May, 2011, Vol. 12, Issue 05
Acupuncturists Stepping Up to the Cancer Challenge
By Harvey Kaltsas, AP, Dipl. Ac., Past President, AAAOMOne of the greatest challenges in medicine is treating the cancer patient.
Successful treatment often involves bringing to bear many different modalities to restore health, a multi-disciplinary model followed regularly in Asia - where acupuncture, nutrition, exercise, hyperthermia, and herbal medicine are often combined with the more commonly accepted Western modalities of surgery, radiation, and chemotherapy.
Now, more and more licensed acupuncturists prepared with high levels of academic and clinical training are assuming integrative roles within Western medical settings. This is especially so at the Cancer Treatment Centers of America (CTCA), which employs eight state licensed or NCCAOM certified acupuncturists (Oklahoma has no licensing statute) at its five hospitals across America – in Seattle, Phoenix, Tulsa, Chicago, and Philadelphia.
In this interview, Acupuncture Today asks three licensed acupuncturists and NCCAOM Diplomates about their experiences working at CTCA. Dr. Irina Aleynikova, MD, LAc, Dipl. Ac. (NCCAOM) earned her MD at Minsk Medical University in Belarus and her Masters of Oriental Medicine at the Midwest College of Oriental Medicine in Chicago. She practices at CTCA's Chicago center. Jennifer Feingold, LAc, Dipl. Ac. (NCCAOM), PA, earned her Master's degree in Acupuncture from The New England School of Acupuncture and her Bachelor of Science and Physician's Assistant certificate from Hahnemann University. She practices at the Eastern Regional Medical Center, CTCA's Philadelphia hospital along with Dr. Gurneet M. Singh, ND, LAc, Dipl. Ac. (NCCAOM) who earned both her Doctorate in Naturopathic Medicine and her Master of Science in Acupuncture at Bastyr University in Seattle.
AT: How did you come to work at CTCA?
Dr. Irina Aleynikova, LAc, MD: My major paper in college was on the use of Chinese medicine in breast cancer treatment. The dean of the school saw this and recommended that I apply to the Cancer Treatment Centers of America due to my interest in the topic and my prior background as a physician in Belarus. After that, I met with Dr. Ray, a reconstructive surgeon and medical acupuncturist, and he told me about the unique approach at this hospital that integrates complementary alternative medicine to treat cancer. After this meeting, I knew that this hospital would be a great fit for me.
Jennifer Feingold, LAc, PA: While I was working at Great Brook Valley and learning both Western medicine and Eastern medicine with Jeff Satnick, MD who is also a NESA graduate, I was strongly considering attending acupuncture school. Jeff encouraged me to look into Naturopathic School as well before I made my final decision. I went to a Naturopathy conference in Seattle around 1996 or so and there CTCA had an informational booth. I was impressed with their integrative model. I had only been a PA for a couple of years and was already feeling somewhat frustrated with the limitations of Western Medicine. I can still remember the woman's face at the CTCA booth and my positive experience with our conversation. I remember thinking to myself that it sounded like an interesting place to work. Perhaps it was an omen. Fast forward many years later. I moved back to Philadelphia to be close to my mother with her ailing health. A massage therapist acquaintance mentioned to me that he had interviewed at CTCA and had passed on my information. I interviewed and knew it was a special place as soon as I walked in the door. And that's how it all started!
Dr. Gurneet Singh, LAc, ND: How CTCA and I found each other is a bit of a story! I received a phone call from a caregiver of a patient at CTCA, who had researched local Philadelphia acupuncturists and found me. She was interested in learning more about how acupuncture could benefit her husband and wanted to know if I could come to CTCA to treat her husband. I told her that I would like to help and would look into it. I called CTCA and was connected with the Director of the Rehabilitation department at that time. At the same time, the director had been looking for an acupuncturist to initiate the development of the acupuncture program at Eastern. She was contacting local physicians, who were also trained in acupuncture. Included in her search, she contacted the doctors that I was assisting in research at the University of Pennsylvania Medical School and they recommended me. As I learned more about CTCA, visited and interviewed at Eastern, I was very excited about the integrated team, the patient focused model, and the wonderful people I met during my interviews. I knew I was in the right place and was thrilled to start my work here!
