our-yoga

I just read this recent post by Shanna Small, titled "Ode to the Unauthorized, Uncertified Hometown Ashtanga Teacher". In a refreshingly straightforward and candid voice that makes me smile at many points, Shanna tells us why she believes that there is a place in the Ashtanga world for Ashtanga teachers who are neither authorized nor certified by KPJAYI. Shanna writes:

"Technically, you are not supposed to teach without the blessing of the Jois family. There are many good reasons for that which I will not go into for this blog. However, Have you seen the authorized/certified teacher list? None of those people live in Nutbush Tennessee,Elba Alabama or Charlotte North Carolina. If you are fortunate enough to have the money, time and babysitters available to travel, that is awesome. However, the average person does not.   

This brings us to the old argument that got many people kicked out of Sunday School . Is it possible for a person to be a Christian & know Jesus if they are never exposed to Christianity & can these people get into heaven? I am not saying that Ashtanga is the way to heaven, but if it is, & we all sit around and wait for a certified/authorized teacher to bless us with their presence, most of the world would wind up in the fiery pit."

What is the moral of Shanna's story thus far? Well, one conclusion we can draw from Shanna's story might be that if you happen to live in Nutbush Tennesse, Elba Alabama or Charlotte North Carolina (or Moorhead, Minnesota, for that matter), you would do well to get your ass ASAP to Mysore to study at the KPJAYI, so that the lack of authorized/certified teachers in these places will soon be rectified!

But I suspect I'm missing the point here (and deliberately so :-)). Shanna's point, as you can see, is that since there are only so many authorized and certified teachers around (and they tend to congregate in large urban centers, for some reason), people who live in smaller cities will not benefit from their presence and instruction. Rather than have all these people wait to do Ashtanga in their next lifetimes (and burn in some fiery pit in the meantime :-)), it would be far better for teachers who are not (yet?) authorized or certified to step up to the plate, so to speak, and offer the gift of Ashtanga to all these people who would otherwise never encounter it. Shanna expresses this point very eloquently when she writes:

"How are people to learn about Ashtanga and experience its benefits if they don't have access to it? Unauthorized teachers exist because there is a hole. There are areas where people want it and there is no one to teach it. It is not about fame, glory and money. Those who come in it for that quickly drop off because the dedication needed to practice Ashtanga doesn't appeal to the average yoga student. Those teachers who venture out to teach traditional Ashtanga are in it for love. 

I am a hometown yogi teaching without the Jois family blessing.  Like many, I fell in love with the practice & it changed me. People came to me wanting to know what I was doing different in my life. When I told them Ashtanga,they wanted to learn it so I taught them thus lighting the fire for many. Without the  hometown Ashtanga teacher, Ashtanga would not have spread the way it did & many people would never have realized its benefits."

But some people might say, "Look, I don't live close to a shala or to an authorized or certified teacher. But I already have my own Ashtanga home practice, and I love practicing at home; it does wonders for me. Why should I care about whether people around me do or do not do Ashtanga, so long as I myself do it and keep the flame alive?" Shanna has some, uh, not-so-nice things to say about these people (do "these people" include me, I wonder?):

"It is always funny to see the Ashtanga snobs come out of their caves when the authorized/certified teachers come into town. What they don't realize is that without the hometown teachers, these people wouldn't be here. There wouldn't be a demand. The hometown teachers created the buzz and lit the candle that drew the workshop attendees to the light. These are the creators and change makers.

But what impact does the Ashtanga snob have on the world? The person who refuses to share their practices or energy with others because of righteousness and superiority? They say they make this choice because they are true to the tradition, but how does their behavior actually help the tradition?"

Hmm... these are very strong and thoughtful words here. As you might know if you have been reading this blog for a while, I tried to make a foray into teaching Ashtanga for a while last year, but things didn't quite work out (see this post). Shanna's words here give me more food for thought in this area. Personally, I don't feel ready or in a good position to teach Ashtanga right now, mainly because of things in my personal and work life. But perhaps, from the viewpoint of Ashtanga, teaching others isn't just something that one chooses to do at one's leisure; perhaps, as Shanna points out here, there is a bigger reason and bigger purpose to be served by teaching others and leading them to the light of Ashtanga yoga. Well, I can't say much more now, because with many important matters (like this one), there comes a point where words become superfluous, even meaningless; you either do it or don't do it, that's all. But I'll keep all this in mind.    

But let's move to some less weighty matters for now. Exactly two years ago on this day, I wrote my first post on this blog: Which means that Yoga in the Dragon's Den is now two years old! Happy Birthday, Yoga in the Dragon's Den! Many thanks to all of you for reading this blog and keeping it alive with your presence :-)

But this also means that this blog might be entering a difficult period of its existence: The Terrible Twos! So this may be a good time and place to issue a warning:

Well, there isn't that much more I can say right now. We'll just have to wait and see what terrible things come out of this blog in the coming year...  

we recommend you to buy some goods below for comfort, safety and ease of your yoga activities

In a time of EHR naysayers, mean-spirited election year politics, and press misinterpretation (ONC and CMS do not intend to relax patient engagement provisions), it's important that we all send a unified message about our progress on the national priorities we've developed by consensus.

