Full-spectrum care: Yoga therapy in gynecological oncology
By Lois Ramondetta
I’m a gynecological oncologist. Doctors in this specialty have long-lasting relationships with patients, and although many are cured, those who arrive in my practice with advanced disease will often be with me from diagnosis until death. My place of work is a major academic cancer center. I am also a yoga therapist with a deep-rooted belief in the transformational power of the eight-fold path of yoga.
I have spent most of my medical career learning about the annamaya kosha—the physical dimension of a human being.Yoga therapy introduced me to all of the five koshas and gave me a much wider lens through which to see patients. By looking at a person in terms of the koshas, I have gained a renewed energy and love for treating people while offering them more comprehensive care.
Assessment using the kosha model
I have always been interested in a more nuanced patient assessment than we usually see on medical forms, and the kosha model offers that. Seeing an individual not just as mind and body but as five layers of being provides a cohesive framework. The kosha model also seemed like a place where the published literature regarding spiritual assessments and meaning-focused work for those with cancer based on Victor Frankl’s perspective naturally fit together.
I incorporate many yoga therapy tools into day-to-day patient care. I recognize the importance of asana (postural) practice for physical self-care but also as the foundation that supports people in learning how to connect to their breath and calm their minds. I regularly incorporate pranayama (breathwork) practices into lectures for surgical trainees as well as into clinic visits for patients who are struggling.
A simple breath practice
One of my favorite practices to teach patients involves using their own pulse like a metronome. First, I teach them to take their pulse. I may start with a suggestion of using a 4- to 6-pulse inhalation, then a 2- to 8-pulse antara kumbhaka (holding of the breath after inhalation is complete), then a 4- to 8-pulse exhalation, and finally a 2- to 6-pulse bahya kumbhaka (holding of the breath after exhalation). I ask people to pick what works best for them to avoid strain, but to really feel their pulse: the whooshing, the vibrations, maybe to also feel their heart beating at the center of their body.
Through this practice and others like it, people learn to notice where their heart rate slows as the practice continues and to adjust counts as needed. They get to tap into what I like to call the voluntary override of the autonomic nervous system and resulting mental calm.
Lois Ramondetta, MD, C-IAYT, is a professor at the University of Texas MD Anderson Cancer Center, where she provides surgical and chemotherapy-directed patient care as well as resident and fellow training. A diplomate of the American College of Lifestyle Medicine, Lois became an IAYT-certified yoga therapist in 2020.