Yoga for Amputees

Yesterday two women who work at several refugee camps in the area joined my Saturday amputee yoga class.  They are psychologists who wanted to see how we adapt yoga for amputees at the clinic.  They enjoyed the class — a simple mat class using seated and prone postures chosen with amputees in mind.  Like  in the patient classes, we also incorporate progressive relaxation.  Actually, the class overall is similar to the patient classes.  I just leave out postures that are impossible with one leg.

They have invited me to lead some classes at the nearest camp, Mae La, in the next couple of weeks and conduct a training for their counselors in March.  The group that I will meet first is comprised of about 30 young men who live and work together in Mae La camp.  Ninety five percent of them are blind and many/most have lost both arms and legs.  Landmines.

I am researching more about yoga for amputees and have found some interesting stuff so far.  From www.amputee-online.com I learned that there are some ways that we can relieve phantom pain (pain in the missing limb) in a yoga class.  For example, tense and release (progressive) relaxation might be helpful for the phantom pain.  We can also do some self massage:  from face and neck to stump.  Click here for more medicinal things to do for phantom pain.

I will begin with breath of course, then a series of seated postures (will need to adapt for upper body amputation), some prone postures, and then relaxation.

I need to remember that they need to move and strengthen their limbs and that there is no shame for them to do so — it is their body.  It’s my own discomfort/worry that needs to be kept in check.

The kindness of former strangers

Frequently during my yoga class at the Patient House (where clinic in-patients stay), I think to myself “Oh the humanity.” There is just so much life.  People with all sorts of ailments living on top of each other.

The patients take amazing care of each other. Honestly, you’d be better off being among Burmese than Americans if you were old, incontinent, unable to walk or talk, etc…  No ailment seems overly embarrassing, no normal bodily function repulsive.

One young man, an eye patient, carries his buddy, a paraplegic, up and down the stairs — during yoga he carefully arranges his friends legs.  When a 20-something mentally disabled amputee (who recently suffered heart failure) was projectile vomiting during my class Friday, three different people leapt up to help.

All of these people were strangers 1 day, 1 week, or 1 month ago.  Now they are like a family.

My Work and Eventual Departure, Yoga for Trauma and Language

I have been teaching for four months at the clinic.  Now I am planning for the hand-off.  It is my hope that the counselors will continue to practice yoga themselves, as well as lead patient classes.   We just need  to find the right balance between too much and not enough.  I have another month at the clinic but I’d like the counselors to take over now so that we can make adjustments if there are problems.

I have been covering a variety of topics in the non-practice trainings:  anatomy, injuries, pre-natal, sequencing, etc… Yesterday, I reviewed  the information that I gathered at the Trauma Center at JRI’s Trauma Sensitive Yoga Training.  My trauma counselors seemed to respond well to the themes (Present Moment, Moving with Direction/Purpose, Taking Effective Action, Choice, Moving in Rhythm with Others) and how to use language to promote these themes in class.

Language is so critical, yet I have been operating without it in many ways.  I have picked up enough Burmese to lead about 2/3 of the class — but what I say is not nuanced.  I encourage present moment awareness with the breath — but I don’t remind often enough about “feet on the floor, hands on the mat”.  I don’t use invitatory language (“If you would like, when you are ready…) nor do I use enough choice language (“Make big circles or small,  keep your neck up or slowly bring it down (Fish)”) or offer enough modifications (“Bend the knees,  your hands may feel better like this”).

To ensure that the counselors understand and use these words, I had them translate my English phrases into Burmese.  I tried to convey the importance of these subtle phrases in a trauma yoga setting.

It was a great reminder for me as well.  There are a lot of balls to keep in the air when you are teaching.  You explain, watch and assist.  The way you say your words is also extremely important.  Whether for trauma survivors or the general public, I think the way that we speak in a yoga class goes a long way to empowering our students.

First day of 2010, Mae Sot style

As a whole the day was great.

Yoga at 9 and then I stopped for a chat with the volunteer acupuncture doctor — a MD from Germany who has seen it all as far as acupuncture goes.  Excellent.  I then rode to the Vietnamese place and grabbed a quick fried/fresh spring roll combo.   Following that I met my family for Dunkin Donuts and arcade rides.  Happy New Year!

Then back to the clinic for the patient class.  As we started the class, a baby was shrieking nearby.  The women in my class told me that the baby boy’s mother was neglecting him…letting him cry all night, not feeding him, and not keeping him warm enough.  Plus he was having diarrhea 5 times per day.  From the look of him, he is less than a month old (Note: Found out today he is 5 months but tiny).  Heartbreaking.  The urge to do something — “Stick him on my boob and see if there’s anything left,” as I told my Counseling Center colleague — was overwhelming.

After class, the patients and I discussed this more and then I brought it to the attention of my boss at the Counseling Center.  He had the baby checked out by the medical staff, who had already treated the baby for diarrhea.  They said there wasn’t anything else to do.  The mom through all this had a blank expression — seems like some mental health issues.  Today I hope she’ll be checked out by my friends at the Counseling Center.

