Late-Onset Scoliosis is Common in Older Adults

by Nina

Reclining Nude, back by Henri Matisse

A recent New Times article Scoliosis Can Hit Well Past Adolescence by Jane Brody confirmed something I have been observing in the yoga community: late-onset scoliosis is quite common in older people. I developed the problem myself in my fifties, so I’m quite aware of the condition, and I’ve noticed a large number of other older yoga practitioners with the same problem. Here’s what Jane Brody said about this:

"Although scoliosis is generally thought of as a problem of adolescents, who often require bracing or surgery to correct the curvature, the condition is actually far more prevalent in older adults. In a study by orthopedists at Maimonides Medical Center in Brooklyn of 75 healthy volunteers older than age 60, fully 68 percent had spinal deformities that met the definition of scoliosis: a curvature deviating from the vertical by more than 10 degrees."

Even a mild version of scoliosis can result in chronic pain of different types. While your pain could be in your back, it might also be in your hip (because scoliosis can make your hips uneven) or even your leg and/or knee (because scoliosis can make one leg “virtually” shorter than the because that hip is higher).

Baxter, who teachers Yoga for Back Care, has already written about scoliosis (see Friday Q&A: Scoliosis). But I decided to write about it today because I think it’s important for us all—students and teachers alike—to realize what a common problem this is. And if you (or a student of yours) are having mysterious back pain, hip pain, or leg pain, it’s worth being checked out to see if this is causing the problem. Some people just don’t think of it! I personally know of two cases of women with pain who didn’t realize they had scoliosis. In one case, the yoga student’s teacher casually mentioned, well, of course, you have scoliosis, because it was visible to his sharp eyes. She had no idea! And in another case, it was I myself who noticed it while I was assisting a fellow student doing a backbend. I just asked her, “Do you have scoliosis?” She was surprised I had asked, but we when talked afterward, it turned out she was having quite a lot of pain, including in her hip. So I encouraged her to get checked out by a health professional, and sure enough, she did have scoliosis.

Getting checked out is not necessarily a big deal. A health professional can do a visual test that is quite simple (he or she will watch your spine as you come bend into a forward bend), although in same cases, if your scoliosis is very mild, you may need an X-ray to detect it. But it is worth knowing the source of your physical problems because, yes, yoga can help. Even Jane Brody had a yoga pose recommended to help her:

Determined to minimize further shrinkage and to avoid pain and nerve damage, I consulted a physiatrist who, after reviewing X-rays of my misshapen spine, said the muscles on my right side, where the spinal protrusion is, were overdeveloped relative to the left. He prescribed a yoga exercise — a side plank — to strengthen the muscles on the left and exert enough of a tug on my spine to keep it from protruding farther to the right. He suggested that the exercise might even straighten the curve somewhat.

That pose sounds like Vasisthasana (aka Side Plank pose) to me! And there are whole lot of other yoga poses you can do to strengthen your back and balance your curve. So if you’ve been diagnosed with this condition, seek out a yoga for back care teacher who understands scoliosis, take a Yoga for Scoliosis workshop, or check out Elise Browning Miller’s web site (she’s a long-time yoga teacher who uses yoga to manage her own scoliosis) for info on her books and DVD and other resources.

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Dispatch from London

I'm in London for 48 hours, working with a group of international experts to define telehealth, care management, and big data opportunities for the UK, Europe, Australia, and US.

During the afternoon break I had a remarkable experience.

Unity Farm apples (40+ heirloom varietals) produce a crisp, well-balanced fermented cider that includes sweet, tart, aromatic, and astringent components.

Kathy, my wife, searched the web for the best cider pub in London and asked me to stop by so I could compare Unity Farm cider making with traditional farmhouse ciders from the UK.

The Cider Tap, a remarkable place, is, by good karma, 100 yards from my hotel in Euston Square.

Professor Justin Beilby, Executive Dean of the Faculty of Health Sciences at the University of Adelaide, and I  tasted six still and four sparking ciders, fresh from the cask.

Still:
1.  Severn Perry (made from crushed pears) - 6.3% alcohol, aromatic, dry, with a subtle pear flavor.

