Conference Day 4 (Fri) 27th February 2009
Synopsis
Friday morning, all conference delegates were brought to the Himalayan Institute Trust Hospital and University campus, where Dr. Kathy McKeehan welcomed the Conference delegates and gave an orientation to the grounds and scheduled activities.
Ms. Maithili gave an overview of the vision of Swami Rama and the present and planned facilities at HIHT. As Director of the Rural Development Institute, she explained its ambitious outreach program.
Dr Singhal discussed the relationship between the body, mind and emotions and the role that the breath can play in balancing the sympathetic and parasympathetic action of the autonomic nervous system. He discussed the nature of pain as a combination of past remembrance, present experience, and future anticipation. With the use of awareness techniques he suggested we can limit the impact to just the actual present effect, and let the other aspects be released. Biofeedback techniques can be used to show subjects the effects of relaxation practices on their physical stress responses, and therefore help them to manage their behavior to reduce stress.
Dr. R.K. Mamgain delineated how Ayurveda can be helpful in the treatment of chronic pain. The concept of three doshas (mind/body types)-vata, pitta, kapha-is fundamental to the Ayurvedic system. The role of vata in the generation of pain was explained.
Dr. Pratibha Mamgain explains why women are especially vulnerable to stress. Stress can be productive over a short term but is negative when chronic and prolonged. Stress is expressed as an imbalance of the doshas and gunas and an accumulation of malas (body waste) and ama (toxins). A program for the treatment of stress was then presented.
Dr. Chauhan spoke about the common problem of lower back pain; its causes, physiology and treatments. He offered advice on preventative measures to avoid aches in the lower back.
Dr. Bova gave a lively and passionate case for the use of homeopathy in treatment of injuries and the management of pain. It has proven to be effective, cheap and with no risk of side effects. Because homeopathy works on the energy level of the human it is difficult for people and the medical establishment to understand how it works. Therefore, acceptance of the therapy is limited. Dr. Bova illustrated the effectiveness of Homeopathy with pictures and case studies of several burn patients she had treated.
Dr. Kaushik gave an indepth lecture on the experience and pathophysiology of pain.
Dr. Saini gave an overview from a humanistic perspective of the treatment of pain in caner patients. There are three types of pain: physical, mental and spiritual. Drugs, injections and surgery are not enough to treat the patient in a holistic way.
Dr. P.K. Sachan spoke abot new challenges to the oncology team in the care of the terminally ill patient. How do we best use palliative care versus the familiar curative care approach?
The day finished with a delightful and varied Kirtan highlighting the talents of several guests and residents of the Ashram. It included a world renowned violinist, an inspired story teller, beautiful dancing and singing/chanting of traditional bhajan.
Name of Lecture: …Introduction to HIHT and HIHT University
Name of Speaker: …Ms B. Maithili
Program Time: …915-945am
Name of Reporter: …Klara Gerrits
Main Points of the Lecture: ....
Dr Maithili, a direct disciple of Swami Rama and Director of the Rural Development Institute (RDI), shared some of her experiences with Swami Rama. She explained about the organization of the Himalayan Institute, which not only comprises the hospital but also the HIHT University, a Nursing College, a Rural Development and a Cancer Institute which is currently under construction. As director of the Rural Development Institute she went into more detail about the working areas of RDI. RDI serves about 1000 villages in remote areas, offering them: education (including technical and vocational training with scholarship-possibilities), health, livelihood, water and sanitation, and health services. The audience had the privilege of being the first audience to whom the new documentary on the evolution of HIHT from 1992 on to the present was shown. The documentary shared the vision and mission of Swami Rama for HIHT Hospital in his own words.
Name of Lecture: …Use of Biofeedback for Pain Control and Stress Reduction
Name of Speaker: …Dr Anil Singhal
Program Time: …9:45-10:30am
Location: ... Himalayan Institute Hospital Trust (HIHT)
Name of Reporter: …Adel Enderson
Main Points of the Lecture: ....
Dr Singhal discussed the relationship between the body, mind and emotions and the role that the breath can play in balancing the sympathetic and parasympathetic action of the autonomic nervous system. He discussed the nature of pain as a combination of past remembrance, present experience, and future anticipation. With the use of awareness techniques he suggested we can limit the impact to just the actual present effect, and let the other aspects be released. He suggested that observation of pain during meditation can be used to observe changes in that pain. With concentration the pain will often disappear or be reduced. Dr. Singhal discussed how the brain can produce natural pain relieving chemicals during periods of relaxation and used the quote, “Tension is who you think you should be, relaxation is who you are.”
