Abstract

The efficacy of complementary and alternative therapies for sleep promotion in critically ill patients is largely unexamined. We found only seven studies (three on environmental interventions and one each on massage, music therapy, therapeutic touch, and, melatonin) that examined the effect of complementary and alternative therapies.

A number of studies, however, have shown that massage, music therapy, and therapeutic touch promote relaxation and comfort in critically ill patients, which likely leads to improved sleep.

Massage, music therapy, and therapeutic touch are safe for critically ill patients and should be routinely applied by ICU nurses who have received training on how to administer these specialized interventions.  Environmental interventions such as:

• reducing noise,
• playing white noise such as ocean sounds
• and decreasing interruptions to sleep for care, also are safe and logical interventions that ICU nurses should use to help patients sleep.
• Progressive muscle relaxation has been extensively studied and shown to be efficacious for improving sleep in persons with insomnia; however, progressive muscle relaxation requires that patients consciously attend to relaxing specific muscle groups and practice these techniques, which may be difficult for critically 11 patients.

We do not currently recommend aromatherapy and alternative sedatives, such as valerian and melatonin, for sleep promotion in critically ill patients because the safety of these substances is unclear.

In summary, we recommend that ICU nurses implement music therapy, environmental interventions, therapeutic touch, and relaxing massage to promote sleep in critically ill patients.

These interventions are safe and may improve patient sleep, although randomized controlled trials are needed to test their efficacy. Aromatherapy and alternative sedatives require further investigation to determine their safety and efficacy.

***

Stuty Authors:
Richards K, Nagel C, Markie M, Elwell J, Barone C.
Central Arkansas Veterans Healthcare System,
2200 Fort Roots Drive, 3J/NLRVA, North Little Rock, AR 72114, USA

25 February 2010

Northwestern Memorial’s Integrative Oncology Program aims to ease pain and help patients manage cancer

CHICAGO- The very instant Penny Kukovec was diagnosed with breast cancer her world permanently changed. Suddenly, it felt as if her life was out of her control. She felt powerless and overwhelmed. There were so many unanswered questions. Why me? What’s next? What about my family? The feelings Kukovec experienced are felt by many cancer patients following their initial diagnosis and as they pursue treatment. In an effort to effectively and compassionately respond to these worries, as well as address common side effects associated with cancer treatment, Northwestern Memorial Hospital and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University now offer integrative oncology services.

“When a patient is diagnosed with cancer many of them want to fully participate in their recovery, but don’t know where to begin. This program gives them control over their treatment,” said Julian Schink, MD, chief of Gynecologic Oncology at Northwestern Memorial and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

The integrative oncology services are part of a larger 360 Care Program that recently launched aimed to address cancer patients’ needs from every angle through treatment that extends beyond medical therapies, to include counseling, stress management and integrative medicine. Integrative oncology services include acupuncture, massage, energy healing and naturopathic medicine offered by Northwestern Memorial Physicians Group’s Center for Integrative Medicine and Wellness.

“Our goal is to treat the whole person, not just their illness,” said Melinda Ring, MD, medical director of the Center for Integrative Medicine and Wellness. “Research suggests that a holistic approach can alleviate stress and anxiety, as well as the physical pain and discomfort patients often experience while undergoing cancer treatments by activating the body’s innate healing process.”

While there is little research to explain exactly how integrative approaches like acupuncture work, researchers at the National Institute of Health state complementary therapy such as acupuncture do improve the body’s immune system. In an oncology setting, integrative approaches provide an effective way to manage symptoms, alleviate side effects, and help patients restore their sense of control and vitality.

“My body was hit hard with trauma. I was so tired, my joints hurt and my muscles were tense. I knew I needed more help. When I began massage therapy my muscles relaxed, and it helped me release my emotions. It reminded my body that it can relax in spite of what I am going through,” said Penny Kukovec, patient at Northwestern Memorial.

Common side effects of chemotherapy and radiation treatment for cancer include muscle tension, aches, pains nausea, vomiting and fatigue. The main role of complementary medicine is to provide supportive care and reduce adverse effects while helping the patient cope.

“Unfortunately, the side effects associated with conventional therapies often cause patients to end their treatments prematurely, or require that we take a less aggressive approach,” said Schink. “We’ve seen this occurrence decrease with the addition of integrative oncology services.”

“The medicine I was taking for my cancer caused nerve damage in my hands and feet. It was very uncomfortable. Acupuncture helped relieve the pain,” said Nancy Amicangelo, patient at Northwestern Memorial.