AT: What kind of conditions do you treat at CTCA?
Dr. Irina Aleynikova, LAc, MD: At CTCA we treat a variety of conditions such as pain, nausea, vomiting, chronic fatigue, peripheral neuropathy, stress, anxiety, hot flashes and others.
Jennifer Feingold, LAc, PA: The conditions that I treat at CTCA include, but are not limited to; side effects from cancer treatment: Digestive complaints - nausea, vomiting, diarrhea, constipation. Musculoskeletal pain, post op pain, fatigue, anxiety, insomnia, peripheral neuropathy, xerostomia from radiation treatment for head and neck cancers.
Dr. Gurneet Singh, LAc, ND: The majority of conditions that I focus on at CTCA are the side effects of chemotherapy, radiation, and surgery. Some conditions that are addressed routinely include: nausea and vomiting, diarrhea, constipation, anorexia, xerostomia, hot flashes or flushes, nicotine addiction, fatigue, peripheral neuropathy, pain, and stress/anxiety. In terms of pain management, this may be pain directly related to the cancer or associated with the treatment of the cancer. I can also focus on any type of pain issues that may be affecting the quality of life for the patient, such as arthritis, low back pain, knee pain, and headaches/migraines. Furthermore, the benefits of acupuncture definitely extend beyond the physical, and I use acupuncture at CTCA for mood support, stress management, and the promotion of an overall sense of well-being.
AT: Are treatments mainly for symptoms or do you also address underlying issues of constitution and balance?
Dr. Irina Aleynikova, LAc, MD: Here at CTCA, most acupuncture treatments are done in order to alleviate the symptoms caused by cancer; it unfortunately does not do anything to treat the underlying disease. Acupuncture is, however, able to successfully decrease the side effects caused by cancer treatment, such the nausea and vomiting caused by chemotherapy and radiation. Acupuncture is also able to help many patients decrease cravings from trying to quit smoking.
Jennifer Feingold, LAc, PA: Our patients are very complicated medically with multiple medical and emotional issues as well as multiple side effects from their treatment. What I have found works best is to try to always balance their pulse as a root treatment and then needle for the presenting complaint. Using the basics of Japanese Acupuncture and using the pulse to guide me seems to work best for these patients. Sometimes when I am squeezed for time, I will do an auricular treatment based on symptoms alone.
Dr. Gurneet Singh, LAc, ND: The treatment sessions are symptom focused. Our acupuncture treatments are physician directed, meaning that a physician's order is placed by the medical oncologist, the hospitalist, or another physician, such as surgeon and the treatment is focused on the condition(s) listed in the physician's order. I explain to my patients that we are not attempting to treat the cancer with the acupuncture, rather we are focusing our treatments on managing, diminishing, and preventing the side effects of chemotherapy, radiation, and surgery. Although the treatments are not "cancer treatment" focused, it is my hope that the acupuncture does help to support the immune system, as studies have shown. Any support to the immune system is very important as it can inevitably help our patients in their fight.
In addition, during the intake for each patient, I also inquire about digestion, mood, energy, sleep, and pain. Often times, these issues are interconnected and I am able to treat multiple issues within one treatment session.
AT: In how much demand is your work? How many treatments do you perform a year on average at CTCA?
Dr. Irina Aleynikova, LAc, MD: Last year, I performed close to 1,400 treatments, so I would say it is in quite high demand.
Jennifer Feingold, LAc, PA: When I first started at CTCA, there was not much demand for our work. Gurneet and I have done extensive education throughout the hospital for the medical staff, and our demand has grown significantly. I see about 1,200 patients per year there. That is based upon 0.6 full time equivalents. I am there three full days per week. We see on average eight patients per day. It is mostly outpatients and some inpatients.
Dr. Gurneet Singh, LAc, ND: I have been working at the Eastern Regional Medical Center since the Fall of 2006. Being the first acupuncturist here, I had the exciting opportunity to launch and initiate the development of our acupuncture service at Eastern. I have been proud to see how our program has progressed and evolved over the years. In particular, it has been amazing to witness the growth, popularity and demand for our services by our patients over the past four years. On average, I provide about seven to eight treatments per day, including both in-patients and out-patients. I work at CTCA three days per week and I provide approximately 1,125 acupuncture treatments per year. Patients are treated in our out-patient clinic treatment room, in the infusion center while receiving chemotherapy, and in their in-patient rooms.
