Hashimoto's

I'm taking a brief diversion from the yoga dance talk to share my experience being diagnosed with Hashimoto's. Hashimoto's is an autoimmune disorder where the body attacks the thyroid, resulting in hypothyroidism, or low thyroid function. It's an extremely common condition, which makes it all the more frustrating that it often goes undiagnosed, untreated, or poorly treated. I've experienced firsthand how difficult it is getting diagnosed and treated, so I'm sharing my experience in hopes that it might help someone else.

Since the beginning of the year, I have been struggling with extreme fatigue. For months at a time, I was forced into taking a break, backing off my yoga teaching and dance commitments because I just didn't have the energy to do anything. For a while, I could get away with writing off my fatigue as simply the result of being super active. I work out a lot and lead a busy life! Of course I'm tired! I'm sure many people have experienced this feeling, but I should have paid attention to my body's subtle signals.

In January, I went on a cleanse diet for three weeks. During that time, I realized that I was using caffeine and sugar to get me through the day, and when I took those away, I felt pretty terrible. I went to see a nutritionist, who helped me revamp my diet. I added in a lot more protein and fat (yum), and started taking supplements to improve my energy levels. The changes I made did help a bit, but my nutritionist suspected hypothyroidism as the cause of my fatigue, so off to the doctor I went.

My doctor ran a complete blood test and confirmed I had hypothyroidism. At first, things were great. She did further tests on my thyroid and established that the hypothyroidism was due to Hashimoto's. She said she wasn't concerned about a specific TSH number and was most concerned about me feeling well. She prescribed levothyroxine and I started feeling better almost immediately. Yay.

Then, after a few months, I crashed. My symptoms came back worse than before. I had no endurance, I was tired all the time, and on top of that I started to suffer from brain fog-- losing words, forgetfulness, and difficulty concentrating. I remember one day I wanted to practice so badly, I tried to push through the fatigue and my muscles totally gave out. It was physically impossible to dance. I ended up collapsed on the floor in tears because I was so frustrated.

I went back to the doctor and she wouldn't change my dosage because my blood test showed my TSH was still within a normal range, in spite of the fact it was nearly double what it was when I was feeling well. I had to wait until my numbers got worse. I might be able to live with that, except that she offered no suggestions as to how I might be able to manage my symptoms in the meantime.

This is unacceptable. I'm not running marathons. I am a dancer and yogini, and while I practice as much as two hours per day on top of my teaching and rehearsal schedule, that's fairly low-impact in the scheme of things. I had gotten to the point where I was barely functional. It's really scary to feel not yourself! I truly felt like a different person, or maybe like a shell of myself.

I then went to see a holistic doctor and he prescribed T3 in addition to the T4 (levothyroxine) I was already taking. T4 is just one of the hormones the thyroid produces and needs to be converted to T3 for the body to use. Many thyroid patients (like me) have trouble converting T4 to T3 and need additional medication. He also gave me some recommendations about supplements based on the rest of my blood tests and my symptoms. He seems just as (maybe more!) frustrated that I am that people are not getting properly treated for thyroid conditions. Many doctors, even endocrinologists, are making recommendations based on research that is decades old, work on a scale for lab numbers that is way too broad to be of any use, and continue to treat patients based only on TSH, which is only a partial picture of how the thyroid is functioning. It seems that holistic doctors and naturopaths are more likely to get thyroid treatment right, but this is unfortunate because insurance does not cover non-traditional doctors. When I told my original GP I went for a second opinion and started asking questions, she refused to continue to treat me. That of course, scared me too, because now I didn't even have access to refill the prescription that was keeping me even barely functioning. I was very fortunate to have found this holistic doctor who could help me so quickly, and to be able to afford going that route. I can only imagine how frustrating it might be to go even longer, bouncing around doctor to doctor trying to get help for a chronic condition.

Anyway, I finally have all of my levels optimized, and have a routine that hopefully will keep me healthy for a long time. My doctor says my case is easy! It was still a struggle for many months, and so I want to share some resources that have been helpful to me.

Nutritionists are awesome! I learned a lot and she worked with me to make changes to my diet that didn't disrupt my lifestyle too much and that would support my stressed out systems. I saw a nutritionist who was finishing her training program so it was at a discount, plus I had the benefit of the knowledge of her advisors as well.

Why Do I Still Have Thyroid Symptoms? made the mystery of the thyroid easy to understand. Such a tiny organ regulates so much! My primary symptom has been fatigue but thyroid problems can cause weight fluctuations, hair loss, depression, infertility, and a long list of other issues. This book explains how proper treatment can bring everything back into balance.

StoptheThyroidMadness.com is a great website with lots of articles about thyroid diagnosis, treatment, and research. It's a little fanatical, but I can't blame them, because it IS madness.

ThyroidChange.org is where I found my doctor. Their list includes doctors who will run full thyroid labs and will treat with T3 or natural thyroid in addition to T4. There are regular doctors and endocrinologists on there as well as holistic doctors.

