Stacy and Mike Brindise with baby Davis.

health

Health Care New & Improved

A new generation of patients and doctors is changing the face of American medicine. Its about more than curing disease now its health for the whole person.
Story by Emma Seppala Photographs by Cameron Wittig
Stacy Brindise, 30, was eager to have children. But after trying for several years to conceive, she and her husband, Mike, were still childless. Like millions of couples, the Brindises were faced with what doctors refer to as unexplained infertility. Couples diagnosed with unexplained infertility are typically active, healthconscious people of childbearing age who find themselvesfor no apparent reasonwithout a crib or a bottle in the house. Like many, the Brindises followed a familiar route, first consulting doctors who recommended hormone treatment, which Stacy reluctantly decided to try.

$34B
Americans spent nearly $34 billion out of pocket for alternative treatments in 2007, according to a National Institutes of Health survey.

The arduous six-cycle program involved daily medications, self-administered hormone shots, and monthly intrauterine insemination with a catheter. But the Brindises still couldnt get pregnant. Physicians next suggested that Stacy try in vitro fertilization. It would involve doses of medication, a considerable price tag (starting at $12,000), and increased chances of her having twinsfactors that gave the couple considerable pause. Nothing had worked and it was time, Stacy decided, to change her approach. When people have a medical problem, everybody seems to jump right to drugs

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as the solution, she says. I wanted to see if improving my overall health and well-being would increase our chances of getting pregnant naturally. Stacy is not alone in her gut feeling that first addressing her overall health and well-beingbefore investing in more invasive solutionsmight be a key element in her health care. Hightech, high-cost approaches clearly have their place, and modern medicine can boast many silver-bullet solutions. But millions of Americans feel thats not enough. They spend more than $30 billion a year out of their own pockets for alternative treatments, according to data compiled by the National Center for Complementary and Alternative Medicine. Funding for NCCAM the U.S. governments lead agency for scientific research on complementary and alternative medicinehit $128 million in 2012, a 156% increase since its inception in 1999. Complementary and alternative is the federal governments current label for approaches that lie outside the main-

stream. However, a nationwide survey shows that approximately 38% of U.S. adults aged 18 years and over use some form of complementary and alternative medicineanything from acupuncture to meditation. Thats starting to look pretty mainstream, which is one reason many doctors prefer the term integrative health care. In 2010, 600 health care professionals assembled in Washington, D.C., for a summit on integrative medicine. It was sponsored by the Institute of Medicine, which defines integrative medicine as health care that addresses together the mental, emotional, and physical aspects of the healing process for improving the breadth and depth of patient-centered care and promoting the nations health. The doctors who champion integrative approaches are not simply proposing alternatives. They advocate an updated model of health care that integrates mind and body, promotes more interaction and communication in the doctorpatient relationship, puts the patient at the center, and encourages self-care.

Florence Strangs successful battle with breast cancer is a prime example of integrative medicineof taking care of the whole person while trying to cure a disease. She is alive today because of radiation, chemotherapy, and surgery. But Strang also attended a mindfulness retreat led by an oncologist, and she credits mindfulness and awareness practices with helping her cope with the suffering that came with those life-saving treatments. I was undergoing a lot of lengthy, painful, and uncomfortable treatments and procedures, she says. In one year I had six rounds of chemo, 25 radiation treatments, three surgeries, and I would not be able to tell you how many difficult tests and procedures. Strang is a registered psychologist who works as an elementary school guidance counselor. She knew the chemotherapy treatments were helping her fight cancer. But in the process, her body was weakening and suffering profoundly. By her second round of chemo, she knew that if she was going to get through it, she needed to stay focused on the positive.

Florence Strang is alive today because of radiation, chemotherapy, and surgery, but she credits mindfulness practices with helping her cope with the stress of her treatments.

Dr. David Spiegel, director of the Center on Stress and Health at Stanford University

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PHOTOGRAPH BY KAiTlYn JARvis

The average doctor spends 7 minutes per patient, while the average integrative practitioner spends 30 minutes.

Getting You & Your Doctor Tuned In

When it comes to getting the most out of a doctors appointment, the goal is to get the doctors attention, so he or she sees you as a flesh-and-blood human being, not just as a body with symptoms, says Toni Bernhard, author of How to Be Sick. We also asked Dr. Barbara Korsch, author of The Intelligent Patients Guide to the Doctor-Patient Relationship, to share her insights. Heres Mindfuls summary:

Make a List

1 2 3 4 5
Be Kind
While its easy to get swept away by your own fears and disappointments, Bernhard says, try to remember your doctor is human, too. And dont take it personally if an interaction doesnt go the way you had hoped. Being kind, respectful, and patient in any relationship can do nothing but good. This doesnt mean that if youre sick you have to put on a happy face. You just need to remember that the two people in the room are both seeking the best outcome possible.

