Summer is in full swing, and it's great to be back in action with all my students and classes at Malibu Fitness. I wish you all a happy July 4th celebration ahead, and a month full of adventures in the outdoors. Strong, healthy core engagement and postural alignment are the foundations for optimizing our enjoyment in hiking, surfing, swimming, biking, rock climbing, and adventuring of all kinds. Enjoy the strength, flexibility, alignment and control that pilates can add to your sports and your daily experience. In addition to its affect on physical performance, how we hold our bodies in space affects how we feel about ourselves. One of my favorite TED talks by Amy Cuddy highlights how our posture affects how we actually think, and relate to the world. Stand tall and feel more confident, powerful, joyful, and purposeful.
Happy Summer to All!
Week four post op has been very inspiring; walking barefoot on the beach (no crutches!) and swimming in the pool are revitalizing. As my hips become more powerful and mobile, my gait is becoming more fluid and at times I am forgetting that I had hip surgery a month ago. Gone are the sharp pains stabbing in the front of my right hip, and the popping/grinding that felt destabilizing in both hips. It is elating to feel that when I take a step, my legs are solid underneath me. I feel strongly supported for the first time in a long while. I knew that my nervous system had previously been working overtime to analyze how to stabilize my body on what began to feel like stilt-legs. Uncaged, I now move with confidence that my legs are strong underneath me, without stabbing pains, and my mental energy is liberated for higher tasks.
I am deeply grateful for all the support I have been granted; especially nutritional and movement coaching both pre and post surgery. I am compelled to emphasize the key role that early physical therapy (PT) has on rapid, effective rehabilitation. I recently learned of a woman who had a single hip replacement in March, and is still very limited in her movement and requiring a walker. Her current therapists believe this is due to lack of effective PT immediately after her surgery. Her complications might have been prevented had she had immediate access to an effective physical therapist and rehab exercise program. I know efficient movement coaching has been critical to my rapid progress. and encourage anyone contemplating joint replacement to organize this ahead of time.
Also, I must emphasize the healing power of food; fueling the body with nutrient dense, whole foods --both before and after surgery--sets the foundation for strong healing. My personal preference is a plant based whole food diet following the paleo principles. Bone broth, organic grass fed meats (including organ meats), wild fish and plenty of organic green vegetables (2/3 of my plate is covered in veggies) provide a winning combination of bone building, tissue and gut healing nutrients. For more details on key nutritional considerations for bone and tissue healing, please refer to my previous blog entry, Bone and Connective Tissue Health, Speed Your Healing, (http://blog.ideafit.com/blogs/jennifer-beamer-fernandez-2/bone-and-connective-tissue-health-speed-your-healing)
Now it’s time for a dive in the pool!
Wishing you health and vitality,
It has now been three and a half weeks since my surgery, and I am quite amazed at how natural my hips feel, and how rapidly progress is occurring. I have no sense that foreign titanium parts are set inside my body; rather I feel more integrated, and connected than I have in a long time. The challenge is to reawaken stabilizers that have been dormant for some time, and unwind destructive tissue tension (hip flexors, adductors and rotators), that developed over decades to stabilize eroding joints and to protect me from pain. Now the real work, to realign and rebalance around highly efficient hip joints, has begun. For the first time in many, many years, I am able to align my hips, knees, ankles and toes properly; and my neuromuscular system is learning to connect the dots to support it.
