Alternative, Integrative, Holistic… Patient Advocates Can Help You Sort Through The Confusion

The term “Alternative Medicine” is frequently used incorrectly. The true definition is ‘any non-conventional intervention that is used INSTEAD OF conventional treatments, NOT in conjunction with them’. This article does a good job of distinguishing and explaining many terms like alternative, complementary, holistic, and integrative. It also discusses several non-conventional modalities- acupuncture, yoga, massage, etc.

What Is Alternative Medicine?

Christine Huang Contributor

Anah McMahon, L. Ac. adjusts one inch seirin acupuncture needles in the muscles around the spine of Mariah VanHorn to relieve lower back pain, Monday, Sept. 24, 2007, at the Pacific College of Oriental Medicine in Chicago. Researchers at Ruhr University Bochum in Bochum, Germany, found that both real and fake acupuncture perform much better than conventional care for low back pain relief.

Acupuncture is an effective form of alternative medicine that has proven to treat over 20 conditions including depression, hypertension and stroke, according to clinical studies conducted by the University of California San Diego Center for Integrative Medicine. (Spencer Green/AP)

If you’ve ever stretched out on a yoga mat or popped a probiotic, you may be part of the growing segment of the U.S. population that uses non-conventional therapies to treat medical problems.

Complementary and alternative medicine, sometimes referred to as CAM, is an umbrella term for a vast array of treatments that fall outside conventional Western approaches. Some have been well-studied and proven to be effective; others have not.

Although labels like “alternative medicine,” “naturopathic medicine” and “integrative medicine” are often casually used (and misused), each term refers to something specific and different.

Here are eight common terms used in non-conventional approaches to medicine and what researchers and practitioners say about them.

According to the National Center for Complementary and Integrative Health, actual alternative medicine is very rare. The organization defines alternative medicine as any non-conventional interventions that are used instead of conventional treatments, not in conjunction with them. Interventions like yoga, acupuncture, herbal remedies and massage therapy may be alternative treatments, but are considered alternative medicine only when they’re used in place of conventional treatments, explained National Center for Complementary and Integrative Health Deputy Director David Shurtleff.

Complementary Health Care

Complementary health care refers to alternative treatments used in conjunction with mainstream treatment.

Using acupuncture in conjunction with standard pharmacological treatment of osteoarthritis of the knee, for instance, is a form of complementary medicine that has been proven to be more effective than the conventional treatment alone.

Shurtleff noted that some non-conventional practices eventually become accepted as part of standard, conventional care. “As the practice becomes more codified, as people start to request it, as evidence starts to become more solid as far as the efficacy…it can become more mainstream,” he said, pointing out how chiropractic care was once considered complementary medicine, but is now part of conventional care for certain people, including veterans.

Integrative Health Care

Integrative health care can be defined in several ways, but “all involve bringing conventional and complementary approaches together in a coordinated way,” according to the National Center for Complementary and Integrative Health.

“Integrative [health care] is a philosophy of how we take care of the patient,” said Melinda Ring, clinical associate professor of medicine at Northwestern Medicine’s Osher Center for Integrative Medicine. “It is an approach that looks holistically at the patient, including all aspects of their lifestyle, their community, their environment, in addition to physical and emotional aspects of their health.” The goal is to seek to address the roots of illness, not just the symptoms.
Natural Health Care Products

Natural health care products are nutritional or dietary supplements, including herbs, that are not vitamins or minerals. The NCCIH reports that the most common natural product used by adults in 2012 was fish oil. Other popular natural products include melatonin, echinacea and probiotics.

Many natural products have not yet been sufficiently studied or scrutinized. According to the NCCIH, more research is being done to determine the efficacy of different supplements.

“Some of the earlier studies were not so well designed,” Ring said. Researchers may not have used the right parts of certain plants or used incorrect dosages. “It’s hard to get conclusive data when these studies are looking at different aspects of things, and not always looking at things the way they’ve been used traditionally.”

Timothy Mitchison, professor of systems biology at Harvard Medical School, said that standardizing herbal medicine so each batch has the same amount of active ingredients is a challenge.

Patients seeking natural products should consult a licensed health-care practitioner before using nutritional or herbal supplements, particularly when using them alongside pharmaceuticals, since interactions can occur.

Mind-Body Approaches

According to the National Institute of Health, mind-body medicine focuses on the way emotional, mental, social, spiritual, experiential and behavioral factors affect physical health.

