Yoga After Heart Surgery for Stent Placement

by Baxter

Back in the late 60s and early 70s, a new surgical treatment for blocked heart blood vessels was being perfected. Known as coronary artery bypass grafting, it allowed doctors to work around the heart’s own blood vessels that supply the muscle of the heart with oxygen and nutrition when they became dangerously plugged with plaque buildup. Patients that previously would have, most likely, suffered severe or life-ending heart attacks were now being surgically repaired and at least temporarily “cured” of their heart blockages. I say temporarily because doctors like Dean Ornish, MD, noticed that many of these patients who had undergone open-heart surgery would return several years later with new blockages in their new plumbing! Most likely, this was due to the fact that they had not changed their lifestyle and dietary habits. 

As early as 1977, cardiologists started trying to treat the blockages in the heart blood vessels without having to crack the chest open, instead threading a catheter into a large blood vessel in the groin area and guiding it up to the heart and into an individual heart blood vessel. Once at the narrowing area of the blood vessel threatening the patient’s heart, a small mesh scaffold, called a “stent,” was slipped into place and gently expanded to reopen the narrowing. This stent was then left in place. 

All this history gets personal for both Nina and me, as we both have had loved ones undergo stent placement for coronary heart disease in the past year. In my case, my family member had just celebrated his 50th birthday, and with little prior warning or symptoms, had a sudden cardiac event at home that required CPR and electric shock to the chest by the EMTs to restart the heartbeat again. Evaluation at the hospital immediately afterwards showed one heart vessel with a blockage and a stent was put in place right away. Follow-up tests showed no permanent damage to the heart muscle from this heart attack—thank goodness!

It has been found that patients who go through “cardiac rehabilitation” programs following stent placement do better down the road than those that don’t. Cardiac rehab involves progressive aerobic activity on treadmill and stationary bikes while having the heart rhythm monitored, for 30 minutes 3 times a week for 3 weeks, then bumped up to 45minutes, 3 times a week for 3 more weeks. In my family member’s situation, he had been very physically active prior to his event, swimming and golfing regularly, and he was anxious to be able to return to those activities. If yoga had been his thing, I suspect that same desire would have been there. So, what are the recommendations about “return to activity” that could guide you as a yogi if you have to have a stent placed? The NIH has the following post-stent recommendations:

“After a stent procedure, [because of the risk of blood clots causing your open vessel to close,] your doctor will likely recommend that you take aspirin and other anticlotting medicines. Patients are told to avoid vigorous exercise and heavy lifting for a short time after the stent procedure. Your doctor will let you know when you can go back to your normal activities. … However, stents aren't a cure for atherosclerosis or its risk factors. Lifestyle changes may include changing your diet, quitting smoking, being physically active, losing weight, and reducing stress. You also should take all medicines as your doctor prescribes. Your doctor may suggest taking statins, which are medicines that lower blood cholesterol levels.”

Interestingly, there aren’t many other warnings I could find about returning to full activities, such as yoga, and no specific warnings about avoiding certain positions, including inverted yoga poses. In fact, a student of mine had his first of four stents placed for angina, or heart pain, starting at age 67 in 2000. He started doing yoga in 2003, which included regularly practicing Shoulderstand (Sarvangasana) at the wall in his new home yoga practice. He has continued to include it since then. He felt pretty certain he had discussed doing yoga with his family doctor at the time, as well as his heart doctor, and was not given any specific restrictions or warnings about yoga in general. 

I would not suggest that this means you should start a vigorous yoga practice that includes a lot a challenging inversions, but would instead suggest a gradual introduction of yoga over the course of time, just as the cardiac rehab is gradually advanced while monitoring for worrisome symptoms. And certainly engage in a conversation with your heart doctor about their views on the safety of your desired yoga program. Also, keep in mind that even a gentle yoga practice, like the one used in the Ornish Heart studies, has been shown to have powerful effects on long term heart health. So you likely have a wide range of options as to the kind of yoga practice you might restart or start for the first time if you find yourself confronted with a new diagnosis of coronary heart disease. If any of our readers have been given different advice by their docs, please write to us about it.

