our-yoga

"Travel is fatal to prejudice, bigotry, and narrow-mindedness, and many of our people need it sorely on these accounts.  Broad, wholesome, charitable views of men and things cannot be acquired by vegetating in one little corner of the earth all one's lifetime."

Mark Twain

Yesterday afternoon, I was trying to get some work done at this coffeeshop that I usually go to, when I got distracted by the sight of a couple of young people playing chess at a nearby table (this has happened before; see this post). I quickly convinced myself (rightly or wrongly) that I needed to take a break from work, and went over to them and asked if they wouldn't mind me watching their game. They did not mind, and I ended up watching the game, and then playing a couple of very good games with them.

During and after the games, we got into a conversation about traveling around the world. It turns out that one of my companions, a young woman who is probably in her mid-twenties, has traveled quite a bit; she regaled us with stories of her travels in Prague, Paris, and a few other cities in Europe whose names I do not remember now. We then got into an interesting comparison of different attitudes that Europeans and Americans have towards such social "evils" as drugs and alcohol consumption.

Not to be outdone, I decided to draw from my own store of stories about the world to add to the conversation. Somehow, without realizing it, I found myself relating the stories about Mysore that I had heard and read from people like Claudia and Kino. In particular, I noticed my companions' eyes lighting up when I related stories about brownouts and water outages in Mysore, and about how one needs to really plan one's water usage when in India. I suppose my companions must have found these stories compelling because they offer a valuable glimpse into a world that is so unlike the sort of relative affluence that I imagine they must have been accustomed to, both at home and in their own travels.

Which is all well and good, except that none of these India stories with which I was regaling my friends were my own; as you probably know, I have yet to make it to Mysore. Of course, being the, ahem, yogic person that I am, I was quick to own up to this fact. Immediately after telling these stories, I also told my friends that these stories were passed on to me from friends and teachers who have been to India, and that none of these stories are my own ("I am full of India stories, none of which are my own!" was what I said; which drew a chuckle.).

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

Memorial Day weekend was a busy time at Unity Farm - spending time with our newly adopted alpaca, doing woodland/forestry management, and inoculating mushroom logs.

How did we adopt new alpaca?

In an unusual chain of events,  a leading alpaca breeder in Maine was the former editor of a healthcare IT magazine and knows me well.   When she heard about a family in Massachusetts trying to place their three alpaca, she recommended Kathy and me as caring adoptive parents.

We gently loaded the alpaca into a transport vehicle and drove them 20 miles from their current home to their new home at Unity Farm.

Since we're introducing new animals to an existing herd, we decided to quarantine them for 4 weeks in our pasture, away from the other alpaca.    

We drove the vehicle into our pasture, closed the gate, and let the alpaca step out on their own.   The picture above shows our newly adopted alpaca - Juniper (dark brown), an 8 year old female; Mint (white), her 2 year old daughter;  and Tahoe (light brown), an 8 year old gelded male.

They have their own loafing shed, hay supply, minerals, grain bowls, and half an acre of orchard grass to munch.  

Our traveling large animal vet will visit them on June 5.  We'll update all their inoculations, do fecal samples for parasites, and begin injections of ivermectin as a preventive treatment for meningeal worm.

Since we had a 3 day weekend, we also aggressively worked on woodland management.   Now that the orchard has opened up the lower 5 acres of the property, I began hauling fallen trees to the woodcutting area and wood chip grinding area.

Saturday was devoted to clearing an old hickory tree that blew down in hurricane Sandy.  Hickory is the finest firewood available - easy to split, yields high heat, and burns cleanly.     I added half a cord of split hickory to our 5 cords of firewood storage.

Sunday was devoted to ash.  Over the past few years a virus killed many old ash trees and the emerald ash borer caused dieback of ash trees in New England.   Some of those trees have fallen and some are still standing, likely to fall in the next big storm.  I began the process of clearing ash and moving it to the woodcutting area for splitting.  Ash does not require aging and can be burned immediately.   We lit a roaring fire of freshly cut ash wood on Sunday night since the temperatures on the farm dropped into the 30's.