2.  Sandford Bumbleberry - 4% alcohol, sweet with a mixture of herbs and berries.    It reminded me of a traditional spiced mead - a metheglin.

3.  Bleangawney - 6% alcohol, dry, with an almost lime-like flavor.

4.   Upper House Farm Oak Barrel aged - 6.5% alcohol, medium/sweet with a clean, crisp flavor.   This was my favorite still cider and a style that I've tried to replicate at Unity Farm.

5.   Severn Farmhouse - 6.2% alcohol, medium, a classic full bodied english farmhouse cider

6.  Burrow Hill Alf n Alf - 6.0% alcohol  with a very complex taste that leads me to think it is half dry cider/half medium cider.


Sparkling:
1. Aspalls Harry Sparrow  - 4.6% alcohol, dry, crisp and clean.  This was my favorite sparking cider, a true scrumpy

2. Lilley's Stargazer -  5% alcohol, medium/sweet, with a great apple flavor

3. Sheppy's Oakwood - 4.8% alcohol, medium/dry without any overtones of oak, despite the name

4. Somerset draught - 5.5% alcohol, medium, well balanced and complex

The proprietress of the Cider Tap explained that the still ciders change weekly, with new fresh products produced in small quantities from local farms.

Tasting living, complex, handcrafted ciders made with centuries of experience was the highlight of my trip.    I only wish we had the local cider tradition close to Boston.    I guess it is up to Unity Farm to bring handcrafted ciders to the Metrowest!

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Sleep, Alzheimer’s Disease and Yoga

by Nina

Sun Behind Clouds by Melina Meza

One of the worst fears I think we all share about getting older is of developing dementia. Just recently I had a long phone conversation with a woman who is trying to deal with a mother in the early stages of Alzheimer’s Disease, and it was just so sad. I had some advice for her, but no solutions, of course. Then I heard a news piece on NPR “Brains Sweep Themselves Clean of Toxins During Sleep”  that gave me  glimmer of hope.

Scientists have been trying to figure out the purpose of sleep for a very long time. A recent study “Sleep Drives Metabolite Clearance from the Adult Brain”  published in Science Magazine, proposed a fascinating new theory. The team of researchers from the University of Rochester discovered that while the brain sleeps it clears out harmful toxins, a process that may reduce the risk of Alzheimer's. According to the NPR interview, during sleep, the flow of cerebrospinal fluid in the brain increases dramatically, washing away harmful waste proteins that build up between brain cells during waking hours. Professor of Neurosurgery and an author of the study, Dr. Maiken Nedergaard, said, "It's like a dishwasher."

The waste proteins getting washed away during sleep are toxic to brain cells, which could explain why we don't think clearly after a sleepless night and why a prolonged lack of sleep can actually kill an animal or a person. The results appear to offer the best explanation yet of why animals and people need sleep.

“Thus, the restorative function of sleep may be a consequence of the enhanced removal of potentially neurotoxic waste products that accumulate in the awake central nervous system.” Lulu Xie, et al.

Alzheimer's Disease researchers say this research could help explain a number of recent findings related to sleep and AD. Dr. Randall Bateman, Professor of Neurology  at Washington University said this about beta amyloid, which is the main component of certain deposits found in the brains of patients with Alzheimer's Disease.

"Beta amyloid concentrations continue to increase while a person is awake. And then after people go to sleep that concentration of beta amyloid decreases. This report provides a beautiful mechanism by which this may be happening.”

The team of scientists discovered the cleaning process while studying the brains of sleeping mice. Dr. Nedergaard said that during sleep the system that circulates cerebrospinal fluid through the brain and nervous system was "pumping fluid into the brain and removing fluid from the brain in a very rapid pace.” When the mice went to sleep, their brain cells actually shrank, making it easier for the fluid to circulate. But when the mice woke up, their brain cells enlarged again and the flow between cells slowed dramatically.

