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Complementary Medicine, In the News, Mental Health, Pediatrics, Stanford News, Videos

Stanford researchers use yoga to help underserved youth manage stress and gain focus

Stanford researchers use yoga to help underserved youth manage stress and gain focus

A segment on PBS NewsHour yesterday explored how Stanford researchers have brought yoga and mindfulness practices to students who experience post-traumatic stress disorder owing to difficult life circumstances. At Cesar Chavez Academy in East Palo Alto, Calif. – a low-income, high-crime area – a group of seventh-graders worked with Stanford’s Victor Carrion, MD, professor of psychiatry and behavioral sciences, and his team during a 10-week program introducing breathing and movement practices to help students manage their emotions and improve their concentration in school.

The researchers used imaging techniques to understand how children respond to daily stress. “With functional imaging, we actually can see what the brain is doing,” Carrion told PBS. “There is a deficit in the area of the middle frontal cortex in kids that have PTSD,” which, he noted, may discourage learning.

In the piece, seventh-grader Brayan Solorio describes how rolling out his yoga mat at home helps him keep his cool.

Previously: Med students awarded Schweitzer Fellowships lead health-care programs for underserved youthThe remarkable impact of yoga breathing for trauma, The promise of yoga-based treatments to help veterans with PTSD and Stanford and other medical schools to increase training and research for PTSD, combat injuries

Complementary Medicine, Mental Health

The remarkable impact of yoga breathing for trauma

The remarkable impact of yoga breathing for trauma

“Military guys doing yoga and meditation?” I’ve been asked in disbelief. It’s true that when they first arrived to participate in my study (a yoga-based breathing program offered by a small non-profit organization), the young, tattoo-covered, hard-drinking, motorcycle-driving all-American Midwestern men didn’t look like your typical yoga devotees. But their words after the study said it all: “Thank you for giving me my life back” and “I feel like I’ve been dead since I returned from Iraq and I feel like I’m alive again.” Our surprisingly positive findings revealed the power that lies in breath for providing relief from even the most deep-seated forms of anxiety.

As many of us know, there is an unspoken epidemic that is taking 22 lives a day in the U.S.

Who is impacted? Those who are willing to make the ultimate sacrifice in protection of others: Veterans.

How? Suicide.

Why? War trauma.

Average age? 25.

After a long deployment of holding their breath in combat, these men and women often return to civilian life no longer knowing how to breathe. Though the military trains service members for war, it doesn’t train them for peace. Ready to give up their life for others, service members embody the values of courage, integrity, selflessness, and a deep commitment to serving. They’ve trained under extreme conditions to do things most civilians don’t encounter: lose parts of their body, kill or injure another human being under orders or by mistake, get right back to work and keep fighting hours after seeing a friend killed, be separated from families and loved ones for months and even years, and live with the horrendous physical and emotional consequences thereof upon their return home.

The National Institutes of Health estimates that 20-30 percent of the over 2 million returning Iraq and Afghanistan war veterans have symptoms of post-traumatic stress disorder (PTSD). This anxiety disorder involves hyper-alertness that prevents sleep and severely interferes with daily life, triggers painful flashbacks during the day and nightmares at night, and causes emotional numbness that leads to social withdrawal and an inability to relate to others. Side effects of PTSD include rage, violence, insomnia, alienation, depression, anxiety, and substance abuse. PTSD symptoms are associated with higher risk of suicide, a fact that may explain the alarming rise in suicidal behavior amongst returning veterans.

While traditional treatments work for some, a large number of veterans are falling through the cracks. Dropout rates for therapy and drug treatments remain as high as 62 percent for veterans with PTSD. Symptoms can persist even for veterans who actually undergo an entire course of psychotherapeutic treatment and drug treatment results are mixed.

Our research at the University of Wisconsin-Madison and Stanford showed that the week-long Project Welcome Home Troops intervention was successful, with our analyses showing significant decreases in PTSD and anxiety. Improvements remained one month and one year later, suggesting long-term benefit. More telling even than the data are the veterans’ words; with a veteran of the war in Afghanistan writing:

A few weeks ago shooting, cars exploding, screaming, death, that was your world. Now back home, no one knows what it is like over there so no one knows how to help you get back your normalcy. They label you a victim of the war. I AM NOT A VICTIM… but how do I get back my normalcy? For most of us it is booze and Ambien. It works for a brief period then it takes over your life. Until this study, I could not find the right help for me, BREATH’ing like a champ!

