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 www.pathwayshealth.org/publications.

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 www.pathwayshealth.org/publications.

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.

Causes

• 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.

 Management

• 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 www.pathwayshealth.org/publications.

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 www.pathwayshealth.org/publications.

Shingles Overview

What is Shingles?

After a person has had chicken pox the virus that causes it stays sleeping for decades in nerves near the spine.  The virus is herpes zoster.  About 20% of people who have had chicken pox will later have a shingles outbreak.  Shingles usually affects older people and people with weak immune systems.

Cold sores on the lips and genital herpes are caused by different herpes viruses, herpes simplex viruses.

Symptoms

If the virus wakes up, it travels along nerve fibers to the skin, usually appearing in one area, on one side of the body, and along the line of a nerve.  But shingles can be anywhere on the body.  The rash is painful and has fluid-filled blisters.  The first symptoms start 1 to 5 days before the rash and include:

• Itching
• Tingling
• Burning sensation
• Pain, sometimes worse at night

Less common symptoms are fever, chills, headache and stomach ache.  Shingles near the eye or ear can cause vision or hearing loss and are usually treated aggressively.

The blisters usually scab over in 7 to 10 days and disappear completely in 2 to 4 weeks.  In most people the rash leaves no scars and the pain and itching go away after a few weeks or months.

In some people the pain from shingles stays for months or even years after the rash is gone.  The pain is from damage to the nerves in the skin.  This is called post-herpetic neuralgia. 

Treatment

There is no cure for shingles.  But there are antiviral medications that can make the episode shorter and milder if given early.  They also reduce the risk of pain after the rash is gone.  The antiviral drug should be started at the first sign of symptoms to be most effective.

Over-the-counter pain and itch medicines, such as calamine lotion, work fairly well for many people.  If the pain is severe or the rash is near the eye or ear, the doctor may prescribe steroids to reduce the inflammation.  Using a compress dampened with cool water may help with itching.  Scratching should be avoided to prevent damage to the skin and to prevent breaking the blisters.

Vaccine

A shingles vaccine is available.  It prevents about half of shingles cases and reduces the frequency of post-shingles pain.  The Centers for Disease Control recommend that all adults 60 years and older be vaccinated.  The vaccine does not work well in people over 80 and is generally not recommended for this age group.

Is It Contagious?

Yes, but you can’t get shingles from another person; only chicken pox.  If you have never had chicken pox, or the vaccine for it, and you are then exposed to the fluid in the shingles blisters, you can get chicken pox.

Caregivers can carry the virus from one person to another and if the second person has not had chicken pox, they may get it.  Shingles can only be transmitted when the blisters have burst and are oozing, before they crust over. 

What can you do to prevent spread?

• Prevent blisters from breaking open.
• Keep the rash covered to prevent the blister fluid from contaminating others. 
• Assist the resident with shingles to wash hands often. 
• Only caregivers who have already had chicken pox should be assigned to residents with shingles. 
• No one who is pregnant should be assigned to a resident with shingles.
• Keep surfaces clean and disinfected.
• If the resident has shingles on the buttocks, he or she should not use common toilets.
• All caregivers and housekeepers should wear gloves in the resident’s room until he is no longer contagious.  Hands should be washed after removing gloves.
• Determine if roommates or others the resident socializes with are at risk.
• Use common sense precautions.
• Washing Linens

People handling sheets and towels of a person with shingles should wear gloves.  Sheets and towels should not be shaken or set down on a surface, even the floor.  They should immediately be put into a linen bag.  No special procedures are needed for washing linens.

Staff with Shingles

Staff members who have shingles should not care for vulnerable residents, including people with cancer, residents with compromised immune systems or those who have not had chicken pox. 

This article was originally published in Pathways & Partners Newsletter - Issue 27.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Hand Sanitizers vs Norovirus

People in densely populated living situations, like cruise ships and skilled nursing facilities, are reaching for the alcohol-based hand sanitizing gel in hopes of avoiding the norovirus.  But does it prevent infection from the gastrointestinal bug?  It looks like the answer is “No.”

Many studies have shown that alcohol-based sanitizers reduce germ counts on hands and can reduce the spread of some strains of flu.  But the nasty norovirus that causes vomiting and diarrhea is resistant.

Some viruses, including the flu virus, have a coating that the alcohol in the sanitizer can burst open, killing the virus.  But the norovirus doesn’t have a capsule that alcohol can penetrate.  So it lives on even when you believe your hands are disinfected.  Noroviruses are so infectious that as little as 10 missed microscopic particles can cause infection.

Bleach kills the norovirus, and a solution of 10% bleach is great for wiping down counters and surfaces that may have been contaminated.  But since we really can’t wash our hands in bleach, experts say we should wash hands frequently with plain old soap and water.

In 2011 the Centers for Disease Control and Prevention studied records from the winter of 2006-07 in 91 long-term care facilities; they found 23 outbreaks of the norovirus.  Facilities where staff regularly cleaned their hands with alcohol-based sanitizers had six times as many norovirus outbreaks than facilities where the staff used soap and water. 

The CDC says that to prevent the spread of the norovirus, alcohol sanitizers should only be used “in addition” to hand washing, but not as a substitute.

This article was originally published in Pathways & Partners Newsletter - Issue 27.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

How Not to Catch a Cold

Meditation Works

If there were a way to avoid getting colds and the flu, would you do it?  There is some compelling evidence that there may be just such an antidote!  Meditation and exercise both appear to reduce the frequency of acute respiratory infections—colds and flu.

Researchers at the University of Wisconsin assigned 149 participants, mostly women and all over 50 years old, to one of three groups.  One group took an 8-week training program in mindfulness meditation, the second an 8-week training in moderate intensity sustained exercise and the third served as an observational control group.  They studied the participants for the duration of one cold and flu season.  These results were pretty remarkable.

Acute Respiratory Infections by Group
Meditation - 27   
Exercise - 26   
Control - 40   

Total Days of Illness by Group   
Meditation - 257   
Exercise - 241   
Control - 453   

Days of Work Missed by Group
Meditation - 16
Exercise - 32
Control - 67

The research was funded by the National Institutes of Health and reported in the Annals of Family Medicine in July, 2012.

In addition to washing your hands and getting your flu shot, this cold and flu season you may also want to engage in some mindful meditation techniques or sustained exercise!

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 www.pathwayshealth.org/publications.