While there are a significant number of people who die from sudden death caused by cardiac arrest related to Ventricular Fibrillation or spasms in the lower heart chambers, (an electrical defect which can only be resolved by shocking the heart to normal rhythm with a heart defibrillator)4; one third of heart attacks are myocardial infarction - that is they are caused by circulatory problems (clogged vessels etc.); and these patients require treatment far beyond that offered by a “shock” to the heart valve, to re-engage the heart muscle.
Coronary Artery Disease, as it is known, a condition under the full spectrum of Cardiovascular diseases, provides the greatest hope for changes, improvements and successes in the treatment of heart disease as Coronary Artery Disease ( CAD as it is known) responses favorable to lifestyle changes, diet and nutrition.
When talking about treatment of heart disease, it should be noted that what is referred to here is treatment of that condition under the heart disease spectrum known as CAD which can be changed, controlled and even reversed. “Coronary Artery Disease is preventable”, said Dr. Johnny Lee, MD, president of New York Heart Associates and an American Heart Association board member.5
With this in mind, the following final question must be answered when discussing “heart disease” before proceeding further. So, then what is Coronary Heart Disease (CHD)? How does it differ from Coronary Artery Disease (CAD)? Does CHD factor into the picture when talking about heart disease in the context of this research paper?
Coronary Heart Disease (CHD) is buildup of “a waxy substance called plaque inside the coronary arteries. These arteries supply oxygen-rick blood to your heart muscle. When plaque builds up…the condition is called atherosclerosis”.6
Coronary artery disease begins at childhood or is the beginning of the development of CHD and requires a healthy diet, weight management exercise to help prevent it from further developing or becoming CHD where the heart muscle becomes at risk for heart failure. For the purpose of this paper we will look at both, CHD and CAD.
Or it can bring about the onset, or diagnosis of arteriosclerosis, a major symptom of heart disease and sign for possible heart attack or stroke.
Hence the signs and symptoms – obesity, stress, high cholesterol, hypertension, angina etc. while they are symptoms of the development or presence of heart disease, it is hard to know if someone is having these symptoms just by looking at a person – which is why regular check-ups are so important in the case of a heart condition.
Common medical treatment for heart disease include “ lifestyle changes, medicines, medical and surgical procedures and cardiac rehabilitation.” The goal of treatment is to relieve symptoms, reduce risk factors, lower risk of blood clots, widen bypass and prevent CHD complications. 10
Generally CHD is treated with medications, and if conditions are severe or if medications still cause a threat- for example in the case of a blocked artery, angina or heart attack -surgery is performed where a stent is placed in the artery to assist with blood flow and prevent angina or a collapse of the artery and/or a heart attack. Or, a “by pass is performed to replace the defect artery with an artificial heart valve to preserve the heart and prevent further damage. Generally medication and surgical procedures are sufficient to relieve symptoms. Then persons are encouraged to make lifestyle changes which include changes in diet, not smoking and learning to manage stress. Oftentimes these changes are carried out during cardiac rehabilitation where a team of experts work with the patient to help them learn lifestyle changes of diet, exercise and stress release to help prevent a reoccurrence of a heart attack.
It is a long held view by traditional medicine that there is no cure for CAD or CHD, it can only be maintained. Traditional medical view does not believe heart disease can be reversed.
Yoga therapy is the therapeutic application of yoga for the total health and wellbeing of the body, mind and spirit. Its intention is to bring about vital integration of the whole person, physically, mentally and spiritually.
“Dr. Ornish’s Program for Reversing Heart Disease is the only program scientifically proven to reverse heart disease currently offered in hospitals, clinics, and physician offices that Medicare and other private insurance companies are covering.”12
Under PMRI the Dean Ornish Heart Disease Reversal program has four component parts – Diet, Exercise, Stress Management and Relationships. The Stress Management component is that component that specifically uses yogic tools as therapy although the diet and relationships areas also apply.
The stress management program at an Ornish Retreat derives from common sense and the historical source of yoga: stretches, breathing practices, deep relaxation and meditation techniques. Yoga encourages comfort, healing and mental poise.”13.
The physiological, psychological and spiritual aspects for this stress management program focused on breathing, stretching and calming the mind, relaxing, diet and relationships. The approach was breathing exercises, known as pranayama; meditation, imagery or visualization; yoga poses, the relaxation response, a vegetarian plant based diet and yoga philosophy for spiritual development and an enhancement of personal relationships.