There is so much need, so many sad stories at the clinic.  The permanent staff have my utmost respect.  They come day in and day out and do such good work, with limited resources and very little pay.

That was my New Year’s Day.  Better than a hangover for sure.

Yoga in Mae Sot: Beyond Asana

I have been teaching Yoga here since October.   For the first 6 weeks, the counselors and I practiced the postures daily and together taught the patients in the afternoon.  Starting this week, I began to introduce different aspects of yoga — beyond postures.  After we do asana (postures) practice, we sit together and look at different topics.

This week we looked at the 8 Limbs of Yoga, Pranayama and how yoga boosts the immune system.  You can click on the links to see my notes.

I am pleased that the counselors, and the Thai woman that I am training to lead my NGO class, seem interested in learning off-the-mat.  One woman’s question about how the immune system is boosted by yoga, led to a whole class on the topic.  It’s great to get questions.  It shows that they want to learn and that they aren’t afraid to ask me.

Pranayama Notes

These are my notes from Central MA Yoga’s teacher training/reading that I have done.  I taught this training to my trauma counselors this week.

Pranayama

Where? Practice in a peaceful place. In the beginning, it will be hard to keep the mind calm.  Day by day, the mind becomes calmer and concentration becomes easier.

When? The best time for pranayama practice is early morning before eating.  Wait 30 minutes after practice before eating.

How? Wear loose clothes.  Sit with straight spine.  Practice for 5-10 minutes daily. (1 hour maximum)

Precautions

1.Breathing should be done with the nose only.

2.Pranayama should feel easy and relaxed with NO discomfort.  If you feel tired during practice, stop and rest for a few minutes with breathing normally.

3.Pranayama should not be over practiced and the duration should be increased gradually.

4.Patients with chronic diseases (asthma, emphysema), high blood pressure, heart patients, and pregnant women should only practice pranayama with doctor’s permission.

Full Yogic Breath

Practice

1.Abdominal breathing. Observe your natural breath. You will notice that as you inhale the abdomen rises and then falls with exhalation. Begin to deepen, lengthen and extend that movement.  While inhaling, let the abdomen rise to its limit and at exhalation let it fall completely. Keep the chest still– only move the abdomen.

2.Thoracic (chest) breathing.  Again observe your normal breath, this time focusing your attention on the chest. You will notice the chest moving slightly up at inhalation and down with exhalation. Begin to deepen, lengthen and extend that movement.  On inhalation expand and lift the rib cage, filling the lungs completely. Then on exhalation, let the lungs collapse fully, sinking to the limits. Keep the abdomen still, moving only the chest.

3.Full Yogic breathing.  This combines the above 2 steps in the following way:

First inhale by filling the abdomen and then CONTINUE inhaling as you expand and fill the chest. Then exhale first from the chest as it empties and falls and then CONTINUE exhaling from the abdomen as it draws inwards completely. This is one round of the full yogic breath.

Benefits

1.Releases muscular tensions around the heart and digestive organs.

2.Helps people with asthma and emphysema overcome the fear of shortness of breath. Increases lung capacity.

3.Encourages proper nervous stimulus to the cardio-vascular system.

4.Calms emotional and nervous anxiety.

5.Improves detoxification through increased exchange of carbon dioxide and oxygen.

6.Improves auto immune system functioning.

Alternate Nostril Breathing

Practice

1.Close the right nostril with your right thumb and inhale through the left nostril. Do this to the count of four seconds.

2.Immediately close the left nostril with your right ring finger and little finger, and at the same time remove your thumb from the right nostril, and exhale through this nostril. Do this to the count of eight seconds. This completes a half round.

3.Inhale through the right nostril to the count of four seconds. Close the right nostril with your right thumb and exhale through the left nostril to the count of eight seconds. This completes one full round. Start by doing three rounds, adding one per week until you are doing seven rounds.

Benefits

1.The exercise produces optimum function to both sides of the brain = more balanced person.

2.The yogis consider this to be the best technique to calm the mind and the nervous system.

Precautions

Alternate nostril breathing should not be practiced if you have a cold or if your nasal passages are blocked in any way. Forced breathing through the nose may lead to complications.

Sitali

Practice

1. Sit with the spine straight. Curl the tongue and protrude it slightly past the lips.

2. Inhale deeply and smoothly through the tongue and mouth.

3. Exhale through the nose. Continue for 5 minutes.

Benefits

It soothes and cools and can be used for lowering fever.   Pregnant women find it cooling.  It is good for digestion. Great powers of rejuvenation and detoxification are attributed to this breath when practiced regularly.

How Yoga Affects the Immune System

We emphasize the benefits of yoga in each class at the Patient House.  One of the benefits is a strong immune system, which leads to fewer illnesses and prevents existing illness from getting worse.   Here are some specific ways that yoga positively impacts the immune system include:

1. Stimulating the Thymus Gland. The center of the immune system, the thymus gland is located between the heart and the breastbone.  It produces T-Cells – the cells that protect the body against bacteria.