Mind-body approaches include yoga, tai-chi, chiropractic and osteopathic manipulation, meditation, massage therapy, and relaxation techniques like biofeedback therapy and progressive relaxation..

“In the West, the notion that mind and body were separate began during the Renaissance and Enlightenment eras,” the NIH reports. “Increasing numbers of scientific and technological discoveries furthered this split and led to an emphasis on disease-based models, pathological changes and external cures. The role of mind and belief in health and illness began to re-enter Western health care in the 20th century, led by discoveries about pain control via the placebo effect and effects of stress on health.”

Today, practitioners of Western medicine are becoming increasingly aware of the connection between mind and body. In a story for The New York Times last year, Dr. Dhruv Khullar, a resident physician at Massachusetts General Hospital and Harvard Medical School, described the risks to physical health associated with social isolation, which might have once been dismissed as an exclusively mental experience.

Studies are now underway to determine whether practices like loving-kindness meditation can effectively train the brain to better cope with stress and emotions.

Acupuncture

Acupuncture, one of the most widely studied non-conventional treatments, involves stimulating various points in the body with needles.

“Clinically, acupuncture is helpful for people who have symptoms and conditions that are made worse by stress, which is most chronic conditions,” said Mel Hopper Koppelman, an acupuncturist and the director of Evidence Based Acupuncture, in an email. “This is partly to do with its effect on quickly rebalancing the autonomic nervous system as well as its role on the hypothalamus, the part of the brain that regulates hormones and the stress response.”

According to the University of California San Diego Center for Integrative Medicine, clinical studies have shown acupuncture to be effective for over 20 conditions including depression, hypertension and stroke. There is limited, but probable, evidence to support the use of acupuncture for dozens of conditions and diseases from opium and tobacco addiction to Tourette Syndrome.

Helene Langevin, director of the Osher Center for Integrative Medicine at Brigham and Women’s Hospital and Harvard Medical School, said that more research is needed to answer other questions about acupuncture, such as whether the location at which needles are placed makes a significant difference. “If we observe different effects of acupuncture when using different combinations of acupuncture points, it is hard to know whether this relate[s] to aspects of Traditional Chinese Medicine theory (like Yin and Yang), or to different nerves being stimulated at the locations that are being compared,” she said in an email.

Naturopathic Medicine

According to the American Association of Naturopathic Physicians, naturopathy draws on traditional, scientific and empirical evidence. Jaclyn Chasse, the president of AANP, said naturopathic physicians are different from Naturopaths, Chasse warned. “Naturopath is not a protected term,” Chasse said.

Unlike Naturopaths, Naturopathic physicians are licensed as primary care providers in many states and receive four years of training in both Western pharmaceutical medicine and other therapies, including nutrition, herbal medicine, homeopathy, physical medicine like osteopathic manipulation, and counseling.

Chasse said most naturopathic physicians prefer to try non-conventional treatments first because conventional treatments are generally restricted to prescription drugs and surgeries. Naturopathic medicine offers more options, she said. “I think there are a lot more tools in our toolkit.” Contrary to popular belief, she added, naturopaths are not against Western medicine.

Traditional Chinese Medicine

Traditional Chinese medicine incorporates a number of treatments, including acupuncture, herbal medicine, cupping, and moxibustion, which involves burning mugwort to improve the flow of energy, or qi. Other techniques often used include tuina, a form of massage, and guasha, in which the practitioner scrapes a part of the body for therapeutic purposes. Practitioners are certified by the National Certification Commission for Acupuncture and Oriental Medicine or the California Acupuncture Board.

“Chinese medicine is essentially a 2,500-year clinical trial,” said Dr. David Miller, a Chicago-based doctor who is board-certified in pediatrics and traditional Chinese medicine.

When properly practiced, Chinese medicine is “very systematic in its thinking,” Miller explained. Before he began studying Traditional Chinese medicine, Miller said his treatment options for patients were limited to pharmaceuticals, reassurance or referral. “Chinese medicine gave me a whole range of treatments that could be appropriated before moving to more extreme stuff that western medicine has to offer.”

Homeopathy

Homeopathy is the practice of treating illnesses based on the “law of similars,” which says that substances known to cause certain symptoms can also be used to used to treat those symptoms when used in extremely small doses, said Ronald Whitmont, president of the American Institute of Homeopathy. A 2005 study suggested homeopathy may be beneficial in the long-term care of patients with chronic illnesses.

