- 44-year-old female, married, two children- one is an adolescent and the other is
- Essential Thrombocythemia, had for a while but got diagnosed in April’22, because of which she bruises easily.
- Has had chronic migraine her whole life – controlled with botox treatment
- Hereditary Alpha Triptasemia and GI issues. GI issues being controlled by a diet change.
- Currently being assessed for auto immune conditions like Fibromyalgia, MS, RA and Psoriatic Arthritis.
- Her stress levels are pretty high. She’s chest breather.
- Lost her father two months ago to PCP (Pneumocystis Pneumonia). Believes that due to her family’s catholic values and celebration of life views, she hasn’t been able to grieve her dad properly and hasn’t had an emotional release. There’s no grief support for her in her family.
- Father was abusive to siblings, so she learnt to be quiet.
- In her teens, spent time in juvenile hall, mental institution, was suicidal. Then sent to a boarding school in Utah, where she says, she found herself again with the help of a teacher.
- Full-time caregiver for her son for the past 5-6 years. Son diagnosed with Autism……
- Does not share a loving relationship with Mother-in-law, who now needs their support and care. She’s conflicted about that.
- Her Father-in-law and his wife also need their support and care but PT is not sure if she’s capable of giving that.
- In addition, being a single-income family is causing a lot of anxiety for both her and her husband.
- Has 3 cats, a dog and 2 guinea pigs. Fosters infant baby animals.
- Volunteers at a herbal garden and is learning to make herbal medicine.

- Barrel breath. Bringing attention back to her breath to trigger relaxation response.
- Gentle stretch ‘n flow practice, to help her connect to her emotions (Manomaya kosha), through breath (Pranamaya Kosha) and physical postures (Annamaya Kosha).
- Include Joint freeing movements to help with the inflamed and weak joints.
- Restorative practice to gently stretch and strengthen the muscles of the body.
- Guided relaxation and Yoga Nidra to help with deeper relaxation.
- Beginning meditation practice to help her be in touch with her inner peace.

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4. Adaptive Teacher Training Manual
5. Yoga for Arthritis Teacher’s manual
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7. Francis AL, Beemer RC. How does yoga reduce stress? Embodied cognition and emotion highlight the influence of the musculoskeletal system. Complement Ther Med. 2019 Apr;43:170-175. doi: 10.1016/j.ctim.2019.01.024. Epub 2019 Jan 31. PMID: 30935526. How does yoga reduce stress? Embodied cognition and emotion highlight the influence of the musculoskeletal system - PubMed (nih.gov)
8. Mooventhan A, Nivethitha L. Evidence based effects of yoga in neurological disorders. J Clin Neurosci. 2017 Sep;43:61-67. doi: 10.1016/j.jocn.2017.05.012. Epub 2017 Jun 7. PMID: 28599839. Evidence based effects of yoga in neurological disorders - PubMed (nih.gov)
9. Zeng X, Chiu CP, Wang R, Oei TP, Leung FY. The effect of loving-kindness meditation on positive emotions: a meta-analytic review. Front Psychol. 2015 Nov 3;6:1693. doi: 10.3389/fpsyg.2015.01693. PMID: 26579061; PMCID: PMC4630307. The effect of loving-kindness meditation on positive emotions: a meta-analytic review - PubMed (nih.gov)

• Yes

Check-in. Because of the fight with her husband and her heightened stress about her results, she was feeling tightness in her chest and anxiety. Joints in her feet were stollen, which she iced and it made it better.
Today’s practice included centering/grounding through body scan, extended exhalation, barrel breath, gentle joint freeing stretches, legs up the chair inversion, restorative backbend, restorative shavasana. Tense and release, Loving Kindness meditation towards herself. End with Bhramari.

Extended exhalation. Setting an alarm and practicing that throughout the day, 5 rounds of breaths, every couple of hours. Practicing legs up the chair/wall for the swelling in the feet. Practicing Bhramari with her 11-year-old child to help him calm down.

