Healing Young Minds: Helping Children Thrive in a Stress-Filled World

A five-year-old boy begins kindergarten.  He goes to school from 8:15 till 3:15, which seems an eternity.  After lunch, he longs for a nap, or at least some time to glide back and forth on the swings.  Instead, he sits and copies words from a text onto her notebook.  The arrangement of letters makes no sense to him.  The teacher encourages him to sound out the words, but he can’t.  He envies his younger sister, who gets to stay home.  When he climbs into the car most afternoons, his sister gaily tells him what she and “my mommy” have done in his absence. Sometimes his jealousy swells so painfully within his chest, he has to hit his sister in order to breathe again.  Even though he knows this action will provoke his mother to yell at him, he can’t control the impulse.  Just after Thanksgiving, he develops chronic stomachaches.  His mother takes him to the doctor, who can finds nothing wrong.

A teenaged girl notices her long, red hair comes out in handfuls when she showers or brushes her hair.  Otherwise, her health is good.  Her grades are excellent.  She plays varsity sports.  Teachers and peers like her.  Between the demands of academics and athletics, she often stays up late finishing her homework.  The pediatrician can’t find anything wrong, nor can the dermatologist.  [xx maybe cut this one.yy]

A previously well-adjusted eight-year-old boy has taken to chewing the cuffs of his shirt sleeves, sweaters, and jackets.  His expression is pinched and anxious.  He seems to always have a cold.  Smaller than most of the other kids in his class, he is a common target of teasing and bullying.  Lately, he has been making excuses to stay home from school.  He has trouble sleeping.  He cries when either of his parents leaves on a business trip.  He admits that he fears they might die and not return.

An eleven-year-old girl’s parents divorce.  She spends weekdays with her mother and weekends with her father.  Her parents do their best to get along with each other and to make things easier for their daughter.   Despite their efforts, their daughter’s grades begin to fall.  She has trouble concentrating on her studies.  As she sits at her desk, she snacks on crackers or candy and listens to her stereo.  When her jeans become uncomfortably snug, she takes to wearing sweat pants.  Her friends stop calling.  At home, she rarely leaves her room, except to eat meals or watch television.  She feels tired all the time.  Her mother has trouble getting her up for school, even though she sleeps ten hours a night.

A ten-year old boy is sent to the school psychologist because he repeatedly gets into fistfights on the playground and refuses to follow the teacher’s instructions.   He lives with his mother and an older brother and sister.  His father left when he was so young he doesn’t remember what he looked like.  His mother works as a secretary at the newspaper.  Sometimes she works evenings.  When she does, the boy’s older sister is supposed to look after him.  Sometimes she takes him to parties, where he sees kids making out and drinking.  Sometimes she takes him to movies, movies that are typically laden with sex and violence.  Sometimes the two of them just hang out and watch TV.  Sometimes she leave him home alone.  He doesn’t mind.  That way, he can watch cartoons and the Disney station without his sister calling him a baby.

Although the children described above have different stories, they all have one thing in common: they are under stress.  More to the point, excessive stress has overwhelmed their abilities to cope.  As a result, they have developed symptoms: depression, anxiety, anger, poor concentration, weight change, sleep disturbance, headaches, stomach aches, hair loss, and combative and defiant behavior.

If you are a parent or anyone who works with children, you are probably well aware children today have to deal with too much stress too soon in their young lives. They have too much homework and too little after-school supervision.   If their parents are still married, it’s likely that both of them work.  Diets have grown thin on critical nutrients, even as the childhood obesity rate has skyrocketed to 15 percent.  Kids get neither enough exercise, nor sufficient sleep.  Unstructured time has practically become an endangered species.  Musical lyrics have become darker.  Music videos are often X-rated.  Many kids don’t feel safe in their schools and neighborhoods.  In addition to books, some kids keep weapons, drugs, and alcohol in their lockers.  It’s enough to make the kids who don’t very nervous.  Hardly a week goes by, without headlines of a kid maiming or killing someone, without headlines of a child being abducted or abused.  Hardly a week goes by when the media neglects to remind us of the eminent threat of terrorist attack.

As stress has mounted, so have rates of childhood mental illness.  So many kids have attention deficit disorders, anxiety disorders, depression, and bipolar disorder that school administrators have had to take on the task of doling out medications.  Visit any summer camp, and you likely see long lines forming outside the nurse’s office when it’s time for the morning and evening medications.

As a child psychiatrist, I have seen an increase in both the number of kids who come to me showing clear symptoms of stress, and the number of kids with symptoms of depression, bipolar disorder, anxiety disorders, attention deficits, and hyperactivity.  A few decades ago, many of these illnesses were uncommon or practically unheard of in children.

