Is Palliative Care Right for You? The Answer May Surprise You.

March 25, 2021

By Sabiha Pasha, M.D.

What is palliative care? Debunking the “end of life” stigma.

Palliative care is a lot of things, but “end of life” care it is not. At its roots, it is care to keep living.

Whereas hospice focuses on the last months of someone’s life, palliative care is concurrent with a patient’s illness – ideally, starting at initial diagnosis through any treatment or post-treatment adjustments.

Serious illnesses cause serious, almost unfathomable disruption across a person’s life. The goal of palliative care is to holistically address issues affecting quality of life and improve patient comfort. This can mean tackling someone’s emotional, financial, psychological, social and physical well-being.

In addition, palliative care also emphasizes planning. This can include the choices for medical treatment, organizing medication, juggling family or health visits, writing wills, tackling finances and all the other small or large details that should be pinned down. These conversations and details are daunting in the best of times, let alone when battling an illness. Working with a trained professional to plan for and confront these issues relieves many burdens.

Palliative care is for anyone living an “adjusted life.” It is for people of any age. It is provided on an ongoing basis or for a short period of time, depending on the individual’s needs. Perhaps most importantly, it places an emphasis on the patient, and not the disease, as the primary focus of care.

Harnessed to its fullest, it can bring hope, a sense of control, and a chance at a better quality of life for patients and their caregivers.

Better living through medical science

I mentioned earlier that palliative care should be a part of the care from the onset of the diagnosis of a serious illness. This is based on growing evidence of the positive impact of this care on quality of life.

Most notably, a landmark New England Journal of Medicine study found that early palliative care not only improved quality of life and symptoms of anxiety and depression, but also improved survival in patients with lung cancer.

The connection to quality of life cannot be understated. Medical science enables all of us to live longer lives, which also means our population is getting older and sicker. If my patients have taught me anything, it is that the quality of those days does matter.

As a result, palliative care can look very different from patient to patient.

For a patient with cancer, for example, an oncologist could collaborate with a team to harness a home health aide to provide support to the family or a nurse practitioner to incorporate ways to manage the nausea, loss of appetite or pain that comes with treatment. It could also mean working with community resources to address the financial stress of being too sick to work or the social isolation that can come from missing out on typical activities.

This focused care helps patients feel better, both physically and mentally.

My surprising life lesson from palliative care

In 2005 I was introduced to palliative care. It promised to restore autonomy and dignity to the chronic and seriously ill. To focuses on quality of life as defined uniquely by the patient. To support the family even while ameliorating pain and other uncomfortable symptoms.

It was exactly what my patients needed. As it turns out, the training and certification was exactly what I needed. Palliative care catapulted me onto a path of self- discovery, compassion and resiliency. Every day I am a witness to fear and courage. And I have learned to be still and just be present.

Ultimately, suffering is a part of life and having someone to hold your hand even for a moment can ease the pain. Palliative care is not rocket science, but it is the one last bastion where the art of healing lives on.

What the **** CAN I eat??

What the bleep CAN I eat?

I get this a lot. In one word the answer is “whole” food.

Whole food is a natural substance that has not been processed or refined and is free from additives or other artificial substances. This includes lunch meats my carnivorous friends. There is no such vegetable as canola and high fructose corn syrup does not occur in nature. In fact, this substance alone may have triggered the obesity epidemic worldwide, depending on who you chose to believe.

High fructose corn syrup showed up as a sweetener in the 1970s. It was concocted in a laboratory in Japan in 1965 and became a cheap way to sweeten processed food to make it palatable. Our body is not equipped to process it and the result is a fatty liver not dissimilar from that caused by alcoholism. If you are into horror movies I would highly recommend watching What The Health, Cowspiracy, and Food, Inc.

So back to whole food (not the grocery store). Here are some simple ways to eat healthier.

  1. Shop along the periphery of the grocery store. That is where the whole food resides. Fruits, vegetables, dairy, bakery, water, seafood and meat.
  2. Read the labels. If it contains an ingredient you cannot pronounce put it back. This includes condiments like ketchup and salad dressings. If it contains high fructose corn syrup do not get it.
  3. Size matters! Portions size should follow the one hand rule. A fistful of grains, meat that is the size of your palm and fats about the size of your thumb.
  4. Water is odorless and tasteless. You cannot not like the taste of water. If you find water bland your taste buds have been hijacked by sugar. This is a very serious condition. Jokes aside. Drink more water 4-8, 8 oz glasses a day.
  5. Give yourself at least 12 hours between dinner and breakfast. If you feel adventurous go two days a week with a 16 hour fast between dinner and breakfast.
  6. Do not eat in a hurry. Give yourself 20 mins for each meal. At around that time the satiety signal kicks in.
  7. Include a spoonful or cup of fermented food once daily for microbiome diversity.
  8. An easy way to start you love affair with fruits and vegetables is to put together rainbow smoothies. Be creative!

