Dr. David Groopman performing acupuncture (Photo by Parker Michels-Boyce)
Complementary or Alternative Health Care: Use of non-mainstream practices in place of traditional Western medicine is considered alternative medicine, according to the National Center for Integrative and Complementary Health. Use of non-mainstream practices together with conventional medicine is called complementary health care.
Monica Batica has dealt with persistent, troubling health issues throughout her adult life. A diagnosis of a thyroid disease, Hashimoto’s thyroiditis, in 2009 brought her answers, but little relief. “I got treatment with conventional medicine, but I didn’t notice much improvement,” she says. Frustration led Batica to do her own research and join online communities for people with the disorder. There, she became interested in alternative and complementary treatments that others with her condition have used to find relief.
Her research led her to Aaron Hartman, a Richmond-based family physician who is one of a growing number of conventionally trained practitioners in the Richmond area incorporating non-mainstream modalities into their practices. In addition to practicing with Family Practice Associates, Hartman sees patients through Richmond Integrative & Functional Medicine, which he launched in early 2017.
Right away, Batica felt like she and Hartman were “speaking the same language,” she says. Hartman manages her disorder with prescription thyroid medication, as well as less conventional interventions including a major diet overhaul, intravenous vitamin C and other supplements. After years of disappointment, Batica says the treatment combination has her starting to feel better.
Batica is hardly alone in seeking treatment outside of strictly conventional medical models. According to the National Center for Complementary and Integrative Health, a division of the National Institutes of Health, 38 percent of adults in the United States are using some form of complementary or alternative health care.
It’s a topic in coursework at medical schools across the nation, including Virginia Commonwealth University, and its practices and products can be found in use by professionals ranging from physicians and physical therapists to chiropractors and medical acupuncturists.
Hartman and many other practitioners in Richmond are bridging the gap between conventional and complementary therapies.
Opening Eyes
Students in Dr. Mary Snyder Shall’s lectures at the Virginia Commonwealth University School of Medicine may be asked to do a bit of yoga, such as a forward bend or to stand on one leg.
“I actually have them stand up and do a bit of sun salutations,” says Shall, the integrative medicine division director for the course “The Patient, Physician and Society” at the school.
The course covers a number of topics, from physician-patient relationships to health disparities and physician bias; Shall’s portion focuses on complementary/integrative health care.
Across the country there is rising interest in complementary and integrative health care. The National Institutes of Health has a center on it: The National Center for Complementary and Integrative Health. (They define a complementary approach as one in which non-mainstream practices are used in addition to conventional medicine, and they use the term “integrative medicine” for care that brings together complementary and conventional approaches in a coordinated way.) Duke Health opened an integrative medicine facility in 2006. The Cleveland Clinic also has such a center. George Washington University offers a program in integrative medicine, as do the University of Arizona and Yale. At VCU, integrative medicine has been part of the curriculum for four years.
Shall introduces her students to a range of therapies as well as research on the safety and efficacy of each. “We talk about Chinese medicine, acupuncture, some of the herbal treatments,” she says. Her students also learn about other techniques and practices, including energy work, yoga and meditation.
But it’s not a class on alternative medicine, Shall emphasizes. “I’m not talking about alternative therapy, but things you would do in complement to Western medicine.”
“You might be seeing [a patient] for back pain, and they will ask you, ‘Well, would yoga help?’ or, ‘Should I be taking supplements or doing mind-body exercises?’ ” she says. “Even if you don’t believe in it entirely, it’s better to know something about it.”
The RAMble at Stony Point Fashion Park (Photo by John Wallace)
Walking the Walk
The third Saturday of every month, doctors and health experts from VCU Women’s Health Center at Stony Point and Massey Cancer Center gather with patients at Stony Point Fashion Park for a morning walk and talk called the RAMble.
“The idea is basically to get moving, to join the community of people who are trying to get out and exercise,” says Masey Ross, an oncologist at Massey specializing in breast cancer. Since August 2017, Ross has also served as the director of integrative health care services for the center.
While Massey has been offering integrative services like nutritional counseling and a dog therapy program, Dogs on Call, for years, they began the process of formalizing their programs in 2016.
“Depending on what study you look at, it’s estimated that 40 to 80 percent of cancer patients have used some sort of integrative therapy before, whether its yoga, herbs, vitamins, special diets, acupuncture,” Ross says.
Programs at locations throughout the Petersburg and Richmond areas include weekly yoga and tai chi, music and art therapy, meditation, massage, integrative health mini-fairs, and several support groups. Each Thursday, Tricycle Gardens sets up a farm stand outside the clinic in downtown Richmond.
