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An Integrative Approach
Integrative medicine, such as massage and acupuncture, provides another health care option for patients.
By JoAnn Guidry - Friday, January 27, 2017
At its heart, integrative medicine is about collaboration.
Centered on the patient-practitioner relationship, integrative medicine focuses on the whole person while making use of all evidence-based appropriate therapeutic approaches, health care professionals and disciplines to achieve optimal health and healing. This can include combining state-of-the-art conventional medical treatments with complementary healing systems and therapies, such as acupuncture, yoga, tai chi, massage and meditation.
Although the awareness of integrative medicine has grown in recent years, it is not a new field. The Academic Consortium for Integrative Medicine & Health was established in 1999 with eight founding members. Today, the organization, which is comprised of academic health centers and health systems in North America, boasts 69 members. Its membership roster includes such high-profile institutions as Duke University, Mayo Clinic, Harvard University, Cleveland Clinic, Stanford University and the University of Arizona.
The University of Florida Health System’s Integrative Medicine Program, which recently marked its three-year anniversary, is also an ACIMH member. The program provides in-patient care at UF Shands Hospital and an outpatient clinic at the UF Health Medical Plaza.
“Integrative medicine has recently become a cultural buzz term. But in its basic form, it’s been around for centuries,” says Dr. Irene Estores, who serves as medical director of the UF Integrative Medicine Program. “Integrative medicine takes into account body, mind, spirit and lifestyle. The patient-practitioner relationship plays a critical role. It’s a collaboration of all the pieces of the health care puzzle.”
Estores’ medical specialty is physical medicine and rehabilitation, having completed her residency training at Johns Hopkins Hospital and Sinai Hospital. She completed her integrative medicine fellowship at the University of Arizona Center for Integrative Medicine, the nationally recognized program founded by Dr. Andrew Weil, who is considered a pioneer in the field. Estores is also a medical acupuncturist, having received her initial acupuncture training at the University of Miami Center for Complementary and Integrative Medicine.
“We treat outpatient and inpatients in the UF program that range from those who are relatively healthy to those in the end stage of cancer,” says Estores. “People also seek treatment for various quality of life issues, like stress, anxiety and chronic pain. Integrative medicine, which is not condition specific, can address all these issues.”
UF Outpatient Clinic
At the UF Integrative Medicine Program outpatient clinic, patient assessments are performed by a physician with training and experience in integrative medicine. The physician obtains a full medical history, performs a physical exam and also assesses the patient’s emotional, mental and social well-being. A treatment plan is then developed in collaboration with the patient. Recommendations may include the use of dietary supplements and botanicals, as well as changes in eating and physical activity. Mind-body procedures such as acupuncture and massage may also be recommended. In addition, referrals may be made to practitioners of other healing systems, such as traditional Chinese medicine, Ayurveda (a holistic medicine system from India) and homeopathy.
“At the outpatient clinic, we offer massage and medical acupuncture,” says Estores, who practices medical acupuncture. “We base our recommendations on scientific evidence. One modality works better for a certain condition or health goal, while another is more appropriate for a different situation. That is why the assessment is important and why the practitioner-patient relationship is even more important. We have a better chance of achieving the health goal by working together.”
Estores notes that “while some health insurance companies do cover the cost of massage and acupuncture sessions, many other complementary modalities are not covered. Patients then have to pay out of pocket, and this is a health care choice.”
But Estores is hopeful that these barriers can be overcome and is optimistic about the future of integrative medicine.
“We are hopeful that integrative medicine will continue to grow as more people become aware of it,” says Estores. “We would like it to be available to as many people as possible as a health care choice.”
UF Shands Hospital Patients
In-patient assessments are carried out by a registered nurse or practitioner with training and experience in integrative medicine. A treatment plan is developed in collaboration with the patient and their primary care medical team. Recommendations made to patients may include massage, yoga, tai chi, qigong, meditation/relaxation and hypnotherapy, all of which can be done with the patient in the bed or bedside in a chair. Thanks to grants and benefactor donations, the complementary services are provided at no cost to the patients.
“The patient demand greatly outpaces our current staff of complementary practitioners,” says Lauren Arce, who serves as the UF Health Integrative Medicine nurse coordinator, managing the hospital-based services and the wellness center. “We have to limit the number of patients we are serving at any one time to about 20. We like to do two sessions per week per patient.”
The program’s priority focus is on adult and pediatric oncology, heart and lung transplant, cystic fibrosis and palliative care patients. Massage is the most requested complementary therapy, which is the specialty of licensed massage therapist Andrew Hix.
“Massage is a great tool to help patients coping with pain and illness to manage their pain and stress,” says Hix, who is also a tai chi and qigong practitioner. “Most patients are looking for some relief, some relaxation. The type of massage I practice is very light, very slow. I consider it a form of connective tissue and neuromuscular massage. Sometimes I use a modified Swedish massage, using gentle compressions.”
Hix calls the work “very rewarding to help a patient and make their day just a little bit better.”
Arce adds, “We regularly survey our patients and have found that as high as 98 percent have a positive outcome with complementary therapies, would do them again and would recommend them to others.”
A Complementary Therapy Sampling
Massage:This modality involves manipulation of the muscles and connective tissues to enhance their function while promoting relaxation and well-being. In integrative medicine, sessions are structured around patients’ needs and goals, such as pain management, increased circulation and sensory-motor stimulation.
Acupuncture/medical acupuncture: An ancient Chinese healing practice, acupuncture is a method of encouraging the body to promote natural healing by inserting needles at very precise acupuncture points on the body. The modern scientific explanation is that acupuncture stimulates the nervous system, which releases chemicals into the brain, spinal cord and muscles, and influences the body’s internal regulation system. The National Institutes of Health states that acupuncture is proven to treat pain. Medical acupuncture is the term used to describe acupuncture performed by a doctor trained and licensed in conventional medicine and who has also received acupuncture training as a specialty practice.
Tai chi: It originated in China as a martial art and is often described as “meditation in motion.” It is a traditional system of low-impact, slow-motion movements paired with deep breathing for physical, mental and spiritual health. The movements can be adapted or practiced while walking, standing or sitting.
Qigong: Pronounced “chi kung,” qigong is translated as “breath work” or “energy work.” Related to tai chi, qigong usually consists of breathing techniques combined with gentle, slow movement and focused intentions to help relax and mobilize the body’s flow of energy.
Yoga: A combination of breathing exercises, physical postures and meditation, yoga is used to calm the nervous system while balancing body, mind and spirit.
Meditation/relaxation: In meditation, the focus is on attention while suspending the streams of thought that normally occupy the mind. Relaxation refers to a group of techniques that combine breathing and focused attention to calm the mind while consciously producing the body’s natural relaxation response. The two modalities can be used separately or in tandem.
Hypnotherapy: Practitioners of hypnotherapy create a state of focused attention during which consciousness is altered and distractions are blocked. This enables people to focus deeply on one thing, promoting relaxation and reducing pain and stress. Some scientists believe that hypnosis causes the brain to release natural painkillers. Other scientists think hypnosis works through the unconscious mind and the power of suggestion.
Want to Know More?
UF Health System’s Integrative Medicine Program
National Institutes Of Health/National Center For Complementary And Integrative Health
Academic Consortium for Integrative Medicine & Health
Sources: ufhealth.org/integrative medicine; nccih.nih.gov; health.usnews.com
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