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Tag: Integrative

  • The future of IBS care relies on a multidisciplinary, integrative ‘team sport’ approach

    The future of IBS care relies on a multidisciplinary, integrative ‘team sport’ approach

    February 28, 2022

    11 min read


    Source:
    Healio Interview


    Disclosures:
    Berry reports consulting for Oshi Health. Brenner reports consulting for Allergan and Ironwood Pharmaceuticals. Chey reports no relevant financial disclosures. Keefer reports financial relationships with AbbVie, Lilly, Pfizer, Takeda and Trellus Health. Scarlata reports consulting for Activia, A2 Milk Company, Beckon and Gastro Girl, serving as a paid board member/advisory board member for FODY Food Company and GI OnDemand and holding stock in Epicured LLC and Fody Foods.


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    According to the International Foundation for Gastrointestinal Disorders, irritable bowel syndrome is estimated to effect 10{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 15{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of the population worldwide, making it the most prevalent functional GI disorder.

    While the exact pathogenesis of IBS remains largely unknown, scientific evidence points toward disturbances in gut, brain and nervous system interaction that can cause changes to normal bowel function and produce symptoms ranging from mild inconvenience to severe debilitation.

    “IBS care in 2022 and beyond no longer relies on just the gastroenterologist — it is a ‘team sport,’” William D. Chey, MD, FACG, of Michigan Medicine, said at the American College of Gastroenterology Annual Scientific Meeting 2021.
    “IBS care in 2022 and beyond no longer relies on just the gastroenterologist — it is a ‘team sport,’” William D. Chey, MD, FACG, of Michigan Medicine, said at the American College of Gastroenterology Annual Scientific Meeting 2021.

    Source: William D. Chey, MD, FACG.

    As knowledge of IBS has progressed, the traditional focus on abnormalities in motility and visceral sensation has evolved to include psychosocial distress and food as the most important triggers that worsen symptoms. Although one or more of these factors are demonstrable among most patients with IBS, none can account for symptoms in all.

    “The diagnosis of IBS relies on the identification of characteristic symptoms and the exclusion of other organic diseases,” William D. Chey, MD, FACG, of Michigan Medicine, and colleagues wrote in a JAMA IBS clinical review. “Management of patients with IBS is optimized by an individualized, holistic approach that embraces dietary, lifestyle, medical and behavioral interventions.”

    The burden of IBS can be measured in a variety of ways with studies consistently demonstrating impairment and decreased quality of life among sufferers with treatment strategies difficult to validate over time due to inconsistent response across the population.

    “Though strategies for managing IBS have evolved, one guiding principle remains true: There is no one-size-fits-all treatment strategy. IBS care in 2022 and beyond no longer relies on just the GI doctor but is a ‘team sport’ that involves a multidisciplinary, integrative care team of dietitians, behavioral therapists and maybe even complimentary alternative medicine providers,” Chey said during his J. Edward Berk Distinguished Lecture at the American College of Gastroenterology Annual Scientific Meeting 2021.

    In identifying how to best provide care, Healio Gastroenterology spoke with experts across the field on their approach to the treatment of IBS; evolving management strategies, including integrative care; and what advice they give for this special group of patients.

    Ask a GI Doctor: Pharmacologic Management

    When discussing the pharmacologic management of IBS, the ultimate goal is to target the underlying cause(s) of symptoms.

    Darren M. Brenner, MD
    Darren M. Brenner

    “We know that disorders of gut-brain interaction like IBS are biopsychosocial disorders. There are many factors involved in the development of IBS symptoms and these differ between individuals. Thankfully, there are now pharmaceuticals proven to improve multiple symptoms,” Darren M. Brenner, MD, associate professor of medicine and surgery at Northwestern University Feinberg School of Medicine, told Healio Gastroenterology. “I like to say that currently available pharmaceuticals have allowed us to move the needle from treating a predominant symptom to global symptoms. Consequently, we find ourselves for the first time able to recommend against the use of less effective therapies.”

    While emerging pharmaceuticals have advanced over time, the next step in pharmacologic treatment progression is precision medicine: identifying the underlying causes of IBS, developing diagnostic biomarkers for them and targeting treatment for these causes rather than the symptoms themselves. Understanding the underlying mechanism of action for treatments, and how they work within the GI tract, also aids in explaining how certain therapies are improving the pathophysiology of each patient’s syndrome course.

    Following the need for more precise medicine is the need for more head-to-head trials, as the lack of data can prove to be problematic for making prescription recommendations when there are multiple therapeutics in one class. Often, decisions come down to personal preference and drug cost.

    When it comes to Brenner’s usual plan of attack, he often sees pharmacologic interventions as complementary to other tools in the IBS management arsenal.

    “I like starting with dietary and behavioral interventions as initial strategies, as IBS is generally a disorder that effects a younger population. If they work, there is the potential for avoiding long-term use of medications. I am a proponent of the low FODMAP diet as a proof-of-concept, not a long-term diet; like all IBS treatment strategies, this diet also requires personalization,” Brenner said. “I am also a firm believer in behavioral interventions, including cognitive behavioral therapy (CBT) and gut-directed hypnosis. However, I am also fully cognizant that behavioral interventions require buy-in from patients: If patients do not believe these treatments are going to be effective, it usually renders them ineffective, and they should be avoided.”

    This is not to say that Brenner does not believe in the benefits of traditional therapeutics; the treatment decision should be agreed upon by the practitioner and patient after an educated discussion. Though dietary and behavioral management strategies have been highly effective in most, some patients will still opt for medication.

    Despite the lack of direct comparison and need for more head-to-head drug trials, there are many different therapeutics to choose from. The decision is typically made based on the IBS subtype.

    “At times this can be frustrating for patients, as symptom improvement may require cycling though one or a combination of treatments until the right ones are identified,” he added. “It is key to educate your patients on the benefits and risks of each therapeutic and to explain the educated trial and error process. Knowing this in advance reduces patient frustration when initial interventions are ineffective.”

