Squats & Séances

The Neuro-Spine Yogi with Dr. Ciara Harraher

• Venessa Krentz • Season 1 • Episode 8

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What happens when cutting-edge neurosurgery meets ancient yogic wisdom? Dr. Ciara Harraher bridges these worlds with remarkable insight and grace.

As a Stanford neurosurgeon and 30-year yoga practitioner, Dr. Harraher offers a unique perspective on the mind-body connection that few can match. 

The conversation weaves between her groundbreaking work as a neurosurgeon treating brain tumors, spine injuries, and stroke patients, and her personal experience with how yoga fundamentally changed her approach to medicine and life.

Beyond technical expertise, Dr. Harraher's story reveals the power of integrated approaches to health. As she navigates leadership roles advocating for both patients and physicians, she demonstrates how ancient wisdom and modern medicine can work together to create more comprehensive healing. 

Ready to explore this fascinating intersection of neuroscience and yoga? Listen now and discover how these seemingly different worlds might hold the key to your own healing journey. 

@neurospineyogi

**Single nostril breathing in yoga can refer to practicing only alternate nostril breathing (Nadi Shodhana).

https://www.apa.org/monitor/2009/11/yoga

https://pmc.ncbi.nlm.nih.gov/articles/PMC6971819/

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Until the next time - stay gritty you badass!



Venessa Krentz:

Welcome to episode eight of Squats and Seances. Today, I have an exciting opportunity to connect our listeners with an amazing individual who also happens to be a leading female neurosurgeon. As with all medical discussions on open source information channels, a disclaimer is necessary. The content of this podcast is intended for informational and educational purposes only. Thank you, healthcare provider, with any questions you may have regarding a medical condition. If you think you have a medical emergency, call your physician or 911 immediately. The information presented is not intended to be a substitute for professional medical advice, diagnosis or treatment. Reliance on any information provided is solely at your own risk. Provided is solely at your own risk. All right, welcome Kira.

Venessa Krentz:

Dr Harraher received her medical degree at McMaster Medical School in Hamilton, ontario, canada, and completed neurosurgery residency training in Dalhousie University in Halifax, nova Scotia. During her residency, she also completed a Master of Public Health at Harvard University. This was then followed by Cerebrovascular Skull Base and Cyberknife Training Fellowships at Stanford University. She assumed a faculty position in the Department of Neurosurgery at Stanford University, where she became a clinical professor in 2020 and serves as the medical director and chief of neurosurgery at Dominican Hospital, with clinical work covering all aspects of general neurosurgery. Dr Harraher joined the AANS Practice Management Committee in 2018 as a member and has served as vice chair and now Chair since 2024. She has also served on the Ethics and Digital Engagement Committees. She joined the AANCNS Washington Committee in 2019 and now serves as Vice Chair of Content on the Communications and Public Relations Committee. In this capacity, she writes and edits content for the Ne and Public Relations Committee. In this capacity, she writes and edits content for the Neurosurgery Blog. She joined the Council of State Neurosurgical Societies as a delegate member in 2018 and now serves as the chair of both the Southwest Quadrant and the Medical Practices Committee. She is also an active member of the Neurosurgical Society of America, serving on both the membership and scientific program committees, and has been the chair of multiple committees in the Western Neurosurgical Society.

Venessa Krentz:

On a state level, dr Harraher was most recently the president of the California Association of Neurological Surgeons, or CANS, in 2024. As president, she wrote a monthly article for the newsletter and organized a historic annual meeting with respect to exhibitor support. Prior to that, she has served as the director and treasurer and treasurer. She was also the delegate from CANS to the California Medical Association, starting in 2017, she was elected chair of the specialty delegation in 2022, served on the Council of Legislation and was elected to the Board of Trustees of the CMA in 2023. As a trustee, she was appointed to the nominations committee.

Venessa Krentz:

Dr Harraher has been active in medical student and resident education at Stanford University, serving as an associate in the practice of medicine and doctoring with CARE course since 2014. She has mentored many students, especially women who are considering a career in neurosurgery. She also regularly leads CME courses in her community and has been an invited speaker at the regional, state and national level. At Stanford University, she is a member of the Senior Clinician Educator Appointment and Promotions Committee and a member of the Diversity Cabinet. She recently completed both the Stanford Leadership Development Program and the Stanford Medical Humanities Faculty Fellowship. Dr Harraher is active in her local arts community, serving on multiple boards, and has worked internationally with the Nepal Spine Foundation, recently completing a mission that accumulated in a fundraising trek to Everest Base Camp.

Venessa Krentz:

Welcome, dr Harahert. I'm lucky to know Dr Harahert, or Kira as I call her. She's been a longtime friend of mine and I'm very excited to bring this conversation to everyone today. The intersection I want to explore is the physiologic and a little bit of the psychological connection of the mind and body. There's many ways in which this plays out in daily life, especially for you, dr Herrher, first and foremost as a neurosurgeon and also as a student of yoga, which I know you have practiced for how many years.

Dr. Ciara Harraher:

Okay, I'm going to say it's been 30 years, 30 years, 30 years, maybe actually coming up on 31 years. Yeah, wow, okay.

Venessa Krentz:

So we've got lots I want to cover today. I am going to try to be respectful of everyone's time because I know you're actually working today. Before we get into the details, the very first question that I like to ask guests what does gritty mean to you?

Dr. Ciara Harraher:

Yeah, I think gritty is being able to sort of rise to the occasion. Like, no matter what the occasion is, people that are gritty or have resilience are able to rise to that occasion when necessary and just have the sense of we always call it delayed gratification in training, right, you know?

Dr. Ciara Harraher:

to become a surgeon you have to go many, many years with little sleep and little pay and maybe defer certain things in your life, other things that other people are doing around you, like buying houses and having kids, and you know you have to be okay with that kind of delayed gratification. And I think that's how I define Gritty just being able to kind of get through the weeds, get through the dirt if you know that there's going to be a worthwhile end.

