muscle, a blog about muscle development and minimalism (two important parts of a yoga practice). Ben is a minimalist, lifter, blogger, and the husband of one of my best friends. He is now also a cancer survivor. You can learn more about his life and ideas on his blog.

Five Ways to Make Patients Healthier and Happier at the Hospital

Until recently, I'd been fortunate enough to have never stayed in a hospital overnight as a patient. My lucky streak ended this month with a week-long stay. While I was very happy with the treatment I received in this specific hospital, I came away from the experience with a lot of thoughts on how hospital stays could be a much healthier and happier experience. Here are the first five that came to mind.

1. Increase the number of healthy food options available. After not eating for nearly a week, I was excited to receive the hospital menu for my first meal. I had no delusions that hospital food was going to be fine cuisine, but I was shocked at the amount of junk food on the menu. Suffice it to say, the healthiest thing on the menu that day was apple sauce and cream of wheat (both of which I ordered). How hard would it be to add a banana or apple to the menu?
2. Reduce the sodium content of all foods. I like salty food as much as the next guy (I have a weakness for Kettle Chips), but much of what I was served was so salty that it was almost inedible. Any dish that sounded potentially healthy ended up having what I suspect to be an entire day's worth of sodium.
3. Disclose the nutritional value of all foods. It amazes me that fast food and chain restaurants are required to state the nutritional content of their food items, but hospitals are not. After all, you don't go to McDonald's expecting to be healthier after you leave, but you certainly expect hospitals to do everything they can to make you healthier during your stay. If the point of nutritional disclosure regulation is to avoid misleading consumers, the better target is hospitals.
4. Have a designated walking loop. According to my doctor, getting on my feet and walking was one of the best things I could do to recover from my surgery. The problem was that there wasn't any safe place to walk, particularly considering my frail state. The hospital hallways were always bustling, and I was almost plowed over several times.
5. Reduce the amount of junk in hospital rooms. Hospital rooms are tiny and difficult to navigate. I recognize that space is a matter of economics, but the existing area could be utilized much more efficiently. For example, I did not need the massive bedside table. Nor did I need the large rolling food table during the majority of my stay, since I couldn't eat (this coincided with the time in which it was most painful to move around, making the food table particularly difficult to navigate around).

Anger

I’ve been feeling angry with my body lately. Terrible allergies, restless unfulfilling sleep, and now my wrist hurts during practice. The wrist is so essential to yoga and I automatically think of the worst possible scenarios. Ugh!

“Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else; you are the one who gets burned.” 

~Buddha

(And the burn is even worse if the person you are angry at is yourself!)

In theory, letting go of anger is the thing to do…but it is HARD in practice!

Guest Blogger, Josh Beisler: The Struggle to Practice

I hope you enjoy this piece as much as I did… written by friend and fellow Philly Ashtanga practictioner, Josh Beisler.

The Struggle to Practice

Josh Beisler

The Ashtanga practice is deliberately designed to remain perpetually challenging. The way that you respond to these obstacles will teach you a lot about yourself. It will mold you in ways that you never expected and which are often life-changing.

All of this is great. But, more mundanely, sometimes it’s really hard to get out of bed in the morning and go to practice. Or to miss hanging out with good friends so you can get to bed early enough to wake up at 5:30 in the morning. Or in general to be ever-vigilant about what you eat and what you do over the course of the day because of how it affects your practice.

It's difficult and unpleasant to practice Ashtanga casually because the practice is so physically demanding that anything less than a three times per week daily practice gets painful. You have to stick with it to keep your strength up and this can create stress when your resolve wavers because it can very quickly feel (whether it's true or not) like you're on the verge of losing your practice altogether, or at least risk losing the ability to do that new cherished asana that you finally twisted into last week after months or years of trying.

I felt my left hamstring pop in kurmasana a couple of weeks ago and slowly things have started to change. It's not a particularly bad injury but obviously I have had to take it easy and not push anything, especially forward folds, which is potentially dispiriting and tough on that ever-fragile ego that we're all trying to transcend. Right around the same time a wave of awesome concerts rolled through town and I missed a couple more classes. We've been having heat issues at one of the studios where I practice and it's made it harder to stay warm and so I've felt the injury more distinctly. All of these events have come together at more or less the same time and so recently I have skipped classes, slept in late, or showed up late and only practiced half primary. Which is very unusual for me.

The question is where to go next. Do I let go of my practice a bit by going to class more infrequently and by cutting my practices short so I can stay up late and be more social and do more of the things I've been missing, or do I redouble my resolve to maintain the status quo? I'm not sure but right now my gut is saying back off.

