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This is an important issue, reminding me of the Terry Schiavo case of some years ago in Florida, on which I also opined with my colleague Roger Blackburn (Gainesville Sun).To answer this question, we need to understand the definition of brain death, and then we need to understand the progression of physiology - the natural history of death, as it were - in the human body. Finally, with these two pieces of information, we can ask the question as to whether a 14 week old fetus CAN be kept alive in a dead host until it is viable.Further, from what was reported in the press, Ms. Muñoz was unresponsive - pulse-less - for an hour prior to return of spontaneous circulation. This means that the fetus was without blood flow for that period as well. One is forced to ponder the state of the fetus' central nervous system after a prolonged period of hypoxia / hypo-perfusion. It will not be a good outcome for the fetus / child even if the mother is forced to play host until term.The other question: Does / should the state have the right to force a family to keep a dead person on "life support" to serve as a host for the fetus ?I use herein some material I have written in the recent past, with references.Brain DeathDefinition of Clinical Brain DeathIn a landmark manuscript, Harvey Cushing described the “Experimental and Clinical Observations Concerning States of Increased Intracranial Tension” (1). Utilizing an animal model and differentiating local compression from a general compression of the brain, Cushing examined the physiology of intracranial hypertension and its effect upon systemic hemodynamics, now known as Cushing's triad (irregular respirations, decreased heart rate and increased blood pressure).In contrast to animal models used by Cushing and others, where the experimentation is undertaken in a controlled setting, the physiology of human brain death remains challenging for multiple reasons: the time of actual brain death may be significantly different from the certification time with significant physiologic changes occurring in the interval, treatment of the patient in the period antecedent to brain death and in the immediate post brain death period may result in abnormalities independent of brain death and, lastly, there will never be a human model of brain death (2). As a consequence, an understanding of brain death physiology is derived from animal models and data inferred from human case series.Somatic death after clinical brain death will inevitably occur in the absence of aggressive support. In an era when brain death was not accepted, prolonged survivorship, with a mean the duration of 23 days, was noted in a study that aggressively maintained brain dead patients (3). Autopsy studies of patients that were declared brain dead revealed histopathologic evidence of necrosis and liquefaction (4).In 1956, Lofstedt and von Reis described 6 mechanically ventilated patients with absent reflexes, apnea, hypotension, hypothermia, and polyuria associated with absent angiographic cerebral blood flow (5). Death was declared when cardiac arrest occurred, between 2 and 26 days after the clinical examination.However, it was after the description of “Le Coma Depasse” by Mollarat and Goulon, in 1959, that the description and understanding of coma and death changed forever (6). These authors presented 23 cases from their Paris hospital in which they described irreversible or “irretrievable coma”. This was coma that was associated with a lack of cognitive and vegetative functions, and went beyond any description of coma that had been previously discussed. This description initiated the discussion and formed the basis of what is contemporarily recognized as brain death. The authors defined the necessity of considering the circumstances of the injury, the role of the neurologic examination, the results of electroencephalography (EEG), and the consequence of brain death on other organs. They found that the majority of injuries to the brain were confined to trauma, subarachnoid hemorrhage, meningitis, cerebral venous thrombosis, massive stroke, and brain death after craniotomy for posterior fossa tumor. In this series, they detailed problems including deterioration of pulmonary function, polyuria, hyperglycemia, and tachycardia. It is intriguing that this paper, even though published in a relatively well known European journal, took more than 15 years before it became known in the United States and Great Britain.In 1963, Schwab and associates reported utilizing EEG as an adjunct for determining death when cardiac activity was present (7). These authors proposed that the patient was dead when: 1. spontaneous respirations were absent for 30 minutes; 2. tendon reflexes of any type were absent; 3. pupillary reflexes were absent; 4. the occulocardiac reflex was absent; and 5. the EEG was iso-electric for 30 minutes.In 1968, Harvard Anesthesiologist Henry Beecher chaired a committee at Harvard Medical School which attempted to define irreversible coma as new criteria for death. The committee defined death as the irreversible loss of all brain function and proposed the criteria necessary to make that determination (8). These included