A look at four patients who are benefiting from UCI’s integrative healthcareBy Janet Wilson
On a muggy afternoon, a dozen cardiology patients arrive for checkups at the Susan Samueli Center for Integrative Medicine in Costa Mesa. But this is no ordinary doctor visit. After their vital signs are taken, they sit around a big table and review what’s going on with their lives and their hearts.
“Hi, I’m Dannie. I’m good,” says Dannie Cassell, 64, softly. Then she opens up: “Well, I’ve actually been having problems. My blood pressure’s up, and I’ve been having chest pains, but I’ve been under so much extra stress, and obviously there’s a correlation.”
She’s been reliving a traumatic incident from decades ago, assisting a neighbor with a life-threatening illness and helping to care for her 94-year-old mother, who has dementia. It adds up.
UCI cardiologist and center director Dr. Shaista Malik, who’s leading the session, ascertains that Cassell’s chest pains lasted only a few seconds – not a cause for alarm – and offers some guidance. “Learning to manage stress is a lifelong process,” she says. “The more you practice at home, the more useful it will be.”
Cassell replies affirmatively: “I’m still walking. I still go to tai chi. So I’m doing all the right things.”
After everyone shares their experiences, they learn to prepare a healthy watermelon feta salad, then undergo mindfulness training. Those who need medical follow-up are pulled aside for in-depth consultations.
“We’re giving them more tools in their toolboxes to stay healthy,” Malik says. “And studies have shown behavioral changes are easier and become more ingrained if you have peers who are going through the same thing.”
After two hours, the group is energized. “It’s 100 percent fantastic,” Cassell says.
Patients across UCI’s vaunted medical system are beginning to benefit in large numbers from comprehensive wellness approaches – also known as integrative care – that not only save lives but boost long-term health.
Heart attack survivors may be referred to the Susan Samueli Center for Integrative Medicine for preventive cardiology sessions on nutrition and mindfulness. Oncology patients at the Chao Family Comprehensive Cancer Center can receive recommendations on everything from art therapy to sexual health – helping them cope with crucial but highly invasive treatments and resume their lives afterward.
A groundbreaking Live Healthy OC integrative health initiative started at UCI’s Family Health Center in Santa Ana assists low-income individuals in tackling high blood pressure, cholesterol levels, obesity, diabetes, depression and other issues. Seven non-UC clinics across north Orange County are following UC Irvine Health’s lead, incorporating wellness instruction into group sessions.
“We’re trying to address the fundamental roots of what makes underserved patients sick,” says Dr. David Kilgore, head of the integrative medicine residency track and vice chair of UCI’s Department of Family Medicine. “While we’re ordering necessary tests and putting them on medications, we’re also working to improve their diets and helping them manage stress, eat and sleep better, and be more active. The blend of both these worlds is the key.”
The approach extends to nursing, pharmacy options and population-based research. As UCI prepares to ramp up integrative medicine and education via its new Susan and Henry Samueli College of Health Sciences, one facet already shines through: People who’ve experienced major suffering are finding welcome relief.
Walk This Way
Dannie Cassell, a self-described child of the ’60s, battled metastatic cancer in her 30s and has experienced major health repercussions since then. She’s always had a hard time reconciling herself to the surgeries, radiation and myriad medications recommended by physicians. But she’s borne most of their requests in order to stay alive, even defying the odds and giving birth to her only child – a son – at age 45. Still, by 2014, she was a tense, aching ball of nerves and had serious weight gain, skyrocketing blood pressure and advancing small-vessel heart disease. She had no desire to start the infusion treatments doctors wanted to try. Concerned, her primary care physician referred her to Dr. Shaista Malik, a UCI cardiologist who directs the Susan Samueli Center for Integrative Medicine in Costa Mesa.
“I’ve been in preventive cardiology for three years,” Cassell says. “I’ve adopted a whole new lifestyle, and I wouldn’t trade it for the world.”
Roasted, spiced garbanzo beans have replaced her favorite potato chips and french fries. A longtime vegetarian, she became a vegan after Malik suggested she eliminate cheese. Vigorous daily walks, regular spiritual practice and tai chi taught by a UCI physician have helped her drop several clothing sizes, reduce stress, and scale back her dosages of statins and other drugs.