What has accounted for this increase?  Genetics can contribute to mental illness, but it’s not as though the country’s gene pool has changed much over the past several decades.  Certainly, we have become better at recognizing mental illness, but increased awareness can’t explain everything.  I believe there’s a link between the increased burdens placed on kids and the rise in mental illness.

We have propelled kids into dealing with adult problems before they’re able.  As a result, they’re developing physical and psychological ailments previously relegated to adulthood.  Kids have obesity, diabetes, and high blood pressure.  And they have symptoms of stress, many of which mimic those of several psychiatric conditions.  Depending upon the child, stress can diminish concentration, increase activity, darken mood, increase anxiety, and provoke aggression.

Not only can stress produce symptoms that mimic mental illness, but it can activate mental illness.  Every child possesses certain vulnerabilities, and stress erodes any native resistance to these susceptibilities.  It undermines a child’s ability to cope and to maintain health.  Stress can cause one child to develop recurrent colds, another to develop migraine headaches, another to become depressed, anxious, inattentive, or hyperactive.

How has childhood stress gotten so out of hand?  I like to think that we adults are neither negligent, nor cruel.  Rather, a number of less sinister factors explaining why well-meaning parents miss signs of stress.  We’ve become so inured to our culture’s fast pace and ambiance that we have accepted the way we tear madly about as normal.  We may be so busy and overwhelmed ourselves as to fail to notice that our children are struggling.  Or we may chalk up our children’s behaviors as part and parcel of a developmental stage.  Oh, we think, he’s just going through the terrible twos, or the terrible teenage years.  Or our children may hide their problems from us.  Or they may only be able to describe the physical symptoms such as headache or stomach upset.  Or we may recognize that there are problems (academic demands out of proportion to the child’s abilities or an unsafe neighborhood or school bullies) but not know what to do about them.

Indeed, many parents do fret that their kids are struggling to cope with too much too soon.  Both in my clinical practice and at social gatherings, the main topic on other parents’ minds is their kids’ struggles.  What to do about the mean girls who won’t let their daughter sit with them, what to do about their sons’ angry outbursts, what to do about poor focus and hyperactivity…

And although many parents, educators, and mental health professionals are rightly concerned with the issues of violence, sex, drug use, and other disturbing trends, we often let more peripheral debates sideline us.  We discuss whether to put metal detectors in schools or whether to randomly test kids for drugs or whether safe sex discussions belong in the classroom or whether we should allow our 2^nd grader to watch pg-13 movies because all the other kids are doing it.  There’s no question that modern life stresses kids and we have to begin to do something about it.  Nevertheless, we have to ask more important questions about why kids commit violent acts, engage in premature and promiscuous sex, and take drugs.

Many of us are worried about these things, but don’t know how to help our children.  How, you may well wonder, can you change the school system, disarm your entire neighborhood, throw a monkey wrench in the whirring gears of American culture?  You can’t.  That is, you can’t precipitate widespread social revolution. Of course, you can take steps to rectify some of the stresses (turn off the TV, establish reasonable bedtimes, feed your child healthy food).  You can alter your child’s perception of stress and help him manage it.  In fact, many small improvements in your child’s life can go a long way toward healing his mind.

For the unavoidable slings and arrows your child will encounter, you can armor your child against them.  Those defenses are the skills of resilience.  Many of us take our children’s “resilience” for granted.  Compared to us adults, they still show a remarkable ability to bounce back from adversity.  However, their innate resilience may not always be up to the task of cope with the myriad modern stressors.  It’s up to us adults to be aware of the pervasive effects of stress on our children and to enhance their resilience.  I’ll devote several chapters to giving you practical ways to give your child the lifestyle habits, thinking habits, emotional skills, social skills, and spiritual cushioning that will help him recover from small disappointments and major disasters.

Of course, your child may develop a problem of sufficient severity that you need professional help.  Sadly, your child may not get the kind of help he really needs.  For one, the doctor may not realize that the underlying problem is stress.  For another, the trap physicians and parents alike have fallen into is to restrict treatment to correcting the child’s behavior or eliminating symptoms.  Doing those things is certainly important.  Unfortunately, we often neglect to get to the root of the problem.  In the case of stress, we either need to remove it or help the child learn to cope with it.