The researchers speculated that the reason the brain doesn’t do this cleaning all the time is because the cleaning uses a lot of energy, and it’s probably not possible for the brain both to clean itself and at the same time be aware of its surroundings, talk, move, and so on. So getting enough sleep—which we already know is vital for our physical and mental health—may be one key to preventing Alzheimer’s Disease as you age.

But what does all this have to do with yoga? Well, if you’re having trouble sleeping, yoga can help with that. Because insomnia is so often related to stress, yoga’s stress management techniques can help you quiet your nervous system so you fall asleep more quickly and sleep more soundly. For  information on how yoga can help you sleep better, see Yoga for Insomnia, Part 1  and Day to Night: Yoga for Better Sleep. The Supported Inverted poses I wrote about recently (see All About Supported Inversions) are poses that I've found particularly helpful.

We’re so careful here at YFHA not to make any false promises and of course as this research is new, we can’t promise that getting enough sleep will definitely make a difference for you. But encouraging you to get a good night’s sleep can’t be harmful in any way, and if this gives you more motivation to practice stress management techniques, which are helpful for preventing a whole host of health problems, we’re doing you a favor. And if you'd like to add an additional practices to encourage brain health, start meditating on a regular basis (see Meditation and Brain Strength) and keep practicing your yoga asanas (see Yoga for Brain Health?).

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Home Practice: Is There an Optimal Length?

by Baxter

Hours of Operation by Melina Meza

This past August I was back in Ocean Springs, Mississippi at River Rock Yoga, leading a weekend workshop. One of the students, who has been a regular in class with me there over the years, brought in a few pointed questions for me that he hoped I could address on YFHA. He has been a regular reader since we started, and practices yoga on his own as well as attending classes regularly. In his search for the perfect home practice, he was very curious if I thought that there was a recommended minimum time for a home practice, realizing that some yoga is better than none!

In his own attempt to answer the question, he cited an April, 2013 article in an issue of Prevention Magazine which claimed, referring to a study done in postmenopausal women, that 42 minutes of vigorous exercise over 3 days (that means 14 minutes a day) maintains telomeres. As regular readers of this blog will know, telomeres are little “caps” or tails on the end of DNA stands that may have a relationship to longevity of certain cells in the body. Recent yoga studies have shown a positive relationship between yoga and telomere length. However, I don’t think the yoga practices in these yoga studies were only 14 minutes long, and likely would not fall into the category of “vigorous exercise.” However, this is an intriguing idea, and I’d say if you could hit the 14-minute mark in your home practice, that is a good start—more on that in a minute.

My student also cited “100 New Scientific Discoveries” issue of Time magazine, where he came across this:

“Researchers [in Stockholm] say that even a single 20 minute workout can lead to epigenetic changes that help make muscles work better.” 

For those not familiar with the field of study known as “epigenetics,” I offer this Wikipedia definition:

“epigenetics is the study of mitotically or meiotically heritable changes in gene expression or cellular phenotype, caused by mechanisms other than changes in the underlying DNA sequence—hence the name epi- (Greek: επί- over, above, outer) -genetics.” 

In this case, exercise is influencing how the genes of muscles express themselves leading to improved muscle function. I’ll take it! And 20 minutes sounds even better to me than 14 minutes for a home yoga practice.

And real life examples of the power of a regular practice are equally compelling to me as scientific studies. Recently, a long-time student of mine who has chronic back pain experienced a distinct change in his daily health. In the past, he had come to my back care yoga class regularly, but eventually found that some of the poses we did would actually flare his chronic back pain. So we met privately and developed a home practice he could do for 15-25 minutes daily, if he so chose. He found that he would do the practice 2-3 times a week, and it helped his overall back pain nicely. 

But then two months ago, he asked if we could audio record a practice that lasted about 40 minutes. He explained that his partner had become interested in doing some yoga at home and wanted something they could do together in the morning before work. We came up with a balanced routine that included poses beneficial for back health, but also breathing practices and a good Savasana at the end. When he returned for a follow-up recently, it was not the lower back symptoms he reported on, but that the chronic loose bowel movements he has suffered with every morning for years had diminished and stopped, replaced by a normal movement each am. He was thrilled and felt it was a direct effect of his new daily morning practice. And for him, 40 minutes a day works just fine.