Monday was devoted to poplar.   Many of the poplars on the farm are 65 feet tall and are approaching an age when they are likely to fall in a storm.   Poplar is poor firewood and we generally chip it for use on our trails.    On Monday, I was spreading mulch on the Orchard trail, a winding path between the orchard and our stream.   I stopped for a moment to check email and received an important budget to review.   I walked to the house to view the spreadsheet on a larger screen.   While sitting at my computer, I heard a loud explosion from the lower portion of the property.   Everyone on the farm ran to discover the source of the disturbance.  What we saw made us turn pale.   A 5 ton poplar had fallen on the exact spot I was standing while spreading mulch.   It crushed a portion of the orchard fence and ripped down the gate, 50 feet away.    Can an email save your life?  On Memorial Day, an email saved mine.    It's hard to imagine an obituary that reads "John was standing in the forest when a 10,000 pound poplar spontaneously fell on top of him."    

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Yesterday I led the Clinical IT Governance meeting at BIDMC and I thought it would be interesting for my readers to get an inside look of the kind of topics we're discussing and how we're implementing our most challenging projects.

1.  Joint Commission debrief
Last week the Joint Commission visited BIDMC and the experience was very positive.  When there are process variations and potential shortcomings identified by the Joint Commission, IT solutions are often suggested.   In this particular visit, there were a few small software changes made during the visit to better support National Patient Safety goals such  as ensuring all care team members know the preferred oral and written language preferences of each patient.   We made modifications to ensure all our sites of care - ED, inpatient, outpatient, OR, and ICU gather this information consistently and display it routinely.   That was the only issue involving IT in this Joint Commission visit.

One of the great challenges of IT governance is maintaining focus on the annual operating plan and avoiding the distraction of the day.   Audits, visiting committees, and even Joint Commission visits have the potential of creating attention deficits which derail IT staff from long term must do's.    I'm grateful that Joint Commission preparation has become such an integrated part of our standard work that no projects were derailed.

2.  Enterprise and Community interoperability
I'm often asked when interoperability will become a standard practice in communities.   In many Massachusetts institutions, data exchange is already happening and the state HIE is processing over a million transactions a month.   However, there are still gaps in offering hospital-based clinicians access to the EHRs of private practice referring physicians.   I outlined the work we're doing this Summer to ensure that opt-in consent to disclose is captured at referring clinician practices as this will enable us to complete the electronic linkage which provides 24x7x365 on demand data sharing.

3.  Annual Operating Plan update
IT has 5 goals in 2013 and I reviewed our progress on all of them
Meaningful Use Stage 2 - we have achieved all MU2 hospital requirements except Electronic Medication Administration Records/Bedside Medication Verification.   Our new EMAR/BMV application goes live in July and we are on track to have 10% of all medication orders processed through it for the October-December Meaningful Use reporting period.

ICD10 - our greatest challenges are clinical documentation improvement such that enough information is available to justify highly detailed ICD10 codes and outpatient coding strategies so that we do not need paper-based superbills hundreds of pages long for every clinic.   We're working with 2 established companies and one start up to create novel computer assisted coding workflows and real time documentation improvement, linking the act of documenting to the requirements for accurate billing in a single workflow.

Laboratory Information System - we go live with the pathology module in our new Laboratory Information System on August 2.  Integrated testing is going well.

ACO support - we've worked hard to generate all the data necessary for our ACO to produce the quality and financial performance reports required by CMS.   We finished our first year as an ACO with a positive margin.  

Compliance/Security - I presented the project plans for 14 work streams of security enhancements suggested by our recent security audit.   Improvements include network access control, security information and event management applications, and a comprehensive NIST 800 ongoing risk management program.