Red: Beets, spinach, celery, apple….

Yellow: Carrots, oranges, mango…..

Green: Kale, spinach, celery, apple…

9.  Every week bring home a fruit or vegetable you have never had before. Find a recipe        and have fun.

If you are eating whole food you do not need additional vitamins or supplements.

Combine Good Nutrition With Other Healthy Habits

Exercise, sleep and learn how to manage stress. Chronic stress results in excessive production of cortisol with is linked with the metabolic syndrome, leaky gut syndrome, hypothyroidism, chronic fatigue….

But that is a discussion for another day!

And even though Victor Frankel would cringe if he heard this version…

-Between the food and our mouth there is space, and in that space there is a choice, and in that choice lies our health and well being.


A Beginner’s Guide to Healthy Eating

The food we eat affects our health and it would not be wrong to say that the majority of our illnesses are the result of what we put into our mouth.

The Standard American Diet (SAD) is characterized by a high intake of red meat, processed meats, fried foods, refined grains, high sugar drinks and the ubiquitous high fructose corn syrup. Fast food is a typical example of this. It is known to promote inflammation possibly the root cause of all major illnesses including heart attacks, strokes, diabetes, dementia and cancer.

The alternative, “non fast” food is considered too confusing and a chore to prepare. Some complain that it is not tasty. Lets understand what makes a healthy diet and then we can talk about meal plans and recipes!

The food that we eat contains macronutrients and micronutrients. As the names suggest, macronutrients are needed in relative large amounts compared to the micronutrients.

The three macronutrients are carbohydrates, fats and protein.

Carbohydrates provide the body with energy (4 calories/gram) and include starchy foods like bread, pasta, rice and potatoes. They also includes fruitlegumes, juices, sugar and some dairy products.

Proteins are the building blocks of our body and also provide energy (4 calories/gram). Main sources of protein include meat, fish, dairy, eggs, legumes and vegetarian alternatives like tofu.

Fats provide our body with energy and supports cell growth (9 calories/gram). It help our body to absorb vitamins and to manufacture essential hormones. Main sources of fat include nuts, seeds, oils, buttercheese, oily fish and fatty meat.

Micronutrients include vitamins and minerals and are required in smaller amounts. They are “essential”, in that we must get them from the diet in order to survive.

Some of the most common micronutrients include:

Magnesium: Involved in over 600 cellular processes, including energy production, nervous system function and muscle contraction.

Potassium: This mineral is important for blood pressure control, fluid balance and the function of your muscles and nerves.

Iron: Primarily needed for making hemoglobin which carries oxygen in the blood.

Calcium: An important structural component of bones and teeth, and also a key mineral for our heart, muscles and nervous system.

All vitamins from A to K, play important roles in every organ and cell in our body.

If we eat “real” (unprocessed) food that includes plants and animals, then we should technically get all the micronutrients without needing to take a supplement.

Why whole food?

“Whole food” is any natural substance that has not been processed or refined and is free from additives or other artificial substances.

If the product looks like it was made in a factory, then it’s probably not a whole food.

Whole foods tend to have fewer calories and more nutrients per serving than processed foods.

Foods to Eat

Plan your diet around these healthy food groups:

Vegetables: Should be included at most meals. They are low in calories yet full of important micronutrients and fiber.

Fruits: Naturally sweet, they provides micronutrients and antioxidants needed for repair and growth.

Meat and fish: The major sources of protein in non vegetarian or vegan diets.

Nuts and seeds: One of the best fat sources available and also contain important micronutrients.

Eggs: An all rounder eggs present a combination of protein, beneficial fats and micronutrients.

Dairy: Dairy products such as natural yogurt and milk are good sources of protein and calcium.

Healthy starches: Include whole food starchy foods like potatoes, quinoa, whole wheat bread and rice.

Beans and legumes: These are a great source of fiber, protein and micronutrients.

Beverages: Water should make up the majority of our fluid intake

Herbs and spices: These are often very high in nutrients and have “medicinal” properties

Why plant based?:   Plants can neither fly nor flee under stress. To survive they adapt by producing phytochemical compounds with antimicrobial, anti fungal and antioxidant properties. More whole, plant-based foods means more antioxidants, nutrients, vitamins, minerals and fiber.

Foods to Avoid

Sugar-based products: Foods high in sugar, especially sugary drinks with high fructose corn syrup, are linked to obesity and type 2 diabetes.