She had a hard week. Her Step Mother-in-law was in the hospital, fought with her husband and the results of her Kappa Quant free light chain came back, which was lower than the normal value. She says she doesn’t understand a lot of it and trying to make sense of that by googling information, which is causing her more stress. She’s going to consult her oncologist.

I think she would have benefitted from a couple more heart-openers like fish pose, to relieve the tightness that she was feeling in her chest. The restorative backbend did help with that but adding one more would have been good.

Joint freeing gentle movements. Continue with Extended exhalation. Loving Kindness meditation towards herself and her children.

• Yes

Check-in. Started with body scan, breath awareness, extended exhalation. Netra Vyayamam, warm ups for upper and lower body, seated twist, end with supine twist. Tense and release, loving kindness meditation towards herself and her children. Bhramari to end the practice.

Continue practicing extended exhalation. Acknowledging the feelings as they come and noticing where she feels it in her body. Taking breaks during the day to sit in quiet for a minute.

Over the weekend, she was helping clean her dad’s rental house. Went through a wave of grief. Went on a steep hike with her younger son and said that she felt good about being able to hike such a steep terrain. Her oncologist ruled out multiple Myeloma, which she was relieved about. She’s stressed about son’s lab results, which suggests platelet disease. Feeling anxious and annoyed because no diagnosis has been made yet, for her or her son. She said she practiced the extended exhales while waiting at the doctor’s office, which made her feel calm and more centered. Has been doing the stretches and says that her body likes the twists more.

Was thinking of introducing Nadi Shuddhi as a balancing breath but felt that she needed to practice more extended exhalation, so will try it in the next session. Since she said that her body likes the twists, I should have tried a few more variations, like in a chair, standing by the wall, lying supine. That would have given her more options to try on her own. Will do that in the next session.

Loving kindness meditation towards herself, her children and someone she’s struggling with. Experiment with twists, using different props, like wall, chair.

• Yes

Check-in. Body scan, Breath awareness, setting an intention of paying attention to the body, what it’s telling you and being present in the moment. Warm ups for lower and upper body. Twists using different props, by the wall, on the chair, supine on the floor, threading the needle. Tense and release, restorative reclined shavasana, tense and release, Guided Secret place visualization. End with Bhramari.

Taking short walks/breaks whenever she can. Practicing joint freeing movements. When feeling anxious, practice exhaling more.

She said she felt so good in the last session that she has started calling our sessions as ‘great reawakening’. She feels like she’s going through a transition but doesn’t know what it is yet. She’s becoming clearer in what she wants and doesn’t want in her life, regarding relationships. Had an argument with husband, says she feels “things don’t change when you have ease”. I asked her to tell me more about that. She said they have become ok with not talking to each other and doing their own thing, but she would like more from her relationship and she has started taking first step by having a conversation with her husband. She has started walking again (around 3 miles in the AM). Her body feels less swollen. Got a diagnosis. Her Rheumatologist says that her symptoms are consistent with Psoriatic Arthritis. She doesn’t have skin issues at present. Had a whole-body rash in Feb’23, which went away with Prednisone.

I think setting the intention at the start of the session and then coming back to it during the session, helped her be more present and helped me to remember what the session was about. Her movements felt slow and deliberate. She mentioned that she would benefit from having a mirror to see if her body is aligned. I have been meaning to order a mirror online but somehow hadn’t gotten to it. Will definitely buy it before the next session.

The sessions went well. Some conversations with her brought up bias for me. I was proud of myself to be able to recognize it and act accordingly. When my biases come forth, I tend to be quiet and not ask much. Thankfully, my client liked to talk and when I gave her silence, she would fill it up. I think that I need to keep practicing motivational interviewing skills. I’ll look for some videos to watch, or maybe a podcast.

Setting intention before each session. Joint freeing exercises. Follow up stretches.