Mini vipassana - day 3 - What is compassion, equanimity, judgement ?

Mini vipassana - day 3

What is compassion?
My perspective is that compassion is an experience of equanimity.  Like everything, it may also be impermanent.  It may be a function of precision, the ability to see things as the really are.  The experience of knowing that I don’t know what I don’t know is an essential perspective necessary for precision.  So such precision may be a function of the collection of perspectives I own.  This collection expands so long as I mindfully interact with others and create space in my thoughts for new perspectives.  Hence to me compassion is not a goal, rather the consequence of growing perspectives.

What is judgement?
Perhaps judgement is not the problem, rather imprecise judgements.  As a physician, I make  judgements frequently  about diagnosis and management plans; the value of these judgements depends on precision.
So given insufficient data,  judgements are imprecise by definition, problematic and unnecessary.  Hence knowing I don’t know what I don’t know mutivate me to create space for what I don’t know.  This is the precision required to feel equanimous and experience compassion for others.

Mindfulness ->
perspective ->
equanimity ->
precision ->


Knowing it is happiness.
Feeling it is joy.
Being it is bliss.

Knowing and feeling are both optional; enough to simply be bliss.
I think the only reason for knowing and feeling is to develop the languages needed to help others who are seeking their own path.

Every path is good; each moment depends on being in the moment and being aware of sufficient perspectives to appreciate the moment and respond to the moment.

My daughter who is in med school asked me a question today.


What kind of nutrition education do you think medical students need and are currently lacking?

My perspective:

I. Knowledge of a concise set of (BWM) Basic Wellness Messages.  Trouble for patients is that there are too many messages and they don’t know what to focus on; I find often patients gets waylaid by messages (albeit true but unimportant) from special interests.

1. Good posture
2. 2 liter of water per day + for exercises (consult your MD)
3. 400 grams of Non-starchy vegetables (no more than 2 fruits) per day.  —World Health Organization
4. Appropriate exercise
5. BAM (Breath Awareness Meditation)

II. Ability to share the importance of self-management at every clinical encounter in a way that the patient will listen; I find that by understanding what each patient want (or don’t want) in life; I can show them how they can get what they want by focusing of the (BWM) Basic Wellness Messages.  I also find that by redirecting all queries back to the BWM, patient hear the same message again and not become distracted by less important but easier to implement wellness “truth”.

III.  I have been successful in sharing the BWM at nearly every encounter in my clinic or in the ER.  Through repetition, I have discovered the attitude, approach and language that is needed to reach nearly everyone.  The immediate feedback from patient has become uniformly positive.  The long term results has also been encouraging.
For my latest inductee into the “I Have Beaten Type 2 Diabetes Hall of Fame”; his A1C was over 11 on Janumet on Jardiance; since following BWM, his A1C is under 6 off both diabetes drugs.

My solution to prevent “burnout”

Based on my personal experience, solutions to burnout for me are personal development, patient education and learning group skills. I discovered all of these can be had by running Physician-led Self-management Group Education and Support.
I feel like, I have retired from a practice of medicine which just puts out fires. Now at every clinical encounter, whether in my office or the emergency department, I address the patient’s reason for the visit first; then I share with them the perspective that knowledge of self-management has the potential to prevent great many sickness, pain and suffering. I invite them to attend my one or two of my three Wellness Tuesday classes. Through these group experience, participants develop the focus to maintain wellness behaviour and the language and skill to share the wellness message with their own circles of influences: patients, family, friends and coworkers. In my experience, every participants including myself takes away new perspectives necessary for wellness at every group encounter. We have shared our open source toolkits on the CFPC’s Best Advice Guide: “Recovery-Oriented Mental Health Care in Patient Medical Home” on how to run physician-led groups. Ajax Harwood Clinic received the “2018 National Merck’s Patient First Award” and selected as a “Success story for Patient Medical Home” by CFPC. I believe the best way to learn group is to experience one. In 2018 we ran such a group for attendees at a Canadian national conference called Collaborative Mental Health Conference and hope to do the same in 2019.
I am grateful to each and everyone of my patients for trusting me and giving me the opportunity to develop wellness as a person and as a physician.
Invitation for anyone who wish to check out these sessions. “See one and do one”. It’s easy and loads of fun!
Here is a blog I write to share my wellness journey with patients, friends and colleagues.

