Heading into its second year, business is thriving at Center for Integrative Medicine
When Tammy Riedel was hit by a drunken driver eight years ago, her life was changed forever. She had to have a rib removed; a nerve in her elbow was surgically relocated; and she began a litany of narcotics to manage her chronic pain.

Four years later, she was sent to a rheumatologist who diagnosed her with a severe case of fibromyalgia – which the doctor believed was triggered by the car accident. “You only need 11 trigger points to be diagnosed, but I had all of them!” she said cheerfully. “So they just put me on more medication!”

But after 3+ years of this regimen, she decided she had had enough.

“I was going to a family therapist at the time who suggested I try the Pain Clinic at University of Colorado Hospital,” she said. “I gave it a try from May to August of last year. They added some muscle relaxants to my prescriptions and suggested I try a vigorous exercise program. When I balked, Dr. Alan Brewer mentioned The Center for Integrative Medicine (at Fitzsimons). They got me in for an appointment the very next day. My only regret is that it took me so long to find them!”

Mel Drisko, MSTCM, CH, Lac, inserts acupuncture needles on Tammy Riedel’s forehead. In treating fibromyalgia with acupuncture, the goal is both to target pain trigger points as well as encourage blood flow throughout the body, Drisko said. In Eastern medicine, fibromyalgia is believed to be caused by a decrease in circulation, or chi, which is why it most often occurs in people over age 35.

Since her first appointment in August 2002, Riedel has returned to the TCFIM two to three times a week for acupuncture, therapeutic massage, biofeedback and psychotherapy counseling.

Though they haven’t made the pain go away completely, these techniques have offered her spells of relief, which prescription drugs were never able to do. They’ve also helped ease her migraines, which have been a life-long problem made worse by the fibromyalgia.

Emotionally, Riedel says she feels less discouraged and more optimistic about the future of her illness.

“I just adore these people,” she said. “I needed to be at a place like this all along. I’m just really sad it took me so long to get there.”

TCFIM Celebrates First Anniversary
When TCFIM opened its doors a little more than one year ago, it was one of only about 20 complementary medicine clinics in the country to be located in an academic health center, said Lisa Corbin, MD, the center’s medical director.

So far, none of them have been able to recoup their expenses – let alone turn a profit – but UCD’s center is projected to do both by year’s end.

When the center opened in December 2001, it had two part-time acupuncturists and two part-time massage therapists on staff, as well as Dr. Corbin.

One year later, the center has blossomed, providing an array of services including psychotherapy, herbal consultations, health and wellness consultations, biofeedback, acupuncture, nutrition, massage and yoga and tai chi classes. In all, the center provided 1,435 patient visits in 2002.

Now in 2003, the center is looking to expand its number of client contacts as well as the types of services it offers by adding a chiropractor and providing in-patient services when the new Anschutz Inpatient Pavilion opens.

“We would also like to add some specialized courses for people with cancer, diabetes and HIV, exploring the larger holistic options for the treatments of their conditions,” Dr. Corbin said.

TCFIM also has awarded its first $15,000 research grant for scientific study into complementary medicine, funded by the Mendel-Asarch Family Lung Cancer Foundation. Associate Professors Jean Kutner, MD, and Marlaine Smith, RN, PhD, will study the efficacy of massage therapy for symptom alleviation in patients with terminal lung cancer.

A breakdown of patient visits shows that the majority of the center’s clients are women – 75 percent – and the average age is 47. About 12 percent of all patients have cancer and 60 percent have a diagnosis that includes pain, the most common of which are neck, shoulder, back, low back and headache.

The most common diagnoses treated in the clinic are low back pain, neck pain, shoulder pain, depressive disorders and fatigue/malaise. Many patients also have concurrent chronic illnesses such as cancer or fibromyalgia.

In contrast, some patients come to the center to get advice on prevention and ways to remain as healthy as possible in mind, body and spirit.

New Branch of Medicine
Among the many challenges of starting a complementary medicine clinic has been getting out the word about what services it has to offer, and educating physicians about the benefits of this emerging field of medical care.

“Right now, much of our business is patient-driven,” Dr. Corbin said. “We would like to see more physician referrals – that’s the evolution we’re hoping for. This involves sending letters, and going out and meeting with doctors one-on-one.”

Many doctors remain skeptical about the benefits of complementary treatments because they weren’t taught when they were in medical school and because the therapies weren’t put through rigorous scientific testing for many years, she said.