Venessa Krentz:

That's perfect. I love it, thank you. I'm eventually going to compile a giant poster of every guest and their definition of what Gritty was, and I think that's going to be very inspiring for people. Thank you for sharing that Now it seems implicit, but can you help explain to our guests, who may not understand, what is a neurosurgeon?

Dr. Ciara Harraher:

Sure. So a neurosurgeon is somebody who is trained in treating diseases of the nervous system. Obviously there are neurologists which I often get mistaken for which diagnose and treat a certain kind of disease many that are more common, such as dementia and stroke and other things. But neurosurgery intersects with that too, especially if there are lesions or problems that we can manage surgically, such as brain tumors or hemorrhages or things called vascular malformations in the brain, also in the spine, which is obviously something that most people are more familiar with in terms of ruptured discs and broken bones in the neck or in the back. Those kinds of things are managed by neurosurgeons. So anything to do with the brain, spinal cord, nervous system that requires an operation, meaning there's actual pathology, that there's an amenable kind of treatment for that, that's neurosurgery versus. Obviously, neurology manages many other diseases, but not in the same kind of technical way. Thank you.

Venessa Krentz:

That's an excellent explanation. There's not a lot of clarity out there on where does one end and where does the other begin. Touched on this already. Next question I had for you was what kind of duties does that entail? And it sounds like if it's a surgical six neurosurgery.

Dr. Ciara Harraher:

Yes, absolutely. I mean not to say that every patient that I meet or speak to obviously goes from point A being my discussion to point B, surgery. That doesn't always happen. There's many discussions where we talk through, especially in the realm of spine, where we talk through various symptoms people are having and there may be management that doesn't always end in a surgery. There may be management that requires other treatments than surgery, but by and large, most of the things that we see people for we're discussing the option of a surgery right. So is surgery something that is going to benefit whatever condition you have is.

Venessa Krentz:

That's a really good distinction to make, segueing into my next question, which is the types of surgical procedures you most often perform.

Dr. Ciara Harraher:

Yeah, so I work here in the community in Santa Cruz. Now I've been here for 14 years no, 15 years, something like that and you know the time that I've been here. What we see in the community is a little bit of everything right. So I see a fair bit of trauma, but it's not a trauma center where we're going to be seeing all the major gunshot wounds and car accidents. So I see trauma like surf trauma, for instance, people that whack their heads when they're, you know, diving in the sandbar and either have a ruptured disc in their neck or some fractured vertebrae in their neck. So I see mountain bike injuries. You know people. Same kind of thing in our active community here in Santa Cruz. I see a lot of degenerative conditions. So you know aging conditions in the neck and spine, which are very common, because now, you know, many people into their 60s 70s are still very, very active and their bodies are wanting to continue to do the things that they used to do and they may be having some issues with their joints and also their spine. So I take care of a lot of that here in this community. But then there's the other things too.

Dr. Ciara Harraher:

Brain tumors are fortunately more rare, but they are something that presents unexpectedly for most people and so they are something we take care of with a fair amount of frequency. Other things like strokes so people that have strokes, that there's types of strokes where there's not enough blood flow getting to part of the brain and that part of the brain becomes ischemic or doesn't get enough blood flow or oxygen and may quote die. There's also strokes that result in a hemorrhage in the brain and occasionally we need to evacuate that hemorrhage if it's causing damage to other structures. So we take care of a fair number of strokes and again, there's a lot more patients now on blood thinning agents, which puts them at a higher rate of hemorrhage from just minor trauma, raises in their blood pressure, et cetera. So I do a fair bit of that. Again, we do other things. The nervous system also encompasses the peripheral nerves, so I do a fair bit of carpal tunnel surgery and ulnar nerve decompressions, things like that.

Dr. Ciara Harraher:

I would not have thought that's interesting. Right, and there's nerves everywhere. So you may have heard of people that have trigeminal neuralgia. It's a really terrible condition where there's a lot of facial pain and there's quite good neurosurgical options for that in terms of treating trigeminal neuralgia and other vascular compression syndromes on the nerve system. So, yeah, we do a whole range of things, but I think the most common thing most neurosurgeons see is spine conditions, because they're you know, there's just a lot more. They're just a lot more common than than some of the other things.

Venessa Krentz:

Interesting. That kind of tracks with what I would have expected, but I never liked to make the assumption. You are involved in so many extracurriculars, as I call them advisory boards, mentorship programs. I mean that's incredibly inspiring. I was hoping that maybe you could pick out the very top one for you in particular and highlight what your responsibilities are and the scope of work that you do in that area.

Dr. Ciara Harraher:

Sure, I mean, I think that a lot of neurosurgeons in academia which is where I am I work at Stanford University we're sort of finding our niche in terms of where we're going to make a difference outside of the OR. Obviously, everybody is making a difference for their single individual patients, but how are we moving the field forward? And what became evident to me quite early in my career was that some of the skills I had were leadership skills. Not a lot of, not to say not a lot, but that's not necessarily a given in a surgeon. So obviously we're all leaders in our own little operating room, but in terms of leadership, I'm able to run teams, run committees, run organizations. That was something that I had some interest in and also talent doing. So I pursued leadership pathways in organized neurosurgery, as we call it, and I think that what I realized when I went into so, in terms of the ones that are most pivotal, I'd say probably the California Association of Neurological Surgeons, has been a big one. I was just recently president of that organization after working my way up from just a committee member, a delegate to, you know, treasurer, secretary, kind of working all the way through the chain of the organization, and that organization represents all neurosurgeons in California.

Dr. Ciara Harraher:

It doesn't matter what kind of situation you work in, if you're private, if you're academic, if you're locums, it doesn't matter. And really looking out for the things that you never get taught in medical school, which is how do you keep your practice doors open? How do you keep your lights on what are issues we need to be facing legislatively that are coming down the pike in terms of, you know, things like right now, the big beautiful bill and things that are going to affect our ability to take care of our patients, and so a lot of doctors are so busy in the doctoring that they are not paying attention to the things that are happening around them. For instance, our Medicare payment rates haven't gone up in 30 years. They haven't got inflation.