“We’re treating the whole body, not just one problem,” Cassell says. She adds that while she respects traditionally trained doctors, many think “alternative” therapies haven’t been proven and don’t belong in medical care. Malik, she says, is different.
“I’ve been in preventive cardiology for three years. I’ve adopted a whole new lifestyle, and I wouldn’t trade it for the world.”
“I think we reached a tipping point as a society about these other avenues a long time ago, and the medical profession is just now starting to fully realize it,” Cassell says. “I feel very fortunate to have an open-minded doctor – and a cardiologist to boot. She’s my angel.”
We’ve Got Your Back
It all began during a weekend getaway in Mammoth in 2010. Mel Shubash and a buddy were lifting a heavy cooler when he felt something sledgehammer his lower back. “It was the worst experience I’ve ever had,” he says.
From then on, he was flattened by excruciating pain for days at a time, missing work, the gym and even the ability to bounce out of bed. He gained weight and lost his spirit as the nerves in his back degenerated. Meanwhile, one of his best friends had spiraled into opioid addiction.
That was on Shubash’s mind when he visited Gottschalk Medical Plaza’s Center for Pain Management and Dr. Rakhi Dayal asked him to try a prescription nerve medication. He took one pill, hated how it made him feel and worried about his inability to focus on work. Dayal, a UCI associate clinical professor of anesthesiology & perioperative care, said they could try other options.
“With every patient who comes to us, we do a really thorough evaluation to figure out a complete treatment plan,” she says, noting that the pain center’s doctors are researchers in an array of specialties, including physical medicine, psychology and anesthesiology. “We want to return them to living as comfortable a life as possible.”
Teams explore the latest technologies – radiofrequency nerve ablation, genetic testing for efficacy of certain medications and, on the horizon, spinal cord stimulation – along with complementary approaches such as yoga and acupuncture, to devise customized care.
“I went home and told my wife, ‘Oh, my God, it’s working.’”
Shubash, 44, of Irvine, came to UCI's Gottschalk facility after an acquaintance mentioned epidural treatments. Long used by women in childbirth, they’re also employed to combat chronic pain, explains Dr. Brent Yeung, a pain medicine fellow. Shubash’s lower back discomfort has been enormously relieved by four of the steroid injections over the last 16 months. But his neck and upper spine still act up.
A UCI surgeon recommended inserting two bolts and a rod in his neck, but since Shubash is still relatively young, the bolts could sink over the decades, requiring more operations. So instead, he’s scheduled for a final epidural to try to soothe his inflamed upper nerves. He’ll know three to five days afterward whether it makes a difference.
If not, Dayal and her team will continue to research other options. And Shubash is consulting a UCI physical therapist too. Now, when he feels his upper body flare up, he performs specific stretches that help the nerves settle down.
Shubash recalls how much that first epidural helped him: “I went to the gym after a few days, because I couldn’t tell if it was my mind telling me I felt better or if I really did.” He was stunned to find that he could bench-press dumbbells. He tried situps, an old favorite, and did them for the first time in six years.
“I went home and told my wife, ‘Oh, my God, it’s working,”’ he says.
A Community of Peers
For Justina Cortes, years of weight gain, insomnia and increasing anxiety after the births of each of her three children came to a head in December, when Dr. Emily Dow, her primary care physician at UCI’s Family Health Center in Santa Ana, told her that she was prediabetic.
“I was very frightened,” says Cortes, 38, of Fountain Valley. Her husband was already diabetic, and she despaired that their daughter and two sons would go the same route. Shy and soft-spoken, she had followed her husband to the U.S., emigrating from Mexico nearly 15 years ago.
“I think one reason for my anxiety is because we have a big family, and it’s only my sister and me here,” Cortes says, noting that she has 10 other siblings. “We don’t have a lot of support, and it’s a really big change for us.” Poverty, isolation and mental health issues frequently affect immigrants’ well-being, says Dr. David Kilgore, director of UC Irvine Health’s integrative medicine residency track.
Cortes suffered such severe panic attacks that she thought she was having heart attacks. She was prescribed anti-anxiety medications, but nothing worked until she came to UCI. Dow, the clinic’s medical director, recommended that she try its group visits. Covered by insurance companies and federal funds, the sessions help patients prevent disease and avoid costly hospital stays.