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Aging, Complementary Medicine, Health and Fitness, NIH, Orthopedics, Research

Measuring the physical effects of yoga for seniors

Measuring the physical effects of yoga for seniors

LeslieAs my grandmother marched into her 80s, she would regularly eyeball pieces of furniture before sitting on them. “I’m afraid I won’t be able to get up,” she’d say, in the spirit of fun but with some underlying fear. Even though she and my grandfather stayed active by taking yoga classes at a senior center, and were a neighborhood hit riding their tandem tricycle in matching helmets and T-shirts, declining strength and range of motion with age just made certain everyday movements difficult.

I thought of my grandma while reading about an NIH-funded study from the University of Southern California and University of California, Los Angeles on yoga for seniors. Published in the journal BMC Complementary and Alternative Medicine, the study quantified the physical effects of seven poses in 20 ambulatory older adults whose average age was 70.7 years. Participants attended hour-long Hatha yoga classes twice a week for 32 weeks. The researchers used biomechanical methods joint moments of force (JMOF) and electromyographic analysis at the beginning and end of the study to measure each pose’s demands on select lower-extremity joints and muscles.

In a Research Spotlight, the National Center for Complementary and Alternative Medicine noted:

Findings from the study may be used to help design evidence-based yoga programs in which poses are chosen for the purpose of achieving a clinical goal (e.g., targeting specific joints or muscle groups or improving balance). The physical demands, efficacy, and safety of yoga for older adults have not been well studied, and older adults are at higher risk of developing musculoskeletal problems such as strains and sprains when doing yoga.

Study author Leslie Kazadi, a Los Angeles-based experienced yoga therapist, designed the yoga program with a geriatrician, exercise physiologist/biomechanist, and physical therapist from the research team and taught participants the poses. She told me that standing poses were chosen to target areas of the body that tend to become weak or limited in seniors. Hip stabilizers, for example, help with mobility and balance – and confidence in everyday situations, such as rising from a chair. “What you need to move around in the world is to be strong in your lower body,” Kazadi said. “If you don’t have stability downstairs, then you’re not going to get freedom upstairs no matter what.”

Previously: Exploring the use of yoga to improve the health and strength of bonesAsk Stanford Med: Pain expert responds to questions on integrative medicineExercise programs shown to decrease pain, improve health in group of older adults and Moderate physical activity not a risk factor for knee osteoarthritis, study shows
Photo by NCCAM/RaffertyWeiss Media

Aging, Complementary Medicine, NIH

NCCAM to host Twitter chat on research and complementary health approaches for Alzheimer’s

Save the date (it’s tomorrow) and tune in for a Twitter chat on Alzheimer’s research and complementary health approaches to preventing or managing the disease. Hosted by the National Center for Complementary and Alternative Medicine, the chat will feature experts from the NCCAM and the National Institute on Aging answering questions submitted using the hashtag #nccamchat.

Discussion topics will include dietary supplements such as ginkgo biloba that have been examined for possible effectiveness in slowing cognitive decline, and mind and body practices for caregivers. Check out the NCCAM’s current resources and Clinical Digest for more information.

Beginning at 1 PM Pacific time on Dec. 18, the conversation can also be followed at @NCCAM and @Alzheimers_NIH.

Previously: “Pruning synapses” and other strides in Alzheimer’s researchHow villainous substance starts wrecking synapses long before clumping into Alzheimer’s plaquesWhen brain’s trash collectors fall down on the job, neurodegeneration risk picks up and Ask Stanford Med: Pain expert responds to questions on integrative medicine

Complementary Medicine, Orthopedics, Research

Exploring the use of yoga to improve the health and strength of bones

Exploring the use of yoga to improve the health and strength of bones

yogaosteo I’ve written before about research studies on yoga, as well as components of my yoga teacher-training program. Delighted to find connections between the two worlds, I was interested recently to attend a workshop on yoga for osteoporosis and osteoarthritis with Loren Fishman, MD, an assistant clinical professor of rehabilitation and regenerative medicine at Columbia University Medical Center, and Annie Carpenter, founder of SmartFLOW® yoga.

