The Self dimension can be thought of as physical and the mental/emotional self. Concepts covered include play and achieving mindfulness through physical activity and experiences. Yoga presented as an example of transcendence through physical activity. Reading and references: History of Yoga, Peak Performance, Essentialism, The Body Keeps the Score.
The Self dimension can be thought of as physical and the mental/emotional self. Concepts covered include play and achieving mindfulness through physical activity and experiences. Yoga presented as an example of transcendence through physical activity. Reading and references: History of Yoga, Peak Performance, Essentialism, The Body Keeps the Score.
Welcome back to operate with Zen. In the first few episodes, we talked about the dimensions of time, space and routine. And we finished with discussions of brain power, and sleep, how to optimize both by optimizing each other. Personally in my life, over the last couple of weeks, I've been challenged with some really tough decisions. And I've practiced what I've preached to you in the last couple of episodes, I've taken time to process information. But I've not stressed over the decisions. What I've done is taken stock of the details of my thoughts, I wrote them down in either letters or diaries or journals ways to kind of instill the information. And then I've created space and time to allow myself to sleep and to allow my brain to work. And I've been astonished, I've woken up in the morning, with some with complete clarity on some really challenging issues in my life. And I'm really thankful that I was able to create the time and space and allow my brain to draw the conclusions that I was not able to draw, when I was consciously thinking of them. And as we move forward, out of the dimensions of time, space and routine, we're gonna start working on the dimension of self, to the Upanishads, are a ancient Hindu text written in Sanskrit, and they refer to the self is made of consciousness and mind of life and vision, Earth and the waters, and is made of air and space is made of light and darkness, desire and peace, anger, and love, made a virtue and vice made of all edges near and all that is far it is made of all. And what it really references is that within all of us, are tremendous opportunities for positive and negative good and bad qualities. And we really have the abilities to shape who we are, and how we want to live our lives. And so we're going to really work on the self over the remainder of this podcast. And we're going to start with the physical self. How do we shape our physical being, and how can we use our physical nature to improve our mental and emotional well being. And so when we look in the mirror, we think about all of the dimensions of wellness that we talked about in the beginning of this podcast, right, emotional, social, spiritual, occupational, physical, intellectual, environmental, and financial dimensions of wellness. So whether we consider the self in the more abstract is in the apana shots, or in the more in objective, like the dimensions of wellness I just mentioned, we can work to shape ourselves and shape our outcomes shape who we are, so that we can better live a clear thinking life, we can improve our relationships, we can develop better approaches to conflict, on an attempt to live a pain free life, whether that pain or suffering is emotional, and or physical. And while this is really pertinent for a surgical career and a surgical experience, this really can be translated to a variety of fields, a variety of vocations, and variety of life experiences. And when we think about the self and the self dimensions, in my mind, at least we can break them down in this framework, we're going to break them down into the physical self, and then the mental and emotional self. And obviously, the mental and emotional self is going to take a lot of our time and a lot of discussion. And there's lots of great things to talk about. But we're first going to focus on in this episode is the physical self. How can we achieve physical well being through things like play and through sport? And how can that help us achieve a better mindset, in our surgical capacities in our daily capacities, and in our life, in general. So medicine is always attributed with lifelong learning, and education. And part of the reason many of us are in medicine is because we love learning. And if you look back to the origin of the word school, the etymology of school it comes from the Greek schooling as ch o le, which actually translate into leisure. And school was supposed to be a fun place learning is a fun activity and should be a fun activity. And as we think about play, and learning, play leads to brain plasticity leads to adaptability leads to creativity, it helps us learn and play can encompass a number of activities. This could be video games, this could be board games with your children. This could be goofing off with your friends, and what we're going to talk about a lot This podcast is physical activity, or athletic activities and how those can translate into wellness and well being and help with the other dimensions of well being. And if you didn't know it, there's actually a National Institute for play in the United States. And Stuart Brown, who is the founder says nothing fires up the brain like play. And if you look in the animal kingdom, there are some data to support that. Play is incredibly healthy. In grizzly bears, for instance, there's some literature that says grizzly bears who play the most live longest. Now, obviously, there may be some confounding