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The Magnolia Tree

 The Magnolia Tree

It’s shedding leaves as autumn starts,

Letting go of the old to rest awhile.

The leaves are scattered by the wind,

They fall in my garden and drift on the breeze.

Leaves falling, tree naked and bare, standing tall and proud

Life goes on, forever changing and renewing,

Look at the trees and how easily they let go

Preparing for the new life to come in spring

What can we learn from the falling leaves?

Can we start again, let go of the old and rejoice in renewal?

Always the hope of renewal,

That things will get better.

Letting go of what no longer serves you,

Look forward to spring and new life.

Mary 

I have just returned home from walking part of the Camino de Santiago.

This is the famous walk to Santiago that has been followed by pilgrims and others since the Middle Ages.

 

 

 

This shell is the symbol of the Camino and walkers/pilgrims follow the shell as they walk the route.


I went with two friends and we were also part of an organised trip.

We arrived by plane into Bilboa and stayed overnight before beginning our walk the next day. We walked part of the route each day, some days were more challenging than others. The first day it was cold and wet, and the path was rocky and muddy. Walking was difficult that first day.

Walking got easier after the first day! As well as walking the Camino, we stopped off to visit churches and cathedrals along the way. In all we did walked for 6 days and arrived at Santiago by walking into the city as pilgrims have done over the centuries. We toured the city and the famous cathedral. On the final day we went to Finisterre – the end of the world – the point people thought the world ended when they believed the earth was flat.

Before I went I read a couple of books on the Camino and watched the film ‘The Way’

with Martin Sheen. The Way tells the story of a man, played by Martin Sheen, whose son dies in a tragic accident while walking the Camino. He then decides to do the walk himself and scatter his son’s ashes along the way. It’s a moving story and I recommend it. Walking the Camino changed his whole outlook on life.


I read Sonia Choquette’s book Walking Home which nearly put me off as she had appalling weather in May when we went. It poured rain, the path was deep in mud, there were thunderstorms and snow!

Here is an account of someone who did the whole journey:

https://uk.video.search.yahoo.com/search/video?fr=mcafee&p=the+camino#id=2&vid=88055c087b9e26c9c56eb42aba18c6d8&action=click

 

Buen Camino!!

Mary

Introduction

Surgeons are in a unique and privileged position. We are permitted, legally permitted, to inflict pain. Our patients ask us to do this for reasons of recurrent physical conditions, sometimes with associated psychological symptoms and sometimes, even for cosmetic conditions. An entire medical speciality called anaesthesia was created to support our endeavours.

 



With the ever-growing popularity of 'minimal access approaches' for a range of surgical conditions, surgeons are performing a number of procedures awake under local anaesthesia as opposed to the patient ‘asleep’ under general anaesthesia. This combination of reduced surgical ‘trauma’ and local anaesthesia use has resulted in reduced post-operative pain and quicker recovery time from surgery as well as from anaesthesia.

Local anaesthesia has variable effects on patients and is also dependent on the technique of infiltration of the agent. A number of different adjunct techniques can be used to reduce the patients’ perceptions of pains, thereby increasing its efficacy. Many surgeons will be employing some of these techniques knowingly or unknowingly.

Pain has a significant neurological component and some forms of pain-killers, act on neural pathways to disrupt them. However, even the most innocuous pain-killers, are not without potential short-or long-term consequences. Given the neurological component, it seems logical that a neurological process may be able to modulate the pain response. I have used the insights gained from meditation as well as my own personal experience with patients in the operating theatre to describe the common meditation and mindfulness techniques and how they work. You don’t need to be a meditator to use the insights gained in the article.

Managing expectations

Few things are worse for the experience of patients and people in general than fear, especially fear of the unknown. For this reason, these techniques are probably not suitable for acute (or chronic) undiagnosed pain. If the symptoms are acute or severe, you should seek medical attention.


Managing expectations, as well as the fear of patients, is important pre-operatively especially if you will be performing the procedure with the patient awake. Ideally this should be performed in an environment away from the operating theatre or procedure room with plenty of time for the patient to absorb the information and ask questions. The steps of the procedure should be explained to the patient.

