Wednesday, March 24, 2010

Reiki in the Parkinsons Guideline

Following Pamela Miles recent posting of a link to one of my Blogs on her Facebook site, I have had a significant increase in comments - each comment is an opportunity to reflect and grow. We are all connected, and all that we accomplish is lifted up by what others have done. The ripples are connected.

This particular Blog reflects on a publication now available through the American Medical Directors Association (AMDA) at

And in reflecting on the year of work and collaboration with physicians all over the country (and indeed including as well Dr Ira Leroi, a colleague who is highly respected in the British Health Service and has been one of the leading researchers in the world on dementia) - my own sense is simply one of humility for being in the right place at the right time to have had an opportunity to take part.

Mostly - this Guideline is about Traditional Medicine, but, importantly, it has major revisions as regards non-pharmacologic remedies. "Complementary and alternative medicine, which is defined as a group of diverse medical and health care practices, and products that are not generally considered to be part of conventional medicine may also be considered. Methods such as Reiki, aroma therapy, music therapy, simple touch and massage all have evidence-based studies suggesting potential efficacy."

Possible goals of CAM include "assisting patients in finding a place of calm, release worry and anxiety, encourage patient to let go of anger, alleviate sense of stress, replenish a sense of hope, relieve the suffering of loneliness, diminish the focus on physical pain, synergize patient's own spiritual connections, offer human presence and connection, facilitate communication with significant others and allow increased relaxation."

Holistic to me means bringing together all the modalities we can to help people. So be it pharmacologic, surgical and CAM - I am thankful to all who have contributed to bringing more light - of course in the human journey we have a long way to go.

On the Reiki side, a special thanks to my first teacher Robin Hannon, and to Robin and my teacher Amy Rowland who with Robin encouraged me to write the Blog; and for Amy's book "Reiki for the Heart and Soul."

To Bill Lee Rand for his work through Reiki news in advancing knowledge of Reiki, and to Rick Rivard, my teacher and one of the founders of Usui Reiko Ryoho International.

To people like Dr Robert S. Mendelsohn, whose books in the late 70's and early 80's challenged medical institutions to give new ideas a chance, and Dr Richard Niemtzow who advanced evidence based understanding of complementary medicine and used acupuncture to help vets in pain returning from war.

To Reiki Masters like Pamela who have worked for many years bringing Reiki into prestigous institutions.

With inclusion into evidence based and holistic practice, there is new responsibility and new challenges. There is much to learn, and much can be improved.

Here are some suggestions:

a) support evidence based scientific medicine for what it can accomplish. Do not allow CAM to oppose transitional methods that work.

b) if you use Reiki - use it a little bit on yourself every day

c) remember that Reiki is simple - you do not need enhanced power or effort to seek the light, you simply need to be open for the light to come to you

d) maintain a sense of humility and focus on the person you are trying to help

The Guideline itself costs is an evidence based Traditional Guideline, for the non health professional, much may not be interesting - but - the inclusion of CAM and Reiki - even in a small way - is a step forward that should be welcomed.

Thank you to all who read the Blog, and who offer comments, and send encouragement - sharing the journey is a part of the joy.