factors, right? healthier, bears may be more likely to play or participate in play activities. But you certainly see that in the animal kingdom, we've all seen documentaries or movies, or perhaps been lucky enough to be on safari or whale watching where we see elephants and lions, and dolphins play. We know monkeys and apes are notorious players, and enjoy playing with each other and fooling around. And all of those, all of us with pets have enjoyed time with our dogs and our cats and our other pets. And we know there are valuable experiences gained from that. But I'll tell you quantifying the benefits of play are challenging in the in the animal kingdom and a lot of the scientific literature to tell you about the bear study already. There's another study of squirrels, which showed that animals that play early in life are better mothers, they tend to often raise more more children within the first breeding season. There's also study of feral horses, which shows that horses that are more likely to kick up their heels or pardon the pun, but horse around within the first year are more likely to live beyond a year old and foals that do not play. And there are a number of studies from laboratory rats that so social and cognitive benefits from rats who are allowed to interact and play with each other rather than kept in isolation. And these can be quantified by through seeing less sensitive responses to stress hormones, particularly cortisol. And so these animals are able to prime or fine tune their own stress response. And there are additional studies which show promotion of brain growth and brain development in animals that play with each other rather than animals who are kept in isolation. And when we think about the benefits of play, as humans, and through our human interactions, we're using our imagination, it can broaden perspective see possibilities, it helps us challenge normal assumptions. We can be receptive to untested ideas. In some play, we can engage in fantasy, whether this is physical sports play, or even playing board games or other such with our friends or our kids. There's a reason classic Fantasy games like Dungeons and Dragons, or more contemporary video games are so popular because they allow us to break down the boundaries of our normal day to day existence in thinking and expand the capabilities of our mind. Play can often be an antidote to stress. And it definitely improves the executive functions of our brain, right? When we're playing a game or playing a sport or engaging in a physical activity. We plan prioritize, schedule, anticipate delegate, decide analyze, these are all executive functions that we're honing through play, and potentially through physical activity. Many contemporary surgeons, myself included, grew up playing a lot of video games. And my mother always says, Well, maybe that's one of the reasons I do a lot of robotic or laparoscopic surgery, because of the video game time. And I think there's a component to that we're more used to looking at screens than maybe some of our colleagues. But I would also make the argument that some of the skills learned while playing some of those executive functions that were developed while playing games may also have helped us become effective surgeons, and effective physicians. And I'm not saying that video games are the only way to learn these skills in play. Certainly playing sports growing up playing with my friends, we can certainly develop these executive functions as well. But video games in particular, give more access to kind of that fantastical thinking or thinking out of the box. That can't happen without other people being around or being involved in a more complex game. So one of the real benefits for me over the last year or so is I really engaged in my yoga practice. And for me, it has built a foundation of wellness. And I've spoken some towards routine and how yoga fits into my routine, but it is the first thing I do in the morning when I wake up. I don't look at my phone. I don't I don't engage in work activities. I drink a large glass of water. I relieve myself in the bathroom and I head to my yoga area and what that does Is it has built a foundation of wakefulness, it is improved my energy throughout the day, it gives me time to reflect, and has helped me a little bit with stress management. As I've worked through my day and my week, it has certainly helped me with my strength, particularly core strength, balance and flexibility. It makes me feel better in the operating room on a daily and weekly basis. Very rarely Am I coming home. Now, despite my operative load, not really changing or occasionally even getting worse or more challenging. I rarely come home with a sore back sore shoulders, because my posture is better, my strength is better. And it has really helped me develop mind body awareness. And I'll give a good example of this. Most of the time, when you're doing a big open operation, let's say a lot of us rely on our back body, right, the muscles in our hamstrings, our glutes are back to hold us upright into the field. And at the end of the operation, your neck hurts, your back hurts, your spine hurts, your legs are tight and sore, because you've relied on your back body for a lot of strength. But by learning that you're using your back end, feeling those back muscles and feeling them strain, you can learn to engage your front body, the front muscles of your core to push up or hold up your body and relieve some of the tension on your back or your spine or your hamstrings or your glutes. And I'll tell you just that subtle difference can make a tremendous