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Archive for January, 2012

As noted in the blog post Complementary Medicine In Cancer Treatment, the number of patients using complementary and alternative medicine is too large to ignore, or avoid, by anyone involved. It is in everybody’s interest to have open, objective discussions on more holistic treatment. When 38 to 60 percent of patients take complementary medicine without informing their doctors, it is a significant issue for both. Why is there this divide?

According to the paper we have been working with in these posts, here are some reasons:

* the topic never comes up in discussion with the health care team
* patients believe that they will be met with indifference or a dismissive reaction
* doctors do not know how to respond
* conventional medical providers don’t know anything about CAM

Talking to the doctors in our network of family and friends who are willing to express themselves anonymously, we find the following:

* many doctors do not think there is any legitimacy to CAM and it also raises serious issues of medical legal liabilities for them
* they are afraid of what their peers and other patients (who are not open to CAM) may think and are therefore reluctant to step out of the normal bounds
* they do not know anything about CAM and given how busy and hard-pressed they are, there is no time to learn enough to give adequate advice to patients

These are all valid and understandable reasons on both sides. However, the numbers suggest that unless this divide is bridged, there are risks to patients. Here are some:

* patients rely on hearsay, the Internet, dubious and misleading advertisements for information–some of it is just plain wrong and dangerous
* patients use CAM treatments that are at best useless and at worst, harmful to them
* these treatments may interfere with, or impede, their ongoing conventional treatment–as their doctors do not know what the patients are doing, they have no way of knowing why the treatment may not be working or perhaps the cause of some adverse reaction

So bridging this divide is critical. I know of several people who persistently talk to their doctors about the yoga and meditation they are doing and supplying them with information regardless of whether the doctor reads it or not. They are proactive patients who do not expect the doctor to raise the topic. Over time, some doctors start becoming more open as they see that something is working well for these patients. At least for some the holistic approach that combines the best of conventional medicine and CAM is producing better outcomes, a better quality of life, better overall function, less anxiety/fear/loss of control.

The next post will discuss what evidence-based CAM is recommended in the paper. I am still waiting to get a response from the lead author for the request of an updated list of resource websites as some in the paper do not seem to exist now.

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As we are talking about integrative oncology, it is helpful to know how oncologists who practice complementary medicine define themselves as well as the care they provide. I think this whole approach can be safely extrapolated to cardiology, gastroenterology, gynecoloogy, neurology, and pulmonology when you read on and understand the background.

In the paper cited in the last post, the Society of Integrative Oncologists (SIO) describes integrative oncology as both a science and a philosophy that focuses on the complex health of people with cancer and proposes an array of approaches to accompany the conventional therapies of surgery, chemotherapy, molecular therapeutics, and radiotherapy to facilitate health.

SIO emphasizes awareness and sensitivity to the mental, emotional, and spiritual needs of a patient. The member oncologists propose to do this by combining the best evidence-based complementary therapies and mainstream care in a multidisciplinary approach that evaluates and treats the whole person.

When I read the definition of integrative oncology and its goal, I was struck by how it is almost identical to that of yoga. The highlighted parts define yoga and its goals. Substitute “yoga” for SIO or integrative oncology. In yoga, the multidisciplinary approach includes hatha, raja, tantra, karma, bhakti, and jnana yoga.

Another point that struck home was the use of the word “spirit” in the healing vocabulary of medicine. Even as the medical academia is embracing a new way of caring, yoga is regressively narrow in its myopic and exclusive attention to hatha yoga. Whatever little research is done is solely on aspects of hatha yoga. The other aspects of yoga can significantly add to the quality of life and healing at the emotional, mental, and spiritual levels.

The next post will inform how and why integrative oncology came to be.

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Slowly, complementary and alternative medicine (CAM) have quietly found acceptance in at least some areas of medical academia. The recommendations, based on evidence, are usually for complementary medicine as opposed to alternative medicine. This important issue will be covered over several posts as many of our readers (this blog and www.mahasriyoga.com) in over 80 countries are deeply interested as patients, caregivers, and doctors. We strongly encourage our readers to participate in a discussion on this via comments or e-mails. Our readership has grown from 35 to over 80 countries in 2011.

Alternative medicine is defined as a substitute for mainstream care and not recommended by the Society of Integrative Oncologists (SIO). According to SIO authors of the source paper cited below: Complementary medicine makes use of unconventional treatment modalities and approaches that are non-surgical, non-pharmaceutical but that have known efficacy. When combined with mainstream care, these modalities can enhance effectiveness and reduce adverse symptoms….Over time, some complementary therapies have proven safe and effective.

