Author: Ingrid Yang

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What inspires you to write?

 

The answer is different for everyone. For me, my inspiration comes from reading the works of great authors. Inspiring authors. Those that have lived through adversity so they could retell their stories of triumph and share the lessons they learned. Authors with different interests., and writers with completely different lives.

 

So when I read, I am inspired to write. And when I write, I seek to connect. I do not purport that I have anything particularly sanguine to share in my writing, simply my experiences and desire to connect. It is how we have been connecting since we learned how to carve images onto walls of caves. Something left there for future generations to read and understand their roots.

 

And now I have co-authored this book, my second, entitled Adaptive Yoga. It is a book that I hope opens doors for many people, students and teachers alike. It is a book that I hope sets a new direction for yoga and its therapeutic benefits. It is a book that, I hope, makes a difference in someone’s life, the way that many of the books I’ve read have inspired me. (If you haven’t read “Better” by Atul Gawande, it was one of my inspirations for going to med school!).

 

The book is releasing this week, and despite the book being written, I continue to write. I am writing articles for magazines about the book and blog posts about my experiences. I am writing outlines for podcasts so I can spread the good word of Adaptive Yoga. I do so with both a love for writing and a fear of judgment. It is hard to write about yourself and your experiences. It is difficult to explain to others what is from your heart.

 

I am not sure what I will write next, but I hope I continue to be inspired to write. And with that, I will continue to read the works of others in hopes I can be heard and connected the way I feel I hear and connect with the authors I love. When inspiration comes from others, their legacy lives on in me, and in those that read what I have written. Thank you for reading with me, and for helping me write by inspiring me. I hope you write something today too, and dedicate it to the authors who inspire you. Love, Ingrid

 

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Yoga Therapy can Help Parkinson’s at any Stage

See my feature in The Official Yoga Therapy blog regarding how yoga therapy can help Parkinson’s at any stage of the disease.

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Parkinson’s disease (PD) is a progressive neurodegenerative condition that affects more than 1 million people in North America alone. After Alzheimer’s disease, PD is the second most common neurodegenerative disease.

As with other chronic (long-term) conditions for which a cure does not yet exist, yoga therapy has a lot to offer those with PD. Yogic tools can complement the most commonly available Western approaches, such as prescription medication and physical therapy. When used carefully and through a therapeutic lens, they can also bring a welcome element of self-agency to healthcare for PD—that is, people can take concrete steps to affect their own well-being.

Photo by Nathan Dumlao.

Regular exercise is especially valuable for those with PD because the disease tends to progressively worsen mobility. Specifically, the physical aspects of yoga can assist in improving the rigidity and flexed (rounded forward) posture that are hallmarks of this disease; the practice may also improve joint pain, motor task function, and even some non-motor symptoms. Yoga can lend a sense of control over the physical aspects of PD, even if someone never engaged in physical activity in the past. Working with a yoga therapist or joining Parkinson’s-specific yoga groups may be a good way to get started.

Improved mobility 

Characteristic symptoms of Parkinson’s include stooped posture and shuffling gait, which increase the risk of falling. Mobility and balance are important components of yoga and can help to decrease fall risk.

As explained in my book, Adaptive Yoga, standing poses for Parkinson’s can assist in improving overall stability.* Research has also shown that one-legged postures can decrease fear of falling and allow those with PD to remain active in their communities. Postures like warrior (virabhadrasana) I and II (wide lunges) and tree (vrksasana, with toes remaining on the ground) may be particularly beneficial for improving balance, stability, and confidence.

THINK BIG!

Therapies for Parkinson’s often involve the guiding principle of moving the whole body in a BIG way. Because gestures and actions become smaller and slower as the disease progresses, learning to make larger movements can help. These exaggerated movements may seem too big at first, but they are actually teaching individuals with Parkinson’s to make regular-sized movements. Standing postures such as five-pointed star (utthita tadasana, arms and legs reaching wide as at left) and fierce angle (utkata konasana, a wide squat as at right) may be particularly beneficial when thinking big!

Improved flexibility

Rigidity is another hallmark of PD, and stiff, inflexible muscles can significantly affect the ability to take care of routine tasks. A therapeutic yoga program may help: Research shows improvements in flexibility and range of motion of the shoulder, hip, and spine in individuals with PD who practice yoga.

An exaggerated kyphosis of the upper spine (stooped posture) is also common in those with PD. Yoga supports an upright posture by improving shoulder and spinal flexibility. Postures that extend the spine, such as mountain (tadasana, standing tall), fish (matsyasana, an upper backbend), and locust (shalabhasana, full spinal extension) could be particularly beneficial in preventing stooped posture from getting worse—or perhaps even reversing it.

