We are pleased to announce that the Department of Integrative Medicine is the recipient of an exciting grant, awarded in October 2010 by the Charles Evans Foundation, to support a 3 year initiative to bring stress reduction and self care modalities to nurses and other clinical staff at Beth Israel. The program is designed as a "Mobile Therapy Station" with holistic nurses traveling to each nursing unit to provide sessions in relaxation, stress management and training in self-care techniques using a variety of integrative modalities. The Charles Evans Integrative Stress Management Program will be under the direction of Aurora Ocampo, RN who has provided over a decade of instruction on mind/body approaches to patients and staff at BIMC.

In addition, the Department of Integrative Medicine has been selected as a client organization of the Capstone Program at the NYU Robert F. Wagner Graduate School of Public Service. Through the Capstone Program, a team of graduate students in the health management and finance field will work closely with our Department during the 2010-2011 academic year, overseen by our Clinical Program Coordinator Esther Sackett, MPA. The project will help identify the cost effectiveness indicators needed to analyze the impact of inpatient Integrative Medicine programs at Beth Israel.

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How long you sit still has an impact on your health

Roberta Lee, MD, Vice Chair, Department of Integrative Medicine                                                                                                                                          

A new study finds it's not just how much physical activity you get, but how much time you spend sitting that can affect your health, especially heart health. Prolonged sitting (such as watching television, working on the computer and gaming, or driving a car for hours) has harmful cardiovascular and metabolic effects even in adults who exercise regularly. "Inactivity physiology" taken from laboratory studies has identified a completely different set of mechanisms that to everyone's surprise impact health as much as exercise. Thus, too much sitting may be at least as important a health problem as too little exercise.  "Move more, more often" was a conclusion by the investigators. In the study accelerometers were worn to assess physical activity and metabolic parameters. Those who took breaks and got up and moved around had better health profiles, particularly in cardiovascular resiliency. The negative correlation of sitting still increased the potential for diabetes and obesity and mortality from cardiovascular disease despite regular physical activity. This drives home the importance of "coffee or tea breaks and personal styles of activity --- e.g. fidgety types, for once, may have one up on us more sedentary types. Nevertheless, this doesn't mean we should give up on our exercise routines!

Lest you feel the urge to ditch your exercise routine and substitute your activity with roaming more frequently to the water cooler - don't act too quickly on this urge. Other studies continue to show positive benefits from regular physical activity. One study that really caught my attention looked at the positive genetic impact of a healthy lifestyle.  The Mac Arthur aging study is a well known research project investigating positive and negative influences on health.  In 2009, three scientists, Elizabeth Blackburn, Carol Greider and Jack Szostak won the Nobel Prize in physiology for telomeres and telomerase. Telomeres are the endpoints on strands of DNA that keep it from unwinding, like aglets on a shoestring. Telomerase is an enzyme that lengthens telomeres. Telomeres shorten every time a cell divides. Part of cellular maintenance involves adequate amounts of the enzyme telomerase to keep the DNA in a resilient state.  In chronic disease telomerase is prematurely lessened and telomeres shorten hastening cell death.  Individuals with known heart disease in the Macarthur study had their telomeres and telomerase evaluated and followed over 12 years. The shortening of telomeres and drop in telomerase over time predicted mortality. For example those who had less telomerase did not live as long. Surprisingly, there was a group in which over a 2 year period telomeres grew longer and telomerase levels rose! In essence, this represented a sort of anti-aging effect. That group had improved their lifestyle by exercising, eating more healthily and reducing their stress levels.  The information gleaned from this study has generated more research as you can imagine.

For Further Reading on the detrimental effects of sitting too long: Owen N, Healy GN, Matthews CE, et al. Too much sitting: the population health science of sedentary behavior. Exerc Sport Sci Rev. 2010 Jul;38(3):105-13. 

For further reading on the telomerase discovery: Corey DR. Telomeres and telomerase: from discovery to clinical trials. Chem. Biol. 2009  Dec 24;16(12):1219-23.

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Interested in learning more from the Web?