Monday, March 22, 2010

A day in the Life

Sunday was my 6th work day of the week, there were patients who needed home visits and not enough time in the other five days. These are not fast visits like office visits, and not easy visits, where one writes a presciption and moves on, these are hospice visits.
One wonders sometimes what makes people get up every day to work in nursing homes and in hospice, usually these are people from the aides to the nurses and doctors and social workes who could make more money doing something else.
One drives from the main roads to main streets with businesses a dn gas stations, neighborhoods change but the experiences are the same. More houses are middle class than rich, many people living in single family homes, perhaps attached (or perhaps in some neighborhoods detached), often a playground or a basketball court at the end of the street.
In a row of houses or apartments one can usually tell which one you are looking for, often a sign is on the door gently warning people not to smoke as there is oxygen inside.
Inside really there is family. That seems a constant. People struggling. Not to get the benefit of a sale, or to get ahead, or to have fun but just trying to live today, or help a struggling loved one live today. The patient has a challenge but so does the family. It is not just that they are facing a loss, they have already had a loss, the person they love cannot do the normal day to day things they once could. And everyone is exhausted. It makes my working a 6th day in the week seem such a small thing.
What one really sees here is a lot of love. A spouse caring for someone she (or he) has loved and shared a partnership with for many years, "we have been married 49 years. Do you think..." a grandchild on leave from college taking care of a beloved grandmother. It is a habit I have gotten into to ask questions about the patient and family before getting straight to the point about the disease, "what work did he (ort she) do?" "How long have you been together?" "Do you have any children or grandchildren?" (and sometimes, yes great grandchildren).
I want to know what they believe will happen in their journey. No one knows, as a daughter said to me yesterday, "no one has come back to tell us." It is an unknown, but for some reason almost everyone has some sort of faith, faith seems almost hard wired into us - have I met an atheist, yes of course, and for them I listen to what they have to say. It is for me about them, their chance to talk and my job is to listen. If I cannot cure them at the least I can help them by listening, it demonstrates on some human level that we care.
The moments here is too large to think about it from my own perspective, this is not a time (however well intentioned) to convert someone to my belief or faith. It is always a two way street, I cannot tell you how often I find patients suffering reduced simply by the fact that someone comes in and cares to listen. And if you do listen with your heart you are graceed with someone's journey, and you feel the faith and love within the home.
Yesterday I was in a neighborhood driving by shops and remembered driving the same business district street 2 months ago, onto a main neighborhood street, and into a residential area. I met a man who was very ner death from cancer, he wanted to go "home." The home he referred to was very far away, it was where he grew up, I felt he really was "home," he was surrounded by an incredible amount of love, a wife, children, their spouses and grandchildren. I explained why he could not take the plane trip he wanted to make. He was angry, we talked a very long time. Time is one thing we can give in hospice. And in the end his family understood (after also calling a second doctor who had known him for years, known I was right but hadn't wanted to say so until asked directly).
After he passed away, his wife told one of my team members she got a call from a friend in their home town. "He died" she said (using the patients name). "How did you know?' his wife asked. "You may find this hard to believe but his spirit just came and told me. "
Traditional medicine can cure so many diseases these days, from when I was in medical school everything is amazing, and I work, I really do, to keep up. Science is a wonderful thing, it is a tool and it often helps us. But as my parter reminds me the greatest scientist of all, Albert Einstein realized science has limits.
We need to be careful not to give up on science because it cannot cure all. But as well, we need to be careful not to give up on human wisdom. Compassionate presence and Simple touch and Listening mean a lot. Reiki is simple and it is a method for learning how to keep your focus on these human values.
Sometimes people ask me why I am on a 6th day of the week driving through neighborhoods to go to homes and visit patients who are near the end-of-life. It seems to be something all we hospice workers do. Understand, there is nothing special or unique about what I do, Hospice Aides and Nurses and Social Workers and Spiritual Therapists, Music Therapists, Chaplains, and yes other doctors do this every day. (perhaps the doctors simply talk about it less - but - from the emails I am receiving it seems people think there are not so many doctyors who care and in truth - there are far more than you know!)
For those doing Hospice work it is simply more than a job. It is what we do because it is who we are.
To all those who believe that giving compassion to others sends ripples of peace through the world, thank you. The intention of this Blog is not about me, it is about you, and the lives you touch.

Saturday, March 20, 2010

Reiki and Where do we go from here

In the glow of coming back from Long Term Care Medicine 2010, I am beginning to ask myself the question "where do we go from here." And in a "microcosm," living my own "just for today," I am paralleling what is happening widely in Reiki - recogntion and acceptance is occurring, is in fact far more widespread than we realize, and we must think about where we go from here.

For much of the past several months, my partner and I have been planning to do a presentation of "Alternative Methods of Pain Management in End-of-Life Care" at a very evidence based symposium. We have been integrating Traditional Evidence Based Medicine with Reiki in a Hospice environment, but now, along with a third colleague, we were going to talk about this in public, in front of an audience of evidence based physicians. And frankly, neither we, nor the program committee who approved our session, knew what the response would be........

In a way, it is easy to say, "I will not worry just for today," but when one puts one's own professional reputation on the line, and the day is today, and the time is now .....but the time came and passed.

And here is what occurred. We had 33 physicians attend our session, and had an incredible response. Almost everyone voluntarily participated in our Reiki meditation at the end of the session, and the critiques of the session were that we were "too apologetic and too tentative." That same day, I gave another session on a very "Traditional topic," attended by 150 physicians, and the buzz in the hall was about our Reiki session. And in private discussions, the questions were more how we would expand the presentation, rather than if we would be asked back next year.

And that is the question. Where do we go from here. It is a question we will spend the next month meditating on.