SIO includes the following in its list of CAM: mind-body modalities, massage therapy, physical activity, energy therapies, acupuncture, diet, and dietary supplements.

According to the National Center for Health Statistics (NCHS which is part of the Center for Disease Control and Prevention) National Health Interview Survey of 31,044 adults in 2002 in the US:

75% of respondents used some form of CAM (including prayer)

50% use some form of CAM (excluding prayer)

80% of cancer patients use CAM, mainly as complementary therapy (Data Monitor 2002 Survey)

40% of cancer patients use CAM during survivorship period following acute cancer therapies

In Japan, according to a separate nationwide survey conducted in Japan, 53% of lung cancer patients use CAM. This is the highest use of CAM in all cancer diagnosis.

CAM users in the US, Japan, and Europe are younger, more educated, more affluent.

The source of all this information:

“Evidence-Based Clinical Practice Guidelines for Integrative Oncology: Complementary Therapies and Botancials” published in the Journal of the Society of Integrative Oncology, Vol 7, No 3 (summer), 2009, pp 85-120. I am having difficulties in providing a link to this source that was listed in the latest, January 2012, NCCAM Clinical Digest (NCCAM_CLINICALDIGEST@LIST.NIH.GOV).

The blog will devote several posts to this important issue and our focus will be yoga and meditation as part of the mind-body modalities. I am often asked by those who attend my class (seniors right now) to speak to their doctors about what we do.

My experience from 2009 to 2011 is that seniors (65 plus), along with all age groups, are increasingly aware and seeking CAM. Our area in the US is affluent; the seniors are proactive, knowledgeable, and open to new options.

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Returning from our trip to India, my friend Bonnie gave me the The New York Times Magazine, dated January 8, 2011, because of the article “All Bent Out Of Shape: The Problem With Yoga”  by William J. Broad. The author is a senior science writer at the paper and the article is adapted from his upcoming book, The Science of Yoga: The Risks and Rewards.

With the dust of Indian villages, towns, and cities still clinging to my shoes, reading this article makes me think Broad is indeed naive, as he claimed to be until he was enlightened by yoga teacher Glenn Black, along with much of the yoga world here.

Yoga is a source of healing and never harm. That is not naive, it is a fact. What is naive is the individual’s delusional, foolish attitude by doing what is harmful, perhaps pushed by a teacher. A knife is an essential tool in the kitchen but if someone does not know how to use it, it can cause harm. In a violent person’s hand, it kills; in a surgeon’s hand, the knife heals. So the knife is not the fault, the way it is used or abused produces the different outcomes.

Yoga does not cause harm. Its abusive, uninformed, and misguided practice causes harm. Normally sensible, intelligent people, who research and question doctors, accountants, lawyers, for some unknown reason drop common sense on the floor along with their shoes when in a yoga class. It never failed to amaze me! I saw someone who had injured his cervical vertebrae through repeated headstands and handstands. He came to me to heal and then went right back to doing what caused him injury even though he was told that these positions were not for him. He could have opted to do simpler poses and held them for 30 seconds instead of several minutes. The choice was his and yoga could hardly be faulted. So the question is, What makes people make poor decisions that are potentially harmful to them? What is in their minds? What is the thinking? Do we desperately want to believe in something that is not real as we evade our own reality? Yoga asks that you face yourself and life with complete honesty, objectivity, and acceptance. It is fundamental.

In 30 years of teaching I stated that we would not do inversions–no headstands, handstands. Only some could do the shoulder stand. Reasons were given to explain why every asana was not appropriate for everyone. Many stayed on, many left because this was not what they wanted to hear–they wanted the asanas that had the potential to hurt them! Here, I totally agree with  Black’s experience after his spinal surgery as he tries to explain that these asanas are not for everyone and finds that people do not want to hear it.

I have heard yoga teachers brag about their yoga injuries as badges of honor. They are totally uninformed about the limitations and contraindications of the different poses. Broad and Black should read Asana Pranayama Mudra Bandha by Swami Satyananda. They seem to have missed one of the most important books written over 40 years ago. Injuries such as stroke, blurred vision, retinal detachment, are all risks associated with inversions (including prolonged downward dog) and those positions are contraindicated for many people. The limitations, risks, people who may be at risk, are all indicated in the book. Even backbends and foward bends require thought. For instance, in the locust the leg should be lifted just 6-12 inches off the floor. Lifting further no longer stretches the spine and instead compresses the lumbar vertebrae. This causes pain and possible arthritis. Observe and feel the body clinically and you will sense it right away.