Regardless of whether symptoms are those of stress overload or of stress-activated mental illness, the standard medical practice of treating symptoms with a pill falls short.  Because misdiagnosis is not uncommon, the prescribed drug may fail to do good and may even do harm.  For example, I often see kids misdiagnosed with attention-deficit disorder whose problem is stress overload.  In such cases, stimulant medications like Ritalin only serve to aggravate symptoms and don’t help the child solve the underlying problem.  Even if the diagnosis is correct, drug treatment alone addresses the symptoms while ignoring the stress that underlies the disorders.

Granted, medications are sometimes lifesavers for kids with psychological difficulties.  But I think it’s a mistake to stop there.  While drugs offer symptom relief, they are at best a half-measure, a finger in the dyke.  If we want our children truly to heal, we must look at the child in all her wonderful complexity and devise a treatment plan that works with that child’s strengths and weaknesses.

In Healing Young Minds, I’ll show you the many other healing therapies I use to help kids get better.  Fortunately, a whole array of options exists.  In my practice, I employ everything from dietary changes to yoga, psychotherapy to acupuncture, vitamin and herbal supplements to medications.  Some of these therapies are so simple and inexpensive you can employ them yourself.  For others, you’ll need to work in partnership with a mental health specialist.  But at least you’ll know how to go about doing so.

On a bright note, children have a natural drive toward health.  Their brains, minds, and spirits are amazingly resilient.  All most kids need is for someone to remove the roadblocks and they will spontaneously heal body, mind, and soul.  Believe me, I’ve seen hundreds of kids recover, even children who have suffered horrible trauma.  I look forward to telling some of their stories and to sharing with you the things that have helped them mend.

This book is an autobiography of the soul of Dr. Lee Lipsenthal in which he describes both his living and dying. Lee was a well known holistic physician whose life work evolved from being an internist in private practice, to being a researcher with Dean Ornish’s prevention programs, and finally an internationally known presenter on creating a balance in a medical professional life.

He died a few months ago from advanced adenocarcinoma of the esophagus at age 53. His diagnosis was a mystery and shock to many as Lee had in many ways epitomized a wellness-oriented life.  He truly practiced and taught focusing on balance, prevention, good diet, exercise, meditation, and other ingredients we all would prescribe for optimizing their and our physical-mental-spiritual being.

Despite his early transition from this life, Lee left a profound impact on the holistic and integrative medicine community in which he was a recognized leader. As a former President of the American Board of Integrative Holistic Medicine, his work, his heart, and his soul reached out to touch many lives, friends, patients, and many other souls.

One way he continues to touch lives is through Enjoy Every Sandwich in which he reminds us to be mindful of and to enjoy each and every moment. A poignant turning point in his life was when he had a problem swallowing while eating a sandwich. As a physician, he immediately knew the potential differential diagnosis. His “cancer story” started at that moment. His story follows an amazing, winding road as he leads us through the psychology of his childhood, his deep, intimate marital and family life with wife and physician, Kathy and their kids, and with many patient stories of healing and of mystery.

Dr. Lipsenthal further guides us skillfully through his own spiritual path, through transpersonal psychology, through dreams, images, prior life remembrances, and psychic premonitions. In all of this journey, he evolves and we evolve as the subtitle of the book “Living Each Day As If It Were Your Last” dawns slowly then brilliantly. He continues, as he had done all his life, to teach us how to be mindful, grateful, joyful even when faced with doubt, despair, and anguish. He died peacefully in the warm embrace of family and spiritually connected with thousands of friends.

To conclude, I’d like to cite integrative oncologist, Don Abrams, MD who wrote in praise of this book, “At once playful and profound, Enjoy Every Sandwich serves up a delicious double-decker. Lee gifts us with gracious guidelines not only for those facing death but for everyone seeking to live life the fullest. Should be required reading for all!”

“When men lack a sense of awe, there will be disaster.”

Lao Tsu

In a recent issue of Academic Medicine, editor Steven L. Kanter, MD, spoke about the value of “case studies that are analytic, penetrating, that illuminate fundamental precepts and concepts, and that reveal new avenues for research or theory development, and have the potential to broaden and deepen knowledge and understanding in  a way that might not be available otherwise.” (1)

The editorial decision made  in April 2011by Academic Medicine, the most prestigious of academic medical journal to start including case studies in their future issues  brought to mind a book I have just read Stories of Healing: A Family Doctor’s Journal by Robert A . Anderson, MD . (2)

Dr. Anderson is a dear and long time friend and colleague and one of the founders of the American Holistic Medical Association and of the American Board of Integrative Holistic Medicine. His life and work as a family doctor has always been on the leading edge of holistic practice. In this short and easy to read book, he documents an amazing series of patient encounters/case studies over his 40 years of practice. These “stories of healing” serve to explore the real mystery and wonder of medicine as a path to continual self-discovery, lifelong learning, the power of observation, and the mystery of the human condition.

