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Integrative Medicine: A Local Look


Posted on January 28

Photography by Roy Wilcox

There is conventional medicine, there is alternative medicine, and today, increasingly, there is what many are calling the best of both worlds: integrative medicine.

It might mean sipping green tea while taking Tamoxifen if you’re a breast cancer patient, or meditating along with medicating when you’re nursing an injury. Distinguished from alternative in that it means “in combination with” instead of “in place of,” integrative also means using evidence-based treatments that are safe and effective, according to the National Center for Complementary and Alternative Medicine.

So now that we’ve got the definitions out of the way, here’s the best part: Even the mainstreamers are starting to get on board. While most are still in the baby steps stage, you can find integrative practices being used in all of the Sacramento region’s “big four” health care systems.

We took a look around. Here’s what we found.




SUTTER: A Leader in Integrative Care

If you happen to visit the Sutter Center for Integrative Holistic Health in Davis on staff meeting day, you might find director Ron Cotterel, M.D., and his team sitting in a meditation circle.

This group of mind-body-spirit healers not only talk the talk, they walk the walk. Among them are an art/dance/movement therapist, a mindfulness counselor, a qigong therapist and a chiropractor.

Their kind and gentle leader, Cotterel, is a family practice physician with additional training in nutrition and herbal medicine. His holistic health evaluations go beyond taking the conventional medical history to include “every aspect of a person’s life that impacts their health,” he says, such as spiritual beliefs and family relationships. Cotterel believes in the power of having patients tell their “story”—and he believes in the power of hugs. He says he feels fortunate “that Sutter lets me do what I do.”

Patients such as Jennifer Shaw also feel fortunate for that. “[Cotterel] basically saved my life,” says Shaw, 44, a local attorney.

Five years ago, Shaw was experiencing tingling in the arms and legs “and a weird heaviness—I couldn’t figure out what it was.” When her doctor threw out possible diagnoses of fibromyalgia, multiple sclerosis and Lou Gehrig’s disease, she hit the wall. A yoga teacher recommended Cotterel, and off she went. “When I sat down in his office and he asked for my story, I just burst into tears,” she remembers. After lab tests indicated what Shaw calls an “astronomical” yeast count, Cotterel’s diagnosis was leaky gut syndrome, a condition many mainstream docs pooh-pooh. Her life was turned around, she says, by a multifaceted approach including dietary changes, acupuncture, a mindfulness-based stress-reduction class and counseling. “The interdisciplinary, whole-person approach totally works,” Shaw says.

At the Sacramento branch of Sutter Center for Integrative Holistic Health, director Maxine Barish-Wreden, M.D., leads an equally eclectic, ever-growing team of practitioners, including a spiritual counselor, a naturopath and a Rolfer. Also included on the practitioner list: Millie and Hazel, facility dogs, who can be found spreading their waggy warmth around the pediatric unit at Sutter Memorial.

Fondly known as “Dr. Max,” internist Barish-Wreden bangs the drum loudly for holistic health, with an emphasis on lifestyle changes and prevention. She’d sooner recommend fish oil, fitness and fun for a patient combating cholesterol, prescribing pharmaceuticals only when necessary. “Holistic integrative medicine focuses on prevention and on the natural capacity of the human body to heal, especially when we create the environment we need in order to heal,” she says. Nutrition, fitness, mind-body practices, work and community involvement can all play a part, she says.

Integrative medicine, Barish-Wreden believes, is the future of health care.
“With its focus on prevention and self-responsibility, I believe it is the only thing that will save our health care system from completely collapsing in the future,” she says.


KAISER Kicks It Up a Notch

Hillary Campbell, M.D., used to feel out of her element when pa-tients posed questions about the Chinese herbs they were taking.

“Patients a lot of times know more than the doctors because they’re the ones reading about these things,” says Campbell, an internist at Kaiser Permanente in Sacramento. “I realized I needed to learn.”

Campbell enrolled in a yearlong herbal medicine course. It was a great awakening.

“I realized herbology and other alternative therapies do have something to offer,” Campbell says. She now serves as one of Kaiser’s alternative medicine gurus, spreading the word to other doctors and encouraging them to offer complementary therapies in their practices, as she now does.

The mammoth health maintenance organization began moving into integrative medicine about a decade ago, according to Campbell. “The thought was not to have a separate alternative medicine department, but to integrate it with Western medicine so physicians could offer one together with the other seamlessly,” she says.

Kaiser’s surprisingly wide range of offerings includes everything from acupuncture, chiropractic and biofeedback to classes in mindfulness, meditation and qigong. On its website, kp.org, patients can download more than 25 guided imagery programs addressing everything from stress reduction to healthful sleep. At its pharmacies, Kaiser carries a handful of natural supplements that have been found safe and effective, such as melatonin, echinacea, saw palmetto and St. John’s wort.

“Safe and effective” is always the key, says Campbell, adding that it’s important to check for possible drug or food interactions when taking supplements and herbs. (Just because it’s natural doesn’t mean it’s safe.)

Data-driven M.D.s may initially resist far-out (to them) therapies, she concedes, but once given sufficient evidence, they do come around.

“I do want to stress that doctors are interested,” Campbell says. “They’re coming to me and asking for information. The biggest challenge is getting the information out to them, because they’re so busy.”

Skeptical patients may wonder how likely it is that their mainstream doctors will get hip to the new beat. But Campbell, for one, is confident. “I know they will,” she says. “I know they will.”