4.  Conversation Ready Project - As part of  the Joint Commission visit, we showed the reviewers screenshots for a new end of life preference documentation application we're building.   Our feeling is that structured data and metadata around end of life planning is not sufficient.   We need documents which reflect a deep conversation about preferences, so that it what we are creating.   Documents may be handwritten, faxed, typed, or natively electronic, so we need to support multiple document capture workflows.

5.  Patient and Family Engagement in ICUs Grant - We collaborating with a major private foundation to think about patient and family engagement in ICUs.   The Clinical IT Governance committee needed to understand the level of work and its alignment with our strategic plan, meaningful use, and compliance requirements.    I always discuss grant opportunities  with governance committees, because sometimes grants are not well aligned with existing work and become a costly distraction.    The committee asked many good questions about this grant opportunity and we're now poised to refine the workplan with the foundation leaders.

A very productive meeting.

Here's a test case. Earlier today, I visited Kino's Facebook page, and saw that she had posted her very popular video on Yoganidrasana, which has had more than 2 million views to date. In case you haven't seen it, here it is:

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As Massachusetts works through the details of building a trust fabric for health information exchange, we have been working through another set of challenges in HISP to HISP communication.

Meaningful use Stage 2 requires EHRs to support the Direct Project implementation guide, which uses SMTP/SMIME as a transport protocol.   Optionally, Stage 2 also supports XDR/SOAP.

In the world of standards, "OR" always means  "AND" for implementers.   Massachusetts needs to support HISPs that allow XDR as well as those which only allow with SMTP/SMIME.   This gets confusing when there is a mismatch between the sender's protocol and the receiver's protocol, requiring a HISP to convert XDR to SMTP/SMIME or SMTP/SMIME to XDR.

There are 4 basic scenarios to think through
1. An SMTP/SMIME sender to an SMTP/SMIME receiver
2. An SMTP/SMIME sender to an XDR receiver
3. An XDR sender to an SMTP/SMIME receiver
4. An XDR sender to an XDR receiver

Scenarios 1 and 4 could be done without a HISP at all if the EHR fully implements the Direct Standard including certificate discovery.

Cases 2 and 3 require thoughtful security planning to support end to end encryption between two HISPs.

These slides provide the detail of what must be done for Cases 2 and 3.  

The challenge of supporting XDR is that the HISP must act as the agent of senders and receivers, holding their private key for use in the conversion from/to SMTP/SMIME.

As Massachusetts continues to enhance its state HIE capabilities and connect many other HISPs (eClinicalWorks, Cerner, Surescripts, AthenaHealth etc) to state government users and those using the Massachusetts HISP as part of their EHR (Partners, BIDMC, Atrius, Tufts Medical Center, Meditech users, NextGen users etc.) we now know what must be done to provide end to end encryption among different HISPs and users connected via 2 protocol choices.

We're learning once again that optionality in standards seems like a good idea, but ultimately adds expense and complexity.
.
Everyone on the HIT Standards Committee knows my bias - offer no optionality and replace the existing SMTP/SMIME and XDR approaches with RESTful APIs such as the Mitre hdata initiative.

Maybe for Stage 3!

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I discovered something this morning: It is possible to do full primary to Sharath's count while having stomach trouble. It all started last night, when I ate an orange that had been sitting in my fridge for too long; really should have known better. About an hour and a half after getting to bed, my stomach woke me up, and I had to go to the bathroom. Nothing came out (TMI?). I made myself go back to bed, but at 3 a.m. my stomach woke me up again. This time, there was a deluge in the bathroom...

Anyway, I don't suppose you care for knowing this level of detail about the goings-on of my digestive system. In any case, when I woke up in the morning, I was wondering if it would be a good idea to do my usual Saturday morning Sharath led primary. But I decided to just go ahead with it anyway; I figured I can always stop if things get to be too much.

It turned out to be quite alright. If anything, the entire practice actually felt a little lighter than usual, maybe because of the loss of water weight. Ha! Now I wonder if this is why people who go to Mysore often report achieving great progress in their asana practice. Could it have something to do with the fact that their stomachs are continually purging the third-world food that they are ingesting, causing them to lose water weight and thus become lighter in their practices? Just speculating here: Those of you out there who have been to Mysore can tell me whether this theory of mine holds any water (no pun intended).