impact on the way you feel at the end of the day. At the end of a week of tough operating. I try to impart this onto our residents and trainees try and teach them how to stand better become aware of how their body is. And I'll tell you for me, it's made a huge difference in a pain free operating room. For me. This translates to robotic surgeries, this translates to endoscopic surgeries. This translates into office based procedures and even just working throughout your day walking through the hospital, seeing patients or being in clinic and sitting in your chair, being aware of how your body is interacting and where you're feeling, tightness and discomfort and all of those things I've learned from my yoga practice, and it's translated into my everyday awareness. Now, I'm not going to make the claim that every person listening to this podcast or every surgeon should be doing yoga. But I think there's components of my practice and what I've experienced that you can take into your life, no matter how you achieve them. And I think the core principles are really core strength, flexibility, and mind body awareness. And if you can achieve those three things, whether it's through Pilates or calisthenics, or cardio work, however you can achieve those things, I think it will really enhance the way you feel on a daily and weekly basis and improve your surgical practice. So I'm going to take a little time to talk about yoga, I think it's, I think it's an important part of my life. Now. It does not have to be an important part of your life. But I think there's some corollaries that you can draw from yoga practice into whatever it is you choose to do. And I would stress that whatever you're going to choose, it should focus on core strength on Mind Body connection, and understanding how you could feel stronger and more comfortable in the operating room and throughout your practice. So just to give some yoga briefs and a little yoga history here, remember Yoga is a practice this is not a religion. It's approximately 2500 years old. It has tenants of Hinduism and some Buddhism in it, but it is not Hinduism or Buddhism. And from the Bhagavad Gita, which is translated to God song, yoga helps, almost through meditation in my own mindfulness, in absence of thoughts yields transformation. And it certainly includes some principles of reincarnation, that patterns of suffering can pass on to others, as well as ourselves until you change those patterns. And a lot of that in yoga has to do with physical work, right. So poor patterns of muscle control or spinal stability can lead to chronic suffering of the back or of the legs or of the knees. And by breaking those pattern patterns and changing ourselves and treating ourselves properly. We can free ourselves from unethical habits and we can root out the sources just in the metaphor of rebirth to awakening in reincarnation. The early forms of yoga acknowledge a body mind connection and often that this was these were ascetics, these were painful poses or body sacrifice or discipline, even self starvation to achieve enlightenment. Now, obviously, that's not a modern that's not in the modern scope of yoga. But as yoga evolved, British colonials, particular mean India viewed Yogi's as contortionists and roadside gimmicks. But as modern quote unquote gymnastics were developing in the 1800s and early 19, hundred's strength, flexibility and mindfulness became much more important to a physical well being. At the same time, Transcendentalism was embraced by great authors and luminaries like Ralph Waldo Emerson, Henry David Thoreau, who were inspired by the Bhagavad Gita and other texts that had their origins that shared an origin with yoga. And PR, Henrik Ling, who's actually Swedish is credited with combining kind of classic yoga tenants with modern gymnastics, made the statement that you want to make inner changes through muscular effort, which is really the tenants of contemporary and modern yoga. And when we think about modern yoga, we think about neuro muscular education through habitual exercises, and how building physical endurance and strength through the muscular system can really enhance our mental capacities as well. And one of the inspirations for yoga was to get away from the the physical strength bulging muscles and robust physique that could lead to a different mindset, a more violent or aggressive mindset, instead to introduce calm gentlemen, and gentleness through rhythmic breathing, long, lean, flexible muscles. Interestingly, some of the lunging positions may actually have originated from physical training of fighters and that's where you get your warrior positions, right? Where are one, two and three that anybody who's participated in a yoga class understands sun salutations are actually less than 100 years old, and they were actually designed to eradicate toxic impurities through profuse perspiration right active movements to kind of sweat out the toxins, but physical exertion was really included to facilitate mindfulness and bks Iyengar who's a famous Yogi talked about his practice and he was an intense yo he says, as I shout at them to straighten their legs in a headstand, they cannot be wondering what is for dinner or what they will be promoted to or demoted to at work. For those who habitually free that present one hours experience of now can be daunting and exhausting. In addition, theories of proprioception or as we talked about in prior calf gas, podcasts, understanding our own movement and our own body position influenced modern yoga. And now there are lots of traditions and lots of styles of yoga. Many people