Acupuncture and Integrative Medicine
Marin Independent Journal
Marin hospitals are taking an integrated approach with acupuncture
By Keri Brenner
IJ reporter
Monday, April 12, 2004 - Nurse Lisa Crespo's back pain started on her last day of work before New Year's Eve.
"I was lifting a patient to help assist him in getting back to bed," said Crespo, who works in a medical surgical unit of Novato Community Hospital. "I made sort of a twisting motion, and I felt a twinge in my middle and upper back."
In January, after pain pills, muscle relaxants and a cortisone shot all failed to provide much relief, Crespo decided to try acupuncture. She didn't have to go far.
Crespo's acupuncturist was a fellow hospital employee: Pat Sanders, a nurse practitioner and licensed acupuncturist at Sutter@ Work, an occupational medicine clinic at Novato Community and at Marin General Hospital in Greenbrae.
With the introduction of acupuncture into a hospital setting, Marin is at the forefront of a growing national trend called "integrative medicine." A blend of conventional and non-conventional therapies, integrative medicine is expanding into major hospitals across the country - including Duke University Hospital in Durham, N.C., Memorial Sloan-Kettering Cancer Center in New York and Cedars Sinai Medical Center in Los Angeles - as research becomes available on applying alternative and complementary therapies to clinical practice.
"I was amazed at how well it worked and relieved the pain," said Crespo, who still is receiving regular treatments. "I actually believe in traditional medicine, where you take a pain pill if you're in pain, but the fact that you could stick a needle in and relieve pain, this is great."
Sanders, who started treating outpatients at the two Marin Sutter hospitals with acupuncture in March of last year, is the first full-time nurse practitioner/ acupuncturist on staff. At Kaiser Permanente Medical Center in Terra Linda, licensed acupuncturist Elon Rosenfeld has been on staff for two and a half years, said Patricia Kendall, medical group administrator.
"A lot of people who are sent for acupuncture have been in pain for a long time, and nothing helped, so they really appreciate when it works," said Randee Allen, director of Kaiser Terra Linda's physical therapy department, where acupuncturist Rosenfeld is based. "It can be a life-changing thing for some people - they couldn't walk to the bus stop before, and now they can. It's a big thing for them."
Sanders was hired as a nurse practitioner at the two Marin Sutter hospitals in October 2000. An acupuncturist in private practice for more than 18 years, Sanders began developing the hospitals' acupuncture program protocols in December 2001. Approval for the program - which included reviews by more than a half-dozen hospital boards and committees - took more than two years after that.
Sanders primarily treats people with workplace injuries, such as Crespo. Those are patients with job-related conditions who are referred to the occupational health clinic, Sutter@Work, and who are covered by their employer's workers' compensation insurance.
This year, Sanders opened up the service to members of the public as well.
"The doctors were very excited," said Patrick Glover, director of Sutter's occupational health department, of Sanders' work. "Here was this actual nurse practitioner who also does this (acupuncture) - it helps her credibility in the physician community."
This summer, the occupational health clinics at the two Sutter hospitals will be consolidated into one facility at the new Sutter Terra Linda Health Plaza, planned for a 75,000-square-foot building at 4000 Civic Center Drive in San Rafael.
The Sutter hospitals also include acupuncture as a treatment option through the Institute of Health & Healing, a program operated in partnership with the California Pacific Medical Center in San Francisco. Licensed acupuncturist Andy Seplow treats outpatients on a part-time basis at the institute's Marin office at 5 Bon Air Road in Larkspur.
Unlike Sanders, Rosenfeld works out of the Kaiser Terra Linda physical therapy department, not at Kaiser's 10-year-old occupational health clinic, called Kaiser On the Job. Acupuncture through Kaiser On the Job - as well as at the physical therapy department - is done on a referral basis from the patient's primary physician, Kaiser administrator Kendall said.
