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Integrative Medicine

Author: Bonnie Durrance
August, 2018 Issue

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A 40-year old Santa Rosa mom with common, everyday life stress was suffering from migraine headaches so disabling that she would lose work several times a month. “Ordinary medications hadn’t worked,” says Catherine Gutfreund, M.D. The chief of integrative medicine for Kaiser Permanente Santa Rosa, Rohnert Park explains the difference between alternative and integrative medicine. “Alternative medicine is the old term for anything that was not Western medicine. Integrative medicine is now the term to use because alternative medicine gives the impression that it’s something other than traditional or Western medicine,” she adds. “The word alternative is [still] sometimes used, but integrative uses all-healing modalities to treat the patient.” Gutfreund began working with the patient on stress management and education. “She took the mind-body medicine class. She learned meditation [techniques], and I worked with her on her diet, adding supplements that are helpful for migraine prevention.” 

The Santa Rosa mom also began acupuncture treatments. “She gets a headache now and then, but her migraines are significantly improved,” says Gutfreund. 

The approach, seemingly indirect, works. “In treatment for insomnia, we’d be looking not at a sleeping pill but at the foundations of why the patient is not sleeping well and working on the root of the problem,” says Gutfreund. “Or, you may have a teenager with chronic anxiety, so, rather than [prescribing] a pill, you’d look at the foundations of the anxiety, asking the patient how they’re sleeping, how much sugar they’re eating, how much time they’re spending on their cell phones, or whether there is trauma in their background.”

In this holistic approach, the physician-patient relationship is crucial. “I start slowly,” says Gutfreund. “I find out where they are, what is important to them, what their issue is, and then go from there.” For her, integrative medicine can begin with convincing a person to take a 20-minute walk three times a week. When that starts to feel good, she may suggest they look at diet or other aspects of their lives. “It’s basically a partnership with the patient,” she says. “I have learned over my years in medicine that you can’t tell people to do anything. You have to work with them. When they’re ready to take action, they’re going to be much more likely to be successful.”

Health and wellness

Today, hospitals across the country are offering integrative medicine—an approach that is still often described as “holistic,” “patient-centered,” or as having a “focus on healing.” Some hospitals offer therapies unique to the facility. The Center for Integrative Health and Wellness at Marin General Hospital, for example, offers numerous creative classes for cancer patients including “horse therapy” at nearby Miwok Stable. In the classes, patients learn basic horsemanship including grooming, tacking up (putting on saddles and bridles) and riding. Patients say that spending time with these large, sensitive creatures, specially chosen for their gentleness, is relaxing and calming. Being out in the beautiful Marin landscape helps, too.

“I look at integrative health and wellness as complementary,” says Tori Murray, registered dietician nutritionist and director of Integrative Health and Wellness at Marin General Hospital. “It’s necessary when anyone is undergoing any kind of illness, treatment or surgery—to treat the whole person. Each of us heals differently. In conjunction with whatever medication that’s given, patients need support for the whole body. So, we might be treating the body in the radiation oncology department, but we’re also treating the mind and the spirit to make sure they can heal as quickly as possible.” 

Marin General recognizes that the same treatment may not be right for everyone, as needs and inclinations are different. Some patients come to the integrative therapies seeking help for stress or normal discomfort after childbirth: some come for palliative care and end-of-life advanced care planning, while others come for support to help them through cancer treatments, or because help is right down the hall. “We had an employee recently who was having major GI (gastro-intestinal) symptoms,” says Murray. “She went to see our dietitian because they work in the same building. The dietitian looked at her diet and worked with her on a program. In a few weeks, her symptoms were significantly reduced. Something worked. I don’t know what. But something worked,” Murray says. “I hear stories like that all the time.”

Easing cancer treatments

Scientific research proves that oncology patients who embrace complementary therapies while undergoing cancer treatments have better outcomes. “The oncologists were the trend setters,” says Murray. “Research shows that while you’re undergoing cancer treatments, by adding these additional therapies, you can have a better outcome—which is how doctors refer to good, timely healing without complications. The Marin Cancer Care program began by adding nutrition and massage and guided imagery for cancer patients. Then, in 2012, the hospital formed the Center for Integrative Health and Wellness. The doctors, says Murray, didn’t immediately all “buy in.” Typical Western medicine is geared to find and fix a problem. Integrative medicine, geared to holistic health and mind-body-spirit balance as well as diet and exercise, are not usually part of traditional medical school curriculum. “It’s a problem countrywide,” says Murray. “A lot of medical schools even skim over the basics of nutrition.” Meanwhile, seekers of health and wellness have found help in the healing arts—massage, acupuncture, chiropractic and the holistic philosophy of Eastern medicines. Now, integrative medicine is opening up those opportunities to hospital patients and communities. 