We know from the work of cardiologist Herbert Benson, that 10 minutes of meditation is the time frame for the body to shift to the Relaxation Response (the Rest and Digest side of the autonomic nervous system), and by 20 minutes the effects are even more profound. And, of course, there are many other variables to consider when you design your home practice, as you can see from the 24 posts we have done to date that address the topic of home practice. We know, for example, that one study showed that it was regular home practice, more than attending classes over time or regularly, that seems to relate to long term health benefits of yoga (see Does Home Yoga Practice Make You Healthier? and Home Practice: The Best Way to Improve Your Health and Well-Being).

But like most issues we have discussed here over the years, the answer to this question of the optimal minimum time for home practice is really “It depends!” But, given what my astute student has uncovered, as well as research findings on the benefits of regular practice, my observations of my students and my own practice, I’d feel comfortable recommending that you try to hit that 20 minute mark, and on days when you feel like going longer, there is nothing to stop you! 

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Pratyahara, the Sense of Sound and Hearing

by Ram 

In a Tunnel by Melina Meza

"Deafness separates us from people" —Helen Keller

In my last post Pratyahara and Healthy Aging, I introduced the topic of pratyahara and defined the term as “Using our our senses with total/complete awareness.” It is through the five senses that we bring in impressions into our mind and body thereby absorbing the world around us. Thus, we are what we eat, smell, see, hear and touch. Since our five senses serve as portals or gateways into our body, mind and consciousness, it becomes very important to be aware of what we are drawing in through the five senses. If we absorb harmonious impressions, we will in turn be healthier. If we take in that which is unhealthy, the mind and body suffer. Thus, physical and mental instability can arise if we bring on low-quality sensory impressions.

The sense of sound is perceived by the ears and through these sense organs we bring in the sounds of the environment. Sounds can have profound effects on our physiology. Ask a person who is living in a war zone and being exposed continuously to high decibel sounds of machine guns or bombers flying overhead. Compare that to the sounds of your breath during a yoga session or to soft sounds of nature. While the former can result in a pathological condition including profound hearing loss, the latter uplifts our mind and spirits.

Hearing loss is a major public health issue and is the third most common physical condition after arthritis and heart disease. Approximately 20 percent of adults in the United States experience some degree of hearing loss, with aging and chronic exposure to loud noise being the two most common causes. There exists a strong relationship between age and hearing loss. Age-associated hearing loss (aka presbycusis) is characterized by changes in the inner ear, which deteriorates as the individual gets older. While the loss may be mild or severe, it is permanent and irreversible.

Other causes of hearing loss include ear-trauma, damage/injury to the ear, infection, common cold, or earwax buildup. Furthermore, hearing loss is often accompanied with severe ringing in the ears (tinnitus) that in itself is very discomforting. In addition, degeneration or loss of function in the vestibular system (the part of the inner ear that is responsible for movement and sense of balance) can lead to balance deficits. Abnormalities in balance function can result in vertigo (sensation of spinning) or disequilibrium (sensation of being off balance and resulting in frequent falls). When balance is impaired, an individual has difficulty maintaining an upright orientation.

Since sound is a form of energy wave and we are all affected by what we hear, we need to be aware of the nature and kind of sounds and create a harmonious auditory environment around us. Other preventative measures to keep the ears healthy include yoga and pranayama, which provide immense benefit to the ears and sense of hearing.

Many traditional yoga poses are focused on balancing the body and the mind. When looking for beneficial yoga poses for the ears, we need to focus on asanas designed to increase balance, including but not limited to standing balancing poses like Tree pose (Vrkshasana), Extended Hand-To-Big-Toe pose (Utthita Hasta Padangustasana), and the Warrior poses, especially Warrior 3 (Virabhadrasana 3). If you have a hearing loss that is associated with spells of dizziness, you need to modify your yoga practice and also avoid holding the poses very long.