Trans fats: Also known as partially hydrogenated fats, they have been linked to serious diseases, such as heart disease.

Refined carbs: Foods such as white bread, are linked to overeating, obesity and metabolic syndrome. For some it is linked with gluten intolerance.

Processed low-fat products: Often disguised as healthy alternatives, low-fat products usually contain a lot of sugar to make them taste better.

There is no need to eliminate your favorite food forever. Limiting the intake of unhealthy food or saving it for special occasions may be all that is needed.

Portion Control

By controlling our portions, we are better able to avoid consuming too many calories.

While whole foods are certainly a lot harder to overeat than processed foods, they can still be eaten in excess.


It is best to get most of our nutrients from whole foods. However, some supplements may be needed in certain conditions.

Vitamin D



Omega 3 

Vitamin B12

Simple Meal Ideas:


Oatmeal with berries or other fruit and walnuts


Whole wheat bread, gluten free bread with nut butter


Whole grain cold cereal with almond, soy or other non dairy milk


Midmorning mid afternoon snack

Rx bar



Lunch (I am thinking at work in the cafeteria)

Meat or fish with vegetables

Hummus with vegetables or fruit



Whole grain pasta with home made tomato/meat sauce and vegetables

Meat or fish with vegetables (Tofu for vegetarians)

Tacos with fish/seafood/meat and slaw (jackfruit for vegetarians)

Websites for delicious healthy recipes abound!

Take charge. Be creative. It is your body and your health. Do not take it for granted. Ultimately it is your choice.

The Gift

It was many years ago at a conference in Hawaii that I heard a speaker talk about our illness bringing a gift. Dr. Lewis Mehl-Madrona also spoke about talking to our illness — and for anyone interested, I recommend his Coyote trilogy.

Over the years this seed concept has germinated and blossomed in my mind. I often see people who live with chronic illness and I wonder why that particular illness visited them and why, like a bad guest it is refusing to leave.

Ayurveda and other Eastern traditions teach us that our body has 7 energy centers or mini brains (chakras) and an illness related to a particular chakra has a physical and psychological signature. For instance illnesses related to the first chakra may have, as their origin, issues related to abandonment. Managing both the physical manifestation of the illness as well as the psychological, allows for healing to occur. Seems simple enough. Why then are some people unable to heal?

The answer lies deep in our subconscious mind. We all have a physical body, which in the event of an illness malfunctions. We have a mind or ego whose function is to ensure our survival. And we have an energy state or true self (also referred to as spirit).

For some people it appears that a healing process is not congruent with the minds perception of survival and it thwarts all efforts to achieve it.

Getting past this major blockade requires honesty and courage. If you are someone that is struggling with a chronic illness ask yourself the following questions.

  1. When did I get ill?
  2. What was going on in my life when I got ill?
  3. What does the illness prevent me from doing? Was that hard to do when I was  well?
  4. Does it bring me help from my friends and family? Did I have trouble asking for help when I was well?
  5. Does it shelter me from social situations that I find anxiety provoking?
  6. Does it give me an excuse not to do things that I dislike doing?
  7. Is the attention I get from my physicians or family pleasurable?
  8. Am I punishing myself or another by remaining ill to obtain relief from real or perceived guilt or shame?
  9. Has the illness allowed me to become part of a group that makes me feel different and special?
  10. What will be the cost of becoming well? Will I lose the attention, love, sympathy and help of my family and friends? Will I no longer have an excuse not to do things that I find anxiety provoking, tedious or easily overwhelmed by? What will make me special?

This then is the “gift” the illness brought you. I allowed you to separate from a psychologically painful situation. You are not faking it. It is unconscious. It does not mean that the illness is pleasurable, just that it has some benefits you were not aware of.

As you go through this exercise a glimmer of awareness may arise. Compassionately attend to these deep wounds. It will take time. You may want to seek the help of a therapist. The good news is that once the light of consciousness shows you your subconscious patterns they cannot be unseen.

You are not your illness, your body or your mind. Allowing your essence or spirit to be in charge of your life rather than you mind or ego, will fill you with unlimited enthusiasm and joy. This is your ultimate gift!

Can you tolerate that??


“Said the web to the spider who thought it was a fly……”

In ancient Vedic texts Indra’s net is used to describe our interconnectedness. It has a multifaceted jewel at each vertex and each jewel is reflected in all the other jewels ad infinitum.

We are like spiders spinning and creating our lives. Then why do we sometimes feel like the fly trapped in the web?

Are angry all the time? If you are feeling that life is happening to you and there is no way out, then read on. Let us try to untangle this web.