1.   Query-based exchange - every country in the world that I've advised (Japan, China, New Zealand, Scotland/UK, Norway, Sweden, Canada,  and Singapore)  has started with push-based exchange,replacing paper and fax machines with standards-based technology and policy.   Once "push" is done and builds confidence with stakeholders, "pull" or query-response exchange is the obvious next step.  Although there are gaps to be filled, we can and should make progress on this next phase of exchange.   The naysayers need to realize that there is a process for advancing interoperability and we'll all working as fast as we can.   Query-based exchange will be built on top of the foundation created by Meaningful Use Stage 1 and 2.

2.  Billing - although several reports have linked EHRs to billing fraud/abuse and the recent OIG survey seeks to explore the connection between EHR implementation and increased reimbursement, the real issue is that EHRs, when implemented properly, can enhance clinical documentation.  The work of the next two years as we prepare for ICD-10 is to embrace emerging natural language processing technologies and structured data entry to create highly reproducible/auditable clinical documentation that supports the billing process.  Meaningful Use Stage 1 and 2 have added content and vocabulary standards that will ensure future documentation is much more codified.

3.  Safety - some have argued that electronic health records introduce new errors and safety concerns.  Although it is true that bad software implemented badly can cause harm, the vast majority of certified EHR technology enhances workflow and reduces error.  Meaningful Use Stage 1 and 2 enhance medication accuracy and create a foundation for improved decision support.  The HealtheDecisions initiative will bring us guidelines/protocols that add substantial safety to today's EHRs.

4.  Privacy and Security - some have argued that EHRs reduce security by making records available in electronic form, possibly over internet connections.   Efforts to enhance certification of the security of EHRs, encrypt data at rest, and create guidance for EHR modules that interoperate with built in security will further protect the data that needs to be shared for care coordination and population health.

5. Innovation - some have argued that meaningful use led to the growth of a small number of vendors and dependency/lock in with those vendors.    Meaningful Use Stage 2 requires interoperability between vendors, export of data from EHRs to reduce lock in, and standards that will enable a new generation of modular "plug ins".   I'm confident that SHARP grant funded work, like the SMART initiative will lead to an ecosystem of applications from small vendors - an app store for health.

Thus, our mantra should be that Meaningful Use Stage 1 and 2 have created a foundation for query-based exchange, accurate billing, safety, security, and innovation.

Stage 3 work is already in progress and from the early thinking that I've seen (will post a blog about that in a few weeks), the trajectory of Meaningful Use will address all the naysayers concerns.

Yesterday evening, I attended a book reading by an author whom we ("we" as in the philosophy department, of which I am a member) invited to campus. I was half expecting (more than half-expecting, actually) to see a smug, pot-bellied middle-aged white guy read dourly and dryly through a section of what he thought was his great book, and answer a few questions in a perfunctory, smug manner. Although I am definitely guilty of stereotyping here, stereotypes, like rumors, often have a grain of truth: Over the years, I have encountered more than my fair share of philosophers who actually fit this stereotype.

So I was very pleasantly surprised to have my stereotype broken last night. The author in question (I'm not going to tell you who he is, because I try to maintain a certain separation of blog and work here, but if you really want to know who this guy is, email me, and I'll tell you...) turned out to be this unassuming Bostonian who has written a few novels that take a humorous, slightly irreverent, yet ultimately charitable view towards things religious and spiritual. As I listened to him read sections from his very entertaining prose and interact with the audience, I couldn't help feeling, in light of all those wonderful things that happened in the yoga world in Encinitas lately, that perhaps too many of us take ourselves just a little too seriously, that perhaps, when all is said and done, life and its contradictions might be just a little more bearable if we learn to laugh at ourselves and also laugh with others.

There was one thing the author said that I found to be quite insightful. He was telling us that he is basically a political junkie, and listens to late-night talk shows hosted by people from every point on the political spectrum. Listening to these shows often make him sad, because he realizes that when it comes down to it, we are actually 99% percent similar to each other, but people like talk show hosts (and probably politicians too, with the aid of the media) really exploit the remaining 1% that make us different (our socio-economic backgrounds, religions, political persuasions, sexual orientation, etc, etc.) to sow fear and division among us. The result is a very divided country in which people talk at each other rather than with each other. Which is not to say that our differences are not important (they are), but why allow these differences to make life more difficult than they need to be?

Honestly, I can't say that I can always see that we are 99% percent similar; truthfully, even as I am writing this now, there's a part of me that finds it difficult to believe that I, a Chinese-guy-born-and-grown-up-in-Singapore-who-moved-to-the-United-States-when-he-was-twenty-five-who-does-Ashtanga-and-stopped-eating-animals-some-years-ago-who-also-teaches-philosophy-who-likes-double-espresso-and-still-sometimes-has-cravings-for-fried-chicken-or-fish-and-chips-even-though-he-has-ostensibly-stopped-eating-animals, can actually be 99% similar to you who are reading this now. But the more I run this 99% similarity thesis, as I shall call it, through my head, the more I sense that it is true: Over and above our differences, we are probably much more similar to one another than different.

Here's something else I heard on NPR the other day that also reinforces this 99% similarity thesis. This economics professor at some Ivy League university conducted an experiment in which she got a random group of people with very different socio-economic backgrounds and political persuasions to come together in a room (now, why don't I ever get to conduct cool experiments like this that make it onto NPR? ;-)). After a round of introductions in which everybody told everybody where they are from, what they do, etc., they were all assigned to try to solve a problem together. The economist reports that all these people were able to work together amiably, despite their differences. The basic idea is that if you get people to sit down face-to-face and talk about things together, people can often set aside their differences and find workable solutions to common problems. Which is, of course, a bit hard to believe sometimes, given all the differences that are being aired everywhere in seemingly every corner of the mass media during this election season.