Dr Singhal discussed the nature of the stress response in the body and identified a number of physical parameters which are affected during periods of stress. At such times the sympathetic nervous system is more active and this has an associated increase in muscle tension, restriction of blood vessel, higher blood pressure and increased heart rate. The negative emotional and mental state which arises during periods of stress was identified as a significant contributor to these physiological changes.
Dr Singhal discussed the stress level test available at HIHT Mind and Body Medicine Department. This is a 15 minute test during which the subject performs a number of mental tasks while being monitored for the key physical paramaters of stress. The biofeedback technique can be used to show the subject the effects of relaxation practices on their physical stress response, and therefore help them to manage their behavior to reduce stress. Dr Singhal noted that the regular practice of biofeedback can be empowering to help an individual manage physical stress.
Name of Lecture: …An Ayurvedic Approach to Chronic Pain and Stress Management
Name of Speaker: …Dr R.K. Mamgain
Program Time: …1130-12am
Name of Reporter: …Yeahee Kim
Main Points of the Lecture: .... Pain is an unpleasant sensory and emotional experience associated with actual or potential damage. Pain can be categorized as either acute or chronic. Modern biomedicine can effectively deal with acute pain, but for chronic pains Ayurveda can be helpful. As an Indian traditional medical system, Ayurveda deals with the body, senses, mind and atman altogether to make a healthy and balanced life. All people are born with a basic unchangeable constitution (prakriti) to which we have to adapt our lifestyle. An underlying concept of Ayurveda is the three 3 doshas which are vata, pitta, and kapha. Among them, Vata has the attribute of vayu and akasha and is the main factor for generating and separating pain. To manage chronic pain with Ayurveda, we have to understand fully the anti-vata medicine and diet and avoid aggravating factors for vata.
In the rational ayurvedic therapy, there are 2 kinds of treatments. The first is samashodhana – panchkarma, purification of the body to clean the channels. Panchakarma is the detoxification process in Ayurveda. It helps to balance the 3 doshas as an anti-vata activity. Second is samasamana – a change of lifestyle.
Title of Lecture: …The effect of Panchkarma in Management of Stress Releated Problems in Women
Name of Speaker: …P. Mamgain
Program Time: …12-1230am
Name of Reporter: …Yeahee Kim
Main Points of the Lecture: .... Dr. Mamgain told the audience that most of her female patients show various symptoms with the common characteristic that they are rooted in stress. Stress is a normal psychological and physical reaction to the demands of life and can be productive or negative. Stress can be productive, in the case of a ‘positive cause’. This happens for example in the case of applying for a new job. In the case of negative causes, stress creates acute or chronic pain. Dr. Mamgain explained that women are more susceptible to stress than men. This results from the combination of a more emotional nature and the multiple roles that women play in life (work, wife, housekeeper, care for children and elderly parents etcetera). The stress response system of the body was explained, as well as the basic causes of stress.
Ayurveda considers a human being (purusha) as a replica of the outer world (loka). In the case of stress there is disharmony with the environment. This is expressed in a disbalance in the tridoshas and the gunas and in an accumulation of the malas (body waste) and ama (toxins). The accumulated toxins go all over the body, especially to the weak points where they create physical and mental disease.
In the management of stress ayurveda aims to bring about the balance of the tridoshas, trigunas and the elimination of the malas and ama. This is accomplished by first, examining the health status and the disease of the patient and second, by applying panchakarma. Panchakarma is a group of therapies. The main procedures are the purification of the body, the removal of toxins, the treatment of the disease, and changes in lifestyle including the practice of meditation, asanas, joints and glands excercises and walking. In this way not only the stress but also the pain caused by stress can be removed.
Name of Lecture: …Management of Pain With Cancer Patients
Name of Speaker: …Dr Sunil Saini, Professor of Surgery, Head of Oncology HIHT, Rishikesh, India
Program Time: …3:00-4:00pm
Name of Reporter: …Peter Fabian
Main Points of the Lecture: ....