non-receptivity and unresponsiveness, no movements or breathing, no reflexes, and a flat EEG. The committee suggested that the tests should be repeated at 24 hours and, in the absence of hypothermia and central nervous system depressants and with no change in examination, the patient would fulfill criteria for the diagnosis of brain death.Subsequently, concern regarding the relevance of EEG unfolded, with the Conference of the Royal Colleges and Faculties of the United Kingdom publishing the Diagnosis of Brain Death, first in 1976 and then again in 1995. This publication altered the definition from brain death to brain stem death (9): if the brain stem was dead, the brain was dead, and if the brain was dead, the patient was dead. The conference required that the etiology of the condition that led to coma be established, and a search for reversible factors – such as central nervous system depressant drugs, neuromuscular blocking agents, respiratory depressants, and metabolic or endocrine disturbances – be under-taken. A period of observation was recommended and the technique for apnea testing was described (9, 10).The only prospective attempt to develop guidelines for determination of brain death based on neurologic criteria was the 1977 NIH-sponsored study (11). Enrollment required demonstration of cerebral unresponsiveness and apnea, and at least one isoelectric EEG. The investigators recommended examinations at least 6 hours after the onset of coma and apnea, with the examination demonstrating cerebral unresponsiveness, dilated pupils, absent brain stem reflexes, apnea, and an isoelectric EEG. As defined in this study, the apnea examination only required that the patient not make any effort to breathe over the ventilator.The Quality Standards Subcommittee of the American Academy of Neurology formally redefined brain death in 1993, utilizing an evidence-based approach from the literature. They defined criteria for evaluating brain death as the presence of coma, evidence for the cause of the coma, including the absence of confounding factors, such as hypothermia, drugs, and electrolyte or endocrine disturbances. Fulfilling the preceding criteria, brain-stem and motor reflexes needed to be absent. An apnea test was finally established as a criteria and part of the exam to define brain death. The Sub-committee recommended a repeat evaluation 6 hours after the initial evaluation, but recognized that the time was arbitrary and suggested that confirmatory studies should only be required when specific components of clinical testing could not be reliably evaluated (12).Ishii and colleagues evaluated the use of Magnetic Resonance Imaging and MR Angiography (MRA) in patients diagnosed as brain dead by, at the time, standard methods (13). In the four cases they studied, SPECT – using 99mTc HMPAO – scanning before or immediately after the MRI studies showed no uptake of radioactivity, the “hollow skull” sign. MRI findings were diffuse brain swelling, central and tonsillar herniation, and loss of the flow void in the intracranial portions of both internal carotid arteries. These investigators suggest that MRA provides a noninvasive and reliable method for the diagnosis of brain death.Falini and associates (14) followed the structural and biochemical changes in a single patient after severe hypoxic ischemic brain injury, using serial MR and proton MR spectroscopy. While this case report did not touch on the issue of brain death, the biochemical metric of the severe neuronal insult – a sharp decrease in cortical N-acetylaspartate and subsequent increase in choline – are of interest.In another single-case study, Lövblad and Bassetti utilized diffusion-weighted MRI (DWI) to evaluate for brain death (15). They again reported – in a 79 year old woman with sudden onset of coma and Glasgow Coma Score of 4 – transtentorial herniation with compression of the brain stem, the absence of flow voids on T2 weighted images, and the absence of intracranial vessels on MR angiography. The DWI images with severe diffusion coefficient decrements suggested profound ischemia secondary to absent cerebral blood flow. Although only a single case, the authors point out that the DWI may demonstrate severe ischemic changes that are simply not consistent with survival, thus potentially providing a non-invasive method to diagnose brain death.Young and colleagues (16), in a brief review of ancillary studies useful for the determination of brain death, point out that the diagnosis remains essentially clinical and only studies that evaluate for brain perfusion are of merit; the authors note that CT angiogram and MR angiogram may be of use.Although not done in conjunction with an MRI study, Zuckier and Kolano (17), and Sinha and Conrad (18) note the utility of using the accepted 99mTc – HMPAO radio-nuclear study as a confirmatory test for brain death. An obvious potential downside to this technique is the need to move a potentially unstable patient to the Nuclear Medicine suite.Most US institutional policies are modeled after the Quality Standards Subcommittee of the American Academy of Neurology (19).Thus, several things are evident from this review:1. The definition of brain death is a clinical one.2. In the presence