A growing program

Treatments for outpatients are starting to expand, and the Marin General Integrative Health program is helping to make this possible. On the inpatient side, patients may be provided massage, nutrition counseling and guided imagery audio tracks which help with relaxation especially before surgery.

“On the outpatient side, we are seeing a lot of growth,” says Murray. “We have acupuncture, massage, nutrition, exercise and more. But, why are we limiting these impactful services to just cancer patients? That’s where we want to grow.”

Some of the outpatient therapies, such as horse therapy need no marketing. “We target to particular patient populations,” she says. “In the horses and healers programs, we haven’t had to market it because we have our pool of cancer survivors and patients finishing cancer treatment and we get four or five people with the first calls we make.”

Most alternative treatments at the hospital are self-pay, except for acupuncture, social work counseling and nutrition counseling. Nevertheless, people come to the Center for Integrative Health and Wellness on their own dime, for the relaxation and well-being and sometimes total relief of symptoms through therapies like Jin Shin Jyutsu.

The power of Jin Shin Jyutsu

Jin Shin Jyutsu is defined as, “the art of the Creator through the person of knowing and compassion,” according to practitioner Corliss Chan, certified massage therapist, who sees patients once a week in the Marin General Center for Integrative Health and Wellness. It is a quiet therapy aimed at supporting wellness by harmonizing the life energy that flows through the body, using hands and breath. It’s an art, she says, because there is no fixed recipe for how to proceed with a given patient. “Five people could come to me, each complaining of headache, but as I feel their pulses––there are 12 pulses on the wrist––and I listen to them, aware that there is a mind-body connection, too. I could take five different approaches because each person is different.”

The immediate aim is to release blocked energy and improve circulation. According to Jin Shin Jyutsu, blocked energy can cause discomfort or illness. “As in other Asian therapies, our bodies contain several energy channels that feed life into all our cells and organs,” says Chan. When one or more of these pathways become blocked, that congesting effect can lead to discomfort or even pain, like a headache. The blockage or stagnation will not only disrupt the local area but will continue and eventually disharmonize the complete path or paths it intersects with, which can lead to illness or even disease if it increases.”

A blocked channel is much like blocked traffic. “Maybe someone has an allergic reaction to all the pollen we’re seeing right now, and the sinuses are swelling. There are multiple pathways that travel through the head, like a freeway system. They go from the head all the way down to the toes, or out the arms. One can feel pain in the head but the head may not be where the energy blockage is,” she explains. “It’s about listening to the person, feeling their pulse, and applying all the information and experience I’ve had to assess where the congestion might be.”

The process appears deceptively simple. “I have a quiet room and people relax,” she says. This is especially important with someone who’s ill or anxious. There are no needles. You lie on the table fully clothed. “Jin Shin Jyutsu is like the exhale, the letting go of what wants to leave the body by harmonizing body and mind,” she says. The result may be relaxation, known to be helpful before surgery or chemo, or it may be a healing intervention to a serious condition.

In many ways, Eastern medicine and Western medicine blend together somehow. Each maintains its integrity in support of the patient. At Marin General, patient navigators, who guide patients through the process of surgery and cancer treatments, will often suggest to a patient who might be getting ready for surgery or chemo, to try a session of Jin Shin Jutsu, massage, acupuncture or nutrition. The relaxation can reduce anxiety and also support blood pressure, so surgery goes more smoothly. Chan mentions a case where a patient had to stop chemo because a low white blood count was causing risk of infection. “After Jin Shin Jyutsu, the patient was re-tested and the blood count had improved and chemo could be resumed.”

Chan says she has found that even taking one of her free Marin General Shin Jin Jyutsu classes, which she gives at the center, and in which she includes some self-help practice, can be helpful. “Recently, a man came up to me after class, and said he had been treated for irregular heartbeat for a very long time, and after the 15-minute exercise class, he could feel his heart rate evening out.” Chan expresses the mystery simply. “It’s a lifelong journey towards self-knowledge and harmony.”

Offering hope

“Sometimes you just have to offer hope,” says Napa chiropractor Douglas Mosher, doctor of chiropractic. “To people who say, ‘I’ve tried everything and I just can’t get any better,’ I say, ‘Well, let’s give this a try. If you don’t try, you don’t know.’”

