Complementary and Integrative Therapies

 Laurl at ONS 

Welcome to the ONS Hot Topic Chats! Today’s expert is Dr, Heidi Lucas, who will be talking with us about Complimentary and Integrative Therapies. Welcome Heidi!

 heidilucas 

Thank you for having me, any questions out there?

 Laurl at ONS 

Heidi, to get the ball rolling, what can you tell us about green tea?

 heidilucas 

I use green tea a lot in my practice for its anti-cancer and anti-angiogenesis properties.

 mabieder 

What concerns should nurses express to pts about massage during chemotherapy tx?

 heidilucas 

Re: green tea: It can be used in tea, extract or powder form. I recommend standardized extract to 80% polyphenols.

 richliz 

My Cancer Center is investigating startup of a CAM program - which are the most popular modalities you encounter?

 heidilucas 

Re: massage: I recommend patients to see a massage practitioner who is familiar with oncology and to avoid any areas of active disease.

 heidilucas 

Most popular modalities are Naturopathic medicine, Acupuncture and mind-body therapy (meditation, yoga, qi gong, tai chi).

 richliz 

Besides the Green Tea endorsement, what is your opinion of Herbal Therapy?

 heidilucas 

Botanical medicine (herbal) is one of my specialties. I highly recommend it when used prescribed by a practitioner who is familiar with the research and clinical use.

 richliz 

Do you recommend obtaining an MD clearance for patients to participate in therapies?

 heidilucas 

I always encourage people to talk to their MD but also realize botanical medicine is not usually in their education, so they may not be familiar with the treatments or interactions.

 mabieder 

How does one find an effective acupuncturist? My husband has seen 3 as adjunct tx post back surgery. One of the therapists did nothing to help with his pain and we were out $270. These txs for our pts are all out of pocket at a time when their standard tx is costing them enough!

 richliz 

Is there any modality you would say a patient should NOT participate in?

 heidilucas 

Yes the treatments are out of pocket, but most of the ones I would highly recommend are not and expensive for example, drinking green tea instead of a latte... or correcting Vitamin D deficiency.

 heidilucas 

I would really talk to patients about their treatments, they are often mistrustful and don't say what they are doing for fear of being judged.

 heidilucas 

I always recommend that they see someone who has clinical experience with oncology.

 mabieder 

One of our Rad Onc docs doesn't allow his pts to take vitamin supplements while on tx. I would agree with not taking excessive doses but what about a simple OTC multi vitamin?

 heidilucas 

Multi-vitamin is fine to take; one gets a lot more anti-oxidants in food and they

 heidilucas 

don't see any interaction in people who eat blueberries or drink green tea.

 heidilucas 

There is a misconception about anti-oxidants and I agree with you, low dose and through food is safe.

 mabieder 

Back to the acupuncture: how do you know if they have oncology experience without making a zillion phone calls to different practitioners? Is there an online association as a reference?

 heidilucas 

In would go to your state oriental medicine association and there should be a list of practitioners and their specialties.

 mabieder 

Thanks, that's helpful.

 heidilucas 

I know that for Naturopathic physicians there is an Oncology Association of Naturopathic Physicians ... OncANP.org

 mabieder 

That's excellent info to have!

 heidilucas 

What state are you in?

 mabieder 

Wisconsin

 richliz 

What about billing insurance and reimbursement?

 mabieder 

We are actually blessed with a school of TCM (Traditional Chinese Medicine) in Racine. But my practice is in the Milwaukee area.

 heidilucas 

In Washington state where I live ND's (naturopathic doctors) are covered by most insurances as well as Acupuncturists.

 heidilucas 

I would call the school and get a good referral; they are great for that.

 mabieder 

I don't think we have coverage here. I know our own health insurance (or should I say sickness insurance) doesn't cover acupuncture.

 heidilucas 

I know, as these modalities become more accepted and patients see the results we will see more insurance benefits.

