The Yoga MD

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#SLOWSEPTEMBER

September and some relief from summer’s humidity. My brain basically stops on humid days,
my thoughts feel like they are moving through pea soup. Thick and slow. So I love it when the
humidity breaks and the cooler air of fall starts to seep in.
I have recently marked the fourth anniversary of my concussion, and though most days are
better, the atmospheric pressure changes still get the best of me. I have no control over the
weather, and that is frustrating when it affects my function. But I have less resistance to it now
and less anger. I have almost learned to surrender. I say almost because I would be lying if I said
that I didn’t test it, that I didn’t still try to push through. Yet, it is so much better when I am
mindful and accept it. Unfortunately, after four years, I have to accept my circumstances because
I will still pay for it when I do overdo it. Luckily, the hard days are fewer, and I have learned to
slow down.
The road to recovery post-concussion is not easy or smooth. The more concussions one sustains,
the longer it takes, and the greater risk of persistent symptoms. Many people with persistent
symptoms say five years and still have to do things differently. Aging probably doesn’t help. In
the next few months, I will be turning 50. Shocker – I still feel 29. But here I am, and it is time
for me to move on to another stage of life.
South Asian culture follows the Ashram System, the four life stages. The first life stage is called
Brahmachara – the child and student phase of life when we focus on growing and learning. After
this, we move into Grihastha – householder stage. This is the part of life where we focus on
family, our occupation, and building wealth. It generally lasts from our 20s to late forties or
fifties, though our modern culture has changed the timeline. After this stage, we move into the
Vanaprastha stage, which translates to forest dweller. At this stage, it is time for the next
generation to take over. We take on more of an advisory role, mentoring and supporting, while
we develop our spiritual side. Then we may move on to the Sanyassa stage, where one will
further detach from life, renouncing material things and desires.
From a career point of view, I find myself in the Vanaprastha stage. Honestly, I never thought I
would reach this stage so soon! In some ways, this change in stage has been hard to accept, as it
was not necessarily my choice. Truthfully, I am a workaholic. Yet every time I increase my
patient load, my health suffers. So again, I am stepping back a bit, and changing how I do things.
I do welcome this time to slow down, to reflect, meditate, and write. I am learning to find the
sweet spot between sharing all I have learned about burnout, concussion, and yoga while
maintaining my health. In addition, I hope to teach others what I have learned so they can carry
the Reconnect Concussion Program further. I have been steadily working on the online
educational versions of my programs. I hope this will increase access to information for those
with a concussion and their families. This way, more people can benefit.
I also hope to get back to guiding our helping professionals recovering from burnout – these past
few years have been brutal. So stay tuned for a membership option for yoga and for the re-launch
of the Rest, Reset, Rise! Program online, which you can do at your own pace. It will involve
short audio recordings, which you can listen to on the go, yoga practices, and reflective exercises
to help you transform your life! We will also schedule coaching calls to connect and reflect on
the process.

Finally, it goes without saying that I will need to be closer to my parents as they age. The
caregiving role never ends as a woman or a daughter. This will likely require yet another pivot.
But, of course, caring for others requires caring for self. If there is one thing this injury has
taught me, it is how much effort, energy, and time self-care really involves. It was certainly
beaten out of me in my medical training.
So I will be going slow this September, conserving my energy, and at my own pace. I challenge
you to do the same. #SLOWSEPTEMBER

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Vata season! Time for Soups + Stews

Mediterranean Lentil Soup

This recipe is from The Stop Community Food Centre cookbook Good Food For All: Seasonal Recipes from a Community Garden written by Joshna Maharaj (@Joshnamaharaj). It’s a beautiful cookbook supporting a great organization, so be sure to pick up a copy!

As we move into fall, we enter Vata season. At this time, many of us may feel ungrounded as our bodies adjust to the cooler days and prepare for the slowing of winter. In such times, you may be craving comfort foods. Warm soups and stews with root vegetables can help us feel grounded as the world around us changes.

One of my favourite soups at this time of year is the following version of Mediterranean Lentil Soup. It is similar to red lentil dahl, which is a little thicker, has carrots, cilantro and other veggies to make it a complete dish on its own.

