stress will kill you. ayurveda can help!

by now it is clear that stress will corrodes our ability to maintain a healthy body and mind. those are well documented considerations at this point. we drive ourselves over the top in our career, sometimes in our relationships, either personal or professional and may end up living in a constant state of stress. i include myself here. the last 5 years have been challenging in so many ways it got more and more difficult to maintain balance.

ayurveda’s approach to the heart is that it is our source of vitality. propelled by the nervous system and influences the rhythms of the range of systems of the body and mind. the heart circulate prana, what is referred to as energy, both energy we take in and energy we expel, and works synchronistically with the breath, therefore.

the heart is governed by the following 3 sub doshas:

  • sadhaka pitta: the fire which determines truth. located in the heart and brain, by which we achieve our goals.
  • avalambaka kapha: the form of water that provides support and is located at the heart and lunge and lubricates the chest. in turn it connects to rasa which is distributed by the heart and lunges.
  • vyana vayu (vata): the pervasive air located at the heart and governs circulation.

a healthy heart means a balance of diet, emotions and mind. stress is a major contributor to imbalances of the heart which leads to cardiovascular disease. the number one killer of men in the continental US.

stress propagates through the body and overwhelms the body with cortisol. in term our heart rate elevates and so does our blood pressure which in turn account for accumulation of fat tissue in the blood transportation system.

ayurveda teaches us that most of heart related diseases stem from an emotional factor: anger, fear or repressed emotions. it is how we respond to stress which affects our bodies the most. effects of hostility and anger will affect our being dramatically. what tools and approaches are available to us to deal and address stress as it manifests in our body and mind?

as with yoga we focus on cultivating and familiarizing (what is named bhavana in sanskrit) awareness and be in the moment so we can pause this cycle rather than automatically responding to a feeling. the gita talks about this and if you read the aditya hridayam it talks about the inner enemies for us to conquer. we learn to relax our mind and therefore our nervous system to increase our inner power.

four approaches to consider:

  1. dharama: if you consult with an ayurvedic MD one of the questions you will be asked is “are you engaged in the work you most want to do?”. in other words what is your dharama and are you walking the right path? because if you are not, any “fix” will be temporary and superficial. at root we find fulfillment in being in service for other people and creatively expressing ourselves. though this path (marga in sanskrit) may be a longer ranging one, it is vital start asking this question in order to find the path and long term healing.
  2. pranayama: take the time to stop and withdraw your senses and connect with your inner self by simply breathing fully. find peace in that given moment, letting go. notice how your breath changes when you are stressed and notice, make that impression, of your breath when you are relaxed. go back to that moment to relax your body and mind. bring yourself actively to balance by changing your breathing practice.
  3. tapas: generate heat by taking a yoga class which is designed to break a sweat. other forms of sweating are wonderful as well if you yoga is not your thing. from a steam to running, playing soccer – whatever works for you. cleansing your body through the sweat glans will balance your mind and nervous system and affect your overall happiness.
  4. eat a fine meal: based on your constitution, location and season, treat yourself to a healthy meal and nourish your body.

the teaching of the bhagavad gita

the main theme of the gita is this notion of “action-less action”. with buddhist and hindu philosophy, the schools associated with yoga are the vedanta on the hindu side and they have been in dialog for 1500 years in india and the religion and practices of the yoga are something that goes along with that, as yoga is a medium, a way of doing things. so if you have a notion of what you want to do in life, yoga is the way you go about that. spiritually if you want to know the nature of god, yoga will become a vehicle for that. but the practices of yoga can be for a different spiritual path. buddhist do not believe in a creator god, though devotion and faith are a big part of it. it is about generating compassion and realizing the true nature of reality and the self, where a misunderstanding about which gets us locked in this state called samsara.

vedanta is mostly used in a theistic context to proof the meaningfulness of the soul, being identical to the divine. buddhist school of thought argue there is no soul at all and the absent of that soul is liberating. my point is that they seem contradictory, though my experience of study and practicing yoga, they have been in this intimate dialog and the point to make is that they are all about the nature of the self and who you are.

in the upanishads, the origins of the vedanta philosophy, the path to liberation is recognizing the true nature of the self, is this permanent imperishable soul. i am god. not the me i think i am, but the me who is truly. buddhist tend to be, at some point, trying to identify this urge we have, this neurotic reflex to make ourselves more real than we really are. that egocentric orientation is the real problem to begin with.

in the gita as krishna speak to arjuna there are themes which are pure vedanta. the soul is not changing, so arjuna do not worry about killing or being killed as these are temporary bodies anyway. this is all brhaman, this one reality. at the same time there is another parallel trend seeing all as krishna, as vishnu – as strong devotional side to it.

at the center of this, as a yoga practice is this notion of going through life with somehow behaving in the world in a non egotistical way. action-less action. do your karma with no expectations of the fruites of your action by dedicating the fruits of your action to god, which will make it more doable as you relinquish all expectations. then it begs the question what is it you are suppose to do? the response is based on cast and social circumstances. the gita is really saying there is an ideal mode of operation in the world. maybe it’s hypothetical, but it is presented as you acting in this world selflessly.

