How to treat a woman: A Broader View Jo Robins, RN, PhD, ANP-BC, AHN-C, CHTP VCU School of Nursing
Outline: What am I offering you today A holistic and balanced exploration of illness and health Both personal and professional
COMPLEMENTARY THERAPIES AND HOLISTIC CARE The Placebo Response Innate healing ability Holism- Mind, Body, Spirit Self-care Personal/Professional Treating/Curing/Healing Partnership Integrative Practice
nccam.nih.gov 1-888-644-6226 Outstanding resource Currently sponsored clinical trials include the areas of acupuncture, herbs, dietary supplements, and massage in the areas of arthritis, neurological disorders, cardiovascular disease, and cancer
Ayurvedic Medicine Focus is on person as energetic entity, balance, breath, diet, exercise, mind-body techniques, yoga Wisdom of Healing; Return to Wholeness by David Simon, MD
Mind-Body Constitution or Dosha http://doshaquiz.chopra.com/ http://www.whatsyourdosha.com/ Vata = Air Pitta = Fire Kapha = Water
Traditional Chinese Medicine Ancient eastern system of medicine focusing on balance, energy flow Meridians Ying/Yang 5 elements: fire, water, air, wood, earth Acupuncture, Massage (Tui Na) , Herbs, Nutrition, Qi Gong (vital energy)
Balancing Yin and Yang Yang is the “daylight”, the “active”, the “doing”, the “producing”. Yin is the “nighttime”, the “stillness”, the “contemplative”, the “refilling”.
Balancing Yin and Yang The flame is the yang; the wax is the yin. The battlefield is the yang; the fort is the yin. Doing is the yang; being is the yin.
Biological-Based Diet: Primary focus for maintaining, rebuilding health. Food is Information. Some truths about Vitamins, Supplements, and Herbal therapies
Resources for Vitamins, Supplements, Herbal Products Herbal PDR Commission E Monograph Herb Contraindications and Drug Interactions by Brinker Natural Medicines Database South River Compounding Pharmacy
Resources for Vitamins, Supplements, Herbal Products Metagenics Perque Phytopharmica Xymogen New Chapter Numerous others
Manipulative/Body Based Massage: Effective for stress management, reducing and eliminating a variety of pain syndromes. Trager-Effective in helping manage Parkinson’s disease.
Energy Fully developed framework Era I, II, III Medicine Healing Touch and Therapeutic Touch help decrease pain and anxiety; improve sleep quality, and well-being
Functional Medicine Functional Medicine Institute www.functionalmedicineinstitute.org Biochemical individuality describes the importance of individual variations in metabolic function that derive from genetic and environmental differences among individuals.
Functional Medicine Patient-centered medicine emphasizes "patient care" rather than "disease care.” Follows Sir William Osler’s admonition that “it is more important to know what patient has the disease than to know what disease the patient has."
Web-like interconnections of physiological factors An abundance of research now supports the view that the human body functions as an orchestrated network of interconnected systems, rather than individual systems functioning autonomously and without effect on each other.
Evaluating CAM Therapies 1. Evaluate the therapy itself- can you assess whether the therapy is probably harmless, possibly dangerous, or potentially helpful in some significant way (ie, does it operate in a plausible way, is there scientific literature?).
Evaluating CAM Therapies 2. Evaluate the practitioner offering the therapy-training, reputation within professional networks (patients/colleagues), Do they have expertise treating your condition? Do they make any claims regarding outcomes? Can they integrate with your conventional therapy? Is the practitioner worthy of your trust?
Evaluating CAM Therapies 3. Evaluate the quality of the service including delivery, cost, and quality of service being rendered.