In the all too brief 160 pages, he skillfully leads us through new learning in multiple areas. Section headings include  such topics as Vital Nutrients, Infections, Our Toxic World, Allergies and Sensitivities, Lifestyle Practices, Attitudes and Emotions, Cancer, What’s the Source of Healing?, and the final section, Mysterium.  Bob presents these topics in a charmingly fresh and succinct way. Often the lesson to be learned from each chapter is disarmingly simple, e.g., think of dairy allergy for patients with recurrent joint or urinary problems, notice the power of belief and attitude in encouraging healing, listen deeply and communicate your truth  gently but firmly, look beyond the appearance of things, and don’t be afraid to challenge the medical status quo.

I strongly recommend this book as an excellent synopsis of the field of holistic and integrative medicine.  As organized around real life examples and case histories, it gives the “feel” of whole-person, patient-centered practice in a robust way without being disconnected with day to day practice. Further, it works quietly to extend our awareness of the incredible  depth and beauty available  to us in the practice of medicine.

As the Lao Tsu quote at the beginning reveals, we must continuously cultivate a sense of awe and wonder for our lives to be truly vibrant and alive. In this book, Dr. Robert Anderson brings us back full circle to the mystery and surprises that are before us every day as we care for patients. We need only use our eyes to see, our ears to hear, our hearts to feel, and our souls to breathe in the miracles around us.

1. Kanter, Steven L. Case Studies in Academic Medicine. Academic Medicine. April 2010;85 (4), 567.

2. Anderson, Robert A. Stories of Healing: A Family Doctor’s Journal . Everett, WA: Starseed Publications, 2011. ISBN 978-0-9837422-1-0.

Our society doesn’t really contribute to healthy sleep. Our staccato, frenzied pace, overstimulation with media, caffeine, and nocturnal lights all break the natural rhythms of the body that are conducive to good sleep. Many health conditions can contribute to poor sleep such as pain, obstructive sleep apnea, many respiratory and cardiac conditions, GERD, anxiety, depression, urinary problems, restless legs syndrome, fibromyalgia, hot flashes, and more.  Increasingly recognized is that poor sleep itself increases the risk of heart disease, diabetes, obesity, strokes, viral infections, and auto accidents. Studies among house staff found that staying up for 30 hours created decreased function and reaction time equivalent to a blood alcohol level of 0.1, legally drunk in all states. Sleep and dream debt cause dangerous mental smog and daze.

We may actually be suffering from a darkness deficiency. LAN (light at night) undermines life’s fundamental rhythmicity. Rush hour, prime time, happy hour, late night TV, drugs, alcohol, and incessant web-browsing, texting, and  e-mail all interfere with the yin and yang of natural sleep and wakefulness.

Because of these factors, taking a sleep history is an essential part of the integrative consultation process. In addition to past history, dietary and exercise patterns, and other lifestyle issues, identifying sleep problems is essential though often overlooked or underappreciated.  Yet, even when a patient complains of insomnia, our tendency is to reach for a prescription sleep aid without more exploration.

Insomnia comes in several varieties: 1) problems falling asleep, 2) problems staying asleep, 3) premature wakening, 4) poor quality of sleep. Each requires a different approach.

Here are some basics to an integrative approach. First, take a good sleep history, including a patient sleep diary if appropriate. Emphasize good sleep hygiene which ought at a minimum emphasize avoiding overstimulation such as stimulant medications, substances, or exercise prior to sleep. Encourage rhythmicity, ritual, and regular patterns much as we do with children with sleep issues. Sleep experts recommend using the bed as a place for sleep or sex but not other activities such as watching TV. Especially for the elderly, avoid daytime naps. Identify contributing medical or psychiatric issues, painful conditions, stimulant prescription medications, e.g. decongestants, beta blockers, calcium channel blockers, thyroid, anti-depressants, anti-convulsants, bronchodilators, steroids, among others.

Treatment always begins with education about healthy sleep patterns and sleep hygiene, e.g., if not asleep in 20 minutes, get up and do something for awhile before returning back to bed. Eliminate worrying or problem solving at night. Resolve anger before going to bed. Keep the room to be dark, cool, and quiet. Avoid watching the clock.

Mind-body therapies to improve sleep include meditation, relaxation and breathing techniques, body scan, imagery, progressive muscle relaxation, or alpha wave training are all useful. Multiple herbs and supplements may be useful and ought to be considered before use of medications as they are less likely to disturb slow wave sleep or be habit forming. These include valerian (1000mg at bedtime), melatonin (2-6mg), St John’s Wort, chamomile, hops, passion flower, kava, lavender, lemon balm, and skullcap.

