• Check in, centering, balanced hatha yoga set considering contraindications, relaxation (with imagery as appropriate),
• Balanced pranayama considering contraindications, meditation/centering.
• Include at least one suggestion from Karma, Bhakti, Raja, or Jnana Yoga tailored for this client.

Centering on chair, establish an affirmation, change, then chair push ups and sitting arcs. Move to your bed to practice 2 or 3 supine pre-surgery strengthening movements before moving on to breath awareness and meditation.

Sankalpa for your heartfelt desire, calling or mission (p. 201) as a journaling prompt: "If you are a unique expression of life, how does it want to live through you?

Centering in chair
Added this to breath technique:
Thich Nhat Hanh on The Practice of Mindfulness
Breathing in, I know I am breathing in. Breathing out, I know I am breathing out. Breathing in, I notice my in-
breath has become deeper. Breathing out, I notice that my out-breath has become slower…. Breathing in, I
calm myself. Breathing out, I feel at ease. Breathing in, I smile. Breathing out, I release. Breathing in, I
dwell in the present moment. Breathing out, I feel it is a wonderful moment.

Check-in

Chair asanas
Joint loosening (no neck, client thinks that was what triggered the nausea last session)
Pre-surgery strength building:
Chair pushups
Sitting kicks (long arc quads)

Supine on bed
Ankle pumps
Thigh squeezes (quadriceps sets)
Buttocks squeezes (gluteal sets)
Heel slides (hip and knee flexion) (use a plastic bag under your heel to help it slide more easily)
Leg slides (abduction/adduction) (plastic bag option)
Lying kicks (short arc quadriceps)
Lie on your back with a rolled-up blanket or towel (at least 6 inches in diameter) under the knee of your surgical
leg. Straighten your surgical leg. Hold for 5 seconds. Slowly lower your leg down and relax. The back of your
knee should stay in contact with the blanket or towel during the exercise.
Straight leg raises
Bend your other leg with your foot flat on the bed.

Supported Savasana
Yoga Nidra with tense and release, body scan; then iRest for chronic pain relief; combining color with breath and
imagery.
"Rather than trying to fix pain, we are allowing it to be there and reveal its hidden layers." Rotation of consciousness, breath and energy awareness; meeting pain with awareness of sensation, breath, energy, emotions, and cognitions. sheath of joy and equanimity, welcoming well-being, whatever is present. (Julie Lusk, Yoga Nidra Meditations, pp.198-206).

Closing
Brief recentering
Taking the practice into the world
Sankalpa
Shanti Chant

During check-in, PAM shared that she had a monkey mind this past week. She started a new medication and today increased the dosage. Advised to stop taking Tylenol to see if the combination of the two new meds is enough. I asked if she was journaling that as well, its effects. "I was just thinking about that," she shared. She "has a sensation across the front of her brain, like an electrical impulse". I noted that that may be worth jotting down for future reference. She agreed.

She said the movements we did today were very similar if not the same as she was told to do to prepare her body for surgery. She is also going to the pool twice a week now as opposed to once a week. She appeared less anxious today than the last time. Her pain was at a 4 on a scale of 1-10.

She also reported during out check-out that the iRest YN 'almost lost her', when the script invited her to notice a color ( "notice if there is a color or substance, notice if it's like a mist, liquid, or an image that's resonating with the sensation..." ). She's been painting since retiring and this spoke to her, bringing back her focus.

I needed to modify the iRest script as it was very long. When PAM reported that I was losing her just as 'color' was presented, and sensations, etc, I knew I'd been right to shorten earlier parts. It is very wordy and one needs to be able to relax for that long, and comfortably focus for that long to complete it in its written entirety. With her hip pain, I didn't think it would be possible.

The concept of meeting pain as pure sensation and being able to use color to release the pain is used to support healing in other cultures. "Combining color with breath and imagery supports the meditator to meet, and potentially move beyond, pain." PAM said she did. As an artist, this spoke to her as I thought it would.

I'd like to participate in this YN meditation, probably a few times to ensure I can meet it with an easeful frame of mind. I believe I would benefit from this meditation.

Continue with strengthening movements. Check-in regarding her thoughts after having time to ponder the iRest YN of chronic pain relief. Did she journal? Note that this will be our second to last session, and if there's anything in particular she'd like to cover during the last session. Sutra 2.15; and the gunas.