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

“When you stand and share your story in an empowering way, your story will heal you and your story will heal somebody else. - Iyanla Vanzant 

Truth. I haven't had a relationship with my mother in almost 15 years. Why? Sometimes I don't even know why. In an act of transparency I am coming out with it. It's not always easy to talk about challenging situations, especially when it comes to family. Life is messy, and doesn't always come in pretty little boxes like we may want to portray. For as long as I can remember my relationship with my mother has been strained. I never understood her even as a young child. No deep closeness. It's one of those things where karmically there wasn't a deep bond. I can't explain exactly why it was like this only that it was.

I think in many ways I came into this life strong willed. I seemed to have clear idea of things. I was creative and boisterous, definitely curious. Especially curious in regards to God, religion and philosophy. Strange, I know. At the same time I could be lost in my imagination. My dreams were relentless. I also struggled with thoughts on death. Contemplating what would happen to me when I died. Blackness was all I could feel. Nothingness. I could scare myself just thinking about. These things I never talked to my parents about. At the same time I felt a strong presence around me at times. Because of a certain amount of sensitivity I held, I could take on the heaviness of others. I could easily absorb it. Especially from my parents. Somehow I felt responsible for everything.

I never had a teenage rebellion. Maybe I should have. There was no room for it, truthfully. I was a good kid (yawn). Years of perfect attendance, a cheerleader, an honor student on and off. I was funny about school. Often I didn't have the drive to make the grades and then I would easily turn it around and make it, even when taking A.P. courses. It didn't seem to matter. For the most part learning in the traditional sense was boring. I didn't like playing the game. Soon, I learned I had to, and at the same time I learned the difference between book smarts and intuitive common sense. They didn't always go hand in hand. I always thought it interesting that book smarts seemed to take precedence in the eyes of many, especially my mother who didn't approve of my lack of motivation at times. When I was inspired I excelled often to the adulation of my teachers. I new how to work it, garnering my teachers' praises on numerous occasions. Then I'd ask myself is this all there is?

You see, even though I never made waves somehow I was often met with my Mother's disapproval for whatever reason. I still to this day don't fully understand it. One of life's great mysteries. I managed to graduate highschool never drinking a drop of alcohol, never smoking cigarettes, never experimenting with illegal drugs and/or having sex. Yes, bor-ring. I never started arguments because most discussions were established on a one way street and often an interrogation would ensue on the most intense level. She talked, I listened, and often for many hours. It was drilled into me that I must at all costs respect because she was an elder and of course my mother. There was never room for discussion beyond that and I wasn't allowed to question it.

I was groomed to live in fear of her ramifications, punishments, and mood swings. Even to the point where teachers reported signs of those ramifications to authorities. A part of me died then and through the years I have done my best to bring the young girl who has laid dormant since then back to life. But would I change the experience looking back on it? I really can't say that I would. Through the challenges it only quickened me to find an authenticity and truth that maybe if my life would have been more comfortable I might not have so hungrily searched for. I can't deny or judge the complexity that is called my life, or better yet, my story, because it is simply that. I can stand at a point where somehow it was what needed to take place.

However, there came a point where I had to finally admit the nature of my relationship with my mother was simply toxic, with most phone conversations leaving me in a puddle of tears, filled with self doubt. I seemed to be the object of her provocation that I never understood at the time. I felt as if it wasn't enough that I hurt; I needed to be crushed and shattered before any form of satisfaction took place. When my mother gave me back a pile of childhood photos that used to hang on the wall in the home of my upbringing as a sign of her distaste I gave up. I needed to pick up the pieces one by one and build myself anew. So I did, as I allowed the healing to take place.