Fishman is a physiatrist, dedicated yogi and proponent of yoga as a non-surgical, non-pharmaceutical approach to healing and preventive medicine. He’s published books on yoga for back pain, arthritis, and sciatica, among others, and he’s conducting a study of yoga in people who have osteoporosis.

Based on a 2009 pilot (.pdf) that showed improvement in bone density over a two-year period for the group of yoga practitioners versus a slight loss of bone in the control group, the current study prescribes a sequence of 12 yoga poses designed to place stress on the bones to generate cells and strengthen the bone’s dynamic support system. Participants track the poses they complete using an online scorecard, and their bone density is measured before and after practice is introduced. So far, he recently reported, in 65,000 hours of practice among 575 participants worldwide, no yoga-related fractures have been documented.

It’s essential for a patient to have a physician’s diagnosis of his condition before beginning yoga or any treatment program, Fishman and Carpenter emphasized in their workshop. And the most important job of a yoga teacher or therapist, Carpenter said, is being able to see the problems people are dealing with in their practice. She provided instruction on how to look at bodies in all three planes, find imbalances, examine the patterning in structure and movement and determine what to offer students as tools to improve their own well-being.

Previously: Ask Stanford Med: Pain expert responds to questions on integrative medicine, Exercise programs shown to decrease pain, improve health in group of older adults, Moderate physical activity not a risk factor for knee osteoarthritis, study shows, Treatments to reduce fractures for children with brittle-bone disease and New genetic regions associated with osteoporosis and bone fracture
Photo by Tiffany Caronia

Ask Stanford Med, Complementary Medicine, Nutrition, Pain

Ask Stanford Med: Pain expert responds to questions on integrative medicine

Ask Stanford Med: Pain expert responds to questions on integrative medicine

rolfing2Sometimes the best medicine is staying healthy. As more Americans look for ways to improve their health, prevent disease and manage pain, the subject of complementary practices may enter more conversations between patients and physicians. So for this installment of Ask Stanford Med, we asked Emily Ratner, MD, clinical professor of anesthesiology, perioperative and pain medicine and co-director of medical acupuncture and the resident wellness program at Stanford, to respond to questions on integrative medicine. Her answers appear below.

As a reminder, these answers are meant to offer medical information, not medical advice. They’re not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and provide appropriate care.

Mary says: Please speak about the efficacy of integrative medicine to alleviate multi-point pain from a variety of causes (ITP, OA, aging). A relative has doctor fatigue as well, and is not interested in anything else.

Integrative Medicine (IM) may be defined as the combination of conventional and nonconventional modalities chosen by a patient and physician in a patient-centered decision-making process in order to achieve the best outcome for an individual. Patients often seek nonconventional modalities when conventional medicine techniques are unable to achieve a particular goal, often pain relief or pain management. As a general rule, multi- and inter-disciplinary measures are often most helpful in relieving suffering from pain. These may include five general categories of nonconventional modalities, although there is overlap amongst the different types:

  • Mind-body medicine: meditation, hypnosis, biofeedback, guided imagery, yoga
  • Biologically based practices: uses substances found in nature – herbs, foods, vitamins, supplements
  • Manipulative/Body-based practices – massage, chiropractic/osteopathic manipulation
  • Whole medical systems: Traditional Chinese Medicine (includes acupuncture), Ayurveda, naturopathy
  • Energy Medicine – Reiki, Healing/Therapeutic touch, Qi Gong, acupuncture, yoga

Depending on patient preference, available resources in the community and other factors, a decision is made where to begin. I often recommend acupuncture as a place to start, closely followed by a mind-body medicine technique, as my experience is that stress plays a large role in either pain or the perception of pain. However, it largely depends on the individual’s needs and preferences.

Scope Editor asks: A recent study of herbal products found that most of those examined contained contaminants, substitutions and unlisted fillers among their ingredients. What are the implications of these findings, and how can consumers protect themselves when buying supplements?

