Twice as Strong

WHEN a medical crisis hits, people want to know that someone smart in a white coat can prescribe Prozac to boost their mood, perform heart surgery to open their clogged arteries, or administer chemotherapy, radiation or surgery to cure them of cancer.

But growing numbers of Americans are also eager to experiment with alternative therapies. They take herbs to boost their immunity, meditate to calm frayed nerves and seek acupuncture to combat nausea and pain. Two 1998 studies reported that 42% of Americans use alternative medical therapies to treat their conditions -- and that, in 1997, Americans made an estimated 629 million office visits to complementary therapy providers. A 2002 government survey found that 36% of adults use some form of complementary and alternative medicine, and if megavitamin therapy and prayers for health are included in the list, the number rises to 62%.

A natural tension has long existed between these two kinds of medicine. Western medical practitioners have been wary of the sometimes wacky-sounding, often-untested therapies in alternative medicine’s toolkit. Alternative medicine practitioners have typically operated outside the conventional system, with consumers paying out of pocket.

But over the last 10 years this wall has started, partially, to erode. Aided by federal funds, an increasing number of alternative therapies have been put to Western-style clinical tests, separating ones that seem beneficial, such as acupuncture for relief of pain, meditation to reduce hypertension, or ginger to relieve nausea -- from the chaff that appears ineffective. And conventional practitioners have come to appreciate the effect of the mind on chronic pain, heart disease, autoimmune conditions, anxiety and depression -- even the progress of disease.

About a decade ago, doctors began to be trained in what health guru Dr. Andrew Weil dubbed “integrative medicine,” a new kind of doctoring that combines Western medicine with the best, most evidence-based alternative therapies.

Creating such centers -- and making them cost-effective -- has proved challenging.

Yet today there are an array of such clinics in Southern California. And the interest is growing. A 2003 survey by the American Hospital Assn. reported that 16% of hospitals, including medical facilities at Harvard and Duke, featured integrated medicine centers -- double the number available in 1998.

Here is a look at three successful centers, each -- in different ways -- blending Western medicine with folk traditions and practices from the East.

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BILL COLEMAN SCRIPPS CENTER

‘I was stressed’

Through classes like music, cooking and yoga, the tony La Jolla clinic teaches its heart patients to reflect on, and revise, their everyday lives.

BY the time Bill Coleman arrived at the Scripps Center for Integrative Medicine in mid-2005, he’d been through the wars. His first heart attack struck in 1998, and doctors put three stents in his heart. Two years later, they put in two more.

Then in 2005, a stress test showed he had a blockage in one of the main blood vessels to the heart -- the left anterior descending artery, also known as the “widow maker.” He awoke after an emergency surgery with a total of seven stents in his heart.

Getting the stents was effective and easy -- too easy in some ways.

“It is such a quick fix. It gives you a false sense of security,” said Coleman, 61, who runs an electrical contracting company in Loma Linda. “I didn’t take care of myself. I didn’t make any lifestyle changes.”

His cardiologist at Scripps Clinic -- the mainstream medical facility that the integrative medicine facility is attached to -- told him he was heading in the wrong direction and asked him to consider the integrative center’s Healing Hearts program, designed to stop the progression of heart disease.

More Americans die of heart disease each year than any other illness. Western medical care excels at acute care and trauma: Stenting and bypass surgery are routine procedures. But once the crisis is over, alternative medicine can offer a prescription for prevention and lifestyle change. Many alternative practitioners deal with the more nebulous -- but still, for heart disease, vitally important -- areas of emotion, spirituality and stress reduction, and are generally more eager to focus on low-tech interventions such as anti-inflammatory, low-glycemic index diets.

The Scripps program started after cardiologist Dr. Mimi Guarneri was approached by Dr. Dean Ornish, the celebrity doctor known for showing that coronary disease could be reversed without surgery using a low-fat diet, exercise, yoga, meditation and support groups. Scripps became part of Ornish’s Multicenter Lifestyle Heart Trial, and Guarneri’s clinic grew out of that experience. Scripps Center for Integrative Medicine opened in 1999.

Perched on cliffs above the Pacific Ocean in La Jolla, the high-end clinic feels more like a spa, and makes no secret of the fact that it caters to the rich and well-to-do. Glossy brochures explain that the center is “a physical expression of the mind/body/spirit connection,” and that the “sacred geometry” of the golden mean informs the architecture, just as it does the Taj Mahal and the Great Pyramid of Cheops.