are familiar with Bikram yoga, which is 26 poses that are repeated in a hot room. Indian traditions often focus on rebirth. And karma Western traditions tend to focus more on the physical stretching and strength. But the authentic process or practice of yoga is really to get to who I am, who am I as a self as a person, and how can I use physical exertion to help get there. And so there is a concept of yoga to transcend transcendence so physical activity to mental well being. And a lot of this comes from the Upanishads, which were the these sacred Hindu texts, written 800 to 200 BC, where knowledge is really considered oneness with consciousness. And it's written in these texts that when control of the senses is fixed, that's yoga, and a person can actually be free of distraction. This can be the highest state where the five senses together with the mind cease from normal activities, and the intellect itself does not stir. Inhaling and exhaling were believed to be acts of communion with the universe. and developing balance in the sense of belonging, can accept can can help you accept your place as part of nature as part of the universe. And the first text to codify yoga practice where Pathan, jollies yoga sutra, and ishvara. Krishna was going to say this completely wrong but some corica and they really focus on concepts of practice and detachment. And in kind of the more contemporary Ashtanga Yoga, this is where breathing and postures were first linked. And it's basically made of two parts were Asana where is the that's the Sanskrit for posture or seat is linked with pranayama or breath control, once again with the ultimate goal of detaching from matter. So yoga unites the individual and the supreme selves, it can offer solution to suffering. And our typical sufferings are considered desires and misunderstandings by changing our relationship to physical Pain and mental anguish. So what understanding why our body hurts or where it hurts when the mental anguish that comes along with physical exertion, we can change our relationship with suffering. And that can translate to other parts of our life. In addition, by replacing old habits with healthy alternatives through a yoga practice, we can improve our outcome. And this is tied to the cycle of karma, at least philosophically, where karma in its simplest sense, previous behavior shapes future actions. So we can replace those old habits those old actions which lead to less than desirable outcomes to a healthy alternative. If you're really interested in more of the history of yoga and more of the theory of yoga, there's a book called The truth of yoga by Daniel Simpson. And I just want to read you a short passage from the end of that book, where he says people go to classes to move on a mat for 90 minutes, but find it hard to sit in silence alone. Physical vigor can cut through the clutter that clogs the mind, get detachment is what makes the difference. The most powerful methods strike a delicate balance between making an effort and letting things happen. That truly yogic dimension is less what we do than the way it is done. And so by practicing yoga, or any physical activity on a regular basis, it can help us achieve balance in both a physical sense. And in a mental and emotional sense. It can help us break bad habits and rebuild with new, more beneficial healthy habits. And it sets a tone for a healthy lifestyle that starts with physical well being. So just some practical guides, how can a surgeon or someone who's not really interested in yoga start with a yoga practice? Well, I can just give you examples from my own life, I would stay short. But routine practice is important. When I first started 510 1520 minutes of yoga makes all of the difference, I can barely touch my toes. Now, a year year and a half later becomes much, much more flexible and much more comfortable in poses in settings. And it just takes time you're looking, you're looking for small increments, not large increments. So I would recommend daily short sessions, find an app or an instructor that's really easy for you to follow. I really like the peloton app, I use that a lot, although the Nike app is great. And there are a variety of other ones out there that are either free or paid for, but an easy way to get involved with short yoga practices that can help you build your flexibility, and your physical yoga practice, but also your understanding of the practice, depending on my day, and how busy my day is in my waking stress levels up to anywhere from 10 to 30 minutes. I very rarely do 60 to 90 minutes of yoga. In fact, I use yoga as a warm up for a lot of my other exercise and physical activities. But it helps me start slow. And it helps me start my day off properly. And if you're looking for ways to get into yoga, I would say start with quote unquote slow flow yoga. This is yoga where you're holding poses for an extended period of time I think for a surgeon. This will help facilitate flexibility and core strength and body awareness. Some of the things we're really looking to get out of yoga, it's not necessarily going to be your cardio or strength workout. I think you can get those from other areas. But I think slow flow holding poses working on once again, flexibility, core strength and body awareness is really what the surgeon in modern practice needs. As you get more comfortable with your yoga practice and understanding principles of yoga. You can engage in power yoga, you can engage in longer classes. You can engage in Bikram yoga, whatever, you'll start to learn what your body needs that day or that week, and expand your practice. But