Integrative Health...It's Not Alternative Anymore by Dr. Jennifer Norden, MD, Maggie Boyd, LAc, and Allieson Mirsberger, LMT

1. Integrative Health…
It’s Not Alternative Anymore
Jennifer Norden, MD
Maggie Boyd, LAc
Allieson Mirsberger, LMT

2. Integrative Health Vision
To offer both conventional and integrative
medicine and wellness services to promote
optimal health, prevent and treat disease,
and meet each patient’s unique physical,
emotional and spiritual health goals.
Focus is on supporting the body’s healing
potential.

6. “Let food be your medicine,
and medicine be your food.”
- Hippocrates, 5th century BC
• The American Cancer Society estimates that
one-third of cancer deaths could be
prevented with healthy nutrition and healthy
weight.
• Another one-third prevented by not
smoking.
• Two-thirds of cancers can be prevented!

7. Title
 Text

8. Pills - Vitamins & Supplements
“Natural” does not mean safe
Not a substitute for a healthy lifestyle
Vitamins through food is best because
of phytosynergy
$28 billion per year
Vitamin D 800 to 2,000 IU qd

9. Reliable Resources
 Consumerlab.com for reliable brands
- $30 per year
 National Center for Complementary
and Alternative Medicine -
http://nccam.nih.gov/
 UW Integrative Medicine web site -
http://www.fammed.wisc.edu/integr
ative/modules
 Micromedex

12. Breathing Exercises to
Calm the Nervous System
 Exhalation should be longer than the inhalation.
 One breath approximately every 10 seconds.
 Activates the parasympathetic nervous system -
the resting, digesting and connecting.

13. Title
 Text

14. Ancient mind-body practices involving
gentle movement with mental focus,
breathing and relaxation.
Improves balance.
Reduces back and knee
pain.
Improves quality of life in
those with chronic illness.
Tai Chi and Qi Gong

15. Title
Text

16. It isn’t a religion.
It isn’t relaxation.
It isn’t an attempt to stop
thinking or have only positive
thoughts.
It doesn’t eliminate sadness
or rough patches from life.
It doesn’t require huge chunks of time.
What Meditation Isn’t…….…

17. What is Mindfulness?
“Mindfulness means paying
attention in a particular way;
on purpose, in the
present moment,
and non-judgmentally.”
All we have is the
present moment –
Everything else is imaginary!

18. Neuroplasticity –
The Brain Can Change!

19. Meditation Programs for
Psychological Stress and Well-Being:
A Systematic Review and Meta-Analysis
Included 47 trials with active controls, 3,515 participants,
(meditations: MBSR, MBCT, MM, TM).
Moderate evidence mindfulness meditation improved
anxiety, depression and pain compared to nonspecific
active controls.
Meditation was equal to specific active controls (those with
known benefit) - meds, exercise, behavioral therapies.
Minimal side effects!
JAMA Intern Med. 2014;174(3):357-368.

20. A Mind-Body Program for Older Adults
with Chronic Low Back Pain
JAMA Intern Med 2016:329-337
 Functional improvement
significant at eight weeks, but
not sustained
 Pain levels improved at eight
weeks and six months
 45 percent of MM group
(versus 8 percent of control)
reported much or very much
improvement at six months
 Back pain for 12 years
 140 patients in
mindfulness meditation
 142 patients in health
education program, “10
keys to healthy aging”
 Eight weeks followed
monthly for six months

21. Resources
 Local classes – Health Resource Center at St. Agnes Hospital
(formerly Journeys), Fond du Lac Center for Spirituality &
Healing, YMCA, Inner Sun - Oshkosh, Lotus Root Yoga - Ripon
 UCLA Mindful Awareness Research Center - free podcasts,
guided meditation
 http://www.dartmouth.edu/~healthed/relax/downloads.html
 Centerhealthyminds.org
 Phone apps for relaxation practices and guided meditations
include:
 Insight timer
 Headspace
 Stop, breathe and think
 Mindfulness training app

22. Acupuncture…Does it Hurt?
 Usually painless but occasional
sharpness.
 Needles stay in place for 10 to 30
minutes.
 Sometimes electrical stimulation of
needles.
 Mild euphoria or drowsiness after
treatment is possible.
 Occasionally pain gets worse initially.
 Mild bleeding, bruising are possible.
 Rarely a hematoma.

