1. Integrating Natural Medicine into Asthma and Allergy Management Beth Kohn-Converse L.Ac. M.T.O.M, Dipl.Ac., Dipl.CH. Henry Ford Center for Integrative Medicine 40000 W 8 Mile Rd Northville,MI 48167 248-380-6201 bkohn1@hfhs.org

2. Complementary, Alternative, Integrative: Complementary Medicine: Systems used as an adjunct to allopathic medicine Alternative Medicine: Systems of care used in place of allopathic medical care Integrative Medicine Blending “conventional” care using allopathic care (Western Medicine) and “alternative” methods (ie: eastern medicine, etc). Or blending many modalities of care. Blending “conventional” care using allopathic care (Western Medicine) and “alternative” methods (ie: eastern medicine, etc). Or blending many modalities of care. Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

3. What is Wholistic/Holistic Care?  Treating the whole person: mind, body and spirit together  Undertanding that we need to address all aspects of a person in treating illness This creates an overall better quality of life! Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

4. EFFECTS OF STRESS ON THE BODY: EFFECTS OF STRESS ON THE BODY: Pain (Headaches, back, neck, etc) Insomnia More frequent asthma issues Digestive Problems Emotional issues: Depression, Anxiety Hypertension Changes in reproductive health Depresses immune system (herpes) Weight Gain Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

5. Managing Asthma and Allergies with natural therapies Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

6. TRADITIONAL CHINESE MEDICINE BIOFEEDBACK CHIROPRACTIC CARE HOMEOPATHY NUTRITION THERAPY SUPPLEMENT THERAPY EXERCISE/BREATHING THERAPIES Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

7. What is Traditional Chinese Medicine? Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH Acupuncture Therapy Chinese Herbal Medicines Tai Chi and Qi Gong Massage and Bodywork Dietary and Lifestyle Modifications

8. THE EVOLUTION OF TRADITIONAL CHINESE MEDICINE  Acupuncture and Chinese Herbal Medicine- >5000 year history  NIH Acupuncture Consensus Conference: postoperative pain & chemotherapy nausea and vomiting postoperative pain & chemotherapy nausea and vomiting postoperative dental pain postoperative dental pain  TCM benefits are documented in peer-review western medical literature  NIH sponsored trials: IBS, osteoarthritis, cardiovascular disease, endometriosis, cancer, and many others Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

9. How Popular Is Acupuncture?  An Estimated 8.2 million U.S. adults have used acupuncture  Used by every class of population and from a multitude of cultures About.com: Holistic Healing (2008). What is Acupuncture?, About, Inc. A part of The New York Times Company Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

10. ENERGY BASED THEORY OF ACUPUNCTURE Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH  Body’s vital life force: Energy/ “Qi”  Energy travels along pathways: meridians: anatomical location of acupuncture points  Energetic and substance imbalance creates symptoms  Acupuncture point stimulation along meridians balances energetics, herbal therapies: substance  Balancing energy helps enhance body’s ability to help in its own recovery/healing

11. ROOT AND BRANCH THEORY OF TREATMENT  Root- identify/understand what caused the symptom  Branch – the symptom itself  Treatment handles resolution of symptom and helps to balance root causes (energetic/substance)  Goal is to rebalance substance and energetics of the whole body Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

12. CONCEPTS OF YIN AND YANG  Complimentary opposites/balance in nature and in body  Yin: Relates to moistening, cooling, nourishing substances in body: blood, mucous, synovial fluids  Yang: Relates to functions, and warming and moving properties (body temperature, peristalsis, digestion) Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

13. HOW DOES ACUPUNCTURE WORK?  A. Increased circulation of blood systemically  B. Neurotransmitter release (endorphins and enkephalins)  This creates the “Acupuncture analgesic” response and “relaxation response”  Energetically: body “qi” movement/flow is restored= balanced body (better health) Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

14. Diagnosis in TCM  Practitioner does detailed intake  Pulse and tongue evaluations are done to determine TCM diagnosis  Acupuncture treatment and herbal therapies are then recommended  Dietary/lifestyle adjustments may also be recommended Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

15. ASTHMA AND ALLERGIES IN TCM  Patterns of asthma relate to Kidney, Lung and Spleen meridian energy deficiencies  These lead to difficulties with inhalation, exhalation and phlegm  Allergies relate to deficient Qi/energy, thus creating vulnerability to environmental factors (pollen, dust, etc)  The relaxation response and immune support benefits from acupuncture also aide in successful treatment Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