of clinical brain death, the body will shut down, on average, 23 days after brain death has occurred. This means that even if we try to keep the body functioning, it will, ultimately, stop working. If this 14 week old fetus needs to be at least 24 to 30 weeks old to survive in the neonatal ICU, then nearly 3 months, not 23 days are needed. It is unliklely that the body of Ms. Muñoz can be kept functioning for that long.3. This has obvious implications. Even if the State of Texas orders Ms. Muñoz act as a host, this will likely not be possible for a long enough period that the fetus becomes viable outside of the uterus.And finally, even if it were possible to use Ms. Muñoz' body as an incubator, the fact that she was in circulatory arrest for an hour before being found means that the fetus / child was without blood flow, oxygen, and nutrients for a prolonged period and will be, most likely, severely neurologically damaged.Is the great State of Texas going to provide financial support to the child and his / her family in perpetuity ? Or will these so-called Right to Lifers behave the way they often do: Very concerned about life while it is in utero, but unresponsive and dismissive after the child is born.Medically, this is a disaster.Morally and ethically, the State of Texas has no right to do what they are doing.It is abuse - of Ms. Muñoz and her family - plain and simple. Texans should be ashamed that their state government abuses the dead and manipulates the emotions of the living.I hope they find forgiveness.References:1. Cushing H. Some experimental and clinical observations concerning states of increased intracranial tension. The American Journal of the Medical Sciences. 1901;124:375.2. Power BM, Van Heerden PV. The physiological changes associated with brain death--current concepts and implications for treatment of the brain dead organ donor. Anaesth Intensive Care. 1995;23:26 – 36.3. Yoshioka T, Sugimoto H, Uenishi M, et al. Prolonged hemodynamic maintenance by the combined administration of vasopressin and epinephrine in brain death: a clinical study. Neurosurgery. 1986;18:565 – 567.4. Black PM. Brain death (first of two parts). N Engl J Med. 1978;299:338-344.5. Lofstedt S. Intracranial lesions with abolished passage of x-ray contrast throughout the internal carotid arteries. Pacing and Clin Electrophysiology. 1956;8:99.6. Mollaret P, Goulon M. [The depassed coma (preliminary memoir)]. Rev Neurol (Paris). 1959;101:3 – 15.7. Schwab R. EEG as an aid in determining death in the presence of cardiac acuity. Electroencephalography Clin Neurophys. 1963;15:147.8. A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. JAMA. 1968;205:337 – 340.9. Diagnosis of brain death. Statement issued by the honorary secretary of the Conference of Medical Royal Colleges and their Faculties in the United Kingdom on 11 October 1976. Br Med J. 1976;2:1187 – 1188.10. Criteria for the diagnosis of brain stem death. Review by a working group convened by the Royal College of Physicians and endorsed by the Conference of Medical Royal Colleges and their Faculties in the United Kingdom. J R Coll Physicians Lond. 1995;29:381 – 382.11. An appraisal of the criteria of cerebral death. A summary statement. A collaborative study. JAMA. 1977;237:982 – 986.12. Practice parameters for determining brain death in adults (summary statement). The Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1995;45:1012 – 1014.13. Ishii K, Onuma T, Kinoshita T, Shiina G, Kameyama M, Shimosegawa Y: Brain Death – MR and MR Angiography. Am J Neuroradiol, 1996;17: 731 – 735.14. Falini A, Barkovich AJ, Calabrese G, Origgi D, Triulzi F, Scotto G: Progressive brain failure after diffuse hypoxic ischemic brain injury – A serial MR and proton MR spectroscopic study. Am J Neuroradiol, 1998;19:648 – 652.15. Lövblad K-O, Bassetti C: Diffusion-weighted magnetic resonance imaging in brain death. Stroke, 2000;31:539 – 542.16. Young GB, Shemie SD, Doig CJ, Teitelbaum J: Brief Review – The role of ancillary tests in the neurological determination of death. Can J Anesth, 2006;53:620 – 627.17. Zuckier LS, Kolano J: Radionuclide studies in the determination of brain death – Criteria, concepts, and controversies. Semin Nuc Med 2008;38:262 – 273.18. Sinha P, Conrad GR: Scintigraphic confirmation of brain death. Semin Nuc Med, 20123;42:27 – 32.19. Wijdicks EF, Varelas PN, Gronseth GS, Greer DM, American Academy of N. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010;74:1911 – 1918.

