First things first. It should be noted here that this story is being written as a way to introduce material related to topics in integrative health. That being said, the story is a work of fiction. Names, characters, events and incidents are either the products of the author’s imagination or are used in a fictitious manner. Any resemblance to actual persons, living or dead, or actual events is purely coincidental. Additionally, the information in the story and elsewhere on this website is not intended as a substitute for the medical advice of health care providers. The reader should regularly consult the appropriate health care provider in matters relating to his/her health and particularly with respect to any symptoms that may require diagnosis or medical attention. Now all that being said, let’s get on with the story, shall we?
[dropcap]A[/dropcap]llow me to introduce myself. I’m Megan, the girl you saw in the course trailer. I’m getting the hang of my first year on campus, and well, that’s a lot. Class schedules to figure out, making new friends, figuring out my own meals, and all sorts of changes are happening now that I’m away from home! I’m doing alright, but am definitely feeling a little tired. Once I got the OK from my Nurse Practitioner, I decided to trek to a vitamin store for a multivitamin. I thought this would be a simple thing, but boy was I wrong! I was completely overwhelmed by the aisles and shelves in that store. I will have to come back some day and spend more time, when I have it, that is. That vitamin store clerk has piqued my curiosity, though, with his comment about other approaches to health and wellness. Well, there’s my phone ringing. Must be Mom. Most everyone else texts me, but Mom still calls to check in. I think she’s less used to my being in college than I am now!
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Well isn’t this just timely. Sometimes I think the Universe puts a few puzzle pieces together and hands them over with a few more for me to fit together. I stared intently at the flier in my hand. I had seen some of the words on it before, and some were completely unfamiliar. Chiropractic. I remember hearing mom talking to a friend of hers about going to see a chiropractor a few years ago, but I never knew what it was. Massage. Yes please. Who couldn’t use one of those? I know nothing about acupuncture other than it involves needles, and lots of them. I shuddered at the thought. Why would anyone do that to themselves on purpose? Hypnosis. That conjures up all sorts of images in my head, some a little unsettling, some that make me giggle. I wonder what Jack and Nicole think about all this stuff. Maybe I’ll bring it up at our study group this afternoon.
Thought questions: What do you think about Megan starting a multivitamin? What is your experience with CAM? How many of the words on the flier did you recognize? What do you know the most about from that list? What do you know the least about? What is one question you have from this part of the story? How might you go about finding the answer?
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I exchanged a glance with Nicole. Sometimes Jack gets so stuck on something that there is no point in trying to continue the conversation. Still, he gave me some things to think about. Sure I’ve heard of the placebo effect; I think just about everyone has. But what is it, really, and what does its very existence mean? Does it matter whether any of this stuff is a placebo, if someone feels better? I suppose there are ethical issues to consider here too. Is it true that there is no evidence for ANY of this stuff, as Jack implied? Where would I even find some of this stuff out?
“Are we done studying? Somehow I don’t think a t-test is going to be any different if I look at it yet again,” I pleaded, still lost in my thoughts and wanting to continue the conversation.
“And ANOVA still won’t tell us WHERE the difference is, no matter how many times we ask it,” Nicole laughed, “and my stomach is crying for some FOOD. Let’s go get something to eat.” I was beginning to think that Nicole was going to be the best roommate I could have hoped for. Jack sighed and said he was going to look over everything just one more time, which was the usual pattern for our study group. Jack was driven, if nothing else, although I sometimes wondered if it was his own desire to go to medical school or the long line of family members with MD after their names at the root of it. I told him I’d text him when we were done and bring something back for him if he was still studying. “Yeah, if you’re not going to give that brain of yours a rest, we’re at least going to make sure it’s well-fed,” agreed Nicole.
As we walked, Nicole explained that she didn’t really want to get into it with Jack right then, but she didn’t buy his comment about there being no evidence for any of it. “My aunt is a doctor too, just not an MD. She’s a D.O., a Doctor of Osteopathy.” The look on my face clearly told Nicole that I wondered what that was, exactly. She went on to say, “They really can do pretty much whatever an MD can do, but they have a different approach to a patient, and they learn these different manipulations of the body, too. It’s not chiropractic, and it’s not massage…I can’t really explain it. Anyway, I just wanted to tell you that I think you should definitely go to the Expo, and if I didn’t have back to back classes that day, I’d probably go with you. I expect to see pictures and hear all about it!”
Thought questions: Several of the first post prompts contain the thought questions for this part of the story. Megan pondered the placebo effect after Jack mentioned it. Jack alluded to evidence-based medicine, spurring the post prompts about the scientific method and the origins of modern western medicine. Jack and Nicole seem to have very different perspectives on CAM. There is also a post prompt asking about your perspectives. Whether or not you choose to create a post from any of these, you should read over the questions. You may also decide to combine more than one of the topics into a single post. If you choose not to create an in-depth post, find a resource or two and put them out on Twitter (and don’t forget our hashtag #vcucamh3!).
