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.

Hip openers and partner yoga

One thing I got out of the yoga anatomy workshop with David Keil last weekend was hip-opening. I’m trying to do this sequence every night (for each one, hold center then right then left - each for a few minutes). Thank you, Caitlin, for posing!

We also talked about handstands at the workshop and I have a lot to work on. I need to have much more engagement of my psoas muscles (psoas engagement = uddiyana bandha) and serratus anterior in order to lift up.

Caitlin and I did our first “partner yoga” session last night! We practiced jumping up into handstands, backbends, and then this chair inversion that releases the traps and makes my neck feel about two inches longer:

Week 1

My mentor is giving me the perfect combination of freedom to be creative with my research questions, structure of specific tasks and goals, encouragement of idealism, and reminders of practicality. This week has been busy and engaging and I love how my life and my “work” are beginning to blur.

Check out this article about the status of research on the health benefits of yoga about the following:

• The article is about the growing body of research on yoga and how several major cancer centers are now offering yoga to patients. “A word of caution, though,” says the article, “the studies that have been done so far have yielded soft findings, with little hard data to back up the conclusions. That said, there is no denying that yoga is becoming a presence even in the ivory towers of academic medicine.”
• The article explains that most of the research has proven the efficacy of yoga for emotional and social well-being such as improving stress, anxiety, sleep, quality of life, mood disturbance, and chronic pain. Despite this evidence, there is still little in the way of physician guidelines/recommendations to prescribe yoga.
• Our current plan for the clinical trial is to look at biomarkers before and after an 8-week yoga program. I really want to look at telomerase activity but it seems to require a complicated assay process which I don’t think we’re capable of just yet.
• The problem with the research on yoga thus far is that the interventions studied all fall under the umbrella of “yoga,” yet they are widely variable. Some are gentle restorative yoga classes, some are Iyengar classes focusing on alignment, some are simply vaguely described as “hatha” yoga. But this is important! The interventions have to be consistent and reproducible. This is why I like the idea of studying Ashtanga yoga as intervention because it is the same no matter where you are or who is teaching. I also like the idea of looking at Ashtanga because in addition to the yogic mind-body awareness practice, it is also a vigorous physical exercise.
• Another question I’m thinking about is whether it is possible to study yoga with our gold-standard randomized controlled trial model. Randomization doesn’t really work here. In the study and in real life, people are going to have to want to do yoga and want to make the lifestyle change. Perhaps a better model is a non-randomized controlled trial, where we compare a more self-selecting yoga group and control group. This would introduce confounders and open us up to more criticism, but I also think it’s more realistic for this study and for real life.
• As the article points out, in order for yoga to become more credible among physicians, there need to be more studies on its effectiveness. These studies need funding. And they need to be published in major medical journals so that physicians begin to see yoga less as an “alternative” medicine and more as a tool to improve health and well-being. As one of the doctor’s in the article said, “Research on yoga for therapeutic benefits really is in its infancy, and to look at how many studies are ongoing and being published the temptation is to think that’s a reflection of how good yoga is, and it may not be. We certainly need more research.”

The whole point

Noah (one of Philly's new teachers) talked about the whole point of the ashtanga yoga practice: to quiet the mind.

He explained that our mind is like a lake, our never-ending thoughts are ripples in the lake, and we see and interpret the world through these ripples. The purpose of the ashtanga practice is to clear the ripples so we can see the true reflection.

He talked about the three ways this occurs through the ashtanga practice:

1. Breathing. Slow, conscious breathing through the nose.

2. Gaze (dristi). Our mind follows our eyes so we must control our gaze. Gaze should be at the nose (most of the time), or third eye, toes, thumbs. It should not wandering around the room or looking in the mirror.

3. Physical postures (asana). The word “asana” is translated to “chair.” Asana is the chair from which we practice breath and gaze in order to quiet the mind.

I like this explanation because it takes the emphasis away from the physical yoga postures, and focuses it on the larger purpose of the practice which is to quiet the mind, and the physical postures are just a tool to get there.

Creating habits

While at the CDC, I went to a workshop on behavior change and I’ve been thinking about this for the yoga study. Are we really going to be able to get a group of busy women to start up a yoga practice? It will require creating new habits and new patterns of behavior, and I am wondering if and how that can be taught.

Below are a few of the social science theories discussed that I found useful for thinking about this:

The 11 variables that influence behavior

1. Intention to perform a specific behavior
2. Environmental factors
3. Necessary skills to perform the behavior
4. Beliefs about the behavior
5. Opinions about consequences or outcomes from the behavior
6. Peer pressure
7. Self-standards -- how someone wants to perceive themselves
8. Emotional reactions towards the behavior
9. Perceived self-efficacy -- self-confidence
10. Cultural believes
11. Contextual factors -- including the “social capital” present in communities such as strong churches, a network of moms, etc… any resources in the community that can be mobilized

Stages of Change

When making behavior change, people go through the following pattern of change:

Pre-contemplation --> Contemplation --> Preparation --> Action --> Maintenance

The “Chain of Causation” in public health

Large scale factors (historical, cultural, political, economic, etc) --> Behavioral Predictors --> Risk behaviors --> Proximate Determinants (pathogens, carcinogens, toxins, etc) --> Disease outcomes.

Medical school focuses us on the last two parts of that chain.

One thing missing from the 11 variables list is the power of good leadership. 

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).

A different kind of poverty

“The greatest disease in the West today is not TB or leprosy; it is being unwanted, unloved, and uncared for. We can cure physical diseases with medicine, but the only cure for loneliness, despair, and hopelessness is love. There are many in the world who are dying for a piece of bread but there are many more dying for a little love. The poverty in the West is a different kind of poverty — it is not only a poverty of loneliness but also of spirituality. There’s a hunger for love, as there is a hunger for God.”  

~Mother Teresa