Mind + Body + Spirit
Established in 2013, the UF Health Integrative Medicine Program is blending ancient practices with conventional medicine to offer patients a new type of holistic healing.
By Marilee Griffin
Before she discovered the lump in her breast at age 51, Elizabeth Kinley thought of herself as someone who never got sick. She’d never had surgery and never needed to stay overnight in a hospital. For her health, she swam, got massages, occasionally practiced yoga, even tried acupuncture — usually opting for alternatives to Western medicine when possible. “Don’t just give me a pill,” Kinley says. “Let’s talk about what else I can do to help my body.”
But when she was diagnosed with breast cancer in December 2012, she knew she needed the full force of modern medicine to beat it. After two surgeries, four chemotherapy treatments and 33 rounds of radiation, Kinley was cancer-free — but still healing.
“I’d been through a lot,” she says. “After almost a year’s worth of cancer treatment, I wanted to start healing from my experience. I started searching for alternative treatments.” Kinley began her search, and wound up at the very hospital where she had been treated for cancer: UF Health.
Acupuncture, meditation, massage — practices once considered “alternatives” to conventional medicine — are now going mainstream in hospitals and medical schools across the country. As research continues to validate many of these ancient practices as effective treatments for chronic pain, nausea and stress, they’ve earned a new name that represents this unique partnership of conventional and holistic treatments: integrative medicine.
This summer marks the one-year anniversary of the UF Health Integrative Medicine Program, led by the first fellowship-trained integrative medicine physician in Gainesville, Irene Estores, M.D. The recently expanded program provides patients and staff with integrative medicine services such as guided imagery, medical acupuncture and yoga.
“Integrative medicine addresses the needs of the whole person — mind, body, spirit — in the context of community,” says Estores, the program’s medical director. “We’re coming back to our roots and honoring what was effective in other healing traditions and using that to be able to be more effective in caring for our patients.”
Last July, the Integrative Medicine Program began offering services for patients seeking treatment at UF Health Shands Hospital and UF Health Shands Cancer Hospital. Consultation and referral services for outpatients soon followed, with clinic locations at UF Health Hematology/Oncology – Davis Cancer Pavilion and UF Health Integrative Medicine – Executive Health.
“We have a community in Gainesville that really supports these kinds of practices,” says Tina Mullen, director of the Integrative Medicine Program and UF Health Shands Arts in Medicine. “As a major health provider in this community, we can provide these types of therapies in unison with very high-tech therapies. This is the thing that truly makes this program unique.”
The Integrative Medicine Program is an outgrowth of UF Health Shands Arts in Medicine, one of the largest arts in health care programs in the nation. Arts in Medicine uses music, visual arts and performing arts to enhance the hospital experience of patients and families — and for years, it’s provided services such as massage and yoga to staff. Often, staff members would ask if the Arts in Medicine team could offer these services to patients, Mullen says. Unfortunately, without the resources or medical expertise, the answer had to be no.
But three years ago, things started to fall into place to change that. A certified yoga practitioner with special training to work with cancer patients joined the team. Two sizable donations were made to the program by community members interested in supporting integrative medicine — with others soon to follow. UF Health leadership singled out Estores, a fellow of the University of Arizona’s nationally recognized integrative medicine center, as a medical professional who could potentially lead integrative medicine practices at UF, says Robert Leverence, M.D.
“It was an alignment of the stars; we had these gifts at hand and a potential champion who’d be able to lead the effort in integrative medicine,” says Leverence, vice chair of clinical affairs in the UF College of Medicine’s department of medicine. “We needed someone who understands at a deep level the interface between physical health, emotional health and spiritual health.”
With support from UF Health leadership, Estores assumed the role of medical director in August and she and Mullen began building a small team of integrative medicine practitioners and artists-in-residence.
“Dr. Estores has brought immediate legitimacy to the notion that we will be providing medical practices as opposed to simply creative arts practices,” Mullen says. “She was immediately able to take a team and transform it from a nonmedical-based practice to a medical-based practice.”
In addition to Estores, who also serves as a medical acupuncture practitioner, the team includes two yoga practitioners, a martial arts practitioner/massage therapist, a mindfulness practitioner, a dance/movement therapist, a holistic nutritionist/massage therapist, two artists-in-residence and a nurse coordinator.