As with all issues in life this one too will require a trip into our past all the way to our birth, infancy and early childhood. The circumstances around our helpless self forged neural pathways that went on to define our personalities. Once created these pathways are used to “unconsciously” respond to life in more than  75% of our interactions.

At the offset I want to say that this is not about demonizing our parents and families, blaming them for everything. For in truth they too are the products of their circumstances in early life and their parents of theirs and so on.

It is believed that some time, around the age of 6 months our ego is born. Its sole function is to ensure our survival. A worthy job indeed. But like the camel that asked to put his nose into his master’s tent and eventually pushed him out, we too slowly but surely handled over the controls of our life to our security software. For most of us this alert system is set and stuck on critical and starts blaring loudly at even the smallest of inconveniences.

Anger is an emotion (you can replace anger with fear, resentment, impatience, blaming, complaining, indifference, yearning, wanting) that is produced by the ego mind in response to a perceived threat. In fact, really any situation that makes you feel diminished and unhappy, likely means that the ego mind is at work.

To break from this unconscious way of living we will need to face our childhood threats and  traumas truthfully. As fearful as that may sound the good news is that you survived. Infants need to be seen and celebrated, nurtured and soothed and provided with safety. For most of us these needs go unmet either wholly or partially not because the parents are evil (although that has been known to occur) but because they are either busy working, tending to other children or dealing with their own issues.

So now that you know the code that runs your reactions, what can you do about it? Reprogram it of course!! Sounds like a lot of work?  Yes and no. The reprogramming will take time and attention but the process is fairly simple. It will require you to sit quietly for 20 minutes everyday bringing attention to your breath, gently becoming aware of the difference between your body, its sensations, feelings and emotions. As thoughts come up (usually about past events or future plans)  apply a label, “past” or “future”to it, then let it go and bring your attention back to your breath. Become aware of who is doing the observation.

Back in real life continue to observe and be aware of which program is running you. When a situation presents itself that flips your alarm, STOP immediately. Step away, breathe, run around the block, do what ever you need to create the space for a considered “conscious” response.  Most situations are value neutral. It is our unconscious ego software that give it charge and then demands a similarly charged response. The more we play and practice this game the better we become at it.

The ego keeps us trapped like the fly in the web. It isolates us, keeping us on high alert which drains our adrenal glands leaving us exhausted and tired. We become victims of the circumstances of our life rather than the creators. Understanding our software opens the door to change. As adults we are no longer dependent on our “parents” ( replace with spouse, boss…) for survival. We do not need any ones love except our own. Forgiveness, self compassion and loving ourselves passionately opens us up to love others in turn. We become the jewels in Indra’s web, interconnected and reflected in all others ad infinitum.

‘“There is only one perpetrator of evil on the planet-Human Unconsciousness” – Eckhart Tolle


How I Tamed the Fire Breathing Dragon

It is official. I am in menopause. The time in a woman’s  life when we finally figure out who we are. Fearless and unconcerned about the opinion of others, living from our heart and manifesting our true essence. I feel fantastic!

It did not happen easily. Last year, for three months straight I was experiencing hot flashes that were waking me up every 2 to 3 hours during the night. For those who haven’t experienced a hot flash it is an internal fire breathing dragon that awakens without warning at the most inopportune times. The heat is felt most often over the face, neck and chest. It may be accompanied by sweating and quickly followed by feeling chilled. You cannot sleep through a hot flash. The disrupted sleep leaves you feeling tired and exhausted and unfit for human consumption. I followed all the recommended guidelines, dressed in layers, kept cold water by my bedside, and took my herbs all to no effect.

In September I had to travel to Phoenix Arizona for a medical conference. Sedona was only 2 hours away. Having never gone there before, I decided to extend my trip to include the side trip there. I also booked a tour of the energy vortexes as I was afraid that I might not find them! Sedona was beautiful, awe inspiring, energizing and calming all at the same time. I need not have feared missing the energy. It was everywhere. My guide was a kind older gentleman who was also a Native American healer when he wasn’t schlepping the likes of me around.

We started our tour at the Airport mesa where he invited me to walk barefoot. As I stepped gingerly on the pointy rocks he noticed my limp. This eventually got us talking about my hot flashes. He immediately knew what I needed. My masculine and feminine energies were out of balance. He next took me to a place behind the Stupa in a dry creek bed where the energy was supposedly balanced. At the bottom of the dry creek I was instructed to lay down and allow mother nature to reboot me. That night I only had two hot flashes! He suggested I hike to and meditate at the Seven Sacred Pools which I did the following day.  I felt my “craziness” dissolve and dissipate completely. It was time to come home.