You can't, because he hasn't really been diagnosed, has he?“Virtually anyone at any given time can meet the criteria for bipolar disorder or ADHD. Anyone. And the problem is everyone diagnosed with even one of these ‘illnesses’ triggers the pill dispenser.” — Dr. Stefan Kruszewski, PsychiatristIn absentia diagnoses are inaccurate, irresponsible, and unethical. If someone diagnosed him without actually examining him, it's completely invalid. Also, it is a violation of doctor-patient confidentiality and HIPAA privacy rules for any medical practitioner to share someone's diagnosis without his/her expressed, explicit consent, aside for certain legal exceptions. A person's doctors should never share this information with a spouse or family without instruction of proper consent.This is why armchair internet diagnoses are nothing short of ludicrous and laughable.A person cannot give consent in absentia.Those “5 psychologists” have no right to do such a thing and should lose their licenses to practice-- that is, if you, dear OP, aren't completely full of sh*t.If you presume to diagnose him, or try to impose invalid diagnoses or inappropriate medical “opinions" on him, he'll be right and proper to tell you you're full of sh*t, as are these “doctors" you say you're quoting.Now… I'm not saying there's nothing wrong with him. I'm simply saying that any in absentia diagnosis is invalid, and any diagnosis shared with anyone else without his express consent is not legal.Addendum:It was suggested, in a comment, that perhaps the OP had relayed details about her husband to these “5 psychologists.” I responded with:It will also color or prejudice such a “absentee diagnosis” with her feelings, suspicions, and impressions, rather than an earnest examination of the patient, which would be the only responsible course.She should positively encourage him to go talk with someone-- of his choosing.Hopefully, he'll find himself a decent, legitimate doctor who wouldn't participate in such illegal and irresponsible behavior.She needs to concentrate on the help aspect, and forget the cockamamie “absentee diagnosis.”Here's the official opinion from the APA, for regular practice, as well as in the context of the Goldwater Rule:American Psychiatric Association Ethics Committee OpinionQuestion: May a psychiatrist give an opinion about an individual in the public eye whenthe psychiatrist, in good faith, believes that the individual poses a threat to the countryor national security?Answer: Section 7.3 of The Principles of Medical Ethics With Annotations EspeciallyApplicable to Psychiatry (sometimes called “The Goldwater Rule”) explicitly states thatpsychiatrists may share expertise about psychiatric issues in general but that it isunethical for a psychiatrist to offer a professional opinion about an individual based onpublicly available information without conducting an examination. Making a diagnosis,for example, would be rendering a professional opinion. However, a diagnosis is notrequired for an opinion to be professional. Instead, when a psychiatrist renders anopinion about the affect, behavior, speech, or other presentation of an individual thatdraws on the skills, training, expertise, and/or knowledge inherent in the practice ofpsychiatry, the opinion is a professional one. Thus, saying that a person does not havean illness is also a professional opinion. The rationale for this position is as follows:1. When a psychiatrist comments about the behavior, symptoms, diagnosis, etc., of apublic figure without consent, the psychiatrist violates the fundamental principlethat psychiatric evaluation occurs with consent or other authorization. Therelationship between a psychiatrist and a patient is one of mutual consent. In somecircumstances, such as forensic evaluations, psychiatrists may evaluate individualsbased on other legal authorization such as a court order. Psychiatrists are ethicallyprohibited from evaluating individuals without permission or other authorization(such as a court order).2. Psychiatric diagnosis occurs in the context of an evaluation, based on thoroughhistory taking, examination, and, where applicable, collateral information. It is adeparture from the methods of the profession to render an opinion without anexamination and without conducting an evaluation in accordance with the standardsof psychiatric practice. Such behavior compromises both the integrity of thepsychiatrist and of the profession itself.3. When psychiatrists offer medical opinions about an individual they have neverexamined, this behavior has the potential to stigmatize those with mental illness.Patients who see a psychiatrist, especially their own psychiatrist, offering opinionsabout individuals whom the psychiatrist has not examined may lose confidence intheir psychiatrist and/or the profession and may additionally experience stigmarelated to their own diagnoses. Specifically, patients may wonder about the rigorand integrity of their own clinical care and diagnoses and confidentiality of their own psychiatric treatment.Psychiatrists, and others, have argued against this position. We address five mainarguments against this position:a. Some psychiatrists have argued that the “Goldwater Rule” impinges on anindividual’s freedom of speech as it pertains to personal duty and civicresponsibility to act in the interest of the national well-being. This argumentconfuses the personal and professional roles of the psychiatrist. The psychiatrist,as a citizen, may speak as any other citizen. He or she may observe the behaviorand work of a public figure and support, oppose, and/or critique that publicaction. But the psychiatrist may not assume a professional role in voicing thatcritique in the form of a professional opinion for the reasons discussed above,those being, lack of consent or other authorization and failure to conduct anevaluation.b. Psychiatrists have also argued that the “Goldwater Rule” is not sound becausepsychiatrists are sometimes asked to render opinions without