If you're struggling with fatigue or are otherwise not feeling like yourself, do consider getting your thyroid checked! And if you have been diagnosed with hypothyroidism and still aren't feeling well, don't give up. It's worthwhile to do a lot of research on your own. Find a doctor who will listen to you and get to the bottom of what's going on. Awesome doctors are out there! It might take some time to feel better. Just do the best you can. Be patient with yourself and know that it's OK to slow down and rest. Tell people who care about you and they will help you, too. Be well!

Yoga for Knees, Part 2: Tips and Transitions

Did you check out my therapeutic yoga practice for knees?  That’s all well and good, you might say, but what happens when you’re up and about or trying to get through a vinyasa class?  I have a few pointers for you.

Solid foundation. I’ll go into this more in a future post, because, frankly, I’m kind of obsessed with feet, and that’s probably going to be even more so the case as I rehab my ankle.  Make sure your feet are solidly connected to the ground.  I recommend trying to lift and spread the toes in pretty much every standing pose.  You don’t have to be an obsessive maniac like I am about it, but this simple action lifts the arches of the feet and wakes up the muscles all the way up the legs, which will in turn give you greater control over what your knee joint is doing.

Tracking.  In many yoga poses, we want to keep the kneecap tracking in line with the ankle and hip, because this is a stable position.  If you browse through some photos of more complex asanas, you'll see this is not always the case.  However, as a general rule, we try to avoid allowing the knee to go past the toes in a lunge position because of risk of strain to the knee.  Knee over ankle is a cue you might hear, though it's important to note that this does not apply only apply to front to back, but also side-to-side.  In Warrior II for example, try to keep the knee over the second toe, rather than allowing it to roll in towards the big toe or out by the little one.

The block trick.  In tadasana, put a block between your thighs.  Bend your knees slightly and lift and spread your toes.  Now squeeze your thighs in and back like you're a human pez dispenser, trying to shoot the block out behind you.  Doing this will probably make you stick your butt out, so pull your low belly in and up to drop your tailbone and bring your pelvis back to neutral.  Keep all that squeezy action in your legs and come into a standing forward fold.  Cora Wen explains this in more detail.  For an extra challenge, keep squeezing the block between your legs as you go through sun salutation A and utkatasana a few times.  You'll have to do a weird penguin waddle to and from plank, but it's fun!

Warrior I.  This cue I hear a lot and it is a huge pet peeve: Square the hips forward.  No no no!  This might be OK for some bodies, but if your heel is down, your hips will naturally open slightly to the side, so then what?  Insisting upon bringing the open hip forward, the torque is transferred to the knee which is not designed to twist when it is straight like that.  Instead, keep pressing the back foot down, let the hips be open slightly, pull the low belly in and up to stabilize the low back, and spiral the shoulders forward for a nice little twist in the upper spine.  Want hips forward?  Take the back heel up so you can pivot freely.

Warrior I to Warrior II.  You'll see this transition quite often in vinyasa classes, and I use it myself sometimes, but it can be awkward and risky to knees and SI joints because you're pivoting from a slightly open hip (relative to the front of your mat) to a fully open hip (now facing the side of your mat), making it easy to twist the knee or SI joint.  A safer way might be pivoting on the ball of the foot, or setting up for warrior II from a wide leg stance.  That's not as fun, though, is it?  Ah, well.  Just be careful.

Straight-ish leg poses. I like to come into Triangle from the bottom up rather from the top down.  From side angle, place your hand on a block or the floor where you usually like it for Triangle.  Make sure you are in a nice tidy lateral bend, with top hip and top shoulder rolling open towards the sky.  Then, start to press your front leg straight, keeping the alignment in your spine.  You might not be able to get your leg all the way straight, but that’s OK.  You might notice by going slowly and not locking out your leg right away, you can improve the stretch on that hamstring and inner thigh.

Sequencing. It's totally OK, even beneficial, to challenge your knees by flexing them deeply in supta virasana or similar poses so long as it is not painful.  However, it's best to do these poses towards the end of your practice, especially if you are doing yin style long holds.  Follow up by doing some non-weight bearing action to gently mobilize the joint again.  If you try to go into some standing or balance pose, you are at risk of injury because the joint is temporarily weakened from the intense stretching.

Here’s an idea for a sequence to practice stabilizing the knees, followed by a few poses to stretch around the legs and hips:

Yoga for Knees Vinyasa Sequence

1/2 Salutes, Sun As
Block trick
Block trick with Sun As, Utkatasana
Sun Bs hips open in Warrior I
Sun Bs with balanced lunge (heel up, arms up)
Warrior II
Side Angle to Triangle (keep knee a bit bent in Triangle)
Garudasana/Eagle (keep standing knee bent)
Anjaneyasana/Crescent Lunge
Supta Hasta Padangustasana/Hand to Big Toe
Apanasana
Savasana

Therapeutic Yoga for Knees

I'm in physical therapy right now for my broken ankle and I asked my PT what the most common injury she sees is.  Knees.  She's says its because knee issues happen from young to old and for many reasons.