I am tremendously grateful for my rapid recovery. I attribute this progress to a combination of factors; being dedicated to healthy living and committed to daily prehab and rehab exercise programs; maintaining a positive, focused mindset; having a supportive medical team and community; and of course, the brilliant work of Dr. Jason Snibbe (http://snibbeorthopedics.com) and his Direct Superior Approach, leading to optimal recovery and return to high function without restrictions. While previously practicing the PATH approach, Dr. Snibbe was determined to develop a method that allowed for faster recovery time and better outcomes. After brainstorming with a few of his highly trusted colleagues across the country, the Direct Superior Approach was born. This involves one small incision, minimal muscle trauma, and minimal structural damage –the piriformis tendon and a small flap of the hip capsule are cut to allow access to the femoral head and acetabular rim, but later resewn). This spares the iliotibial tracts (IT band) that is critical to pelvic stabiliation, and spares the gluteal muscles (the tissues are carefully separated rather than severed). This is in dramatic contrast to traditional hip replacement where all gluteals and external rotators are cut. With the Direct Superior Approach, one has less muscle trauma and, therefore, a much faster recovery. One normally stands and walks the same day of surgery. Highly computerized imaging during surgery ensures utmost symmetry between the legs and return to precise, integrated movement.
Dr. Snibbe chose a Stryker Dual Mobility hip implant for me. With it’s combined high range of motion and stability, this is guiding athletes to return to their high levels of performance. Its longevity record (an upwards of 25-30 years and more) means there is a high possibility of never needing a revision.
Returning to daily function is rewarding. The joy of being able to care for oneself is so refreshing; for example, I had forgotten how much mobility it takes to tie one’s shoes! After a week and a half, I was cleared to return to driving, and to teaching part time. Dr. Snibbe advised me to keep moving while being conscientious of the six week critical healing period, during which time the bone is ossifying around the prosthetics; jarring movements or overloading would hinder healing, while gentle, focused weight bearing and exercises, focused on activating the hip complex, will advance progress. My days are filled with movement, including my personal practice of an hour long exercise program twice a day (guided by programs created initially by Andrew Droll of Home Health Physical Therapy, and advanced by the therapists at Body Logic, Westlake), multiple walks, stair climbing , 20-25 minutes on the stationary bike., and training with light arm weights. Rest periods throughout the day, and a full eight hours of sleep each night are priorities. Rest is where the work of rebuilding the body happens.
I am a sponge for new movement information, and am avidly soaking up the teachings of the therapists at Body Logic. They assure me I am well ahead of the curve, as I ask them intricate questions about why my body is responding in various ways to the surgery and recovery, including irritating hip flexor and rotator tension. Initial programming is focused on activation of the gluteal complex, followed by strengthening in weight bearing positions. They have introduced me to an intelligent system of rehabilitation, Dynamic Neuromuscular Stabilization (DNS), developed by Pavel Kolar, PT, PhD, a Czech physiotherapist. According to DNS theory, core stabilization is achieved through precise coordination of the abdominals, spinal extensor, gluteals and associated musculature, and intra-abdominal pressure regulation by the central nervous system. I found this paper (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3578435/ ) helpful in understanding the principles of DNS . It is interesting to find the parallels between DNS and the breath-work, alignment and stabilization techniques I have learned in pilates and my training as a physical therapy aide at Core Conditioning Physical Therapy. I look forward to bringing this more to my students in the studio.
I am fortunate to have a wealth of movement experience to draw upon in this retraining process, and am eager to share the information to help others navigate the complexities of joint replacement. My studies in pilates, dance, physical therapy, medicine, holistic health, posture and alignment (Esther Gokhale merits special mention) are guiding me to learn how to turn systems on in a natural, integrated way and propelling me forward to my movement goals. Please feel free to contact me with your questions or to share your insights. Let’s help each other get unstuck and move forward to pain free, revitalizing movement.