When someone comes for help, Mosher says he looks at the whole person, trying to see behind the obvious, to get what makes the person tick, to understand what’s going on with the physical structure. “Think of the phrase, ‘Structure affects function,’” he says. “In a building, if the foundation is crooked, the windows probably don’t fit well, the doors probably will stick. When you get the foundation leveled out, the doors and windows will function more appropriately.” He sees the human structure in the same way. If the structure isn’t right, muscles and ligaments and bones don’t function at their optimal ability. “If you can get the structure changed, the function will improve with better structure,” he says. 

In his practice, he’s not limited to bones and backs. He wants to know about the life of the person, about their diet, their sleep habits, their stress levels. “Some people are sick because they’re under too much stress,” he says. “They don’t sleep enough, or they eat a lot of sugar. Their diets are horrible, and they wonder why their digestive systems are upset.”

Like Corliss Chan, he is wise to the physical pathways of pain. “The pain in your knee may indeed be located in the knee, or it may originate somewhere else in the nervous system,” he says. His diagnostic process and his “non-force” process––which he says is a misnomer because there is some very gentle force involved––works to coax the structure back into place where it belongs. For him, as for Chan, the work is an art. “Like massage, sometimes it’s not just in the training, it’s in the natural, innate ability of the practitioner. I’ve seen acupuncture do wonders for people. And I’ve seen people who’ve had acupuncture prior to seeing me and said it didn’t help.” Healing may always be something of a mystery and for him, it’s important to keep an open mind. “Even if I may not understand why someone gets better, they still can get better,” he says. “Even if I don’t understand the ‘why.’” The practitioner of acupuncture might say the same thing.

Chinese medicine

Chinese medicine offers an ancient model for modern times. “Chinese medicine is part of a whole system of life,” says Ned Hoke, doctor of Eastern medicine and licensed acupuncturist, located in Sonoma Valley. “It’s a coherent philosophy of living in the world and is not about fixing problems but about the body as a living, breathing, integrated part of the whole of life. It’s a whole kind of ecology,” adds Hoke, who’s been in practice for nearly 40 years. “It’s a way of living in the world.”

Acupuncture involves the feeling of pulses and placement of needles. People always wonder how acupuncture works. For years, the mystery of its healing power was unknown, but more can be said now. “Acupuncture, in terms of its clinical technology, is now being supported by a lot of basic science,” says Hoke. “Now, people are recognizing that through the introduction of heat or a needle, acupuncture can influence the messaging and electrochemical signaling of the body in ways that are remarkable.” To work as a patient with Hoke is to experience the grace of a healing partnership between the practitioner and the body’s will to be better. He seems to encourage optimism in the body’s own healing power. “I’m supportive of the positive potential of the human form,” he says. “I have faith in the opportunity of wellness. I have faith in the transformative capacity of the cellular structure of our bodies,” he says. “We’re magical beings, and the part of our magic can be a restorative power that’s alive and available to us if we summon it. I think the radiant potential of human existence is a well-honored aspect of living.”

Anyone who’s had a healing experience, from whatever practice or combination of practices, will hear in his words the solidity of experience. “There’s no question in my mind about the magic of life and what I always find myself saying to my clients, who come in and want the technology to be the solution, is that the little technology that I have can give you a hand, but your need is much bigger than my technology. We’re dependent on the magic of your existence and the magic of your opportunity—the magic of your willingness to partake in the opportunity that your life presents.”

When a patient exudes willingness, they’re eager and prepared to take action. Often that involves willingness not just to partner with the practitioner, but willingness to change. “And that means, in some cases, drinking more water,” he says. “For some it means getting a better night’s sleep. For some it means stopping toxic behaviors of one sort or another. So, in other words, to invite the magic in their life, they have to make some changes.”

An integrated approach

The idea behind integrative medicine is to become more inclusive—not to choose one form of medicine over another, but allow different philosophies and approaches of healing to work together. Hoke’s advice illustrates a good way to start. “Many times symptoms are not what we think they are,” he says. “In terms of any kind of significant symptom—you want to be screened. You can get a screening from your general physician, but you can also get a screening from a Chinese Medicine practitioner and screening from a chiropractor. My suggestion is that if you’ve got a mysterious symptom, be screened by all three practitioners.”

The key to alternative or integrative medicine is the focus on wellness, on healing the whole person, and applying, on an individual basis, the benefits of a range therapies, including Eastern and Western techniques and lifestyle changes such as diet and exercise, to complement the traditional medical approach. “We’re looking at lifestyle medicine,” says Gutfreund. “Integrative medicine is for everyone who can take the time to make the adjustments in their lives to begin living in a mindful, healthy way.”