The spiral of the chambered nautilus shell -- an “archetype embedded deep in our collective unconscious” -- adorns the plush carpet and the ceilings. Soft overhead lighting rotates through the “rainbow spectrum” of the seven chakras -- energy centers -- of the body.

The center, which specializes in cardiology and pain management, has built itself into what Guarneri calls a “high-tech, high-touch clinic” with more than 100 people on staff, including doctors, dietitians, yoga instructors, group support leaders, biofeedback specialists, acupuncturists and a hypnotherapist.

From Western medicine, the clinic takes costly, high-end diagnostics such as an echocardiogram machine and a SPECT (single photon emission computed tomography) camera to look at blood flow of the heart muscles. It is one of just 23 places in the country that uses a GE Discovery PET/CT scanner, considered the most definitive imaging device for tracking blood flow to heart muscles. And it uses all the tools of conventional coronary care, such as beta blockers, ACE inhibitors, angiograms and stress tests.

The high-end tests and conventional Western medicine help subsidize low-tech alternative treatments such as acupuncture, massage, biofeedback and hypnosis.

The Healing Hearts program is a 12-week course designed to help patients re-pattern their lives. Patients usually pay $1,800 out-of-pocket for 10 hours a week of classes -- vegetarian cooking, music therapy, yoga, meditation, exercise, stress management -- as well as intimate support group meetings, consultations with a raft of specialists and tests for cardiovascular risk factors, such as blood cholesterol.

More than 1,000 people have gone through the program, Guarneri says, and those who have done it for six months lose an average of 10 to 15 pounds and have an average cholesterol level of 140 (down from 225) upon completion, as well as marked improvements in quality of life, vitality and physical function.

It’s a Monday morning, and Coleman arrives at 10 a.m. Nurses hook him up to a computer and track his heart rate while he rides the stationary bicycle for 45 minutes.

After 15 minutes of stretches with seven fellow patients, the sweaty group -- four men and four women -- troops to a small room for music therapy. All have hearts that may be in trouble: Some have already had heart attacks, others have high-stress lives, high blood pressure or cholesterol, or a family history of heart disease.

They sit in a circle in the music room, around a pile of marimbas, slit bells and drums.

“Did anyone draw a mandala this week?” asks the teacher, Barbara Reuer, a board certified music therapist. Drawing these “sacred wheels,” she explains, is a way for patients to nonverbally express their emotions -- including unhealthful negative and healthful positive ones.

“Name one way you used music this week,” she continues, and the group, heavy on CEOs and Type A personalities, start sharing: One says he’s subscribed to Sirius radio and now listens to music while he works. Another says he listens to music while working out at the gym.

A woman says she hummed a tune when her husband started snoring -- and he stopped.

Then they raise their voices and sing “Healing Journey,” a song they’ve written together, to the tune of “Sentimental Journey”:

“Gonna take a healing journey. Gonna get my heart healthy

Now’s the time to feel so good, gonna give up steak and fries ...”

Small clinical trials have shown that music can help reduce stress and anxiety, make people feel more spiritual or just feel better. One small study even found that drumming can boost the immune system.

“Who remembers the benefits of music?” Reuer asks.

“We are concentrating on music, not on our troubles,” says one woman.

“It brings out the child in me. Like when you discover things when you were really young,” chimes in another patient.

“One half-hour of music-making boosts your immune system,” Reuer reminds the class. “This is about taking responsibility for your health.”

Assistants then roll in a mobile grill for this week’s vegetarian cooking class, “Bountiful Beans.”

Six weeks into the program, Coleman says he’s benefiting most from the group sessions, yoga and meditation -- they’ve given him insights about the cause of his disease, and taught him techniques to quiet his mind. He’s also done some biofeedback, hypnosis and anger management classes.

He says he’s thought a lot about how he ended up at Scripps with such a damaged heart, and has concluded he was there because of his weight -- and, above all, stress. He had a “dad who was an angry guy.” And over the years Coleman’s business changed, so that he was spending less time doing the electrical work he loved and more time managing lawsuits.

“This has brought me heart disease, as far as I am concerned,” he said of his business. “But I am not here to get rid of stress. I am here to learn to cope with it. It is not going to go away.”