    The future of care relies on precision and designing an algorithm for medication choice based on a patient’s personal indications.

    “Don’t get frustrated. When it comes to pharmaceuticals, we are not yet as precise as we would like to be,” Brenner concluded. “Believe that your practitioner has a method to their madness.”

    Ask a GI Dietitian: Dietary and Nutritional IBS Management

    The convoluted and highly individualized nature of an IBS diagnosis has made management more difficult. In past scenarios, where pharmacological intervention has faltered, the offerings for patients have been scarce — until now.

    Kate Scarlata, MPH, RDN
    Kate Scarlata

    “IBS is a complex condition and patients are really suffering,” Kate Scarlata, MPH, RDN, founder of For a Digestive Peace of Mind, said. “Having evidence-based diet interventions for IBS symptom management is relatively new in clinical practice. It is utilizing nutrition to help manage symptoms, which may include the three-phase low FODMAP diet or modifying other digestive system triggers, such as excess alcohol or fat or adjusting fiber intake.”

    Like IBS management strategies as a whole, dietary intervention must be chosen carefully with each individual’s best interests and health history in mind. Though there are a plethora of dietary intervention strategies to choose from, the effectiveness and popularity of the low FODMAP diet has been proven time and time again, while also being backed by robust research and evidence.

    According to results from a network meta-analysis, Christopher J. Black, MBBS, MRCP, and colleagues found the low FODMAP diet correlated with a reduced failure to improve global IBS symptom occurrence compared with all other intervention strategies (RR = 0.97; 95{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} CI, 0.48-0.91). Further, it was also most effective for combatting abdominal pain, bloating or distension severity. Additional research from the Domino study reported on by Karen Van Den Houte, PhD, at Digestive Disease Week 2021 found app-based, low FODMAP intervention was significantly more likely to lead to an improvement in overall IBS symptoms (> 50 point reduction in IBS symptom severity score) at 8 weeks compared with otilonium 60 mg (71{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} vs. 61{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) with durable benefits seen at 6 months.

    “If you’re using the low FODMAP diet, remember that elimination is the beginning not the end,” Chey said at ACG. “If they do not respond to FODMAP elimination, you should take them off the diet and move on to some alternative strategy. On the other hand, if the patients do experience improvement, they should undergo a systematic reintroduction of foods containing individual FODMAPs. This process allows a provider to customize and liberalize a low FODMAP diet plan for each individual patient.”

    Initial assessment for dietetics looks at a wide range of factors, Scarlata said, noting the importance of asking about a patient’s relationship with food. Additional assessments include screening for malnutrition and food insecurity, self-identified food triggers, disordered eating and practicality. The main goal is to provide quality, evidence-based interventions based off particular diagnoses, taking into account potential overlapping conditions and IBS mimickers.

    “GI dietitians provide tailored nutrition interventions that incorporate the patient’s clinical data, nutritional intake, socioeconomics and lifestyle to ensure a feasible and nutritionally adequate plan to manage GI symptoms,” Scarlata previously wrote for Healio Gastroenterology. “A collaborative care process in treating patients with GI disorders allows the dietitian to fulfill gaps in the patient’s medical history that may or may not have been divulged or missed in the GI visit. Together, providers can piece together the patient’s full clinical picture to provide a better assessment and multifaceted approach to care.”

    Ask a Therapist: Behavioral Management

    According to the American Journal of Gastroenterology, advances in the understanding of the brain-gut-microbiome axis, as well as behavioral intervention science, have shown that psychotherapies effective for the treatment of depression, anxiety and chronic pain can be adapted to specifically manage IBS symptoms, including abdominal pain, altered bowel habits and quality of life. These advances, coupled with real-world data, supported the latest ACG guideline which recommended the use of brain-gut behavior therapies for the management of IBS.

    Laurie Keefer, PhD
    Laurie Keefer

    “This was a huge accomplishment [for the ACG] to recommend the use of behavioral therapies earlier on in the care pathway,” Laurie Keefer, PhD, director of psychobehavioral research in gastroenterology at Mount Sinai in New York City, said. “We call them brain-gut behavior therapies because they target the cause of IBS or one of the main causes of IBS: brain-gut dysregulation. We are talking about managing IBS from the gut to the brain, that is what these behavioral therapies are focused on.”

    In conjunction with pharmacology or dietary intervention, the benefits of behavioral therapy for the management of IBS outweigh the costs, Keefer continued. Adding a behavioral specialist to the medical care team allows for more succinct collaboration for the patient without referring them to community mental health providers without explanation.

    The evaluation and application of which behavior therapy to use relies first on the extent of brain-gut dysregulation; how deeply rooted unhelpful coping strategies are indicates how much effort is needed to alter behaviors. While digital therapeutics may be an efficient route to take for newly diagnosed, highly motivated or symptomatically mild patients, those with increased brain involvement with evidence of pain catastrophizing, fear of symptoms or avoidance behaviors may require more personalized cognitive behavior therapy (CBT) to challenge their beliefs, build back self-confidence and reframe ideas about their symptoms.

    “Patients have to understand that the brain-gut pathway is not just the gut, and it is not just the brain; there are things they can do in the brain that help with the gut and vice versa,” Keefer said. “They have to really buy into that before we even introduce the concept of changing their thoughts, behaviors or feelings.”

    Keefer’s main ingredient for therapeutic management is piecing together each individual patient’s story to understand the context of their symptoms in day-to-day life, acknowledging how the problems started, why they continue and how to make improvements. Rather than simply going through common CBT exercises blindly, a GI psychologist provides insight into how these factors come together and which approach will best aid in alleviating the underlying brain-gut issue.

    “It is the integration — it is the doctor and dietitian talking with the behaviorist that, in my opinion, drives the outcomes,” Keefer concluded. “The behavior change techniques themselves don’t drive the outcomes; it is looking at the patient in context together through the same lens as a care team. That is the point of integrated care.”