 


Local anaesthesia is extremely effective if used properly and the patients’ expectations managed. Local anaesthetics selectively block pain receptors, however those receptors for pressure and temperature are still active, and the latter more relevant if diathermy (electrical cautery devices) are used. Local anaesthesia itself requires an injection with a needle. Some patients find this very distressing and this can be reduced using some of the techniques mentioned later as well as the use of a topical local anaesthetic applied to the injection site 30-40 minutes before the procedure. Sometimes the procedure can be done entirely under topical local anaesthesia and using some of the adjuncts described. The infiltration of local anaesthesia itself causes a short-lived stinging sensation before pain receptor blockage.

Attention - distraction

One of the easiest ways to ameliorate most mild forms of pain is to simply take your mind off it. Engage yourself in an activity, listen to some music or go for a walk. Most mild or short-lived causes for pain will subside.


Perhaps the best use of distraction was employed by one of my former trainers, Ian Franklin, who was one of the first to popularise the treatment of varicose veins in a clinic setting under local anaesthesia.

He had a number of techniques at his disposal but perhaps the most effective were:

1. He would allow patients to choose their own music to listen to during their operation. I would say that it is essential to give patients the right to choose their music or to not have any if performing procedures under local anaesthesia. The choice can greatly affect the patients experience of the procedure.

2. He would engage the patients during the procedure, explaining to those interested the steps of the procedure on the ultrasound monitor.

3. The piece de la resistance was the which nurses employed to monitor and converse with the patient. One nurse in particular, let’s call her 'Polly', was perhaps the most talkative nurse in South East England at the time and she could keep patients occupied in conversation for the entire duration of the procedure. This no doubt had a massive impact on the patients' consistently positive experience of the procedure.

Conscious breathing.

We’re all told to take deep breaths at a time of stress, anxiety, pain; childbirth. For breathing to be truly effective, it needs to be conscious. That is, to put your focus and full attention to your breathing. Taking deep breaths in through the nose, feeling how the air, its warmth, and flow feels as it enters your nose, airways, expands your chest and abdomen. On the exhalation, feel the relaxation in your abdomen and chest, feel the warm air leaving your airways and gently exhale it out of your mouth. The exhalation should last slightly longer than the inhalation. Every time you get distracted, especially by pain, go back to the breath and focus.


 

Breathing into the pain

In Vedic tradition, the breath is said to carry ‘Prana’, the vital life force that animates all living things. The breath is said to be healing by its very nature and is employed in a number of techniques that employ visualising breathing into the pain.


Now, you don’t need to believe in Prana to try this and it is likely that this is effective because the process of visualisation distracts the patient from the pain. That being said, it is simple to perform and perhaps a little more effective than conscious breathing. I can personally verify the efficacy of this technique both on myself and with patients during surgery.

“The cure for pain is in the pain – Rumi”

Awareness techniques

These techniques are effective for moderate to severe pain but do require some practice although there are some who are extremely adept and pick these techniques up quickly. They are effective for chronic ailments such as back pain (as previously mentioned, undiagnosed acute or recurrent pain usually requires medical attention).


If you break down pain, beyond any noxious stimulus (such as a burn) that may have precipitated it, it consists of an internal body sensation and associated thoughts and perhaps mental images, emotions and memories. Although the entirety of the experience may seem overwhelming, when broken down, the internal body sensation doesn’t seem as ‘harmful’ or ‘damaging’ without its associated negative thoughts. Similarly, the thoughts associated with the pain can be observed and their transient nature revealed.

It makes sense that conscious perception of pain is better tolerated than tolerating the pain alone.

Body scan meditation

Body scan meditation is a mindfulness practice that is gaining increasing popularity in pain management and pain clinics. It is especially useful for those with chronic pain. As mentioned, pain consists of more than just the physical sensations in the body and always involves thoughts, and often emotions and personal beliefs. Chronic pain can also cause negative emotions such as anger, sadness, desperation and anxiety making their management even more complicated and symptoms often worse.


Pain related thoughts arise spontaneously and most of the time we do not place our conscious awareness on them. Aware of them or not, these negative though associations work at a subconscious level and no doubt make patients ‘perceptions’ of pain worse.

Body scan meditation is said to help with the experiences associated with pain including those that can exacerbate pain such as emotion by placing awareness on them. There is a growing body of research in the peer-reviewed scientific literature attesting to its efficacy in reducing the intensity of perceived pain. This form of mindfulness allows us to change our relationship with pain for the better, instead of feeling like we are being held captive by it.

