Liz Ramos' life hit wall in August 2000 when an angry co-worker assaulted her as she inspected and packed automobile headlight-bulb shields for shipment at a local manufacturing facility. The 27-year-old Lakewood resident fell to the floor during the attack, suffering a sprained left knee and, worse yet, two herniated discs in her lower back. The latter injury proved incapacitating. Suddenly, Ramos could hardly get out of bed, let alone drive a car, go to work, chase after her then-3-year-old son or clean the house.
Over the next four years, she tried everything her doctor prescribed to alleviate the constant pain. Painkillers made her sick to her stomach. Muscle relaxants left her groggy. Physical therapy only made her condition worse. Epidural block treatments ceased to provide relief almost as soon as the series of shots was completed.
"My sister was basically taking care of me, doing all the housework, getting my son ready for school," the single mother says.
Earlier this year, Ramos' doctor finally suggested she try acupuncture, the ancient Chinese practice of inserting hair-thin needles into the body to alleviate everything from allergy symptoms to chronic pain.
"I was very leery, very hesitant," Ramos remembers. "You only hear about acupuncture on TV." But workers' compensation covered the cost and Ramos was desperate for relief. After a few 40-minute sessions at The Cleveland Clinic's department of pain management, she began to get it.
"After the second, third treatment, I started to really notice that I was able to move a little better," she says.
As a result of the weekly acupuncture treatments, Ramos no longer needs to take muscle relaxants and has cut her daily intake of painkillers by 25 percent. Now, she can get in and out of her car to run errands and do some light housekeeping: dusting, vacuuming, washing the dishes. She's looking forward to starting physical therapy, returning to work, even going back to school.
"It has helped me a lot," she declares. "I'm able to do the day-to-day things that I wasn't able to do before."
Ramos is among the 36 percent of adults in the United States who today use some form of complementary or alternative medicine to treat what ails them — a number that jumps to 62 percent when megavitamin therapy and prayer specifically for health reasons are included, according to results from a 2002 study released in May 2004 by the National Center for Complementary and Alternative Medicine and the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.
The NCCAM defines complementary and alternative medicine as "a group of diverse medical and health-care systems, practices and products that are not presently considered to be part of conventional medicine — that is, medicine as practiced by holders of medical doctor or doctor of osteopathy degrees and their allied health professionals, such as physical therapists, psychologists and registered nurses." Complementary medicine is used together with conventional medicine, while alternative medicine is used in place of conventional medicine.
Although CAM use spans all socioeconomic groups, the study indicates that it is more likely to be used by women, people with higher educational levels, those who have been hospitalized within the last year and, curiously enough, former smokers.
Yet more and more people of all backgrounds are embracing CAM, and it's showing up with increasing frequency at some of the nation's most respected medical institutions, including those here in Cleveland.
Here, we query local medical institutions and holistic centers to find out which practices in each of the five CAM "domains" are most popular, who's using them and why.
When prayer is included in the definition of CAM, 53 percent of those surveyed said they used mind-body medicine, which "enhances the mind's ability to affect bodily function and symptoms."
At the Ursuline Sophia Center, a nonprofit holistic health and spirituality facility on the Ursuline College campus in Pepper Pike, yoga — classified in the mind-body medicine domain by the NCCAM — is the most popular of the center's more than 140 classes, programs and services. "It's a good form of exercise that does not overly stress the body," says Sister Jennifer Corlett, a holistic psychologist who serves as one of the 10-year-old center's three directors. "People say it is so relaxing." She estimates that 80 to 85 percent of the center's approximately 2,000 clients a year are women from a wide range of backgrounds, mostly between the ages of 30 and 60.
"The people who are coming for the services that support their health and well-being are people who inherently understand that conventional medicine alone is not enough," she says. "It generally addresses only the physical symptoms, and it views the person in terms of his or her disease. They want an approach that supports them as a whole person: body, mind, emotions and spirit."
Earlier this summer, the Center for Women's Health at University Hospitals Health Systems' Chagrin Highlands Medical Center in Orange Village added hypnotherapy to its menu of services, which include massotherapy, reiki and reflexology. The move was prompted in part by the popularity of hypnobirthing, a course that teaches mothers-to-be self-hypnosis to cope with labor. Hypnobirthing has been included in the center's childbirth services since it opened in September 2003.