In some cases, psychotherapy or hypnosis may be helpful and of course, some patients really need medications. In addition to popular prescriptions such as Lunesta, Sonata, Ambien,  and in some cases benzodiazepines, I have often found tricyclics like Elavil, especially for those with neuropathic pain and/or anxiety; trazodone and analgesics can also contribute to a good night’s sleep.

Remember that homeostasis requires rhythm, repetition, regularity and routine.  Rhythms rule our world and are powerful and healing. Rhythmic activities of our body and mind include our hormones, circulation, indigestion, brain waves, and states of consciousness. The question of why we spend a third of our lives asleep likely has to do with our need to allow our immune system to do its work effectively, to allow our brains to process, integrate, and sort out life through dreams and images, to re-establish our biorhythms, as well as the benefits of physical rest.

So, in conclusion, remember to take a good sleep history. Recognize the essential role of sleep to a happy, healthy life. And develop a broad range of methods and a mindful, consistent approach to managing sleep and sleep disorders in yourself and your patients.  Finally, remember the old proverb, “One hour of sleep before midnight, is worth two after.”

Summarized from a presentation at the American Board of Integrative Holistic Medicine Annual Review Course, St Petersburg, FL, November 9, 2011.

To begin:
Dave Rakel, MD, in his lecture, “The Clinician Effect” challenged us with the statement that “The practitioner is more powerful than the pills we prescribe.” In a study that Rakel and his colleagues conducted in 2009, both the duration and severity of the common cold were reduced in patients who meaningfully perceived their physicians’ empathy, in comparison to those who didn’t.

In another study performed by Hojat and colleagues, diabetic patients who rated their physicians with high empathy scores experienced better control of blood sugar and lipids, compared to those who didn’t rate their physicians as highly empathic. The results suggest that physician empathy is a very important factor as related to clinical competence and patient outcomes.

Though the results of these studies are not particularly surprising, they underscore the vital importance of the art of delivering quality healthcare, and remind us of one of the basic principles of the ABIHM: The Healing Power of Love: Integrative holistic physicians strive to relate to patients with grace, kindness and acceptance, emanating from the attitude of unconditional love as life’s most powerful healer.

Mitch Gaynor, MD, taught us in his lecture “Integrative Oncology” that certain compounds have specific properties as they relate to cancer:
Compounds which prohibit cancer cell proliferation directly: Bee propolis, turmeric, epigallocatechin gallate (EGCG), genistein, resveratrol, vitamin E, selenium
Compounds that act indirectly to inhibit cancer progression: Vitamin C, anthocyanidins, proanthocyanidins
Compounds which stimulate the immune system: Maitake/shitake mushrooms, l-glutamine, melatonin, ginseng

Furthermore, Dr. Gaynor explained that a diet rich in omega 3 fatty acids improved the effectiveness of chemotherapy and radiation in the setting of breast cancer, and that supplementing the diet with omega 3 fatty acids represents a nontoxic and simple way to improve outcomes.

Finally, true to an emergent theme that was discernible throughout the entire conference, higher glucose levels, insulin resistance, and obesity are all poor prognostic indicators of cancer outcomes, suggesting an adverse effect on tumor biology with these risk factors.

If you attended the conference, please take a moment to add the pearls that you learned that you believe are worth sharing!

I’m speaking at the American Board of Integrative Holistic Medicine’s Educational Conference today at 2:00 PM, but have been listening intently to the various presenters — my fellow board members, throughout the event. All of these folks are MD’s who embrace holistic (body, mind and spirit) and integrative (the world’s greatest) treatment modalities for appropriate care in medicine.

I’ve learned about Abraham Flexner who wrote a white paper in 1910 that became the de facto guideline for what would be taught in medical schools; essentially, a reductionist approach to practicing medicine which has led to the modern formula of medical practice, where the physician asks, “What’s your chief complaint.” Then he or she treats that — many times as if it were a stand-alone, unconnected condition, unrelated to any other causal factors. This type of practice has virtually eliminated the holistic approach and pushed medicine into ICD9/10 codes, (currently going from about 14,000 codes to nearly 68,000…in fact, there’s even one specific code for “injury caused by riding on the back of pig!” It all becomes a matter of diagnosis of disorders leading to the prescription of drugs. The U.S. is spending $308 billion a year on pharmaceuticals, which is one half of the expenditures of the rest of the entire world in drug purchases. We’re spending about $14.6 billion on anti-psychotic drugs and $10 billion on antidepressants, alone.

