Monday, April 14, 2014

Yoga for Real People

Is this "real people" yoga? Maybe for some...

After a few years of largely ignoring yoga, I've returned to the mat. I was really hesitant to do so, but I'm very happy I did.

The backstory: I had been practicing yoga on a fairly regular basis (once or twice a week) since the 90's. It was a part of my exercise regimen along with rock climbing and chronic cardio. When I embarked on my self-care odyssey back in 2010, ignoring the slowly surfacing manifestations of my actual organic disease but well-meaningly trying to find what worked to lower my stress levels, yoga was one of my mainstay activities. But after my brain surgery and recovery, I found strength training. Yoga fell by the wayside as I became addicted to the physical and mental gains in strength and confidence that I experienced with weight lifting. On the rare occasion that I did go to a yoga class or pop in a DVD, I struggled to maintain balance in single-leg poses and barely controlled chaturangas without doing a belly flop onto the floor.

For many people, physical activity is an essential ingredient in their black bags for self-care. Silicon Valley entrepreneur Pravin Kothari, who had been suffering from stress-related digestion problems, recently wrote in about how adopting a daily yoga practice saved his health and his business. Because of its marriage of movement with mindfulness, yoga seems to be an ideal activity. A recent article from the Yoga Journal about "getting back on the mat" after a hiatus summed it up well:
"There are different postures and sequences and styles that can accommodate all ages and stages of life. And the combination of breath and movement, along with guiding our ambitious minds toward nonstriving, creates a magical alchemy that few other physical endeavors can."
Guiding our ambitious minds toward nonstriving... what an excellent phrase! I'm not particularly flexible, and I would not ever consider myself to be "good" at yoga, but that (according to everyone) shouldn't be the point of yoga. And yet, I still catch myself looking around the room and comparing myself to others. Is my leg as extended as that girl's? Does my belly fat stick out during this pose? An article from Whole9 called Yoga for the Type-A explores the internal tensions of doing yoga when you're a driven, goal-oriented person. I'll bet a lot of us can relate! And that's exactly why it's such a good thing to try.

So how can we fit yoga into our busy lives, in the midst of work, other fitness or personal activities, family and home responsibilities that make up our Realms of Balance? Again, think of nonstriving... but do show up. Find a yoga style that works for you and a practice length that fits in your schedule. You don't have to sweat through the 90-minute steaming-hot class, mat to mat with 50 dread-locked devotees in order to reap benefits! There are many styles that run the spectrum from simple meditation and breathing to athletic, flowing poses. This article by Jen Keck of Beauty Lies in Strength does a good job outlining the many different types of yoga (in addition to reiterating why you can't ever really be "good at yoga"!).

Many local libraries lend yoga DVDs, and there are tons available for purchase (usually under $20) with detailed reviews on Amazon. When perusing, start with the "most highly rated" picks and work from there, identifying ones that fit the length of time you want to practice; here is the link to the Amazon Listmania yoga DVD page. Classes are often offered at universities and community colleges, in addition to standard gyms like 24-hour fitness. The DVD route obviously offers the most flexibility for working schedules. And for a really cheap alternative where you can preview the practices without even leaving your couch, turn to YouTube. It has a plethora of yoga videos lasting anywhere from 10 minutes to 90 minutes. I especially like the Yoga Journal To Go and Yoga Download. Check them out!

Me? About 4-5 days/week, I have personally been mixing it up with the following: hour-long vinyasa-style classes at my gym on weekends or days off, carefully chosen 30-60 minute DVD routines, or short YouTube videos when I'm pressed for time. I noticed a difference in my physical balance, flexibility, and temperment within a few days of starting this! Some days I am not very motivated to practice, but on those days if I just do a short video or self-guided sequence of my favorite poses, I feel SO MUCH BETTER. Happier. Calmer. It has helped me to stay present in this time of "nonstriving" toward other goals.

Do you use yoga in your self-care or exercise regimen? Good luck finding your perfect practice, and namaste.

Saturday, March 29, 2014

Got March Madness? Stop Bracketing Your Life

 (An image ubiquitous on the internet right now)

March Madness month is almost over, and some lucky (and skilled) players are about to reach their ultimate goals. It's also a time when people spend lots of energy predicting brackets and outcomes, expecting certain teams to win. The appearance of the bracket sheets remind me of my pre-medicine days as an engineer when I used to plan construction and water treatment projects. And it makes me think about how we often try to plan out the events of our lives as if they are on a linear time line... only life doesn't always comply with our plans. It certainly hasn't aligned with my expectations in recent months.

This article from the Huffington Post, although with a slightly mystical or religious bent, delivers the message clearly: life rarely follows a perfect plan. It's best to "show up" and work towards your goals as if they will happen exactly as you want, but don't expect the dominoes to fall perfectly into place. The result may be a richer experience than you ever imagined! The sentence from the article that really struck me is as follows:

"Release your natural need to control your direction, giving yourself permission to move fluidly into this unplanned space."

