Monday, March 25, 2013

Integrative Therapy Benefits

Improves Quality of Life

There are more than 600 million visits a year between patients and alternative medicine providers in the US—and the number is growing.

You can call it alternative, complementary or integrated therapy—it is a group of diverse practices and products not considered a part of traditional Western medicine.  But whether you are a skeptic or a proponent, there is no denying that the public is looking for it. 

For those patients who want this kind of treatment, it undeniably works to improve their quality of life.  After all, a hand massage with aromatherapy and soothing music would improve most peoples’ moods and lower their blood pressure and stress.  As simple as that, quality of life is improved.

More and more hospices are adding Integrated Therapies to their armamentarium for achieving comfort and improving quality of life.  As far back as 2004 60% of hospices reported offering complementary treatments (the most popular being music therapy and massage).  The main obstacles to providing these services are lack of adequate funds, knowledge and qualified personnel.  Other Integrated Therapies include animal visits, guided imagery and art therapy.

Pathways has a robust Integrative Therapies Program that provides numerous benefits. Patients report:

  • A sense of control when so much control over their lives has been lost
  • Improved pain management
  • Enhanced emotional wellbeing and decreased anxiety
  • Opportunities to experience pleasure
  • Better quality sleep and decreased fatigue
  • Enrichment in their lives
  • Decreased nausea and enhanced appetite
Integrative Therapies often do not lend themselves to randomized, double-blind, controlled clinical trials due to the very subjective nature of the discipline.  However, risk-benefit analyses demonstrate very low risk—won’t hurt, might help.

The holistic nature of hospice is a setting made for Integrative Therapies.  They have repeatedly been shown to provide physical, emotional and spiritual benefits to patients and their families.

One Patient’s Story

Advanced pancreatic cancer was Mr. B’s grim diagnosis.  A resident of a SNF, he had prognosis of a few weeks when referred to Pathways by the distressed facility.  During the admission to hospice, the patient disclosed that he was a Christian Science practitioner and was not open to using any medications to manage his rather severe symptoms.

With this limitation, Pathways quickly initiated several Integrative Therapies and held a stat inservice for the SNF staff and his family.  Hospice volunteers, personal care aides, spiritual care counselors, social workers and nurses all contributed their Integrative Therapy skills.  Mr. B received massages, aromatherapy, guided imagery, Reiki, music therapy and comfort touch.  We also involved the family, asking them to find movies, CDs and other forms of distraction that Mr. B would respond to.

Although his pain was never completely gone, the patient reported it was significantly decreased and that he noticed an improved ability to cope with the pain that remained.  Until he died about three weeks after admission, Mr. B reported that Integrative Therapies had helped manage his symptoms to a level he deemed acceptable. 

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 26.  To download this issue in PDF format, or past issues, visit our newsletter archives online at

Monday, March 18, 2013

Addicted to Pain?

Some brains may be wired to become addicted to pain.  In fact, researchers have been able to accurately predict people who will continue to experience back pain more than a year after their initial injuries.

A study done at Northwestern University in Illinois looked at 39 people with recent onset of back pain.  Half still had pain a year later—their original pain had converted into insidious, chronic pain.  All participants had similar pain at the start of their injuries, but the chronic pain cohort had an unusually strong connection between two regions of the brain: the nucleus accumbens and the prefrontal cortex.

The two regions seemed to work in tandem, if one was active the other also “lit up.” A stronger connection correlated with a higher likelihood of developing chronic pain.

“We’re very excited about these results,” observed study coauthor A. Vania Apkarian of Northwestern. “We think they open up a whole new way of looking at chronic pain.” The research was presented in the July 1, 2012 Nature Neuroscience online journal.

Previous studies have examined brain differences in chronic pain sufferers, but researchers had not been able to discern whether these changes were caused by the chronic pain or an effect of living with it.  This study was the first to reveal a predictive signal present in the brain before the pain becomes chronic.