The $2.5 trillion that we are spending on healthcare in the United States is NOT allowing us to live longer than other countries, and the really sad news is that most of these expenditures are for preventable diseases. About 90 percent of our expenditures are because of stress related issues, and when we take such amazing statistics into consideration as the fact that the United States consumes two times more fat than Asia, three times less fiber, and 90 percent more animal protein, it has to make us think a little bit about this course that we are currently pursuing.

If you study the statistics, you’ll see that China consumes less red wine than we…but their population lives longer. Japan consumes less fat than we do, and their population lives longer. Italians consume much more red wine than we do, and they live longer. Germans do everything wrong, i.e., eat high fat, drink lots of beer, eat sausages and fats and even they live longer than Americans. What must our conclusion be? Maybe living in the United States is the problem? (Just kidding . . . but maybe it is the fact that we are so intensely committed to a more-is-better philosophy.)

As a population, we eat about 50 tons of food in our lifetime. In fact, it’s probably been closer to 51 tons for some of us, and, for the most part, we’re eating lots of chemicals, insecticides and antibiotics in our unnatural and subsidized corn fed animals, and farm raised fish. Where am I going with all of this? Have you ever been around a really cocky kid who acts like he or she is invincible? That’s why our highest death rates in the teenage years are primarily related to automobile accidents with Caucasian teens and guns with many of the ethnic teens. They truly believe that they are invincible. It has always been interesting to me that those people who have been fortunate enough to have lived charmed lives with no sickness and no close relatives or friends who have died have a certain air of immortality that surrounds them. They are lulled into the belief that they will beat the odds and live forever. We are, in fact, on a finite journey that requires us to provide some self-nurturing, lots of personal lifestyle education and a willingness to try to do what is best for our long term quality of life issues the majority of the time.

The bottom line? As my friend, Dr. Lee Lipsenthal says in his book Enjoy Every Sandwich, we are dealing with “temporary immortality.” So, live every day as if it were your last!

Those of you who are familiar with Planetree know that it is a healthcare system whose vision is to promote the development and implementation of innovative models of healthcare that focus on healing and nurturing body, mind and spirit. As an international leader in patient-centered care, Planetree has been pioneering methods for personalizing, humanizing and demystifying the healthcare experience for patients and their families for 30 years. Planetree hospitals and clinics are visible in most states, and even in several countries outside of the USA.

Planetree’s Annual Conference is occurring at the very end of this month in Nashville. As part of the conference experience, medical practitioners are invited to attend a one day event that is co-sponsored by Planetree and the ABIHM, with Scripps as the ACCME provider (7 AMA Category One credits available). The Physician Leadership Summit: Integrative Approaches to Care is offered to a medical audience (no need to be a Planetree member) on October 30th at the Opryland Hotel.

The program includes the following content:
Dave Rakel, MD – “The Healing Encounter: How Clinician Trumps the Pill”: Often that which gets the credit in medicine is the external drug, procedure or acupuncture needle. We will explore a growing amount of evidence that the encounter that occurs between clinician and patient before the pill is prescribed may hold the true healing power.

Mimi Guarneri, MD – “Nutrition and Nutraceuticals in the Prevention of Disease”:
This talk will discuss the research on nutrition and nutraceuticals, evaluating the benefits on heart disease, diabetes, inflammation and disease prevention.

Donald Abrams, MD – “Holistic Cancer Care”: Integrative Oncology allows for the combination of conventional and complementary cancer care in a patient-centered program. This presentation will highlight some of the controversies and challenges of
integrative oncology for patients living with and beyond cancer.

Nan Sudak, MD – “Environmental Issues in Health and Medicine”: This lecture will explore some common environmental problems that are specifically related to the practice of medicine, in addition to general environmental issues that concern our
patients. Action steps to mitigate these situations will be offered.

Patrick Hanaway, MD – “When in Doubt, Start with the Gut”: This presentation on holistic approaches to GI illness (IBS, GERD, IBD) will also highlight the importance of imbalanced gut function (digestion, immune function, and gut microflora) as a critical factor in illness and disease. In fact, when the gut is not in balance, the body cannot function properly.

Mimi Guarneri, MD – “Integrative Approaches to Cardiovascular Disease”: This talk will discuss the role of lifestyle change, stress management and emotions in health and illness. Dr. Guarneri will explain the science behind the mind-body connection, emerging risk factors for heart disease and how to use your genetic makeup to develop a personalized and pro-active guide to optimum health.

