Years of standing and cutting hair damaged stylist Gregg D’Addario’s shoulders. A pair of surgeries fixed them but the medication he had to take afterwards bothered his stomach and left him groggy. Acupuncture allowed the 68-year-old Revere resident to reduce his medications and go back to work.
Today, Mr. D’Addario, who also suffers from lower back pain, regularly receives acupuncture treatment at the MGH Community Health Associates Wellness Center in Revere. The sessions make him feel more relaxed and energized. “It helps keep my battery charging,” says Mr. D’Addario, who also appreciates his acupuncturist’s advice about new ways to stand or to sit on a stool when he works. The Wellness Center is part of the Center for Community Health Improvement’s efforts to improve the quality of life for patients served through Massachusetts General Hospital’s health centers in Charlestown, Chelsea, Everett and Revere. In addition to acupuncture, massage therapy, yoga, tai chi and zumba, its offerings include programs for stress management and better sleep. The center also has mind-body groups for parenting, depression, anxiety and living well with chronic pain. Such groups are offered in partnership with health centers’ mental health units.
These services, commonly known as complementary or alternative medicine (CAM) therapies, have become increasingly popular nationwide. Nearly 40 percent of American adults use some type of CAM therapy, according to a 2007 survey by the National Center for Complementary and Alternative Medicine and National Institutes of Health.
More than the individual therapies, the Mass General Wellness Center promotes a holistic philosophy that helps patients adopt a healthier lifestyle, while encouraging self-sufficiency. “The focus on prevention, health maintenance, early detection and wellness fits in perfectly with the new healthcare paradigm,” says Kathleen Miller, RN, MA, PhD, AHN-BC, director of the Wellness Center, which opened in 2007. “Giving people the tools to better care for themselves cannot only help prevent medical problems, it can also help them better manage problems that already exist.”
In the past, insurers paid clinicians and hospitals for taking care of sick patients. Now, with healthcare reform, prevention and health promotion have a great emphasis on keeping a population healthy. The center’s three-pronged approach to wellness focuses on treating the mind, body and spirit. And “spirit” relates to a sense of inner harmony, community and belonging, emphasizes Dr. Miller, who has advanced training in nursing, holistic nursing, Oriental medicine, healing and spirituality. “Our goal is to help people live as independently in the community as possible, whether they want to increase mobility, reduce pain or find a support network,” she says.
At Mass General, the Wellness Center programs are not just complementary or alternative, they are integrated with more traditional medical care.
CAM use has been more prevalent among people with higher incomes because such therapies are typically not covered by insurance. It is through philanthropic support that the Wellness Center has been able to offer programs at relatively low cost, making them affordable for more people. Because the center is located on the fifth floor of the same building that houses the MGH-Revere HealthCare Center and the Revere Beach T stop, it is easier for patients to take advantage of its services.
At Mass General, the Wellness Center programs are not just complementary or alternative, they are integrated with more traditional medical care. And physicians like Roger Pasinski, MD, director of MGH-Revere, embrace the concept of treating the mind and the body. “Everyone over the age of 50 should do yoga,” says Dr. Pasinski, citing the benefits of the flexibility and balance exercises as well as the respite yoga offers from life’s stresses. Following his own advice, Dr. Pasinski makes it a priority to attend the Monday noon yoga class at the Wellness Center. In his class, you will also find Dr. Miller, who says participation helps ground her for the week ahead.
Even patients in their late 80s are able to participate in the chair yoga class taught by holistic nurse Joanne Rowley, MS, RNCS, HNB-BC. There, she soothingly encourages participants to stretch and breathe and “honor the integrity” of their bodies. Chairs substitute for mats. Some participants rest their feet on blue foam blocks in a room that offers ocean views.
The expertise of class leaders like Ms. Rowley fosters trust from physicians and persuades them to refer patients. Twenty years ago, if patients wanted acupuncture, Dr. Pasinski didn’t know where to send them. “Perhaps I would have opened the yellow pages,” he says, “but that was like using a dart board to find services. The quality was a complete unknown.”
Dr. Pasinski refers patients to the Wellness Center on a weekly and often daily basis. “Insomnia, anxiety, chronic pain, migraines, you name it, there’s almost no patient that I can’t send upstairs,” he says. “And the staff of nurses can assess patients comprehensively and safely. They meet patients where they are.”
