At the Vanderbilt Center for Integrative Health, holistic healing and traditional medicine go hand in hand
by Joan Brasher
photography by John Russell

Inside the Vanderbilt medical clinic at 3401 West End Ave., sterile examination rooms are nowhere to be found. Books by Rumi and Thich Nhat Hanh share shelf space with medical journals, and inspiring admonitions such as “breathe” and “keep dancing” are tacked to bulletin boards and affixed to computer monitors. The suite is a spa-like cocoon where yoga, acupuncture, psychological counseling, meditation workshops, myofaschial massage and other nontraditional therapies are offered. And unlike a typical doctor’s visit, patients spend a full hour consulting with an internal medicine physician, who prescribes care not only for the body, but also the mind and spirit. At the Vanderbilt Center for Integrative Health, something very different – one might even say revolutionary – is going on.

Leanne* came to the Vanderbilt Center for Integrative Health in October for chronic back pain caused by a car accident several years ago. Because she is in addiction recovery, she hoped to avoid prescription drugs at all costs.

“The medicines I was taking were temporary solutions and mood altering,” she said. “When my doctor suggested the VCIH, it seemed to me that a comprehensive approach would be more of a long-term fix.”

During Leanne’s consultation with Roy Elam, medical director for VCIH, the two discussed treatment and determined a course of action: physical therapy to reduce pain and increase flexibility, exercise to strengthen her body’s core, and acupuncture in the case of acute pain episodes. She also began a regular yoga and meditation practice.

The results so far?

“Yoga has been a tremendous step in the right direction,” she said. “Physical therapy offers relief and insights into my posture and gives me measures I can take to be more comfortable and healthy on my own. I still take Aleve, but I’m living more healthfully minded around the clock. My entire attitude is better.”

VCIH is not alone in its mission to care for the whole person. As a member of the Consortium of Academic Health Centers for Integrative Medicine, it is one of 42 integrative health centers operated by academic and medical institutions, including Harvard, Yale, Duke and Johns Hopkins universities and the Mayo Clinic.

“We share the belief that who we are is more important than what’s in our tool box,” said Elam, who also maintains an internal medicine practice at Vanderbilt. “We see our patients as much more than symptoms and body parts and believe that healing often involves more than just a prescription or a procedure.”

Defining “Complementary”
Clinicians at VCIH are careful to use the terms “complementary” and “integrative” as opposed to “alternative” when discussing the treatments offered at the center.

“We are not an alternative center,” Elam said. “We use clinically proven complementary therapies and we practice integrative medicine, but we are not looking for alternatives to the internal medicine we practice.”

“Clinically proven” means there’s no talk of aromatherapy, herbal remedies or crystals. Clinicians at VCIH don’t condemn such treatments, but they don’t offer them because there’s not sufficient clinical research to back them up, according to Elam, who has been at Vanderbilt since 2004 and helped start Vanderbilt’s palliative care program.

Elam and his team, which includes health psychologist Tobi Fishel, program manager Patti Thomas and a team of yoga, massage, physical therapy and acupuncture clinicians, work closely with primary care physicians and specialists to coordinate all treatments, which are entered into Vanderbilt Medical Center’s health database. Patients come to Elam by referral and are not encouraged to abandon their current therapies. Rather, complementary therapies are recommended and many are offered on site and covered by insurance.

But do complementary therapies work? Yes, says chronic pain researcher Steve Bruehl, an associate professor of anesthesiology at the Vanderbilt University School of Medicine.

“Approximately one in five people in this country suffers from some type of chronic pain, and many feel that they do not obtain adequate relief from traditional medical approaches alone,” Bruehl said. “This is because chronic pain is a complex condition that has not only a physical component, but also psychological, social and spiritual components. For treatment to have the greatest likelihood of success, it needs to address as many of these facets of the pain condition as possible.”

Caring for the Body, Mind and Spirit
Fishel, director of psychological services, was recruited to the center because of her expertise in the psychological impact of chronic pain. She has served in Vanderbilt’s Department of Psychiatry for a decade, and has a background in holistic medicine and mindfulness-based practices. That expertise is put to the test when presented with patients with complicated health and psychological issues, ranging from cancer and diabetes to victims of sexual assault.

“Some of my patients have both injury and trauma which makes healing the body much more difficult, so it’s important to provide them with psychological treatment along with medical treatments for their injuries,” she said. “There isn’t a day that goes by that I don’t see a patient who tells me, ‘I’m so glad to finally find someone who gets that I am more than my disease.’”

Fishel also facilitates workshops at the center, including a women’s event called Grace and Beauty that takes place
every six weeks. The next one occurs Dec. 13. Components of the workshop include breath work, gentle movement and mindful meditation.