Homeopaths use “medicine specifically formulated from natural substances that are usually extremely dilute,” Whitmont said. Medications are “prescribed on an individual basis on the holistic totality of the patient’s personal, physical, and emotional attributes.”

Whitmont explained that for a certain substance to be considered homeopathic medicine, it must not only adhere to the “law of similars,” but also be prepared in a way that’s approved by the Homeopathic Pharmacopeia of the United States.

Clarified on July 12, 2017: This article has been updated to clarify the definition of alternative medicine.

Tags: health, health care, medicine, alternative medicine, supplements, acupuncture, mental health, patients, yoga

Resilience and Self-Care

Resilience isn’t just for dealing with the tough times.  We can learn and build new ways of facing personal and professional challenges.  Consider these strategies…
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How to Build a Stronger Work Life: Reconsider Resilience

Dr. Marla Gottschalk

I’ve often wondered why building resilience isn’t a key business imperative. Because being human, is often at odds with work life. Our work can routinely bring stress, negativity, setbacks and outright failures — and we are challenged to employ strategies to combat the effects.

We often frame our conversations about resilience with stories of extreme hardship or extenuating circumstances. However, resilience could serve as an ever-present, daily mentor — helping us to rebound from the collected pressures of work life. Most of us forge on, taking little note of the collected toll.

This can be a serious mistake.

Through all of the trials and tribulations, we rarely notice that our psychological resources are waning.We muddle on. We develop idiosyncratic mechanisms to bolster our mood and maintain motivation. However, the damage can accumulate and we become less able to bounce back. Months later, we may realize that we still lament the project that has been cut, laid off co-workers or failing to land an important client contract and our energy levels are affected. When the next event unfolds, we find ourselves essentially bankrupt. Devoid of the necessary resources to meet the challenge.

There have been a number of discussions on the topic, including protecting ourselves from overload, banking positive currency and practicing self-compassion. However, what if we could take resilience one step further? Could we effectively build our skills (and our team’s skills) in this area — just as we challenge our muscles in the gym?

Can we learn to think and act more “resiliently”?

Well — yes. There is evidence that resilience can be learned. The work of Dr. FredLuthens (who explores the construct of Psychological Capital) has completed research examining this area which could be fostered by organizations and shared with their employees. Supporting research completed completed by Ann Masten also provides foundational elements. This includes addressing 1) asset factors (elements that enhance our resilience, such as a stable home life or a healthy way to examine failure), 2) lowering risk factors (for example, a lack of a mentor) and 3) altering our perceptions concerning the potential to influence work life circumstances.

Here are a just few ways to apply this knowledge to our daily lives:

  • Facilitate network building. Building long-term asset factors, provides a stable foundation to help us deal with stressful work situations when they do arise. Consider losing a job for example; stronger networks can help employees move on more effectively by providing access to critical information concerning roles and growth needs.
  • Clarify strategy and goals. Reducing risk factors — elements which weaken our psychological safety net, is also vital. For example, knowing “why” we are completing a task and how our role contributes to outcomes is critical. If we fail to believe that our actions have meaning, we are less likely to forge on.
  • Utilize the “staunch reality” viewpoint. One scenario that quickly depletes psychological resources, is sticking to a game plan that is simply not working. Understanding that we have the ability to influence outcomes by embracing realistic assessments of workplace situations — can help us to prepare. This honest view is necessary to review history, properly identify setbacks, evaluate potential impact and brainstorm possible responses before they occur.
  • Aggressively focus on strengths as a “vaccine”. We can mitigate the negative after effects of stressful events, with a focus on positive elements. This includes the identification and utilization of an individual’s stronger vs. weaker skill sets. A focus on the latter, can quickly deplete our psychological reserves.
  • Explore the sources of “drain”. The elements that drain our psychological reserves can be varied (and often surprising). Consider the sources that affect you and meet with your team to determine where the leaks are occurring. Brainstorm actions to stem the tide.

How do you build (and protect) resilience for yourself or your team? Share your strategies.