Here are some other questions - this particular blog is a lot about questions, because I am less at a point where I can tell everyone else how it should be done, than at a place where I am still learning:

a) Reiki is rapidly gathering evidence based support, so we must now distinguish between "evidence based medicine" and "traditional evidence based medicine." And moreover, the evidence based supports aspects of Reiki including "Simple Touch" (not massage) and "Compassionate Presence" that themselves are gathering evidence based support. In this scenario - Reiki can be presented as a method for learning to focus on Active listening, Simple Touch, and Compassionate Presence - all of which unquestionably help patients and have evidence support.

b) For those of us working at a master level, we believe that we can impact the energy flow, from within the Auric field of the patient, without actually "touching" physically the patient. We also feel that we can "perceive" facets of energy by "scanning," and these techniques has less evidence study.

c) For many of us, we use Reiki in a non-touch related way, Reiki masters write of "flooding a room" with radiant light, and we talk about the power of placing Reiki within "voice." Even here, a parallel art, Music therapy, has strong evidence based support. And many of us combine sound and touch.

d) When we have an impact on energy fields, are we acting as simple channels, and is the Creator or Universal source of Radiant light (or some say "Spirit Guides") acting - or is our intention itself moving energy?

e) It is important to stress that Reiki does not compete with or intend to replace Traditional Medicine. Usui Sensei and Hayashi Sensei and Takata Sensei and Doi Sensei all stress the importance of scientific medicine. Reiki is Complementary. ("Reiki does not oppose modern medical science nor does it replace it.....sickness should be cut from both sides, with Reiki and with medical science")

There are increasing efforts to "organize" Reiki - and no question, there is a possibility that as Reiki becomes more "accepted" there may be an effort to certify it - (and in this regard - I do not refer to certification such as that by Bill Lee Rand and the Center for Reiki, but I mean within organized medicine itself, which tends to take over and control that which becomes mainstream.

Acceptance and certification have benefits and detriments. Reiki performed and described as "Spiritual healing" has elements of constitutional protection within the United States, (though its use may be more limited), and that which becomes "accepted healthcare" becomes more likely to be regulated and certified and controlled.

And I have questions as to whether Usui intended for there to be a Grandmaster, let alone a single path - from history reasonable persons can argue this point.

And so for now, I simply think it best to move forward "one day at a time" - and to share experience and continue to learn. I think there will be many different paths within Reiki, and that multiple traditions can be respected. I think we should take every opportunity to share, every opportunity to help each other and every opportunity to grow.

It has long been a matter of faith for me that acts of Kindness and Compassion join in ripples and spread throughout the world. I am appreciative of everyone who joins in this.

Laurelle Shanti Gaia wrote an excellent article which just came out in Reiki News Spring 2010, "Stepping out of the Reiki Closet." It makes me think of a lot of my own experiences in the past two years. She says "By practicing Reiki without fear, standing in our truth, and coming out of the Reiki closet, we become beacons of light. That light is illuminating the way for many and ultimately assisting humanity in awakening to the promised age of peace."

*I do want to thank those who have joined the Blog, and who have offered comments either publicly or privately. Your sharing is very much appreciated. My stories are not unique, many traditional physicians are open to new ideas. This is a time of much hope.

Tuesday, March 16, 2010

Reiki Meditation for Healthcare workers

Reiki meditation adapted for presentation at Long Term Care Medicine 2010, the annual meeting of the American Medical Directors Association.

"Now we would like to join together in sharing a common mission, as physicians and health care workers, to give compassion to our patients. When we cannot "Cure," we can continue to "Care."

We recognize that all living beings are connected through a universal spirit or life force, and that part of being a good physician is dispelling loneliness and loss of hope.

We ask that this place be filled with the energy and spirit that binds all living things.

Close your eyes and raise your hands above your head and feel the Universal energy that flows all around us.

Now with your eyes closed, focus on your breathing. Feel with each breath that you are relaxing more and more, relaxing any tension, or stress that you might have.

Now, as you inhale, slowly breathe in radiant light from the top of your head through the spinal column to the center of your abdomen. Fill this area called the tandien below your belly button with this energy.

Feel the radiant light start to expand throughout your body from your tandien point, the inner center of your body. Imagine yourself emitting a brilliant light.

Once we are connected to this energy from a spiritual dimension, you are blessed with the healing energy of love and harmony.

In this space which you create by your breathing and your intention, any unbalanced energy such as worry, anger, sorrow, pain and anxiety simply cannot exist.

Now focus on your exhalation. As you breathe out gradually, expand the energy and brilliant light throughout your body. This light becomes a brilliant shining aura expanding eternally. Once you receive this healing energy of love and harmony, it is important to return it to the earth. As you practice, it is easier to reach this place filled with peace, calm, and a sense of connection.