in the beginning, start slow work on flexibility, core strength, and body mind awareness. But Yoga is not your only answer. And a variety of physical activities can allow mindfulness. The other activity I really love. I love playing basketball, I play it at least weekly. It's a great opportunity for me to unplug to be competitive, get in the flow of the game and let my mind go. I also love outdoor activities like skiing, right to be up on the mountains out in nature a great way to detach, let my mind go. I used to do long distance running. I know lots of colleagues now who participate in triathlons and competitive distance events that never did that when they were younger, and quote unquote, more athletic or in their athletic prime. Many people join exercise groups or CrossFit groups, right orange theory, CrossFit gyms. All of these things offer opportunities and mindfulness by allowing us to unplug and by letting us get lost whether it's lost in the game lost in nature, lost in thought. Austin mindlessness, focusing on the physical, we're creating the space for a mindful experience. We're creating the space for us to work on our wellness and our well being by addressing our physical body and giving our mind time to pursue other activities. And I bet you there are a great many people out there who do not consider themselves to be particularly mindful, but who have had great mindful experiences, while either long distance running or participating in strenuous physical activities, where the mind becomes unplugged. And just like we talked about in prior podcasts, you access the subconscious, you let the mind make connections it hasn't previously made, you're freeing your mind to do other things while you're focusing on your physical activities. And one of the really important parts about physical activity is that it allows us to push our personal boundaries and learn that we can do things we didn't think we can do. We can realize that you can push yourself much further physically than you thought you could anybody who's run a marathon can tell you that. I always joke I ran a couple of marathons when I was younger and living in New York. But the last six miles of a marathon are miserable. No matter who you are, whether you're a Kenyan running at world record pace, or, or a medical student who just wanted to check off his bucket list. The last six miles are pretty rough. But you can push yourself through that both physically and mentally. And runnings just one example of that you can do this on steep ski slopes, you can do it, you can do it through more challenging activities, skydiving, bungee jumping, mountain climbing, mountaineering, sometimes the more risky an activity is, the more it forces you to focus on what you're doing in the moment and allows your mind to escape. And you can really create a mindful state for yourself. We also need to recognize the natural limits of our bodies and why those exist, right? Why do we have pain? When we stretch too far? Why do we develop soreness when we work out? Well, in one sense, they're designed to prevent injuries. Right, but by understanding or becoming aware of our bodies, and where we can push ourselves to improve our flexibility to improve our strength to improve our endurance, we can push through those physical limits put that our body puts on ourselves. Similarly, we all have mental doubts, fears, anxieties that are present to protect us against injury, right? Oh, man, I really shouldn't go running for six hours, because it's not good for me. Yeah, a lot of that anxiety is created by the mind and it will physically hurt after running for six hours, but you can push through it and you can achieve those things. But this also doesn't have to be scaled to long distance or really intense workouts. Sometimes it's just getting up in the morning and doing that 20 minute bike ride or run or yoga that you don't really want to do mentally. But if you just tell yourself, you can do anything for 15 or 20 minutes, you can push through that workout, you can push to the end of the workout if the last three or five minutes if you're really struggling. You know, you can get through it if you mentally address the anxieties. In the last really good analogy for physical for understanding the physical self and well being in the realm of surgery, is we really can treat surgery like sport, right? When we think about sports, you have regular exercise or practice regular rest, regular rehabilitation. There's a psychologic component of sport. And there's the and there's components of preparation, practice and coaching. Well, surgery is analogous right? We regularly are honing our surgical skills, we can build in regular rest, as we've talked about in the first few podcasts, rehabilitation or recovery is a huge part of what we do on a daily basis as surgeons, as is addressing the psychologic stresses of operating and the sequela of things that happen after surgery, like complications. We're going to talk about complications and later podcasts and things and how to address when things go wrong. But it's a really important part of what we do. And lastly, preparation and practice. We've talked a lot about coaching we'll talk about at another time. Think about some athletes who are incredibly gifted physically, but also engage in mindfulness. LeBron James, right. Strong meditator was shown famously to meditate during the playoffs during a timeout to help him refocus. We talked about the last dance and how phil jackson brought a mindfulness approach to Michael Jordan, the Chicago Bulls. Derek Jeter is a strong meditator misty may