the gita does not provide it from a single view point. it can be as a devotee of the divine or anyone else, this idea that in these modes of non self referantial you experience happiness, expansive happiness. and that is the exact same prescription for the spiritual path for the buddhist. the number thing to follow the buddihst dharma is to generate a sense of renunciation. not necessarily renouncing your stuff, but renouncing your attachment to it.

the gita has positioned itself as a straw man. arjuna refuses to fight the battle right? and krishna says “you cannot renounce” partly it is a backhanded way to dis the renunciation tradition. but in the end the gita is teaching real renunciation just like the buddhist and in it’s core, at root, the source of all human problems is ego centric oriented action. it is self preoccupation. that’s it. the ways of loosening self obsession is approached and understood in this basic way and that is true for yoga.

this is the thing to be asking about, it is the line of inquiry in our yoga practice. how can we tap into this sense of selfless action? first let’s ask what is action less action? meaning we are not self invested, not attached to the result. sounds impossible right? the gita will talk about it as the devotee doing this for the divine. as a person developing a devotional relationship to god, as the relationship must be relationship as you want to do things for the diety though it does not need anything and brings you down this path as it breaks down this rigid sense of self.

how does yoga fit in? how can it manifest on day to day basis with the breathing system and asana? it is not self evident. guruji presented it, being such an optimistic person, with the identification of the good feeling that comes with simply breathing. it will start loosening that sense of territoriality we have. having that experience of being alive without maintaining a sense of self image, so you start getting the picture that constantly re affirming your self image – you can survive better without it.

so it seems that ashtanga is showing you that you won’t collapse if you lose your self conception. some people are uncomfortable with the little amount of discomfort. i cannot afford to be a beginner. a beginner’s mind means that your limit has not been achieved. you may be the best soccer player in the world the first day you play – who knows? this is a zen buddhist idea and this beginner’s mind is valuable.

in the gitta, nishkarmya karama – action-less action, you cannot conceive yourself as someone doing things in this world to get better at it because it requires total effort and no expectations of getting any results from your effort.

in the gita its’ clear that bhakti is the way to achieve this. devotion. sharing the energy of the divine and approaching the deity. that is necessary for that relationship. with ashtanga yoga, wherever you start and whatever motivation you start your practice for, but when it starts to feel really good it is because it is loosening your sense of ego a little bit and you feel energized by that, as our egocentric way of thinking is like a vice around our heart for the most part. so the question is how do you keep it going? when it becomes more than a skill set? how do you connect it with a longer term project? this spiritual path is cultivating a self of renunciation the belief of real happiness and benefit you might get in life from this rigid sense of self. if your effort is selfishly oriented toward exclusively towards your own well being, it will increasingly become a problem for you.

all the yoga systems recognize that as well, except for maybe monks who are ready to ditch the main stream and live in a cave. for the rest of us this notion comes from active desire to be of service. it has to come from love. you may not even know why. the dali lama calls this enlightened self interest. embracing the needs of others. as much as you can. the gita supports that with an idea devotion to the lord, if you have that going on for you. in not you realize that in the process of doing that you will see the world in a different way. at certain point after a few years of doing yoga you will link it up to your daily life. this notion of seva – of service will be connected to your daily practice.

you cannot really know what it will be like to do sun salutations until you actually do it. until then you follow the motions. this is how it all fits into your life. take the energy you find in your practice and let it be a guide and motivation to serve. all the yoga traditions talk about generating power, stripped away from the spiritual path, it is about attaining and generating power. there is no goal indicated within the yoga technique. the 3rd chapter of the yoga sutras discuss magical feats yogis can attain.

as these powers come you will already be ready for them if you are orienting this practice of service out of love. the sutras, the gita, the buddha in his sutras say that if you want to achieve the goals of yoga, you might generate loving kindness compassion sympathetic joy and equanimity. this is an automatic way to make your life better and also “the” way to have yoga work in the rest of your life. it goes both ways. it is generating the power to help people and love them. this is bottom line the only way that you will take care of yourself. all other attempts will fail. the gita is repetitive about this. you do your action without it being up to you what the results of this action is. because there is no real self who gets the benefit of it anyway.

the yoga practice is about increasing power to conquer the inner enemies. all these afflictive emotional states we live with, battling with our ego, they are all predicated about a will to serve an ego, though happiness abundantly available to us by serving others.

main teaching of the upanishads

the upanishads are lumped with the vedas though they were in production much later, 800 BCE – 400 BCE. those are recorded conversation between the priest and warrior cast discussing the vedas, the meaning of the ritual sacrifice and who is this “one” the vedas talk about.

it is clear that those priests discussing the vedic sacrifice it is not clear what it is all about. rather than tossing the sacrifice aside, this ritual is becoming an internal process. this is the big dawn of yoga. this concept of heat, what is called tapas, is now an internal process. the individual is somewhat burning themselves from the inside, so rather than doing large animal sacrifice to uphold the universe and feed the late ancestors, heat is used to transform the individual. the concept of tapas is key in yoga and also in ayurveda as it is critical to the healing process and heat must be present to sustain a state of balance.