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Stakeholder’s Progress report for FHIR

The following blog entry is a guest post from Grahame Grieve, creator of Fast Healthcare Interoperability Resources (FHIR):

"During the week of Sept 14th to 19th, HL7 held a working meeting during which the organization worked on further developing the FHIR specification.

FHIR is an important new standard, not just because it does what the existing specifications do in a simpler fashion, but because it does entirely new things as well.  Because of this, market interest and hype concerning FHIR is astonishing (see Wes Rishel’s comments ) . The FHIR project team is aware that there is a duality here: expectations and excitement about FHIR are high, but what we have published is still an early beta, and FHIR is not yet ready to meet the expectations that people have about it.  We intend and expect to get there, but it there is still a lot of work to be done.

One of the key gaps the project team has identified is that the clinical content parts of the specification are not as solid as the underlying technical framework. We know that the strength of FHIR isn’t because we’re clever, but because we keep testing it through implementation experience, particularly connectathons – a relentless cycle of test, refine, test…. Our regular developer connectathons are continuing to grow in participation, depth and sophistication, but they don’t test of FHIR’s clinical features well. So this meeting, we did something new: we held a clinical connectathon – a group of clinicians using the FHIR specification to communicate with each other about some prepared clinical scenarios. Like our first technical connectathon, the potential of the specification was clear, but we identified a number of areas where we need additional development before FHIR is ready for real world usage. We plan to make clinical connectathons a regular feature in the future.

During this meeting, we started preparing the next full release of FHIR – DSTU (Draft Standard) 2. We anticipate publishing this in the middle of 2015. It will feature new functionality for clinical records, assessments, claiming, consent management, and more, and we agreed to a number of significant changes to the specification in response to implementer experience. Several organizations (including ONC and HSPC ) and countries are working on implementation guides for FHIR, and their experiences are starting to drive the specification and the development of additional implementation tooling.

Up to now, FHIR has primarily been a standards project: a group of people with a core task of producing a standard. But now, the FHIR project and management teams are going to start placing increasing focus on engaging with the wider implementation community. Connectathons are effective forums for validating the specification, building an active implementer community and seeding specific exchanges. One important part of this will be ever closer cooperation between HL7 and IHE as IHE starts adopting FHIR in the future."

For a more detailed technical progress report, see Grahame's Website.
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Heart Health and Yoga: An Overview

by Nina

The Heart by Henri Matisse*

After three years of blogging, even I, the Editor-in-Chief, can't remember everything that’s on our blog. So because someone close to me has developed heart disease and I want to be able to help him, I’ve been—hahaha—reading through my own blog today. At the same time that I’m trying to see which topics we’ve covered so far (nothing on stents that I can see—paging Dr. Baxter Bell!), I’m also trying to get up to speed on some background information by re-reading some of our older posts. So it occurred to me that while I was educating myself on the topic of yoga and heart health, I should share what I find out with you all. After all, the U.S. Centers for Disease Control says that heart disease is the leading cause of death of in the U.S.

In Shari’s post Yoga for Heart Conditions, she provides an excellent overview of what heart disease is and how yoga can help. She says that she believes that:

“yoga can be so effective for the management of heart disease because it is a holistic health approach that takes into account all of the varied systems of the body —in yoga, the body is part of a greater whole. Yoga is also accessible to all who want to practice, no matter what their physical ability may be. And yoga’s powerful stress management tools, including learning to slow down and breathe deeply, have many beneficial effects on heart health. Several scientific studies have now demonstrated conclusively that learning to breath deeply decreases blood pressure and slows down heart rate by stimulating the parasympathetic nervous system (Relaxation Response) and slowing down the sympathetic nervous system (Fight or Flight Response). And once you learn to become mindful of your breath and of how your body can feel when it is in a relaxed state as opposed to a hyper-arousal state, then conscious, healthy eating is a natural sequel of the yogic approach to health. Finally, learning to move your body (which nourishes all the musculoskeletal, respiratory, lymphatic, and circulatory systems) will help improve heart health.”

In Baxter’s post About Yoga for Heart Health, he wrote about how yoga practices help to maintain or improve circulation in the cardiovascular system, which is essential for heart health. He concludes that post by saying:

"Yoga, therefore, can be said to improve circulation by improving blood flow and the return of lymphatic fluids to the heart, reversing the impact of chronic stress on circulation, lowering blood pressure, slowing down or reversing atherosclerosis, improving the heart rhythm and improving overall heart health."