    The Integrative Care Model

    Although proven to be effective, psychological, behavioral and dietary therapies in an integrated approach have not routinely been provided to patients with IBS or functional GI disorders.

    The MANTRA study, an open-label, single-center, pragmatic trial, found that the integrative care model improved symptom severity, psychological state and quality of life among 188 patients with functional GI disorders compared with standard care alone (84{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} responders vs. 57{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} responders; P = .001). Specifically, among patients with IBS (n= 65{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}), integrated care correlated with a greater reduction in IBS symptom severity score (> 50 point reduction: 66{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} vs. 38{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}; P = .017) and a lower cost per successful outcome.

    “The biggest attractors for integrated care are two main things: one, it tremendously expands the number of treatment options and increases the likelihood that you are going to be able to find something that is effective for that individual patient,” Chey said. “The second thing, which we have not done a good job at until recently, is it meets the patient where they are. If patients want a diet solution or they want a behavioral solution, we should have evidence-based options to satisfy those requests.”

    Like other approaches to management, Chey’s first step in implementing integrative care is verification that a patient’s most troublesome symptoms line up with an IBS diagnosis. From understanding the individual phenotype, he identifies whether symptoms most closely relate with either food or stress and anxiety; the choice of one over the other guides the specific approach to care he employs sooner rather than later.

    “The notion of integrated care really embraces the fact that IBS treatment extends beyond just medications. For years, gastroenterologists have focused on identifying patients’ predominant symptoms and then choosing medical therapy based upon the clinical phenotype,” Chey said. “While that is still relevant and the medications are still very useful, we figured out over time that the medications don’t work for everybody, and a growing number of patients are looking for solutions that extend beyond medications.”

    The Future of IBS Management

    While the data shows that an integrated team of dietitians and psychologists working alongside gastroenterologists significantly improves outcomes in IBS, the vast majority of patients are still unable to access these services.

    Sameer K. Berry, MD, MBA
    Sameer K. Berry

    “Patients with IBS routinely undergo repeated endoscopy and imaging without access issues, yet most have no way to see a dietitian or psychologist,” Sameer K. Berry, MD, MBA, a fellow in gastroenterology at the University of Michigan, said. “We need to flip this paradigm.”

    Operationalizing different treatments for IBS and scaling integrated care relies on reducing access barriers. Much of this is already happening by supplementing face-to-face care with digital health. Digital health tools in IBS can include mobile apps that track diet and symptoms; FDA-approved digital therapeutics that provide app-guided behavioral interventions, such as CBT; at-home diagnostics for bloodwork, stool and breath testing; and virtual-care delivery platforms that connect patients to a multidisciplinary care team from the comfort of their home. These digital health tools are being designed to address access problems, including improved convenience and significantly reduced cost to patients.

    As these tools continue to evolve, the benefits extend beyond the individual patient and reduce total cost to the health care system. “Those of us studying the development and implementation of digital health tools in IBS have started to realize that the direct and indirect cost of IBS in the United States has likely been grossly underestimated,” Berry said. “A significant portion of care utilization by these patients may not be associated with an ICD code for IBS. For example, colonoscopies may be ordered as ‘screening’ to avoid patient copay, when in reality they are being ordered to work up symptoms of IBS.”

    The lack of access to evidenced-based interventions, such as dietitians and psychologists, also leads to overutilization of expensive medications and even unnecessary surgery in some patients. The suffering these patients endure also impacts the workplace.

    “IBS is the second leading cause of workplace absenteeism, after the common cold,” Berry noted. “And patients do not always feel comfortable discussing this disease with their employer.”

    Digital health interventions are quickly supplementing in-person care delivered by gastroenterologists and will need continued collaboration with physicians. “Twenty-five percent of the U.S. population struggles with a GI condition,” Berry added. “They are suffering and seeing a gastroenterologist once every three months is not the solution.

    “However one feels about digital health, whether skeptical or incredibly supportive, I would argue we all need to be on the same page about trying novel approaches, because the status quo is not working. As gastroenterologists, it is our responsibility to rigorously evaluate and study these new tools and work with these companies to help improve care for our patients.”

    • References:
    • Basnayake C, et al. Lancet Gastroenterol Hepatol. 2020;doi:10.1016/S2468-1253(20)30215-6.
    • Black C, et al. Gut. 2021;doi:10.1136/gutjnl-2021-325214.
    • Chey W, et al. Gastroenterology. 2021;doi:10.1053/j.gastro.2020.06.099.
    • Chey W, et al. JAMA. 2015;doi:10.1001/jama.2015.0954.
    • Chey W. The end of the geginning: Megatrends in gastroenterology. Presented at: ACG Annual Scientific Meeting; Oct. 22-27; Las Vegas (hybrid meeting).
    • Ford AC, et al. Am J Gastroenterol. 2018;doi:10.1038/s41395-018-0084-x.
    • International Foundation for Gastrointestinal Disorders. Facts about IBS. Available at: https://aboutibs.org/. Accessed: December 06, 2021.
    • Lacy BE, et al. Am J Gastroenterol. 2020;doi:10.14309/ajg.0000000000001036.
    • Van Den Houte K, et al. Abstract 512. Presented at: Digestive Disease Week; May 21-23, 2021 (virtual meeting).

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  • Wai Acupuncture and Integrative Medicine Expands in Central Florida and Hires Anna Small | News

    Wai Acupuncture and Integrative Medicine Expands in Central Florida and Hires Anna Small | News

    LONGWOOD, Fla., Jan. 10, 2022 /PRNewswire/ — The stresses of the Covid-19 pandemic have taken a toll on the Central Florida group, primary some citizens of the Longwood and Wekiva Springs area to look for a more holistic strategy to address their strain and wellbeing wants.

    As acceptance for acupuncture and alternative medication grows in the Central Florida area, Wai Acupuncture’s mission is to assistance the Longwood and encompassing communities this sort of as Altamonte Springs to achieve holistic wellbeing making use of acupuncture and Frequency Unique Microcurrent treatment.