The problem is that yoga teachers are not taught this, even though the information is there. The ones who know and refer to this book choose to ignore it. It is too much trouble to ask each class member their medical history. Fear of being sued is great. Modifications in a class are disruptive for them. The teachers find all these details bothersome and say that those who come do so at their own risk and as they sign waivers, the teachers bear no responsibility. The teachers are also wary of scaring away people as their aim is to pack the room and promote yoga as the panacea to all ailments and problems. The teachers are at risk themselves because of the ignorance. I have seen this many times at local yoga studios and at teacher training programs. There is a glaring lack of intellectual curiosity, thought, reflection, and scientific observation–all are required in yoga.

Just as every medication or vitamin out there is not for everyone, nor is every asana. An experienced teacher can help choose what is appropriate. Yoga is not just for those in generally good condition, if taught properly. It offers something for everyone. However, the way it is taught in American Yoga, it is true that a general class is for those who are pretty fit.

Several years ago, I went to a teacher training class on chakras at Dharma Mittra’s studio in Manhattan. The teacher was some medical doctor. I came away totally disappointed. The man knew far less about chakras than my students. He refered to a Bihar School of Yoga book and did not understand anything from it. After the class, I asked Dharma Mittra a couple of questions about chakras and came away wondering what the big deal was about him, he had waffled. Yes, he can do many tough asanas but so can an acrobat.

So whose fault is it that we put people on pedestals when they don’t deserve that place? People buy into the marketing and PR but surely after a class or two they should realize if it is for them or not. My yoga friends tell me how they are pushed to do inversions in various yoga classes (I no longer teach) and even though I have drummed into them over the years that they should avoid these positions, at least one of them got nudged into doing it in a class and felt she had hurt her neck.

Having  just returned from our annual India trip to life in villages, small towns, and middle class urban areas (as opposed to affluent South Mumbai), clearly people live very different lives. They squat to go to the toilet, wash clothes, sweep and mop floors, and clean dishes. They sit on the floor to cook, iron, eat, bathe, and socialize. The diet is whole grains, legumes, and fresh vegetables. Their lives are physically active. Most sleep on a mat or hard mattress on the floor. There is no air conditioning in the summer or heating in the winter. The gait of the walk is different. They do not wear high-heeled shoes. Asanas that apply to them may not work for the lifestyle, weather, diets, and bodies over here. For instance, laghoo shankprakshalan (bowel cleanse) is so much easier for the people in India than it is for people here. The yoga that I learned in India was physically far less challenging than anything I see now.

Yoga injuries arise for various reasons: inappropriate use of yoga, ignorant teachers, students who refuse to use common sense. Adequate data and statistics are not available to assess yoga injuries. As more people practice yoga, the number of injuries will rise but the ratio may remain the same. People who practice yoga here also have other activities that can cause injury–dance, Pilates, jogging, weight training, strength training. It is often impossible to assess what caused injury.

Finally, people understandably feel compelled to go to “brand” names whether it makes sense for them or not. As I look around, none of these “yoga teachers” are really yogis to me. They are in the business of physical fitness classes that use yoga asanas out of context and with little understanding. It is more about the business of yoga, the inflated personal ego of the teacher, and the ego of the student.

Simpler asanas are far more effective than complex ones. But hardly anyone teaches the simple ones because people think they are getting more for their money with the difficult, showmanship asanas. There are places that hold true to the integrity of yoga–Satyananda Yoga and Himalayan Institute from the northern lineages of raja and tantric yoga; and Desikachar from the southern hatha tradition. A general class is possible for people if it is designed with thought and care. I did it for many years and we had no injuries.

As far as Indian gurus go, not all are the gurus they claim to be–many have their own ego trips and issues. Using some common sense is always helpful. Iyengar will be the perfect teacher or guru for many but he is not for everyone. For me, it was Swami Satyananda and even though I respect Iyengar, he was not for me and I would never have suited him.

Traditionally, the guru is a spiritual guide as well as a psychotherapist and a physical therapist. He holds you by the hand, body, mind, and spirit. This relationship is rooted in trust. It is nothing like dropping into a “yoga class”. A true guru is hard to find and how many out there really want one?

People get what they seek. So please don’t get all bent out of shape about yoga.

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