16. CUPPING THERAPY  Cupping therapy is an adjunct modality used in TCM  Originally used to help reduce phlegm in the lungs related to colds/asthma  Also can be used as a myofascial release technique Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

17. LOOKING AT THE TONGUE  SIZE AND SHAPE  COLOR OF TONGUE BODY  COATING  TOPOGRAPHY ALL GIVE INFORMATION ABOUT THE HEALTH OF THE ORGAN SYSTEMS- CONSIDER MEDS, TREATMENTS,SCRAPING TONGUE Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

18. Migraine & Digestive Disorder Patient Pre Tx 3 mo Post Tx Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

19. Emotions and Energetics  Use acupuncture therapy to help balance energetics to affect emotions  Each meridian system relates to specific emotions  Acupuncture is a simple therapy which yields powerful results  Effective for helping with depression and anxiety Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

20. Meridians and Emotions  Liver Meridian – Anger/Frustration  Heart Meridian – Joy/sadness, Anxiety  Spleen Meridian – Worry, Obsessive thoughts  Lung Meridian – Grief  Kidney Meridian – Fear Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

21. Chinese Herbal Therapies  Can be used safely in conjunction with prescription medications  Are often a good option for people who are unable to tolerate meds  Help to harmonize and balance the system to prevent allergic reactions and asthma attacks  Typically combinations of herbs, not single herb therapy Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

22. Considerations for Herbal Therapy  Patient’s current medications  Understanding of health history including information about type of cancer ie: estrogen receptive cancers, use of estrogenic like herbals ie: estrogen receptive cancers, use of estrogenic like herbals  Consider patient’s compliance- best preparation  Consider upcoming procedures (surgeries)

23. Comparing Meds to Herbs  Both work based on their biochemical properties  Natural doesn’t always mean safe for everyone  Important to monitor patient’s progress if using them long term and with other medications  Important to use therapeutic dose with herbs and NOT take extra Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

24. BIOFEEDBACK  “ A learned method to monitor and gain control over autonomic reflex-regulated body functions using data obtained from a monitoring apparatus”  “In one study, biofeedback appeared to lessen bronchoconstriction by inducing relaxation of the facial muscles, …..associated with a decrease in air flow resistance as evidenced by an increase in Peak Expiratory Flow Rate (PEFR) in both asthmatic and healthy children” * Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

25. Types of Biofeedback There are many types-these have been associated with successful results in treating asthma  RSA-BF- Respiratory Sinus Arrhythmia  EMG-BF – Neck/Trapezius- Electromyographic Biofeedback and Incentive Spirometry Biofeedback * Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

26. RESPIRATORY SINUS ARRHYTHMIA  Monitoring patterns of heart rate variation related to the respiratory cycle. Electrodes translate heart rate into auditory and visual form. Patients learn to control heart rate- thus improving asthmatic symptoms * Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

27. Neck/Trapezius Electromyographic and Incentive Spirometry  Patients learn abdominal breathing to help relax thoracic muscles assisted by EMG-BF training of the scalene and trapezius muscles. Incentive spirometer training of thoracic muscles during slow, even breathing. * Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

28. Other Types of Biofeedback  Electromyogram: Uses electrodes to measure muscle tension and can promote relaxation in tense muscles  Temperature biofeedback: Monitors skin temperature and patients learn to redirect blood flow to other muscles and organs  Galvanic skin response: Measures electrical conductance in skin related to emotional arousal and sweat gland activity * Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

29. CHIROPRACTIC CARE  Uses spinal manipulation to restore normal function to the spine and nervous system  Chiropractic theory suggests that spinal misalignments cause many health problems because vertebrae pinch important nerves and restrict their effectiveness  This could effect the vasoconstriction patterns related to the lungs Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

30. HOMEOPATHY

31. Roots of Homeopathy  Samuel Hahnemann, MD. was the founder- called the “Father of Experimental Pharmacology”.  Discovered the concept of the Law of Cure- known as “Similia Similibus Curentur” or “Like Cures Like”.  This means that a remedy that produces symptoms in a healthy person will cure the same symptoms in a person who is diseased. ** Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