In Baxter’s post Cortisol and Good Health, he focuses in particular on the relationship between chronic stress and health problems, including heart disease. He says:

"But if you are either under constant stress, or your mind is prone to brooding about the past or anxious musings about the future or even negative assessments about the present moment, your adrenals interpret this as an actual stressful event occurring right now, and cortisol gets released into your system. So cortisol levels remain high in the blood stream for greater periods of time, which can result in swelling of the gland itself, and an increased chance of the following negative effects: loss of immunity secondary to shrinkage of lymph glands, increased risk of stomach ulcers, increased risk of hypertension, heart disease and other vascular disorders, excess sugar in the blood stream and more chance of developing diabetes."

While we in the yoga community all know that yoga can help to improve circulation and reduce stress (see The Relaxation Response and Yoga), Baxter also recently posted Yoga and Heart Health: Newest Study about a scientific meta-analysis study Effects of yoga on cardiovascular disease risk factors: A systematic review and meta-analysis, which concluded:

"This meta-analysis revealed evidence for clinically important effects of yoga on most biological cardiovascular disease risk factors. Despite methodological drawbacks of the included studies, yoga can be considered as an ancillary intervention for the general population and for patients with increased risk of cardiovascular disease."

Baxter has even designed two different yoga sequences for heart health, both short and accessible practices.

The Inverted Heart Health Sequence includes inverted poses because they can have several immediate and long-term influences on your heart and circulatory system. Inversions put your body in a position to take advantage of gravity to assist in venous return to your heart—you flip upside down and gravity pulls the blood back toward your heart and head! They can also have a quieting effect on your nervous system, encouraging a shift from Fight or Flight mode to Rest and Digest mode. Your heart muscle needs both exercise and rest, so a good combination of effort and relaxation in your practice will give your heart a more balanced experience.

The Cardiovascular Heart Health Sequence includes:

• Dynamic Yoga Sequences. Linked sequence of poses that move fairly quickly, such as Sun Salutations, gradually warm up your body and your cardiovascular system, both strengthening and stretching the muscles and connective tissue that your body’s blood vessels pass through, both exercising your heart and encouraging more efficient flow through the piping of your system.
• Static Poses. Poses that you hold for longer periods increase what is known as the “work load” of your heart, providing a different kind of exercise and challenge for your heart. Those with high blood pressure and diabetes will have to approach these poses with  caution and work into the holds very gradually, preferably under the guidance of an experienced teacher. 
• Gentle Inversions and Restorative Poses. These poses quiet and rest your cardiovascular system and your heart, which is equally important to testing and stressing your system. They allow your heart and nervous system to quiet, and as a result can nicely lower your blood pressure, heart rate and breathing rate.
• Pranayama and Meditation Practices. These practices support the effects of the inversions and restorative poses.

If chronic stress is a problem, see The Relaxation Response and Yoga for an overview of how yoga helps with stress and a list of techniques to choose from. We also have many posts on insomnia (see Five Tips for Better Sleep, for example). Finally, if you’re struggling with poor eating habits, see Yoga for Healthy Eating. 

I'll be giving my loved one private lessons, starting with initial lessons on managing the stress related to realizing you have the disease and coping with surgery and recovery, and I'm sure I'll have more to say about yoga for heart disease as I learn more about it myself.

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Friday Q&A: Practicing to Manage Stress

Q: Following the stressful weeks you have just been through, what kind of yoga practice are you craving and what will you include in your home practice to meet that desire?

A: After many, many years of practicing on my own, I do develop specific cravings for yoga poses, depending both on my emotional and physical state. In my case, stress affects me in a very distinctive way: I become hyper, a little manic, and I have a hard time sleeping. So what I really crave (and know from experience will work for me) during a stressful period is the calming superpowers of supported inverted poses (see All About Supported Inverted Poses and Why You Should Love Your Baroreceptors ). What I love about these poses is that they don’t take a lot of mental effort for me (I do breath practices as well but you have to focus on those). I just get myself into the poses, and the magic calming action just kicks in. 

