well being II by Carol Krucoff

the heart ofhealing

I had known about my abnormalheart valve since childhood, when thepediatrician told my parents I had afunctional heart murmur that was noth-ing to worry about. By the mid-I970s,technology to image the heart becameavailable, and I learned that the murmurresulted from a bicuspid aortic valve,one of the most common congenitalvalvular abnormalities. Instead of hav-ing the normal three leaflets, my valvehad just two.

Despite my condition, I had an activeand healthy life without limitations-running regularly,earning ablack belt inkarate, practicing and teaching yoga. Soin 2007, following a routine echocardio-gram, I was shocked to learn that one ofmyvalves had narrowed so severely thatI was at risk of sudden death. In addi-tion, the malformed valve had createda weakness in my aorta-an aneurysmthat needed prompt repair. I scheduleda date for open-heart surgery just after New Year'sDay 2008 and sixweeks before my 54th birthday.

As a yoga therapist at Duke Integrative Medicine, in Durham,North Carolina, I'd often helped others deal with the stress of seri-ous health conditions through relaxation breathing, meditation,and appropriate yoga postures.

Now, as I prepared for surgery, I drew on my own practiceto help ready myself physically, emotionally, and spiritually for thechallenge. I called Nischala]oy Devi - my teacher and friend - forsupport. She pointed me toward Patanjali's YogaSutra II.33, whichsays,"When presented with disquieting thoughts or feelings, culti-vate an opposite elevated attitude."

Prepare for surgery withmind-body techniques that may

help you. recover faster:

"What you say, feel, think, and imagine,"Devi told me, "can make an enormous impacton the outcome."

PERSONAL POWER

The idea that patients have the ability to influ-ence their surgery would have been dismisseda generation ago. But an emerging body ofresearch suggests that mind-body practices,including those used in yoga, can improve yourexperience of surgery and its possible outcomes.

continued on page )I

continued from page 49For example, studies show that patientswho use self-care techniques before sur-gery, including relaxation breathingand guided imagery, may need less medi-cation, experience less pain and bloodloss, and have faster wound healing and 'shorter hospital stays. "Simple mind-bodytechniques like relaxation breathing andvividly imagining the best possible out-come of surgery prior to the procedurecan reduce anxiety, sleep disturbance, andeven the surgical stress response itself,"says]effrey Greeson, a clinical health psy-chologist at Duke Integrative Medicinein North Carolina.

These practices not only relieve suf-fering but can also savemoney. One studyshowed an average savings of $2,003 perprocedure when patients listened to aguided imagery tape before surgery.

PATIENT SUPPORTAnxiety, fear, and high levels of stress arecorrelated with poor surgical outcomes,according to Greeson. Anxiety can alsoincrease pain and make some procedures,like starting an IV, more difficult, saysTeresa Corrigan, a registered nurse andmind-body specialist at the Osher Centerfor Integrative Medicine at the Universityof California, SanFrancisco.

Tohelp lower stress levelsand empowerpatients-and to improve the bottomline-hospitals and medical centers thatfocus on integrative care have begun pro-viding classes in relaxation breathing,guided visualization, and meditation touse in preparation for surgery.

In addition to conducting aworkshopfor presurgical patients that teaches ab-dominal breathing and a "relaxation bodyscan," Corrigan teaches Laughter Yoga topatients in her hospital's chemotherapy-infusion center. The extended-exhalationbreathing that happens with laughterenhances the immune system functionand relieves anxiety, among a host ofother health benefits.

'Just because you're a patient doesn'tmean you have to be helpless," Corrigansays. "Even at a time of ultimate vulner-ability, when you must show up and puton that gown, you still have the ability to

influence your internal environment andmake the experience better."

TOOLBOX OF TECHNIQUES

Taking advantage of hospital-based re-sources to help relieve stress and enhancehealing is a step in the right direction, butpatients can do a lot on their own. Youryoga practice provides a toolbox of tech-niques that can help counteract many ofthe stressors of surgery and bring yourmind and body into optimal alignmentfor healing.

When Gary Kraftsow, founder of theAmerican Viniyoga Institute, was diag-nosed with a brain tumor in 2004, he drewupon the yogic tools he had spent most ofhiSlife developing. Aleader in the field ofyoga therapy, Kraftsow began studyingWithT K. V Desikachar in the 1970s, haswritten books and produced videos aboutyoga for healing and transformation, anddeveloped protocols for National Insti-tutes of Health studies of yoga's thera-peutic benefits.

"1 had one week to prepare myself for'brain surgery and the possibility that Imight not even wake up," Kraftsow re-

The mind-body connection,when aligned and tapped,can be an extraordinaryhealing resource.

calls. "My main work was to go from aplace of fear and uncertainty to a state ofoptimism and peace."'1'he tumor limited his physical abilities,

so his pre surgery practice focused onmamtainmg physical vitality with simplemovement and lots of pranayama. Com-bin1l1gbreathing practices with mantraand chanting also helped balance his emo-tlUnal health. In meditation, he spoke toeach cell in his body with gratitude.

Anyone facing surgery can tailor theirpractice in a similarway,saysKraftsOw.Headvises preparing your physical bodywithammdful posture practice to enhance theflow ot prana (life force), particularly tothe area where the incision will be. You

can help calm anxiety and reduce physicaland emotional stress through appropriatepranayama(see "Healing Tools,"page 50). Itis also important to create a personalizedmeditation-one you can use throughoutthe experience - that tunes your mindand heart to things that have deep mean-ing for you, saysKraftsow.