In his recent post Dizziness and Yoga Baxter provided tips regarding do’s and don’ts of specific poses to relieve vertigo. If the hearing loss is due to an acute infection, poses such as Downward-Facing Dog offer relief by releasing pressure from the ears. Plow pose (Halasana) aslo offers a host of health benefits, including potentially relieving sinus pressure. Notice that in these poses the heart is higher than the head; as a result these poses increase the blood flow to the head which can help restore ear health. For beginners or for people with existing ear issues like pain or pressure, I would suggest doing the above with suitable props. Check Nina’s extremely informative post All About Supported Inverted Poses on supported inversions where she discussed the above-mentioned asanas and other poses using suitable support .

Additionally, pranayama (deep breathing exercises) can help alleviate pain or ringing in the ears associated with tinnitus. In his recent posts Tim McCall described Bhramari pranayama and  Anuloma-Viloma/Aternate nostril breathing. In addition to its immense benefits on the heart and toning down the agitated mind, the role of these pranayama techniques is described in classical texts for in relieving problems associated with the ear and the sense of hearing. Pranayama can be done in conjunction with the yoga poses mentioned above., however, I prefer doing pranyama at the end of a yoga session to achieve greater benefits and relaxation.

Whatever options you choose to keep your ears and sense of sound intact, remember that the power of choice and the power to control our environment that surrounds us lies within us. Let us use this power and surround ourselves with a healthy auditory environment. I am reminded of notable German physicist G.C. Lichtenberg’s famous quote:

"What a blessing it would be if we could open and shut our ears...."

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Friday Q&A: Yoga for a Sprained Ankle

Q: Nina—how bout yoga for a sprained ankle...got some ideas?

A: Why, yes, thank you so much for asking! Last year Baxter did a three-part series on the ankle that is worth revisiting or visiting for the first time if you’ve never read these posts. So check out Getting to Know Your Ankles, Ankle Sprains, and Recovering from Ankle Injuries.

In part 2, Baxter says that a typical recommendation from your doc is to elevate your foot and leg above the level of your heart, and because there are lots of yoga poses that are done lying on your back with the legs elevated, these poses could assist in the healing process. So in the acute phase of injury, try supported inverted poses such as Legs Up the Wall pose, Chair Shoulderstand, and Easy Inverted pose. See All About Supported Inversions for some other possibilities, and links to instructions for them.

Naturally, while you are recovering and need to keep the weight off your ankle, you will need to avoid standing poses. But there are so many other poses you can still do, including seated and reclined poses. If I were in your situation, I’d continue to practice what I could to maintain my flexibility while my ankle was healing. So try some seated poses, such as hip openers, twists, and forward bends, while keeping your ankle in a neutral, pain-free position. Of course, you’ll want to avoid poses that put pressure on the ankle, such as any variation of Hero pose (Virasana) or Half Lotus (Arda Padmasana). Also, many of our office yoga poses, which you can do seated in a chair, will be suitable for you. Reclined poses, including passive backbends as well as restorative poses, can be very effective at opening your body without putting any stress on your ankle. Again, just be sure to keep your ankle in a neutral, pain-free position. It’s kind of an interesting to challenge to figure out how to practice when you need to avoid aggravating an injury (right now I have a plain old skinned knee, so I need to avoid kneeling—it turns out that comes up more frequently in practice that you might imagine).

If the pain and inconvenience of having a sprained ankle is causing you to stress out—which I imagine it would—add in some stress reduction practices, such as meditation, yoga nidra (see the Relaxation Tracks tab at the top of our page), breath awareness or pranayama, or even just a nice long Savasana. Check the index on the right side of our blog for posts on all these topics.

Once the acute phase symptoms have diminished, Baxter says that you can turn your attention to a more typical asana practice, adding in his seated ankle rolls and alphabet spelling exercises (see Ankle Circles). At this point, you can focus on the strengthening aspects of the poses for the ankle and foot area, so add special attention to activating as many of the muscles surrounding your ankles and feet as you do your standing poses.