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The management of Pain is simple. There is allopathic and common man control. Drugs and injections are not enough. We need other options other than surgery and drugs. Many cancer patients with cancer in India are not diagnosed until 3rd and 4th stages, near the end of their disease.
By Dr. Parul, MD
Childs definition of pain: it hurts
Problems with persisting pain include: suffering, dependence, drug abuse, financial loss and domestic disruption. Doctors sometimes withhold using drugs for a variety of fears to include: drug dependence, masking symptoms, respiratory compromise, hemodynamic imbalance, and societal stigma.
We need to treat pain because it affects multiple systems in the body to include: Respiratory System-poor secretion clearing, Cardiac System, GI system with problems of constipation and urinary retention, Musculoskeletal System, Psychological System, Neuro-endocrine System.
We need to treat both the chronic pain and break through pain (periodic episodes of marked increased pain). We must assess the patient and educate the doctor and staff. One formula would include: Ask, Believe the patients report, Choose an appropriate type and amount and Deliver it effectively and timely. There are many routes to administer drugs for pain from oral to rectal and in-between. Injections can target Plexi, ganglions and the spinal cord. There is also surgical remediation of nerves and cord (transecting the Trigeminal nerve of dorsal rhizotomies). Also complimentary therapies can be added pertaining to patient’s interests and hobbies which helps ameliorate the symptoms.
By Dr Saini
There are three types of pain: Physical, Mental and Spiritual. Pain is the most common symptom of a patient with cancer. Treatments include: Analgesics and Pain Clinic approaches. One must evaluate four types of pains that vary for each individual. These include: Threshold of Pain; Tolerance of Pain; Response to Pain; and Recovery to Pain.
One must deal with pain of course. Also we must consider various fears and the fear of death.
He then outlined four case studies from a very humanistic viewpoint.
#1—a woman with a massive belly tumor for many years was successfully operated on by him. The removal of the tumor allowed her to function more normally. She was supported at different stages of her life. She later married and gave birth to a child. She still had metastatic disease to her liver but was able to return to a more normal lifestyle because of her medical and surgical support.
#2—an illiterate man living in a village had pancreatic cancer in 2002. He had proper medical and surgical intervention. Proper education helped. This simple man had great discipline and great faith. He survived into 2008 when he was diagnosed with metastatic disease to his lymph nodes.
#3—A Courageous German woman was dying of a tumor in her belly. (2 years before, she was treated for tumor resection and reconstruction of the chest wall.) Her second cancer was inoperable and treatment was only for symptoms. She died with Dr Saini holding her hands. She had lived life for two months by noticing the beauty of the life she had lived and was still living. (Quoting the German theologian, philosopher and mystic, Meister Eckhart: He who could be—What he had to be—Must finish to be—What he is.)
#4—A patient that was just seen and operated by Dr Saini the day before. He underwent 8 hours of excision and reconstruction of a laryngeal tumor. He was sitting up in his bed after surgery. Demonstrating such strong faith, conviction and discipline.
Dr Saini’s overall message was to follow modern science and to learn to see much more in life that that which one reads in scientific journals. He founded a successful and active cancer support group to help the patients and their families with managing and coping with cancer and its effects.
Name of Lecture: …Holistic Management of Low Back Pain
Name of Speaker: …Dr Vijendra Chauhan
Program Time: …1230am-1pm
Name of Reporter: …Klara Gerrits
Main Points of the Lecture: ....
Dr Chauhan spoke about the common problem of low back pain. Almost all people encounter this problem in a certain moment in their life. Mostly it is an acute form of back ache which comes and disappears in a short time. If the pain lasts for over 6 weeks, further investigation, e.g. MRI, is indicated. The speaker explained the anatomical aspects of the disturbance in the lower spine. The main reason for lower back ache: we misuse our back. Poor posture, lifting weight incorrectly using the back, leading a stressful life, lack of exercise, pregnancy, metabolic disorders and psychosocial factors are some of the main factors that cause this injury. In the field of the treatment of the pain there are preventive, surgical and conservative methods. Surgery is the last resort (rarely done). Among the conservative methods in the treatment of lower back ache are: bed rest, a change in lifestyle, exercises (physiotherapy) as soon as the pain subsides, no prolonged sitting in chairs, no lifting of heavy objects, the practice of spinal extension exercises and (generally spoken) no forward bendings. Dr. Chauhan advises the use of medicines like painkillers to be reduced (‘they will kill the pain and the kidneys’) as much as possible. In the prevention of lower back ache the speaker recommends his students and patients to keep themselves fit by doing daily exercises, practicing good posture, taking care of the back while lifting objects, taking a healthy diet and practicinge yoga (asanas, relaxation, breath awareness, meditation) to bring about the necessary balance in life. Furthermore Dr Chauhan explained the importance of a bed that supports the three natural curves of the spine.
