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Integrative Care: A New Approach to Healing
For a basketball powerhouse like Duke University, losing a star player going into a championship season is a grave matter. So when last year's number one draft pick, Elton Brand, broke his foot two years ago and it looked as though he would be out for the season, he and his doctors were ready to try anything that might help him recover.

Dr. James Nunley, the Duke orthopedic surgeon who operated on Brand's foot, launched what he calls "a three-pronged attack" to help the athlete heal. Along with surgery, he used two nonconventional therapies: ultrasonic stimulation, which passes sound waves over the fractured bone, and PEMS (pulse electromagnetic stimulation), which creates a magnetic field around the bone. Although the combination had never been used for this type of fracture, Dr. Nunley thought it might help speed healing. Brand recovered nicely, returned four to six weeks earlier than expected, and helped lead the team to the Final Four Championship Games. Since then, Dr. Nunley says, he has had good results treating a number of athletes with this protocol.

Medicine of the future
Some are predicting that as we move into the twenty-first century, more and more physicians, like Dr. Nunley, will "integrate" their knowledge of both mainstream and unconventional medicine to find the best treatment solutions for their patients. This approach to healing, often called "integrative" or "complementary" medicine, can encompass vitamins, herbs, foods, acupuncture, and a range of alternative and conventional therapies.

Integrative medicine at Duke actually predates the coining of the term. For almost 75 years, people with heart disease or diabetes have enrolled in the Duke Rice Diet Program, which prescribes a low-fat, low-sodium, mostly fruit-and-rice diet that is thought to help manage such conditions. Others struggling to overcome obesity have participated in two- to 12-week programs in fitness and nutrition at Duke's Diet and Fitness Center. At Duke's nearby Center for Living, patients have been coming for more than 20 years to improve their overall well-being and to learn to live better with such diseases as cancer and arthritis by taking nutrition, stress management, and exercise classes.

In this rich tradition of holistic health, the university launched its Center for Integrative Medicine several years ago. Each spring the center sponsors an annual conference on complementary care called Mind, Body, and Spirit in Medicine. It has now hosted four such conferences and continues to expand.

Holistic clinic
Among the latest developments at the center is the opening this month of a new, outpatient clinic employing a team of M.D.'s trained in conventional medicine as well as various complementary therapies. Many of those who visit the clinic have already tried standard treatments and are seeking additional therapies that might help them cope with such chronic conditions as arthritis, heart disease, persistent pain, fibromyalgia, or cancer.

A patient visiting the clinic initially meets with a staff physician for an in-depth consultation. Patient and doctor discuss the patient's medical history and make sure all appropriate conventional treatments have been considered. The discussion also covers diet, lifestyle, and any supplements, drugs, or alternative therapies a person might already be using. Spiritual values and personal concerns relating to the illness are also addressed.

The consulting doctor then confers with other physicians at the clinic and works closely with the patient to develop an appropriate treatment plan that he or she can realistically follow. A patient might, for example, choose to see a doctor trained in acupuncture, herbal medicine, or massage therapy. He or she might also opt for mind-body approaches, such as hypnosis, meditation, or psychotherapy.

"The goal of the integrative medicine program at Duke is to expand the frontiers of how we practice medicine," says Dr. Martin Sullivan, co-director of the center. He regards the clinic as a fertile learning ground. "Right now, integrative medicine is a sort of subspecialty, and various clinics and programs are emerging in different hospitals. As this trend becomes more and more prevalent, a lot of these ideas will be directly transferred into standard medicine." After a while, he believes, "the lines separating complementary, alternative, integrative, and traditional medicine will start to blur."

For more information, contact: Integrative Medicine Clinic, Duke University Medical Center; 919-660-6081; http://www2.mc.duke.edu/depts/medicine/intmed/
Date Published: 11/29/2002

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