Ingredients:

  • 2 tbps vegetable oil
  • 1 cup chopped onion
  • 3 garlic cloves, minced
  • 1 tsp ground cumin
  • 1 tsp ground coriander
  • ¼ tsp turmeric
  • Cayenne to taste (optional)
  • 1 2/3 cups of red lentils, rinsed and picked over
  • 7 cups of vegetable stock, chicken stock or water
  • 5 carrots, halved lengthwise and sliced thinly, crosswise
  • 1 cup finely chopped red bell pepper
  • 1 handful of fresh cilantro, finely chopped (you can use the stems as well as they are full of flavour!)
  • ¼ cup scallion, greens only ( I substituted chives from my garden)
  • Kosher salt and freshly ground pepper
  • ¼ cup crumbled feta
  • Fresh cilantro sprigs for garnish

Method:

  1. In a medium sized saucepan, heat the oil on medium-high heat. Saute onion until translucent, then add garlic and cook for 1 minute more. Add coriander, cumin, turmeric, and cayenne and stir to combine. Add lentils and stock or water and bring to a boil. Simmer gently, partially covered, fro 15 minutes, occasionally skimming the froth off the top if necessary, until lentils are just less than tender. 
  2. Stir in carrots and red pepper. Simmer another 10 minutes, until carrots are tender. 
  3. Stir in scallion greens, cayenne, and salt and pepper to taste. 
  4. Serve soup garnished with crumbled feta and cilantro sprigs.
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Been around the SUN + Smiling!

It is November, and it is my birthday month. I have completed 49 years around the sun. Not too shabby.

They say the 40s are your best decade. I wholeheartedly agree. There was a lightness, a sense of a weight that lifted off me when I turned 40. 

Truthfully, it has been a roller coaster of a decade – life-changing, career changing, health changing.  Mid-life crisis is accurate, and I am just happy that I made it through my Forties in one piece, even if I needed to glue those broken pieces broke back together. Looking back on it, I know it all had to happen. So, along the lines of the tradition of Japanese bowls, I have put myself back together with gold, a better reflection of my truth. 

If I am being honest, my body has been begging me to slow down for a long time, constantly sending signals to go slower still. I thought I was listening, but then I got whacked on the head as I cycled from work to yoga. 

Recovering from a concussion has taken self-care to a new level for me. It forced me to learn the hard way and listen to all my body’s warning signals. Because now, if I am not listening, if I get caught up in my mind and or push myself, my ears start to ring, my ability to process information shuts down, and my body begins to ache all over. I have learned that self-care is a much more involved process than what everyone preaches. It takes effort, and it requires a daily conscious commitment and a lot of self-compassion. Yet living this way is how I should have been living before – slower, taking breaks, and more in tune with my own needs.

So, here I am at the age of 49, surrendering daily and finding comfort at this new pace. Though my mind still thinks it should all happen faster or that I should do more, I notice those thoughts and let them go. They are just thoughts, remnants of my past life, that are no longer serving me. The beauty of slowing down, and respecting my limits, is that it has allowed me to be available and present for all the universe has to offer.

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Seasonal Affective Disorder | SAD Lamps

Using your SAD lamp first thing in the morning is best. front of your eyes. Instead, position it about 45 degrees to the right or left from your midline or eyes.

Welcome to November! In the Northern hemisphere, we are now entering some of the shortest days of the year. Many people experience Seasonal Affective disorder, which can leave you feeling depressed.

If you haven’t already, it is time to get out those SAD lamps. My favourite SAD lamp is my sunrise “alarm” clock that wakes me up with the morning light, not an alarm. However, a sunrise alarm clock might not work if you and your partner get up at different times. In that case, a simple SAD lamp may work best for you.

There are many options on the market varying in price from $50 -$200. I have even seen them on sale at Costco at this time of year. If that is out of your price range, a simple Daylight Spectrum bulb or even a light bulb that supplies 5000 to 10000 LUX may be helpful.

Using your SAD lamp first thing in the morning is best. Those who have suffered a concussion may benefit from increased exposure, 45 minutes to an hour if you can tolerate the brightness of the light. Simply place the lamp at eye level a few feet away from you, do not look directly at the light. Then, you can use it when you first wake up or make it a part of your morning routine. 

I use mine during my morning workout. 

Remember to take your vitamin D in the morning as well! The daily recommended dose is 1000 IU. However, individuals with darker skin tones may need to increase the amount from 2000 – 5000 IU, primarily if they are vitamin D deficient. Vitamin D acts like a hormone in our body, so remember that not everyone needs a higher dose, so more is not necessarily better.