Although acupuncture use in hospitals is on the rise, most of the country has been slow to pick up. A May 2003 American Hospital Association survey found only 16.7 percent of 1,005 U.S. hospitals queried were using any form of complementary or alternative medicine in 2002.
Area experts say acceptance is slow in some places, because the mixture of a 5,000-year-old Eastern philosophy with conventional Western medical theory is, by nature, a challenge.
For starters, Eastern and Western medical theories are quite different from each other, said Karen Reynolds, an acupuncturist in private practice in Walnut Creek and San Francisco who is also a registered nurse at Kaiser in San Francisco.
Eastern medical theory is based on diagnosing various patterns within the body, mind and spirit of the patient, while Western theory tends to be based on diagnosis by symptoms, Reynolds said.
"What the lay public doesn't understand is that Oriental medicine treats many things, not just pain," Reynolds said. "Oriental medicine treats digestive and gynecological problems and shen (spirit) disorders - such as depression - and it is immensely effective."
Reynolds, a board member of the California State Oriental Medical Association, notes that difficulties in translation also slow the process of integrating Oriental Medicine into Western clinical practice.
"Since it's new in this country, and a lot of the research is from China and Japan, there's a barrier to getting the research and it's hard for the American Medical Association to endorse it fully," she said.
Even though Kaiser has staff acupuncturists at all its Bay Area medical centers, Reynolds said she didn't apply for the positions because she knew she would not be treating the full range of conditions that she is able to treat in private practice.
Sanders, at the Marin Sutter hospitals, also acknowledges that she has had to make accommodations. Sanders said she is trained in Chinese herbology, but does not use it with her Marin hospital outpatients because Oriental medicine herbal treatments would be too difficult to arrange in a hospital setting.
She also doesn't do moxabustion, an herbal heat treatment, in the hospitals for the same reason, but does employ a special heat lamp that works in a similar manner. She also uses an electronic microcurrent stimulator device that is easy to control in a hospital setting.
"I try to keep things simple," Sanders said.
At Cedars Sinai Medical Center in Southern California, however, many barriers to integrative medicine have dissolved. Evan Ross, a licensed acupuncturist on staff at Cedars Sinai since 2001, said he sees 90 to 100 inpatients and outpatients a week for everything from stroke hemiparesis - or partial motor impairment - to post-chemotherapy nausea and vomiting.
"I just did a lecture to the liver transplant team," said Ross, 34, who received staff privileges at the hospital in January of last year. "They're thinking of using acupuncture in surgery, for post-op pain, and for nausea, vomiting and bowel problems, post-op, for patients who don't tolerate medicines and drugs."
Ross, whose specialty is "integrative oncology" for treating cancer patients, is called in regularly by patients' primary physicians for acupuncture consultations.
"I go in the ICU, I go anywhere in the hospital," he said.
Dr. Martin Rossman of Mill Valley, who in 1972 was one of the first Marin physicians to begin practicing acupuncture, called the introduction of acupuncture in hospitals "wonderful."
"Every step like this brings us closer to a real integration of acupuncture and Western medicine," said Rossman, a founding member of the American Academy of Acupuncture. "I don't think it matters where a person gets treated - it's more important whom they get treated by, the person's qualifications, their experience."
According to Nicholas Broffman of Pine Street Clinic, an Oriental medicine facility in San Anselmo, the fact that Marin hospitals are adding acupuncturists is a reflection of the county's progressive attitudes.
"In terms of Western openness to Oriental medicine, it's probably higher in Marin than elsewhere, compared to other smaller suburban counties," said Broffman, whose father, Michael Broffman, is clinic director and a licensed acupuncturist.
Nicholas Broffman said Pine Street, since its inception in 1982, has had an integrative medicine approach, working closely with Western physicians.
"When we started, there were about five acupuncturists practicing in Marin, but now there's about 175," Broffman added. "Certainly, Marin is at the forefront of integrative medicine."
Contact Keri Brenner via e-mail at kbrenner@marinij.com
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