Peace of mind

Yoga therapy can support those with Parkinson’s in many ways, perhaps most importantly by promoting connectedness and mindfulness. Regardless of the stage of PD, yoga can provide a sense of purpose, hope, community support, and confidence.

The practice’s benefits transcend improvements in the physical body, enhancing the energetic body and allowing the practitioner to be present and open to each moment. Freedom in the heart and mind engenders freedom in the body, and within this freedom, the yogic path is revealed.

Ingrid Yang, MD, JD, C-IAYT, E-RYT 500, incorporates medicine into yoga and yoga into medicine. A hospitalist based in San Diego, she has been teaching yoga since 1999 and is the author of Hatha Yoga Asanas and Adaptive Yoga. Find her on Instagram.

*Specifically, targeting the hip extensors, knee extensors, and ankle plantar flexors when selecting standing poses may support the center of mass during walking, improving overall stability.

 

Please note that, like the other information provided on this site, this material is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. You are encouraged to consult your personal physician with questions or concerns. If you are experiencing a medical emergency, please call 911 or the emergency services number in your area.

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Will the COVID-19 vaccine be safe?

Will the COVID-19 vaccine be safe?

I know there have been a lot (and I mean, a lot) of conspiracy theories regarding the COVID-19 vaccine, so I’m here to answer the question that more than a few of you have posed to me:  Is the COVID19 vaccine going to be safe? By all measures, yes. And here’s why:

 

The standard process of vaccination approval is rigorous, scientific, and designed to ensure the scientific community and public’s confidence in the vaccine. Every vaccine being developed for ANY disease (including the 5 that are currently in phase 3 for SARS-CoV-2) has its own Data and Safety Monitoring Board. These boards are independent of the biotech or pharmaceutical companies developing it, independent of the political administration, the FDA, and even independent of Dr. Fauci. They are comprised of scientists, biologists, ethicists and statisticians. At pre-determined time intervals, they review the data and, if at any point, there appears to be foul play, indiscretions with the data, safety concerns, or lack of efficacy, they will stop the development and potentially cancelling the trial altogether. At that point, no one else has access to the data except this board, not even the scientists developing the vaccine or the subjects getting the vaccine, or placebo (thus, the double-blind and randomized control requirement of the study). They could require early cancellation of the trial if it is dangerous and they can even accelerate the trial if they reached the predetermined end point of efficacy. No one else gets to know or see the data or make any determinations on the trial at that point.

 

When pre-determined end-points of efficacy and safety are finally met, the developing company will apply to the FDA to either get an EUA (emergency use authorization) or submit a biological use application (the data is strong enough to pass the FDA process). After they have met the requirements to submit the application, the FDA reviews the data. The career scientists of the FDA and the FDA commissioner have spent their entire lives (way before COVID-19 existed) reviewing experimental vaccines and drug therapies. They are the best in the world at what they do, and apply the scientific process rigorously and ethically time and time again. These are scientists I trust, that Fauci trusts. And you can trust them too.

 

After it passes the application process, the commissioner and FDA then subject the data to yet ANOTHER independent advisory group, the VRBPAC group for further evaluation and a meticulous review of the data and results. And finally, the data is released the public so the scientific community can pour over the data and determine its validity and safety. That’s a LOT of scientists reviewing this data. That’s a lot of people 100x smarter than I will ever be looking at the vaccine that I will put in my body to protect myself and others from COVID-19 infections.   So when a decision is made to approve a vaccine, it has gone through so much scrupulous analysis that its safety is clear. I am not saying there will be no side effects to anyone (that is statistically impossible), but you will know the potential harms and benefits. And for me, the benefit almost always outweights the harms (which may be a little arm soreness and maybe a day or two of fatigue).

 

So, when COVID-19 a vaccine is announced, I will review the data with and for you and do my own independent review. I’ll trust the scientists, but I’ll also do my own research (not from twitter, but in the data!) and I’ll let you know if I trust the vaccine. But all signs point toward trusting the system and trusting this vaccine that, like many other vaccines that preceded it such as measles, polio, influenza, will save a lot of lives.

 

Please note that, like the other information provided on this site, this material is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. You are encouraged to consult your personal physician with questions or concerns. If you are experiencing a medical emergency, please call 911 or the emergency services number in your area.

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Green Smoothie recipe!