The two poses I crave the most are Legs Up the Wall pose (Viparita Karani) and Headstand (Sirsasana). Legs Up the Wall is a guaranteed stress buster for me, and sometimes if I don’t have time for a long practice, I’ll just do the pose on its own (see A Woman Did a Single Yoga Pose and What Happened Next Will Blow Your Mind). Headstand isn’t so much calming for me as grounding. Part of my stress response is to get very flighty and distracted (hahaha, my son recently observed that when I get hyper, I interrupt MYSELF while I’m talking). So if my practice is longer, I like to add Headstand to my sequence, along with its traditional counter-pose, Shoulderstand (Salamba Sarvangasana), and finish off with a long Legs Up the Wall pose.

Yesterday I did my go-to stress reduction sequence, which is actually rather long (though very effective). I started with reclined leg stretches (see Featured Pose: Reclined Leg Stretch ) and hip openers, and then a long shoulder opener. These helped me prepare for the inverted poses, and also released held tension from my legs (I’ve been walking a lot). Then I did all the supported inverted poses, in the following order:

1. Downward-Facing Dog pose (Adho Mukha Svanasana) with head support
2. Standing Forward Bend (Uttanasana) with head support
3. Widespread Standing Forward Bend (Prasarita Padottanana) with head support
4. Headstand (Sirsana)
5. Shoulderstand (Salamba Sarvangasana) with a chair
6. Plow pose (Halasana) with a chair
7. Supported Bridge pose (Setubanda Sarvangasana) with straight legs
8. Legs Up the Wall pose (Viparita Karani)

You can see photos of all these poses in my post All About Supported Inverted Poses. I do understand that some of those poses are not accessible to our readers (though you can do just the ones that are, skipping over the ones that aren’t). 

In the days to come, as I recover from a very stressful few weeks, I’m going to plan several sequences that prepare me for a nice, long Legs Up the Wall pose. For example, a series of straight leg standing poses (such as Triangle pose, Half Moon pose, and Pyramid pose) will prepare me for seated forward bends, and after a few seated forward bends, I’ll be all set for a nice Legs Up the Wall pose. (If I want to do Headstand again—actually I try to refrain from doing this every day to keep from overstressing my neck—I’ll put that and Shoulderstand before the seated forward bends). Or, I might do a few twisting standing poses (such as Revolved Triangle and Revolved Half Moon) and then some seated twists, ending with, yes, you guessed it, Legs Up the Wall pose. Headstand/Shoulderstand could come either before or after the seated twists. I will avoid active backbends for some time (I find these over-stimulating when I’m stressed), though I will do some passive backbends to keep my body balanced. 

At night, before sleep, I will do a short session of breath practice, where I lengthen my exhalations (see Yoga You Can Do in Bed  and Yoga for Better Sleep). The hope is that by practicing conscious relaxation immediately before sleep, I’ll sleep more soundly. I do the same practice if I wake in the middle of the night and can’t get back to sleep.

I do know that other people might find restorative yoga helpful when they are feeling stressed out (see Restorative Yoga: An Introduction). This is especially true for people who find inverted poses challenging, but I suspect it also has to do with natural temperament, maybe even according to Ayurvedic types. So I just don’t feel like practicing restorative yoga poses, unless I’m exhausted. 

Q: Now, I’m curious about you, dear readers. What are your go-to asanas when you’re going through a stressful period or your nervous system feels over-stimulated? And why do you think those poses work well for you? Please let me know either in the comments section of this post or on our Facebook page.

—Nina

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Attachment (Raga), Depression, and Plan Z

by Nina

Plan E

Did you read my recent post about attachment Attachment (Raga) to Our Ideas About Ourselves? Because I’m starting to feel I’m going to be exploring this topic for some time. For one thing, just a couple of days someone close to me found out that he has heart disease, and I know this means he’s going to have to let go of some of his plans/dreams for his future. I don’t know how this is going to play out, but I know it will be painful for him because he was particularly “attached” to his vision of how he should live his life. Also, I know that Jill is going to write something very interesting about her attachment to her appearance. (Jill and I are having a very interesting time exploring the overlap between Buddhism and yoga philosophy.)