The Great Collective Awakening

Perspective is irreversible;
Narrative, indominatable;
Ignorance is terminal;
oneness, eternal.

I feel that in no time in the history of humanity has our collective awareness grown at the present pace.
I sense the “blastoff” of the great global awakening that is happening with or without me.
I am just grateful to be going for a ride; and I will keep my eyes open!

Mini vipassana day 2 - Moments lived in the moment, a momentous life make.

Snow day.  I was the only one in class today.

During this morning’s mini-vipassana, I sat for 50 min resisting desire to move.  I asked the question: Why do I feel strong body sensations (itch, ache, pain) with no apparent reason? I have a theory.   Could it be one of the ways the mind resist stillness or a manifestation of the minds fundamental tendency to perpetuity.

The mind, a garden that grows what’s sown.

I realize my mind plays hymns when I am tired. From time to time when my body may be awake even when tired but my attention is not fully so.  When attention is in this inbetween state, it tends to “randomly” run “unscheduled programming” selected from a list of “populars”.  These programmings may be story of fears, regrets or horror.  For me  are these inspired hymns.  I am grateful for the fellowship of these eternal narratives of devotion to the oneness.

What to do about jaw clicking?

Possible TMJs are strained; ligaments to TMJ (temporomandinilar joint, or the the jaw joint) too lax.  Did you have recent dental work, cleaning done?  Do you have pain?
Generally jaw rest will help.  For a period of time avoid opening mouth wider than that is required to cause the click.  Say > 1” and avoid chewing excessively (gum, steaks, raw hard vegetables and fruits) for 6 weeks.  This will allow the TMJ ligaments time to tighten up.

BAM (Breath Awareness Meditation) is the key

Imprecision are the walls.
Habits are the guards.
Attachment is the narcotic.
Suffering is the doorway to the inner infinity.
(BAM is the key.)

Instructions for BAM

The body breath naturally.  Let’s call this the natural breath.
My mind can tell my body to breath or hold the breath.  Let’s call this the intentional breath.
In BAM, the instructions is simply to wait and pay attention to the happening of the natural breath.
In doing so the mind is yielding to the natural functioning of the body and for an instance I can experience a gap in my train of thoughts.  With practice this gap will widen and allow an increased ability to redirect thoughts and space to experience new perspectives.

Mini Vipassana day 1 at Ajax Harwood Clinic

Finished day 1 of Mini Vipassana; will meet again Tuesday 8-9.

I am aware of a need to commit a time to meditate and started a “Mini Vipassana” series for 2019.
The instruction is Breath Awareness Meditation:
Pay attention to the sensation of the autonomous breath.
It will be every Tuesdays and Thursday.  It should start promptly at 8:00 am and finish at 8:45 am.
Everyone welcome!

Finished day 1 of Mini Vipassana; will meet again Tuesday 8-9.

Freedom and gifts of pain and suffering

External freedom comes with gift of pain that informs that the body’s needs in food and activities.
Internal freedom comes with gift of suffering informs that the thoughts need to stay more in the now and yield to the needs of body, humanity and nature.
Suffering is the gentle warning for unruly thought that becomes self-absorbed and deluded to believe it is immortal, is needed to constantly control, is to be in some place and time other than the here and now; to believe it can exist without the Body, without Humanity, without Nature and without Oneness.
Being grateful and curious for the messages of pain and suffering helps me see things as they are with     equanimity and precision..

Let’s have more conversations! Grateful for Ginette Petitpas Taylor, MP for Moncton—Riverview—Dieppe

The new Canada Food Guide is an honest perspective to share with Canadians.  I am grateful for Ginette Petitpas Taylor, MP for Moncton—Riverview—Dieppe for launching the food guide to expand public awareness.  I believe the next step is to make conversation on wellness a prevailing culture in our communities, education and healthcare systems.  As a family physician, colleague, friend and citizen, I share a Basic Wellness Message whenever I can.
I am grateful that our children are able to grow up in this new era of awakening, gain  authentic perspectives and see things as they really are.😊  Let’s talk!

What I learned.