***Cobra, pigeon, fish, boat, bridge and deep breathing are good for the thymus.

2.  Improve Lymph Flow.  Lymph—the fluid that is formed when interstitial fluid enters the lymphatic system—is not pumped through the body like blood but need contractions of muscles to move. Lymph moves waste products from cells to lymph nodes where dead cells and bacteria are being broken down.  When upside down, the lymph circulation is enhanced.

***Shoulder-stand, headstand, plow and legs up the wall pose improve the flow of lymph and immune cells through the body by increasing the circulation of the lymph system.

3. Improves Spleen Function. As part of the immune system, the spleen also performs vital functions including removing unwanted materials from the blood and helping to fight infection.

***Seated twist and hip openers such seated angle and pigeon are good for the spleen and lymph nodes.

4.  Improves Circulation and Oxygen Flow.  These are vital to the immune system. The body’s cells depend on oxygen — and improving oxygen flow improves the transfer of energy from nutrients to cells.  This makes it easier for the immune system to fight off germs.

***Breathing practice and yoga postures improve these.

5.  Relax the Nervous System.  There is evidence that the immune system and the nervous system are closely connected.  Research has shown that a wide range of stresses, from losing a spouse to facing a tough examination, can reduce immune resources, causing levels of B and T cells to drop, natural killer cells to become less responsive, and fewer IgA antibodies to be secreted in the saliva.

Biological links between the immune system and the central nervous system exist at several levels. One well-known pathway involves the adrenal glands, which, in response to stress messages from the brain, release corticosteroid hormones into the blood. In addition to helping a person respond to emergencies by mobilizing the body’s energy reserves, these “stress hormones” decrease antibodies and reduce lymphocytes in both number and strength.

***Yoga postures, breathing practice, meditation are shown to lower stress hormones and calm the nervous system.

Info gathered from these sites:

http://altered-states.net/barry/newsletter195/immbody.jpg

http://mindbodyfitness.suite101.com/article.cfm/strengthening_the_immune_system_through_yoga

http://thyroid.about.com/library/immune/blimm28.htm

Reflections on my work here ~ The Cougar

I want to say how much I am enjoying teaching the counselors and, especially, the patients. 

When I first started a month ago, what I noticed most when I walked into the clinic were the sad faces and the helplessness of it all.  It was overwhelming to think about how little they can do to improve their own lives.  They must be patient, like the father of the little girl with a distended stomach (who is having heart surgery soon).   It just all felt so unfair — and the task of helping so enormous.

Their situation still sucks.  However, I have gotten to observe, interact with and come to know some of the patients and my perspective has changed.  For example, there is this one woman, who I think of as my assistant.  She’s a 40 something spit-fire who is quick to laugh, burps heartily when the mood strikes her and repeats each of my fledgling Burmese phrases.  It is thanks to her that I am able to teach about half the class in Burmese.  Yesterday she showed me a picture in which she was hugging a young man.  I took him to be her son.  Nope…her husband.  Go figure.  She’s a total cougar.  Just goes to show you: life is life, everyone has their own stories.  And they are not all just sad tales of being country-less and poor.

I really like what I am doing.  I only wish that I could do more.

Big Classes, Sad Stories

My afternoon classes have grown larger, which is nice.  I am doing all seated and lying down poses to accommodate various strength levels.   Yesterday we had 15+ students and the day before 20+.  The weather has cooled off and it’s breezy during the class.  A nice way to spend an hour every afternoon.

Some of the students are very sick.  One young girl, probably about 12, has a huge swollen stomach and skinny, spindly legs and arms.  It seems difficult for her to breath.  Her father, through a translator, said that she is retaining fluid and needs surgery.  She is waiting to be transported to Chaing Mai, about 5 hours away.  This probably takes a while to arrange because she is Burmese/Karen and cannot legally travel in Thailand.  However, I cannot help but think how I would feel if my daughter was sick and I knew that 5 hours away doctors could help her, yet I had to wait.  Needless to say these people are far more enduring and patient than I will ever be.

Due to their circumstances, they have no choice.  So they wait.

Seated Yoga vs. Chair Yoga

This week I have learned that chair yoga is to the West, what seated yoga is to the East.  What I mean is that Burmese/Thai people young and old, sick and healthy can easily sit in ‘Easy Pose’ (Cross-legged) for an hour.  Just as we can sit in a chair easily for an hour.   Because so many of the people in my ‘class’ are sick or have broken limbs or are in pain, I have stopped teaching standing poses.  I am using as many seated poses as I can think of — and there are many.  I am modifying standing poses, just using the arms and above all minimizing the movement from laying to seated.  The students respond by continuing to participate — even the very ill and those in pain.

I still think they participate because I am entertainment.  That is fine.  I feel like my major role is to give them attention.  Some of them have told me that they feel better.

Yesterday I had to laugh on my way to the ‘Patient House’, the chicken coop structure I described before.  I was shooing geese out of my way and stepping in some nasty water from a recent rain shower.  I decided then that I need to buy some Crocs or something to protect my feet from whatever is living in the water/grass around the house.  I will take pictures soon so that you can see what I am talking about.