another big take from the upanishads is the concept of karma and trans migration. the soul is eternal and it is preserved through cycles of existence, just as the universe cycles through the 4 yugas. karma, the idea of action is what the buddha had awakened to, the concept of cause an effect.

the last realization, and this is the big one, is the idea of brhaman, this one reality which all is. brhaman is a neuter word in sanskrit, it does not have gender, and brhaman is this underlying reality which is everything in existence. though it may appear to be that we are discreet people, trees, animals and all around us, they are all in fact brhaman. what is described as namarupa – names and forms, these are the infinite manifestations of brhaman.

initially brhaman is described as a monist metaphysics. in the later upanishads a creator god is added to the mix making brhaman a dual and theistic. these are the two main approached, either this one reality has no quality and can only be described negatively. this is the main work of aadi shankara. and a theist approach to brhaman, what is described as suguna brhaman. brhamana with qualities, a creator god we can interact with.

patient engagement

doctor-and-patientpatient engagement as defined by healthcareITnews.com:

“Patient engagement refers to ongoing and constructive dialogue between patient and practitioner. Within the scope of healthcare IT, patient engagement is driven by technology ranging from patient portals, which enable patients to view test results and records online and communicate with doctors, to electronic data capturing platforms that result in more accurate and streamlined diagnostic information. A high emphasis has been placed on patient engagement in Stage 2 meaningful use.”.

the healthcare system in the US is wonderful in focusing on one thing that has gone wrong and fixing it. it is not so effective in dealing with comorbidities and not so much when it comes to taking daily actions to maintain a state of harmony. mobile devices seem like the right channel to revolutionize the current state. can healthcare be as engaging as our digital social lives? can the same social circle serve as a catalyst to push us in the right direction when it comes to making healthier choices?

why does it seem like we are not getting patient portals and PHR right? to start off, the sicker the patient the less likely they are to use the portal. to put this in perspective, 78% of physicians use EHR while 17% of patients use portals (this data dates back to 2013 by Research Ancker). it is clear that patients do not see the value of the portals yet nor gaining access to their PHR. what is the right model to bond the patient and provider together?

considering that PHR is mostly provider facing, i.e. they are laid out and detailed in a clinical way which makes more sense for the physician than the patient. take clinical notes for example which include terms which do not make much sense to the patient.

but hold on for a second. aren’t the patient already so very much engaged? they suffer the pain, go through the medical procedure, pay the bill… patient are indeed engaged as they fill out the same form multiple times as they visit different departments within the same hospital. as they are expected to accurately name the medications they are taking and the dosage. isn’t it the system that, inadvertently, discourages engagement?
today providers are almost exclusively responsible for deciding a patient’s treatment, next site of care, medications, etc. seeking patient engagement, those key decisions should include the patients and their families, where they can voice their opinion, participate and share responsibility.

consider nutrition and financial wellness as important gaps. patient should know who is responsible for delivering their care. critical data elements can be tied to services rendered to improve outcome in a clear and concise way. regardless of a patient’s spoken language, in order to engage them they should be able to specify clearly and effectively specify what is going on, why they need help and know that someone got their message and is “working on it”. all that within as little clicks as possible.

patient engagement may be the holy grail when it comes to improving outcome and reducing costs. having the patient and their family and friends participate in the process in a meaningful way and be proactive in a timely manner can assist advancing the healthcare system in our country forward.

 

 

2014 new year tech resolutions

it’s that time of the year again to contemplate, appreciate how much we have come and look forward with excitement and anticipation to what is ahead. our team is growing and so the challenge. i am learning to appreciate the intricacies of managing a diverse tech team and providing a solution that is both granular and all encompassing simultaneously. it may sound like an oxymoron though i’m sure this statement holds ground for most HIT startups involved in care coordination and the BPCI program. the truth is that when dealing with standards, data feeds should be synthesized and clean. yes, being compliant with MU1 should mean just that, but the fact of the matter is that it does not. it’s easy to point a finger at the hospitals but that is just not fair. the same is true for browsers who implement web standards. if you are involved in web development you will have to optimize and tweak your code per offering. it’s just how it is. this is where i hope that one day the state HIEs will step up to provide a more robust infrastructure that is both available and clean. the winner will be the one who will have critical mass and will do somewhat of a good job. a good job may mean a decent and somewhat relevant snapshot of the patient. and then some. HIEs can and should be smarted than their users soon. that alone will justify their existence rather than aggregators. it will be  interesting to see how  shiny pans out.

so new year tech resolutions:

1. make the switch from SVN to GIT and implement gitflow. this will allow us to get releasing more quickly.
2. BDD is not just a cool term. it’s how we will ensure quality and scale.
3. quicker more rapid and agile releases. move as close as possible to continuous integration.
4. tailor a winning hybrid schema between document storage and relational. find the balance between the two.