I'm not sure what I'm really trying to say in this post. Maybe I'm not really trying to say anything in particular; just thinking and writing aloud, as I often do. And maybe, if you happen to be on the east coast and are sheltering from Hurricane Sandy (I hope you're alright; but I'm guessing you must be, if you can read this), my random thinking-aloud musings here might just offer you a modicum of comfort and companionship in this, uh, dark and wet hour.

But maybe this is what everything comes down to: Different people come at things from very different angles. Or, to to put it in a more fancy way, different people see reality with different lenses. And if we forget that our differences are due in large part to the different lenses that we wear to see reality with, and forget that underneath the lenses we wear, we are really all quite similar, we end up believing that we are really very different when we are not.

Since this is supposed to be a yoga blog, here's an example from yoga that might illustrate this point. Kino, as many of us know, has posted many, many instructional yoga videos on Youtube; so much so that I recently speculated that if the human race were to suddenly become extinct tomorrow, alien archeologists will probably stumble upon her videos a million years from now, and be able to learn Ashtanga yoga from these videos. But I'm digressing; as I was saying, Kino has made many instructional Youtube videos. One of them which has received many views recently is the one on Yoganidrasana below:


Kino, as you can see, demonstrates and talks us through the posture with admirable ease and clarity of instruction. However, it appears that not everybody who has viewed the video thus far was looking for yoga instruction; this is very obvious if you look at some of the comments on the actual Youtube post (two of which actually made it to the "top comments" section).

Kino herself has noticed this, and has remarked wryly on her Facebook page, "So many views in such a short time. Not sure everyone is watching for yoga, though." A couple of her concerned Facebook followers have also noticed this, and have advised Kino to remove these "unacceptable and offensive" comments. 

I'm not here to advise Kino on what to do; I'm sure she will do what is right and most appropriate. I just think that this example illustrates what I was saying, in a rather weird kind of way. Whoever made those comments could just be a little "crazy" (as one of Kino's followers puts it). Or, for all we know, they could actually be trolling the internet in a sexually-charged state of mind, and certain yoga postures--especially Yoganidrasana, which bares and offers the pelvic region to the heavens--might strike them as being inviting in a sexual manner. For all we know, there might even be porn videos out there that feature some of the, ahem, characters in exactly this posture (I don't know this for sure, one way or the other; remember, I'm a yogic prude...). 

So if my above speculation is correct, then the people who left these "unacceptable and offensive" comments may actually sincerely mean what they say, as creepy as this might sound to some of you. Is this a good thing? Well, the answer is probably no, if acting out one's sexual fantasies using instructional yoga videos (especially those with Kino in them... yikes!) is, well, inappropriate. But here's another way of looking at this matter: What if, just what if, these instructional videos happen to be the online sex-troller's first real exposure to yoga, as unlikely as this might sound? What if, after watching these videos, the sex-troller starts to ask, "Hmm... could there really be more to this body position than as a position for sexual activity?" And this question then leads him (or her) down a path of inquiry which eventually leads him (or her) to become a serious student of yoga? In other words, what if being exposed to these videos causes the sex-troller to put on a different set of lenses, so to speak, and see the same physical things in a different light? Unlikely, I know, but hey, crazier things have happened on this planet... 

At any rate, at least this much can be said: Kino may be doing way more good in the world with her videos than she suspects...                  

we recommend you to buy some goods below for comfort, safety and ease of your yoga activities

With the Golden Spike on October 16, Massachusetts began a new era of healthcare information exchange.   Now that we have momentum and the perfect storm for innovation with alignment of government, industry, academia, stakeholders, and funding,  we want to rapidly advance to the next phase.

Last week, while I was in China, a group from Massachusetts visited CMS in Baltimore to present the Phase 2 plans.   Here is the powerpoint they used.

A few key points

1.  After summarizing the accomplishments of our Phase 1 go live, they presented the sustainability model in detail (see slide 15-16).   The tiered pricing was developed based on several key principles (see slide 13-14) such as the need for large organizations which derive high value from the HIE to subsidize small practices which have limited resources and bandwidth for new projects.   The end result is that comprehensive HIE services cost a solo practitioner just $5/month.

2.  We know that "push" transactions are easiest from a policy and technology perspective, so Phase 1 was limited to use cases like PCP to Specialist, Provider to Public Health, and Hospital to PCP exchange.    We also know that "pull" transactions have a great deal of value by providing just in time delivery of community wide longitudinal health records (slide 21).   Pull models require significantly more complex technology and policy.    Pull models require a master patient index/record locator service and some means of recording consent to disclose records.   Rather than declare that the standards are not ready, the informatics challenges are too great, and the consent models are too complex, we're just moving forward with an aggressive timeline to get it done in 12-18 months.  (timeline is on slide 31)

3.  With Phase 1, we built a guiding coalition of providers, payers, patients, government, and employers to break down barriers and create community wide demand for the service.  Where there were standards gaps we filled them with simple SOAP-based XML exchanges (provider directory query/response).   In this next phase, we're going to do the same thing as outlined in slides 23-30.   Is there a simple set of standards for managing consent that is widely deployed in the industry?  No - we'll create one and refine it in actual production across thousands of users and millions of transactions.   Is there a simple set of RESTful interfaces for query/response retrieval of records across a complex community of non-affiliated organizations?  No - we'll create one and show that it works really well.   To date, our implementation guides for SOAP/REST XML exchanges are less than 10 pages each and do the job well.   Of course we'll use existing mature standards where they exist but we will not select implementation guides that fail the standards readiness criteria simply because the right standards have not yet been invented yet.