But for today I simply want to clarify something about my previous post, because a conversation on Facebook made me realize that something I said may have been misleading and I really want to be clear that I do not see meditation or a even well-rounded yoga practice as a cure for depression. I’ll begin with the Facebook comments from the reader, Lynn Somerstein, and me, and then I’ll comment further. (The really wonderful thing about this Facebook discussion was not only that it made me think, but I also ended up chatting with Lynn, who is a psychologist, a yoga teacher, and a writer, privately. So now we’re friends and may even work on some projects together in the future!)

Lynn: Although I read your blog regularly and gladly, I think today's post is a dangerous oversimplification of what depression is, does, and how it should be treated. People who are depressed often are unable to meditate-- instead they focus on all that they feel is wrong and they experience this as meditation, rather than a symptom of their illness. Depressed people need therapeutic help.

Nina: Sorry if you thought this was about depression. It is not. The person in question is getting professional help and medication. I always recommend that and consider yoga as a supplement only. However, I do think that part of recovering means being able to let go of certain things, and I know this from having gone through this myself (including therapy). I have written some about yoga for depression on the blog, which if you read those posts you will see that I never claim yoga can cure depression. –Nina

Lynn: Thanks Nina. Yoga and Psychotherapy together are a great help for depression and anxiety too. Thank you for answering my comment. I do read your every post. Namaste.

The post I was referring to about the limits of yoga for helping with depression was Yoga is a great thing, but..., in which I addressed the issue directly. The issue of problems that people with depression, anxiety, and other emotional or mental imbalances might have with so-called "relaxing" poses in When Relaxing Isn't Relaxing. Baxter also wrote a relevant post  Friday Q&A: Can Meditation Be Dangerous? about this.

After this discussion I contacted Lynn privately to ask if I could use her comments in a post and she agreed. After she agreed, I asked her if there was anything she wanted to add to her comments. By then, she had read my articles, and she sent me the following comment by email:

I agree, as you wrote in "Relaxing Isn't" that opening your eyes can help. For those who simply don't profit from meditation using a simple movement that can be connected with the breath, like walking or swimming, for example, may work better; as the body and breath unite, the mind quiets.

So, yes, just to be completely clear: I do not believe that meditation or yoga alone can cure depression, and anyone who is suffering from this illness should seek help from a professional. And thank you, Lynn, for helping me realize I needed to clarify this.

However, yoga can be a wonderful supplement in the recovery process, as the asana practice (like walking or swimming) can help get you out of your head and into your body, and sometimes certain asanas can energize or calm you (depending on which you need). See Tamasic and Rajasic Depression. Patricia Walden, a senior Iyengar yoga teacher, who herself suffers from depression, teaches workshops on yoga for depression, and you can find out more about her work in Yoga As Medicine by Timothy McCall (Patricia was Timothy’s first main teacher, and he did his teacher training with her). I have taken her workshop several times, and have been very inspired by her work. I still believe, however, that for some people, part of the process of recovering from depression (and maybe this is an essential part of therapy, but I can't speak to that) includes letting go of certain attachments, including the agenda you had for your life. And before you can move on to that step, you need to be ready to admit that attachment, as Patanjali says, IS an affliction.

2.3 avidya asmita raga dvesha abhinevesha klesah


The five afflictions (klesas) which disturb the equilibrium of consciousness are: ignorance or lack of wisdom, ego, pride of the ego or the sense of ‘I,’ attachment to pleasure, aversion to pain, fear of death and clinging to life. —Yoga Sutras, translation by Edwin Bryant 

To end on a lighter note, I’ll tell you a little story about letting go of plans that I’ll call “Plan Z.” On Sunday my companion and I went into New York City for lunch and a walk around Alphabet City (so many wonderful community gardens there!), and our plan was to take the PATH train home in the mid-afternoon and then do some work we needed to finish. Let’s call that Plan A. Well, it turned out the PATH was completely closed down due to a fire in the tunnel. So Plan B was splurge on a taxi (we weren’t going very far from home, and if there had been a way to walk across the Hudson river, we could just have walked). After a long time trying to flag one down and failing (Other people who couldn’t take the train? People leaving from the Climate March? Both?), we moved on to Plan C, which was calling Uber and/or a car service. Uber was surge pricing, which offended my companion, and we couldn't get through to the car service, so we came up with Plan D, which was to take a ferry to a certain city in New Jersey, and then walk home from there. Our backup plan for that was to go to Penn Station and take a train to Newark, but we knew by now that Penn Station was going to be super crowded. (My companion joked that Plan Z was that we would drink the entire bottle of artisan cucumber vodka we had purchased as a gift for someone and spend the night in Washington Square. Obviously, we weren’t going to do this, but it was a joke that we kept making that cheered us up, and also allowed us to discuss the whole concept of staying calm while letting go of plans in a light-hearted way—okay, maybe black humor—but we like that stuff.)