[toggle title_open=”Close” title_closed=”The Expo” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]
*yAWn* I awakened on the day of the Expo glad it didn’t start until 11, since getting motivated in the morning had not been easy lately. Whose idea was it to sign up for an 8AM class, anyway? I suppose it’s a trade-off, because I got the 8-9:15 Tuesday/Thursday section instead of the 9-9:50 Monday/Wednesday/Friday section, which gave me Fridays with no classes! And really, what is one hour? I took a deep breath, felt the sun on my face, and sat up slowly. After a few more deep breaths, I started to get excited. I may not have had to sit in a classroom, but I was still going to learn some things!
I tossed my empty Smoothie King cup into the trash can on my way in to the Expo. I felt the cool breeze as the door opened and a couple of people came out. I heard them talking about how they would both use information they got their for papers in their respective courses. One said something about the history of Reiki and the other said something about the psychology of placebo/nocebo effects. One more deep breath, and in I went.
Thought questions (these questions are things to think about and possibly explore. They may or may not inspire you to write a post. Also remember to look over the Post Prompts page): What do you know about massage before exploring the therapeutic aspects of it? In what settings have you seen massage therapists work? Who regulates massage therapy licensure in Virginia? What letters (credentials) might Megan be seeing on the massage therapist’s business card?
[toggle title_open=”Close” title_closed=”Investigating Body-based Therapies” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]I stared at the card in my hand. Tina is a CMT, whatever that means. Massage. Who wouldn’t want one, right? I had so many questions. I thought people went to a spa for a massage, but Tina said she works in a chiropractor’s office. I wondered how the two were related. I wondered about this apparently much bigger world of massage than a day at the spa. I wondered why I had not yet made an appointment, since clearly, Tina could clear all of this up for me. I decided to put to good use the the certificate she had given me for a $25, 30-minute massage.
A week later, I sat in the waiting room. I looked around at everything. I saw charts of the spine, central nervous system, and muscles on the walls. I saw pamphlets and brochures about things like subluxation, trigger points, and shiatsu. I saw the guy in the waiting room watching me with amusement. I must have looked overwhelmed, or studious, or both. “First time in?” he asked with a smile.
“Yes, and I don’t know much about this stuff, really. I was at a health and wellness expo and met Tina briefly, and she gave me her card, so here I am. There were so many interesting things there! I keep wondering how each thing could help me,” I replied, feeling like perhaps I was oversharing.
“Ah yes,” he said, offering a handshake, “the firehose of information, the EXPO. I’m Eric. Good to meet you.” Eric went on to tell me how he had a knee injury a while back and did not realize how much he was compensating for it by changing his posture and weight shifting, and eventually ended up with pain in his back because of it. Between Dr. J and Tina, his posture had improved significantly and his back and neck pain are kept in check, allowing him to continue his very active lifestyle. I decided I was not oversharing after all, and was appreciative of Eric’s openness. As Eric was called back, Tina came out to greet me.
“Hi, and welcome! How are you feeling?” Tina had a warm smile and a friendly voice. “Come on back and let’s talk for a few minutes about the best way to use this 30 minute session.” Tina asked questions about where in my body I thought I held the most tension, whether or not I had any pain or discomfort anywhere, if there were injuries she needed to know about, and also asked about medications and herbal supplements. Her final question was whether or not there was anything else I felt she needed to know. She made the recommendation that we spend this 30 minutes focusing on my neck, shoulders, and upper back. She left me for a few minutes so I could get undressed as much as I was comfortable with and get under the blankets on the table. The room was dimly lit and soft music was playing. The sound of the ocean was in the background as well. I heard Tina knock on the door to let me know she was coming back in, and I was already far more relaxed than I had been in quite some time. I joked that perhaps I should just come in for naps here. Apparently I was not the first to make such a joke, as Tina laughed quietly and said “If I had a nickel for everyone who gets benefit just from the room and a few minutes on the table itself….” She asked a few questions at the beginning of the massage, like if the amount of pressure she was using was ok and if I was comfortable enough. I was aware of my breathing slowing down as I relaxed.
When the half hour was over, Tina spoke very quietly, saying “ok, take your time getting up, and I’ll see you out front.” I stayed on the table for another few deep breaths, and sat up slowly. I got myself and my things together and walked out to the front, where Tina was waiting with a cup of cool water. “Now be sure to hydrate really well today, and try to finish this cup of water before you leave the office. Do you have any questions for me?” I was too relaxed to ask much of anything, and was feeling kind of quiet and introspective. Tina was very gracious and told me to feel free to contact her if I had any questions later and to let her know if I felt like I wanted another appointment or if I was interested in seeing Dr. J for a chiropractic consultation. She did not seem pushy, just genuinely helpful.