23. Typical Course of Treatment
Number of treatments required is dependent
on chronicity of concern.
Typically one to two treatments for acute
concerns, and 10 to 15 for chronic.
Usually has lasting effects.
Sometimes requires maintenance treatments.

24. Insurance Coverage
As with any of our service lines, it is important that you contact
your insurance provider to inquire about coverage.
 Medicare and Medicaid never cover acupuncture,
even with a supplement.
 NHP covers acupuncture for headache, neck pain,
back pain and chemo-related nausea, OA of the
knee.
 Sisco, Cypress cover for chronic pain.
 United, Cigna, Anthem sometimes covers
acupuncture.
 Our cash prices - $75/session, $325/ 5, or $600/ 10

26. Massage Therapy
NIH-NCCIH concludes that
evidence points to benefit for:
 Chronic pain - back, neck, OA,
labor pain
 Mental health - reduces
depression and anxiety
 Cancer - reduces pain and anxiety
 Fibromyalgia - improves pain and
fatigue
 HIV/AIDS – improve quality of life

27. Cupping Therapy
Creates suction and vacuum
pressure to skin
 Soften tight muscles and tone
attachments
 Loosen adhesions and lift connective
tissue
 Bring hydration and blood flow to
body tissues
 Move deep inflammation to the skin
surface for release
 Drain excess fluids and toxins by
opening lymphatic pathways.

28. Chiropractic
 NIH-NCCIH concludes that spinal manipulation
can help relieve low back pain.
 Can help with migraine, neck pain and joint
discomfort.
 Evidence is inconclusive for fibromyalgia, PMS,
TMJ and sciatica.
 Probably not effective for
asthma, hypertension or
menstrual pain.

31. Acupuncture for Chronic Pain
Individual patient meta-analysis of acupuncture for
chronic pain, 29 studies.
Pain conditions - Nonspecific musculoskeletal pain, OA,
headaches, shoulder pain.
Bottom line: Acupuncture is associated with improved
pain outcomes compared with sham-acupuncture and
no-acupuncture control, with response rates of
approximately 30 percent for no acupuncture, 42.5
percent for sham acupuncture and 50 percent for
acupuncture.
 Acupuncture for Chronic Pain.Vickers, Andrew; Linde, Klaus JAMA.
311(9):955-956, March 5, 2014

32. How Does It Work?
Traditional Chinese Medicine
theory:
Acupuncture points located on
meridians
Promotes flow of qi
Balances yin-yang
Restores balance and harmony

33. Inserting Needles Into the Body: A Meta-Analysis of Brain
Activity Associated With Acupuncture Needle Stimulation
The Journal of Pain Volume 14, Issue 3, March 2013, Pages 215–222
Changes in brain reflect responses in areas associated with
sensory, cognitive and affective dimensions of pain.

34. WHO-Orthopedic Conditions

35. WHO - Other Conditions Appropriate
for Acupuncture Treatment

36. Clinical Guidelines
Diagnosis and Treatment of Low Back Pain:
A Joint Clinical Practice Guideline from the American
College of Physicians and the American Pain Society
For patients who do not improve with self-care options,
clinicians should consider the addition of non-
pharmacologic therapy with proven benefits, including:
Spinal manipulation for acute low back pain
Intensive interdisciplinary rehabilitation for chronic or
sub acute low back pain
Exercise therapy, acupuncture, massage therapy, spinal
manipulation, yoga, cognitive-behavioral therapy or
progressive relaxation.

37. Acupuncture for Migraine
Prophylaxis
Cochrane Database, 2016:
 22 trials with 4,985 patients. Positive response - 50 percent
reduction in number of headaches.
 Usual care for acute headache - 17 percent had 50 percent
reduction
 Preventative medications - 46 percent at three months,
54 percent at six months
 Sham acupuncture - 41 percent of patients
 True acupuncture - 57 percent at three months, 59 percent at
six months
 Acupuncture patients had fewer side effects than medication
patients.

38. Points to Remember
 Acupuncture is an ancient practice that has
withstood the test of time.
 Integrative health is more than conventional
medicine plus acupuncture needles or vitamins.
 Mind-body practices are evidence-based, safe,
and empowering for patients.
 Resources are available for your patient -
integrative health, behavioral health, population
health referral, Health Resource Center.

40. Thank You.
Questions?