Part 1 Recap. Part 1 Case- Gastrointes;nal 9/25/15. It s Time to Talk: Complementary and Alterna;ve Medicine

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1 It s Time to Talk: Complementary and Alterna;ve Medicine Part 2: Evidence- Based Diagnosis and Treatment Preparing NP s to talk and treat using popular complementary health approaches. NP s can help pa;ents make wise healthcare consumer decisions. 8/30/ Part 1 Recap 1. What CAM therapies do most pa;ents know about and use? 2. What are the important Pa;ent Responsibili;es related to consuming CAM? 3. What are the important NP regulatory issues to keep in mind? 4. What is the best source of CAM evidence for a busy NP? 5. How should NP elicit CAM related informa;on during a pa;ent encounter? 8/30/ Part 1 Case- Gastrointes;nal 8/30/

2 Overview Part 2 Pa;ent Interview Tools Encourage full disclosure on current forms?add an Intake Ques;onnaire to fully explore the Context (Remember CAM s 3 C s )?Add a food frequency ques;onnaire to discover nutri;onal trends Three Case Studies Endocrine, Pulmonary, Cardiac Priori;zing & Prescribing Tools 8/30/ Time to Talk 8/30/ Time to Talk 8/30/

3 Priori;zing & Prescribing Tools 8/30/ Diagnosis DIAGNOSE ACCORDING TO TEXAS MPA & NPA STANDARDS OF EBP, THEN THOUGHTFULLY INTEGRATE CAM INTO YOUR TREATMENT PLANS 8/30/ Case Study Ac;vi;es 1. Divide into groups for our Integra;ng CAM Case Studies 2. Listen to case presenta;on, answer the prime the pump ques;ons (3 minutes or less) 3. In your group review & discuss the evidence (5 minutes) 4. Interview the pa;ent (5 minutes) 5. Prepare a CAM prescrip;on (2 minutes) 6. Present your process & prescrip;on (3 minutes) 7. Q & A as ;me permits 8/30/

4 Part 2 It s Time To Talk: Case Study 1 Endocrine Case Study 2 Pulmonary Case Study 3 Cardiovascular 8/30/ Case Study 1 Endocrine 58 yo white female, cc itchy bodom, resolves but returns with OTC an;fungal cream, associated with not feeling like herself last 18 mo & occasional painless scant BRB per rectum with BM s, uninten;onal weight gain of 20 lbs ROS: +Fa;gue, nocturia, thirst, worsening eyesight Medica;ons: none, no allergies PMH: menopause 9 yrs ago, hemorrhoids FMH: Father Colon Cancer & Smoker, Mom DM, Daughter A&W SH: - ETOH/Tob/Rec drugs, divorced, strong social network Health Maintenance: Current pap/mammo & colonoscopy, flu shot VS: T98.4, P70, R16, BP 148/88, BMI 32 8/30/ Common CAM Approaches to Type 2 DM with episodic Pruritus Ani Herbs Herb Formula: Gymnema sylvestre 100 ml, Fenugreek seed 60 ml, Ginkgo 40 ml, Dose 5 ml ;d Bilberry 20-50g fresh fruit or 150 mg anthocyanins daily Green tea 2 parts, phyllanthus 2 parts, cinnamon bark powder ½ part as infusion, 1 tsp/cup ;d- qid Non- vitamin/mineral natural Home check of BS Weight loss Low GI/Sat fat diet, Fiber 40 g/d Alpha- Lipoic acid 600 mcg in divided doses Chromium 200 mcg daily Mg 400mg elemental daily Omega- 3 fish oil 1000mg ;d Physical Treatments Daily exercise: strength & aerobic Neutral sitz baths 8/30/