    “People today should really consider natural and holistic methods to recover rather than ordinarily relying on plenty of prescribed medication for their illnesses.” said Dr. Nancy Chau, the lead physician at Wai Acupuncture. “Current investigation from 2019 infers that medicine and prescription errors are the 3rd main lead to of death, whereas holistic healing possesses no aspect effects.“

    The increasing demand for holistic therapeutic in Central Florida had introduced Wai Acupuncture and Integrative Medication to broaden their clinic workforce, not too long ago introducing Anna Modest to the Wai Acupuncture crew. Anna Small is a pupil intern at Wai Acupuncture subsequent her enthusiasm to help other folks heal holistically and attain a stability of wellbeing in their day by day life.

    Originally from Buffalo New York, Anna’s journey into holistic therapeutic began when she seasoned a pivotal minute of healing from acupuncture throughout her young many years. The holistic therapeutic encounter experienced turned into a passion for Anna when she attended Buffalo Seminary and finished her undergraduate training at the University of Pittsburgh.

    Anna can take terrific desire in studying herbology and enjoys discovering about Chinese and Eastern philosophies and cultures. The Wai Acupuncture staff is dedicated to aid purchasers holistically recover by way of Acupuncture and Oriental Medication and introducing Anna Tiny to the workforce designed the clinic’s mission to grow holistic healing even much better.

    For the forthcoming calendar year of 2022, Wai Acupuncture and Integrative medication is energized to announce approaching more products and services to enrich the wellbeing of the Central Florida community. Just one of the approaching products and services involves: Tai-Chi / Qigong applications for people who are intrigued in nourishing the mind through the martial-arts influenced fashion of training. Additionally, Wai Acupuncture is proud to announce that Cookie, our clinic canine, is scheduled to acquire a therapy doggy certification in February. Following her certification, Cookie will be capable to take part much more in therapy relevant courses to dietary supplement holistic healing.

    Media call:

    Alex Chau

    [email protected]

    407-335-4688

    Cision Watch authentic content material to down load multimedia:https://www.prnewswire.com/information-releases/wai-acupuncture-and-integrative-medicine-expands-in-central-florida-and-hires-anna-tiny-301456393.html

    Source Wai Acupuncture and Integrative Medication

  • The Expansion Toward Integrative Wellness Approaches in MS Care

    The Expansion Toward Integrative Wellness Approaches in MS Care

    For years, the conversations surrounding care for patients with multiple sclerosis (MS) mainly centered around drug development and the optimization of disease-modifying therapies (DMTs). There are now more than a dozen DMTs approved for MS, administered in various forms such as tablets, injections, or infusions. Although, as clinicians have learned, the management of these patients extends past treating solely the relapses.

    Integrative wellness is a practice based around the belief that treating patients involves much more than only disease and symptom management and has become an approach adopted by more clinicians in recent years. This all-purpose type of method encompasses aspects of diet and nutrition, exercise, sleep, and ongoing preventive care, among others.1,2 Although there are no set guidelines on how to conduct this care, there are several overlapping themes and ideas.

    The conceptual idea of integrative wellness often also carries a stigma, with many assuming these practices are not backed by scientific evidence. Contrary to this belief, ongoing research and the COVID-19 pandemic have confirmed the need for alternative approaches, particularly for patients with MS, who may benefit from interventions tailored to their individual needs.1-5

    Variety in Wellness Approaches

    Kathy Zackowski, PhD, OTR, senior director of patient management, care, and rehabilitation research, National Multiple Sclerosis Society (NMSS), has been at the forefront of researching and advocating for this new style of care. Her organization funds work that ranges from better understanding the use of acupuncture and yoga, to the resilience of psychosocial approaches, to the relationship of dieting and changes in the gut microbiome.

    “The whole idea with wellness is that this is something that everyone can do right now,” Zackowski told NeurologyLive®. “You don’t need a lot of equipment, but you need to understand the important elements of a wellness strategy for you. For someone in pain, we might recommend some of these psychosocial strategies looking at resilience and pain management, but for someone who’s weak, they may need just exercise. Exercise is its own intervention. It’s not simple to go out and say, ‘go exercise.’ We need to understand what elements of that intervention are important for that person.”

    The variety and usage of these integrative wellness approaches differs from clinic to clinic, which has added to its natural phenomenon. At Cleveland Clinic,6 physicians recommend maintaining a low-salt Mediterranean diet, getting at least 150 minutes of moderate movement per week, maintaining vitamin D levels between 40-70 ng/mL, not smoking or using tobacco products, and undergoing routine mental health screening.2,7,8

    Nutrition’s Role in Wellness

    Although there is a migration towards a better understanding of the need for collaboration and comprehensive care, some specialties are not consistently included in the model. Registered dietitians, for example, have historically been excluded from the multidisciplinary care team, with information on nutrition coming instead from integrative or alternative practitioners.

    Mona Bostick, RDN, LDN, a nutritionist living with MS with a dedicated passion for optimizing nutrition, commented on this exclusion, adding that while nutrition is often miscast as an “integrative” approach, diet and how patients eat is not an alternative treatment for MS, but it is rather a pivotal aspect of overall health. Bostick is the founder of her private practice, Food Matters 365, now called MSBites, a source for evidence-based nutrition and wellness advice to help patients with MS.

    “I believe the shift toward the integrative exists precisely because dietitians have not been included in the care team. With MS being such a disease [that] steals control over the things you thought you had control over, when alternative practitioners are promising to heal, beat, reverse, or give you that control back, the vulnerability that MS presents is going to make someone take a risk on that,” she told NeurologyLive®. “It’s important to know that nutrition and what you eat plays an important role in your overall health, but it doesn’t offset demyelination—nuance and context around what food can do is missing a lot of times in these integrative and alternative messages of this practitioners. I find that to be disconcerting because there is a vulnerability to the MS population, for sure.”