Name of Lecture: …Homeopathy, A Different Perspective on Pain Management
Name of Speaker: …Barbara Bova
Program Time: …1-130
Name of Reporter: …Klara Gerrits
Main Points of the Lecture: ....
Dr Bova is Head of the Homeopathic Department of HIHT. She was taught Homeopathy directly by Swami Rama. Her lecture started with why she refuses to call homeopathy ‘alternative’- it all depends on the perspective that one has. What is normal? Dr Bova considers homeopathy to be the normal way of curing. As Swami Rama said, “You must change your worldview and start to look at life from another perspective.” We should accept experience and be open minded instead of making our mind become ever more rigid. The speaker quoted Jesus Christ, “Unless we become as little children, we cannot enter the kingdom of Heaven.” In this context Dr Bova referred to the attitude of her child-patients, who without any expectations undergo the treatments of homeopathic medicine, whereas adults mostly are very demanding and skeptical towards Homeopathy. Open-mindedness is required to enter the inner world, the kingdom of Heaven.
The speaker gave an overview of different perspectives on disease. Contributions to western medicine by renowned researchers in medical science (Pasteur, Bechamps, Bernard, Virchow) were discussed. In contrast, Homeopathy believes – like yoga does – in the energy basis of life. It considers disease as a disturbance of the prana. Homeopathic medicines are prepared in such a way that they are not toxic anymore - just the energy field is there.
Swami Rama said, “Every human life contains the power for self-healing.” Homeopathy boosts this principle by working on the internal environment to bring about a balance.
Dr Bova told the audience that our minds have difficulties to understand how homeopathy works. Because of this, many people are reluctant to find recourse in homeopathy in case of medical problems. Dr Bova pleaded for the medical world to open up its mind and allow a role for homeopathic medicine in pain management. This of course also requires funding.
There are a lot of reasons to allow homeopathy to be integrated in the conventional medical world. Homeopathy is the only therapeutic system that has specific remedies for any type of trauma or injury. It’s cheap, is not a status symbol, has no frills. Homeopathy is effective, safe, has no side effects and (of special interest for children) it is tasty. The use of homeopathic medicine results in fast, rapid healing, and consequently to decreased hospital stay. It leads to less scarring, less pain, less contracture and involves fewer drugs. Furthermore, homeopathy heals on many levels.
At the end of the lecture the audience was shown pictures of some burn cases that had been treated with homeopathy. There were amazing examples of seriously wounded persons whose skin recovered very quickly as a result or homeopathic treatment.
Name of Lecture: …Care of the Dying Patient and Family
Name of Speaker: …Dr. P.K. Sachan
Program Time: …4:00-4:30
Name of Reporter: …Peter Fabian
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There are new challenges to the oncology team. How do we care for the terminally ill patient and best use palliative care versus the familiar curative care approach.
These challenges include:
1. Medicalization of death—people rushing to the hospital and having unrealistic expectations for those terminally ill.
2. Hospitals are run like a business—noisy, no place to discuss and reflect on these deeper issues surrounding dying.
3. Lack of awareness and lack of education of staff—newly trained staff lack training in palliative medicine, management skills are poor
4. Poor symptom control of pain—under or over control of pain symptoms, not dealing with side effects of management.
5. Changing trajectory of disease—better health care giving rise to improved long term survival and how to handle the problems that arise.
6. Difficult to give an accurate prognosis
7. Communication gap between staff, patients and other disciplines in speaking among each other.
8. Lack of planning due to poor information given and received from families and patients.
9. Death is considered a taboo—
(Int J Clin Pract 2009. 63 (3):508-515.)