The referrals continue and grow because the services meet a need. Sometimes the Wellness Center is a last resort. People are unhappy with results elsewhere and are open to trying anything. “I have had doctors send people up here who haven’t slept in three days to counteract the effects of our stressful world,” says Regina Gibbons, MBA, MAc, licensed acupuncturist. She describes herself as a “recovering accountant,” who crunched numbers for two decades, then completed a master’s degree in acupuncture. “Acupuncture literally changes the level of sensitivity by resetting the nervous system so that the body is able to rest and repair,”
The dangers of stress are real. According to Herbert Benson, MD, director emeritus of Mass General’s Benson-Henry Institute for Mind Body Medicine (BHI), more than 60 percent of all visits to healthcare providers are related to stress. It causes the “fight or flight” hormones, epinephrine and norepinephrine, to secrete into the bloodstream. This incites or exacerbates a number of conditions. They include hypertension, headaches, insomnia, irritable bowel syndrome and chronic low back pain, as well as heart disease, stroke and cancer. BHI has worked closely with the Wellness Center to bring evidence-based mind-body programs to the MGH health centers, and to collaborate on research trials such as mind-body groups for depression and anxiety.
The Wellness Center is also home to the Heart Awareness Primary Prevention in Your Neighborhood (HAPPY Heart) Program, a lifestyle intervention research study for low-income, stress-laden women. It started in 2007 in collaboration with what is now known as Mass General’s Corrigan Minehan Heart Center. “Far too often, health is the last priority for these women who have enormous challenges in their lives,” says Malissa Wood, MD, co-director, Corrigan Women’s Heart Health Program in the heart center and the study’s principal investigator.
Through a variety of methods — group education, peer support, health coaches and participation in mind-body therapies — the project seeks to improve both emotional and physical health. In doing so, the study aims to reduce the risks for cardiovascular disease. “We can’t change the fact that a son has a drug problem or that a relative has cancer, but we can help find healthy ways to respond to that stress,” adds Donna Peltier-Saxe, RN, MSN, ACM, HAPPY Heart program director. “If women don’t take care of themselves, how are they going to care for an elderly parent or a son in recovery?”
The HAPPY Heart results are promising. Women who could barely walk ended up doing zumba and yoga. Some lost so many pounds they had to get new clothes. Still others found friends they could turn to for support. Across the group, blood pressure and blood sugar levels decreased and the women experienced a significant reduction in anxiety, depression and stress. “At a personal level, the benefits not only affect that woman, but all the people around her — spouse, colleagues, children,” says Dr. Wood, who is currently pursuing HAPPY Heart II with women of childbearing age.
Beyond the walls of the Wellness Center, Mass General is an international leader in understanding the science of connecting the treatment of the body and the mind. In 2006, Mass General formalized that philosophy when it established the Benson-Henry Institute based on Dr. Benson’s pioneering work. More than 35 years ago, he first described the relaxation response as a state of deep rest that can be elicited though modalities such as meditation, tai chi, deep breathing or prayer.
Until recently, how the relaxation response worked remained a mystery. In a groundbreaking Benson-Henry study published in 2008, the team found that producing the relaxation response could change how genes are activated and potentially counteract stress-related changes that lead to disease.
The notion that our genes may not always determine our destinies opens up enormous potential for patients to improve their own health. The BHI Cardiac Wellness Program combines relaxation response training with exercise, nutrition counseling, yoga and stress management. In 2009, a Centers for Medicare and Medicaid Services study found that, compared to traditional cardiac rehabilitation programs, BHI’s program resulted in reduced mortality rates, more time between hospital re-admissions for cardiac reasons and lower costs per patient.
On a broader scale, the results were definitive enough to help lead Medicare to create a new payment code for intensive lifestyle rehabilitation programs. That was an encouraging step for patients who cannot afford the services and for providers who cannot afford to offer them at lower rates. At the Wellness Center, the fee for patients to participate in programs only accounts for a portion of the center’s actual cost.
Funding such research is another challenge. Projects like HAPPY Heart and the mind-body group partnerships between BHI and the Wellness Center must depend on generous donors and grants funds, which are more and more limited. Yet it’s this type of research that identifies best practices and serves as national models to change the system.
Cardiovascular disease kills more people than all cancers combined. It also costs the nation about $400 billion annually. In the campaign to reduce that toll, programs like the Wellness Center and BHI are ahead of the game with their experience in offering mind body programs that promote a healthy lifestyle and are effective, inexpensive and scientifically proven.
Then, there’s the joy. In the 1970s, when Gregg D’Addario, the hairdresser, first tried acupuncture before the advent of disposable needles, it was a somewhat painful experience. Now, he would not be without his regular treatments at the Wellness Center. Acupuncture allows him to do things that he enjoys, like metal detecting on the beach. A modern-day treasure hunter, he finds old coins and precious gems lost in the sand or the sea. “When I walk into work, everyone asks why I am so happy,” says Mr. D’Addario. “I answer that I can get out of bed. I’m alive. It can be snowing, raining, but I’m there.”