Marin hospitals are taking an integrated approach with acupuncture
By Keri Brenner, IJ reporter

http://www.marinij.com/Stories/0,1413,234~24407~2078635,00.html

Nurse Lisa Crespo's back pain started on her last day of work before
New Year's Eve.

"I was lifting a patient to help assist him in getting back to bed,"
said Crespo, who works in a medical surgical unit of Novato
Community Hospital. "I made sort of a twisting motion, and I felt a
twinge in my middle and upper back."

In January, after pain pills, muscle relaxants and a cortisone shot
all failed to provide much relief, Crespo decided to try
acupuncture. She didn't have to go far.

Crespo's acupuncturist was a fellow hospital employee: Pat Sanders,
a nurse practitioner and licensed acupuncturist at Sutter@ Work, an
occupational medicine clinic at Novato Community and at Marin
General Hospital in Greenbrae.

With the introduction of acupuncture into a hospital setting, Marin
is at the forefront of a growing national trend called "integrative
medicine." A blend of conventional and non-conventional therapies,
integrative medicine is expanding into major hospitals across the
country - including Duke University Hospital in Durham, N.C.,
Memorial Sloan-Kettering Cancer Center in New York and Cedars Sinai
Medical Center in Los Angeles - as research becomes available on
applying alternative and complementary therapies to clinical
practice.

"I was amazed at how well it worked and relieved the pain," said
Crespo, who still is receiving regular treatments. "I actually
believe in traditional medicine, where you take a pain pill if
you're in pain, but the fact that you could stick a needle in and
relieve pain, this is great."

Sanders, who started treating outpatients at the two Marin Sutter
hospitals with acupuncture in March of last year, is the first full-
time nurse practitioner/ acupuncturist on staff. At Kaiser
Permanente Medical Center in Terra Linda, licensed acupuncturist
Elon Rosenfeld has been on staff for two and a half years, said
Patricia Kendall, medical group administrator.

"A lot of people who are sent for acupuncture have been in pain for
a long time, and nothing helped, so they really appreciate when it
works," said Randee Allen, director of Kaiser Terra Linda's physical
therapy department, where acupuncturist Rosenfeld is based. "It can
be a life-changing thing for some people - they couldn't walk to the
bus stop before, and now they can. It's a big thing for them."

Sanders was hired as a nurse practitioner at the two Marin Sutter
hospitals in October 2000. An acupuncturist in private practice for
more than 18 years, Sanders began developing the hospitals'
acupuncture program protocols in December 2001. Approval for the
program - which included reviews by more than a half-dozen hospital
boards and committees - took more than two years after that.

Sanders primarily treats people with workplace injuries, such as
Crespo. Those are patients with job-related conditions who are
referred to the occupational health clinic, Sutter@Work, and who are
covered by their employer's workers' compensation insurance.

This year, Sanders opened up the service to members of the public as
well.

"The doctors were very excited," said Patrick Glover, director of
Sutter's occupational health department, of Sanders' work. "Here was
this actual nurse practitioner who also does this (acupuncture) - it
helps her credibility in the physician community."

This summer, the occupational health clinics at the two Sutter
hospitals will be consolidated into one facility at the new Sutter
Terra Linda Health Plaza, planned for a 75,000-square-foot building
at 4000 Civic Center Drive in San Rafael.

The Sutter hospitals also include acupuncture as a treatment option
through the Institute of Health & Healing, a program operated in
partnership with the California Pacific Medical Center in San
Francisco. Licensed acupuncturist Andy Seplow treats outpatients on
a part-time basis at the institute's Marin office at 5 Bon Air Road
in Larkspur.

Unlike Sanders, Rosenfeld works out of the Kaiser Terra Linda
physical therapy department, not at Kaiser's 10-year-old
occupational health clinic, called Kaiser On the Job. Acupuncture
through Kaiser On the Job - as well as at the physical therapy
department - is done on a referral basis from the patient's primary
physician, Kaiser administrator Kendall said.