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Equity, Diversity and Inclusion – The importance of seeing things from a different perspective

Image – https://www.novascotia.com/things-to-do/outdoor-activities-tours/hiking?f=t8Ki7WybDN

It’s the summer before medical school and I have the most incredible job. I have been hired to hike and map out the trails of Nova Scotia so that the information can be uploaded onto a computer database for everyone to access from anywhere. It’s 1995, and I still don’t know how this is going to be possible. I do not have much experience with the internet, and I haven’t even heard of the World Wide Web.  But I do not really care about the logistics because I am sold on the fact that someone is going to pay me to explore, hike and camp for the summer. My fellow summer students and I are paired up, given our marching orders, and we set off all around Canada’s Ocean Playground.

One night, towards the end of our summer, my co-worker and I find ourselves on the southeast coast of beautiful Cape Breton Island. Another pair of co-workers are in the area as well, and we plan to meet up that evening and share a campsite out on the Mira River that evening.

We get to our campsite and start to set up. I do not want to eat the other’s cooking, so I volunteer to make dinner. They agree, and after pitching the tents, they take on the job of building a campfire. The first guy has a go. He arranges the logs in a tee-pee formation and put some gathered kindling underneath. Then he sets it aflame. Because it rained the night before, the kindling is a bit wet and does not catch. So, the next guy offers to help. He gets some paper, puts it on the kindling and lights it. Once again, it does not catch. Then the next guy makes another suggestion. They continue to go back and forth, trying to get the fire alight. Nothing they do gets the fire going. Then they give up. They sit around the pit and accept that because all three have tried everything, the fire simply cannot be lit. We were going to be sitting around in the dark without a campfire because they believe it cannot be done.

I for one did not want to sit in the dark. So as supper is stewing, I take a turn at building the fire. From where I am standing, I can see that there is too much soot in the pit and that it is wet. (I did try to tell them this, but it fell on deaf ears). I clear out as much as I can and put the kindling and paper back into the pit. The fire catches but does not last. Then I remember that my colleague has packed lighter fluid in the trunk. I grab it and douse a little bit on to the wood. Then I step back, light a match and throw it onto the logs. Poof! It goes up in flames AND the wood finally catches. We have a campfire!

I look over at the guys and smile. They respond with grim faces.

Supper was ready, so I dish out their supper and we sit around the campfire eating. They are completely silent.  They do not say a word to me, and do not even a thank me cooking them dinner! I get irritated.

After a while of sitting in uncomfortable silence, I ask “What’s was wrong guys? Don’t you like the food?” Me so ethnic.

They continue to give me the silent treatment. Then my partner speaks up and says “We are mad that you lit the fire. Lighting a campfire is a guy thing”

I am in shock. A GUY thing? My jaw drops. I had no idea I have made such a large cultural faux pas, and it is not my intention to hurt anyone’s feelings.

So I apologize. Then I say:

“Wait – you all accepted that it couldn’t be done after all three of you had a try. But it could be done, just not by doing it the way you were doing it. You guys just needed to see it from a different perspective. From where I was standing, I could see that the soot needed to be cleaned out, and it wasn’t letting enough oxygen get to the fire.

Obviously, the wood was wet too. But we had lighter fluid, and there’s no law against using it. If using a little bit of lighter fluid could help start the fire, then why not?”

Silence and avoidance.

“Look, I didn’t mean to hurt your feelings. I just wanted to have a campfire because this is our last night out. Honestly, you guys built most of it, I just added my two cents worth.”

I had unknowingly insulted them. But once I explain my perspective, they come around. In the end, they agree that everyone’s contribution was important in getting the job done. We enjoy the rest of the night, out on the Mira, telling stories over the bonfire as it blazes to our delight.

This story reminds of the issues we face in healthcare today. We cannot solve the problems by looking at them from the same perspective we have used in the past. It simply causes us to overlook the root causes of many systemic issues. This is partly because we mostly research and practice from one perspective, while we treat a diverse population, with many variable factors affecting their wellbeing.

I remember hearing Dr. Shawn Whatley, then the President of the Ontario Medical Association, address the OMA’s Women’s Physician Day meeting. In apparent awe, he said we “are discussing important issues that he and general council had not even considered.” Precisely, Dr, Whatley. If we do not create spaces to have discussions with those traditionally not represented at the levels of medical leadership, we will no doubt miss out on many key issues and strategies that are important to leading change and improving healthcare delivery.

To include those voices, we need to actively invite diverse perspectives to the table. Many people may not have had the ability or the comfort level to be at the table, especially if they have previously been excluded, silenced, or shamed due their identity, ideas, perspectives or traditional roles.  We must also make it safe for them to speak and be heard. They are not starting with the same privilege that many at the table have been afforded. So many have also had to put up with the race-based traumatic stress as they train and practice medicine. After dealing with this type of stress daily, there is often little energy or will left to dedicate more time to solving the problems.