2 cups oat milk (or almond)
5 large kale fronds, stripped (or 1 cup frozen kale)
1/2 cup raw almonds
2 TBSP chia seeds
1 banana (frozen preferred for texture)
1 pear or apple (frozen preferred for texture)
1 cup ice

Blend up! Perfect for breakfast, or a post-yoga meal!

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Which mask is the right mask to wear?

Do you wear a face covering when out in public spaces? Thank you. But to add another layer of complexity, the type of face covering you wear matters. A recent study from Duke University (my alma mater!) demonstrated that bandanas and neck gaiters may actually be causing more harm than good. The problem is the porous nature of the fabric. The study demonstrates that if you sneeze or talk under a gaiter or bandana, the larger droplets may actually disperse into smaller droplets, which are lower in weight and mass. These lighter and smaller aerosolized droplets are more apt to linger in the air (which is the main avenue by which COVID is transmitted).

Based on the study results, the most protective masks (protecting others from you!) are N95 and surgical masks. But everyone in the world wearing N95 or disposable surgical mask is not sustainable. So, default to a cotton mask; they are still quite effective (reducing your expelled droplets by 10-40%) due to the multi-layers and tightly knit cotton. A good rule of thumb? If you can see through it when put it up against a light or you can blow through it easily, you are not protecting anybody. And continue to socially distance to further reduce your rate of transmission.

Remember, this pandemic has been so hard to contain because of asymptomatic carriers. And masks keep these carriers from unknowingly spreading the virus when they cough, sneeze or just talk.

I know this virus is complicated. But the guidelines are not. Wear a mask. Wash your hands. Socially distance. I’ll share something I said to my own mother the other day: “Just because it’s not convenient for us, does not mean we should ignore the science.” I’m not telling you what mask to wear. I trust and believe you are trying your best. But I want to share the science as it evolves, so you can make an informed decision. This study demonstrates that the right face covering works. And if we want this pandemic to subside, the-right-mask-wearing is the way to do it.

Thanks for listening and spread the word (not droplets). 😉

Love, Dr. Yang

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Do masks restrict your breathing?

Warning! Math coming your way!
I wanted to dispel a common claim that masks disturb breathing.

A coronavirus particle is 120 nanometers (nm) in diameter. Oxygen is 0.120 nm and Carbon Dioxide is 0.232 nm. To interpret these numbers very clearly, oxygen is 1000 times SMALLER than the coronavirus particle and carbon dioxide is 517 times SMALLER than the coronavirus. Meaning that in the same little hole that one coronavirus might be able squeeze through, 1000 oxygen molecules can get in and 517 carbon dioxide molecules can get out.

The pore size in N95 masks is generally 100 to 300 nm. Meaning the average single pore will allow 1667 oxygen molecules in and 862 carbon dioxide molecules out.  Other masks like surgical or cloth masks have even higher pore sizes. Therefore, it is not mathematically sound to say that that a mask restricts oxygen or carbon dioxide flow. In fact, it is impossible. It doesn’t mean that the wearer does not feel restricted (psychological effect), however, the math and physics are not consistent with that feeling.

So why wear a mask? The good news is, you don’t have to worry about the 120nm coronavirus particle itself because the virus collects together in larger droplets from your respiratory tract. The average size of the droplets is 1000 nm. And a mask is quite effective at blocking the droplets you are exhaling, coughing, or sneezing. So, the mask prevents the droplets from your mouth and nose from going anywhere past the mask, thereby leaving no SARS-CoV-2 particles in the air for someone else to inhale.

So woo hoo! By mask wearing, you can breathe freely AND keep you respiratory droplets to yourself. It’s like magic! Except it’s really just math.

We have the ability to end the pandemic in 4-6 weeks if everyone would wear a mask 100% of the time in public! AND we could all get back to our lives of going to the restaurants we love, traveling, going to the beach etc. so the economy would recover much sooner IF WE ALL JUST WORE MASKS!

Wear a mask, save a life. Maybe also your own. And please share the math!

Love, Dr. Yang

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Some words of caution as we lift shelter in place orders…

As of yesterday, San Diego fully entered Phase 2b, which means restaurants and retail businesses can have in-person customers with modifications to operations.

I wanted to offer some words of warning as we begin to venture out.
We have entered that stage of the pandemic where we’re just tired. Tired of working so hard and so long. Tired of the loneliness, for ourselves, for our loved ones. But remember, we have met with a novel virus that is causing disease unlike anything we have ever seen, during an era of scarcity that we have never before encountered, in a time of rapidly unfolding science and ever-changing information… and misinformation. In this time where every aspect of our lives has been affected by the virus, letting exhaustion affect our decisions will be detrimental. My only plea? Don’t let boredom or fear create a monster so scary that you start to believe that he’s real.