    Zackowski echoed similar thoughts to Bostick, adding that even the general public should be exposed to nutritional dietitians. “With MS, it’s complicated. We don’t have the cure yet, and one of the ways the [National MS] Society talks about this is the pathway to cures. The idea that there’s not just one cure, there are multiple cures, and people define cure in a different way. One way of defining cure is taking away symptoms. If diet can provide some improvements in the symptoms people [with MS] have that’s one form of an MS cure,” she explained.

    Sharing Best Practices for a Sense of Community

    Amidst the ongoing COVID-19 pandemic, the shift to telemedicine challenged clinicians to provide care remotely, whether that be for symptom management or for integrative approaches. Interestingly, some clinicians say the use of telemedicine had a positive effect in increasing collaboration and information sharing within the MS field, as the unknowns associated with COVID-19 generated a need for experts to share timely data relating to the virus and overall best practices with one another.

    Mitzi Joi Williams, MD, CEO, Joi Wellness Group Multiple Sclerosis Center, spoke on this increased sense of community within the MS field since the onset of the pandemic and over the course of 2021. Williams noted that her colleagues were not afraid to share findings and information from registries, whereas in the past, the scientific community had cultivated a sense of protectiveness in terms of clinical data that had yet to be published.

    “The information sharing that has emerged from the COVID-19 pandemic has really been amazing, and to see the collaboration from people from different academic centers, from the academic centers in the community, to across the pond, across the world, across the globe, has really been astounding,” Williams told NeurologyLive®.

    Social media has been crucial in establishing this sharing of information and collaborative attitude, allowing experts in the MS field to share information quickly and freely via online platforms like Twitter, Williams said. Monthly webinars and conferences also aided in the dissemination of updated data, with experts then able to implement practices in real time.

    “I hope this collaborative approach amongst MS specialists, general neurologists, and my colleagues around the globe stays,” Williams said. “There has been this amazing unity amongst everyone to try to find the scientific answers we need to be able to adequately care for our patients. We’ve seen a lot of synergy with people creating registries fairly quickly—a lot of things that we thought couldn’t get done are absolutely getting done, [and] a lot of things we thought couldn’t be done remotely are absolutely being done remotely.”

    Zackowski spoke on ongoing work of the NMSS to improve this collaboration and sharing of information as it pertains to wellness, which includes the development of the Wellness Research Group and 3 different subgroups: physical wellness, nutritional wellness, and psychosocial wellness.9-11 Information published online is tailored specifically to patients or clinicians, making it easier to access veritable, valuable sources, Zackowski said, noting that patients “do not need to be scientists” in order to understand findings from ongoing studies. This is not, however, a foolproof method for getting the word out about wellness, particularly due to the need for practices and information to be adjusted for individual patients.

    “The idea of integrating just those 3 areas is challenging—and that’s not really addressing everything—there’s so many symptoms that people have with MS that I think can be addressed by different wellness approaches,” Zackowski said. “I think it’s really hard to get the message out to people about what to do because there’s no regulatory body on how to make sure the standards are the same everywhere, and that’s something we as a society are trying to grapple with a little bit more.”

    Need for Increased Research

    Although there is good reason to be excited about these integrative approaches, clinicians themselves also agree that there is a need for extended research that aims at understanding and optimizing these methods. As of now, clinicians use their better judgement, paired with what’s been observed in the literature and through the help of their multidisciplinary teams. There is no current law-abiding guideline that the community has developed or strictly follows.

    “When you talk about exercise, diet, or even cognitive rehabilitation, no one knows exactly the right dose, Zackowski stressed. “How much do you need as a person with MS to address your particular issue? We do this automatically with medications because the FDA dictates that you have to put a particular dose and explain what that dose is. In the wellness area, we need to address those things, we need to understand the dose, the intensity, the setting that this is done in, and how that approach will be effective in people who have more than one symptom.”

    Despite advances in research in recent years, the space is stilling being held back. Without backing from pharmaceutical companies or industry leaders, it has been difficult to conduct large scale trials that further help validate these methods. These groups have yet to formally recognize integrative wellness as something that has significant therapeutic benefit, especially since the data thus far has been hard to quantify.

    That, ultimately, leaves supporters of integrative wellness practices like Bostick and Zackowski to fend for themselves in terms of powering research, or forces them to turn to organizations such as the NMSS in hopes of acquiring funding and materials.

    “I’m thinking of getting pharmaceutical companies interested in this combined approach that uses a medication and a wellness strategy,” Zackowski said. “This might be another way to encourage greater funding for this, but it will take time and money to get this understood better. We are right on the forefront though—we’re at a place where this can be studied now, and I’m encouraged by that.”

    A Look Ahead

    In addition to the need for increased research, there remain complexities in the integration of dietitians into standard of care, according to Bostick. “Out in the community, there are dietitians everywhere. At this point, the obstacle is that continuing education hours are expensive and difficult to obtain. There’s not been a reason for a dietician to justify becoming educated and informed on this topic, because they’ve not yet been welcomed into the comprehensive care team,” she said.

    Bostick added that once the talents of these specialists are more appreciated, they may go back to their communities and advocate for these roles as well as provide information for newcomers to feel more comfortable. While a dietitian may have a broad knowledge of nutrition, they may not be as equipped at that moment to treat the MS-specific component. “Broadly speaking, multiple sclerosis is not discussed in our education and training. That’s the obstacle,” she said.

    Much like how the efficacy of drugs continues to be optimized in post hoc analyses, it will only be a matter of time before similar studies to further validate these wellness approaches. Overall, the commitment to these nontraditional, forward-thinking ideas represents the general trend within the medical system in recent years to treat the patient from a complete holistic perspective that addresses all downstream aspects of the disease, and not just the root cause.

    This contribution to HCPLive’s 2021 This Year in Medicine series comes from sister publication NeurologyLive®.