Interestingly, the study may link chronic pain development to the brain’s addiction conduit since both include the nucleus accumbens.  “This is certainly part of the addiction pathway,” Apkarian noted, observing that though the idea hasn’t been tested, chronic pain may stem from the brain essentially becoming addicted to pain and warrants further study.

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 26.  To download this issue in PDF format, or past issues, visit our newsletter archives online at

Monday, March 11, 2013

Macular Degeneration

Losing Sight

Age related macular degeneration usually affects older adults and results in a loss of vision in the center of the visual field.  It’s due to damage to the retina. Macular degeneration can make it difficult or impossible to read or recognize faces, although enough peripheral vision remains to allow other activities of daily life.


  • Aging: About 10% of people 66 to 74 years of age will have some evidence of macular degeneration. It’s 30% in patients 75 to 85 years old.
  • Family history: For someone who has a relative with it, the risk of developing late-stage macular degeneration is 50%.  It is only 12% for others.
  • High blood pressure plays a role in MD.
  • High cholesterol, obesity, and high fat intake are associated with an increased risk of MD.
  • Smoking increases the risk of MD by two to three times that of someone who has never smoked, and may be the most important modifiable factor in its prevention.
  • Reducing fat intake:  This means cutting down greatly on red meats and high-fat dairy products such as whole milk, cheese, and butter, and eating more cold-water fish (at least twice a week); eating any type of nuts may help.
  • Nutritional supplements: Some evidence supports increasing intake of two carotenoids: lutein and zeaxanthin.  Eating foods high in omega-3 fatty acids has been correlated with a reduced progression of early macular degeneration.
  • Adaptive devices: These help people read and include everything from magnifying glasses to computer software.
  • Audio books: are also helpful.
  • Reverse print: Written material with white text on a dark background is easier to read for people with macular degeneration.

This article was originally published in Pathways Residential Care Journal - Issue 5.  To download this issue in PDF format, or past issues, visit our newsletter archives online at

Monday, March 4, 2013

A Full Life

Setting Priorities

When things in your life seem almost too much to handle, when 24 hours in a day are not enough, remember this story about a jar and two glasses of wine.

A professor stood before his philosophy class with some items in front of him.  When the class began, he picked up a Costco-size jar and filled it with golf balls until he couldn’t cram another one in.  He then said, “I guess the jar is full, huh?” They agreed that it was.

The professor then picked up a box of pebbles and poured them into the jar.  He shook the jar lightly and the pebbles rolled into the open areas between the golf balls.  He said, “Now the jar is really full, right?” And everyone nodded in agreement. 

Next the professor poured a bag of sand into the jar. Of course, the sand filled up everything else.  He asked once more if the jar was full. The students responded with a unanimous, “Yes!”’

The instructor then produced two glasses of wine from under the table and poured them into the jar, effectively filling the empty spaces in the sand. The students laughed.

“Now,” said the professor as the laughter subsided, “I want you to recognize that this jar represents your life. The golf balls are the important things—your family, your children, your health, your friends and your favorite passions—and if everything else was lost and only they remained, your life would still be full.

“The pebbles are the other things that matter like your job, your house and your car. The sand is everything else—the small stuff.

“If you put the sand into the jar first,” he continued, “there is no room for the pebbles or the golf balls. The same goes for life. If you spend all your time and energy on the small stuff you will never have room for the things that are important to you.”

He concluded, “People should pay attention to the things that are critical to their happiness: spend time with your children, and parents and grandparents.  Take time to get medical checkups.  Take your spouse out to dinner. Play games.

“There will always be time to clean the house and fix the disposal.  Take care of the golf balls first—the things that really matter. The rest is just sand.”

One of the students raised her hand and inquired what the wine represented. The professor smiled and said, “I’m glad you asked.  The wine just shows you that no matter how full your life may seem, there’s always room for a glass of wine with a friend.”

This article was originally published in Pathways Residential Care Journal - Issue 5.  To download this issue in PDF format, or past issues, visit our newsletter archives online at