UC DAVIS: Ramping It Up

“Integrating the integrative” seems to be the next step for UC Davis.

“We’ve already got some of the important components of an integrative medical program,” says Craig McDonald, M.D., a physical medicine and rehabilitation specialist at UC Davis Medical Center. Patient care at UCD is already collaborative, with doctors from different camps working together. But the hope, he says, is to move toward a “more centralized” approach to integrative medicine.

Acupuncture is high on the list of complementary modalities currently used at UC Davis, McDonald says. Holly Zhao, M.D., of the physical medicine and rehabilitation department, says she’s been using the needle-based treatment for patients for the past six years, with good results. “I get lots of referrals [for acupuncture] from both UCD and within the community,” she says. “When they try other modalities and don’t get satisfactory results, they ask for acupuncture along with other therapies. It increases range of motion.” Rotator cuff injuries, osteoarthritis and frozen shoulder are among typical problems she treats.

Mindfulness and similar alternative therapies also are being used in conjunction with more conventional treatments, notes UCD psychologist Debra Fishman. A patient with back pain, for example, may be treated “not only with surgeries or medication, but with other therapies, such as techniques for managing anxiety and worry,” she says. “It’s important for patients to understand we are trying to treat them as a whole person. Things are moving toward more integrative instead of ‘either/or.’”

Tai chi classes have also been offered through UC Davis, adds Zhao, and there has been talk of adding Pilates and yoga to the mix. “We’d like to formalize that, and place these classes in a central location,” she says.

Though they’re still working to integrate the integrative, McDonald says, they’re moving in that direction.

“I think complementary and alternative treatments are gaining acceptance in the medical community, and that we are increasingly going to see these treatments in practice,” he says.


At MERCY’s Caring Center, Complementary Is Complimentary


On Wednesday evenings at Mercy Hospital in Folsom, a miraculous thing happens. Around 6 p.m., two large classrooms are magically transformed into a makeshift clinic, complete with treatment tables and a waiting room. When the patients arrive, the show begins, with practitioners offering massage, reflexology and other forms of healing touch between 7 and 9 p.m. At the evening’s end, the equipment and materials are put away until the next curtain rises.

It’s called the Caring Center, and perhaps the most caring part of all is that services are free. (It’s run by volunteers, and anyone can attend.)

“Many of our patients may not otherwise be able to afford these types of treatments,” says center coordinator Marcia Taylor-Carlile, a registered nurse and therapeutic touch practitioner who helped to start the center when it opened nine years ago.

The impetus behind the center, says Taylor-Carlile, was not only to provide a vital service for patients, but to spread awareness of lesser-known modalities and educate patients on the role of complementary care.

“Massage is pretty standard—most people know what massage is all about,” she says. “But many people may not have had experiences with other kinds of body work, such as acupressure or craniosacral therapy. This is a safe environment where people can come and try these things and find out if it works for them.” No invasive therapies (such as acupuncture) are offered, she adds.

For Vickie Feld, who suffered from chronic pain after a 2003 car accident left her with severe nerve injury, the center represented the last glimmer of hope. “Even after surgical procedures, I couldn’t sleep because of the pain,” remembers Feld, 46. After seeking help elsewhere and finding she couldn’t afford it—“You usually have to be rich, or have super-duper insurance, to get any kind of integrative care,” she says—she heard about the center’s free services and gave it a try. After nearly a year of treatments including Reiki and craniosacral therapy, her condition improved so dramatically that she was able to return to work. The experience led to a personal metamorphosis, inspiring Feld to become a licensed massage therapist. In addition to maintaining a private practice, she volunteers at the Caring Center, where Taylor-Carlile calls her “one of our best practitioners.” 

Chronic-pain sufferers and cancer patients contending with the side effects of chemo or radiation are frequent visitors to the center, says Taylor-Carlile. Others are simply seeking relief from anxiety and stress. “There’s a lot of anxiety going around these days, especially in this economy,” she says.

While the center represents Mercy Hospital’s only formalized foray into the integrative fold, Taylor-Carlile suggests that Mercy’s approach is inherently holistic. “The Mercy philosophy has always been, because of the Sisters of Mercy, the mind-body-spirit philosophy,” she says. Mercy Hospice’s SOUL (Source of Unconditional Love) program, also volunteer-run and offering terminally ill patients a little love in the form of visits with furry four-legged friends, may attest to that. 



Paying for Complementary Therapies: Don’t Count on Insurance

If you’re seeking complementary care, be sure to ask about costs. While some hospitals featured in this story offer free care—Mercy’s Caring Center is one, and Sutter offers some services, such as art therapy, at no cost—by and large, it’s not often covered by insurance.

“Some insurance plans cover these services, some do not—it depends on what you’ve signed up for,” says Maxine Barish-Wreden, M.D., director of the Sutter Center for Integrative Holistic Health in Sacramento. “In the future, I suspect a lot of us will have PPO insurance plans with very high deductibles, and that we will be paying for both traditional and alternative therapies out of pocket until we meet our deductibles.”

For the time being, patients will have to be patient. “The popularity of complementary and alternative medicine has skyrocketed in the past two decades, but the insurance groups haven’t acknowledged it,” says Ron Cotterel, M.D., Barish-Wreden’s counterpart at Sutter in Davis. “The optimistic part of me wants to think we’re head over heels toward an integrative system of health care. But the reality is that until the finances catch up with what the people want, it can’t happen.”

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Published: Sunday, April 13, 2014