Mindfulness, Meditation, & Medicine

 

    I want you to look at this photo (Etlingera elatior, which I took at the botanical gardens in Rio de Janeiro), take a deep breath, maybe a cold shower, meditate a bit, do some yoga, sing a song, laugh, whatever it takes to pump up that vagal tone! Last week I was invited to give a lecture on Mindfulness, Meditation, & Medicine to the Lifestyle Medicine group at UCF. The lecture was attended by first and, mostly, second year medical students. We went over, the what, why, and how of meditation and mindfulness. Sadly, the practice of medicine in the modern era is rarely about wellness, but rather interventional disease management. Most healthcare providers aren't "well" themselves, much less their patients, and are caught in vicious, stress inducing circles both from personal choice and from circumstances out of their control. go to sleep). One of the topics that I like to bring up is the importance of vagal (nerve) tone in balancing out our sympathetic nervous system. I touch upon this in my book Zen in the Art of Surgery, and I will post a short excerpt here. Hope you enjoy it... 

(Excerpt)

    The Eastern philosophical and religious traditions have long understood the importance of meditation and breathing. Ask any Yogi, Sufi, or monk and they’ll tell you. I have. They all approach meditation in slightly different ways, but the principle is the same. What is meditation? Well, that can be answered at two levels, but first you have to understand what mindfulness is. Mindfulness is being fully present in the here and now, not thinking about anything else, past, future or whatever your mind would normally wander off to. You’ve silenced your monkey mind. Yes, there are those peak experiences where you are so present in what’s happening you can’t think, and there is a sort of silence of the mind in full awareness of the moment, and those moments in a way are mindfulness (at some point “practicing” meditation will get you there more often, especially in the less than peak moments, and in Zen there are just moments, none more important than another), but most of the time we are thinking about what’s happening, or worse, something else - and so life and whatever it offer us in the moment passes us by.

    So meditation at one level is the practice of becoming more mindful through one of many forms of training,  such as meditative breathing, chanting, yoga, tai chi, amongst others, and then at another deeper level it is just being present with what is, or mindful, so that you could be meditating wherever you happen to be and whatever you happen to be doing. Well, for the purpose of training surgeons, I like to teach meditative breathing as the method of practicing meditation since that is something you can come back to while in the operating room, in the clinic, or anywhere. You can’t break out into chant or a yoga pose in the operating room, but you always have your breath (when that’s gone, trust me -  you won’t need to worry about meditating, the monkey mind or anything else, for that matter). That’s how I learned meditation - first you master your body, then your breath, and then your mind comes along with it.

     Now what does that mean? The first step, which is often the hardest for beginners, is to sit still, absolutely still. Start by finding somewhere comfortable, like a cushion or a meditation stool, or even a nice chair, and sit still. You have to master and be aware of your body first, which, by the way, is also true in surgery. Part of medi­tation is learning to sit and be patient with all the little body aches and urges to fidget and shift position, because when you move, your mind moves along with you. The discomfort and urge to move will eventually dissipate. They’re just thoughts and perceptions in the mind, but most people never wait long enough for that to happen. I also recommend beginning meditators close their eyes or use a blindfold as the eyes wander and with them comes a flood of thoughts, and find somewhere quiet. Once you’ve mastered the body, and can sit still long enough, the next step is to observe your breath. In doing so, the mind slows down. You can either pay attention to your breath or you can have a thought about something else – you can’t do both. The mind can only hold one object at a time, and that’s helpful when you might not want to listen to your thoughts. Whatever sounds you hear, try not to label them, because those labels too are thoughts, Just focus on your breath. What you’ve done is basically directed your otherwise random thoughts, and your attention, toward the object of breathing. Of course, new thoughts will pop right back up, but that comes with the human mind and consciousness. The key is recognizing when they occur and being able to return to observing your breath. This creates a degree of separation be­tween you and those thoughts. And, if you pay attention long enough, you can see how some thoughts cause emotional and physiologic sequelae. Thinking about something fright­en­ing or uncomfortable, such as pain, or surgical case gone wrong, will re­sult in a more rapid, chest breathing pattern, an in­creased heart rate, and tension somewhere in your body, just like in the operating room, while thinking of something relaxing, like your last va­cation or simply returning to observing your breath, will cause you to return to a deeper, belly-breathing pattern and a slower heart rate.

    Some people observe their breath, some chant, some count rosary beads (anxiety beads, really), some pray – it’s all the same principle. They’re all differ­ent ways to take you away from your thoughts and silence the mind. So, start with a few minutes and then slowly increase how long you sit, re­peat every day, multiple times a day, and, eventually, once your thoughts no longer have sway over you, you can be a reasonably calm person and you’ll find that you have a more normal heart rate, lower blood pressure, good digestion, and you sleep better.

    But why? Scientific minds want to know. It all has to do with your reflex, or autonomic, nervous system.  The auto­nomic nervous system is re­sponsible for our non-voluntary activity, such as sweat­ing, heart rate, bowel movements, and other vital bio­logical functions. It has a sympathetic and parasympa­thetic division. In emergen­cies that are stressful and re­quire us to "fight" or take "flight" (run away), think of a tiger attacking you in the wild or maybe someone, perhaps even yourself, yelling at you in surgery, or for some just doing surgery at all, the sympathetic nervous system takes over. It drives up your heart rate and your blood pressure, you start to sweat, your digestion slows – everything your body would need to fight or flight from a stressful encounter. It releases neurotransmitters like adrenaline, epinephrine, and cortisol, which cause some of us to have tremors and a lot of us to have our thoughts run amuck. The same thing happens when you take sympa­thomimetic drugs like caffeine. And because everything in the body,  and the universe, has its own yin and yang, the para­sympathetic nervous system does the opposite in non-stressful situations. Breathing patterns vary when we’re under the influence of one or the other. When the sym­pathetic nervous system is in control, we’re taking short, rapid breaths, and when the parasympathetic nervous system is in charge we’re taking slow, deep breaths. That breath­ing is the key to understanding the effects of meditation.

    Let’s return for a moment to medical school, back to your anatomy class, when you had to dissect out the vagus nerve. Turns out that was far more important to your sanity and wellbeing than you could have imagined, the key to future bliss and nirvana. The vagus nerve, the longest of all cranial nerves that travels across the neck, thorax, and abdomen innervating several vital structures, is the lynchpin of the parasympathetic nervous system. How active your vagal nerve is, or vagal tone, has direct implications on how healthy or stressed out you are. Higher vagal tone is associated with psychological and physical well-being while lower vagal tone is associated with negativ­ity, inflammation, and heart attacks. Deep abdominal breathing, especially with a long, slow exhalation, stim­ulates the vagus nerve and, in turn, the parasympathetic nervous system. So do cold showers, yoga, and singing by the way. The vagal response reduces heart rate and blood pressure. It changes the function of certain parts of the brain, calming it down, and stimulating di­gestion, all the things you might expect to happen when you’re re­laxed. Activating the vagus nerve releases all sorts of anti-stress hormones such as prolactin, acetylcholine, vasopressin, and oxytocin. These improve memory, im­mune function, and sleep, while also decreasing inflam­mation, allergic reactions, headaches, and pain. But most importantly, it helps young surgeons perform with sang­froid in the operating room. You think less and “do” more.  So it’s really simple; deep breathing means you’re not thinking, just doing, and vice versa. Pay attention to the people around you. By watching their breathing patterns you’ll be able to tell if they’re thinking too much, and from the context, what they’re thinking about...