MY OPEN HEART

After more than 30 years of practicingyoga and IO years of teaching, I was wellaware that the mind-body connection,when aligned and tapped, can be an ex-traordinary healing resource. In the sixweeks I had to prepare for surgery, I diddaily pranayama, deep relaxation, andmeditation. My asana practice changedaccording to my needs - some days it wasdynamic and energizing, other days calm-ing and restorative. During meditation, Ivisualized myself going through the pro-cedure successfully, then celebrating mybirthday, happy and surrounded by fam-ily and friends. I saw myself completelyhealed by April, co-directing the springsession of the Therapeutic Yoga for Sen-iors program at Duke. I prayed often, ask-

ing for help and the strength to bearwhatever was to come.

I loaded up my iPod with per-sonaiized guided meditations andwith my favorite Sanskrit chants,including "Om Namah Shivaya,"byWahl, and "Chit Ananda," by DevaPremal. I listened to these duringmy preoperative cardiac catheter-

ization, while being wheeled into surgery,and in the intensive care unit. Listening tothe meditations and becoming absorbedin the chants calmed my fears and helpedme find strength in the connection withmy unchanging, true Self

Three months after my surgery I wasback to teaching yoga, and today I amgrateful to feel better than ever. Now, inmy morning meditation, I have addedtwo "moos" to honor my new bovine (cow)heart valve. .:-

Carol Krucoff, E-RYT, is a yoga therapist at

Duke Integrative Medicine and the author

of the new book Healing Yoga for Neck &Shoulder Pain (New Harbinger, 2010).

............., healingtools Try these mind-body techniques to help prepare for and recover from surgery.

focused breathingDiaphragmatic breathing, or belly breathing,in which you breathe deeply into the lungsand expand the diaphragm, "can make ahuge difference both in oxygenation and inrelieving anxiety," says Teresa Corrigan, RN,a mind-body specialist who teaches presur-gical workshops through the Osher Centerfor Integrative Medicine at the University ofCalifornia, San Francisco. "When people arefearful, their bodies go into a white-knucklereaction that has a domino effect on theentire system:'

Gary Kraftsow, founder of the AmericanViniyoga Institute, recommends extended-exhalation breathing to help calm jitterynerves. Start where you are; then beginto deepen the length and smooth the flowof your inhalation and exhalation. Evenpeople with little or no training can typicallypractice inhaling for four seconds andexhaling for six.

Dirga Pranayama, called the Three-PartBreath, can also be used to move the bodyinto a state of relaxation and calm. As youinhale, fill first the lower, then the middle,and finally the upper portion of the lungs, sothat the belly rounds, the rib cage expandsout to the sides, and the upper chest broad-ens and fills. Then, as you exhale, everythingsoftens back down.

affirmations& mantras Affirmations are spo'

ken statements that help you to counter negativethinking and visualize positive outcomes, saysauthor and psychologist Belleruth Naparstek. Anexample: "More and more I can let go of worryabout things I can't control and focus on my owninner peacefulness:'

Mantras from the yoga tradition are sacredSanskrit sounds that are chanted as a vehicle formeditation and prayer. Reciting a mantra-whichmay be a simple Om or a more complex group ofsounds that have a particular meaning to you-helps focus attention by anchoring and calmingthe mind. "Become absorbed in the meaning andfeeling the chant engenders," says Kraftsow.

guided imagery Guided imagery acts as "a rehearsal thatfocuses your intentions on the best possible outcome,"says psychothera-pist Leslie Davenport, the author of Healing and Transformation ThroughSelf-Guided Imagery and a founding member of the Institute for Healthand Healing at California Pacific Medical Center in San Francisco. A kind ofmeditation in which you direct your focus for a specific intention, guidedimagery has been found tobe a successful tool in influ-encing outcomes in thingslike sports competition andsurgery. In fact, a study ofsurgical patients using aguided imagery tape foundthey lost significantly lessblood and stayed in the hos-pital one full day less thanthose in the placebo controlgroup. "When we worry,we're doing imagery-but notthe kind that supports ourhealth:' Davenport explains."But we can learn to usethis same mind-body connec-tion in a positive way thatsupports our healing andwell-being:'

Download a guidedvisualization recordingby Leslie Davenportto prepare for surgeryat yogajournal.com/guidedimagery.

visualize health To create your ownguided visualization, Davenportrecommends writing a script thatwill lead you through a 20-minutemeditation. Record it yourself,backed by relaxing music, or asksomeone whose voice you findsoothing to do it for you.

Start with an intention for healthand healing. With your eyes closed,deepen and lengthen the breath.Inhale and imagine your body fillingwith light and vitality. Exhale andfeel all tension releasing.

Visualize a place where you feelsafe and peaceful, taking time tonotice every detail: the colors, the

scents, the sounds. Thensee your closest friendsand family members joiningyou, even pets and spiritguides, blanketing you withtheir love and support.

From this place of sup-port and comfort, imagine

the day of your surgery. See yourmedical team ready to offer you thebest care possible. Ask that yourbody's intelligence align with thiscare, and direct healing energy there.

Now visualize the procedure end-ing in total success. Your body willsense the shift to ease and recovery,already sending nourishment tothe surgery site as you graduallyawaken, knowing that you are wellon your way back to health.

present momentawa re ness Mindfulness, a practice of cultivat-

ing awareness of the present moment without judgment,uses the breath to help train attention and to connect bodyand mind. It's a useful skill when preparing for surgeryand during the healing time afterward. "Some people areextremely dissociated from their bodies:' says Corrigan.Being mindful can help you tune in to the subtleties of ten-sion or discomfort and also help you identify ease.