by Kathleen Reynolds
Newer medical terms can be confusing. Do the words “integrative,” “alternative,” “complementary,” “natural,” “functional” and “holistic” mean separate things or are they interchangeable? Let’s look at the first term, “integrative.”
The U.S. Department of Health and Human Services, the National Center for Complementary and Integrative Health (NCCIH) defines “integrative medicine” as “the treatment of patients through spiritual, emotional, mental, and environmental in addition to the physical means, while still being rooted in scientific discovery and inquiry.”
The general principle is that all aspects of the patient are considered in the treatment plan to optimize health and treat illness. Treatment strategies utilize natural and less invasive alternatives when possible but combine this with conventional therapies as needed. The patient and health care provider form a partnership that allows for a holistic approach, with the goal of overall wellness for body and mind. Specific techniques can include lifestyle advice, including nutrition and exercise programs, specific nutritional supplements, herbal medicines, acupuncture, mind-body and stress management therapies, chiropractic, massage and other bodywork, and the use of restorative hormones when indicated.
Napa has several integrative professionals. We asked one of them, Wendy Pomerantz, L.Ac, PA-C, to help us sort out what that means. She has practiced since 1978 with a focus on integrative medicine since 1991. She is licensed both as a PA-C (Physician Associate Certified, previously known as “Physician Assistant”) and L.Ac (Licensed Acupuncturist). As a PA-C she can write prescriptions under the medical practice umbrella of a physician. She splits her clinic time between Napa and Sacramento.
“Integrative, holistic, nutrient-oriented and functional medicine are terms that basically mean using all the tools we have to treat each unique person. Patients often come because they have problems that have not been fully addressed elsewhere: fatigue, digestive issues, menstrual problems, brain fog, chronic pain, or they just “don’t feel right.”’
“In my practice I look at your health history and medications, lifestyle and food choices, sleep quality, ability to handle stress, level of physical activity, family history and genetics. I also discuss ‘epigenetics,’ which is a term that refers to factors outside of genetics that can influence the expression of your genes. Patient evaluations start with taking an extensive history, and may include comprehensive blood tests, physical exams, functional intestinal health assessments and more.”
“My biggest focus right now is using bio-identical hormone therapy. Our hormone levels can get depleted or go out of balance due to age, stress, illness, medications, environmental and lifestyle factors. I mainly treat women in menopause, though I also treat men as they also go through age-related hormonal changes. I have found nothing as powerful as this therapy to restore physical and mental wellbeing, especially as part of a comprehensive health plan.”
According to the Cleveland Clinic, “Hormones are chemicals made by your endocrine glands. They are messengers that tell other parts of your body how and when to work.”
“Bio-identical” hormones refer to substances that match human hormones on a molecular level and are therefore an exact mimic of the originals,” says Wendy. “They are derived from plant bases and have been available since the late 1930s. Our bodies recognize and can easily process these hormones, because their structure is the same as the hormones we produced earlier in life.”
Hormone loss in menopause in women typically leads to symptoms of hot flashes, night sweats, sleep disturbance, loss of libido and moisture, depression and anxiety, joint pain and stiffness. Behind the scenes, bones lose support and decline in density, arteries tend to become stiffer, and mental clarity can decline. In men hormone decline can result in of loss of vitality and muscle, loss of mental clarity and sexual dysfunction.
“Many of my female patients come to me when they’ve reached menopause and aren’t getting what they need from their practitioners. They complain that they don’t feel listened to, feel dismissed and ignored. Practitioners are often rushed or misinformed and afraid of hormone therapy,” says Wendy.
“Most medical practices, especially when part of large institutions, have time constraints, and even the best-intentioned doctors must work within those constraints. In contrast, the first visit with me is a one-hour consultation. This allows enough time to look in-depth at the person’s history, triggers and influences. Follow-up appointments are usually half an hour. I see patients every 2 to 3 months at first, then when they’re stable, every six to twelve months.”
“Primary care providers order lab tests, but I usually go into more depth: in addition to basic chemistries, I usually check sex hormone and thyroid levels, markers of autoimmunity, certain vitamin levels and bone turnover markers as indicated. I’ll then use that information to guide people about what they need to do to address symptoms but also for the long term to increase their ‘health-span’ and decrease sick time. The goal is to stay healthy for as long as possible, although personally I don’t like the term ‘anti-aging.’”
The NCCIH reports, “Integrative health aims for well-coordinated care among different providers and institutions by bringing conventional and complementary approaches together to care for the whole person.”
Wendy agrees. “I don’t provide acute care; it’s better to have a regular physician for that. I do wellness care. I don’t do emergencies and I’m not affiliated with a hospital. I also don’t treat serious chronic Lyme disease, because those patients are better served by specialists who have more in-depth knowledge of the subject.”
“The term ‘alternative medicine’ causes a misconception. If the word ‘alternative’ is used, we get painted with the same brush as every other practitioner. People ask me if I’m like the Naturopath who was printing false vaccine cards. I’m not anti-vax, I focus on nutrition and lifestyle needs. I’m not a dietician, I give general information on nutrition and vitamins.”
What has been Wendy’s experience with conventional physicians?
“I’ve seen medical practitioners hungry for this knowledge.”
“The idea is that I’m at patients’ service to keep them healthy. I can suggest, but not to beat them up over what they eat or drink. Integrative medicine involves collaborating with people to stay healthy. I can help optimize what your body can do for you. Patients can take prescription drugs, but also have healthy practices.”
“You are better off being motivated than coming in thinking there’s a quick answer. There’s ‘no magic bullet’ which will fix every problem and patients need to be an advocate for their own healthcare.”
For more information on Integrative medicine, go to NCCIH.nih.gov.
Wendy Pomerantz, L.Ac, P.A.-C.
935 Trancas Street, Suite 4A, Napa | 707. 224.1000