When he had checked in with Guarneri after four weeks he had actually gained a pound.

“Do you want to die?” he says she asked him.

But some techniques are paying off. When Coleman wakes up in the middle of the night, he meditates, and is able to get back to sleep. And though at first he found guided imagery classes uncomfortable -- and would sneak peeks at his fellow patients -- that, too, has helped.

“I knew I was stressed, but I didn’t know how badly,” he says. “Now I have ways to deal with it. I think of a good thought when I am stressed. Now I think of my granddaughter: She just turned 1.

“Every time I am stressed, I think of her face. It really helps.”

**

COLLEEN SHAFFER NORTHRIDGE INTEGRATIVE

‘Helping me plow through’

In Dr. Jay Udani’s one-man program, patients learn to cope with the effects of disease through analysis, referrals and plain talk.

COLLEEN SHAFFER, 55, sits in the waiting room of the Integrative Medicine Program at Northridge Hospital Medical Center with two shopping bags full of herb bottles and several magazine articles about “green” remedies that she wants to show her physician.

She is tall and statuesque, with a toned, athletic physique. One would never guess she has terminal breast cancer. She had a double mastectomy in 1999, but the cancer metastasized to her bones in 2002 and her liver in 2003. She will be on oral chemotherapy for the rest of her life -- and she has already outlived her life expectancy by three years.

Today she is here so that Dr. Jay Udani, who runs the Northridge program, can help her boost her immune system and combat the side effects of the powerful chemotherapy medications she must take to stay alive.

The drugs make her feet and hands redden and peel, like second-degree burns, so badly, at times, that she cannot walk.

They cause diarrhea and, once, a severe swelling in her legs.

Her doctors must constantly adjust the drugs so they do not overpower her system. Even so, for every three active days she must plan a day of rest. “I have a chronic disease,” she says matter-of-factly. “I don’t have the stamina. My body will not get better.”

With cancer, the role of integrative medicine is not to cure people, explains Udani, who estimates that one-third of those he sees are cancer patients, referred to him by the oncology department at Northridge Hospital Medical Center. His role is to reduce the side effects of the drugs without interfering with chemotherapy, radiation or surgery.

Whatever “side” patients are on -- fiercely anti-Western medicine, or single-mindedly committed to conventional treatment -- Udani sees his role as teaching them to take from the other side.

The Northridge Integrative Center opened in 2001. Originally housed within the walls of the medical center, it has moved across the street to an older building within walking distance of the main complex. Udani was recruited from an integrative program at Cedars-Sinai Integrative Medical Center that was unable to run in the black.

This center caters to neither the affluent nor the uninsured. Most of the patients are middle-class Americans struggling to cover any extra therapies they need through their employer health plans or out-of-pocket. Cost is always a concern.

The model Udani designed is a far cry from the opulent “Taj Mahal” model, as he terms it, of Scripps.

Instead, Udani, an internist who is also trained in acupuncture and has conducted research on herbal remedies, runs a one-man show at the hospital and refers patients to trained and licensed specialists in the community -- massage therapists, guided imagery specialists, support groups and yoga teachers that either he or the hospital have vetted and chosen for offering high-quality, affordable, treatments.

It’s a model he terms a “virtual integrative medicine center.”

Shaffer says she is skeptical of alternative medicine. But she was at a point where she was willing to try anything. Before Udani, she visited another alternative doctor, but she left because his treatments were “out there.” He sold “special” formulas of vitamin C for $1,100 a month and once had her stand on a platform holding a metal cylinder while he scanned her with low voltage electricity to test if her body was accepting the supplements she was taking.

“It wasn’t very scientific,” Shaffer says.

She likes Udani because he is a licensed internist, affiliated with UCLA and uses treatments with research to back them up. She knows certain herbs he recommends may not be covered by insurance, but that regular visits are -- and that matters to her.

On this day, she is here for a vitamin analysis. Six weeks earlier, Udani drew her blood and sent it to a lab that looks at the white blood cells related to immune function: Many cancer drugs impair patients’ immune systems, and he uses herbs and vitamins to try to get their bodies stronger.

“The test guides us to which herbs and vitamins we need to increase,” says Udani, examining the results. He points to two lines: They reveal that Shaffer is deficient in vitamin B12, glutathione, Coenzyme Q10 and selenium.