    REFERENCES
    1. Latimer-Cheung AE, Pilutti LA, Hicks AL, et al. Effects of exercise training on fitness, mobility, fatigue, and health-related quality of life among adults with multiple sclerosis: a systematic review to inform guideline development. Arch Phys Med Rehabil. 2013;94:1800-1828. doi:10.1016/j.apmr.2013.04.020
    2. Fitzgerald KC, Tyry T, Salter A, et al. Diet quality is associated with disability and symptom severity in multiple sclerosis. Neurology. 2018;90:e1-e11.doi:10.1212/WNL.0000000000004768.
    3. Farinotti M, Vacchi L, Simi S, Di Pietrantonj C, Brait L, Fillipini G. Dietary interventions and multiple sclerosis. Cochrane Database Syst Rev. 2012;12:CD004192. doi:10.1002/14651858.CD004192.pub3
    4. Skovgaard L, Bjerre L, Haahr N, et al. An investigation of multidisciplinary complex health care interventions–steps towards an integrative treatment model in the rehabilitation of people with multiple sclerosis. BMC Complement Altern Med. 2012;12:50. doi:10.1186/1472-6882-12-50
    5. Alphonsus KB, Su Y, D’Arcy C. The effect of exercise, yoga and physiotherapy on the quality of life of people with multiple sclerosis: Systematic review and meta-analysis. Complement Ther Med. 2019;43:188-195. doi:10.1016/j.ctim.2019.02.010
    6. Rensel MR. Wellness Practices That Can Improve Multiple Sclerosis Outcomes. August 14, 2017. Accessed December 10, 2021. https://consultqd.clevelandclinic.org/wellness-practices-that-can-improve-multiple-sclerosis-outcomes/
    7. Petajan JH, Gappmaier E, White AT, Spencer MJ, Mino L, Hicks RW. Impact of aerobic training on fitness and quality of life in multiple sclerosis. Ann Neurol. 1996;39(4):432-41. doi:10.1002/ana.410390405
    8. Mokry LE, Ross S, Ahmad OS, et al. Vitamin D and Risk of Multiple Sclerosis: A Mendelian Randomization Study. PLoS Med. 2015;12(8):e1001866. doi:10.1371/journal.pmed.1001866
    9.Wellness and Lifestyle Research. NMSS website. Updated 2021. Accessed December 10, 2021. https://www.nationalmssociety.org/Research/Research-News-Progress/Wellness-and-Lifestyle
    10. Society-Supported Wellness Research Group Publishes Strategies for Improving Diet Studies in People with MS. NMSS Website. April 27, 2020. Accessed December 10, 2021. https://www.nationalmssociety.org/About-the-Society/News/Society-Supported-Wellness-Research-Group-Publishe
    11. Fitzgerald KC, Sand IK, Senders A, et al. Conducting dietary intervention trials in people with multiple sclerosis: Lessons learned and a path forward. Mult Scler Relat Disord. 2020;37:101478. doi:10.1016/j.msard.2019.101478

  • IncellDx’s Chronic COVID Treatment Center Partners with ARISE MD Integrative Medicine & Surgery to Evaluate Novel Therapeutic Approach to Chronic COVID

    IncellDx’s Chronic COVID Treatment Center Partners with ARISE MD Integrative Medicine & Surgery to Evaluate Novel Therapeutic Approach to Chronic COVID

    SAN CARLOS, Calif.–(BUSINESS WIRE)–IncellDx’s Chronic COVID Treatment Center (CCTC) (www.covidlonghaulers.com) and ARISE™ MD Integrative Medicine & Surgery announced today a new partnership to evaluate CCR5 antagonists and statins as a potential therapeutic treatment approach for chronic COVID, also known as long COVID or post-acute sequelae of COVID-19 (PASC).

    In a randomized, placebo controlled trial led by co-Investigator Adam Miller, MD, CEO, Medical Director, ARISE, a combination of maraviroc, a CCR5 antagonist, and a commonly administered statin, atorvastatin, will be evaluated for its efficacy in alleviating PASC symptoms.

    In the trial, under an Enriched Enrollment Randomized Withdrawal (EERW) design, patients who experience symptomatic improvement with maraviroc and atorvastatin in an open label phase will enter a second phase and be randomized to continue active treatment or placebo.

    The study aims to support clinical approaches developed by IncellDx’s Chronic COVID Treatment Center, which has enrolled more than 12,000 patients and published multiple articles on the application of precision medicine and biomarkers to determine the underlying pathways involved in PASC.

    “At CCTC, we provide consultation to physicians across the country who are treating patients with chronic COVID,” said internist and physician Eric Osgood MD, physician, CCTC. “We are excited to partner with Dr. Miller to further evaluate the clinical observation that a biomarker-driven, precision medicine approach can result in improvement of long COVID symptoms as well as resolution of abnormal cytokine profiles that may be the underlying cause of this condition. In continuing to advance new research into diagnostic criteria and clinical approaches to treatment, we aim to provide lasting symptom alleviation in patients with PASC.”

    “Based on outcomes we observe in long COVID patients being treated under the CCTC program protocol, we believe this condition can be objectively assessed and that addressing immune disruption from PASC may be central to its treatment,” said Dr. Miller. “Through this study, we aim to assess whether reducing the activity of CCR5 in the body with the use of CCR5 antagonists can play an important role in treatment of long COVID. We’ll also be evaluating the potential for the IncellDx Long Hauler Index, or LHI, to provide important diagnostic information about this condition that can inform treatment. We’re very excited about the potential of this study to validate clinical application of IncellDx’s LHI and a novel combination therapeutic approach leveraging already commonly used medicines.”

    About IncellDx

    IncellDx is a precision medicine company advancing novel diagnostics and prognostics to better understand and treat infectious disease and cancer. The company’s innovative technology platform enables simultaneous cell classification and single cell analysis of proteomic and genomic biomarkers. The company launched the Chronic COVID Treatment Center to apply precision medicine approaches to evaluate, characterize and more effectively address chronic COVID.