32. Primary & Secondary Actions of a Remedy  The primary action results from the first encounter between the external agent and the vital force  The second action is the result of the vital force’s reaction to the symptoms of that primary encounter.  Led to understanding the curative powers of poisonous substances.** Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

33. Treating Allergies with Homeopathy  The focus isn’t on using the opposite approach (ie: allergies are related to histamine so take an ANTI-histamine)  Focus is use of remedies that create similar symptoms: (ie: Allium cepa: red onion) to produce the same symptoms that would be related to common cold/allergies.** Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

34. NUTRITION THERAPIES  Diet therapies or nutritional advice is most common “alternative” therapy  Thought to be mediated through both IgE (conventional) and IgG (alternative)  Epidemiologic data demonstrates association between dietary deficiencies (Omega 3, vitamin C, magnesium, selenium, Vitamin E) and asthma  Populations with higher intake of polyunsaturated fatty acids (omega 6 fatty acids) have a higher prevalence of asthma, eczema and allergic rhinitis  Thought that eliminating certain “allergenic” type foods and decreasing exposure to things such as dairy products (believed to associated with increased mucus production) will help with chronic asthma symptoms and their severity. ***  Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

35. Studies say:  Few studies to support dietary claims-mixed results  One positive long term study of vegan diet (Lindahl 1985)  1 year prospective study, 25 subjects  Diet excluded meat, fish, eggs, dairy, coffee, tea, chocolate, sugar and salt  Decreased cost and use of medications  92% improvement in biochemical and clinical markers *** Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

36. Elimination Diet  Elimination diet- pick a food that the patient appears to be sensitive to, such as nuts or eggs, and then eliminate it from the diet for 2 weeks  At the end of the 2 weeks, gently reintroduce the food into the diet  If there is significant change, such as bloating or headaches, the patient may indeed be sensitive to that particular food *** Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

37. More Nutrition Information  Eliminate allergens (dairy, preservatives (MSG), sulfites, additives  Increase fresh fruits and vegetables  Increase fish in the diet (to increase omega 3 fatty acids)  Use healthier oils (ie: olive) *** Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

38. Allergy Testing/Food Sensitivity Testing  Classic back scratch test: Can identify allergens, not always accurate  Food sensitivity testing: “Measures body’s cellular response to various foods, additives, colorings and chemicals. The individual’s cellular reactivity after exposure of the blood to the various test agents, versus the person’s own baseline control, tells the healthcare provider which substances may be causing a sensitivity- related response in the body.” **** Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

39. SUPPLEMENT THERAPY  Strong epidemiologic evidence demonstrates association between poor dietary intake and asthma Omega 3 fatty acids Anti-oxidants and cofactors (Vitamin A, C,E, Zinc, selenium and copper) Vitamins and Minerals (Magnesium, B6 and B12) Specific supplementation of nutrients has yielded mixed results at best Nonetheless, very common integrative medicine strategy *** Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

40. Exercise and Breathing Techniques  Numerous studies have shown improvement in asthma is patients who exercise regularly  Yoga: Helps to decrease medication use and lowers anxiety (Vedanthan 1996).  Reduces airway hyper responsiveness and improved some aspects of quality of life (Menocha 2002)  Qi gong- deep diaphragmatic breathing in TCM can help to relax musculature-creating more systemic relaxation *** Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

41. Center for Integrative Medicine, Novi Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

42. Center for Integrative Medicine 40000 W 8 Mile, Novi Services Offered: Acupuncture and Oriental Medicine Chiropractic Care Massage St John Neuromuscular Therapy Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH

43. References  *The Role of Biofeedback in Asthma, Georges Ramalanjaona, MD., DSc, MBA, FACEP Alternative Medicine Alert, July 2003  ** Dr. Luc. Com website  ***Integrative Medicine: Management of Asthma lecture, Andrew Heyman, MD, MHSA. Adjunct Assistant Professor, Department of Family Medicine, University of Michigan  ****ALCAT Worldwide Testing brochure-Cell Science Systems, 852 South Military Trail, Deerfield Beach, FL 33442 (Fell P. Brostoff, J, et.cal (1988), ALCAT, “A New Test for Food Induced Problems in Medicine?”. Presented at the Annual Meeting of the American Academy of Otolaryngic Allergy on Oct 1, 1988. Created by B.Kohn-Converse, L.Ac., M.T.O.M.Dipl.Ac.,Dipl.CH