 Laurl at ONS 

Heidi, can you give us some guidance for what to do for burns from radiation?

 mabieder 

I'm hoping with Obama looking at healthcare, if there are studies that prove efficacy, there would be movement toward more coverage.

 heidilucas 

Re: burns: I have patients use topical fresh aloe from the plant, it works the best. The aloe in the bottle can be drying and irritating to the skin.

 heidilucas 

In reference to studies on herbs or vitamins there are many already out there- we need more though.

 heidilucas 

Regarding studies, for example MD Anderson is doing a study on turmeric and gemcitabine for pancreatic cancer.

 heidilucas 

The early reporting has been compelling so the study continues.

 mabieder 

Do you encourage your pts to use more organic foods in their diet as opposed to those not stating organic?

 heidilucas 

I also just read about a study with green tea extract and CLL, a human study, showing a drop in lymphocyte count with a standardized extract of 800mg -4000mg daily.

 heidilucas 

Yes I encourage organic food if they can; I try not to make it too stressful if it is not readily available.

 heidilucas 

I frame it in the idea that it is healthier for you in terms of less pesticide and herbicide exposure and better for the overall environment too.

 heidilucas 

I think it’s also key especially in breast cancer to stress hormone free animal products.

 mabieder 

Those are good ways to frame it, thanks.

 heidilucas 

There is a great book called "Food Matters" by Mark Bittman. It also includes recipes and easy to understand rationale for eating healthier.

 mabieder 

Back to the CLL study: was the extract part of the tx or used as maintenance post tx?

 heidilucas 

Re: study: It was newly diagnosed patients that were in a watchful waiting period, they took it for 1 month.

 heidilucas 

It was done by researchers at the Mayo Clinic.

 mabieder 

So, would you recommend the green tea extract if someone has completed tx and is currently on observation?

 heidilucas 

They had been looking at green tea for a while and this is a population where if you can keep them stable longer they can avoid chemo until necessary.

 heidilucas 

Yes that would be a perfect time. I think one of the greatest strengths of some of the natural agents is in keeping people stable and decreasing recurrence.

 Laurl at ONS 

Are there any other examples of cancers where during a watchful waiting period you can offer a similar remedy to delay conventional tx?

 heidilucas 

Prostate cancer patients are great for this treatment; you can look at the diet and lifestyle studies by Dean Ornish.

 Laurl at ONS 

What would you give them? Does this include high risk pts (with hereditary risk?)

 heidilucas 

High risk is a different story, I would usually recommend more conservative approach especially if the patient was younger.

 Laurl at ONS 

Does this include healthy, currently cancer free men with high hereditary risk?

 heidilucas 

For your average early stage patient, the most important recommendations would be correcting vitamin D deficiency, increasing soy, green tea, ground flax, omega 3 and consider a good anti-inflammatory formula.

 heidilucas 

Yes to clarify these things would be good for primary prevention; those men wishing to avoid prostate cancer.

 mabieder 

What do you mean: good anti-inflammatory formula?

 heidilucas 

Herbs that have anti-inflammatory properties: boswellia, turmeric, scutellaria, quercetin, ginger. A good example of this formula is one called "Zyflamend".

 heidilucas 

Omega 3 fatty acids in the form of fish oils also have strong anti-inflammatory properties.

 Laurl at ONS 

Now that the men are covered (!) what would you recommend for currently cancer free women to give them the best chances of avoiding cancer?

 heidilucas 

Low glycemic diet (decreased refined grains and have protein and fiber with every meal), Exercise 30 minutes 5 days a week, drink green tea, use turmeric in cooking, enjoy your life, express emotions.

 Laurl at ONS 

Yes! Nurses are usually pretty good at expressing emotions!

 heidilucas 

I encourage journaling, support groups, counseling, creating community with friends and family.

 mabieder 

Re: above recommendations for men: I'm sure one needs to do a medication reconciliation to look for any potential adverse interactions.

 heidilucas 

Yes always important to check on interactions. I use these types of formulas a lot and do not see a lot of adverse interactions.

 Laurl at ONS 

It’s a few minutes before the end of our chat- please don’t stop asking questions! However, when you can, please take a moment after the chat to cut and paste this URL into a browser window and take our very brief survey- we’d love to hear what you think of these chats! The URL is http://research.zarca.com/k/RsTUTRsTPPsXYURUsPsP

 heidilucas 

The most common concern is with surgery. I avoid any high dose anti-inflammatory RX 5 days before surgery.

 mabieder 

Thanks, I enjoyed this interaction.

 Laurl at ONS 

Thank you for attending - it was a great chat and thank you for your participation. Thanks Heidi for all of your guidance!

 heidilucas 

Thank you your questions and all you do for patients! Healing to you.

 Laurl at ONS 

The next chat is tomorrow at 3:30 pm Eastern - please tell your friends and co-workers about it!

 Laurl at ONS 

Good night all.