There is evidence that integrative approaches may also play a role in reducing the rate of depression among cancer patients. Services such as massage therapy are believed to have a short-term effect on reducing anxiety related to depression among patients.

“You’re sick, your hair falls out, and your family is stressed. When you are diagnosed it’s sometimes all that you can think about. The massages offer me a chance to escape,” said Kukovec.

While integrative medicine does not offer a cure for cancer, there is strong evidence that it positively affects the patient. Studies show 77 percent of cancer patients who incorporate complementary approaches believe it improves their quality of life, and 73 percent state it makes them feel hopeful. In addition, 71 percent say it helps to boost their immune system.

All patients under the care of a Northwestern Memorial oncologist are eligible to receive free integrative medicine services as part of their cancer treatment. The 360 Care Program was made possible by a generous gift from Abra Prentice Wilkin, board member of Northwestern Memorial Hospital and longtime supporter of the hospital.

Source:
Angela Salerno
Northwestern Memorial Hospital
Photo credit: Emory University

ANN ARBOR, Mich.—Only 68 percent of corporate executives took their cholesterol lowering medication as prescribed by a doctor, a new study shows.

Overall, the executives who took their medication even sporadically were twice as likely to meet their cholesterol goals. The study finding also questions the prevailing wisdom that income is a primary factor in medication adherence.

University of Michigan researchers studied 1,607 executive level managers at a major financial institution from 1995 to 2004, said Alyssa Schultz, health science research associate at the U-M School of Kinesiology Health Management Research Center, and one of the study authors.

Researchers wanted to discover the rate of medication adherence, and also what happened to cholesterol levels in executives who did or didn’t take statins. Statin drugs lower the low-density lipoprotein (LDL) cholesterol, or the so-called bad cholesterol. Statins are proven effective and are a first-line treatment for lowering cholesterol.

Adherence was defined as taking medication as prescribed at least 80 percent of the time. Overall, statin users were twice as likely to meet the near optimal goal of 130 mg/dL or less, than non-statin users. Among executive who took statins, 70 percent achieved the near-optimal goal and 30 percent achieved the optimal goal of 100 mg/dL or less, compared to 55 percent and 21 percent, respectively, for non-statin users who weren’t prescribed the drug

Even executives who took their medication sporadically did much better than the non-statin users, Schultz said. “It seems to show that some medication use is better than none, however adherence is associated with the best outcome of all,” she said. The executives who actually did adhere to the statin regimen were significantly more likely to achieve their cholesterol goals than those who took the medication sporadically.

Researchers in this study did not look at reasons why the executives did or didn’t follow their doctor’s orders, but past research on the topic suggests cost is a factor. However, this study population was predominately white male and more highly educated and compensated than more than the average person.

“Many people think cost is the main reason for medication non-adherence but this doesn’t appear true since these people have relatively high salaries,” said Schultz.

Using statins could actually save money. Previous research on the effectiveness of statin use in a population at high risk for cardiovascular disease found that a health plan with 210,000 covered lives and 9,336 at-risk employees could yield a $1,735 reduction in costs per treated patient.

So what can employers do? Make sure statins are a covered benefit, said Schultz. Do screening to identify at-risk employees. Partner with health care and pharmacy providers to address reasons for poor medication adherence.

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And suggestions from Catherine at Continuum Wellness:
Actually 68% is rather high. There have been numerous studies describing the problem with statins, and the questioning their need. Why should a company partner to have statin medications paid for? Why isn’t their choice to cover my healthy way of eating or herbs, or acupuncture of homeopathic remedies? Why is everything slanted to covering drug costs? Let us explore other options…they do exist. And many prefer them.

Employers can promote wellness activities, and programs. High cholesterol isn’t a given. It is the result of eating certain food groups, inactivity, inflammation, stress and other factors. If we focus on restoring balance and increasing our innate ability for well-being, cholesterol won’t be a problem. Perhaps intuitively the bosses wonder why they have to take medication daily to be healthy. This is a first in the human history, where the populace is encouraged to take prescription medication, for an unspecified amount of time, supposedly as a necessity to be healthy. Does this make sense? Is this truly medicine?

Cytotoxic effects of ultra-diluted remedies on breast cancer cells.

Frenkel M, Mishra BM, Sen S, Yang P, Pawlus A, Vence L, Leblanc A, Cohen L, Banerji P, Banerji P.