Remember, you can connect to this place and free yourself from worry and stress whenever you need to do so. Even when you cannot cure your patients, you can help them reach a place of connection.

Now gently open your eyes and stretch your body and fully awaken yourself.

Thank you for sharing a moment of commitment to compassion, kindness, and harmony to our patientys and to all human beings. As we bring ourselves to a palce of calm, we become more effective physicians and happier human beings."

This mediation is adapted an not in exact form of thoseI have been taught. However, the concepts in the meditation are inspired by my training in Gendai Reiki, the system developed by Hiroshi Doi, as taught to me by Amy Rowland and Rick Rivard.

I thank all who have taught and gone before, and all who Share the Journey of compassion.

Saturday, March 13, 2010

Message from Long Term Care Medicine 2010

Yesterday, along with Dr Charles Crecelius and Dr N. Sharlene Rajapakse, I was on a panel that presented "Alternative Integrative Methods of pain management in End-of-Life Care." More about segments of that session in future blog postings. Also - AMDA (American Medical Directors Association) - an organization of nearly 7000 physicians in Long Term Care, published its revised Clinical practice guideline on Parkinsons Disease. This guideline is now available only at the LTC Medicine annual meeting but will later be available for on-line purchase. The guideline reflects on the current evidence based support for certain elements of alternative or complementary medicine (including specifically Reiki).
More later.
Today - I am scheduled to do a cable radio spot relating to yesterday's session, and specifically relating to our use of the term "Transition" instead of Death.
"When I'm treating a patient at the end-of-life, I prefer to refer to Death as Transition.
Look, science cannot prove or disprove the continuation of consciousness after death, but most of humanity believes in some form of afterlife.
As a physician, it is not my job to convert or dissaude, but to listen, support, and dignify the life of the patient!
And when a physician cares to listen to what the patient perceives they are facing in the mysterious journey ahead, the patient is spared loneliness and gifted hope.
In my opinion, the patient of a doctor who cares when he cannot cure feels more respected, and suffers less."
Share the Journey

Saturday, March 6, 2010

Rules for performing Reiki in Hospice

A) Start by talking with the patient. Introduce yourself, and your intention. Although Reiki is very important to you, your primary intention is to be there for the patient. It is all about him or her. So to begin with, whether or not you do Reiki is not the most important point. Or, said another way, Reiki can be done without touching someone or using your hands.

B) Gift the patient with compassionate presence. You are there, and you are present, and you are sharing a moment. If you are a doctor or a nurse, take off the white coat. Share a moment. For the patient, you do not know, it may be one of the most precious moments of their life. They may have something to say, or to share, and simply your presence can mean a lot. And remember, Reiki is never unidirectional. When you connect with another person, it can be an important moment for you as well. Patients near transition often have insights that we lack, and the sharing they do is to be highly valued.

C) Listen. Ask open ended questions. Convey verbally and non verbally a willingness to listen. Ask about things that might matter to the patient. What was their work? Recently I was caring for a patient who when healthy had been a trouble shooter for an airline. she had helped stranded travelers - and on my unit, dying of cancer, she still saw herself as being that person (though she knew "the airline will have to go on without me.") Allow the patient to retain all that matters to them in life, honor their lives by listening. Who and what matters to them matters in that moment. Much of Reiki is about creating what some call a "sacred space," a place where we can open a channel for spiritual energy - and that "space" is enhanced by caring to listen to the patient. Often, listening is more important in Hospice than placing hands in bringing Reiki energy.

D) Ask about the patient's own source of spiritual strength. I am Jewish and I connect as well using Reiki, but many times I have been thought to be a Christian doctor, or a Muslim doctor, and simply stated in that room it is not about me - I am about serving the patient and honoring what matters to him or her.

E) Do not attempt to insert your energy or spirit into the patient, or take spirit or energy (or even pain) from them. Be a simple channel. Be a compassionate presence.

F) Understand that we are not in control. Transition will come when the Creator decides. In Hospice we do not attempt to either shorten or lengthen life, what we do is make the moments that exist precious and free of pain. If a spirit is transitioning, do not impede it, and do not attach to it, but marvel in it, and be honored to be present.

G) If the patient wishes to have Reiki performed then do so, but realize that in this fragile state full Reiki sessions are often not appropriate. In this situation, traditional hand positions, valued as structure, may not be meaningful.