AT: Do you get to use any moxibustion in your treatments? If so, I assume that would be indirect, yes?
Dr. Irina Aleynikova, LAc, MD: Yes, I use them indirectly.
Jennifer Feingold, LAc, PA: We do not use moxibustion at this time. I hope that we will be able to in the future.
Dr. Gurneet Singh, LAc, ND: We are not using moxibustion at our center. Because many of our patients are very sensitive to different scents, we were concerned about the odor associated with moxa (even smokeless moxa). Additionally, we are not permitted to light anything on hospital grounds, which would be necessary to use moxibustion.
AT: Do you get to use any herbal remedies in your treatments? If so, do you recommend Shih Chuan Da Bu Wan (Ten Flavor Teapills) for treatment of low white blood cell counts? This condition is normally treated in the West with injections of Neulasta or Neupogen.
Dr. Irina Aleynikova, LAc, MD: Although I have a MS in herbology, I do not prescribe herbal remedies because we have a department of naturopathic medicine that deals with the prescription of herbal supplements.
Jennifer Feingold, LAc, PA: In the acupuncture department, we do not use any herbal remedies. However, as you know, we employ naturopaths who use extensive herbal remedies.
Dr. Gurneet Singh, LAc, ND: We do not use any herbal remedies as a part of the acupuncture services at Eastern. When patients begin treatments here, they will meet with a naturopathic doctor, who will conduct a thorough review of all of the supplements that the patient is using. All of the supplements and herbal products that are recommended by our naturopathic doctors are evidence-based, meaning that they have been researched for efficacy and safety.
As a side note, if I am aware that a patient has low white blood cell counts, I will include acupuncture points in the treatment which can help support the immune system, including white blood cells. Also, if a patient is being treated with Neulasta or Neupogen, a common side effect is generalized body pain or achiness, which can be addressed with acupuncture.
AT: Have your patients remarked at all upon their treatments with hyperthermia? If so, what has been their general reaction?
Dr. Irina Aleynikova, LAc, MD: I have not treated patients with hyperthermia, so I am not able to comment on that question.
Jennifer Feingold, LAc, PA: Most patients have been very satisfied with their hyperthermia treatments. I saw one very young adult who was in her early 20s. I treated her for anxiety associated with using hyperthermia. Another that I recall had a lot of fatigue from her treatments. They both did very well and benefitted from including acupuncture in their treatment regimens.
Dr. Gurneet Singh, LAc, ND: I have worked with patients who are also undergoing hyperthermia treatments. I have not noted any complaints of side effects related to hyperthermia that patients wanted me to work on.
AT: What has been your experience of working with other members of the medical staff? Do you feel to be integrated into the team?
Dr. Irina Aleynikova, LAc, MD: Here at CTCA, I feel very integrated into the medical staff. When doctors and nurses see a patient that can benefit from acupuncture treatment, they never hesitate to refer them to me. This is especially true of the pain team and medical oncologists who very frequently refer patients for acupuncture treatment. Doctors are well aware of the way in which acupuncture works and we are able to provide a very integrated approach toward medicine at CTCA.
Jennifer Feingold, LAc, PA: In the beginning when I arrived at CTCA, the medical staff were not familiar with our work and were a bit skeptical. However, over time and with our education and patient feedback, I feel that we are well integrated into the team. We have numerous referrals from the physicians, and we are likely going to expand our department.
Dr. Gurneet Singh, LAc, ND: I can say with 100 percent confidence that CTCA has truly realized, actualized, and implemented an integrated care model. This integrated team approach is one of the main reasons I wanted to join the CTCA family. Each member of the team is valued for the special expertise he or she can contribute to the care and healing of each patient. We work seamlessly together as a unified team to ensure that all the of patient's physical, emotional, mental, and spiritual needs are met with care and respect. We rally around and support our patients to the best of our abilities and strive to surpass the expectations of our patients. I feel that my expertise is respected and valued by patients and my fellow clinicians.