Marsha J. Handel, MLS

Our informatics Director, Marsha Handel, is constantly evaluating information for its usefulness and credibility. Additionally she is always on the hunt for great websites as well as developing new ones for our department. Here is the latest addition she has made with the collaboration of experts in the field. You can also access this site via our website at www.healthandhealingny.org

 Preparing for Surgery                                                          

This unique free online mind-body program is based on the Holistic Surgery Program developed by Aurora Ocampo, RN, the clinical nurse specialist at the Center. The site not only discusses the specific benefits of stress reduction techniques before and after surgery, but takes you step by step through a complete program.  It teaches mind-body therapies such as breath work, centering and grounding, guided imagery and biofeedback in audio and video formats so you can do the work of pre­paring for surgery at home, while being guided by an expert in the field.  All audio exercises are now available in MP3 format for downloading.

Cancer Resources on the Net

Inspire Health: Integrative Cancer Care

InspireHealth, a not-for-profit organization dedicated to integrative cancer care, posts Research News and Research Updates once a month to inform those interested in integrative cancer care. Authoritative articles are selected based on the quality of evidence and their relevance to this area of medicine.  Articles are archived back to January 2008.  You can also sign up to receive them by email.

This non-profit organization provides reliable, evidence-based information on integrative cancer care to reduce cancer risk and improve cancer-related survival, quality of life, and whole person care.  The website content covers issues related to body, mind, spirit, social and environmental factors, a resource section, and a cancer A to Z section of relevant research-based topics such as acupuncture and cancer. 

National Cancer Institute PDQ database

Contains summaries on a wide range of cancer topics for both patients and health professionals.  Peer-reviewed summaries are updated every 6 months on cancer treatment, screening, prevention, supportive care and integrative approaches.  Also includes a registry of 8,000+ open and 19,000+ closed cancer clinical trials from around the world and information on 2,300+ agents used in the treatment of cancer or cancer-related conditions.

Of Tweets and Facebook pages

To our online community please join our newly created Facebook group page Continuum Center for Health and Healing and follow us on twitter . We will be posting pertinent health-related news and events taking place at the Center plus tweeting daily health tips and articles for your education and consumption.

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Current Research at the Center

• The Bravewell Simtap project, which is observing how chronic pain treatment differs in integrative medicine, is a research initiative with eight other leading centers in the Bravewell Collaborative Network.  This study has now completed recruitment, having reached our targeted goal of 50 participants. Thank you to all who have volunteered for this project and we will enjoy continuing to work with you for your follow up appointments.


• The Center will be presenting the results of our Urban Zen study at the Society of Integrative Oncology meeting in NY next month.  The full report of the results has been accepted for publication in the Journal of Alternative and Complementary Medicine.

From the Holistic Nurses Corner:

by Wanda Diaz, RN

 HOW TO TELL IF YOU HAVE A COLD VS FLU

The flu season is here. It's a time of sniffles, sneezes and coughs.  So how can you tell if you have a cold or flu?    Knowing the differences, causes, symptoms and treatment recommendations will help you get through the season.

Cold

Cause:  There are close to 200 different viruses that cause the common cold.  These  spread easily when people are indoors where you have a higher chance of inhaling viral respiratory droplets and  contact with contaminated surfaces.

Symptoms:  Most common symptoms are sneezing,  stuffy nose, cough, congestion, sore throat, and low grade fever ( mild body aches, fatigue and headache).

Duration:  Onset usually takes 2-3 days.  You are also most contagious during this time.  Symptoms can last up to 10 days.  Cough can last up to 2 weeks.

When to seek medical attention:  If symptoms do not improve after 10 days or if you are experiencing any shortness of breath, wheezing, dark or colored mucus or phlegm, high fever, extreme fatigue, chest pain or worsening of symptoms.

Flu

Cause:  Influenza virus Types A and B are the culprits. Some well-known Type A strains are the Avian  (Bird flu) and H1N1 (Swine Flu).   These viruses are commonly spread through respiratory droplets and touching contaminated surfaces.

Symptoms:  Most common symptoms are cold symptoms, high fever (over 101), headaches, cough, moderate to severe body aches, fatigue & chills, possible diarrhea or vomiting and loss of appetite. 

Duration:  Very Sudden Onset.  Note this is the most contagious the first 5 days.  Symptoms can last up to 2 weeks but fatigue can continue for 3 weeks. 

When to seek medical attention:  Follow the same criteria as above for the Cold; if you have a fever that remains high (over 104) and last longer than 3 days; if you have a pre-existing condition which puts you at a higher risk for flu complications like pneumonia.