When I had brain surgery almost 3 years ago, I came out of a tough recovery period with a sense of gratitude and a singular focus on self-care. But as months passed, residency came to a close, and scars healed. At one point (with the nudging of my husband), I decided it was time to get serious about personal goal-setting. Ever since that time, I've been on a string of self-improvement projects. It started with gaining strength through a weight training program, then it was ramping up my clinical skills as a new attending anesthesiologist, then achieving a previous level of rock climbing prowess, then passing the oral boards... now getting pregnant. There were some 30-day challenges thrown in here and there, too - no complaining, no eating candy, 10,000 bodyweight squats, do a pull-up again, etc. While I have experienced frequent success in these endeavors, some "projects" haven't followed the expected timecourse. 

So what now? In the midst of my "one long pregnancy", I've decided to resist the tendency to control my direction and get back to the basics of self-care. I'm not worrying about my (lack of) strength. I'm not climbing much except a little bit for fun, and it's ok if I struggle on an easy boulder problem. Instead, I'm doing a mini-reset: focusing on balance and flexibility with a yoga session and/or a walk as many days as possible per week. Enjoying the clinical aspects of my work, celebrating my gifts of connecting with patients and working well with the surgical team. Journaling and blogging and connecting with friends and family. Doing craft projects with my hands. Looking into buying a piano, something I've wanted to do since I stopped playing in college. Not ignoring my ultimate goals per se but keeping away from expectations.

Monday, March 17, 2014

Think of it was one, long pregnancy

(Photo: Jim Lowman)
I knew he meant well, but he could not and would not ever really understand.

"Think of it was one, long pregnancy," he said.

"I mean, all those eggs were all taken out of you on the same day and fertilized on the same day..."

"So it's like they're all part of the same process."

At first I laughed through my tears. To me, the only thing that felt real at the moment was the inevitability of my miscarriage. Though scientifically and evolutionarily flawed to say the least, I vaguely got what he was trying to say. And as the time marched on, I saw the true meaning of my husband's words.

I was well aware that by telling everyone about my pregnancy at an early stage I ran the risk that I would have to someday share bad news. So many people had already known that I was waiting for the results of my first IVF. Now I was regretting my choice, because only a week after the early sighting of a strong heartbeat, that day had come. The sac was being crowded out by accumulating blood, and there was no more heartbeat. The reality is, at age 40 and with hypopituitism, miscarriage is much more likely for me than for others. And that is saying something, because miscarriage in the first trimester is actually quite common. It may be swept under the rug by many when it happens, hoping to forget the torture, and it also may occur without a woman even knowing it. An especially heavy period a few days late is nothing much to think about, except when it's an early miscarriage. The most common reason a first trimester miscarriage occurs, especially in older women, is a genetic or chromosomal abnormality that arrests further development. It definitely doesn't feel like it, but in that sense, it's happening for a very good reason and all involved will be better off with this result. And yet, there is a secrecy and shame still associated with miscarriage. In this article, Erica Berman points out the damage this paradigm does to women's mental wellbeing.

In my mind I'm already jumping ahead to the future, violating the things I said I learned from this... We have 6 good-quality embryos frozen (more than many women ever get from a single egg harvest)... When can I go through another transfer? How long will it take everything to go back to normal before we can start again? Fear creeps up in my throat when I wonder how many times I can do this without going crazy. Then I remember to "think of it was one, long pregnancy". This is all a process, and I'm in the middle of it. During every fertility treatment I've undergone this past year, there have been learning opportunities and improvements in something. My first ovulation induction was crazy-long with strange ups and downs in hormone levels, but this streamlined greatly into a smooth arc over the next tries as my body got used to hormone stimulation it hadn't seen for years. The lining of my uterus grew thicker and more uniform each time in better preparation to keep a pregnancy. And with this last treatment (the IVF), I had actually gotten pregnant! That is a HUGE improvement in the process! When I first told a friend of mine that I was pregnant, qualifying it with the "it's early and anything can happen" back-pedal, she said to me, "Six weeks pregnant is a hell of a lot more pregnant than you've ever been." Now I see the wisdom in those words.

So I'm still moving forward in this process, trying to remember myself and not get lost, and trying to stay present.