“We help the participants – some who are patients, some who are not – quiet their mind and develop a kinder relationship with their body,” Fishel said. “People who have chronic illness start hating their bodies. We work to help people become more aware of their thoughts, their feelings and their spiritual needs and give them tools to connect with those.”

Inhale, Exhale, Heal
One of those tools is yoga, which is proven to alleviate pain and reduce stress. Just ask VCIH yoga instructor Clyde Lee, a former Vanderbilt and professional basketball player who was among the inaugural class recently inducted into the Vanderbilt Athletics Hall of Fame. Twenty years ago, a doctor suggested he try yoga to relieve his 6-foot-10-inch frame of debilitating pain accrued during his years of playing basketball.

“The pain was so bad that I had to stand up slowly or I might collapse,” Lee said. “Although I was hesitant, my pain was greater than my fear, so I gave it a try. I eliminated my back issues as well as discovered that there is a lot more to yoga than just stretching.”

He said practicing yoga not only managed his pain and increased his flexibility, but also gave him the tools to reduce his stress and focus his mind.

“Visualization was a major tool I used as a professional athlete, so I enjoy the mental work associated with the practice,” said Lee, who has practiced yoga with a number of Vanderbilt athletes over the years.

“Clyde meets us where we are,” said one participant in his class. “He gives us a workout, but I come away from his classes feeling relaxed, like I’ve just gotten a massage.”

Jackie’s Story
Jackie* first came to VCIH in 2007. She had been experiencing physical pain since 2005 and doctors couldn’t find the cause. Pain medication was prescribed and surgery suggested, but she hoped for a less invasive remedy. By chance she stumbled upon the VCIH Web site and began researching the center and its practices.

“It seemed like it was worth my time to pursue this if it would give me a better understanding of what was going on with me,” she said. “I’m very open to trying new things, so I was eager to find a solution, no matter where it came from.”

Jackie also was going through a difficult divorce at the time, and her stress level was at an all-time high, exacerbating her physical symptoms. Elam prescribed regular psychological counseling for managing her stress and emotional pain, a referral to a rheumatologist to explore her symptoms further, and massage therapy for her aching body. In addition, Jackie started yoga classes and began attending the Sangha (Sanskrit for “community”), a monthly meditation gathering held at
the center.

“The full cause of my pain has yet to be determined and the research will continue, but my body is responding to medication and the pain management practices,” she said. “I’m thankful that I found the center, where I could get the help I needed during this difficult time.”

New Roots
In two years, VCIH has established itself within the Vanderbilt Medical Center family, not only through the clinic, but also in the lab through research efforts and the classroom through Elam’s and Fishel’s instruction of Vanderbilt’s medical students on the practice of integrative health.

The center reveals a different side of Vanderbilt to the world, according to Patti Thomas, program director at VCIH.

“In a way, our existence softens the Vanderbilt Medical Center brand and adds a new dimension to what Vanderbilt is known for,” she said. “It emphasizes the fact that Vanderbilt isn’t just about pills and procedures.

“We’re proud of how far we’ve come, but we’re still defining who we are and we’re changing and growing every day,” she said.

One major growth spurt will happen in about a year, when VCIH takes up residence in the new Vanderbilt Health at 100 Oaks. Additional space and closer proximity to clinics will result in greater convenience and more services for its clients, Thomas said.

“So many of our patients – particularly those with diabetes – will be able to come straight out of their specialist’s office and down the hall to see us. It’s going to be one-stop shopping, and we are all looking forward to that.”

In the meantime, VCIH’s staff continues to grow. Linda Manning, former director of the Margaret Cuninggim Women’s Center at Vanderbilt, recently joined the clinicians at VCIH. For the past 30 years, Manning has worked as a therapist and educator focusing on trauma imposed by acts of violence against women. She will facilitate emotional healing workshops and provide counseling services to patients.

Plans are also in the works to hire a nurse practitioner to serve as a health coach, as well as a nutritionist and an activities coordinator to manage the burgeoning schedule of workshops and classes offered by the center.

“We are developing a yoga class for people with migraines, one for people with cancer, and one for people with fybromyalgia,” Thomas said. “Each day we learn something new and incorporate modalities that our patients can benefit from.”

While VCIH clinicians are pleased that the center is growing, one thing that will not change is the emphasis placed on taking the time to create a strong and dynamic doctor-patient relationship, Fishel said.

“A big part of the treatment is simply listening to the patient. How many times have we reached out for help but haven’t been heard? Here at the center we offer so many things, but the most important thing we can do is listen.”


*The names of patients mentioned in the story have been changed to protect their privacy.

Posted 12/01/08