This is a significant issue that highlights the need for increased supplement regulation, although the study to which you refer has been criticized for some of its conclusions. While FDA regulations for supplements are a bit stricter than for foods, the regulations are far less comprehensive than those for pharmaceutical agents.

That being said, product contamination with heavy metals, undisclosed pharmaceutical agents (especially in products from outside the U.S.), and inaccurate product ingredient amounts plague this field.

Until improved regulatory procedures are instituted, I suggest looking at a reputable database that independently tests these products, such as ConsumerLab.com. This and other independent organizations add their seal of approval to product labels that have tested either the products or the manufacturing practice involved in production of the substance. Look for the Consumer Lab seal or other seals: cGMP (current Good Manufacturing Practice), USP (United States Pharmacopeia), or NSF (another independent lab).

Some experts note that specific stores have strict quality control for their products – like Sam’s Club, Costco, Whole Foods – but I typically look up each individual product on a database (I use consumerlab.com) prior to recommending it.

Another option is to consult with a trained Integrative Medicine practitioner who has access to these databases and is knowledgeable about these products.

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Ask Stanford Med, Complementary Medicine

Ask Stanford Med: Pain expert taking questions on integrative medicine

organic produce and Whole FoodsIntegrative medicine – the combination of traditional Western medicine with evidence-based, complementary approaches to health improvement, symptom management and disease prevention – encompasses many disciplines. The National Center for Complementary and Alternative Medicine (NCCAM), one of the 27 members of the National Institutes of Health, oversees scientific research and informs decision-making in the area. NCCAM’s mission “to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care” is upheld by a number of academic medical centers, including Stanford’s Center for Integrative Medicine.

If you’ve downed a spoonful of fish oil, taken vitamins or probiotics, visited a chiropractor, or engaged in deep breathing to manage pain, you’ve experienced a practice of integrative medicine. But for many, there’s a shroud of mystery around the subject, and while peer-reviewed research studies have been conducted on some aspects of the discipline, other practices require further study.

So for this edition of Ask Stanford Med, we’ve asked Emily Ratner, MD, a clinical professor of anesthesiology, perioperative and pain medicine and co-director of medical acupuncture and the resident wellness program at Stanford, to respond to your questions on integrative medicine.

Ratner’s research interests include the use of acupuncture to manage medical conditions and to address pain and side effects from surgery and cancer. She also studies physician and trainee burnout and resilience.

Questions can be submitted to Ratner by either sending a tweet that includes the hashtag #AskSUMed or posting your question in the comments section below. We’ll collect questions until Sunday, November 10 at 5 p.m.

When submitting questions, please abide by the following ground rules:

  • Stay on topic
  • Be respectful to the person answering your questions
  • Be respectful to one another in submitting questions
  • Do not monopolize the conversation or post the same question repeatedly
  • Kindly ignore disrespectful or off topic comments
  • Know that Twitter handles and/or names may be used in the responses
  • Ratner will respond to a selection of the questions submitted, but not all of them, in a future entry on Scope.

Finally – and you may have already guessed this – an answer to any question submitted as part of this feature is meant to offer medical information, not medical advice. These answers are not a basis for any action or inaction, and they’re also not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and give you the appropriate care.

Previously: Director of Stanford Headache Clinic answers your questions on migraines and headache disordersStudy shows complementary medicine use high among children with chronic health conditions,Ask Stanford Med: David Spiegel answers your questions on holiday stress and depressionReport highlights how integrative medicine is used in the U.S. and Americans’ use of complementary medicine on the rise
Photo by ASSOCIATED PRESS

Complementary Medicine, Medical Education, Mental Health, Research

Benefits of mindfulness programs for med students

Benefits of mindfulness programs for med students

mindful2Previously on Scope, we’ve written about the prevalence of burnout among medical students and the use of mindfulness-based programs to help physicians facing similar situations. Now, a study conducted at Wake Forest Baptist Medical Center documents results from a meditation and stress-reduction training program for third-year medical students.

The program, Applied Relaxation and Applied Mindfulness (ARAM), includes guided relaxation and training in mindfulness meditation. From a recent Wake Forest release:

The goal of the Wake Forest Baptist training was threefold: to help familiarize future doctors with techniques recommended in many medical treatment plans for patients; to reduce stress and prevent professional burnout; and to enhance performance by improving working memory and empathy and by moderating performance anxiety.