“Are you still on Xeloda?” he asks as they sift through the bag of herbs together. Yes, Shaffer says, she’s still taking the oral chemotherapy drug. Udani says he had wanted her to have more B12 but worries it would interfere with her cancer medications.

Certain herbs, in small trials, have been found to boost the immune system and white blood cell count, without interfering with chemotherapy drugs. In one Chinese trial, astragalus -- used in China for more than 2,000 years to increase “protective energy” around the body -- improved length of survival when added, along with ginseng, to a regimen of chemotherapy to treat small cell lung cancer.

The two run through Shaffer’s bag and adjust her herb and vitamin doses. Astragalus and selenium to boost her immune system, fish oil and curcumin as anti-inflammatories; vitamin C, green tea extract, Coenzyme Q10 and more, including milk thistle and magnesium to manage the side effects of her chemo.

Shaffer peppers Udani with questions: She seems to know almost as much about herbs, medications and research as he does. He listens quietly, and answers. They talk of her migraines and some back pain from an earlier spine injury. Udani presses his fingers against her shoulder and neck, finds her trigger points -- the sensitive spots in her body -- and inserts acupuncture needles to relieve her.

“My oncologist is keeping me alive,” says Shaffer. Udani, she says, looks at the whole picture. Along with the supplements and acupuncture, Udani has recommended counseling and a biofeedback machine to help manage her stress. When a number of friends died of cancer last year, Udani “knew it would affect my health.”

Throughout talks and doctor’s appointments, Shaffer speaks authoritatively, energetically and openly about her disease and chances for survival. But when pushed, her voice momentarily falters. “When I go to get my CT Scan or get my labs back, you better believe that, even though I try not to think of it, I am praying,” she says. “I am just trying to think of something positive.”

In May, Shaffer was encouraged to learn that she no longer has cancer in her bones, though it’s unknown why. “Metastatic cancer has not had a good survival rate,” she says. “I’m a pioneer. I am here today because of new technology and because of how integrated medicine is helping me plow through this.”

**

MARK HERNANDEZ VENICE FAMILY CLINIC

‘I feel human again’

The free clinic’s pain program is familiar to many patients who practice folk medicine.

IN a conference room fitted with a worn carpet and functional chairs, two doctors, a social worker, an osteopath, seven acupuncturists and five chiropractors sit around a generic institutional table discussing the day’s patients.

“Mark Hernandez is a 48-year-old Hispanic man who was recently been diagnosed with diabetes,” says Todd Plymale-Mallory, a student of traditional Chinese medicine. “He has pain in his shoulder. He has had steroidal injections, some Vicodin and is awaiting orthopedic analysis.... He has a liver and kidney yin deficiency.”

It is grand rounds at the Venice Family Clinic’s new multidisciplinary chronic pain clinic -- and everyone at the table is speaking a different language. The acupuncturists speak of the body in terms of yin, yang and energy flow, in phrases that sound like poetry.

The chiropractors, highly technical, speak of the body like master engineers. And the doctors speak in physician shorthand, tossing about multisyllabic Latin names.

Dr. Mary Hardy, codirector of the integrative medicine clinic, is a conventionally-trained physician who specializes in botanical medicine and has studied some oriental medicine. She translates.

The Venice Family Clinic, the largest free clinic in the country, is the first such facility to offer integrative medicine to the poor and uninsured. Wedged onto a tiny plot of land in Venice on the border of the Oakwood community -- a rapidly gentrifying low-income community -- the second-floor waiting room of the nondescript building is crowded with children, parents and grandparents, many of whom speak only Spanish.

Rooms are small, clean and functional. The free clinic is not a supplement to these patients’ medical care. It is their medical care, covering everything: chicken pox, depression, herniated discs. The chronic pain clinic -- available at two of the Venice Family Clinic’s seven sites -- helps people with few options.

Hernandez, a handsome man with a big chest, found his way here this spring.

The former bouncer was horsing around with his daughter about a year ago when something happened that “brought me to my knees like 13 toothaches,” he says. The pain got progressively worse. By the time he went to the clinic he could barely use his left arm.

Doctors gave him steroidal injections, put him on 1,000 milligrams of naproxen a day, then 750 milligrams of Vicodin. “The Vicodin took the pain away but there was no increase in my range of motion,” he says.