Dr. Ciara Harraher:

So while the administrative there's this great graph that I can show you where, like you know, the cost of healthcare have gone like this and most of the cost of healthcare have been due to sort of administrative costs, right, and things like that in terms of hospital administration. But actually physician salaries and physician reimbursements have gone like this and that hasn't been adjusted with inflation. And I mean that partially is because doctors are not always trained or paying attention to these kinds of things right, and so I think that, to me, is the most rewarding when we make some headway in terms of that, in terms of making sure that patients have access to doctors, because that's part of the issue in a lot of communities in this country is no access to physicians, or narrow networks and insurances or issues getting prior authorizations. All of these things are not anything that patients know about, or doctors. We weren't taught this. We didn't think this was going to be what we had to know about Exactly.

Venessa Krentz:

You went to medical school, not business school, right.

Dr. Ciara Harraher:

And so I do think that that has been a real in terms of a growth for me especially I'm from Canada where we don't have insurance companies, we have universal healthcare and sort of being in a different kind of system and trying to figure out how to navigate that. So that has been really rewarding for me in terms of CANS, because we really can make a difference, meaning we can. We have neurosurgeons in California, have been part of big legislation that has brought the field forward. So I think that's been very, very rewarding for me. And also it also CANS also provides a support network for other neurosurgeons in the state, meaning we have, you know, we can meet annually, like we did here in Santa Cruz. I held my meeting in Santa Cruz County and you know we had some really great panelists that came to talk about even their struggles as a neurosurgeon and the stresses of this job, and I think a lot of people in the room learned from that as well. So I do think it's just a support for surgeons. So I think that's been great.

Dr. Ciara Harraher:

And then the other one I would say, which is outside of neurosurgery, which is why I really like it, is the California Medical Association. The California Medical Association represents all doctors in California, not just surgeons, and so, as you know, you can see all the different priorities of maybe the difference between a pediatrician or an ophthalmologist and a neurosurgeon, you know. But again it's trying to figure out unifying, really how to improve care for Californians really that's the ultimate goal and also protect and advocate for the physicians in California and federally and really be able to use my voice to make change, in the sense that coming from a position as a trustee and as a neurosurgeon can at least get me in the door with people to really bring up some of the issues that I feel need addressing in this state. So I think that's been and it's been eye-opening in terms of politics as well, right.

Venessa Krentz:

Yeah, a huge component of that there.

Dr. Ciara Harraher:

Yeah, you know and in terms of having to talk to people on both sides of the aisle to try to get things finished, to try to get things accomplished, trying to find the intersections of bipartisanship on certain issues to move things forward Again, understanding the compromises that need to be made sometimes in order to move something forward legislatively and the conversations you need to have to get that done. So that's been a real education for me personally in terms of, yeah, just by nature I wouldn't have considered myself somebody who's more, you know, more sort of seeing always both sides of the issue.

Dr. Ciara Harraher:

I can be quite passionate about my views and quite passionate about what I believe in and I think I've had to learn to really understand that to get things done that are going to really benefit the patients and the physicians in California, you sometimes have to have a more nuanced approach to things than I had ever really understood or appreciated.

Venessa Krentz:

We're lucky to have you in that role because, like you said, it's not just the other neurosurgeons or other physicians that you're advocating for, but it's really having your feet on the ground and being like these are the changes coming down the pipeline and then affect us as the care providers and the patients on the end.

Venessa Krentz:

So that's powerful stuff. The other thing that I wanted to honestly just congratulate you on I know you and I have had conversations about this, but being a woman in this field is still predominantly men. The reason I bring this up is not to create any kind of separatism or not to make this about patriarchy or anything, but I do think that, as a biological woman in the field that you're in, that creates a default of some type of marginalization and that there's additional barriers that you have to overcome. I'm curious to know if you're willing to share in any ways that that, either aligned with your experience, didn't align. And, more importantly, I think my overarching goal in bringing that up is to be like what was the happy ending on the other side? Because you're clearly doing it, you're successful, you're out there lobbying and advocating for change, you're in a faculty position and you're teaching, and none of that came without a lot of hard work, especially as a woman. So taking a moment to honor that and see what your thoughts are about that.

Dr. Ciara Harraher:

Yeah, neurosurgery is one of the more male-dominated fields in medicine, so, if not the, maybe side-by-side with cardiothoracic surgery. And even though it's improving for sure, in the sense that most of the residency programs now in the country have maybe 20, 30% women, that wasn't always the case and even the numbers aren't changing as quickly as I maybe thought they are. You know, in some of my professional organizations in neurosurgery there's still only like 5% are women and not that many are leading committees or president or sort of in those roles. So the change is slow for sure in neurosurgery, slower than other fields in medicine, and that is unfortunately a deterrent for many women to want to enter the field because it's perceived as like an old boys club and you know it's not wrong in some ways. But I do think that there has been a lot of thoughtful, intentional work in various places across this country to address that and that's one of the reasons why I stayed at Stanford. So when I came to Stanford my experience part of that had not been I was the only female resident. For most of my training there hadn't been female faculty where I trained. And yeah, when I got to Stanford it was a very different story and it had its own scandals, which are not as no secrets here. The Stanford scandal in the 80s really paved the way for changes for women in medicine, in fact in academic positions and also in neurosurgery, and there was an intentional decision to make the Stanford neurosurgery program very different and very diverse.

Dr. Ciara Harraher:

But I do, yeah, I have definitely faced many forms of discrimination. I've definitely had horrible things said to and about me, mainly of being a woman. But, that being said, I have had some really great sponsorship and mentorship, both from females but also from men in neurosurgery who have really put it and put me out there, put me forward for these positions, put me forward for these committees and these roles and getting me started on that pathway, which would have been exceedingly difficult for me to do on my own. So I do think that, although there are those bad actors and maybe more of them there is also there's also been some great mentorship and sponsorship that I've had in neurosurgery from probably mainly men because there's more men, but I've also had that from some more senior women than me as well in neurosurgery. That has really helped. And then you know again, I think the harder thing about being a woman isn't necessarily your colleagues per se or the field, in that it's more that the actual nature of the job is is a bit more challenging in some ways for people perceive it to be for women.