We all have masculine and feminine energies coursing through us. Maintaining a balance keeps us on an even keel. The ancient Eastern traditions had it figured out long ago. The good news is that we don’t have to travel to Sedona to balance our energies. Here are some of the techniques I learned that I would like to share with you.

First of all I have to clarify that having male or female energy has nothing to do with being a man, or a woman. It has more to do with the reservoir of energy we draw from to accomplish a task that can be either male”/masculine or “female/feminine.

For example if someone cuts in front of us in traffic. We can either respond with aggression (male) or surrender (female). Being creative taps into our feminine energy while being analytical uses our masculine energy. Both are essential for our survival and ultimately balance is key.

I believe that in menopause, due to declining female hormones there is a relative increase in masculine energy which promotes hot flashes.

There are several ways in which we can bring balance back into our nature. We can use our right brain by indulging in art, music, and other creative activities. Practicing Yin yoga, alternate nostril breathing and meditation regularly will buffers us from our daily stress.  At the very least, without any investment in time we can learn to breathe. By allowing the in-breath to be shorter than the out-breath we can calm ourselves down in an instant while the opposite can activate and energizes us.

And this is how my friends, I tamed the dragon!

On Forgiveness


“The more you know yourself, the more you forgive yourself.” —Confucius

For weeks I was burning with anger. The scenarios kept playing back in my mind over and over again. In meditation as I tried to let it go, it gripped the back of my neck and gave me a throbbing headache. My stomach hurt and I developed heartburn. Meanwhile the perpetrator of my trip to hell went about, happily oblivious of what they had done. There was something wrong with this picture.

As I took this apart and observed my body, I realized that there was a lot more going on than someone doing something to me. The incident had affected my sense of self worth (third chakra located in the solar plexus). The feeling of anger (my ego) was defending something. It had deployed the full fight and flight reaction. Adrenaline and cortisol was coursing through me. My mind (ego) was at war. With my body!

We leave a trail of blood and gore from our wounds as we go through life. We are born into imperfect families. The familial deficiencies becomes our core agenda around which our personalities develop. As children we try to “fix” this family deficiency. Not succeeding we are left with a feeling of failure and worthlessness. As we grow older we may not have been seen for who we are, leaving us feeling “never good enough.” We try to live up to expectations and end up feeling inauthentic and fake. Shame is born and we spend the rest of our lives hiding it. We all go through this, only the players and stories are different.

“Shame is an intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging. It is the fear of disconnection. Connection along with love and belonging is why we are here, and it is what gives purpose and meaning to our lives.

“Shame derives its power from being unspeakable. That is why it loves perfectionists. If we cultivate enough awareness about shame to name it and speak it we are basically cutting it off at the knees.” -Brene Brown.

The fact is that humans are not perfect. Not me, you or anyone. The experiences of my life had primed me to react with anger when my vulnerable wound was scratched. Understanding this  gave me a choice. I could roll with my anger and torture myself or I could forgive myself for believing that I was unworthy. For allowing another to treat me with disrespect.

Far worse than being betrayed by another is betraying oneself. As that realization sunk in, just like that, my anger was gone. It turns out, forgiveness is not about the other person at all but about understanding and loving oneself.

No one is doing any thing to any one!

“Once you forgive yourself, the self-rejection in your mind is over. Self acceptance begins, and the self love will grow so strong the you will finally accept yourself just the way you are. That’s the beginning of the free human. Forgiveness is the key.”—Don Miguel Ruiz