Monday, March 3, 2014

What IVF Taught Me

 (Photo: personal collection)

I recently completed my first cycle of in vitro fertilization (IVF). It is a long and detailed process, requiring lots of resources, money, time, and patience. The first stage involves, ironically, taking oral contraceptives to reset the hormone milieu and force all eggs into a senescent, follicular stage. The second stage involves injecting repeated doses of hormones to stimulate ovarian growth and maturation of as many eggs as possible. There is quite a bit of monitoring at this stage, including almost daily ultrasounds and blood draws to evaluate the progression of the eggs. The third stage is egg retrieval, in which all fluid-filled cysts within a certain size distribution are aspirated for the contained egg. The eggs are then fertilized with the intended sperm in a lab and are allowed to grow for 3-5 days into multi-celled embryos. The last stage is the embryo transfer in which the best-quality 2-3 embryos are injected back into the uterus for implantation. After that point, it's up to fate (and continued progesterone supplementation)... after the dreaded "2-week wait", it's time for a pregnancy test!

Some of you may not have wanted that much detail, but I figured it would be helpful to understand what is involved. Needless to say, I had to take some time off of work to do this, rearrange travel, etc. It may have been physically challenging, but it was also humbling and eye-opening. Here are some lessons I learned from my experience.

Accept where you are in the process. I never thought I'd be here. First of all, as I've mentioned, we weren't even completely sold on the idea of having kids until recently. Only at that point, I had already been rendered infertile by my brain tumor. Bad timing! We've been married almost 15 years; what if we had started a family years ago? It may have been much easier to have a baby, but who knows how else things would have been different? I probably never would have traveled like I did, gone to medical school, built the strong bond that my husband and I share... "What-if's" are futile, which leads me to the next lesson...

Live in the present moment. I know. This is such a common sentiment these days that it's becoming cliche. In this particular case, I learned to not overplan my life. Whenever I would go to the doctor's office for an ultrasound of my growing eggs, things would be different than I expected. Medication doses changed, the egg harvest day that was originally projected (around which I had built my monthly work schedule) changed three times... And stepping back to a longer term perspective, I honestly had hoped to already be pregnant by the winter! There are times for serious planning and times to live day by day. Things don't always go the way you or others predict; you have to be able to ride the waves.

You have more strength than you think. I'm fully willing and able to perform all sorts of invasive procedures on other people, and I have no problem doing so. But all bets are off when I'm the patient; I've always been a complete baby with shots, IVs, even eye drops! This attachment to a self-imposed identity simply had to explode when I faced four subcutaneous hormone shots a night, frequent ultrasound probes in the nether-regions, and multiple blood draws per week. Then came the progesterone-in-oil, a viscous and irritating liquid injected intramuscularly in the buttocks nightly... for 10 weeks! When I received the progesterone injection supplies from the pharmacist, my eyes widened when I noted that I could see down the barrel of the needles. But you know what? Some ice beforehand, a little heat afterward, and it's really not that bad. (BTW my advice for anyone having to face such frequent injections is to do them yourself; I think it hurts less when you know it's coming.)

Love yourself. My body and my lifestyle changed significantly when I started IVF, and I had no choice but to embrace it. In a month of oral contraceptive use, I easily gained at least five pounds. About 15 pounds separates me now from the fittest, most active time of my postop life, including the last 8 months of hormone injections. Because I "luckily" have lots of eggs for my age, my ovaries grew during the stimulation period to the point where my pelvis felt like it was carrying two water balloons! This feeling persisted and even worsened after my egg retrieval, as the ovaries continued to produce cyst-like fluid for a period of time. My activity level was drastically restricted for the entire IVF process. Thus, I wasn't allowed to lift heavy weights or climb much, or even do much other than lay on the couch at certain times! But if I had fought these changes, held onto some past image of myself, or worried about how my skinny jeans are not fitting, what would be in store for me during pregnancy and parenthood (when bodies and lifestyles change beyond our control!)? The worst thing would be to stress out, ignore recommendations or restrict eating in response... NOT good for fertility!

There is a delicate balance between hope and expectation. Hope and positivity are integral to happiness and stress management. However, an ardent "be the change" approach can easily lead down a slippery slope to rigid expectations. On the flip side, protectively assuming the worst will lead to unhappiness and increased stress. In this brave article, HelloBee discussed what it's like to be pregnant after 3 miscarriages, sadly assuming the worst at every turn which negatively affected her experience and her relationships. Knowing yourself can help to find the fulcrum point between the positive and negative, where you don't go crazy.

After my embryo transfer, I felt blissful and positive. I visualized implantation by meditating on the picture of the implanted embryos given to me by the IVF clinic (above). But part-way through the waiting period, I started experiencing mild cramping that I assumed meant my period was coming. I had yet to experience any classic symptoms that most women describe early in pregnancies; however, one key thing that I had to remember was that if I were like "most women", I wouldn't be needing IVF. So I got positive again... what I did not do was move into a fantasy world shopping for maternity clothes and picking out baby names; statistics are statistics, and just because I saw embryos deposited onto my uterine wall, that did not mean that I was pregnant.

But you know what? Turns out I am! I'm 6 weeks pregnant this week. :)