Dr. Ciara Harraher:

You know it's a long training. So I, you know, for instance, I finished my training at 32, which was on the young end. Most people aren't finishing their training till they're more like 34, 35. And then you're hundreds of thousand dollars in debt. You have to start working. Then you're hundreds of thousands of dollars in debt. You have to start working.

Dr. Ciara Harraher:

And most people again I'm saying the normal situation here and so a lot of and also there were it wasn't very accepted for you to have a child, for instance, during your training and it would have been very difficult. But they've tried to make. You know, I think a lot of programs have tried to change that, to attract more females to the specialty and to also just make the living conditions better for everybody, men included. So I think you know a lot more residents are having children during training, taking time off, doing research while they're. You know you can do a lot of wonderful research and other things when you're not working 100 hours a week and having to operate and stay up all night, which you know.

Dr. Ciara Harraher:

There are times, as you know, that it's challenging as a mother to or as a pregnant you know person to, you know do that load when you're nine months pregnant, which you know.

Dr. Ciara Harraher:

Again, there's evidence out there, there's robust literature about the risks for the surgery trainees and a seizure trainees you know that are in the OR all the time, in terms of pregnancy related complications et cetera.

Dr. Ciara Harraher:

So I think I think that it's getting better than when, you know, when I was going through it, where it wouldn't have been very easy for me to have a baby when I was, so it did defer my, my family a little later and also the lifestyle we have. Again, you know my life, you know the situation I have with my husband, who has really his career, has really taken a back seat a lot of times not always, but a lot of times to mine to be able to support my two children and my two dogs and our life here, because it's very difficult. And I've had lots of help in other ways too. I've had au pairs at various points. I've had friends, you know. I've had family come and help me. So I think that's an aspect of being a woman that you know you have to factor in in terms of this, but it's not an obstacle that cannot be overcome, but it does require sometimes making different choices.

Venessa Krentz:

That was actually one of my next questions was how you know because I know you personally and I know you have children and you're married and you've been married for a long time balancing work life in such a high profile, intense and demanding field. It is like something has to give somewhere and there's a finite amount of energy. There's a finite number of hours in your day. You perfectly outlined there Like it is hard, ladies, if you're listening and you want to do this, but it is not impossible is the key, and it's getting better with every next generation that comes through, is what I'm hearing is it's going to be a little easier, more accommodations. Women are speaking up for what they need in order to pursue these goals and still balance everything out.

Dr. Ciara Harraher:

Yeah, and I think somebody said this it's not me, so I don't want to take credit for it but I think I do push back a bit on the work-life balance because I don't know if I'm ever I've never always completely imbalanced, like there's always going to be things that are, at whatever period in my life.

Dr. Ciara Harraher:

One thing is going to be maybe you know a little bit more and then at other points in my life you know it's shifting right and I you know I might go through phases where my you know my fitness and my a lot can't be as much of a focus for me and I always prioritize my health, but I'm not going to be training for triathlons and marathons and out doing four-hour bike rides on the weekend like I was before I had kids or, you know, like when I'm working a lot. So I think that I don't think I have balance per se work-life balance, but I think at certain points in my life things are going to be more of a priority than others and I've learned to accept that you know, that at certain points I'm not going to be balancing every.

Dr. Ciara Harraher:

I'm never going to be perfectly fit, perfect mom, perfect wife, perfect sir. Like it's not going to happen.

Venessa Krentz:

Oh, it's like you know so it's, I don't.

Dr. Ciara Harraher:

I think it's balancing, like understanding where you're at with your family, with your job, with your career, and realizing that there are going to be sacrifices.

Venessa Krentz:

Well said, it's true, for every field, every opportunity for work, every parent out there.

Dr. Ciara Harraher:

And I think there's a lot of pressure on women to be like oh, you need to achieve work-life balance, you need to be managing all these things perfectly, and it's okay to admit that you're not succeeding at every aspect of your life every day. There's going to be days that some of that is going better than others, for sure, For sure. Well, that resonates with me.

Dr. Ciara Harraher:

And I think we as women need to stop sort of saying like, okay, like putting on a pedestal like women that we think are like mastering it all, because they're not like I can tell you that right now, like they are not, and they are there is a juggling act, right yeah, and that juggling act is some days a ball will fall and you just that. And so I think social media kind of can do that too, right, Like it can make everybody's life seem perfectly balanced. And I think, yeah, I would say to any women listening that's, you know, I don't have perfect work-life balance, I just it ebbs and flows. I love that, Thank you.

Venessa Krentz:

I really value that kind of authenticity, like it's huge because people do it, women especially. We need to hear it. I was just in a small group discussion the other night about this very topic of these plates that are spinning and these expectations that we have to try to get everything going all at once, and I was like just stop. So, in addition to all of these things, all of these plates, all of these balls that are being juggled, as we touched on at the beginning, 30 years of a yoga practice and this is really where you came to mind to have on this podcast as the intersection of physiology and, by proxy, because we're talking about the brain, there is a psychological tie-in, it's that unique organ where all these things come together and the spirituality component, like everything, is there. But specifically I wanted to talk about the unification of the mind and body through yoga, which I know speaks pretty strongly to your heart, as it does to mine and, for those that might be listening, on top of all everything else, she also finds time for yoga practice.

Venessa Krentz:

There are many different types of yoga. Again, like I said, the common theme here is uniting the mind and body. You've got the intersection of psychology and physiology and spirituality. You have things in yoga that we refer to as asanas, which are postures or body positions, and they are paired with pranayama, which is life force or breath. So I'm curious if you could tell us when and where did you originally begin your practice of yoga and what kind of yoga did you practice or do you practice, as it possibly has evolved over the years?