conducting anexamination of an individual. Examples occur, in particular, in certain forensiccases and consultative roles. This objection attempts to subsume the rule withits exceptions. What this objection misses, however, is that the rendering ofexpertise and/or an opinion in these contexts is permissible because there is acourt authorization for the examination (or an opinion without examination),and this work is conducted within an evaluative framework including parametersfor how and where the information may be used or disseminated. In addition,any evaluation conducted or opinion rendered based on methodology thatdeparts from the established practice of an in-person evaluation must clearlyidentify the methods used and the limitations of those methods, such as theabsence of an in-person examination.c. Psychiatrists have further argued that they should be permitted to renderprofessional expertise in matters of national security and that the “GoldwaterRule” prohibits this important function. While psychiatrists may be asked toevaluate public figures in order to inform decision makers on national securityissues, these evaluations, like any other, should occur with proper authority andmethods within the confidentiality confines of the circumstances. Basingprofessional opinions on a subset of behavior exhibited in the public sphere,even in the digital age where information may be abundant, is insufficient torender professional opinions and is a misapplication of psychiatric practice.d. Some psychiatrists have argued that they have a responsibility to render anopinion regarding public figures based on Tarasoff duties to warn and/or protectthird parties. This position is a misapplication of the Tarasoff doctrine. Actionsto warn and/or protect a third party occur in situations in which a psychiatrist isproviding treatment to or an evaluation of an individual who poses a risk toothers and Tarasoff serves as a rationale for a limited sharing of otherwise confidential or privileged information. However, for information in the publicdomain, law enforcement agencies that have the same, and perhaps evengreater, access to information about the individual are charged with protectingthe public.e. Finally, some psychiatrists have argued that rendering an opinion based oninformation in the public domain without conducting an examination should bepermissible because psychiatrists are often involved in psychological profiling.However, psychological profiling differs markedly from self-initiated publiccomments as described in this opinion. Psychological profiling occurs when alaw enforcement or other authorized agency or authorized party engages amental health professional to provide information about the characteristics of anindividual who might have perpetrated a crime; the behavior of a suspect orother figure; other characteristics of an individual; or a prediction of future risk.The authorization for this work derives from the requester and is not initiated bythe psychiatrist. It is also meant to be shared with the requester, and not thegeneral public. Finally, as this work often lacks examination of the individual andrelevant data from appropriate collaterals, the psychiatrist must explicitlyaddress the limitations of the methods used in rendering a profile, should notopine about a diagnosis, should not include a diagnostic opinion, and mustclearly state the inherent limitations in making predictions about futurebehavior.Nothing in this opinion precludes the psychological profiling of historical figures aimedat enhancing public and governmental understanding of these individuals. As OpinionQ.7.a states, this profiling should not include a diagnosis and should be based in peer-reviewed scholarship that meets relevant standards of academic scholarship. Suchscholarship should clearly identify the methods used, materials relied upon, andmethodologic limitations, including the absence of formal evaluation of the subject of inquiry.APA Ethics CommitteeMarch 15, 2017

Great question Gin Ko.There is a saying in yoga when the student is ready the teacher will appear.The origins of this saying are obscure, however it generally means, when you are prepared and open to learn “something different or upgrade your skills or knowledge, your “new” teacher will appear.Bearing in mind the traditional path of yoga is to support the body to sit in meditation, “the teacher” can come in a variety of forms.Your next teacher may be a physical teacher, an inanimate object or even a life lesson, which when you relate to yoga, enhances your yoga practice.The key is to be open to learning and know that every experience you have, prepares you to do yoga.For example, a yoga teacher can demonstrate a new pose and tell you to “be patient, present and focusing on your breath as you get into the new pose”, - however, you can also learn about being patient and presence from observing the interaction between a patient parent teaching their children a new skill.Once you adopt this mindset, have a look around various yoga studios, and observe the teaching styles of the different teachers.Other Things To Consider:Pay attention to how the students are responding to the teacher’s teaching style.For example is the