Over the next few months our push HIE will grow to scale as more providers and vendor products are connected to it.   Currently NEHEN, our administrative transaction HIE in Massachusetts, does over 100 million exchanges per year, so we're confident we can achieve and support clinical healthcare information exchange at large volumes.    We'll dive headlong into the pull HIE work very soon as the funding is finalized.   We'll broadly share our lessons learned, our policies, and our technology.

It's a great time for HIE in Massachusetts and I hope we can be a catalyst for wider push and pull HIE adoption in the country.

There's a discussion going on over at the Confluence Countdown about "holding students back" in the Ashtanga system. The blogger, Bobbie, makes some very interesting points about the system from a philosophical / psychological perspective, the discussion of which I'll leave to her blog. I'm outta that relationship, remember? ;)

What is interesting to me is the question of whether it's good for students to practice exclusively the primary series for too long. Bobbie and many of the commenters come to the same conclusion that I did, that practicing exclusively the primary series for years on end does not give your body a healthy or balanced practice. And since the system seems to have developed rules over the years about when/how students are "given" (I agree with Bobbie, I also dislike that word!) the next pose or series, e.g. being able to bind in Marichyasana D or being able to stand up from and drop back to Urdvha Dhanurasana, many students find themselves practicing primary for years.  Many, like myself, don't have regular access to a teacher who can "give" them the next pose or teach them 2nd series. Nonetheless, we are told not to do other yoga, to "pick a system and stick with it," that doing other yoga will somehow dilute the transformational power of the practice.

Bobbie and many commenters on the post feel what I felt, deep inside my body, and what led me to "break up" with Ashtanga and start practising other poses - that the primary series is not, IN ITSELF, a balanced practice. And quite possibley it wasn't intended to be that way, but that is another conversation. In any case it's good to hear that many of the senior teachers seem to agree.

Essentially the points made in the post and the comments, which may not be experienced by everyone, but which me and my body agree with wholeheartedly after practicing Primary for 3 years:

[NB: In response to a comment left on the blog, I realised that my original post used language that was a bit too absolute, so I've edited the original wording a bit to emphasise that what I'm talking about is relativity within the sequence. I've also added some more anatomical precision.]

• Primary has a relatively greater emphasis on forward bending, stretching the muscles of the  back (in particular the erectors spinae and the quadratus lumborum) more often than it strengthens them (one of the best poses for that is shalabasana). In some people, an overemphasis on forward bending can be destabilising for the SI joint. Sciatica or SI pain, anyone?
• It develops relatively more upper front-body strength (pec minors) without developing the corresponding upper back-body strength (rhomboids and rotator cuffs). My yoga therapy teacher believes that this is why many Ashtangis (and others who practice vinyasa-based yoga) develop shoulder injuries, because those crucial muscles that stabilise the shoulder blades can become relatively weaker on the back than the front. Another effect of this is that the front body, especially the front of the shoulders, while getting very strong, may become tight and "closed", as there are relatively fewer poses to open it up (the best stretches for here are back-bends with the arms extended behind the body, e.g. purvottanasana, ustrasana, shalabasana, dhanurasana).
• While Primary certainly stretches the hamstrings, it doesn't provide space for deep hip-opening in certain directions. There is a lot of external rotation and flexion of the hip joint, but relatively little extension or internal rotation. The sequence also strengthens the psoas, the quads and the external rotators of the hip (the glutes, the piriformis) relatively more than it stretches them. These muscles are key muscles for postural stability and the health of your spine, and balanced hip-opening (internal and external) is important for maintaining the safety of the knees and the lower back.

Since I stopped practicing Primary about 6 months ago and moved to a more balanced practice, I am feeling my body in a whole new way. Most noticeable is that my back body is much stronger as a result of the targeted postures I have been doing, and this has significantly reduced the shoulder pain I used to often experience (which was also related to my scoliosis). This has also made my posture better and I've made some progress towards reversing the forward-hunch that my shoulders had developed through a combination of too much computer time and too much emphasis on forward-body strengthening (in particular the pec minors). No thanks, kyphosis, not for me!

The moral of the story, for me at least?

• Listen to your body and think about finding balance in your long-term yoga practice. 
• If you stretch a muscle, strengthen it. It doesn't have to be the same day, but overall!
• If you stretch/strengthen somewhere, be sure to also stretch/strengthen its opposite (antagonist).
• If you feel like your body is imbalanced from a practice you are doing (chronic pain or recurring injuries are a good sign), listen to those feelings and find a teacher or yoga therapist who will help you identify what's going on.

And above all, remember, it's only asana!

we recommend you to buy some goods below for comfort, safety and ease of your yoga activities

It has been a most interesting weekend. Not so much in a yoga kind of way; although, come to think of it, if all life is yoga, how can anything not be anything in a yoga kind of way? So I guess what I was trying to say is that the weekend wasn't interesting in a yoga-on-the-mat kind of way.