To your health,
I am now two weeks post op, bilateral hip replacements with Dr. Jason Snibbe, at Cedars Sinai Hospital, Los Angeles, and elated to be walking, climbing stairs, and living my life without pain. Taking this step by step, and honoring the healing process, I am moving at a pace that is much more gentle and attentive, than I am used to. And there is so much information at this pace, leading to rapid advances. This is a fascinating journey. Learning to walk again, with hips made of warrior style titanium, takes vast amounts of energy. As my body emerges from medications and anesthetics used in surgery, my normal high energy is returning and my mind tells my body to spring into action. My body responds with enthusiasm, but also emphatic reminders that I just had canals drilled into my femur bones to accommodate the stealthy new titanium shafts upon which my new ceramic femoral heads dance upon, encased in polyethylene liners, all housed within the titanium rim that now my pelvic bones are becoming very neighborly with. As my body recovers from surgery (indeed, a trauma of sorts), my liver, kidneys, lungs and lymphatic system are working overtime to detoxify from an array of foreign chemicals introduced in surgery and post-op (astonishing how this all occurs relatively pain free), my bones and tissues are working overtime to rebuild, and my nervous system is at the helm, taking in all kinds of new information and integrating these new bionic Stryker Dual Mobility hips into my entire system for the intended goal….Strong, efficient movement forward. (photos are coming!)
I am astounded at how the body and mind adapt so quickly to new challenges. After only one day, I was up and walking (with a walker) and by day 2 doing stairs. Progress would have been even faster if it had not been for my very low blood pressure, leading me to dive into lightheaded oblivion every time I stood up. Day two BP hovered around 73/33 on standing. Such orthostatic hypotension (dips in blood pressure with changes in position) is apparently common in healthy athletes after surgery. Not due to extensive blood loss, but to a phenomenon called third spacing: the blood vessels become highly permeable, as a result of a complex cascade of chemical inflammatory changes in surgery, allowing fluids to escape from the vessels into the interstitial space (between vessels and tissues). The vessels cannot accommodate quickly enough to changes in position relative to gravity, and blood pressure plummets. My doctor reassured me that my healthy body would soon recover, and sure enough, after a day of increased fluids and protein intake, I was standing and walking, without stars dancing in my head.
Welcome aboard new hips. Prior to surgery, a good friend reminded me to thank my old hips for all they had brought to my life. Rather than be frustrated by limitations brought on by extensive arthritis, bone spurs and cysts growing in response to bone on bone friction, I embraced a spirit of gratitude for the incredible journeys my hips had taken me on…dancing around the world, overcoming the obstacles of starting professional training at the late age of seventeen, my facility and determination led me to a wonderfully vibrant dance career. Indeed, I had left my third year of medical school at UCSF to embark on opportunities to dance in Paris, France. Though initially intending to go back to finish my M.D., my dance career had taken off, and was leading me to incredible new discoveries in ways I could contribute to the world. Seeing the excitement and gratitude in people’s eyes in Belarus, Poland, Germany, Russia, Scotland, and the US, and hearing how performances brought new inspirtaion to their lives…. feeling my mind and body focused in an extreme state of focused harmony…this fueled a new stage in my life, and I embarked on a fifteen year dance career, starting in Europe and maturing with Liss Fain Dance in San Francisco (www.LissFainDance.org). See them perform this weekend at Yerba Buena Center for the Arts, SF. More soon....time to go for a walk!
Best to all,
Thank you for your stream of support and kindness. This has propelled my healing forward. Thanks to my all star surgeon, Dr. Jason Snibbe, innovator of the Direct Superior Approach, my community, and health, I am now two weeks post surgery (Bilateral hip replacements) and back in action. It is fascinating to learn to walk again, integrating new high tech parts into the complex system of the body. I am astonished by how quickly this occurs and will be writing about the experience, here in my blog, in the coming weeks. I look forward to dancing and moving powerfully again, and guiding others to their own vitality and strength through movement. This journey continues to deepen my respect for the body’s power to heal, and generates empathy for those in pain or instability, seeking the keys to unlocking their potential for powerful movement. May this experience make me a better guide to others. I am back in the studio part time this week and looking forward to seeing you soon. With gratitude to all, Jennifer
Last weekend I was honored to be back in the hallowed lecture halls of the UCSF School of Medicine for the Evolution of Medicine Symposium, led by Dr. Akil Palanisamy. It had been 16 years since I had last attended lectures at UCSF and a rush of adrenaline shot through me as I remembered my transformative experiences there. It was at UCSF that I had embarked upon a career as a doctor (which shifted as I took time in my third year to dance in Europe...time which expanded to a 14 year dance career), spending sacred time with patients, learning their stories, understanding their deep desire to heal, searching for answers, and feeling the influence of the pharmaceutical industry and conservative viewpoints on the practice of medicine. A myriad of memories showered upon me. It was fascinating to be in the UCSF lecture hall and to reflect upon where I was then, as a student, in terms of what I believed about the role of medicine and the art of healing…and where I am now, after a career as a dancer, healing from many injuries and conditions such as arthritis and osteoporosis, and now teaching pilates and wellness. The importance of diet, lifestyle, movement, and behavior upon one's health cannot be understated. The Evolution of Medicine symposium, organized and moderated by Dr. Akil Palanisamy emphasized this.