Stages of life:
As a child, I learned that only if others were pleased and the world don’t blowup...
As teenager, I learned that if only I were smarter and better looking...
As young man, I learned that only if I were hard working, accumulate wealth and goodwill...
In middle life, I realized many of these perspectives I have learned lack precision. My new perspective is that I am grateful for this moment as it is.  I’m simply to pay attention, be curious, understand the messages behind pleasure and suffering, be aware of my tendency to judgement based of my past experiences and imagined fears of future, and respond to the the needs of the collective oneness with love.

Is the nutritional crisis due to lack of money or knowledge or something else?

Is the nutritional crisis due to lack of money or knowledge or something else?

2016 CANADA imported 3.7 billion worth of vegetables

The value of vegetables produced in Canada  rose 2.0% to $1.2 billion in 2017.

The food and beverage processing industry is the second largest manufacturing industry in Canada in terms of value of production with shipments worth $105.5 billion in 2014

Canada has positive trade balance at $2.6 billion in 2014 for processed food and beverages.

Assuming CANADA don’t export vegetables; then Canadians paid  $4.9 billion for vegetables in 2016

Assuming food processing and beverage industry did not change between 2014 and 2016, then Canadians spend $102.9 billion for processed food and beverages.

Hence, in 2016, Canadians spending on vegetable is <5% compared to spending on processed food and beverages.

So the problem with low vegetable consumption seems to be pandemic;
 - possibly a problem for the rich and the poor.

Is the problem with low vegetable intake financial or educational?

A breakfast consist of only processed simple carbohydrates was served to thousands of my family physicians colleagues at the Thursday session of Family Medicine Forum 2019.   The selection was cakes and beverages.

I can’t help but wonder, If I a family physician presumably a leader of wellness for my community do not make good nutritional choices in my own life, how can I help my patients.

Do vs Don’t

Do vs Don’t
I think there are multitude of “facts” about nutrition but little guidance on which of these “facts” are the most important ones.  I think it is human nature to follow the recommendation that is easy or tasty and ignore the rest.
So my approach is to focus on the “low-hanging fruits” - these actually turns out to be vegetables.  I encourage a “do” rather than a “don’t” approach.  I believe if I FIRST eat sufficient amount of vegetables, there would be less room in me to eat the “don’t”s.
1. Eat Well Plate: “At least 400 g (i.e. 15 oz or nearly 1 lb) of fruit and vegetables per day (2), excluding potatoes, sweet potatoes, cas- sava and other starchy roots.”  I ask my patients to take the mindset that these vegetables are their medicine and are non-discretionary.

2. More than 2 servings of fruits increase risk of type 2 DM

3. Aside from processed foods which may contain chemicals unatural to the human physiology, ALL other foods may be enjoyed in moderation.  Variety is the spice of life.
I share the following with my patients every chance I get, in my office or in the ER.  I try to help them realize the powerful control they actually have on their own suffering.  Knowledge is often only half the battle.  To provide self-management support I also run weekly groups and share the same information.

My sister asked me, “Which should I use on Apple, my dog”?

Which one should we give Apple for her joint pain (known to be arthritis)? :)

I am not a vet but I am happy to share my opinions as long as I am asked to do so and I don’t think I am doing any harm.
Following is my reply:
I’d give her lots of green vegetables as natural anti-inflammatory and for its metabolic benefits.  The pain will slow her down for a while so she can recover naturally from likely some episodes of overuse.
Hard for you to watch her limp; but that’s nature’s way of allowing the body to heal.
Dogs respond to nociception with limping; nociception informs the body to adjust weight loading and limit usage.  They do not suffer regrets, shame, worries or fear.

Based on these two studies:

Oranges contain about 50mg Hesperidin per gram of peel.

In animal model, 63% observed to have anti-inflammatory response equivalent to indomethacin when given 100mg/kg dose of Hesperidin.

So assume Apple is 30kg, her dose is 3000 mg of hespedin or 60 grams or 2 oz of orange peels.

What Canadians paid for vegetable vs processed food and beverages.

2016 CANADA imported 3.7 billion worth of vegetables

The value of vegetables produced in Canada  rose 2.0% to $1.2 billion in 2017. 

The food and beverage processing industry is the second largest manufacturing industry in Canada in terms of value of production with shipments worth $105.5 billion in 2014

Canada has positive trade balance at $2.6 billion in 2014 for processed food and beverages.