But it was an interesting weekend, anyway. I spent Friday and Saturday down in the Twin Cities (that's Minneapolis and St Paul, for those of you who don't live in the United States), where I presented my stem cell research ethics paper at a philosophy conference for the first time ever. It was quite well-received, and I got some useful and constructive feedback from a few people who also work in bioethics, although they had to put me through the usual academic-conference gauntlet (being grilled, being subject to powerfully voiced objections delivered in an intimidating professorial tone of voice, etc.) before they offered the constructive feedback. That's okay; there's probably a nicer, less ego-driven alternative to this kind of academic conference gauntlet, but I'll take what I can get right now. Can't expect the world to change overnight. Besides, wasn't it Gandhi who said that you need to be the change that you want to see in the world?

My presentation also went well in another way; only one person got upset by what I was presenting (for another example of somebody getting upset by my, ahem, dangerous ideas, see this post). This person actually said to my face, "You would do well to change the thesis of your paper..."

Now, I've read this particular turn of phrase ("You would do well to do such-and-such") many times in print, but to actually hear it spoken to me in person is quite an experience, to put it mildly. In any case, at a post-mortem of my presentation conducted at the post-conference reception (lubricated by a few glasses of red wine), a few colleagues and I agreed that this person probably got upset because she misunderstood what I was saying. Which made me feel better about her feeling upset... uh, well, this is not a good way of putting it, but I hope you get what I'm saying, which is that although upsetting people is always not a good thing, it is better that people get upset not because of what I said, but because of what they think I said. Does this make sense? I hope it does...

I must be boring you with the boring details of my professional life... I mean, isn't this supposed to be a yoga blog? So let's turn to something more... yoga. After the conference last night, I had to make the four-hour drive back up to northern Minnesota. Along the way, I stopped for some great Indian food at an Indian restaurant in St Cloud; if you're ever in St Cloud, Minnesota (why would you be, I wonder?), check out the Star of India.

Well, that was the good part of the journey. The bad part happened after dinner. In the last fifty miles of the drive, it started snowing pretty heavily. The snow was pelting my windshield, and I couldn't see more than ten feet in front of me. At the same time, the road was so thick with snow that I couldn't see the lane markers. Which meant that I had no idea whether I was straddling two lanes at once or worse, in danger of driving into a ditch. I had never driven through a snow-storm on the Interstate before (I grew up in the tropics), so this was definitely an experience, to put it mildly. At first, I wondered if it was safe to continue driving, and I thought about stopping; but then if I did, I wouldn't know how long the snowstorm would continue to rage, and I might either (a) get snowed in right there on the Interstate, or (b) get hit from behind by somebody who's hauling ass (but who would haul ass in a snowstorm?), or (c) both (a) and (b).

So I decided that my best option was to continue driving. I slowed down to about forty miles per hour, and kept as close to the road shoulder as I could without actually getting onto it (as you probably know, you can "feel" the road shoulder by the grinding sound your tires make when they are on the road shoulder); that way, I knew I was still on the road, and was in no danger of driving into the ditch.

The whole time, I was holding on to the steering wheel firmly without gripping it too tightly; if you grip too tightly, you won't be able to maneuver well, and won't be able to respond quickly and effectively to the ever-changing conditions on the road. So, what has any of this to do with yoga? Well, I think Kino said in some video somewhere that the bandhas are like the steering wheel of the practice; you engage them, and use them to bring your body where you want it to go in the most efficient and effective way. And perhaps what is true of driving in a snowstorm is also true of bandha-engagement; you need to engage and "hold" the bandhas firmly without gripping too tightly; if you grip too tightly, you become a tight-ass (literally), and you won't be able to respond quickly and effectively to the ever-changing conditions that the road of practice constantly throws at you.

So yeah, who knew that driving in a snowstorm can teach us a thing or two about asana practice (and vice versa ;-))?


While I was in the Twin Cities, I also bought myself a copy of the novel Cloud Atlas. As you probably know, the movie adaptation, starring Tom Hanks, Halle Perry, Jim Sturgess, Zhou Xun and Bae Doo Na, among others, came out this weekend. I heard some good reviews on NPR, and decided to buy the novel and read it first before watching the movie. Anybody seen it yet?

In any case, here's what the back cover of my copy of the novel says about David Mitchell, the author:

"A postmodern visionary who is also a master of styles and genres, David Mitchell combines flat-out adventure, a Nabokovian love of puzzles, a keen eye for character, and a taste for mind-bending philosophical and scientific speculation in the tradition of Haruki Murakami, Umberto Eco, and Philip K. Dick. The result is brilliantly original fiction that reveals how disparate people connect, how their fates intertwine, and how their souls drift across time like clouds across the sky."

With such a description (especially the comparisons to Murakami and Dick, two of my favorite authors), how could I resist buying the novel and setting myself back US$15? ;-) Let's hope it lives up to its back cover... Maybe I'll post reviews here as I read it.

More later. Oh, and if you live on the anywhere on the U.S. eastern seaboard, be safe: Stay out of Sandy's way.    

we recommend you to buy some goods below for comfort, safety and ease of your yoga activities

Last week I spent 5 days in Shanghai and Hangzhou as part of an American delegation advising Chinese government and private sector leaders about healthcare reform.

We met with the Mayor of Shanghai, the Health Minister of Shanghai, many hospital presidents, and several public health officials.