Prevention:

1. Hand washing, Hand washing, Hand washing is key in prevention! The most common cause of colds/flu is contact with contaminated surfaces with hands, then touching the mouth, nose or rubbing the eyes.  Viruses enter through the tear ducts, sinuses, mucous membranes and infect nasal passages. 
2. Covering your mouth and nose when sneezing or coughing.
3. Building up your immune system and keeping yourself healthy.

Treatments for Cold & Flu:

• Rest
• Fluids:  Drink lots of warm fluids such as herbal teas (Lemon, Peppermint, Chamomile, Orange), soup (nourishing and immune boosters- add garlic, onion, ginger, cayenne or chili pepper), water or coconut water (helps to replenish electrolytes).
• Avoid dairy products since they produce mucous. 
• Honey helps with cough, soothes a sore throat and is also good to add to tea.
• Gargle with warm water at least 3 times daily.   Add 1 drop of tea tree oil to 4 oz of warm water to create an extra immune fighting gargle rinse.
• Netti Pot-  Nasal irrigation helps to flush out sinus and congestion. Use normal saline nasal spray to help keep sinus passages open and lubricated.
• Essential oils - use in chest rub, bath or humidifier- Eucalyptus, Lavender, Ginger. 
1. Bath/Shower- add 2-5 drops to shower/bath 
2. Humidifier- use 2-5 drops to diffuse in air          
   
3. Chest Rub- For adults add up to 5 drops in 1 tsp of carrier oil/white lotion. * For Children add 1-3 drops in 1 tsp of carrier oil / white lotion.                                                          
• Supplements: *Elderberry, Vitamin C, Echinacea, Oscillococcinum. Avoid antibiotics since it does not help with viral infections. 
• Seek medical attention if symptoms worsen or persist for more than five days.

*Please check with healthcare provider for safety before using.

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Internal Medicine/Integrative Medicine

Pamela Yee, MD is board certified in Internal Medicine and has extensive training in integrative medicine. She combines her medical training with evidence-based integrative modalities for the treatment of a variety of conditions.  Supporting her patient's goals, treatment can co-exist with their conventional management to enhance effectiveness, reduce the reliance on pharmaceuticals, and increase patient participation in their treatment by involving different modalities such as nutritional intervention. Many of the issues that Dr. Yee treats do not simply fall into diagnostic check-boxes; illness and disease are often the manifestations of complex interactions between many biologic processes and systems. Complex and difficult to diagnose and treat conditions are the standard cases Dr. Yee welcomes.

Dr. Yee received her education at Barnard College at Columbia University and State University of New York at Stony Brook School of Medicine and trained in Internal Medicine at Santa Barbara Cottage Hospital in California where she also served as Chief Resident. She also completed a prestigious fellowship in Integrative Medicine at Beth Israel Medical Center in New York. Her diverse training includes clinical hypnotherapy through the Milton H. Erickson Society for Psychotherapy and Hypnosis and medical acupuncture through the UCLA School of Medicine. She and her husband manage an organic micro-farm at home and frequently write and speak on the topic of nutrient dense farming and local and sustainable food practices.

CP: You are an integrative medicine /internal medicine doctor. What are your special interests? 

PY: I'd like to prefacethis question by stating that when seeing my patients, it is especially important to me to understand them in totality which always includes a very in-depth review of not only their medical histories, but their lives.  I think what I am able to provide, which may seem simple but is often very difficult to find, is focused listening to the patient.  I believe this is extremely integral to being able to absorb and process a case and it is how I am best able to work with a patient and their specific needs

My interests are quite varied.  I enjoy both difficult cases where patients have not been able to find a diagnosis as well as situations where patients may have a diagnosis but have not been able to find adequate conventional treatment.  For example, I recently saw a patient with an incurable pulmonary mycobacterial condition for which no treatment is available.  As this is rare, I've approached this case by doing as much scientific research as possible and creatively constructing a treatment plan using the best available evidence to date.  These cases offer a challenge that I welcome. 