Treanor and Kerri Walsh right the great beach volleyball duo, but We've a lot in meditation and visualization. In 2014, Pete Carroll instituted mindfulness to the Seattle Seahawks and helped them win a Super Bowl. And you've heard me talk about Kobe Bryant before. But Kobe's approach to mindfulness and meditation, once again fostered by Phil Jackson really speaks to his approach to life, to athletics to basketball. And one of the reasons I really once again admire Kobe Bryant, and there's a current list of active athletes who engage in mindfulness and meditation. And the way I think of this is, if you're already in the 98th, or 99th percentile of physical ability, the only way you're going to be able to differentiate yourself from your competitors, is through potentially a mindful or mental approach to the game. And a lot of athletes are taking that on, I think we can do the same thing surgically. There are very many of us who have excellent surgical skills. That's how you graduate your program, you've met a certain competency, but by engaging in a better mental approach to our our sport, which is surgery, we can achieve better outcomes. And so when we think about the analogies or the continued analogies between athletes and surgeons, we know that athletes spend much of their time mentally and physically preparing for competitions to improve their performance. Also to surgeons, we spend decades training mentally and physically to be surgeons. And we know that inconsistent performances both in athletics and surgery can be due to anxiety, lack of self confidence and other barriers. We know that those when those issues arise in athletics, they can create feelings of worthlessness, physical or emotional exhaustion and a reduced sense of fulfillment. Well, I just described burnout and a lot of what Physicians and Surgeons experience in this country and around the world. We know that if surgeons dwell on past performances, and when we worry about future actions, you can lose focus on what's going on in the moment, the same could be said. same can be said for athletes. And we know on the flip side that a mindful approach to both athletics and surgery can improve awareness acceptance of internal and external stimuli. And help you develop a non judgmental present moment awareness that can improve concentration can help performance whether it's on an athletic field or in an operating room. And lastly, being mindful has been shown to help athletes enjoy their sports. And it certainly should be able to help surgeons enjoy their career and reduce the potential for burnout. And by incorporating physical and mindful approach, you can become aware of your personal thoughts, feelings, and other internal stimuli to focus on practices and processes that improve your outcomes, your life your patients outcomes, instead of focusing just on performance, right? That have a good ischemia time today, my partial nephrectomy, or was that a good operation? in whole as a whole? Did that patient do well? Is the patient going to get out of the hospital? Did we treat their cancer effectively? These are probably the more important outcomes that we have not found a good way to quantify yet I think a really good example from sport comes from Larry Gell. wicks, and many people probably don't know who Larry Gillick says, but he is a famous rugby coach, as a high school rugby coach with a record of 418 and 10. And he has a philosophy that's aptly called winning. But winning is an acronym doesn't stand for actually winning the game. It stands for what's important now wi n. And he says that being beaten happens when you play a faster, stronger or more talented team. But losing is when you lose focus. And he stresses in his players and his team to focus on what's important. Now in the moment, don't think about what happened five minutes ago, don't think about what your team needs to happen 10 minutes from now focus on what needs to happen on the moment. And to operate at that highest level. Or you can operate at your highest level when you deliberately tune in to what's important here and now. And I think we all can do that in the operating room in our lives in the here and now what exactly is important now what happened last time I did this operation, not what's going to happen two weeks down the road if things don't go exactly as planned. What do I need to do here and now to achieve the best outcome for myself and for this patient The moment so to summarize this podcast by integrating regular physical activity into life, we can help better define ourselves, we can improve our sense of self, and it can help us engage with a mindful approach to life. The physical benefits, we should particularly seek out flexibility, core strength, and a mind body connection, whether that's through yoga or other activities. I think treating surgery like sport can enhance our abilities in the operating room. You don't need to be a former athlete to understand all of the relationships I described between sport and surgery, we can all enhance the way we act and behave in the operating room by treating our profession like sport. And we're going to take this further in future episodes, we're going to talk about the mindful and emotional self. There are a variety of episodes, but related specifically to the physical self in sport. We're going to talk about coaching, we're going to talk about performance. We're going to talk about poor performance, and we're going to talk about how to improve all of those things through a mindful approach. So hope you enjoyed this episode, and I look forward to talking to you again.