A letter to my nephew

Dear Nephew,
You are searching for yourself. “Who am I?” you ask. What is my purpose in life? Should I go to graduate school? Should I become a firefighter?
I commend you. It took me 50 years to figure some of this out so I want to share it with you.
We are a composite of three distinct entities and they are often at cross purposes with one another.
Our body is the physical structure that houses the mind and through which our energy flows like a pleasant wind. It needs to be safe, soothed and connected to be healthy and strong. Without this a deep dark hole opens up in the pit of our stomach. The hole grows deeper and wider as we continue to ignore it. Frantically we keep stuffing it with food and drugs but it is bottomless.
Our mind is our wannabe God. It seeks to control our body, our life and energy. It wants to survive at all costs. It seeks recognition, fame, applause, always wanting to be right. When it does not get what it wants it gets angry, impatient, defensive, and starts complaining and blaming others. Deep down inside it knows it is fake. In order to hide that discovery it keeps piling layers upon layers of protection and armor to where the body and energy gets smothered and trapped.
Our energy is that gentle, child-like, pure essence that permeates through us with each breath. When ignored and intimidated by the mind it hides, often in that black hole in the pit of our stomach. Occasionally it comes out to play like when the mind is anesthetized with drugs or in meditation.
Integrating these three entities can be a life long endeavor. All three are essential.
So where do we begin?
The good news is that you are already well along on your journey by asking the question “who am I?” The answer of course is, all three. Here is the humble advice of your Aunt given with love and awe of your potential.
Become acquainted with your energy. While sitting quietly, direct your attention to your breath. Your breath pulls in the energy, not just air, from your surroundings into our body energizing and healing it. Play with it. Discover how you can change your energy state with some rapid deep breaths where your whole body feels charged and tingly. Now take some slow calming breaths with long expirations and see how quickly you become relaxed and drift off to sleep. Thats it. You are now in control of your own energy state.
Watch where in your body your energy wants to go and become aware of any areas of tightness or pain in your body.  Give those areas your loving attention. You’re now beginning to integrate the body with your energy.
While in this calm, connected state become aware of all the gifts that this universe has bestowed upon you. Are you good with words and able to counsel and teach? Are you empathic? Are you trustworthy? Do you feel compassion? Are you a good friend? Do you seek knowledge? Do you have the fortitude to stay calm in a chaotic situation?
You will realize that at the core of all the gifts is the principal of service, a desire to facilitate peace and love within yourself and all others. That is our purpose in life. How you accomplish it will depend on your special gift.
Connect your mind to this energy-body complex. Use it to achieve your goals. The mind is clever. Set it to work to figure out ways in which to realize your life purpose.
A word of caution here. The mind will resist taking orders from you. You will notice that very often it will directly sabotage your plans. It wants to be in control. It’s agenda is not aligned with your life purpose-yet. It’s responses and needs are based in fear. The fear of being nobody, non existent and ultimately the fear of death. It has a bunch of tricks it will use to derail you.
Be vigilant anytime you feel angry, impatient, resentful, depressed, despondent, defensive, complaining, whiny and insecure. Know immediately that your mind has gone rogue. In fact, anytime you feel diminished in anyway call a time out. Ask yourself what is driving this fear.
According to Sufi tradition, fear usually arises either from a primary or secondary wound. The secondary wound feels like shame. You will feel it in your stomach. We feel that we have failed to fulfill what our society and family required us to do. We feel worthless and it creates a rift in our being.  Anytime a life event or encounter touches this wound we either collapse or attack. When you see yourself attacking or collapsing send compassion and loving kindness to yourself. You cannot fill the family hole. You came with your own agenda and your life purpose is the only purpose you need to follow. The primary wound is deeper. You feel abandoned by the Devine. So you turn away with anger, rejecting life.  This wound can only be healed by forging a relationship with the divine whatever you conceive it to be. It is usually the start of a spiritual journey.
We are trying to integrate and tame the mind not kill or annihilate it. It is a proud stallion but it is our steed not our jockey. Like a horse whisperer forge a relationship of trust and love with it where it will allow you to slip the bridle into its mouth. Know that you will be kicked and thrown off again and again. It will require your constant presence. The practice of daily meditation where you review your day will allow you to stay connected and to keep an eye on the trickster and it’s mischief.
Then one day you will wake up feeling Real.
Happy travels!
– Sabiha

An Integrative Approach to Care

Western medicine, over the course of its development, has not only separated the mind from the body when considering treatment, but has further fragmented the body into organs, with a “specialist” appointed to take care of each. 

Even as scientific knowledge about how our minds and bodies work — and how these different systems interact — has improved, the overall health of the population has declined, with increasing rates of obesity, diabetes and cardiovascular disease. At the same time the cost of care has skyrocketed and is now considered unsustainable.

Integrative medicine is an approach to care that takes into account the full range of physical, mental, social, spiritual and environmental influences that affect a person’s health, and which leverages the full spectrum of therapeutic responses that have been shown to be effective in creating and maintaining good health. 

Integrative medicine is not the same as “alternative medicine,” which refers to any approach to healing that is utilized in place of conventional therapies, nor is it “complementary medicine,” which refers to healing modalities that are used to complement allopathic approaches. 

The defining principles of integrative medicine are:

• The patient and practitioner are partners in the healing process.

• All factors that influence health, wellness and disease are taken into consideration, including body, mind, spirit and community.

• Providers use all healing sciences to facilitate the body’s innate healing response.

• Effective interventions that are natural and less invasive are used whenever possible.

• Good medicine is based in good science. It is inquiry driven and open to new paradigms.

• Alongside the concept of treatment, the broader concepts of health promotion and the prevention of illness are paramount.

