The use of Constitutional Assessment to determine dosha, current state and possible state of imbalances.

The goal of MG's sessions are reduce the intensity of Hashimoto related flare ups with self care practices such as modifications in diet, stress reduction and movement. We will meet for 40 mins once a week for 4 weeks. We will asses levels of improvement to current symptomology on a weekly basis and at the end of the 4 wk period.

MG is a 42 year old female mother of 2 and oncology nurse. She has a history of Hashimoto's disease (Dx in mid 30's), acid reflux, seasonal allergies, intermittent diverticulitis flares as well weight management and emotional eating issues. Family hx of significant trauma and GI issues. Client currently takes Synthroid for Hashimotos and Omeprazole for reflux. She report having significant Hashimoto flares during stressful periods and with specific foods and at certain times of the year.

Helping the client understand the principles and benefits of Ayurvedic practices, the doshas and the concept of potential imbalances. The plan was to work alongside the client to help her identify current diet and self-care practices as well as daily stressors and understand how they can contribute to potential imbalances. To work in tandem to create measurable and attainable goals to aid her in potentially reducing her current symptomatology over a 4 weeks period of time.

Hatha: Asana, pranayama practice, and relaxation. The observance of non overexertion.

Raja: Self discipline, meditation, ahimsa (physical and mental)

Bhakti: Prayer and Chanting

Jnana: Reflection and self-inquiry through analysis of current daily practices, meditation

Japa: Repetition of mantra

All of the aforementioned practices within the branches of IY help pacify the heat of Pitta and bring balance between all the doshas. These practices also encourage the opportunity to foster mind-body connection, aid in reduction of physical symptoms and stress levels, and cultivate self-awareness for the client.

Ct stated that the results of constitutional assessment and dosha quiz “uncanny and very spot on”. She was easily able to draw parallels to areas in which she had been neglecting self-care and sometimes overlooked signals from her body. During first session modifications were made to bring asana to the seated level and also incorporate the use of bed for supine asanas as the client had significant difficulty getting down to the ground. Client also stated that she has been experiencing significant joint pain in hands, wrists and knee so a partial joint freeing sequence (JAPA) was also added to plan. MG incorporated JAPA practice 3x/week reported a significant shift in mood and symptoms that was also noted during the second and 3rd sessions.  

Client reported history of childhood trauma and not having fully processed many events. I advised the client that top-down approaches such as psychotherapy could be incredibly effective in helping her process this trauma. Client was referred to a vetted local psychotherapist who specializes in trauma and practices EMDR.  The client has been a nurse for over 20 years and also busy caring for her 24-year-old son living with autism and epilepsy and her 15-year-old daughter who is currently struggling with an eating disorder. Client reports having little to no time to ever think about what she really wants or desires within the realms of emotional of physical self-care. Client was encouraged to continue joint freeing sequence and making a list of potential ideas for self-care even if in short increments. MG was open to additional sessions to address physical and emotional stressors.

With the implementation of the slightly modified 4 week plan and a few of the dietary and self-care suggestions, the client was able to see a significant difference in overall energy, Reduction of symptoms during a Hashimoto flare, and less gastrointestinal distress. The client was also able to make a direct correlation with many or suppressed emotions especially. Hashimoto’s is a condition where the body attacks its own thyroid tissue. The thyroid is also located at the fifth chakra (vishuddha) which can be the bridge between the heart and mind and it represents our voice. Client realized that there was much of the past that she was holding onto and feelings of guilt and unexpressed anger towards herself. During one of the sessions the client stated “ I guess I’ve been on an attack of myself as well for a really long time”.

Writer ended up adapting many of the planned asanas to chair focused adaptations. As the client had a hard time getting down to the ground. We also realized when doing pranayama (Nadi Shodona) that the client was experiencing a lot of joint pain in her hands and wrist and subsequently we realized knees and ankles as well. Writer and client pivoted to more of a joint freeing sequence on to adapted poses like cat/cow, seated fish and version of Vaparita Kirani on the bed which was much easier than getting down to the ground. A key learning was to have a flexible plan in order adjust and meet the client where they are. 

Yes. But I would have asked more questions regarding goals and follow-up strategies during assessment. Accountability was very important to this particular client as self care has not been on the top of her list for quite some time. This may be an incredibly important question to ask especially when assigning any type of homework exercises for a client. The simple question “Would you like me to check in with you during the week” made a very huge impact in follow-through and compliance as well as the client stating “ I feel cared for and I’m usually always taking care of others”.

Overall the experience went very well and it was good to be able to practice adapting quickly. It also helped the client see that I was willing to meet her where is was and also helped build trust. This allowed the client the space to open up about past experiences and how much they impacted her. The client was very receptive and thankful for the referral to a trauma-informed therapist and reports currently working with that therapist. Ct states it has been a "crucial part of her current emotional and mental well being".