Later on, I remembered Tina mentioning something about trigger point work during our conversation after I said that I sometimes get headaches. I had forgotten to ask more about that. I also wondered if insurance covered any of these things, because $25 for half an hour was a deal, since prices seemed to be $40-60 for half an hour at other places I had found in the area. This could work for someone who could budget that, but massage might just be a special treat for a college student on a tight budget.
Thought questions: Megan wondered about trigger point therapy. What different types of massage have you come across? Perhaps a deeper look into one is of interest to you. Do you see massage therapy being of use when integrated with modern western medicine? If so, where, and why? If not, why not? If you are interested in other body-based therapies, you may look for information on Feldenkrais, Trager, and Alexander therapies, to name a few. Megan did not see Dr. J, the chiropractor. What are the guiding principles of chiropractic? What is the theory behind how it works? What training has Dr. J likely received?[/toggle]
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I found myself back in the vitamin shop, exploring the aisles and bottles, which seemed endless. Eric, a guy I had talked with at Tina and Dr. J’s office, mentioned something he took for his knee…if only I could remember what it was. As I browsed, I noticed that some of the bottles had a green and yellow label on them that said “USP verified” and some did not. Most had a label that said “GMP Good Manufacturing Practice” on them. I made a note and took a picture with my phone so I’d remember to look this up later.
“Hi, you’re back! How are those vitamins working out for you?” I heard the familiar perky, bordering on overly enthusiastic voice of Dan, the vitamin store guy. I smiled and told him they were fine, and that I was feeling pretty good. I explained that today I was not looking for anything in particular, but just came in to browse the other dietary supplements and herbs too. I told him I met someone who told me about something he was taking for his knee, but I could not remember what it was. “OH! I’m sure that was glucosamine. Or maybe glucosamine with chondroitin. And maybe it had MSM too. Here, come let me show you.” I decided that I might as well get the information Dan was surely going to give me whether or not I wanted it. I followed Dan across the store, only glancing at what was around me in an effort to keep up with him. I think that Dan may be so full of information he wants to share that he may burst if he does not.
“So glucosamine is something we already have in our bones, but most of the stuff that is manufactured comes from shellfish. That’s why the bottles all have allergy warnings. Thing is, they use the shells, not the flesh of the animal, so it really should be ok even if you are allergic to shellfish, but better safe than sorry. A lot of people don’t realize that it comes from shellfish, though, so sometimes we get some angry vegans who bought the stuff and didn’t realize it. I try to warn people before they buy it, just in case. Chondroitin is a component in cartilage, so it’s easy to see why we might put them together for bone and joint health, right? Most chondroitin comes from cows or pigs, so again, strict vegetarians should be warned about its origin, but also some religions that don’t allow for consumption of certain animals. You’ll also see here that we have a few calcium and vitamin D products, even though they’re vitamins, because they’re specifically for bone and joint health too.”
Dan’s voice trailed off as I went into my own head. It makes sense that there is a lot to think about when considering herbal supplements. The source of the primary ingredients or what else might be in them had not occurred to me before, but the possibility of allergies, food sensitivities, and special diets for various reasons was an interesting dimension to consider with herbal medications. I remembered that whey had something to do with milk and cheese and wondered how much of a concern that would be for dairy-sensitive people. I thought omega-3’s were possibly fish-related. I was snapped back into reality by vaguely hearing Dan say something about soy and a word like “phytoestrogen,” and then “How’s that for way too much information?” I smiled and told him it was all quite fascinating and that I’d let him know if I had any other questions.
I made a quick note in my phone to investigate soy further, since that word Dan said had “estrogen” in it, and I at least knew that was a hormone. I had been eating more soy lately, since Nicole and I had discovered a vegetarian restaurant that did some amazing things with tofu. Who knew. I looked around the shop, at the different sections they had. Previously, I pretty much stuck to vitamins, which were plentiful enough. Now I was interested in what else was there. I was currently in the section for “Muscle, bone, and joint” health. I could see sections for weight control; protein; digestion; heart and cardiovascular health; immune support; brain, memory, and attention; women’s health; men’s health; kids; and even a section for pets.
Thought questions: Megan mentions USP and GMP labels she saw on some of the bottles. What are these about? What do they mean, and what do they tell a consumer about a product? You might consider visiting a supplement store in your area. Can you find these labels? What other things do you find there? What, if anything, do you choose to ask staff about, and how did that conversation go? Megan has some good thoughts about things to consider when taking dietary supplements and herbs. Are there supplements you know about or can find that might have special dietary or other considerations? You might also consider choosing one of the sections Megan sees in the store. What kinds of things might she find in those sections? What do we know about the use of any of those products?