Scott Shannon, MD – “Depression: What works”: This presentation will review the current research on anti-depressants and the concerns with it. Also, it will explore the research on three non-conventional treatments as well as a review of integrative approaches for depression.

Scott Shannon, MD – “Spirituality in Healthcare“: Here we explore the evidence and value of an individual’s spiritual and religious practices and beliefs in their health, we discuss the elements that appear to be the most useful for primary care physicians to
assess during patient care visits.

Q and A Facilitated by Steven Horowitz, MD

We are delighted to collaborate with Planetree and Scripps for this event. Planetree’s 10 Core Components resonate beautifully with the ABIHM’s 10 Principles of Practice. We anticipate a day full of learning and connection, and hope to build a lasting relationship with Planetree for future cooperation.

The Leadership Summit occurs within a week of our Annual Review Course, The Science and Clinical Application of Integrative Holistic Medicine, held this year in St. Petersburg, FL from November 6th (preconference day) through November 11th, followed by our Certification Exam on November 12th.

Remember a time when integrative holistic conferences were far and few between? We have certainly arrived at a new era in which these learning opportunities abound! And it’s gratifying when leaders in the field can come together to co-sponsor events, both bringing their own strengths to the table.

To learn more about the Leadership Summit, please click here

It is with a very heavy heart that we announce the passing of Lee Lipsenthal, MD, ABIHM.  Lee was diagnosed with esophageal cancer in 2009; it returned several months ago.  He was surrounded by family when he crossed over on Monday, September 19, 2011.

Lee had a conventional medical training, with an undergraduate degree from George Washington, medical school at Howard University, residency at Medical College of Pennsylvania.   During his training, though, he became interested in prevention of heart disease, rather than just treatment, and he spent the early part of his career in Pennsylvania developing treatment programs for patients with heart disease and those at risk for heart disease.  He went on to become internationally known for his research work with Dr Dean Ornish.

More recently, Lee had been an author and educator, working in the area of practitioner wellness.  His first book, Finding Balance in a Medical Life, was the basis of many workshops and talks given to medical students, residents and physicians in practice, helping them find their own health and renew their passion for working in the medical field.  Lee was a member of the American Medical Association’s Physician Wellness Committee and a sought-after lecturer and keynote speaker.

The American Board of Integrative Holistic Medicine was fortunate enough to have him as a board member and president.  It was through Lee’s leadership and amazing connections that the board weathered a difficult time of growth; it can be said that without him, the Board and its certification process might not exist today.

This description, though, gives only the bare outlines of a complicated, full life.  Lee was, to many people, a guiding light.  He showed us how to be our best selves, reminding us to look within, know ourselves, take a deep breath.  He reminded us to live fully and laugh a lot.  He was full of contradictions: his meditation music was classic rock, and he much preferred a good margarita or glass of wine to a handful of vitamins.  Once he joined the board, we were sure to dance together often (and he didn’t dance like a stiff white guy!).  None of us got enough of him and yet plenty of him.  When Lee spoke with you, you had his undivided attention.  And then he’d make sure you all had a good belly laugh.

Our board had a conference call scheduled on the day Lee first got his cancer diagnosis, literally moments after he got the phone call.  It was shocking.  Yet, we had the opportunity to watch as he navigated this part of his life and it was amazing to see.  Lee was truly at peace with dying.  He had always said “It’s a good day to die” as a way of reminding us to live fully; when we expressed our concern for him, his answer was “it is what it is”.  Lee was ok with what was unfolding; I think his only concern was for the loved ones he was leaving behind.  His teaching in this past year was all about living with dying and holding death in a balance with a full life.

Perhaps the best way to remember Lee is in his own words.  I suggest that you watch the trailer for his upcoming book, Enjoy Every Sandwich, due out in November. “Enjoy Every Sandwich”

One of Lee’s favorite expressions was “sweet!”.  Indeed, that’s what it was, having him as part of our lives.

(This article was originally published in Holistic Primary Care)

Women with breast cancer often experience severe joint pain as a consequence of treatment with aromatase inhibitors like Tamoxifen. Researchers in Barcelona suggest that vitamin D supplementation can prevent or at least reduce the pain. This is important because severe arthralgias often limit a woman’s willingness to complete tamoxifen treatment.

Daniel Prieto-Alhambra and colleagues at the Hospital del Mar, studied a cohort of 290 breast cancer patients undergoing treatment with Tamoxifen or another of the aromatase inhibitors (AIs). At baseline, 90% had serum vitamin D levels under 30 ng/ml, which is considered deficient in sunny Spain.