How it works
Doctors throughout the hospital system can now write orders for inpatients to receive an integrative medicine assessment or services, including massage, meditation/relaxation, bedside or chair yoga and bedside martial arts during their stay.
During the assessment, patients receive a physical exam, identify problem areas and learn about integrative medicine services, says Lauren Arce, M.S.N., R.N., the nurse coordinator for the program.
“A lot of times, people are so taken aback by an illness that when they look at where they want to be and it’s so far away, it’s discouraging,” says Arce. “But what can we do this week, today, in this moment to start you on that path?
“Building that rapport with patients, being able to introduce them to these practices, adding some humanity back into the system is a gift.”
Another addition to the program is the ability to accept referrals for anyone in the community wishing to receive a consultation or medical acupuncture. The program also offers group classes to patients, patients’ families and staff members interested in practicing yoga, tai chi, meditation and mindfulness-based stress reduction.
A group class led Kinley to the integrative medicine program at UF Health. During a monthly meeting at the Winn-Dixie Hope Lodge in Gainesville, she heard a speaker mention that the program offered a class geared toward cancer survivors and caregivers. The class, “Yoga of Awareness for Well-Being,” aims to reduce anxiety and depression through yoga, guided meditation, breathing techniques, awareness practices and group sharing.
Kinley signed up, joining a group of 10 participants and one instructor. Over the next eight weeks, Kinley and her classmates shared their stories, practiced yoga, kept journals and listened to CDs of guided meditation instruction.
She may not have always finished her homework, Kinley says, laughing, but it was a wonderful, healing experience.
“What I loved so much overall, about the whole experience, was that it was so loving and gentle,” she says. “It helped me be gentle, kind and loving with myself and feel supported in my recovery.”
The yoga practitioner who led the class, Tammy Bernard, M.Ed., is certified to work with oncology patients.
“There’s a whole toolbox of practices that one might use that fall under the umbrella of yoga,” Bernard says. “It empowers patients to feel that they have skills and inner resources, so that they can actively participate in reducing suffering and stress when the symptoms from treatment are challenging.”
For example, connecting with the breath is a very basic technique that can support a reduction of various stress hormones, she says. Bernard is excited to see research coming out that substantiates the effectiveness of practices like this. For example, the National Institutes of Health reports that relaxation techniques such as deep breathing may be effective as part of an overall treatment for anxiety, depression and some types of pain.
“So many people nowadays don’t realize the impact the way we feel affects the way we heal,” says Madeline Austin, an artist-in-residence who works with patients and staff using meditation and guided imagery — a form of deep relaxation that helps relieve stress using soothing mental images.
“It’s empowering for patients to realize that by calming their body and mind, they can affect how they feel,” she says.
One of Estores’ main goals as medical director of Integrative Medicine, besides making sure the program’s practices are safe, ethical and relevant to the needs of patients, is ensuring the techniques used in the center are research-based, she says.
“There are a lot of therapies that are still not strongly supported by evidence that I am very careful about,” Estores says. “And that is part of why I am thankful I am part of an academic institution, because my peers are going to hold me to a certain standard.”
NIH-supported studies show that her own specialty, medical acupuncture, may be an effective treatment for conditions such as migraines, chronic pain, osteoarthritis and nausea caused by chemotherapy or pregnancy.
Many insurance companies cover acupuncture for these conditions and offer limited coverage for other integrative medicine services such as massage, Estores says. As part of the expansion of the program, UF’s own insurance product, GatorCare, now covers selected services from the program as well.
Estores says that in the fall, there are plans to add a holistic nutrition and integrative weight management program. She and an integrative medicine practitioner with training in these areas are developing a program that focuses on mindful eating, lifestyle changes and health literacy.
Now that her class has concluded, Kinley is currently meeting with Estores for general integrative medicine consultations as part of her healing journey. Together, they are exploring some lifestyle options and non-drug alternatives; for example, plant-derived products to lower high cholesterol and breathing techniques to address hot flashes, one of the side effects of chemotherapy.
“One of the goals of integrative medicine is health promotion — regaining health and maintaining it so we can not only be healthy, but feel well,” Estores says. “This is the fertile ground for growth and the formation of a program that is excellent, caring and will be a pioneer in our region.”