Knees are between two other important parts, hips and feet, so if you're experiencing knee pain, it's possible there is an imbalance somewhere else along the chain.  One thing you might want to try is looking in a full length mirror.  Wow, aren't you beautiful!  And your legs are so strong!  Anyway, about those knees.  Do they bow out or are they knocked in?  If you engage your quads to lift your kneecaps, do they lift straight up or towards one side?  Do your knees and feet face straight ahead or in or out?  Now look at your feet.  Do you tend to roll to the inside or outside of the foot?

In a perfect world, we might all have exquisitely lifted arches with knees over ankles and everything facing forward.  However, injury, imbalance, or simple range of normal variation in skeletons does not make this so.  If your knees are knocked in, you might want to try strengthening the inside of the and legs and stretching the outside to bring balance, but don't necessarily force yourself into a prescribed alignment.  Having an understanding of what your default posture is like will help inform you of imbalances and bad habits, but will also give you some idea of how to customize poses to prevent undo strain on your joints.

I've made a short video with a therapeutic, exploratory practice for knees.  There's no weight bearing so there is minimal strain on the knees.  This is a viniyoga inspired practice that will gently strengthen and stretch hamstrings, quads, abductors, adductors and all around the hips and low back.

Give the whole sequence a try and feel free to repeat, omit, or otherwise adapt the practice to serve you better.  If you have an injury or imbalance, I recommend trying some of these poses asymmetrically, doing the right and left side alternately.

Stay tuned for part two for tips about stabilizing knees in more athletic styles of yoga!

Broken Ankle

Two weeks ago, I broke my ankle in a rock climbing accident. I went bouldering with my husband at a rock climbing gym. Unlike rock climbing, there's no ropes, just free climbing.  I scrambled up to the top, and on the way back down, I lost my footing and decided to drop off the wall while I was still about six feet up. My right foot missed the mat, and I ended up dislocating and breaking my ankle in two places. You can see in the photo it's now held together with a plate and screws.

I'm so grateful that doctors can put bones back together like this, and it's even more amazing that the body will heal itself if you pretty much just let it be.  I can't have any weight on my leg for a couple more weeks, but I am feeling well enough to do some yoga and conditioning on the floor.  I'm learning a lot about patience and gaining a whole new perspective on practice that I will continue share here and in my classes in the upcoming weeks. 

Check my schedule, where I will be updating my class and performance schedule!

Transient

Jumping Back to Chatturanga

There is a troubling trend I'm seeing in yoga classes: jumping from uttanasana (standing forward fold) into plank.  Where are people learning this?! Not in my classes!

This is a really risky move.  The shock of jumping back with locked out arms, is hard on your shoulders, elbows, wrists, and even the spine.  You might say that you always jump back to plank and it feels fine, but if you're doing vinyasa style practices several days a week, jumping back like that all the time... not good!  Vinyasa classes are primo places for repetitive stress injury because, chances are, you are doing elventy hundred "vinyasas" every week, and that will cause wear and tear on your joints if you're not paying attention.  Just because it's yoga doesn't mean it's necessarily safe or good for your individual body.  So what to do?

Jumping back to Chatturanga

Ah yes. Chatturanga Dandasana.  We so often try to cheat our way through it in our yoga practices because it is HARD.  First, a few alignment pointers for Chattruanga.

  1. Elbows over wrists. Rules of physics say this makes sense.  Keep this in mind for arm balances like bakasana (crow).  This is a good foundation and gravity will transfer weight straight down your armbone, with minimal pressure on the wrist.  To make this happen, I like to give a little push forward with my toes in plank before I lower down.
  2. Don't lower more than halfway.  This is "past the point of no return" for many people.  It's hard to push back up from there! Also, this puts undo strain on the rotator cuff.  It's not necessary.  Your upper arms should not dip down below parallel with the floor.  If halfway is still too much for you, maybe just bend 1/3 of the way, or if you're still building strength, an inch or two.
  3. Find your wings! hugging elbows to ribs is the traditional way of doing this pose, however, it does not work for every body.  I have to have my hands slightly wider than shoulder width apart in Plank, Down Dog, and Chatturanga for my shoulders to be happy.  That means my elbows go out a little bit, and that's OK.
  4. Belly in and up the whole time!  This is the hard part.  But it will make it easier on the arms and shoulders, so it's a fair trade.
  5. If this is impossibly hard for you, do the whole shebang with your knees down.  Belly still pulls in and up though!  Once you're comfortable holding chatturanga for five breaths or so, you should be well on your way to jumping back like a ninja.

How to jump back:

  1. In uttanasana, place your hands shoulder-width apart next to your feet so that your elbows are already over your wrists.  Your shoulders will probably be forward of your wrists and that's OK.  Bend your knees as much as you need to to get your palms down.
  2. Inhale, lengthen your spine. 
  3. Exhale, pull your belly in and up as hop your feet back.  Land with bent elbows or bending elbows to your happy place in chatturanga.
  4. Flip over to the tops of the feet and inhale to upward facing dog. 

Here's a video where I break all this down:

Give it a try!  If jumping back to chatturanga is not your jam, STEP back to plank, then work on your chatturanga or bypass the whole vinyasa nonsense and head straight back to downward facing dog.