Bernhard says going into an appointment with a list helps you keep your attention on the task at hand. The key is clarity and setting an agenda, says Korsch: Get your concerns into the interaction early and also allow the doctor to state what his or her plans are. Be realistic about the amount of information that may fit reasonably into one appointment, but dont let any issues drop off your radar or your doctors. If need be, book an additional appointment to get everything covered.

Seek Answers

If youre confused about something, dont let it slide. But dont take a confrontational stance either, says Korsch. Go with an open mind and with questions and concerns and state them up front. Bernhard adds: Dont be afraid to question treatment and ask about alternatives. It spurs doctors to talk to you about whats going on in their heads, and you want them to share that with you. While feeling ill and needing help is a highly vulnerable position to be in, dont let that translate into being embarrassed about your needs or curtailing your questions. Once you stop blaming yourself for needing help, you can really start to take care of yourself.

Consider Taking Someone with You

Be in the Room

If you have a loved one or a friend in the room with you, this can trigger greater communication. Doctors can sometimes be more detailed in their explanations for the benefit of that third person, says Bernhard. If complicated matters are being discussed, another set of ears and moral support can be excellent. However, according to Korsch, for routine appointments, you may not want to complicate your relationship with your doctor.

Its a rare appointment when you dont have at least some waiting to do, and Bernhard suggests two ways of approaching that. If shes feeling anxious, she sits and concentrates on her breathing. It calms my body and gives me courage. I bring my attention back to my body and feel whole again, rather than all scattered. If she feels restless and bored while waiting in the examining room, she practices being present. I focus on my senses and scan the room, looking at the equipment, the pictures on the wall. This transforms waiting times into times of engagement.

By Line Goguen-Hughes

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When Richard Low returned from Iraq and started breathing practices, he learned a lot about PTSD and how much it had affected him.

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The most important thing I did is what I would call mindfulness of healing, says Strang. Instead of fighting against these treatments, which left me feeling in such misery, I just observed and accepted what was happening. And I would think to myself, Chemotherapy is my friend. Its going to save my life. If I observed the treatment from a place of being kind and healing to myself, rather than looking at the treatment as some horrible thing that was happening to me, it made it easier. Bringing mindfulness and kindness to your care gives you a different perspective. This is when Strang came up with what she calls her survival plan, which tookand continues to takeher own body and mind into account. To help focus her mind on the positive, she started a blog, www.perksofcancer.com, which chronicles her approach to dealing with the disease. Strangs way of coping with her cancer reflects the approach that integrative health care doctors take, according to Dr. Margaret Chesney, director of the Osher Center for Integrative Medicine at the University of CaliforniaSan

Francisco. Chesney emphasizes that the best way to enhance health and heal illness is often a combination of conventional medicine and healing methods that address the person as a whole, that see where they are in their lives from the point of view of mind, body, spirit, and community. For a patient at the Osher Center who wants to prevent heart disease, for example, the treatment plan might include an appointment with a cardiologist for appropriate testing but also a stress-management program such as yoga, meditation, or massage. Richard Low served for 16 months in Iraq as an officer in the 4th Battalion of the 23rd Infantry Regiment. He didnt think of himself as the sort of person who needed yoga to round out his life and help him heal. He wasnt even sure he needed healing, but he volunteered anyway to be part of the Veterans Wellness Study at the Center for Investigating Healthy Minds in Madison, Wisconsin. During the study, I learned a lot about what PTSD was and just how much I had been affected, Low now says. He also learned how to use a yogic breathing technique called sudarshan kriya, which has been found to be particularly effective for trauma sufferers. With trauma usually comes agitation, and that makes most meditation techniques difficult. Its hard for people with traumatic thoughts to sit still and relax, but breathing techniques give them a way to feel their body and find relaxation there. Low came to some realizations. I really numbed myself out after returning from Iraq, he says. I was disconnected, but I didnt really know it. Other family members noticed, though. His dad, for one. We were out deer hunting, says Richard. We were talking about the study and my dad said, I can see that youre you nowthe you from three or four years ago. I was happier, joking around again, relaxed. Standard treatments for post-traumatic stress include therapy and medication. However, recent studies have shown that both therapeutic and drug treatments have high dropout rates, and of veterans who do complete treatment, only about half experience a reduction in symptoms. Shad Meshad, founder of the National Veterans Foundation, was instrumental

+156%
2012
Funding for NCCAM the U.S. governments lead agency for scientific research on complementary and alternative medicinehit $128 million in 2012, a 156% increase since its inception in 1999.

I really numbed myself out after returning from Iraq.