Hypnotherapist and registered nurse Jackie Gnatovich now offers hypnotherapy for stress reduction, smoking cessation, weight management, surgery preparation and, most recently, as a complementary treatment for irritable bowel syndrome. She says her patients range from 20 to 70 years old, depending on the condition or problem for which they're seeking treatment. "I've helped equally as many people under 40 as over," she says. Some have tried traditional therapies and medications without success and see hypnotherapy as a last-ditch solution; others are open to less conventional treatments.
Dr. Jennifer Kidd, the center's medical director, describes hypnotherapy as "guided relaxation."
"You're awake, you're aware, you're alert, but your mind is more open to positive suggestions," she says. It's a definition clearly at odds with the robotic, trancelike state depicted on television and in movies that leads many people to believe it's nothing but "hocus-pocus." In fact, she says, psychologists have been using hypnotherapy for years, although they may not refer to it by that name.
"Gastroenterologists are very enthusiastic about the hypnotherapy program here," Kidd says. "There's only so much they can do. If the medications that we have available don't work, they're stuck."
Biologically Based Therapies
When prayer is not included in the definition of CAM, study participants turned to body-based therapies such as diets, herbals and vitamins more often than mind-body medicine. Twenty-two percent said they used the former, while only 17 percent said they used the latter. Kidd says vitamins and natural supplements and remedies are popular because they allow those who use them to self-medicate. "They want control, and they really prefer not to go to the doctor if they don't have to," she explains. But Phillip Nabors, co-owner of Mustard Seed Market and Cafe, a natural and organic supermarket and restaurant with locations in Solon and Fairlawn, says there's a far simpler answer as to why people buy them: "Because they work."
"Twenty years ago, we were considered quacks," Nabors recalls. "But as science has figured out that, hey, maybe there's something to these natural things, the category has gotten more credibility. At the same time, traditional medicine has become much more open to it."
Abby Clark, assistant manager for the holistic health department at Wild Oats Market, a natural and organic grocery in Woodmere, notes that natural supplements and remedies account for as much as a quarter of all store sales. "Most of our [department] consumer base is the middle-aged to elderly," she says. "It's almost evenly split between men and women, and it's a good racial mix of both black and white." The department's biggest sellers include acidophilus, which Clark describes as a preparation of healthy bacteria that aids in digestion, and glucosamine sulfate, a substance found in oyster shells that's used to maintain joint health or relieve joint pain.
High among women's requests are herbal remedies containing black cohash, dong chai and red clover, which contain estrogen-like compounds occurring in plant foods used to ease menopausal symptoms (see page 118 for more information on this topic). Also popular are weight-maintenance products featuring ingredients such as green-tea extract and conjugated linoleic acid, a derivative of sunflower oil that Clark says helps metabolize fat in the body.
Men, on the other hand, are snapping up energy supplements to boost athletic performance, the extract of saw palmetto berries to promote prostate health, and herbs such a horny goat weed and maca to enhance sexual stamina.
At Mustard Seed's Solon location, sales associate Christine Spiroch says customers of both sexes commonly ask for essential fatty acids such as fish oils for cardiovascular problems and joint pain; methylsulfonylmethane, a sulfur-based compound more commonly known as MSM, and the spice turmeric for joint pain; and phytosterols, plant-based compounds found in vegetable oil that Spiroch says "serve as a sponge" to help remove cholesterol from the bloodstream. The majority of customers are women in their 30s, 40s and 50s, typically well-educated and affluent, according to Nabors.
Kidd agrees that there are some supplements and remedies, such as glucosamine, that have been scientifically proven to be effective. But she points out that because the United States regulates natural supplements and remedies as foods, not medicines, there is no guarantee that they contain the amounts of active ingredients touted on the label.
Others simply don't work. Her biggest concern is that people on limited incomes are spending their money on ineffective or unproven remedies instead of much-needed prescription medications.
"When I was in private practice," she says, "I'd have people who'd say that they just couldn't afford their blood-pressure medicine or some medication that I thought was critical. And yet they'd spend huge amounts on vitamins that had no proven benefit to them whatsoever."
Manipulative and Body-based Methods
Perhaps unsurprisingly, chiropractic and massage rate among the 10 most common CAM therapies: 7.5 percent of respondents indicated they used the former, 5 percent that they used the latter. But Dr. Salim Hayek, an anesthesiologist in The Cleveland Clinic's pain-management department, estimates that about 10 percent of the department's patients — "more women than men" — are treated with acupuncture, either exclusively or in conjunction with other therapies. (According to NCCAM, acupuncture can also be classified as an energy therapy or, when used as part of Chinese medicine, an alternative medical system.)
