Carolina Salvador spearheaded the effort to open the new UAB Integrative Medicine Clinic. Breast cancer specialist Carolina Salvador, M.D., who joined the Division of Hematology and Oncology in 2011, loves her work but has long felt frustrated that the current health care system does not afford physicians with the time or training they need to address patients’ life concerns during and after treatment.
“Experiencing through my patients what a cancer diagnosis brings—how it changes your body, your mind, everything in your life—and treating the cancer without attending to the rest of the things that are happening to the person feels a bit like cheating to me,” she says.
Salvador’s dedication to treating the whole patient’s needs led her to pursue training in integrative medicine, and helped convince UAB to create an Integrative Medicine Clinic, which opened in January in The Kirklin Clinic with Salvador as director. She trained for two years at the Arizona Center for Integrative Medicine, which was founded in 1994 by the renowned integrative physician Andrew Weil, M.D. Salvador began incorporating some of the center’s methods in her own oncology practice this past year.
Holistic Healing
Since patients remain under the care of their primary oncologists or primary care physicians, Salvador stresses that integrative medicine does not replace conventional medical treatment. Rather, it is a holistic method of caring for and treating patients across a broad range of needs. For example, the Integrative Medicine Clinic’s doctors may refer patients for nutritional, exercise, sleep, energy therapy, and/or dietary supplement counseling depending on their needs. The clinic’s doctors can recommend patients see psychologists, exercise physiology experts, and acupuncturists when appropriate. They also encourage certain patients to participate in activities like yoga, tai chi, and qigong. The clinic has a team psychologist, Phyllis Mark, Psy.D., who has decades of experience working with patients with chronic illnesses such as multiple sclerosis. She also has expertise in bereavement, depression, and trauma-related issues.
The Integrative Medicine Clinic enlists the help of the UAB Arts in Medicine (AIM) program to offer patients visual art classes, dance and movement activities, storytelling, drawing, and a “Joy of Singing” program. The clinic also counts on UAB’s Pastoral Care team to provide patients with emotional support and compassionate listening, companionship, and spiritual counseling that cater to any faith or spiritual view.
“I think the most important thing to stress is these are modalities that have been proven scientifically to work,” Salvador says, adding that integrative medicine is not the same as alternative medicine. “Alternative medicine is usually something that has no scientific basis. We are doing scientifically based therapy modalities that are not common in Westernized medicine. We care for the whole person and not just the disease. We try to bring forth all the inner strengths and the inner abilities of the patients to heal themselves.”
These types of clinics are becoming increasingly common at large medical centers, particularly top cancer centers, Salvador says. Oncology patients are the current focus of the UAB clinic, but the goal is to open it to people with a variety of chronic illnesses. “People are learning there are other ways we can improve quality of life that don’t involve just popping a pill,” she says. Salvador and her colleagues are also working on building an integrative medicine research trial at the clinic.
Patient-Driven Benefits
Patients today are often aware of the health and mental benefits of practices like yoga, meditation, and art and music therapies. Many physicians want a place to refer patients that can offer guidance in a clinical setting with a physician’s oversight. “This is information patients will go looking for on their own if they don’t get it from their doctors,” Salvador says. For example, Salvador provides guidance on supplements, educating patients about those that shouldn’t be taken while they undergo chemotherapy and informing them about more benign ones that should be used judiciously.
A physician referral is preferred for the full program. When the clinic was first announced, there was a misconception it was a “boutique” or concierge clinic that would be expensive for patients. It is quite the opposite, Salvador says. Insurance covers visits and counseling with Salvador as well as psychological counseling, and other lifestyle counseling is free to patients. Classes such as specialized yoga and weekly guided meditation have a $5 or $10 fee.
UAB’s AIM program, which is active throughout the hospital, uses painting, music, storytelling, and other creative outlets to help the Integrative Medicine Clinic’s patients feel like themselves again after so much of their lives revolve around fighting a disease. AIM Director Kimberly Kirklin says professional artists-in-residence work with patients in ways that are proven to be beneficial but don’t necessarily have measured outcomes. Patients who are non-ambulatory or are weak from chemotherapy can also enjoy these activities.
“It’s all about being in the moment with the patient and basing it on the needs of the individual,” Kirklin says. “We sometimes call it the ‘ministry of presence.’ We’re there to provide a safe space for creating art or just having creative interaction with no judgment. It’s about patient experience; it’s about empathy.”
Physicians may view some of integrative medicine’s effects as foreign in the clinical sense, but anyone can understand the benefits of its methods from a nonclinical perspective. “When you dance, you have a certain nonverbal awareness and joyfulness,” says Mark. “Dancing or drawing or listening to music also improves your stress response and your immune response.” It reminds patients of the beauty of the world, she says: “When someone is being torn apart by cancer, it’s about reconciling that person’s sense of self.”
Salvador says she hopes these methods will soon become a regular part of the medical school experience. “Integrative medicine is currently taught in several academic centers in the United States, in the form of fellowships and residencies, and is slowly getting into medical schools. I think every doctor in training needs to know there is more than just allopathic medicine and understand when to incorporate integrative medicine.
“Plus, integrative medicine benefits practitioners in a number of ways,” Salvador continues. “They learn about nutrition, ways to deal with stress, how to use supplements and herbal medicine, how to use exercise to combat fatigue, and how to deal with spiritual concerns. Everybody can benefit from integrative medicine—physicians and patients alike.”
By Tara Hulen