Integrative Health…It’s Not Alternative Anymore

Jennifer Norden, MDMaggie Boyd, LAc

Allieson Mirsberger, LMT

Integrative Health VisionTo offer both conventional and integrative medicine and wellness services to promote optimal health, prevent and treat disease, and meet each patient’s unique physical, emotional and spiritual health goals.

Focus is on supporting the body’s healing potential.

“Let food be your medicine, and medicine be your food.”

- Hippocrates, 5th century BC

• The American Cancer Society estimates that one-third of cancer deaths could be prevented with healthy nutrition and healthy weight.

• Another one-third prevented by not smoking.• Two-thirds of cancers can be prevented!

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Pills - Vitamins & Supplements“Natural” does not mean safeNot a substitute for a healthy lifestyleVitamins through food is best because of phytosynergy

$28 billion per yearVitamin D 800 to 2,000 IU qd

Reliable Resources Consumerlab.com for reliable brands

- $30 per year National Center for Complementary

and Alternative Medicine - http://nccam.nih.gov/

UW Integrative Medicine web site - http://www.fammed.wisc.edu/integrative/modules

Micromedex

Breathing Exercises to Calm the Nervous System

Exhalation should be longer than the inhalation. One breath approximately every 10 seconds. Activates the parasympathetic nervous system -

the resting, digesting and connecting.

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Ancient mind-body practices involving gentle movement with mental focus, breathing and relaxation.

Improves balance.Reduces back and knee pain.

Improves quality of life in those with chronic illness.

Tai Chi and Qi Gong

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It isn’t a religion. It isn’t relaxation. It isn’t an attempt to stop thinking or have only positive thoughts.

It doesn’t eliminate sadness or rough patches from life.

It doesn’t require huge chunks of time.

What Meditation Isn’t…….…

What is Mindfulness?“Mindfulness means paying

attention in a particular way; on purpose, in the present moment,

and non-judgmentally.”

All we have is the present moment –

Everything else is imaginary!

Neuroplasticity – The Brain Can Change!

Meditation Programs for Psychological Stress and Well-Being: A Systematic Review and Meta-Analysis Included 47 trials with active controls, 3,515 participants,

(meditations: MBSR, MBCT, MM, TM).Moderate evidence mindfulness meditation improved

anxiety, depression and pain compared to nonspecific active controls.

Meditation was equal to specific active controls (those with known benefit) - meds, exercise, behavioral therapies.

Minimal side effects! JAMA Intern Med. 2014;174(3):357-368.

A Mind-Body Program for Older Adults with Chronic Low Back Pain

JAMA Intern Med 2016:329-337

Functional improvement significant at eight weeks, but not sustained

Pain levels improved at eight weeks and six months

45 percent of MM group (versus 8 percent of control) reported much or very much improvement at six months

Back pain for 12 years 140 patients in

mindfulness meditation 142 patients in health

education program, “10 keys to healthy aging”

Eight weeks followed monthly for six months

Resources Local classes – Health Resource Center at St. Agnes Hospital

(formerly Journeys), Fond du Lac Center for Spirituality & Healing, YMCA, Inner Sun - Oshkosh, Lotus Root Yoga - Ripon

UCLA Mindful Awareness Research Center - free podcasts, guided meditation

http://www.dartmouth.edu/~healthed/relax/downloads.html Centerhealthyminds.org Phone apps for relaxation practices and guided meditations

include: Insight timer Headspace Stop, breathe and think Mindfulness training app

Acupuncture…Does it Hurt? Usually painless but occasional sharpness. Needles stay in place for 10 to 30 minutes. Sometimes electrical stimulation of

needles. Mild euphoria or drowsiness after

treatment is possible. Occasionally pain gets worse initially. Mild bleeding, bruising are possible. Rarely a hematoma.

Typical Course of TreatmentNumber of treatments required is dependent

on chronicity of concern.Typically one to two treatments for acute

concerns, and 10 to 15 for chronic.Usually has lasting effects.Sometimes requires maintenance treatments.

Insurance CoverageAs with any of our service lines, it is important that you contact

your insurance provider to inquire about coverage.

Medicare and Medicaid never cover acupuncture, even with a supplement.

NHP covers acupuncture for headache, neck pain, back pain and chemo-related nausea, OA of the knee.

Sisco, Cypress cover for chronic pain. United, Cigna, Anthem sometimes covers

acupuncture.

Our cash prices - $75/session, $325/ 5, or $600/ 10

Massage TherapyNIH-NCCIH concludes that evidence points to benefit for: Chronic pain - back, neck, OA,

labor pain Mental health - reduces

depression and anxiety Cancer - reduces pain and anxiety Fibromyalgia - improves pain and

fatigue HIV/AIDS – improve quality of life

Cupping TherapyCreates suction and vacuum pressure to skin Soften tight muscles and tone

attachments Loosen adhesions and lift connective

tissue Bring hydration and blood flow to

body tissues Move deep inflammation to the skin

surface for release Drain excess fluids and toxins by

opening lymphatic pathways.

ChiropracticNIH-NCCIH concludes that spinal manipulation

can help relieve low back pain.Can help with migraine, neck pain and joint

discomfort.Evidence is inconclusive for fibromyalgia, PMS,

TMJ and sciatica.Probably not effective for

asthma, hypertension or menstrual pain.

Acupuncture for Chronic Pain Individual patient meta-analysis of acupuncture for

chronic pain, 29 studies.Pain conditions - Nonspecific musculoskeletal pain, OA,

headaches, shoulder pain.Bottom line: Acupuncture is associated with improved

pain outcomes compared with sham-acupuncture and no-acupuncture control, with response rates of approximately 30 percent for no acupuncture, 42.5 percent for sham acupuncture and 50 percent for acupuncture. Acupuncture for Chronic Pain.Vickers, Andrew; Linde, Klaus JAMA.

311(9):955-956, March 5, 2014

How Does It Work?Traditional Chinese Medicine theory:Acupuncture points located on

meridiansPromotes flow of qiBalances yin-yangRestores balance and harmony

Inserting Needles Into the Body: A Meta-Analysis of Brain Activity Associated With Acupuncture Needle Stimulation

The Journal of Pain Volume 14, Issue 3, March 2013, Pages 215–222

Changes in brain reflect responses in areas associated with sensory, cognitive and affective dimensions of pain.

WHO-Orthopedic Conditions

WHO - Other Conditions Appropriate for Acupuncture Treatment

Clinical GuidelinesDiagnosis and Treatment of Low Back Pain:

A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society

For patients who do not improve with self-care options, clinicians should consider the addition of non-pharmacologic therapy with proven benefits, including:Spinal manipulation for acute low back pain Intensive interdisciplinary rehabilitation for chronic or

sub acute low back painExercise therapy, acupuncture, massage therapy, spinal

manipulation, yoga, cognitive-behavioral therapy or progressive relaxation.

Acupuncture for Migraine Prophylaxis

Cochrane Database, 2016: 22 trials with 4,985 patients. Positive response - 50 percent

reduction in number of headaches. Usual care for acute headache - 17 percent had 50 percent

reduction Preventative medications - 46 percent at three months,

54 percent at six months Sham acupuncture - 41 percent of patients True acupuncture - 57 percent at three months, 59 percent at

six months Acupuncture patients had fewer side effects than medication

patients.

Points to RememberAcupuncture is an ancient practice that has

withstood the test of time. Integrative health is more than conventional

medicine plus acupuncture needles or vitamins.Mind-body practices are evidence-based, safe,

and empowering for patients.Resources are available for your patient -

integrative health, behavioral health, population health referral, Health Resource Center.

Thank You.Questions?