[toggle title_open=”Close” title_closed=”Hypnosis and Mind/Body Medicine” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]“Hi, Megan. Come in and have a seat.” Ben’s voice was warm and inviting, which was good, since I was a bit nervous. I made the appointment after hearing a story from a professor about her personal experience with hypnosis during a class session about making and breaking habits. Since coming to school, I was getting up later and later, and finding it harder to enjoy my day. I like to be up in the morning early enough to have a decent meal and a cup of tea without feeling rushed into my day. Lately, however, I had been waking up and making a mental “to do” list in my head, thinking of all of the things I needed to get done, and feeling really unmotivated to get up. Now that I was here, however, I was a little nervous. It must have been apparent to Ben, who smiled kindly and said “why don’t we start with whatever questions you have for me?”
I did have one. Or maybe several. All I had known about hypnosis involved people on stage clucking like chickens and a mysterious guy waving a watch or pendulum and saying “you’re getting sleeeeeepy,” all of which was both comical and creepy. “So I have to ask…can hypnosis be used to control someone?”
Ben smiled. Not in a condescending or mocking way, but rather in a way that this was an expected question, and one he had certainly heard before. “Hypnotists use a variety of tests to see how suggestible people are. Stage hypnotists use these and watch the audience, and take volunteers who are particularly susceptible. The fact that they are volunteers means that they want to be there on stage anyway, and are likely not all that opposed to doing something a little silly. Hypnosis could not make someone do something they were morally opposed to, nor could it make someone tell their deepest darkest secrets if they did not want to do so. Does that answer your question?” I decided that it did.
“So what is the swinging watch thing about?” I asked, feeling more comfortable in unearthing these mysteries. He seemed open enough in giving answers, so I might as well ask.
“Oh yes, the swinging pendulum thing, or the swirly circles,” he chuckled a little. “There are many different techniques for inducing a hypnotic state, and one of the oldest is something called ‘eye fixation.’ The idea is to bring something in and out of focus, causing the eyes to get tired and to narrow the mind’s focus on an object to help induce a hypnotic state. I will be using a progressive relaxation technique instead. Depending on your preference, I may use imagery or just body awareness, and that will be up to you.”
The testers he talked about included something with a balloon and a book, something about my fingers and magnets, and then one about a lemon. That’s the one I remember the most because he explained how he was using that one to determine which senses would work best for me. I was to picture myself in my kitchen, hear my footsteps walk across the floor, feel my feet on the floor, hear the refrigerator door open, feel the breeze on my face, look at every detail about the lemon. The color and texture, the smell of it, every detail was described with every sense. I was walked through the process of cutting the lemon, seeing, smelling and feeling the juice run out of it; even tasting the sour juice as I put a lemon wedge into my mouth was part of the visualization. All of my senses were engaged and it was kind of neat to go through that exercise even though I was not put into a hypnotic state beforehand. We talked about my usual morning routine, how I use to like to get up early, make a nice meal, have a cup of tea, and take some time to enjoy the morning. Ben said that for this session, he would be focusing on that. If I decided to have another session, we could focus on separating the “to do” list from the process of waking up and getting up.
I awakened right on cue as Ben said “open your eyes” and asked how I felt. I was a little disoriented but also somehow calm, peaceful, and energized. I was overwhelmed by the positive feeling of remembering how wonderful mornings like the one he described in the session felt. I had no idea how much time had passed. Ben said the session had been about 30 minutes, give or take. We continued to talk a little as he helped me come fully back into the real world and made a copy of the session for me so I could listen to it whenever I wanted to.
I decided that hypnosis was really interesting and I wanted to know more. Ben had mentioned these brainwave patterns and did say that he was giving a simple explanation. I wondered what the longer explanation was and where the other brainwaves came into play. I wondered about the different induction techniques – how many types were there? He said that making and breaking habits has always been right in the wheelhouse of uses for hypnosis, but that in his practice, he had all kinds of clients, for things like stress management in cancer, increased body awareness in movement disorders, etc. I wondered what else it could be useful for. It seemed that this really was the quintessential mind over matter. I couldn’t wait to talk to Nicole about my experience.
“These are all good questions you have. Do you suppose Ben would answer them if you asked?” Nicole had listened to my story with sincere interest. I told her that he did say to let him know if I had any further questions. “You know, you have a point about the mind over matter thing, and this is a pretty literal example of that. How do you suppose meditation fits into this? Are they the same state of mind? And how about some of the things they classify as ‘moving meditation,’ like Yoga and Tai Chi? We should check that out. You know I was looking at classes for next semester, and they actually have a Tai Chi class here! It’s in the dance department, so it would count as a participatory art for us! What do you say?” I agreed with her emphatically, excited to continue exploring these things, and so thankful to have a friend to accompany me.
Thought questions: Look at all of the things that Megan wondered about and that she and Nicole talked about together. Do any of these questions interest you enough to look for more information? What other forms of mind-body medicine can you find, and what have they been found useful for?