• The care is personalized to best address the individual’s unique conditions, needs and circumstances.

The Space Between Stimulus and Response

Our life is what our thoughts make it.

      — Marcus Aurelius 161-180 AD

All day long we think and we change our minds a million times.  There is a little voice in our head constantly talking to us, telling us what to do and what to watch out for. It even tells us what we are capable of doing and what we should definitely stay away from.

As I think about the statement, I realize it’s truth but also it’s falsehood. Human beings are physical bodies and we relate to the world through the use of our senses. We have a mind that has hardwired and automated our responses to our surroundings, a process that starts in utero and continue throughout life. In fact, early childhood experiences etch pathways into our mind that can indeed determine the path our life takes if we not careful making the statement a reality.

An experience is just that. An event. It is value neutral. Think of a cup of hot coffee. The valence we give to a hot cup of coffee is dependent upon our previous experience with it. Do we like cups? Or do we prefer mugs? Do we like coffee? Do we like hot beverages? Did we ever have an experience of getting burned from a hot beverage? Based on our previous experience the hot cup of coffee can either be a delight or thing to avoid.

There are 10 billion neurons, give or take a few billion, in the cerebrum, the thinking part of our brain. Each neuron typically fires from around 1 to 30 times a second. In any given second hundreds of trillions of neurons are firing in our brain. Every sensory experience in our surrounding is processed by the neurons, given a valence, based on previous experience, and then generating a response. All this work is done for predominantly one reason alone. The survival of the organism.

Unwitnessed and unmodulated drive to survive, our mind can push us into a life of fear. Alarm bells go off at the least possible thing. We are afraid of the food we eat. We fear the traffic, the weather, foreigners, love… Living in fear is not really living but more like waiting for the next shoe to drop. And then our times up and the end approaches unleashing the ultimate fear- the fear of death.

The ticket out is space! No I’m not putting us all on rocketships to Mars.

Victor Frankel said that between stimulus and response there is a space and in that space is our power to choose our response. In our response lies our growth and freedom.

Between our out-breath and in-breath is that space. In that space resides a subtle life energy. It  is a silent witness to our responses and our life. Some call it our essence. It is that, which permeates our cells and gives them life. And when it separates from the body and mind we die.

This energy has a personality of its own. Observe children at play. Their young minds have not learned to control them fully and so they are moved by their energy. They are playful, fearless and awed by bugs and rainbows. They are full of joy. As we grow older our mind takes over more and more control of our responses. Coming from a place of fear we ignore our subtle life energy and end up losing our joy for life. We allow it to emerge only sporadically, as when we gaze upon a baby or look at fireworks. And then are surprised at how it moves us.

That space can easily be accessed through meditation. Meditation is not rocket science. It is merely the act of breathing as we watch our breath. Who is watching us? As we befriend our energy, we can allow the narrow space allocated to our energy by our mind to widen.  With time our responses become modulated and more appropriate to the actual stimulus. We start experiencing joy, reminiscent of our childhood. We no longer live in fear. And then one day we wake up and realize we are not really our mind. We are something so much more. And we find ourselves joyful and alive again.

“Many people are alive but don’t touch the miracle of being alive.” — Thich Nhat Hanh

My Personal Journey

What do you want your health for?

To be able to walk without pain.
To go on a hike once again.
To be able to pursue my career and provide for my son.

“It’s bad news. You will need surgery.”

It was the summer of 2010. My son and I had galavanted through Europe and we had finally arrived in Karachi to visit my parents. As pleasurable as that trip had been it was marred by the excruciating pain in my right ankle. My college friend, an orthopedist in Karachi ordered an MRI and now stood outside my parents’ home giving me the bad news. He suggested that I return to the US for the surgery.

Back home and three orthopedic consultations later the verdict was the same. Surgery gave me a 50% chance of being pain free. But I would most likely need a hip replacement 10 years there after.

The pain in my right angle began in earnest when I was about 30 years old. I changed my diet and became a vegetarian. I took supplements to reduce inflammation. Having grown up in Pakistan, I had learned from my grandmother the salubrious effects of spices and how best to use them. I tried acupuncture with efficacy but nothing really stuck. I have practiced yoga since the age of 18 years which I continued. I kept going. The pain would start about an hour and a half into my work day. With lots of ibuprofen I got through my day limping. But my story really starts much earlier than that.

I was born with bilateral clubfeet. My parents were told that I would be a cripple and never walk. My mother was plunged into a deep depression and cried every time she saw me. So she just stopped looking. When I was about six months old, a visiting orthopedist from England offered some hope. He agreed to try corrective surgery. Multiple surgeries later by the age of three years I was walking.