We decided to walk on the High Line (the beautiful elevated park) to make the most of our walk to the ferry, but we were rushing a bit because it was getting later and later, and the ferries stopped at seven. When we finally made it to the ferry terminal we found that the ferries to the city we wanted to go to didn’t run on weekends, so we made a snap decision to take the ferry to Hoboken instead, and figured from there we could either take the light rail train or walk. We called this Plan E. Plan F was if we couldn’t get on that ferry, we’d go to Penn Station. Long story short-ish, we got the second ferry to Hoboken (some other people had the same idea about how to escape from Manhattan) and then had nice dinner in an outdoor restaurant. Refreshed after our rest and meal, we were able to walk the rest of the way home. 

Obviously, this “escape from Manhattan” could have been very stressful (we had reasons why we needed to get back home that night) but our joking about all our plans and backup plans and how we had to keep letting go of them, helped us stay calm and even enjoy many aspects of our adventure. There were people playing bagpipes below the High Line at one point—why?

Unity Farm Journal - Fourth Week of September 2014

As we prepare for winter, we’re busy splitting wood, preparing the winter garlic beds, and finishing the building maintenance tasks for the cold and wet months ahead.

We burn about 3 cords of wood each winter, all split from fallen trees on the farm.   We use small amounts of cedar as hot, fast burning kindling.   We use Oak, Maple, Ash, Hickory and Black Bird for hot, slow burning sustained warmth.   We do not use poplar, which burns cool/quickly, instead saving it for mushroom production.

Last week I created a system for labeling all our half-cord wood racks (21 of them).   I painted galvanized strips of metal which now hang from hooks on each rack, coded as follows

Cedar - Red (Red Cedar)
Oak -  White  (White Oak)
Maple - Gold (Golden Maple)
Ash - Green  (Green Ash)
Hickory -  Unpainted  (Hickory has no color names)
Black Birch - Black  (Black Birch)

This winter we’ll have fully cured wood of all types, so we’re ready for whatever Mother Nature throw our way.

We’ve found good homes for many of our Summer guinea offspring and the total count is now down from 88 to 68.  Ideally we’d like to overwinter about 50.

We’ve picked McIntosh and Roxbury Russet Apples.   Our Empires will be ready in a week or two.   We’re looking forward to 3 more weekends of cider pressing in October/November.    The fermentation of our first batch is going well and we’ll likely rack it this weekend and then start malolactic fermentation, turning the sharp malic acid into rounded, complex lactic acid.

We continue to harvest tomatoes, turnips, and greens from the hoop house.   Peppers and eggplants are nearly done producing.   We’ll replace those raised beds with winter lettuces soon.

We'll plant the garlic in mid October, but the outdoor raised beds for overwintering garlic are ready.

The big project over the weekend will be building our room sized refrigerator for storing all the mushrooms of Fall between picking and delivery to farmstands/farmers markets.    Our Italian and Grey Dove Oysters are fruiting.  Our Native Harvest Shitake are pinning and we’ll pick them soon.    We’ve optimized our mushroom workflow by using plastic picking boxes from an agricultural supplier in Canada.   We use one container from log to refrigerator to market.

The bee preparation for winter continues as we feed them, optimize the hive configuration to reduce moisture/cold, and ensure pests/diseases are minimized.

One of the ducks aspirated some water (caused by rough underwater mating behavior) and we’re treating her with antibiotics for pneumonia.  Her breathing is labored but she’s eating/drinking, and alert.

I look forward to a weekend of crisp Fall weather, harvesting, hauling, and preparing for the months ahead.

You know Meaningful Use is Real When...

My 83 year old father-in-law returned from a recent outpatient visit to his primary care provider with two customized handouts  - a transition of care summary detailing problems/meds/allergies and an opt-in consent for the exchange of that care summary over the state Healthcare Information Exchange, the MassHIWay.