    About the Long Hauler Index

    The Long Hauler Index or LHI was developed and patented by IncellDx to provide an objective method of identifying patients suffering from long COVID or PASC. The LHI assesses cytokines and chemokines believed to cytokine storm conditions and chronic COVID patients (often referred to as COVID “long haulers”).

  • Experimental, integrative medicine and alternative medicine therapies

    Experimental, integrative medicine and alternative medicine therapies

    In India, out of two women of all ages with breast most cancers just one will die in just 5 a long time. Many of these lives can be saved by early detection of most cancers. If cancer is detected at phase 1 when it is regional within the breast, the 5-year survival charge is 99{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}. If it is detected at stage 3 or 4 when it has unfold to other overall body elements and organs, the 5-12 months survival amount falls to 22{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}. In India, most situations are detected at phase 3 or 4.

    Cancer is endogenous, section of the approach that produces and ends existence. Hence, it can be neither prevented nor treated. But early detection can maximize lifestyle expectancy and boost the put up-most cancers quality of existence. For most cancers, the saying is not “prevention is the get rid of,” but “early detection is the treatment.”

    By 2030 India will have 200,000 situations of breast cancer and 100,000 deaths. Twenty-five several years ago, about 30{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} people had been down below age fifty. Now, about 50{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} are. And 5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of instances are in gals under 40.

    Experimental and Integrative medication therapies give much better cure and strengthen the put up-cancer quality of daily life. Alternate therapies are a misnomer. Simply because health-related remedy has no possibilities. Nutritional and organic nutritional supplements can be harmful. Let us seem at all of these.

    Experimental Cancer Therapies

    A. Gene Remedy: In gene remedy, a nucleic acid-primarily based drug is sent to both appropriate or ruin the genetic aberration (most cancers) cells. Its benefits are:

    *It targets tumour cells and does not affect typical cells.
    *It corrects molecular defects and thus retards the cancer progression.
    *It has little toxicity as opposed to other therapies.
    *It is effective to a significantly stubborn variety of breast most cancers cells and leads to them to self-destruct.
    *It lowers chance of recurrence of the cancer.
    *It helps improve the usefulness of some kinds of chemotherapy.
    *It is also applied to provide RNA interference systems, or most cancers DNA vaccines.

    It is probable to turn out to be a well-liked treatment for breast and other cancers but at present does not have authorised merchandise for breast cancer.

    B. Concentrated Ultrasound Therapy: High-intensity centered ultrasound (HIFU) is a novel technological innovation which is currently being investigated. HIFU focuses a tension wave with a higher frequency on a tiny goal volume. It will cause an raise in community temperature which induces coagulative necrosis (demise) and protein denaturation (disruption of structure) of the goal most cancers mobile inside of a couple of seconds. It is utilised to deal with each benign and malignant tumours. Its advantages are:

    *It is an early-stage non-invasive therapeutic technology and hence has a lot less threat for infection and blood clots and has prospective for shorter restoration time.
    *It can be specific specifically and therefore minimizes problems to non-qualified healthful tissue.
    *It has no ionizing radiation and so can be applied regularly.
    *It can be employed by itself, or as a enhance to drug remedy enabling enhanced delivery of chemotherapy or immunotherapy to tumours.
    *It could induce an anti-tumour immune response.
    *It can boost the excellent of existence and lower the charge of care for individuals.

    Integrative Medicine

    Integrative medication is a mixture of professional medical treatment and complementary therapies. The latter do not treat most cancers but can help cope with indicators and symptoms – these types of as stress, fatigue, nausea and vomiting, discomfort, trouble sleeping, and pressure – brought about by cancer and cancer therapies.

    A. Complementary Therapies

    Varieties of complementary therapies that can increase nicely-getting consist of Hypnosis, Massage, Meditation, Relaxation strategies, Work out, Yoga, Acupuncture, Aromatherapy, Hypnosis, Audio remedy, Tai chi, Chiropractic treatment, Reflexology, Reiki, Therapeutic contact, Biofeedback, Imagery (Imagining scenes, shots, or ordeals), Creative shops (artwork, songs, or dance).

    It also includes Natural vitamins and dietary nutritional supplements, Botanicals, which are vegetation or sections of crops (e.g., hashish), herbs and spices this kind of as turmeric or cinnamon, and exclusive foodstuff or diet programs.

    Most of the complementary therapies are secure and effective.

    B. Helpful Dietary supplements

    Clinical trials show that some herbs and dietary health supplements enable to handle certain aspect outcomes of cancer remedy. For case in point, American ginseng and Astragalus root utilized in classic Chinese medication could support reduce some side consequences of chemotherapy, these types of as fatigue. Nutritional supplements like glutamine, vitamin B6, vitamin E, and omega-3 may well aid treat peripheral neuropathy. Nevertheless, these supplements are not appropriate for everybody, and additional exploration is needed to validate their safety and success.

    C. Different therapies

    Alternate therapies are at times instructed as an different to health care treatment method. These therapies assert that most cancers can be dealt with by taking specified herbs or dietary supplements, or foods, and preventing sure food stuff. But these therapies are disproved or unproved. They do not take care of most cancers and are generally destructive. Mainly because they do not cease the expansion of cancer. It may well as a result worsen and consequently reduce the therapy options because of the severity of the most cancers.

    The claim that these therapies are normal and therefore harmless is fake. All-natural is not essentially safe. Toxic mushrooms are all-natural but not safe. Organic nutritional supplements may well be destructive when taken by themselves, with other substances, or in significant doses. For instance, kava kava, an herb employed to assistance with pressure and nervousness, could bring about liver injury. And St. John, applied for melancholy, might bring about specific cancer medication to not perform as effectively as they really should.

    D. Nutritional Nutritional supplements

    Individuals consider dietary or natural products to increase health, to get extra nutrition, to boost the immune process, or to handle aspect consequences. Dietary goods are vitamin and mineral items. Herbal, botanical, and other “natural” merchandise may well comprise plants or components of vegetation, algae, or fungi, or extracts from animals, this sort of as toad or snake venom.

