Linda A. Lee, MD, director of the Johns Hopkins Integrative Medicine & Digestive Center (JHIMDC) in Lutherville, Maryland, believes that an integrative approach to treating conditions and symptoms helps improve patients' quality of life.
Linda A. Lee, MD, director of the Johns Hopkins Integrative Medicine & Digestive Center (JHIMDC) in Lutherville, Maryland, believes that an integrative approach to treating conditions and symptoms helps improve patients’ quality of life. At the Second Annual NCONN Conference, she described the origin of her interest in holistic treatment.
Several years ago, Lee, who is board-certified in internal medicine and gastroenterology, was primarily seeing patients with chronic problems and felt improperly equipped to help them. “I felt very limited in how I had been trained. I began to learn and reach out to other healthcare providers to find out what they brought to the table regarding how to help our patients achieve a better quality of life.”
Integrative Medicine: A Primer
Integrative medicine integrates the best scientific medicine with a broader understanding of the nature of illness, healing, and wellness. This practice makes use of all appropriate therapeutic approaches and evidence-based modalities to achieve optimal health and healing, Lee explained.
She also pointed out that integrative medicine “doesn’t reject conventional medicine, but seeks to enhance it.” Further, while Lee is a strong supporter of integrative medicine, she doesn’t uncritically embrace all alternative practices.
Lee’s center in Maryland, JHIMDC, is a multidisciplinary clinic for patients. Along with using the best therapies available to treat a variety of medical conditions and symptoms, the staff incorporates nutrition and other healing modalities to improve symptoms and outcomes. Medical services include acupuncture and Chinese medicine, digestive health services, integrative psychotherapy, nutrition consultations, and therapeutic massage.
“When a person comes to our center, we spend a lot of time educating the patient. We want them to be an active participant in their healthcare,” Lee said. The emphasis is on an individualized approach that considers a patient’s beliefs, values, and concerns.
Cancer and Integrative Medicine
Cancer patients frequently deal with chronic issues. For example, breast cancer patients can experience weight gain and loss, fatigue, menopausal symptoms, psychological distress, and lymphedema. Integrative medicine may help these patients, but finding evidential support for the nonstandard therapies can be challenging.
“There is evidence if you look for it,” Lee said. “It’s very hard to find evidence for integrative medicine therapies in our standard medical journals. While the medical literature is full of reports, it takes time to sift through, find, and weigh how reasonable [a therapy] is.”
Lee highlighted a study by Walker et al (http://bit.ly/gz4Y45) published in the Journal of Clinical Oncology that examined acupuncture for vasomotor symptoms in 50 patients with breast cancer. Patients were randomized to either 12 weeks of acupuncture (n = 25) or venlafaxine (Effexor) (n = 25). The results showed that acupuncture was as effective as venlafaxine in reducing hot flashes. Patients receiving acupuncture also experienced no adverse effects (AEs), compared with 18 incidences of AEs in the venlafaxine group. Within 2 weeks of discontinuing drug therapy, the venlafaxine group experienced significant increases in hot flashes, whereas hot flashes in the acupuncture group remained at low levels.
Safety of Therapies
Integrative therapies are safe when used appropriately, Lee informed NCONN attendees. She specifically mentioned that acupuncture needles do not cause significant bleeding, even in patients with low platelet counts or at risk for increased bleeding, and modified therapeutic massage (oncology massage) can be done safely in patients with cancer who have undergone surgery.
Lee noted the importance of educating patients on integrative therapy use, particularly dietary supplements due to their popularity. “Eighty percent of cancer patients you’re seeing use dietary supplements. Cancer patients love dietary supplements,” Lee said. She then described situations when specific supplements should be avoided.
Patients should not use probiotics if they have a central line (a tube inserted in the patient to administer treatment) and should avoid antioxidants during radiation or some forms of chemotherapy, Lee advised. “If they’re actively getting radiation or chemotherapy, I tell patients taking antioxidants at this time it is probably not a good idea because theoretically it can counteract what radiation and chemotherapy do,” she said.