5 Case Study 2 Pulmonary 31 yo AA male, cc cold that s worse, started 2 weeks ago as a regular cold in his nose but went into his chest, yellow- green sputum worse in the morning, cough is keeping him awake at night, cold air makes it worse, nyquil helps at night ROS: +Fa;gue, - F/C for over a week, - travel/exposure to illness, +sore chest & SOB only with coughing fits, - blood in sputum Medica;ons: none, no allergies PMH: none FMH: Father Stroke & Smoker, Mom osteoarthri;s, Son A&W SH: + ETOH 4-5/wk, - Tob/Rec drugs, married, happy at home/ work Health Maintenance: doesn t take flu shots VS: T98.8, P82, R18, BP 136/76, BMI 29 8/30/ Common CAM Approaches to Acute Bronchi;s Herbs Herb Formula: Echinacea root 50 ml, Thyme 30 ml, Mullein 55 ml, Astragalus 60 ml, Ginger 5 ml, dose 5ml qid to resolu;on OR Tea: Elecampane root 2 parts, Thyme herb or flower 1 ½ parts, Echinacea root 2 parts, Peppermint herb 1 part, Ginger root ¼ part as infusion, 1 tsp/cup qid Non- vitamin/mineral natural Eucalyptus oil 12 gds oil in boiling H2O as steam inhala;on or 5 gds in nebulizer Menthol or peppermint liniments to chest Healthy diet, Allergy tes;ng, Inc fluids 1 part mustard powder: 3 parts flour with H2O for paste to chest Querce;n 1500mg daily in divided dose Omega 3 fish oil 4000 mg daily in divided doses Physical Treatments Daily exercise, reflexology, Accupuncture, hot chest showers Daily breathing exercise &/or Bodle blowing 20 ;mes on 10 8/30/2015 occasions 14 Case Study 3 Cardiovascular 55 yo Hispanic female, cc dull headache at the back of head upon awakening, worse aler working 3 or 4 days in a row as a legal aide, drinks 5 cups of coffee/d at work, headaches are increasingly common over 4 months, HA worsens during the day- beder in the evening ROS: +Fa;gue, + fast heart beat with lots of coffee, + fingers swell some;mes, - neck injury/pain, - jaw pain/click Medica;ons: none, no allergies PMH: none FMH: Father 2 MI s at 60 yo, Mom osteoarthri;s, 3 sons A&W SH: + ETOH 4-5/wk wine, - Tob/Rec drugs, married Health Maintenance: Last mammo/pap 3 yrs ago, no flu shots VS: T98.8, P92, R16, BP 160/92, BMI 31 8/30/

6 Common CAM Approaches to Essen;al Systemic Hypertension Herbs Herb Formula: Hawthorn leaves 50 ml, motherwort 30 ml, St Mary s thistle 50 ml, Coleus 70 ml, dose 10 ml bid OR Compounded Tablet: Dan shen 500 mg, Hawthorn 750 mg, Coleus 700 mg, Valerian 450 mg, 2 tabs bid Coffee Alterna;ve Tea: Passionflower 2 parts, peppermint 1 part, lime flowers 1 part as infusion, 1 tsp/cup ;d Non- vitamin/mineral natural DASH diet, 10% Wgt loss, Reduce coffee and ETOH Daily BP check & Headache diary Menthol or peppermint liniments to chest Fresh Garlic mg/d in divided dose Coenzyme Q mg daily Mg 600 mg in divided dose daily Omega 3 fish oil 7000 mg daily in divided dose Physical Treatments Daily aerobic exercise, Yoga or Medita;on or relaxa;on therapies, Acupuncture, Massage Hydrotherapy 8/30/ More Resources for Learning IntegraLve Medicine BEST INTEGRATIVE WEB SITES Santa Rosa Website hdp:// Integra;ve Medicine for the Underserved hdp://im4us.org University of Wisconsin Integra;ve Medicine Handouts hdp:// Vitasearch hdp://vitasearch.com/ Food Nutri;on and Health hdp:// Food as Medicine hdp:// University of Arizona hdp://integra;vemedicine.arizona.edu/educa;on/fellowship DRUG- NUTRIENT INTERACTIONS EpocratesRx (paid version has herbs and some supplements) Medscape Drug Interchecker Natural Medicines Comprehensive Database hdp://naturaldatabase.therapeu;cresearch.com 8/30/

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