The all star panel of presenters, including Robb Wolf, Chris Kresser, Chris Masterjohn, Michelle Tom, Stephan Guyenet, and Justin Sonnenburg not only brought extensive scientific research to the audience, but framed it within the context of tangible steps to integrate the information into a meaningful plan for healthcare practitioners.
Robb Wolf began the presentations, taking a look at medicine from an evolutionary perspective. He illustrated how the transition from Paleolithic hunter-gatherer society to Neolithic agrarian society gave rise to Western diseases (diabetes, cardiovascular disease, diabetes, obesity, and autoimmune disease). This shift also marked a dramatic decrease in diversity of gut flora, and a rise in gut inflammation. The prevalence of lectins in grains has been linked to leptin resistance and decreased glucose tolerance. Gluten increases gut permeability and inflammation throughout the body, even when no symptoms of gut irritation may be present. This is expressed as an array of suboptimal health conditions, including aching joints, fatigue, brain fog, and hormone imbalance, all of which indicate inflammation in the body. If allowed to persist, this progresses to the inflammatory disease states of diabetes, CVD, obesity, autoimmune disease, and more. Loss of intestinal barrier function ("leaky gut") is inherent in the development of autoimmune disease, a condition born of the agrarian era. Take home points from Wolf: avoid gut and microbiome irritants such as refined foods, acellular carbohydrates, gluten and sugar, while increasing intake of vegetables, nuts, seeds, fermented foods, and fiber which gut bacteria thrive on.
Dr. Akil Palanisamy, author of The Paleovedic Diet, combines western medicine and the wisdom of Ayurveda into a holistic integrative practice. He took the stage to explain how the balance of one's true dosha nature, Vata, Pitta and Kapha, leads to wellness and healing from within. Imbalance in the doshas, induced by the stress of toxins, relationships, social isolation, and unhealthy diet, leads to disease. He shared some culinary pearls to maximize the nutrient value of foods; eat whole, organic, local foods, rich in a diversity of color, consume antioxidant rich skins of fruits and vegetables, organ meats and spices. These are described in detail in his book.
Michelle Tom, a UCSF pharmacist turned author and food blogger presented the art and science of the fifth sense, Umami. She described how savory, meaty taste is key to survival, illustrating how animals are hardwired to seek out protein in the wild. Inspired to turn away from Big Pharma to the chemistry of healthy food, she presents an array of seaweed, mushroom, seafood and meat dishes (with many kid friendly options) on her NomNom Paleo website.
Justin Sonnenberg, author of The Good Gut, described the relationship of gut microbiota to all of health. For every one human cell, each of us has ten bacterial cells within us. We have a zoo of microbes inside ourselves and to achieve optimal health, we must carefully cultivate a healthy microbiome. Each of us is a true ecosystem of human and microbial cells. The bacteria living in our gut influence our immune function, metabolism, vitamin biosynthesis, hormone production, and more. Imbalance in the microbiome leads to impairment in these systems, and inflammation throughout the body. In one study, the transfer of microbes from lean donors to obese recipients (with no lifestyle or dietary interventions) led to enhanced insulin sensitivity and weight loss in the recipients. Sonnenburg explained how innovative techniques, such as fecal transfers, introduce healthy strains of bacteria to diseased populations and have dramatic therapeutic impact.