~Josh Beisler

The doctor of the future

“The doctor of the future will give no medicine, but will interest his patients in the care of the human body, in diet, and in the cause and prevention of disease.”

~Thomas Edison

Triple negative

This was an inspiring TODAY show segment (~5 min) about Jennifer Griffin, a 40 year-old reporter and mother of three who was diagnosed with Stage 3 “triple negative" breast cancer 5 months ago.

This designation of triple negative is relatively new and means the tumor is negative for both estrogen and progesterone receptors (ER/PR) and the HER2 protein. It is an aggressive form of breast cancer, occurs in about 15% of breast cancers, and is not susceptible to hormonal treatments (but is susceptible to chemotherapy).

Triple negative breast cancers tend to occur in younger women. In Jennifer’s case, it was 8cm - about the size of a lemon - and had been masked by pregnancy and breast-feeding.
 
Jennifer emphasizes the important of exercise throughout her treatment. “You need to exercise every day.” She looks amazing, and as they say in the segment, “she’s in the best shape of her life.”

When she shaved her head before losing her hair to chemo, Jennifer said, “When I first looked at myself in the mirror, I felt very strong… like I was a warrior.”

I also liked how she said she never goes out without her “body armor” – which includes her wig and her lipstick – to make sure she doesn’t feel like a sick person.

Injuries and women

Lately, I’ve been practicing next to a significant number of injured women… and seemingly uninjured men. This gender discrepancy could be for many obvious reasons -- maybe there are simply more women practicing yoga (making the odds higher), maybe the injured women have been practicing for a longer time-period (thus more prone to overuse injuries), maybe women are naturally more flexible (and thus push themselves too far), or perhaps some men are injured but are masking their injuries.

After some research, I found that female rowers are injured more frequently than their male counterparts. This study looked at 398 rowers (42% female, 58% male) competing in the Junior World Rowing Championships in 2007, finding overall 73.8% reported overuse injuries, and 26.2% reported injury from a single traumatic event. Females had more injuries than males (110.2 vs 90.5 injuries per 100 rowers). (I'm still wondering if there was a gender difference in traumatic versus overuse injuries).

This is leaving me wondering -- is there something that makes women more prone to injuries from intense physical practices such as Ashtanga or rowing?

I’ve been thinking about the hormone progesterone. During pregnancy, the high levels of progesterone help the woman’s body gain flexibility in preparation for labor and delivery. Progesterone levels also rise in the last two weeks of the menstrual cycle (the “luteal” phase). Could this make women more “open” during this part of the menstrual cycle, and thus more susceptible to injury? (It could be coincidence, but this was the time when I pulled my serratus anterior back in December).

I was glad to see that this question has begun to be studied. Though a very small sample size (n=8), this study showed no difference in flexibility over the menstrual cycle. They divided the cycle phases into menstrual (estradiol and progesterone levels low), ovulatory (estradiol high and progesterone low), and luteal (progesterone elevated), and measured maximal isometric voluntary contraction, muscle activation level, and tendon properties (using ultrasound). They found no significant changes during the three phases.

I would love to see a prospective study of hundreds of Ashtanga practitioners (or a similar daily physical practice), that tracks type of injury along with menstrual cycle phase/progesterone level. In the meantime, I’ll continue with self-observation on this question.

Guest blogger, Caitlin White: Different perspectives on injury

Different perspectives on injury

Caitlin White

Since deciding to enter the medical profession, I have found myself analyzing the personal interactions I have with health care providers. I keep a running list in my head of ways in which I would like to emulate them, or ways in which they leave me with a sour taste in my mouth. I tend to dwell on the latter, asking myself: "What is it about that interaction that left me feeling so empty? So unheard?"

I recently injured myself while coughing - of all things - and after several frustrating weeks of practicing through the pain, I re-injured my muscle worse than it had originally been. After about a week of giving up practice to allow it to heal, I found myself back at the studio and impatient for its resolution. It didn’t seem to be getting better so I made an appointment with a sports medicine MD and an acupuncturist/massage therapist, while also soliciting guidance from my Ashtanga teacher (the health care provider I see most regularly!!). Each one left me with a completely different impression.

1. The MD: My visit was less than 15 minutes, and she examined me for less than two of those. Her diagnosis? 

"It is probably a just pulled muscle. I am not going to have you go through range of motion or strength testing because these chest wall injuries are difficult to tease apart anyway."

She told me to take off completely (not even stretching) for 6-8 weeks and take nine ibuprofen a day (3 tabs three times daily).