The themes we highlighted included:

*Quality must be measured, not assumed, and this should be enabled by the universal adoption of electronic health records

*Data should be shared among caregivers with a focus on longitudinal coordination of wellness rather than episodic treatment of illness

*A primary care model coordinating patient treatment via a team that knows patient care plans and preferences will be more efficient than the current model in China in which the patient can go anywhere without a referral.   A simple headache might be first evaluated by a neurosurgeon at a tertiary care facility.

*The measures of success should be healthcare value (quality/cost), safety, and patient satisfaction

My role was to spread the gospel of Meaningful Use.   I highlighted the multi-phased journey in the US and our focus on policy outcomes rather than hardware/software implementation.

I toured several facilities and had the opportunity to study the IT infrastructure and applications used in different settings.

A few observations:

*Shanghai community hospitals have deployed a standardized EHR that is good enough - it enables enough clinical documentation to provide continuity of care.

*Tertiary facilities have not widely adopted advanced clinical IT systems.  They have focused on  administrative transactions (registration/scheduling) and ancillary automation (lab/rad/pharmacy) but not provider order entry, decision support, or clinical documentation.   The systems are optimized for episodic and not continuous care.

*This is my third visit to Shanghai and I've advised their health information exchange efforts by suggesting content, vocabulary and transport standards.    Shanghai is piloting health information exchange that involves transport of XML-based summary records over VPN.  The Chinese have a national identifier they use for healthcare and have privacy policy that makes data sharing a public good in society.    Culturally, there seem to be few expectations of healthcare data privacy.    Limited regulatory/compliance oversight enables the Chinese to move quickly but also providers fewer controls.   There is very little assertion of malpractice.

My conclusion from these Chinese visits is that healthcare IT challenges are similar worldwide.   I enjoy sharing our US experiences with other countries and look forward to the day when continuous lifetime coordinated care based on interoperability of data is a worldwide possibility.

During practice this morning, I tried speaking to the cockatiels again while holding my heels in Kapo. I didn't say anything profound, just some rather inane things like "Hello birds, where are you?" I did this, because I recently came up with this theory that if I can speak in complete sentences (albeit rather short and probably creepy-sounding ones, if anybody were around to hear them) in a more or less even tone while in the depths of Kapo, then my breath must be pretty even, and I must not be doing too badly in the pose. Maybe I should even give this thing I do a name: The bird-speaking test for proficiency in Kapotasana.  

For the record, I don't know what the Official Ashtanga Policy is on speaking to animals (or speaking to anything, really) during practice. I don't know if the Ashtanga police will arrest me (or maybe, let me get away with just a citation) for such incorrect method. But I really think there is some truth to this theory of mine: I mean, if you can't communicate with birds during a pose that is named after a bird, well, what good is your yoga practice? :-)

It also just occurred to me that this is one of the little advantages of practicing at home: If I try doing this in a shala, people will quite definitely think I'm nuts. In a shala, the problem will be compounded by the fact that there are no birds there. Which means I will probably have to try speaking to my neighbor while in Kapo ("Hello, so-and-so, what are you having for breakfast after practice?"...).  Which would quite definitely be creepy.

That said, however, there are good reasons for practicing in a shala. Especially if you are seriously thinking about making the transition from a led practice to Mysore style practice. Speaking of which, Kino just made a video about this topic:

I think Kino admirably answers the question in a way that is thoughtful and sensitive to where the student who posed the question is probably coming from: A place of uncertainty, of thinking about taking what seems to be a big step into unknown territory. If somebody were to pose the same question to me, I would probably say something along the lines of, "Sure! Of course you are ready! Mysore Style is traditionally supposed to be the way people learn Ashtanga anyway. So how can you not be ready? You are never more ready, nor will you ever be more ready, than you are right now!"

Which sounds like a nice, pat answer on the face of it, but is probably a bit disingenuous, since I myself did not learn Ashtanga the traditional Mysore way; for more details, see this post. Which is also why I think Kino's suggestion (give it your best shot and really commit to it for one month, and then see what it does to you) would probably do a much better job of reaching the student where he or she is (as opposed to where I would like he or she to be) and setting that student's mind at ease.


A recent post over at the Babarazzi discusses a rather bizarre but perhaps understandable phenomenon: Some yoga teachers in this country (I'm not naming any names here) have adopted this interesting practice of de-culturing or whitewashing yoga; as in, washing it of its Sanskrit nomenclature and other hocus-pocus elements, thus making it supposedly more friendly to white people... well, I mean to say, some white people.

If you read this blog regularly, you probably know where I stand on this issue, so I won't rehash my views here (Is a white-washed Ashtanga Fundamentalist still an Ashtanga Fundamentalist? That's a hard one...). I'm just going to say two things here:

(1) If Americans white-wash yoga in America, wouldn't people in other parts of the world follow suit? The Chinese will then start yellow-washing yoga, Africans, I'm guessing, will also start black-washing yoga, and maybe people in the middle east will then start brown-washing yoga... actually, I have this feeling that the Chinese will probably be quite happy to keep yoga as it is; in my personal experience, Chinese people and culture have always had this syncretistic, pragmatic attitude towards things foreign to them ("You want me to chant this Vande Gurunam thing before I can take practice? Sure, why not? If it enables me to tap deeper into the benefit of the practice and also look kinda exotic in front of my friends, what's the problem?"). But I can't speak for African or Middle-eastern people. But maybe all of this is not a problem, anyway: If there are white-washed and yellow-washed and black-washed and brown-washed (and whatever-other-color-washed) yogas, wouldn't this make yoga more colorful (literally)? So yeah, go ahead, white-wash away. Just don't make me white-wash along with you. I like my vande gurunam the way it is ;-)

(2) But here's another, possibly more significant problem with this white-washing business: Ever heard of Wonder Bread? If you haven't, it looks like this:

we recommend you to buy some goods below for comfort, safety and ease of your yoga activities

we recommend you to buy some goods below for comfort, safety and ease of your yoga activities

Sometime last month, I invited readers of this blog (that includes you :-)) to submit guest posts about practicing with injury and using the practice to heal from them. I'm very pleased to report that Yoga in the Dragon's Den now has its very first guest post. In response to my invitation, Michelle Ryan has very generously written a long guest post, which you will have the pleasure of reading below.

