Real health reform (Part 3 of 4): Integrative care

3) Integrative care:

• As discussed in the earlier post on meditative medicine, we need to shift away from the division between “conventional” and “alternative” medicine. 

• There are cost-effective alternatives to expensive medications and interventions. Andrew Weil said: 

“As long as medicine remains this costly, it’s going to sabotage any system we create. You just can’t do statin therapy and stents and angioplasties on everybody; we can’t afford that. And there are low-cost alternatives to that kind of intervention.”  

The alternatives? Diet changes. Exercise. Stress reduction. 

• Unfortunately, these alternative approaches are often marginalized as “Complementary and Alternative Medicine (CAM),” when they are not complementary or alternative at all, but rather part of simple, fundamental health care. Mimi Guarneri said:

“I used to be called the ‘alternative cardiologist’ because I talked about nutrition, exercise, and stress relief. I thought, ‘Alternative to what? A bypass?’ [Nutrition, exercise, and stress relief] are not CAM, they’re not conventional, they’re basic health care, and they should be available to everybody.” 

• We need to stop calling basic health habits “CAM” when there is plenty of evidence behind them. Not to mention the fact that they are low-cost and have few, if any, side effects. 

• Integrative methods need to be part of medical school training in order to become part of our health system. James Gordon, MD, Director of the Center for Mind-Body Medicine, said: 

“When doctors, medical students, and residents experience these approaches themselves, then it will become part of practice.”

Guest blogger, Alicia Maxwell: My practice through cancer

My practice through cancer 

Alicia Maxwell

On January 16th, 2010 I will be celebrating my two-year anniversary of surviving breast cancer. I was diagnosed with Stage IIA breast cancer at the young age of thirty, finding the lump myself while showering. Needless to say I was shocked because of my age, no family history of the disease, and my overall healthy lifestyle. However, cancer does not discriminate. You cannot control cancer, but you can control how you react to it. My reaction to my diagnosis was to survive and not let this cancer thing get me down. I wanted to continue striving for the things I had planned and continue doing the things I loved. There would be no quitting anything while going through treatment, only modifications. 

My ashtanga practice played an integral role in my recovery, mentally and physically. At the time of my diagnosis, I was just a few poses away from finishing the primary series. I was looking forward to transitioning into second series and gaining a deeper understanding of my practice. As I got closer to treating my cancer, I knew that my practice would have to be modified significantly. My treatment plan included a lumpectomy followed by months of aggressive chemotherapy and radiation. 

The first practice after my diagnosis, I rolled out my mat and worked on quieting my mind. It was difficult. My surgery date was approaching and I needed to prepare for battle. My first vinyasa was the most difficult, thoughts flooded my mind and I was bombarded by every emotion imaginable. By the end of my practice I was calmer and more at peace with facing the challenges ahead. Surgery day came, the cancer was removed from my breast and lymph nodes. But it was just the beginning of my journey. 

The lumpectomy decreased my shoulder range of motion and I had paresthesias in my arm, and pain in my breast. I couldn’t do certain poses and my practice was modified significantly. I felt like it was my very first time on the mat. I was frustrated. As I sat in child’s pose, I let go of my frustrations and took this as an opportunity to find myself in each posture. My range of motion slowly started coming back, thank you sun salutations, and I was getting closer to starting chemo. 

My long silky black hair would be gone. The thought brought tears to my eyes. My hair always seemed to come undone during my practice, sweeping my face, and I would become distracted. Now, it had a completely different meaning. I would begin my practice with my hair long, feeling it brush across my shoulders and face. Midway through my practice I would place my hair in a bun, enjoying the texture of my hair. I just wanted to remember. 

I started chemo and my doctor said my hair would fall out in fourteen days. I noticed a few strands of hair in the shower and on the floor, but wasn’t ready to shave it off yet. On day thirteen, I looked down at my mat and the surrounding floor and my hair was everywhere. I came to terms with losing my hair during that practice. The next time I stepped on the mat I would be bald, but still me. Adorning a vintage scarf, I began my practice. The silkiness of the scarf now brushed my neck and shoulders. I took a depth breath and I was at peace. 

Chemo is tough and it’s the hardest thing I’ve ever had to do, but you get through it. I practiced as much as I could during treatment and it helped keep my body and mind strong. At times I could only do a few postures, leaving the remaining time to meditate and pray. It was obvious to my fellow yogis that I was sick. One day a gentlemen I had never spoken to before approached me after class. He said he dedicated his practice to me. It was such a kind and loving gift, I will never forget it. Just speaking of it now brings a smile to my face. 

My journey benefited from placing my bare feet on the mat and allowing my practice to just happen.