2. The Acupuncturist: My visit lasted an hour. Of that, he spent about 20 minutes examining my side, rib alignment, and range of motion. His conclusion?

"I think you will respond better to acupuncture than massage. I suspect you pulled an intercostal muscle because your pain tracks along the rib, however I am also concerned that you injured your rib because there is a painful ridge in it near your spine, and it is tender from its origin to insertion. I would like to you see me at least three times over the next three weeks, and I believe that it will improve greatly in that time."

3. My Ashtanga teacher: Our discussion lasted about 10-15 minutes after I finished my practice. His advice?

1) Continue coming to practice daily.

2) "Listen to your body- it is your instrument for exploration; observe and respect it. Do not force it to do something that is painful, otherwise it will not heal."

3) "You likely pulled a muscle. Try not to get too frustrated, and remember that this is not permanent."

4) "Sometimes an injury like this is the body's way of slowing us down. Perhaps you were asking too much of it in the first place, moving too fast. Now is the time to take it slow and reconnect with your body."

Our interactions with people can be so different while trying to accomplish the same goal. I am disappointed that my appointment with the MD was time wasted, I am optimistic that the acupuncturist will help my side heal faster, and I am inspired by my teacher to focus less on the physical poses (asanas), and more on being present in my daily practice.

Healing process and practice

I’ve been observing myself going through this healing process. At first I felt frustrated, irritable, unmotivated, etc. It’s been over a week and my rib is still hurting, stopping me from practicing normally. But over the past few days I’ve been feeling more content... and actually, I’m kind of starting to enjoy my time off.

Or maybe this new perspective is from “juicing.” I’m on my third day of JUST JUICE (pomegranate, blueberry, carrot, greens & spirulina... anything I can find that’s colorful and antioxidant-filled). I’m getting plenty of calories, but giving my GI tract a much needed rest. And I’m feeling great - energized, steady, attentive. I’d keep it up for longer if it weren’t for all the holiday food to munch on. But maybe I’ll start doing this more regularly, maybe on moon days?

Practice today was slow and tentative, I’m afraid to do anything that might hurt my body (although I did backbends for the first time in a week - they felt good). David said to be “narrow” in what I eat over the holidays, and to make sure to give my body some time without food so it can direct energy towards healing.

Breathing

I bought Iyengar’s book “Light on Pranayama” and am taking advantage of my extra time to study pranayama -- breath control. This is the 4th limb of Ashtanga yoga.

And under my friend Xochitl’s influence, I am doing a three-day juice cleanse. Her family used to do this periodically growing up. She’s read a lot about it and thinks it might help heal my injured muscle.

So, I bought jugs of anti-oxidant filled juice (need to get a juicer!) and am starting to flood my body with it.

Inspired follies

"What is life but a series of inspired follies? The difficulty is to find them to do. Never lose a chance: it doesn't come every day."

~George Bernard Shaw

Last week I worked hard on two grant drafts -- one on the telomere study and one on the yoga clinical trial. I hope something will come out of them because so far it’s just been a lot of ideas, outlines, and drafts. 

I need to work on enjoying the process. 

And the same goes for yoga: it’s about the process. Fellow ashtangis have been surprised when I tell them this is my first injury that has really put me out of practice. It has happened to them, it’s part of the practice, and it’s a necessary lesson… to be humbled, to listen to my body, to protect it. 

Nonacquisitiveness

Yoga Sutra II:30 --

Non-violence, truth, abstention from stealing, continence, and absence of greed for possessions beyond one’s need are the five pillars of yama. 

“In the effort of accumulating material possessions and wealth, in protecting the acquired, in their decline, in the latent impressions they leave on the mind, and in the unavoidable harm caused to other living beings – in all these there lies unhappiness. Thus the yogi practices nonacquisitiveness.” ~Vyasa commentary

“A mind with desires does not ignite and glow, nor does it generate light and warmth when touched with the fire of knowledge.” ~Iyengar

So… I’m working on nonacquisitiveness towards my practice. Today I spent most of my time inverted in shoulderstand and headstand, then sat in bada konasana against the wall and breathed… for a long, long time.

Pain empathy

This pain in my rib hurts with every breath I take. It is constantly on my mind, it makes me grumpy, it takes me out of my normal routine, and it occupies my mind making it difficult to be creative or thoughtful or compassionate. One positive outcome: it is helping me understand the experience of pain.