Assuming CANADA don’t export vegetables; then Canadians paid  $4.9 billion for vegetables in 2016

Assuming food processing and beverage industry did not change between 2014 and 2016, then Canadians spend $102.9 billion for processed food and beverages.

Hence, in 2016, Canadians spending on vegetable is <5% compared to spending on processed food and beverages.

So the problem with low vegetable consumption seems to be pandemic;
 - possibly a problem for the rich and the poor.

Is the problem with low vegetable intake financial or perhaps mostly educational?

The tree, my cat Marley and I

Nature spoke to me this morning at breakfast.

The tree:
It stands erectly and reaches broadly into the sky to breath air through its leaves and absorbs water and nutrients through its roots.
It does not feel pain when it’s pruned for it has not pain sensors; instead it may grow with more vigor.
It also does not suffer fear of pruning next season for it has no brain.
It simply lives.

She breath.  She drinks water.  She eats.
(She also use the litter box, grooms, purrs, sleeps and bathe in the sunshine)
Unlike the tree, Marley does not have to and won’t take any abuse.  She does not like her nails clipped and we respect her rights.  Once I stepped (accidentally) on her and experienced the painful reality of all of her claws.  Unlike the tree,  Marley and I both can feel pain.  The pain taught us well.  For a long time we chose to keep a respectful distance from each other.
So such pain was a good thing... I think.. at least from Marley’s perspective.
I don’t think Marley suffers worries.  At least she does not seem to “worry” about when we might “abandon” her again to go on vacation.
She seems to enjoy herself and live in the moment.

Like Marley and the tree, I breath.  I drink water.  I eat. (and do bunch of other things)
Like Marley, I also feel pain. Pain is in the present moment.  It may be avoided chemically with medication or substances often followed by pain of withdrawal and significant physical side effects such as pain from opioid mediated constipation and abdominal pain from chronic cannibis usage.  Pain is the way my body tells me what to do or not do.  For example I may have feet pain or back pain if I don’t keep an erect posture; kidney stone pain if I don’t drink 2 liters of water per day;  infection related, inflammatory, heart attack or cancer pain if I don’t eat enough flavinoids; shoulder or knee pain if I don’t allow my body to recover from routine wear and tear.  I have leaned to appreciate my pain for it keeps me healthy and out of trouble.
Unlike Marley, I have thoughts.  For me these thoughts offers moment by moment choices which I must choose from.  If I am not mindful and don’t exercise that choice, I suffer.  If I allow my attention to default to thoughts of regrets from my past and fear of my future, I suffer.  I suffer not from pain of the present rather than what is already past and what I imagine might come.  If I try to block my suffering using medication, substances, food, gambling, keeping busy, self-righteousness and many other substitute; I would have only delayed suffering.  It would be like borrowing from one credit company to pay another.  Eventually, all have to be paid in full.  Principal plus interest.  The persistent avoidance of clearing this suffering debt start as a psychological loop of grasping, quick-fix and shame that gathers energy to become an addiction.   Now I know to accept all things as they are; all things in my past as they were and  all things in my future as they will be.  I choose to be grateful of being alive. I choose to pay attention to the wonder and newness of each present moment.  My techniques is to label thoughts of regret, pride, fear and hope as “thinking” whenever I notice them and redirect my attention back to the present moment that is my breath.  I may also choose to direct my attention away from a present experience of obligatory pain towards a pleasant thought.  I can recall a story from the past and smile.  I create a story in the future and laugh.  I can marvel at the vividness of each moment and be in awe.  My thoughts are pleasure to me.
I also realize that my thoughts are not me.  Like books in my library, they all belong to me but no one book or collection of books define me.  Owning a horror story books does not make me a horrible person.  I have learned to accept these horror story books just as they are - books; for if I tell myself how much I hate these horror story books, I have only managed to add yet another horror story to my collection.  Unlike books, I can’t get rid of my thoughts.  Like books, I can add to my collection of thoughts and perspectives.  The larger my collection of perspectives the more choices I have to choose from to meet the needs each moment presents.  I learn new perspectives by staying in the moment with the curiosity of a beginner’s mind and listen to what’s said and not said and understand what’s seen and unseen.

The blue jay spoke to me... everything is and will be fine..

“The blue jay spoke to me... everything is and will be fine..”

