I had known about my abnormal heart valve since childhood, when the pediatrician told my parents I had a functional heart murmur that was nothing to worry about. By the mid-1970s, technology to image the heart became available, and I learned that the murmur resulted from a bicuspid aortic valve, one of the most common congenital valvular abnormalities. Instead of having the normal three leaflets, my valve had just two.
Despite my condition, I had an active and healthy life without limitations—running regularly, earning a black belt in karate, practicing and teaching yoga. So in 2007, following a routine echocardiogram, I was shocked to learn that one of my valves had narrowed so severely that I was at risk of sudden death. In addition, the malformed valve had created a weakness in my aorta—an aneurysm that needed prompt repair. I scheduled a date for open-heart surgery just after New Year's Day 2008 and six weeks before my 54th birthday.
As a yoga therapist at Duke Integrative Medicine, in Durham, North Carolina, I'd often helped others deal with the stress of serious health conditions through relaxation breathing, meditation, and appropriate yoga postures.
Now, as I prepared for surgery, I drew on my own practice to help ready myself physically, emotionally, and spiritually for the challenge. I called Nischala Joy Devi—my teacher and friend—for support. She pointed me toward Patanjali's Yoga Sutra II.33, which says, "When presented with disquieting thoughts or feelings, cultivate an opposite elevated attitude."
"What you say, feel, think, and imagine," Devi told me, "can make an enormous impact on the outcome."
The idea that patients have the ability to influence their surgery would have been dismissed a generation ago. But an emerging body of research suggests that mind-body practices, including those used in yoga, can improve your experience of surgery and its possible outcomes. For example, studies show that patients who use self-care techniques before surgery, including relaxation breathing and guided imagery, may need less medication, experience less pain and blood loss, and have faster wound healing and shorter hospital stays. "Simple mind-body techniques like relaxation breathing and vividly imagining the best possible outcome of surgery prior to the procedure can reduce anxiety, sleep disturbance, and even the surgical stress response itself," says Jeffrey Greeson, a clinical health psychologist at Duke Integrative Medicine in North Carolina.
These practices not only relieve suffering but can also save money. One study showed an average savings of $2,003 per procedure when patients listened to a guided imagery tape before surgery.
Anxiety, fear, and high levels of stress are correlated with poor surgical outcomes, according to Greeson. Anxiety can also increase pain and make some procedures, like starting an IV, more difficult, says Teresa Corrigan, a registered nurse and mind-body specialist at the Osher Center for Integrative Medicine at the University of California, San Francisco.
To help lower stress levels and empower patients—and to improve the bottom line—hospitals and medical centers that focus on integrative care have begun providing classes in relaxation breathing, guided visualization, and meditation to use in preparation for surgery.
In addition to conducting a workshop for presurgical patients that teaches abdominal breathing and a "relaxation body scan," Corrigan teaches Laughter Yoga to patients in her hospital's chemotherapy-infusion center. The extended-exhalation breathing that happens with laughter enhances the immune system function and relieves anxiety, among a host of other health benefits.
"Just because you're a patient doesn't mean you have to be helpless," Corrigan says. "Even at a time of ultimate vulnerability, when you must show up and put on that gown, you still have the ability to influence your internal environment and make the experience better."
Toolbox of Techniques
Taking advantage of hospital-based resources to help relieve stress and enhance healing is a step in the right direction, but patients can do a lot on their own. Your yoga practice provides a toolbox of techniques that can help counteract many of the stressors of surgery and bring your mind and body into optimal alignment for healing.
When Gary Kraftsow, founder of the American Viniyoga Institute, was diagnosed with a brain tumor in 2004, he drew upon the yogic tools he had spent most of his life developing. A leader in the field of yoga therapy, Kraftsow began studying with T. K. V. Desikachar in the 1970s, has written books and produced videos about yoga for healing and transformation, and developed protocols for National Institutes of Health studies of yoga's therapeutic benefits.
"I had one week to prepare myself for brain surgery and the possibility that I might not even wake up," Kraftsow recalls. "My main work was to go from a place of fear and uncertainty to a state of optimism and peace."
The tumor limited his physical -abilities, so his presurgery practice focused on maintaining physical vitality with simple movement and lots of pPranayama. Combining breathing practices with mantra and chanting also helped balance his emotional health. In meditation, he spoke to each cell in his body with gratitude.
Anyone facing surgery can tailor their practice in a similar way, says Kraftsow. He advises preparing your physical body with a mindful posture practice to enhance the flow of prana (life force), particularly to the area where the incision will be. You can help calm anxiety and reduce physical and emotional stress through appropriate pranayama. It is also important to create a personalized -meditation—one you can use throughout the experience—that tunes your mind and heart to things that have deep meaning for you, says Kraftsow.