Integrative Medicine Bridge the East and West First

Integrative Medicine - Bridge the East and West First Chinese Medicine Residency in U. S. Amy Matecki, MD. FACP, MSc. L. Ac, Chief , Division of Integrative Medicine Department of Medicine, in affiliation with UCSF Alameda Health System May 18 th , 2018

Disclosure • I have received no financial support for this • • • presentation. I am the Medical Director for Alta Bates Summit Medical Center I am the President of International Center for Integrative Medicine (ICIM) All Photos are consented by patient and family

Objectives • Introduction of Integrative Medicine (IM) for Clinical Cancer treatment at Alta Bates Summit Medical Center 1. Acupuncture 2. Nutrition: Herbal Supplements • Pioneering Research in Integrative Medicine 1. Acupuncture safety and efficacy for lymphedema 2. Chinese Medicine Enhance Therapy in Rare Cancer 3. Acupuncture for Pain and Nausea in ICU • First Chinese Medicine Residency in U. S. at Highland Hospital Alameda Health System

Objective # 1 Introduction of Integrative Medicine (IM) for Clinical Cancer treatment at Alta Bates Summit Medical Center 1. 2. 3. Acupuncture 2004 Nutrition: Herbal Supplements 2005 Qigong: 2009

Integrative Medicine (IM) – “Whole Person Care” IM = Conventional + Complementary Physician Practice Nurse Physician assistant Chinese Medicine Doctors Patient Physical Therapist Pharmacist Dietitian Psychologist

Current Care Vs. Integrative Medicine • • Disease – oriented Find it, fix it Reactive Sporadic Physician-directed Dogmatic Expensive • • Patient - oriented Identify risk, minimize symptoms Pro-active Lifelong planning Partnerships Individualized Cost -Saving

Integrative Chinese Medicine for Cancer Patients – Alta Bates 2004

Analgesic Effect of Auricular Acupuncture for Cancer Pain: A Randomized, Blinded, Controlled Trial Journal of Clinical Oncology Nov. 2003

Hypothalamus and Amygdala Response to Acupuncture Stimuli in Carpal Tunnel Syndrome First evidence suggesting that chronic pain patients respond to acupuncture differently than Healthy Control (HC) https: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 1997288/

Acupuncture is Effective for the Treatment of Chronic Pain Individual Patient Data Meta-analysis (RCT) 17, 922 patients were analyzed) A: Osteoarthritis, B: Chronic Headache C: Musculoskeletal pain D. Shoulder pain Arch Intern Med. Published online September 10, 2012. doi: 10. 1001/archinternmed. 2012. 3654

Acupuncture As an Integrative Approach for the Treatment of Hot Flashes in Women With Breast Cancer A Prospective Multicenter Randomized Controlled Trial (Ac. Cli. Ma. T) Lesi, Grazia; Razzini, Giorgia; Musti, Muriel Assunta, et al. J Clin Oncol. 2016 May 20; 34(15): 1795 -802.

Objective #2 Pioneering Research in Integrative Medicine 1. Acupuncture safety and efficacy for lymphedema 2. Chinese Medicine Enhance Therapy in Rare Cancer 3. Acupuncture for Pain and Nausea in ICU

Pioneer work: Acupuncture Safety and Efficacy studies in Patients with Lymphedema 2008, 2009, 2010

Impact on U. S. Integrative Medicine

Division of Integrative Medicine (DIM) Development The First Public Hospital in the U. S. to offer Acupuncture Service since 2011 • Clinic 2011: Inpatient Consult 2012: Outpatient Clinic K 6 • Research • Education

2012 - IRB approved Feasibility study of Acupuncture in the ICU at Highland Hospital Concept Approach: Ø Could acupuncture relieve two of the most common symptoms in the ICU, pain and nausea? Ø Would American patients be receptive to it? Ø Could it lower the requirement for traditional medication? Ø How do you design research on a therapy as individualized as Acupuncture?

Acupuncture for Pain and Nausea in ICU Started in 2012 - Published in 2017

Results:

Morphine Equivalents Dosage: There was a significant decrease in the amount of morphine equivalents given four hours prior to and four hours post each treatment.

Acupuncture’s Role in Solving the Opioids Epidemic

NIH Supported Acupuncture Research 2 million 1992 to 124. 1 million 2015 3, 975 Acupuncture research articles were published from 1991 to 2009 Han & Ho in Neuroscience and Biobehavioral reviews, 2011

Objective #3 First Chinese Medicine Residency in U. S. - Highland Hospital Alameda Health System

Establishment of TCM Residency To build integrative medicine approaches for patient care Build the trust from patient and their MDs 1. Fulfill patient’s need, safety concerns from MD’s 2. Communication effectively with MD’s 3. Know the medications’ side effect and drug and herbal interactions 4. increase job opportunity

Training Methods 1. 2. 3. 4. 5. 6. Morning report Noon conference Grand Rounds weekly Morbidity and Mortality monthly Journal club monthly Inpatient consultation with various specialties One on One Integrative TCM presentations (TCM Research articles vs Western Medicine diagnosis and treatment protocols)

Clinic Teaching Out-patient care since 2012 Patient’s waiting time for one year

Bedside Teaching Round In-patient Consultation since 2011 ICU, Surgery Floor, OBGYN, Cancer infusion center, ED

TCM Resident Research Presentation International conference 2018

Finish the Residency… Excel in “CAR” Clinical Skills, Academic and Research “Bridge communication between Eastern and Western Medicine”

The First TCM Residency Alameda Health System

Joint Commission Update Acupuncture is specifically listed as a Viable Option in Standard Primary Care. “Effective January 2015, The Joint Commission updated their standards for pain management to include non-pharmacological strategies for palliative care. ” https: //www. jointcommission. org/assets/1/18/Clarification_of_the_Pain_Management__Standard. pdf

Conditions refer to DIM Acupuncture Treatment: • • • • Allergy: Allergic Rhinitis Cards: Essential Hypertension, Primary Hypotension, Dental pain Emergency: Acute Epigastralgia Endocrine: DM peripheral neuropathy Gastroenterology: nausea, vomiting, Biliary colic, Dysentery, IBS Neurology: HA, Stroke, Facial pain Hematology/Oncology: Adverse reactions to radiation/chemotherapy Pulmonary: SOB, Viral Syndrome, Psychiatry: Depression, PTSD, Anxiety Surgery: Post-operation Rheumatology: Rheumatoid arthritis Nephrology: Renal colic Orthopedic: Neck, back, knee Pain Periarthritis of shoulder, Sciatica, Sprain, Tennis Elbow, Carpal Tunnel Syndrome, • OB/GYN: Induction of labor, primary dysmenorrhea, Correction for Malposition of fetus, morning sickness, • World Health Organization United Nations, 1996, cited at http: //www. essentialhealthcare. com/info_for_practitioners/efficacy. html

“Ask what you can do for Chinese Medicine”

Acknowledgement: • • Division of Integrative Medicine Team Dept. of Medicine, Surgery, ER, OBGYN, Orthopedic Highland Hospital Research, Medical Staff, Nursing Highland Hospital Administrative Staff, Public Affairs, etc. Five Branches University California Institute of Integral Studies (ACTCM) International Center for Integrative Medicine (ICIM)