Hernandez found himself faltering physically and emotionally. He snapped at his daughter and had trouble doing his job as an apartment manager.

An estimated 50 million Americans live with chronic pain. Many don’t seek care because they lack insurance. Others can’t afford or get access to the medications used to treat their conditions -- or they dislike the side effects. Some don’t improve even with all that Western medicine can throw at them.

The chronic pain clinic is part of the free clinic’s new integrative medicine program. It opened in March through a $3-million donation. Patients end up here after physicians refer them, and a team of doctors, acupuncturists, chiropractors and social workers then match patient to treatment. The directors hope that if they can make this clinic work, the model could be replicated elsewhere.

“The misconception is out there that this is something only rich people are interested in,” Hardy says of acupuncture, chiropractic and osteopathy. But some Latino immigrants see this as more like their traditional and folk medicine. “To some degree this is an extension of their own cultures,” she says. Most of the acupuncturists and chiropractors here are advanced students at local schools such as Emperor’s College in Santa Monica, Yo San University of Traditional Chinese Medicine in West Los Angeles and the Cleveland Chiropractic College on North Vermont Avenue in Los Angeles. Overseen by licensed teachers from their respective colleges, they offer their services for free in exchange for the opportunity to work alongside doctors.

“It is like educating a new breed of medical providers,” says Dr. Myles Spar, the integrative clinic codirector. “The alternative medicine practitioners really learn to integrate, they learn western concerns. The Western doctors learn how to examine just like chiropractors.”

An hour after the medical conference, a nurse ushers Hernandez into a small room to see Plymale-Mallory, the acupuncturist. This is Hernandez’s eighth session out of 12.

“Is your shoulder still popping?” Plymale-Mallory asks.

“It’s decreasing the more I do exercises,” Hernandez says.

Hernandez removes his shirt and Plymale-Mallory begins to tap tiny acupuncture needles into Hernandez’s feet, calves, scalp, knees and shoulders. It looks random, but each point, Plymale-Mallory says, corresponds to a trigger point for pain or corrects an imbalance. Twenty minutes later Plymale-Mallory pulls out the needles -- and Hernandez swears he can move his arm farther. He is giddy. Two-thirds of the way through his treatments, he can raise his arm as high as his shoulder, reach back and put his wallet in his pocket, and bathe himself.

“This is nothing to a lot of people,” he says, raising his arm awkwardly to demonstrate his new range of motion. “But now I can do this without tears in my eyes ....I was a mess. Now ... I feel human again.”

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(BEGIN TEXT OF INFOBOX)

A guide to a developing field

Consumers seeking the very best of Western medicine, combined with the safest and most effective therapies of the East, may have difficulty finding a clinic they can trust.

Doctors and alternative practitioners recommend that patients begin by asking local hospitals if they have an integrative clinic or if they can refer them to one. Patients can also ask their personal physicians for a referral. Integrative clinics or practitioners in other cities can also recommend high-quality practices. Patients must then evaluate the quality of a clinic’s practitioners.

* First, ensure that the integrative clinic has a medical doctor. Otherwise, it provides not integrative care, but alternative care.

* Ask for licenses and certifications for all alternative practitioners. These differ by the type of therapy, by state and, sometimes, municipality.

* In fields with state licensing, the California Department of Consumer Affairs (www.dca.ca.gov) can provide information on whether a person is licensed and whether there are complaints against him or her.

* Determine if the medical professionals interact and exchange information with the group. Sharing and coordinating information between everyone who treats the patient is critical. If an alternative practitioner is reluctant to interact with a doctor, doesn’t want to disclose treatments or medical information, or encourages you to avoid medical treatments other than his or her own, beware.

* Ask where doctors and practitioners were trained and how long they have practiced. Training through fellowships, weekend courses or self-teaching is not as reliable as hands-on clinical practice, but keep in mind that this area of expertise is still a work in progress.

* Ask for a list of physicians who refer patients to them. If few, or no, mainstream practitioners are willing to vouch for the clinic or practice, that should be a cause for concern.

* Beware of practices that espouse scientifically invalidated therapies such as coffee enemas to treat cancer. Acupuncture, massage and stress-reduction, on the other hand, have been scientifically studied and found to have some measurable effect. For more information, go to NCCAM (nccam.nih.gov).