The ARAM training was composed of three sessions integrated into the third-year family medicine clerkship. According to [William McCann, PsyD,], 90 percent of the students found the class beneficial.

The release quotes McCann as saying, “The rate of burnout among doctors is sobering and every medical school needs to include stress-management training in their curriculums.” He and his colleagues also note in their study, which appears in the fall issue of the Annals of Behavioral Science and Medical Education, that:

It has been suggested that inadequate self-care and ineffective coping styles are often established during medical training; they may persist after training and be self-destructive in the long-run. Therefore, introducing students to self-regulation skills along with other self-care approaches during medical school may improve their personal health and professional satisfaction not only during residency but also beyond.

Previously: Using mindfulness interventions to help reduce physician burnout, Stanford establishes ‘banking system’ to help faculty balance their professional and personal lives, How mindfulness-based therapies can improve attention and health and A closer look at depression and distress among medical students
Photo by IntelFreePress

Aging, Cancer, Complementary Medicine, Men's Health

Practicing Qigong may help older prostate cancer survivors fight fatigue, pilot study finds

Practicing Qigong may help older prostate cancer survivors fight fatigue, pilot study finds

PEOPLE PRACTICING QIGONGRecovering from a severe illness can take a toll on a person. For older men who have survived prostate cancer and undergone androgen deprivation therapy, lingering effects may include fatigue and associated quality-0f-life issues. A small pilot study in older prostate cancer survivors has found that practicing Qigong – a gentle body-mind practice that incorporates fluid movement, deep breathing and meditation – may be a helpful non-drug tool for relieving this fatigue.

Scientists at the University of New Mexico Cancer Center and the University of North Carolina at Chapel Hill conducted the 12-week randomized controlled trial in 40 men with an average age of 72. All of the participants reported high levels of fatigue at the beginning of the study. One-half of the men engaged in Qigong classes, while the other half participated in a stretching class.

As outlined in the study (subscription required), published in the Journal of Cancer Survivorship, the researchers ”found that the Qigong intervention was associated with significantly larger improvements in fatigue and distress than the stretching group.” The findings, they noted, “are consistent with other Qigong [randomized controlled trials] for cancer survivors and depressed, chronically ill older adults.”

Co-lead author Rebecca Campo, PhD, said in a release, “Qigong may be an effective nonpharmacological intervention for the management of senior prostate cancer survivors’ fatigue and distress.” She added that larger trials and ones that include racially and ethnically diverse participants are needed to confirm the results of the initial trial.

Previously: NIH hosts Twitter chat on using mind and body practices for managing holiday stress and anxietyStudy shows practicing tai chi may increase brain volume in healthy older adults and Study examines the benefits of Tai Chi for the elderly
Photo by ASSOCIATED PRESS

Cancer, Complementary Medicine, Health and Fitness, Pain

A cancer survivor’s yoga journey

A cancer survivor's yoga journey

yoga4

Yoga is my favorite thing. As a former dancer, I love the efficiency of strengthening and stretching my entire body in one practice, and the focused flow found by paying attention to the activity of body, mind, and surroundings. This Well blog essay on a patient’s use of yoga after a series of aggressive and depleting cancer treatments beautifully describes what listening to our bodies can reveal. From the piece:

As we became warriors, children, cats, cows and pigeons, I realized that concentrating on position and breath takes even the most cerebral of us out of our nattering, hectoring brains, reminding us that we have feet, ankles, knees, a spinal column, arms, shoulders, neck, mouth, all of which can stretch and relax, stretch and relax to release tension.

Body awareness — the mind aware of the body, the body of the mind — provides physical but also psychological therapy.

A four-year-long zombie stoicism had been broken. With relief, I realized that yoga was teaching me to be patient with my frailties.

Previously: The promise of yoga-based treatments to help veterans with PTSDNIH hosts Twitter chat on using mind and body practices for managing holiday stress and anxietyStudy offers insights into how yoga eases stress and Study shows mindfulness may reduce cancer patients’ anxiety and depression
Photo by Bliss Flow Yoga

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