We discussed them over dinner.

A photo is shown below (with his consent)

As I’ve written about several times, the Meaningful Use Stage 2 Transition of Care and Patient Access requirements are hard since they require environmental and cultural changes.   There’s no magic bullet to implement them, it just takes time and diligent effort, one patient at a time.

His opt in consent is signed and his data is viewable throughout Massachusetts for care coordination, population health and quality measurement.   The numerators for Stage 2 are being incremented every day.

As I watch the rollout in Massachusetts I see an amazing trajectory - over 150 healthcare organizations are on the MassHIWay, using the standards required by Meaningful Use Stage 2 certification.  The key to our success has been low cost, a flexible on boarding approach, and common patient/provider educational materials shared by all.  

Here are the actual statistics of what BIDMC has sent over the past year using Meaningful Use Stage 2 standards.  

As I described in a previous post, this is more evidence of interoperability that’s real.

How do we ensure that extends across the industry?

When I meet with many vendors, they measure success when the sale is made or when the go live occurs rather than when adoption achieves the outcomes desired.    Today I’m at KLAS in Salt Lake City with several EHR vendors discussing “magical thinking”.    Over the course of the day we all concluded that we need to redefine success based on outcomes - mutually aligned self interest that pays vendors for achieving commonly agreed upon goals.   The CIO wants improved quality/efficiency, fewer emails, and great communication.   The vendor wants to make a sale, achieve customer success/reputation, and grow market share.    Some vendors have recast their business as a process delivery rather than product delivery.    We can all learn from that.

My father in law has demonstrated the Meaningful Use policy outcome - an understanding of his care and respect for his privacy preferences.  As we think about the next steps to enhance interoperability, industry stakeholders should forge collaborative relationships outside of regulation that align incentives to achieve the results we all want.

Savasana: Silent or Not?

by Baxter

One of our readers recently sent us this topic idea for a post:

I am usually ready to cry in class when the teacher insists on talking throughout Savasana. I had one class where the teacher literally droned about how important silence was for >10 minutes. If silence was so important, why couldn’t she have given us some?

There is more to this question than meets the eye, or the ear in this case! Some of the challenge is that modern Savasana (Corpse pose) is taught is so many ways by so many teachers, and different modern yoga traditions often have different recommendations on the best way to do it and what the purpose or focus should be.

One option is that Savasana is just another body position in which you can meditate. If so, getting yourself or your students into a comfortable Savasana and then letting yourself or your students use whichever the meditation technique they are presently practicing for the remainder of the Savasana time is all that is required. So there would be the potential for the room to be quiet for a good part of the pose (that may not be the case with your mind, of course, but that is what you are working on!). In a mixed level class, I feel as a teacher that I may need to talk for a few minutes on how to enter the meditative practice, especially if I have newer students in class.

There is another option of Savasana being used for a guided mediation, such as a simple body scan (see Audio Tracks for a free recording) or a more elaborate yoga nidra practice (see Audio Tracks for recording of a short version), in which the practitioner is guided by the voice of teacher for most of the time in the pose. I find for students with very active minds who get more busyness in their minds when the room is completely quiet, these guided meditations in Savasana actually quiet their minds and bodies more effectively than a silent personal meditation.

In some traditions, Savasana is also used as a spacer between more active poses, where the practitioner goes into Savasana between every other pose done in a particular practice. That is a lot of Savasanas! But in these classes, it is only held for a minute or so, and can be an opportunity to reflect on the effects of the previous pose done or just to rest.

Historically, Savasana, translated as “Corpse” pose or “Death” pose, was likely nothing like it is today. After all, who in their right mind would name a pose after death if they wanted to appeal to a modern audience! This is probably why a lot of teachers rarely mention the real translation and instead call it “Relaxation” pose. In has book Original Yoga Richard Rosen notes:

“We know for sure that some schools of Hatha [Yoga] encouraged members to frequent graveyards and to meditate there on the transience of life while perched on a corpse no less—quite literally a Shavasana, “corpse” seat.” 

Why on earth, you may ask yourself, would they want to do something like that? Richard explains:

“Death, too, had a different meaning for these men; it stood not for the much-feared end of worldly life, but for the death of their limited ego identity and their final release from existential suffering.”