—Nina

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Restorative Yoga Better Than Stretching for Reducing Subcutaneous Fat in Overweight Women

by Nina

Just a quick announcement today about some research findings I think you’ll all enjoy hearing about. Baxter and I read about a recent study, designed by Maria G. Araneta, PhD, MPH, of the University of California, San Diego, to determine whether obese women would see a loss of fat from less intense exercise instead of aerobic activity. Although not a huge study, the group sizes were larger than most of those we see in recent studies, with the yoga group of 88 having a mean age of 55 years with an average BMI of 36 kg/m2 and the stretch group of 83 having a mean age of 54 years with an average BMI of 32.5 kg/m2.

Along with her co-authors Matthew A. Allison, MD, MPH, Elizabeth Barrett-Connor, MD, and Alka M. Kanaya, MD, Dr. Araneta presented the results at the 73rd Scientific Sessions of the American Diabetes Association in Chicago (June 21-25). And their findings showed that the restorative yoga practitioners lost significantly more subcutaneous fat over the initial six months of the study period, and kept losing it during a maintenance period with less direct supervision! This is important because all the women participating in study had metabolic syndrome, which the Mayo Clinic defines as:

Metabolic syndrome is a cluster of conditions — increased blood pressure, a high blood sugar level, excess body fat around the waist and abnormal cholesterol levels — that occur together, increasing your risk of heart disease, stroke and diabetes.

Metabolic syndrome affects 44% of the U.S. population older than age 50. And reducing abdominal fat may help reverse the syndrome.

Although the team is still reviewing the data, they’ve speculated that one explanation for the difference between the effects found with restorative yoga and stretching may be that restorative yoga reduces levels of cortisol. As Timothy wrote in his background post Stress, Your Health and Yoga, cortisol levels rise during times of stress and is known to increase abdominal fat. And in Baxter’s post Cortisol and Good Health Baxter wrote about the dangers of prolonged periods of stress and high levels of cortisol. I wrote specifically about the relationship between stress, cortisol and weight management in my post Yoga, Stress and Weight Management. So we'll be very interested to see the follow-up studies.

In Baxter's post on cortisol, he actually recommended restorative yoga along with yoga nidra as stress reduction—and cortisol-lowering—solutions. However, meditation (see Starting a Meditation Practice) and supported inversion poses (see All About Supported Inverted Poses) are also helpful. For a complete overview of how to use yoga to switch your nervous system from the Stress Response (Fight or Flight) to the Relaxation Response (Rest and Digest), see The Relaxation Response and Yoga.

In her presentation, Dr. Araneta did not recommend restorative yoga as a replacement for aerobic activity; instead, she said this “complementary” practice could provide a means of gentle movement for those severely obese patients for whom other activity is not practical. But as I wrote in Restorative Yoga: An Introduction, restorative yoga is a complementary practice that benefits all of us.

If you haven't already, check out Baxter's video of the classic restorative pose, Reclined Cobbler's pose! 

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Lessons Learned from the Health Insurance Exchange Launch

CIOs face many pressures - increase scope, reduce timelines, trim budgets.     After nearly 20 years as a CIO, I've learned a great deal about project success factors.

When faced with go live pressures, I tell my staff the following:

"If you go live months late when you're ready, no one will ever remember.

If you go live on time, when you're not ready, no one will ever forget."

I have hundreds of live clinical applications.    Does anyone remember their go live date?  Nope.

Were there delays in go live dates?  Many.

With even the best people, best planning, and appropriate budgets, large, complex projects encounter issues imposed by external factors (new regulations, competing unplanned events, requirements changes) that cannot be predicated during initial project scheduling.

It helps no one - the users, the business owners, or the IT department to slavishly adhere to a deadline when the project is not ready to go live.

I work on federal advisory committees in the Obama administration and truly believe in the goals of many administration programs - Meaningful Use, HIPAA Omnibus rule, and Affordable Care Act.

However, we've seen that in the interest of accelerating change, deadlines have been imposed that do not allow for sufficient testing, piloting and cultural change.  The result is that haste makes waste.