Although acupuncture use in hospitals is on the rise, most of the
country has been slow to pick up. A May 2003 American Hospital
Association survey found only 16.7 percent of 1,005 U.S. hospitals
queried were using any form of complementary or alternative medicine
in 2002.

Area experts say acceptance is slow in some places, because the
mixture of a 5,000-year-old Eastern philosophy with conventional
Western medical theory is, by nature, a challenge.

For starters, Eastern and Western medical theories are quite
different from each other, said Karen Reynolds, an acupuncturist in
private practice in Walnut Creek and San Francisco who is also a
registered nurse at Kaiser in San Francisco.

Eastern medical theory is based on diagnosing various patterns
within the body, mind and spirit of the patient, while Western
theory tends to be based on diagnosis by symptoms, Reynolds said.

"What the lay public doesn't understand is that Oriental medicine
treats many things, not just pain," Reynolds said. "Oriental
medicine treats digestive and gynecological problems and shen
(spirit) disorders - such as depression - and it is immensely
effective."

Reynolds, a board member of the California State Oriental Medical
Association, notes that difficulties in translation also slow the
process of integrating Oriental Medicine into Western clinical
practice.

"Since it's new in this country, and a lot of the research is from
China and Japan, there's a barrier to getting the research and it's
hard for the American Medical Association to endorse it fully," she
said.

Even though Kaiser has staff acupuncturists at all its Bay Area
medical centers, Reynolds said she didn't apply for the positions
because she knew she would not be treating the full range of
conditions that she is able to treat in private practice.

Sanders, at the Marin Sutter hospitals, also acknowledges that she
has had to make accommodations. Sanders said she is trained in
Chinese herbology, but does not use it with her Marin hospital
outpatients because Oriental medicine herbal treatments would be too
difficult to arrange in a hospital setting.

She also doesn't do moxabustion, an herbal heat treatment, in the
hospitals for the same reason, but does employ a special heat lamp
that works in a similar manner. She also uses an electronic
microcurrent stimulator device that is easy to control in a hospital
setting.

"I try to keep things simple," Sanders said.

At Cedars Sinai Medical Center in Southern California, however, many
barriers to integrative medicine have dissolved. Evan Ross, a
licensed acupuncturist on staff at Cedars Sinai since 2001, said he
sees 90 to 100 inpatients and outpatients a week for everything from
stroke hemiparesis - or partial motor impairment - to post-
chemotherapy nausea and vomiting.

"I just did a lecture to the liver transplant team," said Ross, 34,
who received staff privileges at the hospital in January of last
year. "They're thinking of using acupuncture in surgery, for post-op
pain, and for nausea, vomiting and bowel problems, post-op, for
patients who don't tolerate medicines and drugs."

Ross, whose specialty is "integrative oncology" for treating cancer
patients, is called in regularly by patients' primary physicians for
acupuncture consultations.

"I go in the ICU, I go anywhere in the hospital," he said.

Dr. Martin Rossman of Mill Valley, who in 1972 was one of the first
Marin physicians to begin practicing acupuncture, called the
introduction of acupuncture in hospitals "wonderful."

"Every step like this brings us closer to a real integration of
acupuncture and Western medicine," said Rossman, a founding member
of the American Academy of Acupuncture. "I don't think it matters
where a person gets treated - it's more important whom they get
treated by, the person's qualifications, their experience."

According to Nicholas Broffman of Pine Street Clinic, an Oriental
medicine facility in San Anselmo, the fact that Marin hospitals are
adding acupuncturists is a reflection of the county's progressive
attitudes.

"In terms of Western openness to Oriental medicine, it's probably
higher in Marin than elsewhere, compared to other smaller suburban
counties," said Broffman, whose father, Michael Broffman, is clinic
director and a licensed acupuncturist.

Nicholas Broffman said Pine Street, since its inception in 1982, has
had an integrative medicine approach, working closely with Western
physicians.

"When we started, there were about five acupuncturists practicing in
Marin, but now there's about 175," Broffman added. "Certainly, Marin
is at the forefront of integrative medicine."