All the patients were given 800 IU/d vitamin D, but those who were deficient also got an additional 16,000 oral boost every two weeks.

Among the women who were pain-free at baseline, those who reached serum levels of 40 ng/ml were 50% less likely to experience drug-associated joint pain than those who remained vitamin D deficient. The authors note, however, that it is challenging to get the blood levels up to this protective level. At 3 months, 50% of the women treated with the booster doses were still deficient (Prieto-Alhambra D, et al. Breast Ca Res Treat. 2010; DOI: 10.1007/s10549-010-1075-9)

“We conclude that most women requiring AI therapy have low concentrations of vitamin D at baseline, and the appearance of AI-induced arthralgias in women with early breast cancer is associated with their plasma concentrations of Vitamin D,” said Dr. Prieto-Alhambra.

The relationship between vitamin D, breast cancer, and aromatase inhibitors is complex. The Barcelona group had previously shown that vitamin D deficiency is extremely common in women treated with these drugs. The question is whether drugs like Tamoxifen can cause the deficiency.  There is some evidence that aromatase inhibitors compromise vitamin D metabolism by competing with cytochrome P3A4 enzymes in the liver. The clinical significance of this has not yet been determined.

Dr. Prieto-Alhambra and colleagues recommend routinely assessing serum vitamin D levels in any woman considering aromatase inhibitor therapy, and supplementing if she is deficient. Not only might the vitamin reduce the odds of drug-associated joint pain, it might actually reduce risk of recurrence.

While serving as a hospital administrator for over twenty years, I was aware of numerous people who had died in the emergency room because they had no insurance, had not yet qualified for Medicaid and were terrified that the cost of care would force them to live on the street.  Consequently, they waited too long to come in for treatment, and they died.

Modern Healthcare’s August 22nd edition has listed the 100 Most Influential People in Healthcare in 2011. (Somehow they’ve missed me again.)  They’ve listed Republican  Congressman Paul Ryan of Wisconsin as the number one most influential person, and the Democratic Governor of Vermont, Peter Shumlin, as number two. Ryan is interested in a complete re-make of the Medicare and Medicaid programs, and Shumlin wants to move the citizens of the State of Vermont to a government-run, single-payer system.

Needless to say, these are very different views. It’s interesting that they both agree that employer-based insurance should be eliminated, so that neither portability nor employment is an issue. They differ in that Ryan believes that each individual citizen should receive a refundable tax credit for healthcare and that providers should compete based upon quality, price and outcomes. Shumlin, on the other hand, wants to do away with “fee for service healthcare,” but clearly understands the American’s public’s concern about government-run anything, and even says, “Government has gotten it wrong, every single time.”

According to Modern Healthcare, both want to fix the system that is bankrupting the nation. Ryan wants to “maintain a world class system built on innovation and excellence,” while Shumlin wants that single payer system to eliminate waste, administrative overhead and insurance company profits. It is Shumlin’s contention that enacting all of the Tea Party cuts and taxing the wealthy would still lead to the same federal budget challenges in the trillions of dollars that we face now.

Ryan wants to cut $750 billion in Medicare spending by making the allocation a block grant. People like Rose Ann DeMoro, executive director of the AFL-CIO- affiliated National Nurses United labor union say, “The market isn’t magic and it doesn’t trickle down…the Paul Ryans of the world don’t want a society.  They want individuals and corporations to make ungodly amounts of money.”

And so the debate continues. There is no magic elixir that will fix this without huge disagreements and turf battles.  As the Obama legislation began to unfold, the initial reaction from many within his own party was that his administration had “sold out” to Big Pharma and numerous other lobbies, and, as the Republican plan continued to be unveiled, the response was similar to DeMoro’s, because it was so heavily skewed toward big business and the free market, while providing only marginal assistance for the underserved of this nation.

Ironically, as I look out my window and then drive a block from my apartment in Pittsburgh, I see another new “colony” of homeless people living under the bridge, and as I round the corner under Route 279N, there is a virtual apartment building under that road comprised of sheets and blankets hung to create separate partitions for the individual homeless people to live. At the next light leading to the North Side, a 30ish young mom begs on the corner for money for her kids, and two blocks past her is a homeless Veteran asking for money as well.

In the midst of all of this, the $9 billion UPMC battle with the nearly $4 billion Highmark juggernaut continues over an insurance company owning a hospital, and a hospital owning an insurance company.  Surely, in the richest country in the world, there are answers to these challenges that do not bankrupt the pharmaceutical or insurance companies, do not make our physicians second class citizens, and do not close two thousand small and medium sized hospitals while still providing care for everyone.