Health Professionals as Patients: Collaborating for Our Holistic Health

A new advocacy client of mine is a MD.  His stress levels have been off the chart, and his self-care skills negligible.  As a RN Patient Advocate, I helped navigate his 1.5 week hospitalization, and was present for his discharge to home.  I’ve suggested an anti-inflammatory diet, acupuncture, and guided imagery.  He’s agreed to everything, and is researching other complementary modalities.  Keep an open mind, and recognize that “other” licensed providers have ethical modalities that aid in our whole-person well-being.  Connect and collaborate for our collective health!

kevinmd.com

What it feels like to be a patient from a doctor’s point-of-view

Anonymous | Conditions | November 3, 2016

For the first couple of years of medical school, the constant stream of exams and the anxiety that came along with each one seemed never-ending. I told myself that it was worth sacrificing my personal health to better the lives of others.

I put off addressing my own mental health needs to keep advancing to the next level of education. I let stress manifest itself in new ways that my body wasn’t used to. I compulsively ate away my feelings with total disregard to both my physical and mental health. I was diagnosed with polycystic ovarian syndrome (PCOS) and became pre-diabetic by the end of my first year. I thought to myself “everyone goes through things like this during medical training. I’ll lose the weight next year”.

Another year went by and along with it came a new diagnosis. I started having terrible headaches that were different from the migraines I had become used to. I became preoccupied with my headaches. If I wasn’t in overwhelming pain, I was having anxiety about when my next headache would occur. After going through months of diagnostic imaging studies and to various physicians, I finally found a cause to my pain. By the end of my second year, I developed a medical condition known as idiopathic intracranial hypertension or pseudotumor cerebri.

My neurologist said that if my headaches weren’t well controlled, I could lose my vision. The pressure in my head could even get so bad that it could cause my brain to herniate if severe enough. It was a huge wake-up call. It’s hard to say how much medical school played a role in the development of my condition, but my headaches and instances of increased intracranial pressure have correlated highly with my stress level.

Making steps towards leading a healthier life by implementing exercise into my daily routine and identifying stressors has improved my symptoms greatly. The process of being a patient has taught me empathy for the patients that so often feel dismissed in our health care system.

A physician recently took the time to research the effects of the anti-inflammatory diet to augment the medications for my condition. The fact that he went above and beyond to provide me with an alternative to the medications that have been failing me for the past few months made me feel cared for. I invite health care professionals to take the extra 5 minutes to examine the current research and alternative modalities to medicine being used to treat your patient’s condition. It can make a huge difference in their quality of life.

My call to action to other graduate students struggling with chronic diseases and mental illnesses during their training processes is this: take care of yourself. You can’t take care of anyone if you’re dead. Your health is worth saving. Ask for help when you need to and advocate for what you believe in.

The author is an anonymous medical student who blogs at Naked Medicine.

American Holistic Nurses Association http://www.ahna.org/

I’ve been a member of the American Holistic Nurses Association since the 1980’s, an organization that grew out of the need to heal the healer and prevent nursing burn-out.  AHNA emphasizes the holistic needs of the health professional – through self-assessment, personal development, and stress management.  Holistically caring for ourselves (body, mind, spirit) is an absolute prerequisite before effectively caring for others.

http://www.ahna.org/

PROVISION 5: SELF-CARE FOR NURSES

“The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth”.  That’s Provision 5 of the Code of Ethics for Nurses with Interpretive Statements (American Nurses Association, 2015 revision).  Holistic self-care (mental, emotional, spiritual, physical, environmental, social) is an ethical and professional responsibility equal to a nurse’s professional development.

You’re probably acquainted with nurses who focus on caring for others (patients, family, friends) more than caring for themselves.  It would be preferable to see them as role models for wellness, having balanced lives, emotionally healthy, and practicing personal safety.  If you’re a health care leader, there are ways for you to help and support nurses engage in self-care practices.  For example, are you offering flexible scheduling, adequate staffing, liberal PTO, continuing education, no mandatory overtime, professional recognition, pay raises, and well deserved break times in comfortable break rooms?  Nurses don’t work in a vacuum, and other health fields encounter similar problems:  burnout, stress and fatigue, bullying, lack of focus/motivation, compassion fatigue, and increasing hierarchical demands.  What are each of us doing to promote and support the health and well-being of ourselves and others?  Remember!…when caregivers are cared for, employers and patients benefit, too.

Stephanie Frederick M.Ed., RN and Jennifer Reich PhD, RN offer retreats for health professionals:  Shifting Our Spirits: Balancing Our Lives Through Creative Strategies.