In Iyengar’s book Light on Yoga, he writes about the niyamas. Niyamas are the 2^nd limb of Ashtanga and make up the individual disciplines (Yamas, the 1^st limb, are universal ethical disciplines). One of niyamas is Santosa, meaning contentment. Iyengar says, “Santosa or contentment has to be cultivated. A mind that is not content cannot be cultivated.” And a mind distracted by pain cannot be content!

After some desperate googling I came across Epsom salts. A quick PubMed search came up with ZERO on Epsom salts for muscle pain, but I found a few answers on the Internet (though not sure of the science behind them). Epsom salts are made up of magnesium sulfate, which readily absorb through your skin helping bind “toxins” and reduce inflammation. I ran out to RiteAid and bought two big jugs, put 2 cups into hot water, and soaked for about 20 minutes. 

Ahimsa and my pulled muscle

Ahimsa is the first of the yamas (the 1st limb of Ashtanga’s 8 limbs). Ahimsa means non-violence. Non-violence towards other beings, and non-violence towards ourselves.

For me, ahimsa often means doing less. In my practice, it means taking some days off from the physical practice and taking some days for less asana and more breathing. In my life outside of practice, it means saying no to things and protecting my time. It applies to my internal thoughts, my actions, how I eat, the footprint I leave on the earth, etc.

And I can no longer ignore that it applies to my pulled serratus (maybe intercostal?) muscle. I think I overdid my jump-backs and now my right ribcage is terribly painful with almost every movement. Practicing through the pain has not been helping, so I have to rest.

Ashtanga in Rwanda - Project Air

Check out this video about a medical NGO which started using yoga to help rape victims in Rwanda.

And this interview with Deirdre Summerbell who started it all.

Deirdre said yoga in Rwanda is a "conceptual void" so the women had no anticipatory skepticism. Deirdre started by doing some demonstrations and the women "were horrified!" But they threw themselves into it and loved it.

They teach Ashtanga yoga, taking the women through the fixed routine. It helps the women heal and reconnect with their bodies, as well as make them strong. She said "Yoga is slow medicine, but it is medicinal in character."

It's gone so well in Rwanda that they're now seeking funding to bring it to other places... (how about Penn!)

Project Air: http://www.project-air.org/

Yoga at the cancer center?

I had an idea today. Instead of providing the yoga classes at a studio in Philadelphia, why don’t we start classes in the hospital at the cancer center? The building is new, huge, bright, and beautiful. 

I would think (hope) that Penn would be interested in offering services such as yoga to patients (not to mention medical staff), especially since major cancer centers are already doing this. Having a small room there for integrative medicine would not only be much more convenient for patients, but also a great service for the cancer center to be able to offer.

Un-numbed at family medicine conference

After studying to numbness for the past three weeks, it was really wonderful being at the family medicine conference in New York this past weekend. It reaffirmed that family medicine is what I want to do with my life. It’s about relationships. It’s about treating the whole person. It’s about inspiring, motivating, and encouraging. And it’s about service.

I just wish family medicine doctors were more visible. I wish they published more influential research. I wish they made themselves indispensible. One of the speakers said, “Family Medicine is the best kept secret.” But why are we keeping ourselves a secret?

Some favorites from the workshops:

• "Every time someone asks you to do something, ask yourself if you have room for it and what you’ll take off your plate in order to do it. Say ‘no’ to a bigger ‘yes.’”
• "How you spend the first hour of each day acts as a rudder to your ship."
• Only 30% of doctors advise patients about exercise and nutrition.
• “We should be giving more “thought” and less “care” (treatment). Exercise should be prescribed as a drug, as medicine.”
• “If you have a body, you are an athlete.”
• “Doctors are trained to fight disease, not prescribe health.”
• The Magic 6 of Healthy Aging: Don’t smoke. Take to exercise daily. Maintain your weight. Eat close to the earth and sea. Give care and belong. Have moderate alcohol intake (1-2 drinks/day).
• When running (or any exercise), always focus on learning something to keep from getting bored – have good postural alignment, lean forward (using gravity to move forward, like you’re going down a ski slope), lift heals instead of pushing off, relax your body while running, practice belly breathing (relax the diaphragm, exhale belly-button to your back).

Yoga for "chemo brain"

I'm back in DC practicing this week and learned that one of my yoga teachers had B-cell lymphoma and has been going through chemo. He looks great I would have had no idea if he hadn't told me. He has continued his practice through all of his treatments despite his body feeling like "sludge." He just started moving more slowly and holding postures longer. He said he had "chemo brain" and some neurologic problems from the medication, but attributes how well he is doing now to his yoga practice... I bet he's right.

On top of all this, he doesn't have health insurance and laughed at the thought of ever being able to afford it.