Techniques for body scan meditation

1. Bring your awareness to the internal sensations in the body region by region. Acknowledge whatever sensations are present, without judgment. Notice those areas where the pain is more intense or more diffuse compared to those where it is more localised. Just allow these areas to ‘soften’ before moving on to the next region

2. Focus on the breath as you are bringing attention to the different areas of the body. Many people tend to hold their breath or conversely hyperventilate in situations of pain, neither of which are in any way helpful. Bringing your attention back to your breath. This regulates the breathing and helps avoid shallow breathing that can exacerbate the sensations. As mentioned earlier, breathing into pain has a naturally calming effect.

3. Bring your awareness to the thoughts and emotions that may be accompanying the sensations. There may also be memories or mental images.
By doing this you are disentangling the somatic (body) features of pain with the mental characteristics. With all pain, the two always arise together.

We all have a unique perception of pain that can vary day by day even hour by hour. Understanding the components of pain is important if one is to manage it with mindfulness. Body scan meditation may significantly reduce pain and suffering, even if the causative factor is still present.

(for a free downloadable body scan meditation click here).

Detachment from pain

This is perhaps the most difficult technique to ‘master’. However, if you have time for nothing else or if in an extreme situation then this technique may be effective (and anyway, you have nothing to lose!). It involves detaching yourself from the pain at a deep level and becoming the ‘witness’ or observer of the pain. There has to be a deep belief that you are not the ever-changing and healing body that is experiencing pain, that the thoughts associated are temporary and fleeting and you are that who is ‘witnessing’ the pain. If done earnestly, this will cause immediate separation of the pain and the perceiver of the pain. As an Advaita Vedanta practice of awareness, I practice this technique often when I experience the back discomfort of sitting for long periods in meditation. I have also used it to great effect when I burned my hand on a 300-degree paint stripping gun. You may want to start with the niggly back pain though! The experience that I have when using this for focal (usually musculoskeletal) pain is the perception of the pain ‘melting’ away. Using this technique in the situation of the burn, the process definitely modulated the deep ‘internal’ pain to the point that it was negligible. The perception of pain superficially on the skin was also reduced significantly but not completely eliminated.


Whether you use any of these techniques or not, it is empowering to not be reliant on pain-killers and to know that pain itself is not a faceless intruder.

Article by Vikas Pandey MB ChB, MD, MRCS (Eng), FRCS (Gen Surg), Dip BSoM Consultant Surgeon

Vikas Pandey is a consultant surgeon based at West Hertfordshire Hospitals NHS Trust and teaches meditation on Harley Street, London.

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People often ask me “what is mindfulness”?


My answer is always this: it’s about BEING. HERE. NOW.

But what does that really mean, and how can you practice mindfulness?

• It’s the opposite of being on autopilot, where you automatically go through the motions of your day to day routine, without really registering/feeling/enjoying each of the moments and appreciating the moment for what it is.

• It’s where you’re not worrying about the future, or reliving events of the past – these are the 2 major sources of chronic stress we suffer today and with a bit of practice we can train our brains to remember to come back to focusing on the here and now, rather than the things that have already happened that we can’t change, or the future which we simply cannot control.

• It’s realising that the future is not yet here so avoid wasting energy worrying about it, the truth is none of us have any idea what the future holds.

• It’s realising and accepting that the past is dead and gone, and as tempting and habitual as it is, rehashing and reliving events in our past WILL NOT change what has already happened, nor will it move us forward.

If your mind and thoughts are scattered and you feel like your head is all over the place, you need to anchor and ground yourself in the present moment. The brilliant news is that there is a shortcut - YOU CAN USE YOUR SENSES to bring you back into the NOW.

 

Here’s how you can do this in 3 simple steps:

 

1. For one minute, look at something (anything!) - properly focus on it, what do you notice about its shape, appearance, texture, colour? What can you see now that you’re studying this object that you’ve never noticed before?


2. For one minute, touch something - how does it feel? Is it rough or smooth? What do you notice about the feel of the object? Is it hot or cold? Is it strong or supple?

3. For one minute, listen - what sounds can you hear? Get quiet and still, notice the sounds around you and tune into them. Whether it’s the rustling of the leaves, or the sound of cars going by, or the hum of machinery, just notice the sounds.

It’s just about being present and noticing your environment and what’s going on.

All these things will help your mind to bring you into the here and now. They will help you to be mindful, to feel calm and centered.

Nicky Thackray is a student on the BSoM Meditation Teacher Training course in the North East with

Pauline Archer

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