Kristine Kaoverii Weber, in her lecture on Yoga and Cosmology referred to the chakras as follows:
Chakras communicate via the nadis. Nadis run through the connective tissue (fascia). This communication may be explained scientifically through PNI (psychoneuroimmunology). The yogis understand that chakras are related to mental emotional states and that when they are not functioning properly, the mind is imbalanced. 14
In her book Wheels of Life, Anodea Judith speaks about the fourth chakra as love, air, breath, balance, relationship, affinity, unity, healing….
Listen deep and hear inside, a silent sound.
In this very significant reach into the physiological and psycho-emotional dynamics of the healing power of the chakras, Dr. Ornish fortified a very fundamental aspect of his heart health program. In the book Dr. Ornish states as follows:
Awareness is the first step of healing, for individuals as well as society……when you feel love, nurtured, cared for and supported and intimate, you are much more likely to be happier and healthier….
In the Dr. Ornish Spectrum program today, relationships remain a key element of his four fundamental components for healing the heart and reversing heart disease.
In solidifying the yogic remedies for the condition it is important to first clarify the distinctive differences between a Yoga Therapy based heart health program and one based on the traditional allopathic approach to medicine.
Some significant remedies in the Yoga Therapy program that still does not exist in the traditional medicine program for Heart Disease today, is as follows:
1. The diet component of a yoga therapy heart health program far exceeds that of traditional rehab diet programs for heart health. The Dean Ornish Comprehensive Lifestyle change program, which included diet, saw a reduction in weight loss for most patients - up to 15 lbs after one year- and 90% improvement in all categories of Type 2 diabetes, blood pressure, cholesterol and weight after 1 year of adhering to stringent dietary changes.18. The Dean Ornish program, as any yoga therapy health program, looks at food as “whole foods”, fresh and organic, with a significant focus of a plant based diet. President Bill Clinton, a client of Dr. Ornish, is living proof of the Dean Ornish diet program.
Under a traditional system diet, based on the National Heart, Lung and Blood institute,
One of the first remedies for improved health and wellbeing is to set an intention specifically for that purpose for strengthening willpower and resolve, and instilling hope.
Sankalpa is the resolve, determination and good intention that resonates precisely in the core of one’s being and aligns sublimely with one’s essence. Setting the intention for good health and wellbeing and reminding oneself of this good fortune routinely, helps create the reality of what one wants happen.
Setting intention and reminding oneself of that intention throughout the day or at systematic intervals during the day, is very purposeful and should not be overlooked to help bring about the change that we seek.
If the client has had heart surgery particularly Open Heart Surgery, then the client is generally fearful to damage their heart again, however during this stage when they are able to start moving again, movement will be a very mindful, very gentle and particularly focused practice, perhaps commencing in a chair eg:
It will help the pain that usually accumulates in the shoulders, discomfort in the chest, swelling in the feet ankles and legs and fluid in the lungs.
Allows the heart to rest, and poor circulation in the legs is greatly improved….Many of us sit or stand for hours with our feet down. The pull of gravity and lack of muscle movement encourages the blood to pool in our feet and legs…..Shoulder stands aid the return of the blood to the lungs for oxygenation, by raising the feet and legs and pelvis higher than the head.22
Once the shoulder stand is comfortable clients are encouraged to begin the Fish Pose with a small pillow to support for the neck and to provide a gentle arch in the back. This pose is very useful to relieve tightness in the chest after surgery.
With the pain or sickness calling our attention, we just need to meet that attention in a positive instead of negative way. You may have a wound that is open and sore. Imagine what it looks like when it is healed. Then, slowly – in your mind – create the healing” 24
Ayurveda – Diet and nutrition, a sister therapy treatment that works hand in hand with yoga therapy is Ayurveda. Following an ayurvedic diet, understanding one’s doshas both primary and expressed, and taking ayurvedic herbs and spices in the diet can help the patient come back to balance and eliminate inflammation buildup in the body.
According to Ayurveda principle there are 6 stages of disease: accumulation; aggravation; overflow, relocation, manifestation; diversification. Yoga creates balance and a certain patterning within the body that maintains balance. Hence a yogic map of healing comes about when the patterns of yoga practice create a dynamic balance within the life. #25
When we practice pranayama, we either reinforce patterns of breathing already set or we create new patterns.
When we do the various pranayama techniques we are patterning the input thru inhalation, exhalation, right and left sided breathing…..by practicing pranayama you are orchestrating a complex form and sequence of vagal stimulation that has significant implications in the way that the nervous system configures itself. #26
Deep breathing creates a calming effect on the body and mind and allows us to step back and become more aware of how the mind and breath are functioning. When this happens this awareness gives us an opportunity to choose rather than react…..it is at this stage of awareness that we can begin to set new patterns and change or reset the central nervous system and therefore greatly influence, in a positive way, the healing process.