But that’s changing.

Professional journals are increasingly publishing research studies on some of these age-old therapies. CU School of Nursing Associate Professor Marlaine Smith, RN, PhD, published two studies just this year on the impact of touch therapies on cancer patients and bone-marrow transplant recipients.

Much of the research into massage therapy is being conducted at the University of Miami’s Touch Research Institutes. http://www.miami.edu/touch-research/home.html.

And the National Institutes of Health has created a National Center for Complementary and Alternative Medicine to review published research. www.nccam.nih.gov.

It is estimated that two-thirds of U.S. medical schools now offer courses in complementary medicine, but even for Dr. Corbin, a fairly recent graduate of medical school, openness to these different ideas didn’t come through her schooling.

“I kind of stumbled into this myself,” she said. “When I did my internal medicine residency here I was asked to be chief medical resident. Part of the job was to give a medical grand rounds, and it was totally overwhelming. I didn’t want to pick something that everyone in the audience knew a lot about – because then they would be critiquing everything I said! – so I picked herbal medicine. From that, things just kind of snowballed.”

Pegged as the “complementary health expert” on campus, Dr. Corbin began fielding calls from her colleagues about herbs, their potential benefits and risks, and their pharmaceutical interactions. From there, her self-studies grew into other modalities like massage and acupuncture.

When the university convened a campuswide task force in 1998 to explore the possibility of starting an integrative medicine program, she was a natural candidate to be considered for its medical director. She assumed the post in 2001.

Funding for TCFIM comes in part from the Mendel-Asarch Family Lung Cancer Foundation, which is donating $250,000 over five years. The foundation was launched in 1998 by Ethel Mendel and her family during her long fight with lung cancer. She believed complementary therapies prolonged and enhanced her own quality of life and wanted to bring this help to others by supporting the burgeoning center at UCH.

Navigating the Insurance Maze
Insurance companies have been slow to pay for complementary therapies, but that is slowly changing over time.

About 40 percent of all patients treated at TCFIM are covered by insurance, said wellness concierge Blake Humphrey, who is the office’s insurance specialist. For the initial wellness assessments with Dr. Corbin, about 99 percent of those visits are covered.

“We want to charge the insurance company instead of the patient whenever possible, so we always research and find out what is covered under an individual’s health plan,” Humphrey said. “It just depends on who their carrier is, and who their employer is.”

The majority of the center’s insurance-carrying patients are covered through Cigna, which pays for health and wellness assessments and acupuncture to relieve nausea or post-dental surgery pain. Cigna, both commercial and through CU, also covers behavioral counseling and biofeedback.

For non-covered services, TCFIM works with Cigna’s Healthy Rewards Program to offer a 25-percent discount.

Whether a patient needs a referral from his or her primary care provider also varies by insurers.

Tammy Riedel’s insurance plan, UnitedHealthcare, pays for a majority of her services, including massage and acupuncture. Her mental health plan, Magellan, covers 50 percent of her biofeedback and psychoanalysis treatments, which are out-of-network. If they were in-network, she would only have a small co-pay for those services too.

Riedel feels fortunate that she hasn’t had to worry about paying for her treatments.
“I'm one of the lucky ones,” she said.

And the temporary relief from pain these treatments have brought her has enabled her to start thinking about work again.

Prior to her injury, she was a stay-at-home mom who also did data entry at home for a company. She had to quit that years ago, but still enjoys being the baptism and wedding coordinator for Queen of Peace Church.

“I’ve only done one wedding since I began going to the integrative medicine center, but we have some big ones coming up this summer, so I’m going to start using the techniques they’re teaching me in biofeedback,” she said. “I’d also like to start volunteering here at the clinic.”

One of the biggest struggles faced by people with chronic illnesses is the difficulty and even inability of their loved ones to really understand what they are going through.

Being around people who do understand has perhaps been one of the greatest gifts of all at TCFIM, Riedel said.

“I never believed in a connection of mind, body, spirit,” she said. “But I firmly believe in it now because I have experienced it. My family, though, that is another matter. I went to a family funeral in Kansas and started talking about this stuff, and they looked at me like I’m crazy!

“Even my kids, age 15 and 14, and my husband - they just don’t understand what this pain is like. But here, at the center, they do understand. They see people in this clinic who have things a whole lot worse than I have. I never get the feeling, though, that I’m not as important to them as somebody else.”

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