    Not all health supplements are harmless or effective, especially all through cancer treatment method. For example, health supplements like garlic, ginkgo biloba, ginseng, and Vitamin E can maximize chance for bleeding. This could be dangerous for patients going through or recovering from surgical treatment. Health supplements can also interfere with prescription and about-the-counter remedies. They may possibly also be unsafe in particular health challenges, including higher blood tension, diabetic issues, psychological wellness conditions, heart ailment, or blood clotting difficulties.

    E. Facet results of nutritional supplements

    *Dietary supplements can result in severe facet results together with:
    *Substantial blood force
    *Nausea
    *Diarrhea
    *Constipation
    *Fainting
    *Problems
    *Seizures
    *Coronary heart attack
    *Stroke

    Summary

    *Nutritional or organic products do not treat cancer.
    *Herbs may well interact with chemotherapy and other drug therapies.
    *Antioxidant health supplements could make most cancers treatments fewer helpful.

    Complementary and Choice cancer therapies do not address most cancers. But they may well reduce signals and signs – these types of as stress, fatigue, nausea and vomiting, soreness, problems sleeping, and pressure – brought on by most cancers and most cancers therapies. Hypnosis, massage, meditation, rest techniques, yoga, acupuncture, aromatherapy, music therapy, and Tai chi – by itself or in combination may perhaps be useful.

    But lots of alternative cancer remedies are disproved or unproved, and some might even be hazardous.

    Most cancers Treatment in other Units of Medication

    Ayurveda, Siddha, Unani, Yoga, Naturopathy, Homoeopathy, Chinese Medication also have cancer therapy. But these are not verified. Though some of these could support cope with the side effects of most cancers and cancer treatment method.

    Conclusion

    “The only individual who can preserve you is you” – Sheryl Crow

    Most cancers is a 3200-calendar year-outdated disease. It is endogenous, a portion of life-procedure. So, it can neither be eradicated, nor prevented, nor fixed. Nonetheless.

    Late detection of most cancers is lethal. The leads to for late detection are numerous but absence of consciousness is the principal induce. Other main causes are client becoming shy, social stigma and doctors’ ignorance for the reason that of which the cure is delayed. An awareness method will address all these issues.

    If you liked your lifestyle in advance of cancer, do not be frightened of life soon after most cancers. You will discover elegance yet again. “I have beloved the stars much too fondly to be fearful of the night time.” — Galileo.

    Will some radical discovery in the long term make cancer prevention and heal doable? We do not know. But we can always hope.

    Since as Richard Causer, Director, NCI, United states of america, says about the foreseeable future of cancer heal, “There are significantly far more great historians than there are prophets.”



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    Disclaimer

    Views expressed previously mentioned are the author’s have.



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  • Deepak Chopra Joins UCF College of Medicine To Teach Integrative Medicine

    Deepak Chopra Joins UCF College of Medicine To Teach Integrative Medicine

    Integrative medication advocate Deepak Chopra has joined the UCF University of Medicine as a volunteer faculty member to present electives and other applications on the head/physique link for wellbeing and perfectly-remaining.

    Chopra has been a frequent customer to Lake Nona, having portion in the once-a-year Lake Nona Impression Discussion board, which draws globally industry experts on wellbeing innovation, wellness and engineering. Much more lately Chopra has built Lake Nona a additional long lasting household and will be paying time performing with the health care faculty, his Chopra Foundation and the new Lake Nona Effectiveness Club, a medically supervised physical fitness facility.

    “One of the things that drew me to the professional medical metropolis is the range of talent, and variety of schooling and diversity, education in quite disparate fields of information and facts technologies, and also the biological sciences,” Chopra says.

    His aim is how medicine and technologies can come jointly to provide better wellness monitoring, sickness avoidance and mental and actual physical wellbeing. His exploration with the Chopra Basis is hunting at engineering and synthetic intelligence to help psychological health, notably employing chatbots to decrease suicide by creating counseling a lot more available.

    “Every function that takes place in the intellect is registered in the system and vice versa,” he suggests. “And so we can look at a more holistic, integrative way of knowing what we contact the therapeutic approach. I consider as we fully grasp a lot more about that, the upcoming of nicely-currently being results in being very specific, really personalized, preventable, predictable, participatory and approach oriented.”

    Chopra initially researched medicine in India in advance of coming to the U.S. and has taught at Tufts, Harvard and Boston College. Skilled as an endocrinologist, Chopra at the moment also serves as adjunct professor of urology at Mount Sinai, clinical professor of family medicine and general public health and fitness at the College of California, San Diego, and as a senior scientist with the Gallup Group. He has also collaborated with scientists at Duke College and Scripps Health and fitness.

    Sharon Wasserstrom, a way of living medicine specialist at UCF Overall health and medical director at the Lake Nona Performance Club, is doing work with Chopra on creating courses on making more healthy life-style possibilities.  Medical pupils have the option to conduct exploration with club users on how the overall performance programs can help greater deal with continual diseases this kind of as diabetes.

    “We can enable equally our upcoming wellness professionals, our local community, and with any luck , create a hub for each integrative medication and way of living drugs, to improve and learn methods to carry out this, that can be achievable for every person,” suggests Wasserstrom.

    Jeffrey LaRochelle, affiliate dean for Tutorial Affairs, suggests Chopra’s classes will support students superior connect with patients to help inspire them to make healthy selections and will complement the conventional curriculum. “It delivers is one more pathway for persons to fully grasp why it is important to alter their life and the influence it can have to control of their possess health,” he says.

    Chopra claims the Faculty of Medicine partnership offers an opportunity to create plans that will impression many learners.

    “We’re looking ahead to generating some applications here for healthcare students, citizens, certification affiliation with other integrative platforms throughout the country, a telemedicine built-in system,” he claims.