Dr. Ciara Harraher:

Yeah, so I really do think that me discovering yoga was one of the top five best things that ever happened to me. To be honest, I found yoga when I was 18, 17, I think and it was not popular, so it was before. It had had sort of its nexus with Madonna and Gwyneth Paltrow and everybody. It had had sort of its you know nexus with Madonna and Gwyneth Paltrow and everybody, and it was in a kind of abandoned warehouse downtown Toronto and I had been told about it.

Dr. Ciara Harraher:

I was a dancer and I'd been told about it by some of my dancer friends that this practice that was being done by these like skinny guys in a warehouse wanting to be really, really helpful for like injuries and alignment and just sort of care for our body and for strengthening and like balancing a lot of the hard work we were doing with our bodies as dancers. So I remember going to my first yoga class, as I said, and it was I am an Ashtanga yoga practitioner and it was, yeah, it was transformative. I mean, ashtanga is kind of considered the sort of like type A personality attracted to Ashtanga yoga.

Dr. Ciara Harraher:

It was the beginning or the basis of what people now call power yoga or flow yoga vinyasa flow that comes from, mainly from Ashtanga yoga, which is, as you said, based on mainly based on Vinyasa flow yoga. There's the primary series, which most people are familiar with If they do Ashtanga yoga. That can be done led by a teacher and it's the set. It's a set sequence of movements, that's, and postures that are the same every time. And if I did a primary series yoga class here in California, or if I went to India, or if I went to Italy and did a primary series class, it would be exactly the same basically, maybe some slight differences with little things, but by and large the same movements.

Dr. Ciara Harraher:

And then there's the second series which kind of is trying they're both trying to build on different kinds of energy, you know, in terms of your inward energy and your I won't get too into all of the Sanskrit words, but you know your inner fire and then some of the other kind of more balancing out of your energy. Series like the second series and third series, which are very advanced. Many people never get to them and there's no, you know it's not, there's some people that are very traditional. So you don't you kind of do the postures in order and you don't get given the next posture until you've mastered to a certain extent to what your body can do.

Dr. Ciara Harraher:

Not everybody's bodies are the same. You don't get given the next posture until you've kind of mastered the one before, because there's an order that makes sense it sounds very similar to the 26 and 2.

Venessa Krentz:

Yeah, I mean, they're all-.

Dr. Ciara Harraher:

Is it different, though? Different postures?

Venessa Krentz:

Oh, different yeah.

Dr. Ciara Harraher:

I mean, I think all of these an original, the origins of all of these are not dissimilar. Between Iyengar and Bikram, you know, and I think they all have a lot of. There are a lot of more similarities than there are differences. But I'm less familiar. I've definitely done Bikram, I've definitely done Iyengar, but the one that I sort of grew up doing, that I kind of always come home to, is a Shtanga, and so I started at that age doing it and then when I was finished medical school, there's a short window of time which is kind of considered your last time for a long time that you have any free time, and so a lot of people were going and doing tours of Europe or going to the beach, and I had always really wanted to go into my practice more. So I actually went to India and I was fortunate enough to practice with Guruji Patabi Joyce before he passed away. He passed away maybe 10 years after I was there, maybe less. He was in his nineties when I was there, and I was again very fortunate that I was there at a time when, like, I literally just showed up with a backpack and said I want to practice yoga and he answered the door and was like, okay, come tomorrow at 5am, you know, and that's just crazy. I just got very, very, very, very big scene. Thereafter His grandson took over. His grandson just recently died, unfortunately Sharath, who was my teacher mainly when I was there. It was very tragic, but I spent those months in India. I met some great people, that my current Ashtanga teacher, who unfortunately is in Southern California so I can't practice with her live, but we did a Zoom practice throughout the pandemic together is in Southern California and I met her in India over 20 years ago and, yeah, it was life-changing for me. I think that again in so many ways, but physically, yes, but I think mentally more. So I think the thing about yoga is and I had been and I am but I think yoga made me less hard on myself.

Dr. Ciara Harraher:

So there is a word called ahimsa, which means nonviolence, and one of the first things that struck me is I think I was 19 maybe when someone talked about that, like at the beginning of a yoga class and was going through the asanas and um and the eight limbs of yoga and also has only one limb. But the eight limbs of yoga asana is one limb, correct, one part, just one small part, and pranayama is another right, and then there's six more after that, this concept of nonviolence, and you can apply nonviolence to others, to animals, to the environment, to our world, but you also and what was talked about in this class, I remember, was more about applying it to yourself, and that the first thing you need to do if you don't want to be violent in this world is not to be violent to yourself. And I think I had been and lean towards being really hard on myself. And I think that you know when I say that yoga saved me or helped me, I think that one thing really changed me Like I just stopped being, I just stopped being so hard on myself and I think I stopped seeing the need to be so hard on myself.

Dr. Ciara Harraher:

And I think I think I could have seen myself going down another pathway of self-destruction if I hadn't found yoga, to be honest, at that time in India, where I really centered and figured out like this basis of who I was going to be, like I was 25 or whatever, I don't know and like this basis of who I was going to be going forward in my life and the kind of life I wanted to live, right, so, um, and the kind of people I want to surround myself with, and I've never been in a Nishnanga studio in the world, and I've been to hundreds anyway, and anytime I travel I try to find one.

Dr. Ciara Harraher:

I've been to hundreds. Anytime I travel I try to find one. I've never been in an Ashtanga studio in the world that hasn't had people that I connect with or that I bond with or that I can have things in common with, and it's not that I there's been. Again, like I was saying earlier, there's been times in my life where the balancing act, the ebb and flow, mean that my connection to my Ashtanga practice is more or less you know, there's times where I'm doing Ashtanga two hours a day.

Venessa Krentz:

Right now in my life.

Dr. Ciara Harraher:

That's hard, oh yeah, because I have a lot of other things going on and also, you know, right now in my life I'm needing the community and some of the heat of being in an actual studio versus just practicing in my, where I'm sitting right now.