As I've written in my blog many times, ICD-10 will become a crisis for the Obama administration.   Payers and providers will not be ready by October 1, 2014.   Documentation systems and clinician billing process changes will not be mature enough to support a successful go live.   More time is needed.    My experience with IT crises is that you can survive one at a time, but a succession of problems creates a pattern that users and oversight bodies will no longer tolerate.   I hope the premature go live of the Health Insurance Exchange results in a review of ICD-10 go live dates.

Meaningful Use Stage 2 attestation criteria are good.   The certification scripts need very significant revision.   How did this happen?   They were created in a rush to adhere to an artificial deadline, not reviewed by the federal advisory committees, and not piloted tested/revised.     New regulation is needed fix them and that will take time.   Again, the lessons of the Health Insurance Exchange should cause us to extend Meaningful Use Stage 2 deadlines by a year, deferring future stages of Meaningful Use until we have consolidated our gains and understood our successes/failures with current stages.

The Office of Civil Rights is an important watchdog of patient privacy.   We all believe respecting patient privacy is one of our most sacred responsibilities.   However, at times government auditors have enforced policy for which the technology and infrastructure of the country was not ready.    Yesterday I received an email from Harvard Medical School noting that the laptop encryption software installed a few years ago was deemed too error prone and too hard to support so it would be retired.   Luckily in 2013, encryption is natively supported in current releases of Mac OSX, iOS, Android, and Windows.   The industry is ready to support robust device encryption now.    However, enforcement/breach penalties related to encryption on mobile devices started years ago when products were as stable as the Health Insurance Exchange.   We should have aligned enforcement with product maturity in the marketplace.   Similarly the HIPAA Omnibus Rule contains provisions like the self-pay redaction requirement that no hospital has figured out how to support.  However, enforcement is starting now.

Do we a see a pattern here?   Policies are good.   Policymakers are well meaning.  Timelines are set in such a way that none of these activities - Health Insurance Exchange, ICD-10, Meaningful Use Stage 2, or HIPAA Omnibus Rule have enough time for testing, piloting, and cultural change.

As I've written about previous in my post the Toad and the Snake, I'm not yet at that time in my life when I resist change or innovation.   I'm simply an IT leader and physician in the trenches who knows that 9 women cannot create a baby in a month.   There is a minimum gestation period for IT projects and our policymakers should learn from the lessons of the Health Insurance Exchange and re-calibrate the timelines shown in the graphic above so that everyone is successful.

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Building Unity Farm - Fall Hoop House Planting

It's Fall in New England and the weather is turning cold.  Nights are in the 30's and days are in the 50's and 60's.   All the ferns in the forest are brown and most of the insects are gone.   On the farm, the apples are harvested, cider made, mushrooms dried, paddocks/pastures readied for winter, and the pace of harvest-related food preservation projects is slowing down.

We now turn our attention to Fall and Winter plantings.  Our 48x21 foot hoop house heats to 80 degrees F during the day by trapping solar energy under a 6 millimeter roof of UV resistant plastic sheeting.  We use barn fans to circulate air and hand cranked rollers to open the sides and prevent overheating.    The roof has a "gothic" cathedral shape which sheds snow and resists wind.

Over the summer, we built fifteen 4x8x1 foot raised beds and a gardening bench.   We brought water and electricity to the hoop house via a 200 foot trench from the house.   We placed a foot deep foundation of alpaca manure under each raised bed and now we're filling the beds with compost, moss, and perlite http://en.wikipedia.org/wiki/Perlite

In our first 2 beds we planted 200 bulbs of garlic, which will overwinter and produce new bulbs in the spring.   We've grown garlic for many years and enjoy bulbs of oven roasted garlic brushed with olive oil.

In our second 2 beds we planted romaine and oak leaf lettuces.   The heat of the hoop house should enable us to pick fresh greens every day during the winter.

In our remaining beds, we'll plant additional lettuces, kale, spinach, chard and other cold tolerant plants, keeping our kitchen and our barnyard stocked with fresh greens.   The ducks and the alpaca really enjoy a fresh head of romaine.   For the ducks, we chop the lettuce and mix it with water, creating a soup which they can easily slurp.