It may seem uncomfortable at to try new ways of doing things, especially if we are only used to the Eurocentric methods of governance and problem-solving that we have been taught through our colonized education systems. However, if we can see that our processes have proven to be exclusive and ineffective, then perhaps we can understand why we need to approach our problem from a different angle. Einstein is often credited for saying “Insanity is doing the same thing over and over and expecting different results.” Perhaps it is not the issues of equity, diversity and inclusion that are unsolvable, rather we cannot solve these issues using the same method or thinking that we have used in the past.

I commend the Canadian Medical Association (CMA) for proposing a new procedure to increase under-represented voices in medical leadership. This is a key step to improve healthcare delivery. I am heartbroken that so many of my colleagues did not have the perspective to see why these changes were so important. They may not be perfect, but at least we could apply the methodology of quality improvement. The CMA proposed a plan that could have been tested and studied. If it worked, we could continue to implement the change, and if not, we could learn from what didn’t work and develop a new method. After all, continuous improvement is how we evolve. We ALL know medical culture needs to evolve.

If we do not make change now, we will continue to be a group of blind men just looking at the same part of the elephant and agreeing with each other, because we are so ignorantly unaware that rest of the elephant exists. We will be missing the forest because we are only examining one tree, ignorant that the forest is  made up of many different types of trees. We will not have all the pieces of the puzzle so we will not be able to solve it. We will end up sitting around in the cold and dark, when we could be enjoying the light of the fire and the warmth of each other’s company. I refuse to sit in the dark, when siting in the light is so much more enjoyable.

This blog post was inspired by a recent blog by Dr. Shawn Whatley on attempts at Equity, Diversity and Inclusion. It was also inspired by recent events at the Canadian Medical Associations AGM, where a motion to adopt a new method to increase representation in CMA leadership was voted down.

   

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#LetsTalk Burnout

It’s #BellLetsTalkDay

Let’s talk #Burnout

As humans we were designed for survival.

We were designed for acute short-term stress.

When we face a challenge or stressor, or Sympathetic Nervous System (SNS) is triggered and we go into our Fight-Flight-Freeze- or Please (Fawn) response to help us fend off the Stressor.

It is a charge that goes into the body, that should get discharged as we fight, run away, appease that which is stressing us. After which, we are supposed to go back to our homeostatic state, where we are back in our ventral Vagal Parasympathetic Nervous System “Rest & Digest, Pause & Plan, Calm & Clear” Response. Our Window of Tolerance, where we can live SAFELY. The process of going back to Homestasis is called Allostasis. Some guy got it wrong – it is an alloDYNAMIC state in which we are continuously cycling in and out. (Homeostasis should also be called Homeodynamic. Shout-out out to Dr. Ananda Balayogi Bhavani for calling that out!)

However, when we go into freeze, or when we get overwhelmed, we can no longer sustain the energy of the SNS response. We “dive” down into our dorsal Vagal Hypoarousal response, where we begin to numb, dissociate, even feign death. This is not weak, it is a smart physiological solution to help us conserve energy. Unfortunately, we are humans, and we have expectations of ourselves, and we start getting mad at ourselves to motivate us out of this state. It just stresses out and keeps us stuck in Hypoarousal state.

Right now, we are facing a prolonged chronic stress response, from which we have not had adequate opportunities to discharge stress. You may see us getting angry at each other (fight) as a way to clear the stress. We have nowhere to run, and our hearts can only beat so fast before we dive down into the cave. Our Allostatic load (the cumulative effect of stress) are very heavy, and the process to come back to homeostasis is not always possible.

What’s worse is COVID 19 is a NEW stress. It’s Novel. It requires even more resources. Unless we have supportive environments and communities to which we can safely return to homeostasis, we will burnout.

This is just our physiology.

This is how we are wired.

This stress needs to be released. It doesn’t have to be a big work out. It can be a big laugh or cry, dancing to your favourite song, singing, chanting, yodelling even!

Just don’t beat yourself up about it. Some of us have been carrying large loads for a long time. Be kind to yourself.

Slide source: Unknown but depicts Dr.Stephen Porges’ Polyvagal Theory with the Yogic Concepts of the Gunas (Rajas, Tamas and Sattva), the three states we are constantly cycling through.

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Mom’s Saag Paneer coming full circle

Saag Paneer is one of my favourite dishes, though as a kid I hated it. Mostly because the way my mom made it was nowhere near the fancy version you get in a Punjabi restaurant. The latter version is pureed, often has cream and I am sure they put sugar in it, making it way more tasty then the bitter greens sauteed with onions, garlic, and spices served up to me as a kid. Of course, now I much prefer my mom’s healthier version.