My brother-in-law shared with me this Christmas that one day he was all stressed out from a seemingly impossible task at work; he happened to look out the window and saw a blue jay perched on a tree branch.  At that instant he remembered and experienced what the shaman he met some time ago in Yellowknife had said “... all the answers are in nature... we just have to be still and listen.”

And everything was fine.

Can I prevent Inflammatory bowel disease, psoriasis, celiac disease?

Recently, one of my children was diagnosed with inflammatory bowel disease and a nephew with psoriasis. We are Chinese.
30 years ago, I was taught in medical school that inflammatory bowel diseases and psoriasis mostly affected caucasians; and these autoimmune disorders were mostly caused by genetics.  There are evidences to suggest that environmental factors plays an important role as well!
Could it be chemicals in our food?
So what am I to do?
My new relationship with food.

Rising prevalence of IBD (Inflammatory bowel disease) in Asia.
IBD: China: 3.08 times 1980 to 1990
UC (ulcerative colitis) in Hong Kong increased by 6 times over the 2 decades.
Japan since has National IBD registry. It is shown that the incidence of IBD rises tenfold.

Prevalence. Psoriasis is the most prevalent autoimmune disease in the U.S. According to current studies, as many as 7.5 million Americans—approximately 2.2 percent of the population--have psoriasis.

Rising prevalence of psoriasis in China:

The researchers in the following article found that
“Rheumatic, endocrinological, gastrointestinal and neurological autoimmune diseases revealed the following annual % increases per year: 7.1, 6.3, 6.2, and 3.7, respectively. In all of these, differences between old vs new frequencies were highly significant (p < 0.0001). Comparing various autoimmune diseases, celiac disease increased the most and the highest increase in incidence”
They then concluded that “a stronger influence of environmental factors as opposed to genetic factors on autoimmune disease development.”

My new relationship with food.

My regrets, fear and purpose

I once questioned my safety from nuclear disaster, darkness, ghost, boogeyman, my size, height, attractiveness, intelligence, morals, choice of spouse, ability as lover, husband, father, my kid’s safety, future, choice of partners...the list goes on and on.. I suspect all common humanity stuff.

I know now to accept all things as they are; all things in my past as they were and all things in my future as they will be.  I spent good part of my past dwelling in regrets and fears because I did not have this new perspectives.
“Positive” thoughts of pride or hope may be a reactive way to avoid “negative” thoughts of shame or fear.  The “positive” thought may be akin to buying happiness on credit.
I also think knowing to accept all things does not necessarily imply my moment to moment experience will never be highjacked by thoughts of regrets and fear.  My techniques is to label them “thinking” whenever I notice them and redirect my attention back to the present moment that is my breath.

As for purpose of life; I think now that I have some notion or perspective that everything is fine just the way it is then the “purpose” is to interact with everything and everyone within boundaries of my perception and collectively gain an ever larger set of perspectives of this sense of okness and oneness.
Suffering is the consequence of the delusion of self.
The cessation of suffering is not a purpose but a consequence of this collective enlightenment.

My new relationship with food: Farmaceuticals, toxified, discretionaries

My new relationship with food.  I see them in three broad categories:
1. Farmaceuticals: 400 grams per day of a wide variety of non-starchy vegetables as recommended by  World Health Organization may contains over 6000 flavinoids with antiviral, antibacterial, antidepressant, anti-inflammatory and antineoplastic properties.  I see the consumption of these foods to be non-discretionary like sufficient engine oil for proper maintenance of my car, brushing my teeth or prescription pharmaceuticals recommend by my doctor.  400 gram is approximately 15 oz.  I eat 5 oz before each meal three times a day.
2. Toxified foods are processed foods where unnatural substances are introduced by mass farming practices or by manufacturing processes.  These are to be avoided regardless of how pervasively and recursively I am exposed to advertising campaigns that try to reassure me that they are “The Real Thing”
3. Most other foods are to be enjoyed at my own discretion.  Having met most of my farmaceutical needs already, I will more likely eat mindfully, moderately, sensibly, stay healthy and enjoy life!!

I just read that in new document “Health Canada said most Canadians do not eat enough vegetables, fruits and whole grains, and many also drink beverages high in sugars.”  I note the subtle switch in language:  “...vegetable, fruits...”.   Reversed order compare to most prior literatures.
Follow link for difference between vegetables and fruits.
Humanity is waking up to the truth.