Through the years many have asked why at certain times am I withdrawn or quiet, and I can honestly say my default can easily slide into that young girl who wanted to fall apart and let go, and couldn't, because keeping some type of stability in tact was the only thing she could rely on. Through it all, even the times I have felt completely lost, with no chance of certainty, God's grace would prevail somehow, someway. This is how I came to believe on a experiential level. To know that everything is grace, even pain and confusion.

Grace is everywhere. There is learning in everything. I think when brought face to face with the challenges of life or feeling like your experience is so different from those around you can bring one to live in grace and/or to become graceful. It's a practice of sorts. Why share this now? In the end this is simply a story I have experienced and doesn't have to cause me to live in bitterness or doubt. People do the best they can with what they know or with the awareness they hold at any given time. My life has been far from perfect and in that I can then lean on the perfection that connects us all. 

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

On Saturday night 96,000 Italian bees arrived at Unity Farm in 8 hives.   What are Italian bees?   Here is an overview of bee types.
There are many subspecies of the honeybee, Apis mellifera.  Each has different characteristics in temperament, honey production, winter hardiness, swarming behavior, and disease resistance.    We chose Italians that had overwintered in Massachusetts for their lack of aggressiveness, consistent ability to produce honey, and their likelihood of reproducing sufficiently to sustain a stable population in our orchard and meadow.

Our Guinea fowl enjoy eating bees, so we created an elevated platform using oak pallets that ensures the hive entrances are higher than guinea mouth height.

To begin our bee journey, we placed 4 "nucs" or nucleus hives in the orchard and 4 nucs in the meadow near the stream.   A nuc is a fully functional starter hive consisting of a laying queen and bees on frames of brood, honey and pollen.  Soon these frames will be transferred to standard Langstroth hives which consist of combs hung in vertical sheets for easy honey harvesting and bee care.

At the moment, the bees are staying close the their hives, circling to get oriented to their new home.   They're very gentle and will land on me as I approach the hive.   I've not been stung and expect that we'll have a great long term symbiotic relationship.   The apple trees are in full bloom and pollen/nectar is plentiful in the orchard.   Similarly, wildflowers are abundant in the meadow, so all 8 hives are buzzing with food gathering activity.

Before I begin this post, I should make a couple of disclaimers:

(1) I probably have no business writing this post, all things considered. I don't know that much about ninjas (although I can at least claim an active interest in them; this blog, for instance, is named after one of my favorite kungfu movies, Ninja in the Dragon's Den. Also, when I was a kid, I wanted to become a ninja when I grew up. Well, I'm sure you know how that turned out...). I also don't know if being a ninja would make you a better yogi, or vice versa. But there are times when I just can't resist the urge to write about stuff that I know shit about. This is one of them.    

(2) I have nothing against Sadie Nardini, either as a person, as a yoga teacher, or as a ninja(?). I have nothing against her as a person, because I don't know her personally. I also have nothing against her as a yoga teacher, because although I have never taken any classes or workshops with her, she seems to know what she's doing asana-wise; at least, that's the impression I get from having watched a couple of her videos, even if I really don't get the ninja connection in her yoga. But more on this later. And I don't really have anything against her as a ninja either, because, as I said, I really don't know enough about being a ninja to say whether she is one, let alone a good one. But I do think I know a few things about yoga; at any rate, I think I know enough to be able to be genuinely puzzled at the ninja connections that she claims in her yoga teaching. Again, more on this later.

Wow, that was a very long-winded couple of disclaimers. But I thought I'd put these out there, so that those of you out there who are fans of Sadie would (hopefully) refrain from leaving hateful comments or sending me hateful emails. Moreover, I of all people should know the pain of seeing one's own teacher trashed online. So I'll try to refrain from groundless trashing. No promises, but I'll try.

So what on earth is this post even about? You might be wondering. Well, it's probably best to start at the beginning. Yesterday, I read this very interesting post over at the Babarazzi about the supposed ninja credentials of Sadie Nardini... Well, as with anything of such a controversial nature, it's best to hear it straight from the proverbial horse's mouth. Here is Sadie addressing rumors about her ninja credentials:

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