It’s just not running smoothly,” you tell your mechanic about your car’s performance and its bumpy start-and-stop ride. “Well, I can do this, and I can do that,” the mechanic replies, “but when did you last….” Yup, you haven’t driven mindfully, added quality oil or given it the other care that an owner of such a big purchase should be committed to doing on a regular basis.
Let’s move from the body shop to your body. What are your roles in your own health care, both when you are ill and when you’re feeling well? What are the roles of healthcare providers in helping you be a partner in your well-being? Enter integrative medicine, sometimes termed complementary therapies, some of which have been around for thousands of years. A number of practices in the Capital Region use integrative or complementary approaches.
There’s an increasing amount of discussion and interest in integrative medicine but with that, comes some confusion about the nature of these therapies. MD Anderson Cancer Center, based in Houston, Texas, provides this definition:
“Integrative medicine is an approach to health care delivery that balances complementary health approaches and lifestyle medicine with conventional medicine in a deliberate manner that is personalized, evidence-informed, and safe. Complementary health approaches refer to natural products (e.g., dietary supplements, herbals), mind and body practices (e.g., meditation, yoga, massage, acupuncture) and other systems of care such as traditional Chinese medicine, Ayurvedic medicine, or naturopathy.” [Inside Integrative Medicine, December 2018]
Key phrases here include combining conventional and complementary approaches, the use of scientifically evidence-based safe methods, and a plan that is personalized for the individual’s conditions. Further, the complementary therapies are identified in an integrative approach under the guidance of healthcare professionals.
Let’s meet some of the Capital Region’s integrative practitioners and learn how and why they developed their practices and what approaches they take.
Stram Center for Integrative Medicine
The emergency room can be a window on ills and injuries. There, healthcare providers see acute health conditions where the focus is treatment for an injury, episode of illness, or an urgent medical condition, such as heart attack or stroke. Patients with situations stemming from chronic or longer-term illness may also present there when a problem flares up.
The emergency department is where Ronald Stram, MD, could be found earlier in his career. With a quarter century of work as a board-certified emergency physician, he saw a need for a preventive and holistic approach to care to help “reduce the debilitation associated with chronic disease so often seen too late in the emergency setting.” A fellowship followed for Dr. Stram with the world-renowned integrative medicine physician and educator Andrew Weil, MD, and then the founding of the Stram Center for Integrative Medicine (90 Adams Place in Delmar) 17 years ago. More than 10,000 patients have been seen there over the years.
“The mission was to create an integrative medicine approach. No one individual is equipped to handle the human condition,” he explained. In addition to Dr. Stram’s care, the Center includes nurse practitioners, acupuncturists, nutritionists, massage therapists and healthcare providers in other complementary therapies. Patients with chronic disease may be experiencing poor quality of life—nausea or fatigue, for example—because of their condition or from the side effects of treatment, such as chemotherapy. That’s where the complementary therapies, in coordination with the conventional treatment, can make a difference in an individual’s wherewithal to life’s activities.
Patients coming to the Stram Center are asked a range of questions, from lifestyle, to what and when they eat, their sleep, activity, behavior, changes in routine or feeling of well-being, and more, during a 90 – 120-minute session. There may be a look at such areas as hormonal issues and toxicity testing, too. Seeking the root of the problem, “we throw out a big net,” Dr. Stram explained. This is a critical element in creating a very personalized plan for improvements that may involve therapies or actions by the patient, such as diet or activity. “We consider patients to be partners and help them navigate their health.” Follow-ups look at the status of health, such as cognition, digestion, sleeping, and level of pain.
Since the Center opened, Dr. Stram noted, patient awareness of and interest in seeking an integrative medicine approach have increased. The public discussion of opioids also has raised interest in integrative medicine’s approach to pain management through the use of other therapies and reduction in reliance on pharmaceuticals.
The patient composition also has shifted over the years. There’s been an increase in the number of male and pediatric patients at the Stram Center. It’s now about 50 percent each male and female. Last month, three families from Europe were visiting the Center for health services.
Amy Cole, ND, was on a pre-med path in college when she encountered health problems. The various medications were producing side effects. A visit to a naturopathic doctor resulted in her feeling better and sparked thoughts of a career in that field. She went to the University of Bridgeport, one of seven accredited naturopathic schools in North America. Dr. Cole maintains her Elevate Naturopathic offices at 407 Albany-Shaker Road, Loudonville, and Bennington Center for the Healing Arts, 160 Benmont Avenue, Bennington, VT.
The Council on Naturopathic Medical Education, the accreditation agency for doctoral programs in naturopathic medicine in the U.S. and Canada, defines naturopathic medicine as “a system of primary healthcare that blends modern scientific knowledge with traditional and natural forms of medicine … such as nutrition, lifestyle counseling and botanical medicine—to promote wellness and treat illness.”
Dr. Cole holds a license as a naturopathic physician in Vermont. New York State currently does not offer ND licensure, so the Latham location provides consultation services using naturopathic principles to help support body, mind and spirit, and referral as appropriate to other healthcare providers. In some cases, she noted, a patient may be coming to the office with a diagnosis and is seeking naturopathic approaches to aid in living with that problem, such as migraines.
Her patient consultation, preceded by an extensive questionnaire, takes about 90 minutes to listen and learn about the individual’s symptoms but also their lifestyle, emotions and life events. “I look for patterns and changes,” she said. A series of labs or other tests may be ordered to see where blood pressure, cholesterol or other conditions stand. The resulting plan—developed specific to the patient and shared with the primary care physician—might recommend changes in diet, activity, stress reduction, hydrotherapy, and other approaches. It’s not about recommending alternative treatments, she said, but identifying complementary therapies and actions.
Center for Integrative Health and Wellness
A few months ago, two nurse practitioners, Natasha Ruiz, FNP-C, and Jennifer Goldstock, ANP-BC, opened the Center for Integrative Health and Wellness, at 654 Watervliet Shaker Road in Latham. Each brings many years of nursing and integrative practice, including some time when they worked together. Reflecting need and interest, the Center already is a busy practice through word of mouth and Facebook.
The 25-year nursing career of Ms. Ruiz included emergency department work, as she considered acute care experience to be very important. But what can be done to promote preventive healthcare and quality of life for the non-acute problems? “I wanted to know why people were sick,” and what could be done aside from a pill, she observed. This interest led to her training as a nurse practitioner and work in facilities that use integrative medicine and complementary therapies.
Meanwhile, Ms. Goldstock was following a similar path in Chicago and elsewhere, including the treatment of persons with HIV and AIDS. She was raised with the view that wise choices in food have a correlation with health, but she found that nutrition was not necessarily reflected in the meals served to patients – for example, dinner might be heavy on sugar. In pursuing training as a nurse practitioner, she also decided to focus on integrative medicine.
They both report that patients of their practice are looking for the extensive patient-healthcare provider communication that is a key element of integrative medicine. “We need to get to know and connect with the patient,” Ms. Ruiz said. Questions also include the patients’ views and thresholds on involvement in their own healthcare. Patients, she added, also welcome the wide-ranging work-ups. It’s a deep dive into what’s going on the patient’s well-being now and their health-related history from birth. They also ask about medications and over-the-counter drugs and supplements.
This promotes prevention, rather than dealing with a situation when something happens. Their work-ups seek to uncover the root of health problems. They note a recent case of tick-borne illness that hadn’t crossed the mind of the patient. Ms. Goldstock explained that the review might also involve referrals with primary care and testing. Ms. Ruiz said, “We focus on wellness, empowering people to have a role in their health.”
— By Beth Krueger