Awakening: path from addiction to unimaginable beauty

Perhaps the solution to addiction is not to block and let go of everything rather to “awaken” and clearly understand which “needs” is actionable and pay attention.

Memory of past need may be regret or disguised as pride.
Imagined future need may be fear or disguised as hope.
Present need is real.

The Maslow Hierarchy perhaps can be applied to regrets and fears as well as needs.

In autopilot, my brain mingles this matrix of regrets, fear and needs and reacts sub-optimally to situations.
In “awareness”, I see things as they really are, let go of regrets and fears and address only the needs.

In autopilot, there are three level of sufferings:
1. Real needs are unmet while regrets and fear are blocked or escaped from using substitutes or quick fixes. These addictions or behaviour of insatiable craving can be outwardly apparent as in case of overeating or substance abuse or not quite as outwardly apparent in case of perfectionism, workaholism, self-righteousness or being self-absorbed. I think there are many more examples of subtle addictions.
2. Needs unmet and behaviour of using substitutes leads to more regrets (shame) and fear (panic) which propels the infinite loop of addiction.
3. Opportunities to enjoy the vividness of each moments are forever lost.

In “awake-ness”,
1. regrets (shame) are in the past, unchangeable, belongs forever in my memory, informative but does not define me any more than the volume of horror story book sitting on my bookshelf.
2. Fears (panic) are imagined, seems real and becomes intolerable when I pay attention to it and vanishes when I simply redirect attention to the present moment of my breath.  In Harry Potter, Voldemort’s power vanished when Harry accepted and leaned into his paralytic fear.
3. I vividly see things as they really are and responds to the opportunities presented by each moment and meet real needs and experience a life of unbounded, untethered, ungrounded and unimaginable beauty.

To an observer, “awake-ness” looks like:

To Jon Kabat-Zinn,

Beginners Mind
Letting Go

To Stephen Covey,

Habit 1: Be Proactive
Habit 2: Begin with the End in Mind
Habit 3: Put First Things First
(Habits 4, 5, and 6 then address interdependence:)
Habit 4: Think Win/Win
Habit 5: Seek First to Understand, Then to Be Understood
Habit 6: Synergize

Illness, an opportunity for wellness

Illness, an opportunity for wellness.
Through illness my patient’s body speaks a message.
When a patients come to see me they are often only looking for an outer solution.
As a physician, I listen, understand and decide what is the outer solution, more often than not, there is none.
I can either offer a substitute or help them find an inner solution.
These inner solutions are the perspectives that is wellness.

Should Must and Will

To experience is to be alive.
To be alive is breathing, drinking, eating, seeing, hearing, tasting, smelling, feeling, loving, exploring, listening, thinking and expressing.  Thinking about what I “will”, “should” or “must” do is a tiny part being alive and warrants only a blink of attention as I enjoy all other aspect of being alive equally.  Being alive is beauty.

William Osler said:
“Your future is now, embrace and enjoy it.”

Acceptance to me is...

When my attention is focused on a future I have imagined that will make me happy; I tend to blur my present experience in haste to arrive at a future in almost all cases (based on my past experience) quite different than imagined.

In cultivating a curiosity and love for the vividness of each present moment and experience; I also  arrive at a future reality quite different than one I could imagine.

Believing that I will be OK with this future reality is acceptance.

This acceptance is the fruit of my experiences.

Gastrointestinal problem sufferers may want to read this

“Celiac disease, and, more generally, gluten intolerance, is a growing problem worldwide, but especially in North America and Europe, where an estimated 5% of the population now suffers from it. Symptoms include nausea, diarrhea, skin rashes, macrocytic anemia and depression. It is a multifactorial disease associated with numerous nutritional deficiencies as well as reproductive issues and increased risk to thyroid disease, kidney failure and cancer. Here, we propose that glyphosate, the active ingredient in the herbicide, Roundup®, is the most important causal factor in this epidemic.”

It is in our sugars, animal feed production and other farm products.  It is also implicated in rare cancers.  I think all gastrointestinal problem sufferers may want to read this article.   Please share.  Thanks!!

On the topic of polyamory

  When your parrot falls in love, it's called polyamorous; When you play games with your parrot, it's called polygamous; When your p...