Dr. Ciara Harraher:

My office just to do some physical stuff. I'm going through so right now, but I always build in even to the whatever I'm doing right now in terms of yoga. I always build in my breathing from Ashtanga yoga, some of the postures that I can center, and come back to my Shavasana like a lot of things. So again, it ebbs and flows, my classical ashtanga practice, but I never move away from it completely. Never have in this whole time ever moved away from it completely.

Venessa Krentz:

There's a saying. I'm sure you've experienced this. I have. My practice was more 26 and two through, like the last 20 years. So where they say you know the postures don't change, you do. Yeah, your body changes, your mindset changes around the postures, and it sounds like that it's that kind of shared awareness almost that you're talking about when you walk into a room full of yogis, that everyone's there for that same purpose, each individually, but also collectively.

Dr. Ciara Harraher:

Yeah, and I mean, like I remember Sharad, or even maybe Karuji, you know, some days you just come in, sit on your mat and take five breaths, yeah, and five deep Ujjayi breaths. Maybe you do one sun salute and then that's maybe all you do that day. That's a yoga practice. That is a yoga practice. And I think that again, that comes back to the nonviolent bit. Right, there's many other things that that actually relates to, but we don't have, and there's no competition in yoga either. There really isn't. In true yoga. There's no, of course. Of course people are. People are intrinsically going to look at others and compare themselves to others, but it's not encouraged If anything, it's discouraged to do that. It's your practice. Yeah, you do it at your own pace. It's tech. You know the?

Dr. Ciara Harraher:

The classic way to do Ashtanga yoga is Mysore, which is self-directed. You don't have a teacher. You have a teacher that walks around the room and everyone's doing their own practice in their own time. Oh, interesting, and my foot practice is the way that Ashtanga is supposed to be mainly practiced, and once you know the series, you just do your own thing, and that's why you can do it anywhere. You can do it in a hotel room. You can do it on a beach. It's your practice. So I really feel like that's been such a gift to me. You know to have that because it can go with you anywhere.

Venessa Krentz:

Huge psychological spirituality, and even the physiologic. I had something I wanted to read that I found I thought this will tie in nicely to the physiologic component and I'd love to hear how your practice of yoga, after I share this, has also influenced your practice of yoga after I share this has also influenced your practice of medicine, because I do believe that those two things probably hold hands at some point. So we know that there's physiologic and psychologic benefits to yoga. There's countless clinical studies that yoga can improve overall physical fitness, strength, flexibility, lung capacity, reducing heart rate, blood pressure, alleviating chronic pain, including back pain. What I didn't realize but this also aligns with our discussion I discovered in a PubMed listing about an article from Brain Plasticity in 2019, they reviewed 11 studies examining the effects of yoga practice on the brain structures, function and cerebral blood flow. Collectively, the studies demonstrated a positive effect of yoga practice on the structure and or function of the hippocampus, the amygdala, prefrontal cortex, cingulate cortex and brain networks, including the default mode network. These studies offered promising early evidence.

Venessa Krentz:

Behavioral interventions like yoga hold promise to mitigate age-related and neurodegenerative declines, as many of the regions identified are known to demonstrate significant age-related atrophy. This makes perfect sense to me. I think it probably does to you, but there seems to be a very slow public uptick of understanding about how something that seems so low impact and so spirituality based has such real and quantifiable effects on the physiologic body. I was kind of curious what have you seen, or have you seen in your practice of medicine, the difference between an individual that practices yoga doesn't practice yoga? Can you tell when there's atrophy and degradation or someone comes to you with back pain?

Dr. Ciara Harraher:

and they're like you know, what do you do? Yeah, yeah, I'll talk about the back pain, one first Cause, I think that one is probably a little easier to quantify. So I mean, again, I do think that if you go to India and you see, you know yogis and you see how they practice, how they move, how they sit, how they move through the world, right, a lot of it is sitting in postures that are better, you know, better ergonomically for our posture and our alignment, right, not sitting in desk chairs or you know things like that. I'm sitting in kind of a semi squat position. That's a very common way for people to actually just be in India, right, yeah, and I think that. And also a real focus on core strengthening right, again, I think we say core, we say you know all of these kinds of things, but what does that actually mean? Well, I mean yoga practice. There's no weights, there's no, in the classic form, bands or things like that. Obviously, people can make modifications. Any kind of yoga practice can be modified, but in essence, you're really able to move your body by engaging, you know, really engaging your core, your abdomen, your abdominal muscles, your butt, your quad, like all of that, and it's not individual muscle development like doing you know, I'm going to do 10 reps of this particular one muscle and I think that what I see for yoga, and why I recommend it to many of my patients that come to see me with back pain is just that awareness that you put into engaging your bandhas, which is these holds that we have, which and again, that would be a whole episode on bandhas, engaging these. You know, some people would say it's kind of like a Kegel exercise, but it's a little bit different.

Dr. Ciara Harraher:

Engaging these things when we're straining, when we're moving, engaging our core when we're lifting, when we're bending, when we're twisting, to me that's second nature because I am a yogi, I've done it since I was 18 years old. To me it is second nature to engage those things pretty much all the time. And I think I remember when I had just had a baby, being like panicking, that for like a little while it was kind of hard to feel some of those things and I was like, oh gosh, I hope this comes back because it's very intrinsic to you know who I am. I feel like, unfortunately, you know it did, but I think that I do, I really do believe, and it doesn't have to be classic yoga. I think there's other ways of fitness to do this as well, but I do.