Integrative Medicine Program-Unit 145, Department of Molecular Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA. frenkelm@netvision.net.il

The use of ultra-diluted natural products in the management of disease and treatment of cancer has generated a lot of interest and controversy. We conducted an in vitro study to determine if products prescribed by a clinic in India have any effect on breast cancer cell lines. We studied four ultra-diluted remedies (Carcinosin, Phytolacca, Conium and Thuja) against two human breast adenocarcinoma cell lines (MCF-7 and MDA-MB-231) and a cell line derived from immortalized normal human mammary epithelial cells (HMLE). The remedies exerted preferential cytotoxic effects against the two breast cancer cell lines, causing cell cycle delay/arrest and apoptosis. These effects were accompanied by altered expression of the cell cycle regulatory proteins, including downregulation of phosphorylated Rb and upregulation of the CDK inhibitor p27, which were likely responsible for the cell cycle delay/arrest as well as induction of the apoptotic cascade that manifested in the activation of caspase 7 and cleavage of PARP in the treated cells. The findings demonstrate biological activity of these natural products when presented at ultra-diluted doses. Further in-depth studies with additional cell lines and animal models are warranted to explore the clinical applicability of these agents.

Amy Lansky has written an insightful article to address some of these concerns, here is a link.

Also why do we need (allow) these individuals to decide if we want access to medical freedom, choices and options in our health care? Medical freedom is a necessity, not an option.

Is there a role for complementary therapy in the management of leukemia?
Expert Rev Anticancer Ther. 2009 Sep;9(9):1241-9
Patients with leukemia often seek additional treatments not prescribed by their oncologist in an effort to improve their cancer treatment outcome or to manage symptoms.

Complementary therapies are used in conjunction with traditional cancer treatments to decrease symptoms and side effects associated with cancer or cancer treatment, and to improve patients’ overall quality of life. Complementary therapies are distinct from so-called ‘alternative’ therapies, which are unproven, ineffective and may postpone or interfere with mainstream cancer treatment. Complementary therapies are pleasant, inexpensive, nonpharmacologic and effective. For patients with leukemia, the complementary therapies that are always appropriate include mind-body interventions, such as self-hypnosis, meditation, guided imagery and breath awareness. Massage and reflexology (foot massage) decrease symptoms with effects lasting at least 2 days following treatment. Acupuncture is very beneficial for symptom management without adverse consequences. Physical fitness with regular exercise and healthy dietary habits can significantly decrease side effects of cancer treatments and may prolong survival. Botanical extracts and vitamin supplements may interfere with active cancer treatments, and should be discussed with the oncologist or pharmacist before use.

Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, 1429 First Avenue, NY 10021, USA.

Question:

Lately, my husband has started sweating profusely when he is asleep.  His sweat has a strong cheesy smell. He is showers regularly so that is not the problem.  Is this serious?

———

A Homeopathic Look

I’m not speaking to the, is this serious question, as I am not an medical doctor.  Let’s take a peek at this situation from a homeopathic perspective.

I decided to repertorize these few symptoms and see what comes up.  Look below.  Of course, other factors have to be taken into consideration to make a remedy decision.
Cheesy perspiration, could also be close to “fetid” and “offensive”, but I like this rubric since it quite distinct and in the person’s own language.

Perspiration
ODOR, cheesy, (8)

Perspiration
PROFUSE (224)
night (97)

Based on this limited information what homeopathic remedy might you suggest for this individual?

For a doctor’s perspective on the question read here.

Help for High Blood Pressure

Enter the Polypill.  Researchers want to create a pill a 3 in one that can reduce the risk of heart attack, stroke and high blood pressure in one.  article here
Truth is it has been created or should I say they have been. When we eat whole foods, contained therein is a synergistic blend of vitamins, proteins, amino acids, flavonoids, solar and lunar energy and maybe even (hopefully) love from the gardener. We cannot get this from a pill.

Run This Way

Instead of running from nature, run to nature. Nurture yourself with learning how to live in balance. It’s free. It’s the healthiest choice for yourself and the planet. Give it a try. Polypill? Try basking in the sun, or hugging a dear friend, cook yourself a meal with a big dose of love in it…you’ll be glad you did, for benefits no Polypill could ever provide.

At Continuum Wellness we offer homeopathic care and wellness coaching to promote wholeness, health and well-being.

Some of the comments that I received is that it was a quality event, that the vibe was very soothing, nourishing and uplifting. Attendees said how so many others could benefit from the information provided at the program. And then a lot of folks wanted to know when will we have the next one.

Ahem, cough, cough… let me just say that while I thoroughly enjoyed pulling this together it is a major to do, so, you can mark your calendars now, we will have it again next February 2010.

Last but not least (forgive the cliche) were the wonderful vendors, who came out to share their products.
And thanks to all who came out to participate in the 1st Annual Living Well Holistic Health Fair.
*each one, teach one*

stay tuned, some pic’s will be posted