Embedded in that paragraph is another story. One of childhood trauma, bound feet and pain both physical and emotional. I learned to dissociate, to cut myself off from my pain body.

By the sheer power of my will I powered through life. I became a doctor, got married and came to the US.

But the body doesn’t lie nor does it forget. As I was turning 30 my marriage started disintegrating which is when the pain returned. The divorce had pulled the rug right out from under me and I was left with not a leg to stand on.

So back to the summer of 2010 at the mention of surgery all my childhood terrors were activated.

I started seeing a bioenergetic therapist to make sense of my childhood trauma. I began to understand the reason why a physical problem with my ankle was triggering so much mental anguish.

It was around that same time that I read about Rolfing. Rolfing is a form of body work the aims to produce structural re-integration and alignment. I clearly needed that but what I was not prepared for was the emotional memories that arose after each session. Ever so slowly, little by little my pain receded. Bioenergetics and meditation helped me to release locked up trauma and pain and allowed me to stitch together my mind, body and spirit. With the addition of energy healing I was able to walk sure footed again.

And so my journey continues. As I walk the halls of the hospital I meet kindred souls everywhere.
The bleeding ulcer from not being able to say no.
The intractable headache of anger that dare not be expressed.
The lupus flare of self-hatred.
The cancers of shame.
The broken heart from feeling never good enough.

The list goes on. We have all been touched by life. Our bodies tell the tale. The good news is that the healer lies within us. Suffering is not our destiny.

Integration implies two processes. The integration of all aspects of ourselves, mind, body and energy, and the incorporation of carefully selected non Western modalities into traditional care to facilitate healing.

So now I ask you the question. What do you want your health for?

— Sabiha Pasha, M.D.

What does ‘Salutogenesis’ mean?

By: Sabiha Pasha, M.D.

Salutogenesis is a term coined by Aaron Antonovsky, a professor of medical sociology. It describes an approach to healing that focuses on factors that support human health and wellbeing rather than on those that cause disease. It looks closely at the relationship between health, stress, and coping.

Holistic/Integrative medicine looks at the whole person, including an analysis of one’s physical, nutritional, environmental, emotional, social, spirtiutal, and lifestyle values. It encompasses all modalities of diagnoses and treatment, including drugs and surgery, if no safe alternatives exist. It focuses on education and responsibility for personal efforts to achieve balance and wellbeing (as defined by the American Holistic Health Association). Learning about ourselves and how we uniquely respond to stress, and thus, learn to modulate our behavior, puts the power of our health in our own hands.

Unexamined stress and our response to it is wreaking havoc with our health, as evidenced by the prevalence of many chronic illnesses such as metabolic syndrome, diabetes, cancer, anxiety, depression, etc. The traditional teaching–that serious illness is caused by genes alone– is flawed. The study of epigenetics–how environmental signals regulate our genes– has shown that environmental stress is perceived differently and uniquely by the central nervous systems of different individuals. The central nervous system then engages in cellular processes via the secretion of hormones, thereby influencing cell survival or death[1,2,3]. Cell biology has shown us that cells can either be in a “growth mode” or a “survival/protection” mode, not both simultaneously[4,5]. How we perceive our environment, then, affects how our bodies react to it. Our perceptions are rooted in our beliefs, and chronic unregulated stress keeps our cells in a state of protection and survival, thereby inhibiting growth, recuperation, and ultimately our vitality. Merely getting rid of our stressors would bring us to a neutral state. To thrive, we need to engage in healthy behaviors that promote growth and wellbeing.

“Between stimulus and response there is a space, and in that space there is a choice, and in that choice lies our growth and freedom.” -Victor Frankl

When examined, many of our beliefs turn out to be misguided and self-limiting. It is my sincerest hope that I can help guide you to recognize your true self for better health and healing.

[1] Jones, David S. (2010). The Textbook of Functional Medicine.
[2] Pray, L. A. (2004). “Epigenetics Genome, Meet Your Environment.” The Scientist 14-20.
[3] Segerstrom, S. C. and G. E. Miller (2004). “Psychological Stress and the Human Immune System: A Meta-Analytic Study of 30 Years of Inquiry.” Psychological Bulletin 130(4): 601-630.
[4] Cornell, B. A., V. L. B. Braach-Maksvytis, et. al. (1997). “A biosensor that uses ion channel switches.” Nature 387:580-583.
[5] McEwen, B. S., and T. Seeman (1999). “Protective and Damaging Effects of Mediators of Stress: Elaborating and Testing Concepts of Allostasis and Allostatic Load.” Annals of the New York Academy of Sciences 896: 30-47.