But first, a few things about Michelle. Michelle is the owner and director of Florence Yoga in Northampton, MA (I just realized I actually don't know how to spell MA in full...). She has been practicing Ashtanga since 1997. Among other things, her studio boasts a big beautiful Ganesh statue. I have yet to see it, but I hope to someday go there and practice in front of it; I have a good feeling that my practice will improve by leaps and bounds when I do so :-) If you are ever in the area, please think about stopping by her studio to practice.

I guess I've said enough. I should let you read what Michelle has to share below. She combines her knowledge of the Ashtanga practice with an intimate knowledge of Ayurveda (especially the Ayurvedic concept of Dinacharya, or "daily routine") to fashion a comprehensive path towards greater well-being. Enjoy!

So, you’ve gone to Ashtanga class, and at some point in the practice, you forgot to breathe, lost your concentration, or pushed a bit too hard and you feel a sharp pain. Or, you were chopping wood, or raking leaves, or walking an overzealous dog, and you go inside and notice "something" hurts. You’ve pulled or strained something, and you are unsure if you should do your practice.

Approaching your practice with an attitude of self care is vital at all times, but especially when you are injured. The practice is a brilliant means of bringing you health and wellbeing, a way to clear and revitalize your mind and body, when approached wisely and compassionately. You should feel buoyed and energized, not depleted and discouraged, by your practice. A compassionate, non-striving approach goes a long way.

But, we have bodies, we can use them rigorously, and sometimes we get hurt. Here’s what I do when this happens, and it’s based on the Ayurvedic concept of “dinacharya” or “daily routine.”

(A couple of disclaimers: with any injury or pain in yoga practice, especially if it’s chronic, it’s best to talk to a healthcare professional to determine whether or not the pain is something more serious. Yoga can help and even heal the body, but you must be certain your injury is not something more serious, that may require Western medicine. Also - I am not an expert on Ayurveda. I have had this post fact-checked by one of my students, Kim Jorczak, who is a trained Ayurvedic Consultant - and I owe much of my original information to my friend and teacher, Christine Hoar, who has shared these strategies with me over the years.)

Very succinctly, Ayurveda, the “sister science” of Yoga, was developed in India over many centuries to help us put our bodies into harmony with nature’s rhythms. The easiest way to think about these rhythms is to imagine that our bodies are like clocks, where every system of the body has a time period of optimum function. Aligning your choices with the optimum times of when and what to eat, when and how long to sleep, when to do mental work, and when to be physically active, and then following the regimen regularly, on a daily basis, along with awareness of the season, is the basis of Ayurveda. It can have a profound effect on maintaining and even enhancing our health and wellbeing, especially as it gives us the means to do so naturally, without resorting to panaceas that only mask or treat the symptoms.

Our bodies like routine - and rituals. Just as doing a daily asana practice becomes something we begin to look forward to and benefit from, dinacharya - daily routine - will also be something your mind and body will benefit from, too. Dinacharya follows the Ayurvedic tenet that as long as we live in harmony with daily and seasonal rhythms, our body and our minds will respond by being more healthy and well as a result, giving us the means to live in balance.

My personal dinacharya helps me manage those aches and pains that inevitable arise through the rigors of the practice. Besides my 5-6 days of asana and pranayama practice each week, I practice the following methods of self care every day:

• going to bed and getting up at the same time 
• scraping my tongue 
• using a neti pot 
• dry brushing before I shower 
• doing uddhiyana kriya (not necessarily ayurvedic, but it really helps your digestion to do this) 
• sesame oil self-massage (especially ears, hands and feet)

In addition, I eat moderately and healthfully, according to my ayurvedic constitution, at optimum times for my digestion. I also drink warm water or herbal tea throughout the day, and have cut way down on fats, sugars, wheat, and most animal products.

If this seems like a lot to do, it’s not, really. It only takes me 30 minutes to get ready every morning, including my daily cup of chai, before I head out the door. It has become my way of managing my health every day, and the results have been very positive. I began doing these dinacharya practices, in addition to my yoga practice, 7 years ago, with Christine's guidance. While I had a daily asana practice, I wasn’t fully healthy: my blood pressure was considered “borderline” high, and my cholesterol was above 200. I was overweight by about 15 lbs, had chronic back pain, debilitating allergies that were leading to asthma, and Reynaud’s syndrome, an auto-immune related disorder that effects circulation, and is a pre-cursor to more serious autoimmune disorders.

I just went to the doctor a few weeks ago for a complete “work up,” and every test fell well within the “normal” range. My Reynaud’s is gone (it disappeared about 5 years ago); I fortunately never developed asthma; my weight and BMI are within normal range, and my cholesterol and blood pressure are excellent; I still have some seasonal allergies, but they are not as debilitating or year-round as they once were. I no longer suffer from back pain. I am very healthy - and I attribute it to these dinacharya practices that I have added to my Yoga asana practice.