I also see a spectrum of conditions in which patients have been treated conventionally and desire a more comprehensive approaach utilizing non-conventional as well as conventional treatments to better meet their goals.  This absolutely includes a nutritional approach to their condition.  Sometimes I am simply a fresh pair of eyes reviewing their case with them and providing a viewpoint from both the conventional and integrative world. I see conditions ranging from autoimmune diseases like scleroderma and Hashimoto's hypothyroidism, neurodegenerative conditions like multpile sclerosis, psychiatric issues such as depression or anxiety, or digestive issues such as reflux or IBS.  But really, I don't like to pigeon-hole someone with a diagnosis.  Each case and person is unique and may require very different approaches.  If ten patients come to me with rheumatoid arthriatis, they do not receive a "protocol" but are assessed individually and oftentimes treated very differently.

Oncology is another area of interest. I treat patients in various stages to support them through conventional treatments from diagnosis to remission, from surgery through chemotherapy and radiation and then through secondary prevention to prevent further disease.  Oftentimes cancer patients let their guard down after treatment, but in fact, this is a time to explore what they can do to prevent recurrences. The ideal situation is to be able to work in conjunctin with their oncologists and never against them.  I feel that it is detrimental to the entire treatment process if all the providers in a patient's treatment team are not working together.

CP Beyond integrative training have you extended your knowledge by working with other notable experts in the field and what did you learn?

PY: Aside from the excellent training in integrative medicine I received as a full-time fellow at the Center in 2004, I worked cloesly for years with some of the pioneers in integrative medicine including Raymond Chang, MD who is known for his work in cancer and Leo Galland, MD, considered the grandfather of nutritional and integrative medicine.  I think the most important thing I learned from these experts is to intellectually and scientifically think about every case individually and to look for clues in each case, to never give up if something fails because there's something you haven't thought about or tried, and most imporantly, to use the available scientific evidence to help guide treatment even though it may not be "mainstream."

CP: As an internal medicine doctor what do you feel is an important contribution you can make to cancer patients in active treatment?

PY: I think there are two general ways I've been able to contribute to the care of a cancer patient.  Firstly, to make the patient feel heard by answering the most basic questions (and there are many when one is diagnosed) and by providing the patient with a dialogue of issues that they feel uncomfortable raising with their oncologist such as the utility of nutrition, how one can strengthen their immune system, and what effect vitamins, herbs and supplements can have on their cancer either during or after chemotherapy.  I feel that it is very detrimental for oncologists to dismiss these questions as patients oftentimes feel very strongly about them.  There are many things that patients should not be taking during chemotherapy which I always discuss and when a barrier is put up between the patient and the treating physician, full disclsoure of what the patient may be taking can be compromised.  If there is not an open dialogue, a patient may very well be doing something that may interfere with chemotherapy and if that patient does not have an open relationship with their oncologist they may not discuss it out of fear of ridicule from their oncologist.

The second contribution I believe I've made to many of my cancer patients is to give them help in the reduction of side effects of treatment and to aid in their overall well-being.  I'd like to think I help in also keeping them as disease-free as possible once treatment ends.

CP: As an ambassador of evidence-based academic integration what kind of misconceptions do you address up front with patients you are working with who are actively in cancer treatment?

PY: There are a few patients that look for ways to avoid conventional treatment and I am up front with them that there are no magical herbs from the Amazon that can dure their cancer.  I am explicit in my viewpoint that the best way to approach cancer is a combination of their conventional treatment with the use of evidence-based herbal or neutraceutical support, nutritional modification, and addressing and managing stress.

CP: You also are an avid organic micro-farmer and grow food for your community in the lower Hudson valley. What interested you in starting this project?

PY: It probably first started because of my enjoyment of cooking and eating, but it became a much larger entity as I became more aware of the quality of our food.  When you grow your own food not only do you contorl what goes into the soil and ultimately what you eat but there is a life-changing view of food that happens when you start from seed to the time you harvest.  Since I'm intimately involved with growing food it only enables me to give better advice on diet and nutrition.

I look at this not so much as a project but as a way of life that many decades ago was a necessity.  Not only has it brought the obvious benefits of eating ultra nutritious food, but it has enabled me to teach others in the community about food, health and self-reliance.

CP: if people are interested in learning more about your work with organic foods do you have a website where more information can be found?

PY: I keep a blog on growing food, medicinal virtues and nutrtional values of foods, homesteading and sustainability issues at www.hookmountaingrowers.com. 

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