Please remember that we were sheltering in place so as to not overwhelm our health care system.

If you become ill with COVID-19 and you have to go to a hospital, you are overrunning the hospitals and potentially taking ventilators away from people with cancer or involved in major trauma. A child with cystic fibrosis or debilitating asthma can’t control the exacerbation of her disease, but you can exert some semblance of control as to whether you contract COVID-19. In the last 2 months, I have taken care of plenty of COVID-19 patients in the hospital, sure, but the majority of my patients are those with end-stage cancer or severe kidney/liver/cardiac disease. They need to be hospitalized or they will die, and we need to save beds for them. So, can we bear another surge, with potentially more cases? No, we need to save beds and ventilators for innocent, compromised patients, not for those that want to go to bars and play beer pong.
I feel impatient as well. I want to get back to life as much as anyone else. I want to travel and embrace my family. I want to see my best friend’s new baby. But I remember that we have a greater purpose and it’s to make space for the people that need us. For my cancer, my liver, my trauma patients. Thanks for sharing.

Love, Dr Yang

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Why you should wear a mask, explained.

Why should I wear a mask? Here’s why:

Masks provide “source control”—blocking the spread of respiratory droplets from a person with active, but perhaps unrecognized, infection. A study published in Nature showed that surgical masks are effective at blocking 99% of respiratory droplets. Double-layered cotton masks, the kind most of us have been making at home, can block droplet emissions as well. And the Sars-CoV-2 virus doesn’t last long on cloth; viral counts drop 99% in 3 hours. A recent review of the research suggests that if at least 60% of the population wore masks that were just 60% effective in blocking viral transmission (i.e. a cloth mask), the epidemic could be stopped. Read that again. If just 2/3 of us would wear masks, COVID-19 COULD BE STOPPED.

I don’t think this is asking a lot. If you have to wear pants in public, it is not much more burdensome to wear a mask.

Cloth and surgical masks don’t fit tightly, so it is hyperbole to say you can’t breathe. Maybe it is not as comfortable, but you can breathe air coming in around the sides. They are designed to safeguard others, not the wearer. The basic logic is: I protect you; you protect me. Benefit to the wearer may be limited, but it’s not insignificant: surgical masks reduce inhalation of respiratory-droplet-size particles by about 75%. Two-layer cotton masks filter about half as much, though a good fit can improve that considerably. Masks also prevent wearers from touching their noses and mouths.

Evidence of the benefits of mandatory masks is now overwhelming. Our hospital system would not be able to stop viral spread without them. So yes, you should wear a mask. I protect you and you protect me. We’re in this together, let’s beat this virus together. Thanks for sharing this info and wearing a mask! .

Thanks also to @atul.gawande for providing the majority of these statistics! .

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We are not less productive, we are just less frantic

I had the loveliest facetime catch up with my amazing friend Diane today. She is not just a deeply knowledgeable and heartfelt yoga teacher, but also a wise and connected human and friend. We were talking about social isolation, as many of us do today, and I jokingly posed the question to Diane: “Why am I so much less efficient now when I have so much more time, than I was before social isolation?” She laughed and answered, “Maybe you’re not less efficient, just less frantic.” And there it is. I let out a sigh of relief and realized how incredibly right she is. I am not getting any less done that I used to be. I’m still going to the hospital and taking care of sick patients. I’m still preparing for the publication of my next book. I’m still cooking, and caring for the dog, and cleaning the house, and sending out emails. But all this is done in a setting that is so much less frantic.

I’m no longer running myself ragged on my days away from the hospital – trying to see friends, go to the store, and get to a yoga class. Now I get to practice the same yoga class at home. Now, instead of rushing from event to event, or packing for trips, I am taking my time planning meals for myself and my partner, and taking the dog on long walks.

So today, instead of mourning the loss of “all the things” that kept me frantically busy, I will celebrate the freedom of a less frenetic way of being. Instead of rushing through my chores or my workouts, I will languish in the spaciousness. Instead of being frustrated that the dog interrupts my yoga session, I will giggle that she wants to be support this emotionally exhausted frontline worker and restart the posture sequence.

We’re doing all the same things – we are just less frantic.  Thanks, Diane. Thanks for sharing your wisdom with me, and with all of us. Let’s all find a little more perspective and space within our less-frantic socially-isolated lives.