Ross says it’s about taking a holistic view of wellness that encompasses prevention, treatment and survivorship. “We really want to place emphasis on conventional care — chemo, radiation, surgery — but then use adjuncts to help patients in whatever they’re dealing with.” She says often patients are interested in integrative therapies for relief from physical symptoms, but they can be looking to enhance emotional well-being, too.
“As humans, we are complex,” Ross says. “We have a spiritual side, an emotional side, and providing supportive care for those sides can be really helpful.”
Massey’s palliative care dog, Renny, pays a visit. (Photo by John Wallace)
Straddling Two Worlds
Dr. David Groopman was working as an emergency room doctor in Richmond when he visited a friend running an in-patient substance abuse treatment clinic.
“One of the things he was using was auricular or ear acupuncture as a means of enhancing detox and calming people down while they were withdrawing,” explains Groopman, who received his medical degree in internal medicine from New York University. “If you’ve ever seen a population who’s in that state, they’re pretty fractious. I watched him put five needles in each of their ears, and within about 10 minutes; they all kind of calmed down.”
It was the late 1990s, and research on acupuncture was thin. Watching his friend’s patients was more than a little intriguing, says Groopman. “I had absolutely no clue why this should be effective. There was nothing in my training that allowed me to sort of say, ‘Well, yeah, that makes sense.’”
He enrolled in a program at UCLA School of Medicine to train physicians in acupuncture and earned certification, though he continued to practice emergency medicine, too. In 2007, he went full-time, becoming a fully specialized medical acupuncturist. (Medical acupuncture refers specifically to acupuncture practiced by physicians.)
Groopman says he’s often “the court of last resort” for patients who’ve exhausted conventional treatments for their conditions and still haven’t found symptom relief. Some of these patients use his services as stand-alone treatment for their conditions, while others use it in addition to other conventional and nonconventional therapies.
“One of the adjunctive functions of this type of practice is that I can help [patients] understand what others are telling them,” he says.
“Some problems are better understood with the metaphors of Chinese medicine,” Groopman adds. “Other times, problems are better managed by seeing them strictly neurologically, for example. All day, every day, I’m straddling these two worlds.”
Ashley Mannell, founder of Richmond Psychiatric & Nutrition Services (Photo by Parker Michels-Boyce)
Seeing the Patient, Not the Diagnosis
The average amount of face time American doctors spent with their patients in 2016 was 13 to 16 minutes. For Ashley Mannell, a psychiatric nurse practitioner, and Richmond physician Aaron Hartman, that wasn’t enough.
“When you’re taking insurance, your hands are really tied. … It just adds this huge stress to the practice,” Mannell says. “I left to get free from that and be more autonomous and work with patients in the way I knew I wanted to work with them.”
In addition to their conventional training, Mannell, who started Richmond Integrative Psychiatric & Nutrition Services, and Hartman, who runs Richmond Integrative & Functional Medicine, are certified through the Institute of Functional Medicine. As an approach to health care, functional medicine considers the body a system and attempts to find root causes for patients’ conditions.
“It’s a way of looking at health through a systems biology approach or a network approach,” Hartman says. “So instead of looking at things from just a diagnostic or disease [perspective] … I look at how … everything interact[s] with everything else.”
The cornerstone of functional medicine is sound nutrition — healing the gut to heal overall health.
“If, according to the Harvard school of public health, 80 percent of heart disease can be [attributed] to diet and lifestyle,” Hartman says, “then I think that should be 80 percent of what we do, not 5.”
Working with either practice begins with a lot of digging — family histories, lab testing, genetics — all toward getting a more complete picture of the patient, not just his or her diagnosis.
“I’m doing what I think is ideal primary care,” says Hartman. “Though I hate calling it that, because we belittle it so much these days.”
Both practitioners emphasize spending time to educate their patients. “There has to be buy-in,” Mannell says. “We’re really talking about lifestyle medicine. It’s not just, ‘Here’s a prescription or here’s a supplement.’ ”
Neither Mannell nor Hartman is anti-medication, they say. “As a medical doctor, I have to at least do the standard of care,” Hartman explains. “But as an integrative guy, I’m not limited to the standard of care.”
Mannell says medical care doesn’t have to be an either-or approach. “There needs to be more providers who are trained in conventional medicine but who are looking for other tools to help our patients get better,” she says. “You don’t have to be all the way at one end of the spectrum [or the other].”
Do Your Homework
Before incorporating a new treatment into your health care, always consider the proven benefits and safety risks, says oncologist Masey Ross. “Sometimes there is a misconception that because something is natural, it is safe,” she notes. “It can be difficult to sort through.” Certain herbal supplements, for example, can interact with prescription drugs, and because they are not regulated by the FDA, there’s no guarantee that what’s on the label is true. Ross recommends talking with your doctor first and making sure your providers are aware of any treatments you are using.