Cryotherapy—a “cool” new therapy

For athletes or those suffering from inflammation, cryotherapy is the growing modality trend rising in poularity. A whole-body cold treatment in which you stand in a chamber enclosed from the shoulders down, while the cold turns up to a below freezing temperature—for three minutes. That is the maximum time for cold benefit, says technician Jakob Diehl, who is licensed by Impact Cryotherapy, manufacturer of the “cryosauna” unit. His small, tidy office, within the Gitali Institute, off First Street in the City of Napa, is equipped with the unit, an oversized fan sucking any released nitrogen into the air, and an O2 sensor that constantly monitors the oxygen in the room.

The therapy, as such, is not medically recognized as “best practice,” but, to the first-time visitor (as we confess to being) seems to have an exhilarating, relaxing effect that has no association with discomfort, once you get used to being in a closed cabinet with a cold hissing going on inside. Diehl, kind, careful and reassuring is in the room at all times, for the client’s safety.

In the cryosauna cabinet, you wear a hospital gown and your extremities are protected from frost burn by gloves and booties, and underwear for men. One benefit, as Diehl describes it, is that the cold helps reduce inflammation. Although cold is a time-honored treatment for pain (ice packs for headache, cold compresses for muscle strain), but this particular treatment, while pleasant, is not medically proven. Nevertheless, he says, “It’s the easiest, most comfortable way to get the benefits of cold.” He compares the benefits to that of an ice bath. But also, in the cryosauna, you don’t step into a freezing unit. Instead, the temperature gradually gets colder while the person is in the unit. “Your body goes into a state of thinking you may have to endure that cold forever,” he says. Mind and body have a disconnect with time. It’s only three minutes. Most first timers are stopped at two minutes. There are no benefits past three minutes.” He is right. Time goes by fast, and you are ready to step out and go on about your day, feeling strangely relaxed and serene.

Diehl says that of the people who come to him for cryotherapy, many are athletes, hoping to see quicker recovery from workouts and injuries. Others come for alleviation of the various results of every-day stress. He reminds us that this is just another form of cold therapy and not to “over-think” it. “We’ve known forever the cold can be helpful to the body, and this is the newest form of cold therapy.”

 

Integrative Medicine Q &A

As a practitioner of both family medicine and traditional Chinese medicine, Jeff Daisin, M.D., is co-medical director of the Institute for Health & Healing and Lead Integrative Physician for Sutter’s Specialty Clinics in San Francisco, Greenbrae and Santa Rosa. He the following questions about integrative medicine.

What are the core characteristics of integrative medicine for your practice?

1. A holistic approach to care. Integrative medicine involves a mind-body-spirit approach appropriate to the individual.

2. A combination of fields, modalities, services which are beyond what one finds in a conventional medical setting including traditional medicine like Chinese medicine (and acupuncture) or Auruveda; manual and somatic therapies like chiropractic, massage, and osteopathy; mind body services including expressive arts, counseling therapies, spiritual care; energy medicine like reiki or acupuncture; nutrition and the list goes on.  

3. An expanded medicinal formulary. Integrative practitioners use an array of nutraceuticals, herbs, botanicals, homeopathic remedies and other natural therapies to support their work.

4. An expanded approach to diagnostics. Practitioners may also use specialized examination techniques—tongue and pulse diagnosis of Chinese medicine, or diagnostic tests to evaluate patients and assist in their care planning.

5. A broader objective of care. The integrative medicine approach moves beyond that of standard care. The focus on getting healthy—on restoration—may even precede other areas needing attention. The most important medicine is always to be found in the individual seeking care.

6. Personalized care. A key aspect important to integrative medicine is the relationship with care providers and the relationship within the care team.

Why seek out integrative medicine?


Integrative medicine includes standard biomedical care plus everything else described above. In that way it’s right for everyone. It’s up to the individual to define the extent of their need, curiosity and commitment to what integrative care offers. If the usual care has not led to satisfactory results or if the components of care aren’t right—trade offs with side effects, the taking of medicines, the idea that one would prefer a more natural approach— an integrative approach offers alternatives. And even when symptoms improve, if there’s a lingering sense that you don’t feel well, that clue adds an integrative perspective and may be valuable.
 


Can anyone benefit from Sutter’s program?


Prior enrollment in Sutter based services is not required. We see anyone regardless of their affiliations with other systems. Integrative medicine is also an entry point for patients into Sutter Health. As noted above individualized and personalized care is always the goal. 


How do you find a family practitioner who is versed in integrative medicine?

Ask for a referral. Many integrative medicine associations have practitioner referral services—identifying practitioners who have certified under their training. There are integrative medicine fellowships that now confer fellow status. It’s true that as a new field many longstanding excellent practitioners are not formally credentialed.



 

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