Many Professional Organizations American Holistic Nurses Association (www.ahna.org) American Holistic Medical Association (www.ahma.org) American Association of Integrative Medicine (www.aaimedicine.com)
Peer Reviewed Journals-Nursing and Medicine Journal of Holistic Nursing Holistic Nursing Practice Journal of Complementary and Integrative Medicine
Peer Reviewed Journals Evidence Based Complementary and Alternative Medicine Alternative Therapies in Health and Medicine Journal of Alternative and Complementary Medicine
What is “Stress” ? Overused, non-specific Typically viewed as negative Promotes adaptation, growth, learning
Stress Response Brain integrates and coordinates behavioral and neuroendocrine responses to “stress” and normal diurnal rhythms. Remarkable individual differences in coping related to genetics, early development, behaviors, experience…. Neuroendocrine and behavioral responses programmed to adapt for homeostasis, allostasis. Must efficiently turn on and off.
Short-Term Adaptive Responses CV-catecholamines (CAT) increase HR, BP, Vasoconstriction to be upright, active Brain-Adrenal hormones (AH), CAT increase awareness, memory retention Immune- AH & CAT promote cell trafficking; modulate cyto-,chemokines
Stressor Factors Person Factors STRESSOR T Social- Environmental Factors STRESSOR Norepinephrine NKC Epinephrine B Cortisol Mn/MN DHEA Spleen Cerebral Cortex IL-2 IL-6 TNFa Limbic System IL-1 IL-3 Hypothalamus CRF PVN CRF CRF Locus Ceruleus Pituitary Proopiomelanocortin: b-endorphin, ACTH, ANS a-melanocyte stimulating hormone Lymphoid Tissue ACTH Adrenal Cortex Adrenal Medulla IL-2 Thymus Enkephalins TNFa , IL-1, IL-6 Met-enkephalin b-Endorphin Interferons IMMUNE SYSTEM
Potentially Damaging Long-Term Effects CV- prolonged BP elevations accelerate atherosclerosis and with metabolic hormones lead to Type II DM Brain- HPA overactivity, excitatory neurotransmitters reduce neuronal excitability and atrophy, hippocampal brain cell death Immune-Immunosuppression and immune overactivity (autoimmune, inflammation)
Allostatic Load: McEwen & Stellar, 1993 “Hidden cost of chronic stress to the body over long time periods, which act as a predisposing factor for the effects of acute, stressful life events.” “Wear and Tear” “Presents a model showing how individual differences in the susceptibility to stress are tied to individual behavioral responses to environmental challenges that are coupled to physiologic and pathophysiologic responses.” (p. 2093) Cumulative result of allostasis, allostatic state
4 Types of Allostatic Load 1. Repeated events over a long period of time (sustained economic hardship) 2. Failure to adapt to a repeated stressor (never adapting to flying or public speaking) 3. Failure to shut off hormonal stress response or return to normal trough (sleep deprivation) 4. Inadequate hormonal stress response allowing other systems to be overactive (autoimmune)
Contributors-Allostasis, Allostatic State, Allostatic Load Daily diurnal patterns (sleep-wake, cardiovascular changes to stand) Genetic predisposition LBW Early development- bonding, abuse Perceived loss of control Learned helplessness Learned behaviors/ lifestyle choices- exercise, diet, smoking, alcohol consumption, mind-body fitness, spirituality Health Disparities
Mediators of Allostasis Adrenal steroids Catechoamines DHEA Prolactin Pitocin Growth hormone Sex hormones Cytokines Once hormones are released there are immediate and long term effects on cellular function.
PERCEPTION Negative Affect or Loss of Personal Control.
PERCEPTION Positive Affect; Sense of Personal Control
BREATHING- The Basis of Health and Healing Learning to be, be with without doing is the path of the feminine Breath=Spirit Begin by observing breathing patterns Three deep breath upon arising and before sleep Promotes relaxation-de-activates SNS (impacts neuroendocrine, cardiovascular, and immune systems Dr. Andrew Weil audiobook “Breathing”
Creating Change From a feminine perspective, it is about process instead of outcome It is a process-the beauty and glory are in the process of growing and evolving, not necessarily the “getting there”
What Have I Learned Own and honor therapeutic presence