Richard has more to say about this important pose in his book, and I highly recommend the book for those of you who don’t already have it!

So, to our reader, I’d encourage her to find a teacher that offers the Savasana experience she is looking for, or push the boundaries of her understanding of Savasana and try out many types of Savasana with an open, curious mind. 

For more on Savasana, see Savasana (Corpse Pose) for instructions on how to practice Savasana, Savasana (Corpse Pose) Variations for information on supported versions of the pose, and Friday Q&A: Savasana vs. Seated Meditation for a conversation between Nina and Timothy McCall about the difference between meditating in Savasana vs. seated meditation. 

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9 Tips for Being a Good Yoga Student

by Nina

Teacher's Birthday by Norman Rockwell*

In my post When to Fire Your Yoga Teacher I wrote about the responsibility that a yoga teacher has (or should have) to respect his or her students. But like every relationship, the teacher-student relationship is one that goes both ways. All of us here at Yoga for Healthy Aging are both yoga teachers and yoga students. No matter how much or for how long we’ve taught, we also still take public classes from valued teachers we highly respect. So we have a pretty good idea of how to conduct ourselves on both sides of the equation. And, frankly, I’ve recently heard some disturbing stories about student behavior, including a student who seriously injured himself after ignoring his teacher’s warnings. So I decided it was time to write a little something about how to be a yoga student.

After giving it some thought (and talking with one of my teacher friends), I’ve come up with the following guidelines. This list has just been updated after my original post (see Eight tips for Being a Good Yoga Student). However, if you have more suggestions for guidelines you think I’ve overlooked, please comment on this post or send me an email, and maybe I’ll update once again!

1. Tell your teacher before class about any injuries, medical problems, or other issues that might affect your performance during class. See What Your Yoga Teacher Really Wants to Know for details about what kind of info your teacher needs to keep you safe.
2. Make an effort to show up on time to class. All your yoga classes are planned with appropriate warm-up or opening poses, and missing the beginning of class can affect your ability to do the rest of the sequence. Besides, it’s just good manners!
3. Pay attention to your teacher’s instructions. We all have wandering minds—the kids, the job, your date tonight, the phone call from your mom yesterday, dinner—ooh, yes—but concentrating as best as possible on being present in your class will not only help you stay safe (which is a priority for your teacher), but you’ll also learn more. In addition, staying present will make your yoga session more effective at reducing stress levels as you get a break from your everyday worries.
4. If your teacher asks you not to do something because he or she is concerned for your safety, don’t do it, even if you feel confident that it won’t be a problem for you. Just. Don’t. Do. It. Okay? Your teacher may be wrong, but he or she is trying to look out for everyone in the class.
5. If your teacher asks you to do something that you don’t usually do and don’t particularly want to do—use a particular prop, change your alignment, try a new pose, and so on—go ahead and try it, just this time. You might learn something new, and you can do whatever you want later in your home practice. The only exception to this is if you feel your teacher is asking something that will put you at risk for injury or other harm, or something that you are absolutely too frightened to try. In this case, briefly explain why you can’t do it, and ask for an alternative.
6. Rest if you need to (see Resting Between Poses). Stop if you are in pain (see When to Stop Practicing Yoga). Looking after yourself is a great favor to both your teacher and yourself.
7. Don’t flirt with your teacher, ask your teacher on a date, or make inappropriate personal remarks (you know what I mean). Good yoga teachers don’t have romantic relationships with their students, and overstepping the boundaries they are trying to maintain only makes them—and other people in the class—uncomfortable. (I hate to have to bring this up, but, really, I’ve heard some disconcerting things over the years....)
8. Also, respect your teacher's boundaries and limitations regarding time spent with you outside of class. Asking a simple question before or after class is appropriate and often welcomed, but you should not request free advice or guidance outside of the classroom, whether in person, by phone, or by email. Of course, many teachers give private lessons for a fee, so if you need or want personal attention and can afford it, consider that alternative.
9. After class, give your teacher occasional feedback about what you found helpful, what you found confusing, or what didn’t work for you (very politely, of course!). All of us teachers want to continue to learn and, hopefully, improve, and getting occasional feedback is very valuable. So don’t be shy!

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