"It definitely has earned its place in the management of chronic pain," Hayek says. "Unfortunately, its application is hindered because a lot of insurance carriers don't cover it and there are a lot of poorly controlled studies to establish its efficacy as a mainstream application in pain management."
Dr. Leonard Torok, director of the Ohio Holistic Medicine at Trillium Creek in Medina, was so amazed by the results obtained by a Chinese anesthesiologist with whom he worked while an orthopedic surgeon at Wadsworth-Rittman Hospital that he completed fellowships in the alternative medical systems of Chinese medicine and homeopathy and eventually opened the holistic medicine center last year.
"Seeing patients that I couldn't get better — other than writing them a prescription for Vicodin or something like that — to know that he was able to relieve their symptoms and they didn't need the medication, that really throws you back on your heels," he admits.
Cleveland Clinic acupuncturist Michael Hunter says he sees plenty of nurses and office professionals, mostly middle-aged, suffering from back and joint pain, headaches and "overuse injuries." Although he calls pain management "the bread and butter of many acupuncture practices," he is quick to add that it is also used to treat allergies, depression and mood disorders, sleep disorders, alcoholism and drug addictions. Anne Kinchen, a registered acupuncturist with offices in Cleveland and Youngstown, says the bulk of her clients are women who have tried to get pregnant using in vitro fertilization and other forms of current reproductive technology and failed. Acupuncture, she explains, can be used to help regulate the menstrual cycle.
"A lot of these patients are referred by physicians they're seeing," she says. "Some of these patients get pregnant before they even go in for their next round [of fertility treatments]."
Alternative Medical Systems
Torok says the therapies most popular with the clientele (80 percent female) at the 5,000-square-foot Ohio Holistic Medicine fall under the alternative system of homeopathy. That's a field of medicine developed in Germany 200 years ago that employs "energies" derived from natural substances, mostly plants and minerals, to relieve the symptoms of everything from PMS to eczema to autoimmune diseases such as lupus. These "energies" are obtained by diluting the substance or extract from that substance over and over again. Torok notes that, in many cases, these substances in their normal, everyday form cause the body to react in a manner totally opposite from the response elicited in their homeopathic forms. Syrup of ipecac, for example, is commonly used to induce vomiting. Yet its energetic form is used to treat morning sickness during pregnancy.
"In homeopathic medicine, symptoms are understood to be good things," Torok says. "The paradox is that when we give a person more of an energy that's the same energy as their symptoms, they don't suffer more — they heal."
Among the homeopathic remedies most requested at Ohio Holistic Medicine are those for menopausal symptoms. "We've had a huge influx of people who want to or have stopped their hormone-replacement therapy," he says. "They're looking for an alternative to minimize their suffering." Many others come in complaining of anxiety-related disorders such as irritable bowel syndrome and colitis.
"Most of our patients have chronic problems," Torok notes.
He's heard the criticisms from fellow medical doctors that homeopathic remedies can't possibly be effective because they contain no active ingredients.
"I used to be in that category," he says. "It doesn't seem to be possible or logical: On a material basis, there isn't anything there. -- We just don't have the knowledge and ability to understand how it works. We just know if you follow the rules, it does work."
According to the study, less than 1 percent of participants used energy therapies such as reiki, an ancient Japanese therapy in which practitioners place their hands above or on the body to help release negative energy from it. But at Reflections, a 3-year-old program at The Cleveland Clinic Foundation that offers a limited number of free aesthetic and relaxation services to its cancer patients, more clients are requesting reiki than facials, the most-requested service last year. The same goes for reflexology, which uses acupressure points on the foot to improve the flow of chi, the Chinese word for life force, in the body. (Reflexology can also be classified as a manipulative and body-based method.)
"A lot of people know more about them now," says aesthetician and certified massage therapist Michele Taylor. "One patient will have it and they're like, 'It's so wonderful! You have to do it! It makes me feel so much better!' "
"Women are more open at first," Taylor observes. "But once the men come in — or their spouse or a physician suggests it — then they come back all the time. We've had great feedback from the patients and the physicians." So great, in fact, that the program will be moving from its one room in the clinic's radiation oncology department to larger quarters in the Taussig Cancer Center when construction on the space is complete.
"As a cancer physician, I'm personally convinced that a cancer patient's state of mind and stress level play some role in modulating their defenses against both tumors and negative side effects of some parts of the anti-cancer therapy," says Dr. Roger Macklis, chairman of the Clinic's radiation oncology department. "We need to treat the whole patient. The Reflections program is one step on the road to this sort of bodywide healing."