Planning the care of the terminally ill patient is important. Discuss the prognosis properly. Don’t make predictions. Meet with others in the team who are the seniors for more information. Don’t be extreme, nor overly optimistic. Look at the statistics for each problem. Explain these statistics and course of the disease to the family so they can make a good decision. Explain the events that will happen and the best form of timely treatment.
There are barriers that inhibit advanced care planning. Does the doctor lack curiosity—is the doctor more concerned with only diagnosis and medical/surgical treatment. Has the doctor learned about the patient’s hopes, likes and dislikes and general life that has been lived and now will be ending? How to best support this patient? Does the doctor emphasize curing the disease or helping to heal the patient who has a terminal disease? How does the doctor inform the children? If the parent is dying, find out who in the family/village that is closest to this child. What are the cultural and religious considerations of the patient and the family?
There are many considerations to palliative care: relieve pain and symptoms, consider that dying is normal, do not hasten or delay the process, utilize proper support and integrate other services, use a team approach to coordinate and manage the program properly.
Patients want relief of their suffering. Try to optimize their physical comfort, maintain proper management and prepare for their death.
There are multiple problems and systems that must be managed: Insomnia, fatigue, psychological problems, respiratory problems, bleeding and GI disorders
Consider sources of distress that come from the family and finances. Be attentive to spiritual concerns and prepare for the final days (patient/family comfort and staff support). Prepare to deal with grief and bereavement of all concerned.
Name of Lecture: …Pathophysiology and Modulation of Pain
Name of Speaker: … Dr RM Kaushik, MD, FICP, Professor of Medicine, HIMS, HIHT, Dehradun, India
Program Time: …230-3:00
Name of Reporter: …Peter Fabian
Main Points of the Lecture: ....
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Pain is a person’s experience. It is what he says and what he experiences. Pain has a personal meaning for the patient. It is real. It is difficult to measure. There are three types of pain: sensory, cognitive, and behavioral pain. They differ in their location, duration, intensity and etiology. Pain can also be referred (i.e. coming from a site distant from the current symptom). Pain can be acute (less than 6 months), chronic (more than 6 months, often duller), or cancer pain.
We can measure pain on scales of intensity, i.e. analogue scale, numeric scale, descriptive scale. He spoke about various concepts including pain threshold and pain tolerance.
He described the neurophysiology of various pain pathways to include: ascending pain pathways from the spinal cord to higher centers, descending pathways and other spinal pathways. There was a review of the chemical mediators of pain like histamine, endorphins and enkephalins for example.
Nocioceptors perceive and transmit pain. Different fiber types of the nervous system transmit different information. There are four processes that can be viewed in relation to the nocioceptors. There is transduction (conversion of the mechanical, thermal or chemical stimulation into the nervous system for transmission), transmission (movement of the information from the peripheral to central nervous system), perception (CNS response, either brief or prolonged), and modulation (internal and external ways of increasing or decreasing the pain).
The Gate Theory (a gate in the spinal cord that determines what information goes to higher centers) proposed by Melzak and Wall in 1965, has been significantly expanded to include other areas in the brain that can modulate pain not just the spinal cord).
Many influences on pain by cognitive processes as well as mediated chemically. Endogenous opiates play an important role. Also many other neurotransmitters can affect neurotransmission of the pain pathway. A review of common drug approaches was stated. He listed many non-drug management categories: meditation, asanas, progressive relaxation, biofeedback, exercise, transcutaneous nerve stimulation, thermal modalities, and others.
Name of event: …Friday Evening Kirtan
Names of Performers: …Lynn Evans, Mr Yoblokow, Lela Pierce
Program Time: …8-10pm
Location: ...Meditation Hall, SRSG
Name of Anchor:…Swami Vachananda
Name of Reporter: …Shruti Singhal
Main performances:....The evening was opened with a Guru vandana (paying respect to the Guru) by Gurukulam-student Gita Bhoi. Lynn Evans, an English teacher from SRSG enraptured the hearts of the audience with her outstanding storytelling skills. The next performance was violinist Mr Alexander Yablokov, from Slovakia. He played beautifully compositions of Telemann, Bach, Paganini and other classical violin works. This was followed by a sensitive and graceful fusion dance performance on a bhajan of Kabir by Lela Pierce. It was an eloquent interpretation of the words and meaning of the bhajan. A group of Gurukulam-students presented some popular bhajans in the last part of the event.