Dr. Ciara Harraher:

There's, at least, you know, 10 exercises that I routinely recommend to people with lower back pain. You know that classic lower back pain not ridiculous, meaning, not bad sciatic up where you know at that moment. You know, doing a yoga class might flare something up, obviously, but you know, the more prevalent thing I've seen is people with chronic lower back discomfort and I do think that switching the you know the brain connections between how you engage those muscles at all times, not just when you're exercising. I think learning that which she's learned through a yoga practice can be hugely beneficial for people with back pain. And I tell people myself, if I know that if I, for whatever reason in my life, things aren't balanced and I haven't been able to do yoga for several days maybe and I'm standing in the operating room, my back's going to hurt, it is. It's directly proportional to the amount that I have been doing, you know, in terms of my practice. So I think I definitely recommend some form of yoga, pilates, for most of my patients that are dealing with. You know not to go out and just try to learn it themselves. I do believe that having teachers and you know, to go out and just try to learn it themselves. I do believe that having teachers and you know experienced teachers in all of these modalities is safer, but I do think I recommend it for, you know, all of my patients. And so back pain, definitely I can say I personally think yoga can be a remedy for certain yoga postures can be a remedy for a lot of these things and I do them myself when I have back discomfort.

Dr. Ciara Harraher:

I also think breathing. So I do think there's certain types of pranayama breath that when you learn a breath practice which, again, it's not, it doesn't have to be an hour a day you can do a 10 minute breath practice, you can do a two minute breath practice. I really do think the mental clarity and also definitely the heart rate reduction, absolutely dealing with things like nausea, high blood pressure. Again, the physio, like you know, simple exercises like breathing through one nostril for the other than breathing through this. I've had moments where I've just done that to center myself for maybe 20 seconds. Like you know, the benefits are immediate. Yeah.

Venessa Krentz:

I just recently stumbled upon that in a meditation practice that I was doing. It has a name and I can't remember what it's called. I can't remember the name right now either.

Dr. Ciara Harraher:

I'll look it up guys, because, again, a lot of the times when we're doing these exercises there's no talking, so you're just kind of watching the teacher do pranayama or you're learning it. So I don't remember what that one's called either. I think it's called Nadi Shom, I can't remember.

Venessa Krentz:

Yeah, I'm not going to make it up. We'll find out.

Dr. Ciara Harraher:

Yes, but again, I just think that, and again I'm sure no one's ever fully studied what exactly happens in that moment with your cerebral blood flow. But we know how cerebral blood flow impacts blood pressure, for instance heart rate. We know that. So we know that as we're increasing oxygenation and we're increasing certain things, we're going to be changing our cerebral blood flow. We know that breath rate controls our intracranial pressure.

Dr. Ciara Harraher:

So I mean, again, all of these things you can, without there being live experiments of doing this and people figure out what these things are actually doing to your brain chemistry, when you're figure out what these things are actually doing to your brain chemistry when you're doing them, breath is so powerful for your brain in terms of oxygenation effects on cerebral blood flow and everything else and pressure levels and all kinds of things. So I do think that for those kinds of things, when it gets to things like dementias and atrophy, those are going to be harder to say for sure, other than because often we don't get to look at those brains until the person has passed. Unfortunately it's not like a situation where someone with Alzheimer's when they're alive, we open up and look at their hippocampus. We don't.

Dr. Ciara Harraher:

We know on their imaging that mesial temporal structures and a lot of dementia syndromes are smaller. And that's part of how you make a diagnosis in some people of Alzheimer's. Dementia, for instance, is how big those areas of their brain are on imaging and they're graded. But again, I don't know, I don't think we I think we have these early studies. I don't think we have big, you know, randomized clinical control studies that are going to ever show a population of people doing yoga having less rates of Alzheimer's.

Dr. Ciara Harraher:

But my guess is I wouldn't be surprised Based on again when you think about neuroplasticity and network building in your brain when you're doing a practice like yoga. Again, a lot of it is memory, right? So when you learn a primary series, I'd have to count the postures If I had my book here, I don't know, probably a hundred postures Maybe, oh, wow, in a primary series.

Dr. Ciara Harraher:

Yeah, I'd have to count them. I mean, you know we can figure out what that actual number is. I've never actually thought about that. And then sometimes you're doing part of the primary series and you're doing part of the second series and then maybe you're adding in a few third series postures for advanced practitioners. Think about the memory that you're doing with that. Yeah, you know, in terms of that day in, day out for your life and using those, so like consolidating those memory circuits. I think absolutely I can see, I can see why you know, if you're doing this day in, day out, that would stimulate those areas of your brain you know to have stronger connections, for sure. But again, I think that would stimulate those areas of your brain to have stronger connections, for sure. But again, I think the breath one is a little easier maybe for people to understand because it's really measurable in terms of your oxygenation levels and your cerebral blood flow and all of those things.

Venessa Krentz:

Case in point, there's evidence of bounds right that there's such a good correlation between this practice and physiologic health. I mean, we haven't even gotten into the psychological side of things and all of that. I mean I feel like I'll save that because there's so much more I would talk with you about right now, and I know that I've got to wrap it up here. Thank you for sharing all of that and the impact that it's had on your life. To bring things full circle, what would you advise? Here's the theoretical Someone that's in chronic pain. They've got a back injury. They're too afraid to proceed with surgery. May or may not be necessary. Also unsure about doing this yoga thing.

Dr. Ciara Harraher:

As the doctor in the room. What would you tell them? Yeah, I mean again, I think that if they haven't tried it. So a lot of my patients that come to see me have tried lots of stuff, right, and they're coming into me and they're like I've tried this, I've tried that nothing's worked, and I've said, look, okay, you haven't tried this, you don't want to take medicine, you don't want to do this, you don't need a back surgery, or I don't think it's going to help you. And you know that that needing and needing and getting a back surgery to do very different things.

Dr. Ciara Harraher:

Obviously I'm very conservative when it comes to who I think actually needs a back surgery, but I I also encourage people to try things that are relatively low risk, right, like so if you're going, if you've gone through the mill, you're really suffering, I think there's a pretty low risk for you trying something else. So I tend to find that there are, you know, different kinds of people, some that do better in like a gym environment, like a fitness environment, like that, and we, fortunately, here in Santa Cruz have some great practitioners in sort of the PT space and the fitness space that I send some of those people to that I know will work on some of the strengthening that I think they need and the fear that they have, because a lot of people live in fear of putting their back out and I think that. So I think there are people that can benefit from that fitness type route as well. I think everybody would benefit from some degree of meditation through that being just a breath practice, a meditation practice. We know those decreased basal levels of pain more than taking a Percocet. So I think that is something that anybody could do through, like a calm app on their phone or something like that. And then, for others that are open to it, I again recommend them taking an introductory yoga class.