While most of you will know it as Palak Paneer (Spinach & cheese), you can actually mix different greens together. In this version, I have mixed Kale and Spinach (delivered in my good food box via @FoodshareToronto). I substituted the Paneer with Tofu marinated with turmeric and lemon, stir fried just before adding to the pureed, curried greens. I have adapted @TwoSleever’s recipe here and I make it in the Instant Pot.

mom-s-saag-paneer-coming-full-circle

1 bunch Spinach, deveined and chopped
1 bunch of kale, deveined and chopped
1 whole onion, diced
5 cloves of garlic – finely chopped
1 inch of ginger – shredded
2 tsp cumin
2 tsp Garam Masala
1 tsp tumeric
1 tsp salt
1 Tbsp Tomato Paste (or a fresh diced tomato)
1 tsp salt
½ cup of water.
Cilantro for garnish

Turn the Instant pot on to saute. Put in a lug of cooking oil (I use Avocado forc it’s high smoke point). Add add the onions, garlic, and ginger. Once the onions are translucent, add the cumin, turmeric, and garam masala, saute until fragrant. Add the tomato paste and salt. Stir. Add the spinach and kale. Add ½ cup of water. Cover and turn the instant pot on for 4 minutes at high pressure.

While that is cooking, saute the marinated tofu.

When the cooking is done, quick release the pressure and, using an immersion blender, puree the greens (or leave unpureed for the authentic version!). Stir in the tofu, et voila!

Good for balancing Pitta & Kapha Types, Vata types can also eat in moderation, though they say moderation with kale.

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September – Dinacharya and Getting Back on the Wagon

Summertime always throws me off the wagon. Not alcohol — I don’t drink. I mean, off the wagon of routine. The higher temperatures and humidity of summer, the laissez-faire days, create a heaviness that seems to block my daily intentions. It is one reason I welcome September, with its cooler days (hopefully) and the momentum of “back to school,” bringing us all back to the necessity of a daily routine.
 
In Ayurvedic practice, a daily routine is essential for the maintenance of health and wellness. But not just any routine, a routine that tunes our body into the natural cycles of the day, which in turn regulate our body’s own biological clock. The term for this routine is Dinacharya. Dina means daily
and Charya means to follow. Alternatively, in Hindi, Din means day and Acharya means teacher. So to me, dinacharya has a double meaning — the daily routine is the teacher, and its guides us for self-care.
 
Dinacharya intends to set the individual in the right direction for the day. It involves noticing the cycle of the day — from morning to night, and tuning your energy and activities to match the biological circadian rhythm (marked in Ayurveda by the doshas — Vata, Pitta, Kapha).
 
Traditionally, this meant waking up with the sun, washing and eliminating from the body that which accumulated overnight, followed by exercise and meditation to warm up the body and focus the mind. Then proceeding with breakfast and on to the work of the day, taking a break at noon for lunch, and resting prior to returning to end the day’s work. As the sun begins its descent, having dinner, and taking the opportunity to wind down with family and friends, relaxing in some way, before the nightly bedtime routine and sleep.
 
The practice of Dinacharya has been particularly helpful to me in managing my migraines and in recovery from concussion. Unfortunately, suffering the two together has been synergistic in terms of symptom severity. Observing my bedtime routine and getting to sleep on time (which for me is before 10 pm) has been helping me sleep through the night. Then waking early ensures I have time to get the key exercises in to strengthen my neck muscles, which I incorporate into my morning yoga practice.
 
The problem is that I am my own worst enemy. I fight sleep, and I enjoy the comfort of my warm bed in the morning. I have to admit, I have been, putting off my morning practice. So this has become my tapas, the effort I must put in and the actions I must perform to take care of myself. It is not easy, and I feel like I fall off the wagon every summer and I have to start over every September. They say it takes twenty-one days of repetition to form a habit, so I am going to be gentle with myself and re-start with the first step being putting my feet on floor to get out of bed, then taking one step at a time.
 
As the kids get ready to go back to school, I am harnessing that energy to fuel my daily routine — exercise, meditation and getting to bed on time. I encourage you to do the same. It is our daily patterns of actions that become the habits which set us up for a life of wellness. We are in this together. Every year. Bring on September!
 
 
To learn more about the Yoga of Burnout Recovery Program or to or sign up for my newsletter, visit theYogaMD.ca