Richard Low, who served for 16 months as an officer in the 4th Battalion of the 23rd Infantry Regiment

in bringing attention to post-traumatic stress disorder before it was a clinically acknowledged diagnosis. He is internationally renowned for his work with trauma and was asked by the U.S. government to train critical-incident and trauma teams after the 9/11 attacks. Meshad uses a technique called TFT, in which a practitioner asks the patient to recall a traumatic event, then helps them tap different parts of the body known as meridian points (mostly on the face) in order to release the trauma. This practice is often coupled with breathing practices. Combat veterans in particular are often averse to talking about their trauma to a stranger. The great thing with this method, says Meshad, is that they dont have to go into the details that distress them. They just need to describe the moment that led to the trauma and what haunts them, and then we go through the procedure. I ask them to rate their anxiety on a scale of 1 to 10. If they are at 10, my goal is to get them to 1. People think Im a miracle worker, but I know this stuff works. Ive watched a decorated combat vet laughing or crying with joy like he won the lottery because he feels free. Its freedom, a release from the imprisonment of the brain, a release from hell.

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38%
Read/Watch/Click
Leaves Falling Gently: Living Fully with Serious & LifeLimiting Illness through Mindfulness, Compassion & Connectedness by Susan Bauer-Wu Mindfulness Meditation for Pain Relief: Guided Practices for Reclaiming Your Body and Your Life by Jon Kabat-Zinn Womens Bodies, Womens Wisdom by Christiane Northrup Calming Your Anxious Mind: How Mindfulness and Compassion Can Free You from Anxiety, Fear, and Panic by Jeffrey Brantley Escape Fire: The Fight to Rescue American Healthcare, documentary, released October 2012 For information on Sudarshan Kriya for veterans, visit Project Welcome Home Troops www.pwht.org For information on TFT and Shad Meshads work with veterans, visit www.nvf.org To find an integrative health care center near you, visit the Consortium of Academic Health Centers for Integrative Medicine www.imconsortium.org Approximately 38% of U.S. adults aged 18 years and over use some form ofcomplementary and alternative medicine, according to a nationwide government survey released in December 2008.

quality of their care, as measured by the health of their patients. This approach stems from a health care system that responds to health problems more than it prevents them from occurring in the first place. Disease management tends to outweigh health care in such a model. But change is afoot. The system is shifting, says Dr. Adam Perlman, executive director of the Duke Center for Integrative Health. Were seeing much more emphasis on prevention and lifestyle. Its an exciting time for integrative health. It was a friend of Stacys who helped the Brindises solve their unexplained infertility. She was a nurse in an obstetricians office and she told Stacy that she had met many women who had used acupuncture successfully when they were trying to get pregnant. Despite some misgivings about the little she knew about acupuncturenamely, that it involved a lot of tiny needlesStacy booked an appointment at the Acupuncture and Chinese Medical Center in Edina, Minnesota. My first surprise was that the doctor spent a good hour and a half with me, Stacy says. She asked me detailed questions about my eating habits, stress levels, and lifestyle. She took the time to get to know all of my habits so I could make choices that were more conducive to pregnancy. Her assessing my overall wellbeing made me feel really comfortable and taken care of. The acupuncturist advised once-aweek acupuncture sessions and dietary adjustments. Five weeks later, Stacy got her second surprise: She was pregnant. Stacy and Mike welcomed a healthy baby boy into the world in November.

For more resources and reporting on integrative health go to mindful.org/health

The power of integrative medicine doesnt just lie in techniques. According to Dr. David Spiegel, director of the Center on Stress and Health at Stanford University, part of whats powerful about any integrative approach is that it helps patients feel more involved, more in control and responsible for their own health care. It also allows for more time with a medical practitioner. The average doctor, says Spiegel, spends seven minutes per patient and the average integrative practitioner spends 30 minutes. The medical care system in this country is broken, says Dr. Jeffrey Brantley, director of Mindfulness-Based Stress Reduction at Duke Integrative Medicine in Durham, North Carolina. One of the ways its broken is that both people in that seven-minute exchangethe patient and the doctorare being short-changed. Many factors weave together to create this problem: our medical culture, our national view of health, our reimbursement models. The fee-for-service reimbursement approach is a cornerstone of the U.S. health care system. It pays doctors for services supplied. It does not evaluate the

Emma Seppala is associate director of the Center for Compassion and Altruism Research and Education at Stanford University and a research scientist and honorary fellow with the University of WisconsinMadisons Center for Investigating Healthy Minds.

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When people have a medical problem, everybody seems to jump right to drugs as the solution, says Stacy Brindise, whos holding her baby boy, Davis. I wanted to see if improving my overall health and well-being would increase our chances of getting pregnant naturally.

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