H) If family is present, and they are comfortable, establish a circle. Bringing evergy together and synchronizing spirit is precious. Do not dominate a circle. Do not bring your own vibrations to the forefront. Imagine yourself a dancer whose task is simply to blend with one's partner. The melody is not yours to play, allow yourself to harmonize, let your spirit guides assist you.

I) Understand that you can Care even when you cannot Cure. Understand that presence and connection are wonderful gifts. Understand that you cannot give of your own energy, or you will be drained, rather, allow energy to simply pass through you from the Creator, likely a small percentage will be left with you as a gift.

J) Be at peace and be calm. Transition is not to be feared. It is a moment of awe. Accept all of creation with a simple grace. Have no fear. Have no anger. Be grateful to be alive. Be grateful to be present. Your gift of compassion is your presence.

K) If you are fortunate, you will from a distance have a vision of the light.

Wednesday, March 3, 2010

Presence and Hope count

I received an email the other day, that stated "no one wants to talk about death." And there is soe truth to the statement, in that, people don't want to be in the position where they have the need to talk about death. But on my hospice unit, patients and family members ask me every day to talk about death, because it is the reality they are living in that moment. "doc, please talk to me about ..." (their loved one).

Hospice units are set up to manage pain, and pain is a complex feeling. For one thing every day we see patients in pain, but we also see their loved ones in pain. There is physical pain, but as well there is the pain of loss, and of loneliness, and of hopelessness.

It never ceases to amaze me that medical specialists, claiming to be "evidence based" through science to the wind, and "try" futile medically ineffective actually sometimes harmful procedures with the intention of giving someone "hope," and at the same time deride prayer as "unscientific." Physicians are trained (or ought to be trained) to weight benefit and risk, and when we have no scientifically proven cure for a disease, the comparing of benefit and risk isn't all that complicated.

Now as a caveat - it is my own practice to always attempt to utilize scientifically effective methods such as medication and surgery, when they are likely to help a patient. This is what we are trained to do as physicians - the dilemma is when we do not have an effective cure. What then?

A "scientific" analysis of prayer would show it to have low to no cost, and no physical side effects. There isn't a lot of downside. And in large scale lookback studies done of the medicare database, hospice patients lived an average of 21 days longer than patients treated with aggressive medical processes that could be shown in advance to be unlikely to work.

Here are a couple of observations from many years of end of life care:

1) We can continue to care even when we cannot cure.

2) Patients and families want to talk about the realities that they are facing.

3) Patients who focus on the faith that comes from their own family and their own history, suffer less than patients who focus on "the pain."

This was really hammered home to be today, when I offered an increase in pain medication to a patient with a very severe cancer. The patient said, "I want to be more awake when my son comes to see me, let me take more medicine later if I really need it."

Moments can be surprisingly meaningful, people can talk to loved ones (or if the Team will listen, just to other human beings who give the gift of "presence.")

Most Christians, Muslims, Buddhists and Jews agree that there is some sort of continuation of consciousness after death, we cannot test this "belief" - that's the definition of faith - acceptance of something for which we do not have proof.

However this much is scientific fact and scientific truth - patients who are encouraged to talk about their own beliefs suffer less than patients whose care teams focus on death as "the end." Patients who are allowed to have hope, and gifted with presence, and who not face loneliness, suffer less than patients who are told in effect - "you are going to die. There is nothing I can do. Come to terms with it and accept it. I have to treat someone else who can still be saved. Don't cry - you'll upset other people."

Chaplains and Social workers in Hospice are very helpful in combatting loneliness. I have seen wonderful stories of Chaplains helping people pray, not in the belief system of the Chaplain, but in the tradition of the patient. It is about the patient.

Alternative methods such as Reiki and Music Therapy and Massage are all helpful, and in fact, scientific studies have shown they are helpful. What is fascinating with Reiki, is that the skill level of the practitioner is not always the most important thing. Presence alone combats lonelines; talking about whatever faith a person has reduces the sense of hopelessness, and as we provide presence and hope, we see less suffering.

I can remember patients from 20 years ago, who passed away from illnesses for which we have cures today. I can recall the faces, and the hope and the spirit of some of these people. And in caring for patients today, I know we will develop cures over the next 20 years that will alleviate some diseases we cannot cure today. And what I have learned is the need to work within the present, and to work with what we have.

Human wisdom though, does not begin or end with science. Science is an incredibly valuable "tool," and we want to use it whenever we can. We should never stop Caring with those aspects of human wisdom which we have, when science has not yet given us a Cure for today.