teacher gentle and responsive to the students individual body shapes and sizes,.How much guidance and instruction does the teacher give during the lessons.Is the teacher present and focused on adapting the class to the various levels of students abilitiesOr does she adopt a cookie cutter teaching style.Talk to the students after the class and get feedback from them about what they think of their teacher.If you find a teacher who meets the above criteria, contact them and ask the following questions1. What Are Your Formal Yoga Teaching Qualifications?It is always best to learn yoga from a qualified yoga teacher.Ask your prospective teacher what style of yoga she teaches.Where she trained.How long her yoga teacher’s training course lasted.What subject areas where covered.For example:-Yoga Teacher Training can be anything from a four-week intensive while living in an Ashram (that’s how I gained my Sivananda Yoga Teacher’s Training Course) to 2–4 years of training, or online teacher training courses.Always ask how much practical teaching experience is taught on the course.Also, find out how long your prospective teacher has been personally practising yoga,How often she practices and who inspires her to continue with her training.To stay faithful to her teachings, it is essential your potential yoga teacher has her practice.2. Do You Run Yoga For Beginners Courses?If you are new to yoga or looking to improve your practice, it is a good idea to join a Yoga for Beginners Course.A beginners’ class will be tailored to ensure you carefully learn the foundations of yoga. Generally, Yoga for Beginners Courses is between 6 and eight weekly sessions of 60–90 minutes each. Different studios offer various levels of teaching – beginners, intermediate, advance.In these situations, it is best to have a chat with the teacher before you sign up to find out what level of “skill” they are teaching in their class.3. How Many People Attend Your Class?As an advanced beginner, look for a class that isn’t too crowded—between five to fifteen students is ideal.A smaller class allows the teacher to get to know you, observe your practice and make appropriate adjustments to your technique.Plus, a lower number of students enable you to get to know your fellow yogi students and ask questions at the end of a course.4. What Time Do You Hold Your Class And Where Do You Hold Your Class?Knowing what time and where the classes are held is crucial.All too often students start a course without really working out how they will fit the course into their current personal and work schedule.From experience, many people prefer to take a class on the way to or from work, or a class which is near your home.Anything too far, difficult to reach or held at an inconvenient time for you will be harder for you to start and integrate into your daily routine.5. How Did You Get Into Yoga?Ask your potential yoga teacher whether he has a niche or focus.Some teachers prefer to teach beginners while others focus specifically on more advanced students, children or pregnant women.If you have any health needs or disabilities, this initial conversation is the ideal opportunity to see if your teacher can adapt the sessions to your needs.By talking, you will also find out more about his style of teaching, his overall health and wellness philosophy and any other quirks he may have so you can gauge how comfortable you feel learning with this teacher.Once you have this information, it becomes easier for you to find a yoga class suited to your health and wellness needs.Even though you might get the answers to the above questions,You still have a role to play.To maximise your enjoyment of your yoga class, it is vital you pay attention to the following practice guidelines and safety tips.1. Treat your body with respect, care and love.2. If you have a medical condition, always check with your doctor to make sure yoga is suitable for you.3. Wear comfortable clothing that won’t restrict your movement or get in the way when you practice the postures.4. Never practice on a full stomach. Allow at least 90 minutes after eating before you start your class.5. Listen to your body and move into each position slowly and carefully.6. Practice yoga barefoot. Being barefeet enhances your sense of being in a pose.7. Do not compare and compete with anyone, even yourself, in the class.8. Focus on your breathing as you move in and out of your poses.9. Do not hold your breath in postures. Focus on breathing slowly and smoothly through your nose as you practice. Some breathing practices, such as Alternate Nostril Breathing, encourage you to hold your breath. When the time is right, your yoga teacher will guide you through this. Some poses and sequences in Kundalini advocate exhaling through your mouth; again your yoga teacher will advise you about this.10 Exhale as you stretch into a pose.SummaryAs you can see, regardless of your level of skill and ability in yoga, there are still lots of subtle factors to be aware of to ensure you have a safe and enjoyable yoga lesson.Take your time when choosing a new teacher, follow the above practice guidelines and safety tips and remember, when the student is ready the teacher will appear.Have fun and enjoy your yoga practice.