Real health reform (Part 2 of 4): Individualized Care

2) Individualized care

• Providers need to see each patient as a unique human being, not simply as a collection of symptoms.
• This approach requires time and a trusting patient-provider relationship. And, it requires more primary care physicians who are trained to look at the wider picture of a person.
• Brian Berman, Director of the Center for Integrative Medicine at the University of Maryland said: 

“Individualization – what’s appropriate for that person at that point in time – is what integrative medicine is really about. Someone may come in with a symptom, say, back pain. Perhaps as you start to talk with her, you realize she’s not satisfied with her job, which is a big predictor of continuing pain. Then you talk further and learn because she hasn’t been able to exercise and play with her children, her self-worth has taken a beating, and she’s been overeating. And because she’s gained weight, she has inflammation within the body that perpetuates that pain,"...  it’s really the whole person – mind, body, and spirit – that is out of balance.” 

Caitlin White Guest Blogger: Epsom salt hypotheses

Caitlin’s findings on our Epsom salt question! Thank you, Caitlin (and Caitlin's mom)!

So I asked my mom (high school chemistry teacher) for any ideas she had on why bathing in Epsom salt/magnesium sulfate is supposedly so healthy. 

Here is what she hypothesized: 

1) Magnesium is a cofactor for a lot of enzymatic reactions in the body (including enzymes used for detoxification). It is also a component of synovial fluid. 

2) Sulfate binds heavy metals more avidly than magnesium, so theoretically would exchange magnesium for a heavy metal it came in contact with. When sulfate binds a heavy metal it becomes insoluble and precipitates out of solution (which would drive the reaction further towards completion). 

3) The super-saturated salt bath acts as a disinfectant (similar to honey because they are both hypertonic solutions) on open wounds by lysing bacterial cells. 

Number 1 seems plausible to me since your skin can definitely absorb nutrients/chemicals, so I guess bathing in magnesium sulfate would increase the amount you have available in your body? Number 2 seems a little far-fetched, since I don't know that we really carry a lot of heavy metals in our body (any of you know about this?), and Number 3 also definitely seems likely... but I wonder if frequent baths would change your natural skin flora for the better or the worse? 

Also, during her "research" she said she stumbled upon an article on the benefits of fasting combined with vigorous exercise (she is always giving me a hard time about practicing yoga on an empty stomach). Apparently this combination promotes detoxification because a lot of toxins are stored in fat cells (where they can hide out for long periods of time), but when you fast, your body is forced to metabolize fat to provide energy, thereby releasing the stored toxins to then be metabolized or excreted in your sweat. I wonder, should I be showering immediately after yoga to wash off my sweat then, otherwise these toxins will be reabsorbed through my skin if I don't?

Real health reform (Part 1 of 4): Health care, not disease care

I read a great article in Body & Soul magazine on the future of medicine, where they interviewed several leaders in the field of integrative medicine.

“Somewhere beyond the endless health-care debates could lie real reform: A future where we – an our doctors – will take a more balanced approach to keeping ourselves well...” 

There are 4 main parts to this, but today I’ll just address the first...

1) Health care, not disease care

“We don’t have health care: we have disease care.” ~ Mimi Guarneri, director of the Scripps Center for Integrative Medicine 

• Our health system is good for emergency care – heart attacks, strokes, trauma, and serious infections – but not great for keeping people healthy in the first place. 
• The preventive care provided is not really prevention. Guarneri said, “Prevention isn’t having a mammogram… Prevention is eating an anti-inflammatory diet rich in greens and whole grains and exercising.” 
• The current fee for service structure reimburses physicians for providing treatment. Physicians should be reimbursed for their time teaching about prevention and lifestyle change. 
• Medical schools need to expand their curriculum to teach about nutrition, exercise, and stress reduction. Andrew Weil, founder of the Arizona Center for Integrative Medicine, said: 

“There should be a course on the body’s healing system, on all the mechanisms from DNA on up, by which it can self-diagnose, repair, regenerate, and adapt… It seems odd to me, when you look at the NIH, that there’s really nothing there about health: it’s all about diseases… and that’s representative of what’s off in our whole way of thinking about the body.”

Some notes on second series

Great second series workshop with David this weekend… I am incredibly sore!

David described second series as a “wild” series… while primary is very grounding and introverted with a lot of forward-bending, second series is more energizing and extroverted with a lot of back-bending and opening of the spine. He said this is why when people start second series they notice changes in their energy levels, and especially trouble sleeping.

I wonder why back bending has this effect -- more blood flow and oxygen to the spinal cord stimulating the sympathetic nervous system? Or maybe compression of adrenal glands and stimulation of cortisol release? Any other ideas?

A perfect way to start the year

Awesome led primary class this morning at the new Y2! A perfect way to start the year.