Dr. Ciara Harraher:

It doesn't have to be Ashtanga yoga, I do think, with practitioners that are, you know. I do think it's important to have, especially if you have no experience with yoga, having people there that are going to adjust you appropriately and make sure you're not doing anything. Anything can be done that's going to hurt, right. There is a right and a wrong way to do it, such that you don't injure yourself or push yourself too much, and there's always a modification for any posture. So I think taking a yoga class or even Pilates I think Pilates for some people. They may find that a little easier to kind of get their head around. Some people struggle with a yoga room and the Right.

Venessa Krentz:

There is a psychological block, especially for us type A personalities that are like go go go, go, go, right, right.

Dr. Ciara Harraher:

But I think that part of it is very good for people. Yes, I agree, but if I really feel like someone's desperate and they're having lower back pain. I give them options of things to try. I'm obviously a big proponent of yoga and I think it's done thoughtfully, with teachers that can guide you appropriately. You have to be consistent. Unfortunately, if you do yoga once a year, it's going to hurt. It's going to stop.

Venessa Krentz:

You know you mean that's not going to fix my back pain.

Dr. Ciara Harraher:

No One glass every three to five days, Unfortunately, you know I think, like anything in life, you have to be consistent and thoughtful about your movements and in your practice, and so I think obviously there's no quick fix, but I do think there's many people out there in the world that are maintaining a variety of, say, musculoskeletal things, so let's not even talk about mental Musculoskeletal issues. With a regular yoga practice, they're maintaining themselves. They're maintaining this machine without maybe needing as much in the way of intervention like from medicine or surgery. By a regular yoga practice all over the world, I can guarantee that that is the case, and it doesn't have to be ashtanga yogis that are upside down doing five, eight types of headstands. That doesn't have to be your yoga practice. There's benefits to headstands, though.

Dr. Ciara Harraher:

I mean that could be a whole other episode. There's many benefits to going upside down. Oh yeah, people need to go upside down more you know, and people are afraid to do it. And that's very good for your back. It's like a traction device right. It takes all of the pressure off the discs when you do that. So I do think, going upside down, like again, you could do a whole episode on that.

Venessa Krentz:

Oh my gosh, there's so much and I would love to do that. We're definitely going to have to have another conversation if I can steal you for an hour. I just want to close by saying that, for me personally, I had two bulging discs and I had a fissure and I had to take about a year off of my traditional training program and I did almost exclusively yoga, had a follow-up MRI. Everything was gone.

Dr. Ciara Harraher:

Yeah, I mean, I do tell people that like things heal.

Venessa Krentz:

Yeah, I did not expect that. I was amazed.

Dr. Ciara Harraher:

Yeah, things heal and your body is a dynamic thing. So your discs are like your shocks right, so they're constantly moving, depending on what your position is, what your weight is, what you know, what your core strength like. I mean they are reactive to the forces around them. Yeah, and fissures, especially annular fissures, they tear and they heal and so, again, I think that's why we don't rush every single person to the operating room when they have a bulging disc or an annular fissure, because the natural history is like yours, that with time and, I think, interventions that are preventative, most people get better.

Venessa Krentz:

Thank you so much, Kira. I'm so grateful for your time I know, you're incredibly busy and literally saving lives. Let's drop a pin in this and let's come back, because I think there's going to be a lot of people that would love to hear more about how you're combining neurosurgery with real, actionable ways for people to take care of themselves. That's huge.

Dr. Ciara Harraher:

Maybe help me too, because I've never really been. You're probably like the third person in the last year to kind of ask me to speak on maybe more on this in the last year and I've had some people suggest that I like have a resource like a social media, like one that's more like neurosurgery spine doc or something that's like. So if you have any skills in that area, maybe you can help me.

Venessa Krentz:

I would. I have no skills in that area.

Dr. Ciara Harraher:

Because I mean? Because sometimes people will say you know, oh, what's your, where can I find you when?

Venessa Krentz:

can I find you and?

Dr. Ciara Harraher:

I don't really have anywhere.

Venessa Krentz:

That was one of my questions. Sorry, listeners, I'm not giving out her personal email.

Dr. Ciara Harraher:

My social media is not that I think I probably do need one. That is, if you have thoughts in that regard, let me know, because then it's not my area of strength or expertise. In doing that kind of thing, I'm marketing myself. To be honest, it's not really.

Venessa Krentz:

Oh, I've got lots we could trade back and forth, and when this podcast gets published in another couple of weeks, it'll be a great segue too. You'll be able to put it out there.

Dr. Ciara Harraher:

Maybe you can help me come up with something by then. That sounds awesome. Thank you so much.

Venessa Krentz:

I really appreciate your time. No problem, take care of my friend.

Dr. Ciara Harraher:

I'll talk to you soon, thank you.

Venessa Krentz:

Bye. In closing, I want to offer a reminder that your voice matters and I would love to connect with you. If you feel called to contribute to this community, please reach out. You can email topic ideas, suggestions for interviews and feedback to vanessa at squatsandsayancescom. That's Vanessa with an E-V-E-N-E-S-S-A at squatsandsayances. All spelt out one word in its entirety. You can find new episodes of Squats and Sayances on all major podcast platforms and the adjacent vlog cast on my YouTube channel. I'll link the YouTube channel in the reference notes for you. Find and follow me on social media. At Squats and Seances, I'm on Instagram, facebook and TikTok Instagram, facebook and TikTok. Until the next time, may you continue to live well, embrace authenticity, question everything and, of course, stay gritty.