The common theme amongst presenters was clear: The most powerful drug is our diet. Eating a plant based diet, rich in a variety of fiber, including fermented foods, nuts and seeds, promotes a diversity of healthy gut flora. Exposure to dirt, pets and time spent in nature also enhance microbiome diversity. Detrimental to gut flora are low fiber diets, use of antibiotics and sanitizers, C-sections and lack of breast-feeding for infants. While probiotics can be beneficial, they provide only transient strains of bacteria to the gut. To cultivate healthy, balanced, resident flora, a diet rich in fresh, varied, fibrous plants is necessary.
Stephan Guyenet presented the idea that hard wired economic preferences lead humans to overeat. He outlined how obesity has skyrocketed in the past century, with readily available convenience/fast foods. To combat obesity, he proposes a public health movement to impose a tax on convenience/fast foods, thereby raising their cost and diminishing their perceived value.
Chris Masterjohn, PhD, outlined the body’s delicate balance of Vitamin D in the forms of calcidiol and calcitriol, with serum calcium. He proposes that parathyroid hormone, rather than vitamin D levels, may provide a more accurate picture of the dynamic state of bone health at any one point in time.
The event concluded with a panel discussion addressing questions from the audience. Most impressive was the team approach embraced by all; ego was checked outside the hall, and the presenters interacted with a desire to learn from one another, and, from the audience. What a refreshing approach to medicine; collaborative brainstorming, with respect for the experience and insight of all. Having been a student at UCSF, I observed this approach to be completely in league with the team based learning I had experienced here. While many medical symposiums can convey a dizzying array of facts and figures, leaving the audience impressed but stunned as to what to do with them all, this team presented all facts within a holistic, empowering framework, leaving us ready to take active steps for ourselves, and our community. Transformative results are possible with simple shifts directed at the core of our health, the microbiome.
Vigorous rounds of deep inhalations and exhalations filled the small Storey Fitness Studio last weekend, the sound of driving chanting music and voices of coaches Chris Tai Melodista & Jared Tavasolian powerfully encouraging us onward, despite our fatigue. Though I was merely breathing, the volume and pace of my breaths led me to feel that I was sprinting for my life. After multiple rounds of this intense work, we plunged into a bath of ice water, testing our ability to withstand extremes thorugh our mental focus. I was learning the Wim Hof Method.
Wim Hof, a Dutch "daredevil", has been called The Iceman due to his ability to withstand extreme cold. Through his training in extreme temperatures and intense breathwork, he has upregulated his immune function, blood oxygen content, and resiliency to stress. More about his work, and the science behind it, can be found at; http://www.icemanwimhof.com/innerfire.
My personal case study of one, resulted in a deep sense of calm, relief of pain and inflammation, heightened mental acuity, joy and mental presence. The day was fatiguing, but left me revived and in a high performance state for the week. When I practice the Wim Hof style of breathing during my High Intensity Interval Training, I feel my legs moving easily beneath me and I achieve higher speeds with seemingly less work. While I am a novice at this, I do feel its benefit and am grateful for the intensive focus Jared and Chris provided. The workshop inspired me to infuse the work into my daily life and teachings. Joseph Pilates was a strong believer in the power of the breath to achieve high mental and physical states. He called it the, "Internal Shower", and began his matwork with the vigorous breathing of The Hundred exercise. While we are all aware of the essential quality of breath to our lives, we tend to live within a small, contained amount of it. A study of the Wim Hof method amplified my breathwork practice and I am eagerly bringing this forward to my students.
And, while it's not a plunge into an ice bath, my daily dive into the cold ocean is a definite endorphin boost. Try adding deep breaths and a 30 second cold shower to your daily routine, and let me know your results.
Here's to upregulating your health,