Cortes – joined by her sister – began going in January and is now an avid attendee. A summer session, conducted in Spanish, exemplifies the complementary approach. After vital signs are taken, there’s a lively lecture by a registered dietician. Coconut oil, diet soda and other items are debated. Halfway through, there’s a Zumba workout, and class concludes with restful meditation and deep breathing.
“It’s much better for my motivation to know that there’s people with cases similar to me. It feels like a family.”
“It’s the happiest part of my day,” says Dr. Elana Craemer, who tops off days of seeing 22 individual patients by supervising the group sessions. She says having family members participate reinforces good habits like making better choices while grocery shopping.
Cortes has learned to substitute tuna or grilled chicken for tacos with queso fresco and blends vegetable shakes for breakfast. “No more hot dogs for us, Mommy,” her daughter cheerfully tells her at home. She does research online and watches YouTube videos about staying healthy after the kids are put to bed. But it’s the classes that have transformed her, she says.
“It’s much better for my motivation to know that there’s people with cases similar to me. It feels like a family,” says Cortes, adding that she’s finally been given the tools she needs to maintain her health. She has lost more than 20 pounds and reduced her glucose, blood pressure and cholesterol numbers to acceptable levels. Her husband is making strides too.
“In April, my test results came that I was no longer prediabetic,” she exults. “Just my triglycerides left – and I’m still trying!”
Running the Gantlet
A week after Lesley Ginsberg had placed first in her age category for the fifth time at the Camp Pendleton Mud Run in 2012, she noticed an unusual bloating in her abdomen. To her shock, she was diagnosed with stage 3 ovarian cancer, “a silent, awful thing,” she recalls.
Ginsberg, now 70, of Newport Beach, and her husband, Phillip, swung into action. They researched ovarian oncologists worldwide and found Dr. Robert Bristow, a widely recognized specialist “in our own backyard at UCI,” she says.
Bristow, director of gynecologic oncology services for UC Irvine Health, and two other surgeons performed 12 hours of complicated surgery. “It’s a big insult to the body,” Bristow says, “but the fact that she was in such good shape really helped.” After that, she endured nine months of chemotherapy.
Ginsberg's determination to get back to being healthy was invaluable, Bristow says. A patient’s mental state is critical. “Lesley is tough as nails,” he says. “She was scared, but she made up her mind that she was going to beat this.”
Bristow says he treats people with a disease, rather than simply seeing a cancer he needs to cure: “Instead of sitting down with patients and running through numbers, you need to talk to them about their relationships and support systems, about menopause and fertility, and what else they’re going through. It’s mentally intense for both the doctor and the patient, but it’s much better on the back end.”
Inquiring politely about their lives pays off, he says, by allowing him and his team to tailor the timing of treatments and to motivate patients to stick with grueling bouts of radiation and chemotherapy. In Ginsberg’s case, they delayed chemotherapy until after she and her family had enjoyed a long-planned Christmas vacation.
Ginsberg also appreciated the individual nurse assigned to answer questions via email or phone calls. She received counseling offered by the Queen of Hearts Foundation, a nonprofit ovarian cancer research and advocacy organization.
Bristow says he’s a “huge fan” of integrative health. “For the most part, modern medicine is driven by clinical trial-based work that’s been proven and published in the New England Journal of Medicine,” he says, “but we can lose sight of other treatments that are also effective. We limit ourselves as doctors.”
He advocates everything from art therapy to acupuncture – not as a substitute, but to offer relief from highly invasive traditional cancer care. Painting classes, for example, could provide a beneficial routine for cancer patients also suffering from depression – and could be vital. If people can’t get out of bed, he notes, they’re not going to make it to chemotherapy.
For her part, Ginsberg willed herself to move day after day, taking just a few steps shortly after her surgery and eventually working back up to 5-mile jogs. She now runs every weekday morning with two close friends along the beaches of Crystal Cove in Newport Beach. “It’s great for my mind, it’s great for my body,” she says, “and it makes me start my day in the best way possible.”
“It’s great for my mind, it’s great for my body.”