As the days shorten, we'll have less light to work in the hoop house, so I'll add 2 pendant galvanized barn lights http://www.barnlightelectric.com/pendant-lighting/barn-pendant-lights/the-original-stem-mount-pendant.html which will enable us to pick fresh salad greens in the evening after the work day.

It's our goal to become increasingly self-reliant over the next year as well as sell many of our products - honey, mushrooms, apples, blueberries, and vegetables at local farmers markets.   Although we've been farmers for a year, this will be our first winter with a hoop house, so I'm sure there will be many lessons learned growing vegetables as the snow begins to fall.

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Balancing Your Nervous System with Alternate Nostril Breathing

by Timothy

Mountain, Sky, Clouds by Melina Meza

In my last post Pranayama for Everyone: Bhramari Breath I wrote about the importance of pranayama (yogic breathing practices) and introduced one of my favorites, Bhramari, the buzzing bee breath. Today, I'm going to tackle the pranayama I consider the most important: alternate nostril breathing (Nadi Shodhana or Anuloma Viloma).

It turns out that almost all of us breathe primarily through one nostril for parts of the day, and then switch to breathing primarily through the other nostril at other times. The ancient yogis knew wrote about this and modern science has confirmed it (see p. 62 of my book Yoga as Medicine for details). Research has confirmed that breathing through the right nostril is linked to the sympathetic nervous system (SNS), whereas left nostril breathing activates the parasympathetic nervous system. This is pretty much exactly what's described in ancient yogic texts, albeit using metaphoric language. The left channel ida [pronounced ee DAH] is the feminine, lunar, cooling side, the texts say, whereas the right channel pingala [pronounced peen gah LAH] is the masculine, solar, heating side.

Many people in the modern world have an imbalance in their nervous systems, usually too much activation of the SNS, the flight or fight response. Others, such as some people with chronic fatigue syndrome, have too much parasympathetic tone. In either case, alternate nostril breathing can be useful. In Ayurveda, Nadi Shodhana is felt to be good for people of all constitutional types. I have found it particularly useful for students with an increase in the vata dosha (see Autumn, Healthy Aging and the Ayurvedic Dosha Vata), which is especially common now as we move into the cooler weather of the fall season.

If you have never tried alternate nostril breathing, you may have seen pictures of yogis using their fingers to alternately close of one nostril, then the other. Typically the thumb of the right hand is used to close off the right nostril and the fourth finger (or sometimes the fourth and fifth together) is used to block the left nostril. This "digital pranayama" is a wonderful practice that I've done daily for many years. But not everyone can do it.

For example, some people with arthritis find it too cumbersome or painful to use the fingers this way. If you've got a deviated septum or nasal congestion, digital alternate nostril breathing similarly may not work well due to the obstruction to air flow. In these instances, mental alternate nostril breathing, where you simply imagine to air going into one side and out the other is a great option. And the practice is so simple and safe that I often teach it to beginners.

To practice mental alternate nostril breathing, sit as you would for meditation, relaxed but perched high enough that your lower back can have its healthy inward curve. With your eyes closed, slowly breath in and out a couple of times. Then imagine you are inhaling through the left nostril and that you are exhaling through the right nostril. Next imagine inhaling through the right nostril, and exhaling through the left. Continue this pattern:

1. Inhale left
2. Exhale right
3. Inhale right
4. Exhale left

If you're new to pranayama, try this practice for just a minute or so. If it feels comfortable, you can continue for five minutes or longer. Since you began by inhaling on the left, end your session after an exhalation out the left nostril. Did you notice that your breath followed your intention?

If you are comfortable, I'd suggest you sit quietly for a few minutes after you finish or, if time allows, do a meditation practice. The ancient yogis taught that the balancing effects of Nadi Shodhana make it the perfect prelude to meditation, helping your meditation be calmer and more focused.

If you are an asana practitioner who tends to skip both pranayama and meditation, I have a challenge for you. For the next two weeks, try to do two minutes of mental Nadi Shodhana, followed by three minutes of sitting every morning before eating (or another time that suits you), and let us know how it goes. I suspect you'll be pleasantly surprised by the results.

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