We participate in daily in-patient rounds where clinicians from the different departments including nutrition, naturopathic medicine, acupuncture, mind/body, pain management, rehabilitation, and pastoral care can meet to review the status of each in-patient with the hospitalists and nurses. This provides a forum where each department can be updated on our in-patients and furthermore, each department can determine if they can help address particular issues that each individual patient may be experiencing.
AT: What is your overall impression of CTCA?
Dr. Irina Aleynikova, LAc, MD: CTCA is a very warm and friendly place to work. Doctors, nurses, and all staff members are very compassionate and caring to the patients needs, and we are able to put the patients' needs first at this organization. We all provide a unified effort to ensure the patients' physical as well as mental welfare.
Jennifer Feingold, LAc, PA: My overall impression of CTCA is very positive. Here is an institution that uses conventional cancer treatment as well as treatments that are considered alternative - acupuncture, naturopathy and mind body support. Also, sound nutritional support. They do not just offer lip service. CTCA takes the CAM services very seriously. I have worked in many medical institutions over the years. It is very refreshing to work in a place that is not afraid to step outside of the box and do what is right for excellent sound patient care.
Dr. Gurneet Singh, LAc, ND: I think very highly of the model, mission and values that CTCA upholds and I enjoy my work here tremendously. It has been a pleasure and honor to work at CTCA...first and foremost for our wonderful, strong, courageous, and inspiring patients.
The atmosphere at CTCA is very special and different than other hospitals. As soon as you enter one of our hospitals, this difference is palpable. You walk into a facility that looks more like a luxurious hotel rather than a hospital. You are immediately greeted with friendly smiles and "hellos." The mood is set as a place of healing and you can sense the dedication and compassion from the employees at CTCA.
AT: I understand that its co-founder wanted care-givers at CTCA to treat patients as they would their own mothers, hence CTCA's trademark Mother Standard(R) of care. What does the Mother Standard(R) of care mean for you in your work at CTCA?
Dr. Irina Aleynikova LAc, MD: The Mother Standard(R) is a wonderful care system that treats every patient as an individual rather than a physical problem that needs to be solved. The Mother Standard(R) aims to provide the highest level of care to people that is struggling with a difficult problem in their life, because cancer is not only a physical ailment, but a mental struggle as well.
Jennifer Feingold, LAc, PA: I love the Mother Standard of Care here at CTCA. It means all of the staff are on the same page. I have tried to use the same philosophy in my clinical practice over the years. It is easy to do when one is working solo in a private practice. However, when working in a hospital, there are many other challenges when working with other medical staff. Some staff may not have the patient's best interest at hand at the moment - for varied reasons. It usually is that a staff member wants to just complete a task and may forget about the patient in his or her diligence to complete a given task. With the Mother Standard, everyone in the hospital is on the same page - from the cleaning lady who does not speak much English up to and including our CEO. Everyone knows that the patient comes first and it makes a HUGE difference for the patient and also the staff. Everything flows so well here at CTCA. It is a pleasure to work here. The roadblocks and bottlenecks do not exist as they do in other facilities where I have worked. The energy is very open positive and flowing.
Dr. Gurneet Singh, LAc, ND: To me, the Mother Standard(R) is the ultimate and ideal patient focused care model. The Mother Standard(R) means providing the best care that I possibly can and providing that care with heart and compassion. The Mother Standard(R) holds that each patient is treated as if he/she is a part of our own family and we are expected to give the care that we would give to a loved one. Our patients are the reason that we are here and their journey, health, and comfort are of the utmost importance to us. I feel honored to be welcomed into and included in my patient's lives. Working within this type of model, we become close to our patients, forming memorable connections every day. I am truly touched by my patients' stories and I am inspired every day as I witness their courage, hope, and strength.
Dr. Harvey Kaltsas was president of AAAOM from 1992-1994, served as chair of the Florida Board of Acupuncture from 1987-1991, and was vice chair from 1999-2001. He is in private practice in Sarasota, Fla. and is currently authoring books on gua sha massage and the dangers of X-rays.