This may sounds very self-satisfied, but I am very humbly grateful to my dinacharya routine, and thank Christine for her kindness and wisdom in sharing it with me. Your routine may be different, and I highly recommend that Ashtanga practitioners meet with a qualified consultant to have their own Ayurvedic evaluation, and be given a dinacharya routine specific for you and your body type.

Now, some additional things - some Ayurvedic, some not - that I do when I am injured - My mantra is “decrease inflammation, increase circulation.”

• Ice the injury to decrease inflammation. 
• Put sesame oil on the affected area at night, before you sleep. Gentle massage brings stimulation and circulation to the injury, which ultimately speeds up the bodies natural healing process, and doing so before you go to bed is very effective, too, as you sleep more deeply, which helps promote healing.

• If you have worked particularly hard in a class and know you’ll be sore later, take an Epsom salt bath that evening, before the oil massage. Epsom salt has long been associated with helping to decrease muscular pain and inflammation. You will sleep like a baby after this warm bath, which again, promotes healing. Follow up with a bit of sesame oil massage on the affected area before you go to bed (wear old clothing, as the oil can stain.)

• Consider trying an interesting “hybrid” homeopathic/herbal anti-inflammatory ointment called Traumeel. It’s also available in an internal “tincture” form. It includes arnica and a variety of other herbal anti-inflammatories. It’s effects are helpful in decreasing muscle and joint pain. I have had success with Traumeel in the past - and know of many other students and friends who have had the success with this product as well. (My mother, who suffers from Fibromyalgia, swears by it.) It’s good to put it on right after you injure yourself, so keep some handy when you practice, just in case!

• If you are not allergic to ibuprofen (as I am - and I kind of dislike suggesting this), but it may help to take some for a limited time to help with the inflammation. Do not become dependent on it, however, as it is only a panacea - and can wreak havoc on your liver if you take it for long periods of time.

• Reduce caffeine, alcohol, sugar and fats in your diet. This can be hard, but it’s necessary. For me, a vegetarian diet is best for promoting healing and renewal - you may be different. 

• Eat more pineapple - it is great for reducing inflammation. Juicing is great, as well, since the micronutrients you get from one 16oz. glass of freshly juiced veggies and fruits are concentrated and easier to consume than eating the original large amount of veggies.
• For old injuries where there is scar tissue, hot castor packs work wonders. (I used these on my C-Section scar about 5 years post-partum, and it dissolved the scar tissue from the incision.)

• If you can afford it, get good body work from a qualified professional. The modalities I personally prefer for injury are acupuncture, shiatsu and deep tissue massage. Do what makes your body relax and renew. It’s worth the cost to give this gift of to ourselves. 

• Talk to a qualified Ashtanga teacher to see what else you can do in your practice to promote healing. Modification of postures is preferable to re-injury, and it’s the wise yogi who does this. Also, study the anatomy of the affected area - I have found this is very helpful in giving me a greater understanding of what I should do in my asana practice to prevent further damage, and also future injury.

Although there may be an understandable desire to “take a break” from practice to heal the pulled muscle, I’ve found that after a short rest of a day or two to let any swelling subside, it’s better to continue my practice, albeit, carefully. In general, it’s also better to practice for shorter periods of time, but more regularly, because you will feel less sore and depleted when you practice gradually, adding a little more every time you practice.  

I use the asana practice to promote healing. I listen to my breath and intuition even more as a guide and make sure to explore alternatives and modify postures that would exacerbate the injury. Following Primary series carefully, moving through the postures and ending my practice if a posture is not working or feels like it exacerbates the injury, is wisest. The next day, I go through the series and only add a posture when there isn’t pain associated with it. If it hurts, I close my practice. Each day, I do a little more, adding postures as they become comfortable. I may get “stuck” on a posture for some weeks before being able to move on.

Patience is key to this slow and steady approach. It can feel like you are going back to square one - you may only be able to do Suryanamaskar at first - but this method can work to resolve longstanding issues in your body. You have your whole life to practice and explore - what’s the rush?! Pushing to “fix” yourself with the practice by doing it as you “think” you should be doing it, or as you were doing it before the injury, is counterproductive. Trust the practice, because it’s healing, but trust your intuition too. If something hurts very badly, or makes you feel worse afterwards, STOP. Don’t keep doing it. Close your practice for the day. Take rest. The Ashtanga Police will not arrest you for taking good care of yourself.

Finally, see this amazing  man and definitely watch this amazing woman's story; both of these videos offer a refreshing, inspirational perspective on the Ashtanga practice and the potential of our minds and bodies.
Injuries can be humbling and frustrating, no question. But, I suggest, you will find greater clarity, depth, humility and acceptance of what “is” when they do happen to you. It's then that the true yoga practice can begin.       

we recommend you to buy some goods below for comfort, safety and ease of your yoga activities

This week I'm in Shanghai and surrounding cities working on EHR implementation and health information exchange issues.

There will be a few days without blog posts this week due to my travels, but I will detail all the lessons learned when I return.

Aligning quality, safety, and efficiency with technology and politics pose the same challenges all over the world but the scale of China makes implementation particularly interesting.  

And now off to spread the gospel of Meaningful Use.