Pranayama, or breathing practices are very key to yoga and to the healing aspect of yoga. It is scientific and was developed by ancient yogis to help maintain a healthy body, not for the body itself, but because a healthy body, they realized, was needed to attain self-realization. The power of the breathing practices of yoga has this promise. Hence it is a very useful tool to use in the process of yoga therapy for all health conditions.
In Yoga Therapy it is also important to pay special attention the The Koshas, or 5 sheaths and the idea of “re-patterning”. According to Rick Panico, MD, in “How Yoga Heals”, he puts special attention on the koshas as a map for healing, pointing out that:
Annamaya kosha – re-patterns the tissues
If someone stands constantly with his or her feet moving outward and tries during yoga practice to change that proprioception, this is what occurs with re-patterning. However re-patterning is more than “proprioception”, the 5 sheaths or koshas, reach deeper than just the physical body.
It should also be remembered that when we do our yoga, we impact these sheaths, sometimes more than one at a time. Even our karma yoga has an impact of the koshas. This also explains how and why the power of relationships (in addition to its effect on the chakras) can be so healing for the body, mind and spirit.
Heart disease is the leading cause of death in Bermuda as it is in the United States of America.
Every 33 seconds someone in the United States dies from cardiovascular disease…by 2020, heart disease will be the leading cause of death throughout the world. #29
The percentage of Bermudians with cardiovascular disease as of a 2011 statistic is between 5-10%.
Insurance companies remain uncommitted and uncertain about the benefits of yoga therapy particularly in matters relating to major diseases like heart health; and, therefore continue to deny coverage to patients for this alternative treatment.
Change will take time.
Insurance companies are a business, so ultimately health care deductables would need to satisfy their business plan in order to be considered for coverage.
Complementary and Alternative Medicine, known as CAM, according to the National Centre for Complementary and Alternative Medicine of the National Institute of Health, says that in 2007, as much as 33 Billion dollars was spent on alternative healthcare. #30
Yet still today, in 2014, insurance companies still shrink away from insuring CAM providers. Hence, also in Bermuda, Chiropractors, massage therapists and acupuncturists remain the only
1. Bermuda is a heavily influenced “Christian” community, and the concept of yoga, is still perceived by many, to be “religiously based”. The education and reintroduction of yoga as therapy is just beginning to take root.
2. Health insurance companies say they want proof, despite the fact that a steadily growing portion of the community are willing to pay out of pocket expenses for their yoga practice and therapy.
4. The wheels of change in Bermuda turn slowly.
Trainings have begun in the Bermuda community to connect symbiotic stakeholders; for example, we recently held a Pain Care Yoga training for physiotherapists and yoga therapists and teachers. This has gone a long way to refine and reestablish “scope of practice”; hence now in particular, some physiotherapists better understand when to refer to a yoga teacher and a yoga therapist; and, when patients that they may be currently seeing and/or cannot service might benefit from the service of a yoga therapist.
Insurance companies and the Bermuda Health Council continue to be educated and kept abreast of the work of the Bermuda Association of Yoga Therapists.
Change will take time, however the high cost of servicing health care in the Bermuda community may very well speed up the decision for more inclusion and a cheaper alternative.
Since Bermuda is on par with the US in health care costs, the squeeze is on to “do something” to benefit ailing clients/patients.
Insurance companies request and require measurements, lasting many years oftentimes, before sponsoring treatment. Hence it is no wonder the Dean Ornish preventive healthcare program is the only one of its kind that is being sponsored.
At the moment those invested in healthcare (insurance companies, corporations, governments) continue to be cautious about programs like yoga or yoga therapy as an adjunct to tradition treatment and recovery. However, this is changing as more and more people, particularly those who can afford it, are having input into the decision making for their own healthcare approach and treatment.
Programs like the Dean Ornish program and other successful yoga therapy programs are paving the way. Clients are wishing and requesting options that might afford them a better quality of life. Yoga therapy, particularly for improved heart health and possible reversal of the heart condition, provides a hopeful option.
Under traditional care, doctors treat the condition, which may happen again and again. The yoga therapy approach for CHD (and CAD) is a preventive approach, so the goal is to treat the whole person, using yoga therapy to bring body, mind and spirit back to balance and to understand that patient care and cooperation are paramount in the outcomes of their treatment plan.
If we consider the dilemma of healthcare today - particularly in the US and in Bermuda, next to the U.S. - it is just a matter of time, when less invasive and expensive; and, more holistic approaches, like yoga therapy, will be welcomed.