Bypass Surgery Patients At Cedars-Sinai Participate In Nation's First Study Of Cardiac Inpatient Acupuncture Therapy

The acupuncture study is one of three pilot studies aimed at assessing the benefits of “integrative” or “alternative” modalities. A study of massage, like that of acupuncture, is in the final stages, while one on guided imagery is now underway, according to Gregory P. Fontana, M.D., a highly respected cardiothoracic surgeon at Cedars-Sinai.

“Our patients have gone through a very dramatic event and they’re often in a great deal of discomfort. If they’re stressed, they can’t sleep and they hurt, their first response is usually to ask for a pain medication,” said Dr. Fontana. “I’ve always believed that massage and other therapies can be very powerful in helping patients relax. If they can allow themselves to relax, accept what has happened, and realize a state of well-being, pain becomes a less important part of their consciousness.”

Dr. Fontana began about two and a half years ago to make preparations for the launch of this program. One major hurdle was the fact that few Western-style hospitals have a process in place for credentialing acupuncturists and other non-traditional therapists.

“We designed a concept for the program and we wanted to involve the best practitioners available. We wanted great acupuncturists and massage therapists who had experience and respect within the community,” said Dr. Fontana. As a result, the three acupuncturists participating in the study are key faculty members of Emperor’s College of Traditional Oriental Medicine in Santa Monica, and the massage therapists are on the staff of Burke Williams Spa. All are now credentialed by Cedars-Sinai.

The pilot studies to evaluate patient satisfaction and solicit their suggestions will lead to larger, randomized, scientifically documented research. Although several other heart surgery programs have initiated studies of certain alternative therapies – ranging from yoga to herbal supplementation to healing energy therapy – few have resulted in objective, peer-reviewed information.

“Studies in recent years have shown that perioperative patients can benefit tremendously from learning how to relax and how to visualize positive outcomes, but we believe this is the first inpatient program to include acupuncture,” said Kathy Wanderer, a registered nurse who coordinates the Cardiothoracic Integrative Medicine program.

“We’re receiving great comments about both massage and acupuncture,” said Wanderer, who has been a registered nurse for nearly 10 years. Although she has practiced in pediatric intensive care and is a certified recovery room nurse, Wanderer has held an interest in alternative therapies since her nursing school days when she worked in a clinic that offered medical care, chiropractic and acupuncture. Now she’s completing the requirements for a master’s degree at Emperor’s College.

While the Western world’s approach to medicine has through the years seemed incompatible with the practices of Eastern medicine and other alternative approaches, Wanderer said dissimilar perspectives actually work well together.

“Although the two systems of medicine are not based on the same ‘principles,’ they integrate beautifully. Whether you call them ‘integrative,’ ‘alternative,’ or ‘complementary,’ all of those terms imply that they can work together even though they are based on different ways of approaching a patient and different ways of looking at disease,” said Wanderer. “There are a lot of tools available that are not specifically tied to a Western medical model.”

Dr. Fontana noted that he and the other researchers make it a point to avoid suggesting possible outcomes to patients in the study. “We don’t want to give them expectations because we don’t want to influence their perceptions,” he said. “Instead, we say that we’re using this to see if we can improve their experience after having heart surgery. If they ask in what way, we tell them we’re looking at pain, relaxation, anxiety, sleep and many different areas.”

Not only is the hospital a new environment for acupuncture, treating patients shortly after open-heart surgery is an unusual challenge for acupuncturists, who often are called upon to treat a specific pain. Dr. Fontana said that when the sternum is opened and stretched, as it is in heart surgery, patients often have a sense of significant pain that is widespread, not just in one place. The acupuncturists in the pilot study have directed their efforts toward bringing about relaxation while relieving specific pains.

“Because there is no previous experience with acupuncture after heart surgery, the information we’re gathering from patients now is going to help us focus our next studies on what is most realistic in this situation,” said Dr. Fontana. “Acupuncturists in China and in other parts of the world have used acupuncture in incredibly dramatic ways, even in lieu of general anesthesia.”

Caroll Clark is one of the Cedars-Sinai patients who volunteered for acupuncture therapy. She expected the bed rest after surgery to exacerbate an ongoing back problem.

“I have a vertebra in my back that I was a little concerned about, that I had told the doctor about,” she said. “My back was hurting the first two days (after surgery) and then when they did the acupuncture, it quit hurting and I never took any pills after the second day I was in the hospital. One evening I took some Extra Strength Tylenol but as far as pain pills, the narcotic kind, I didn’t have to take any after that.”

Her pain relief was so complete, Clark thought she was receiving pain medication. “I asked the nurse about it. She said, ‘No, you don’t get pain medicine unless you ask for it. Do you want some?’ I said, no, I just thought you gave it to me naturally because I wasn’t having pain.”

Clark said she quickly learned to look forward to her acupuncture sessions. “What I really enjoyed was when they came in, I’d get to lie there for about 20 minutes and nobody could bother me. I mean, it was just so relaxing,” she said. “I was skeptical of it (acupuncture) to begin with but now that I’m home, I know that it had to have worked because now my back’s bothering me.”

Jan Alcott volunteered for the massage therapy pilot study. He said he has heard that the highest compliment that can be given a massage therapist is to fall asleep during a treatment.

“They all got a kick out of it – including Dr. Fontana – because after working on me for 10 or 15 minutes, I was out like a light. It was wonderful. Initially, coming out of surgery, being very sore, it was difficult to get comfortable. To have this massage to help relax your whole body and the anxiety, I felt was a tremendous asset in my being able to get comfortable within just a few days,” Alcott said.

In fact, after the second day, Alcott requested that there be no other interruptions during his massage, allowing him to “get the full benefit of this relaxation. And after that, that afternoon I noted that I did not have to request a pain shot and I slept anywhere from a half-hour to an hour. I just cannot say enough about it,” he said.

Wanderer said all of the acupuncturists and massage therapists provided their services without charge during the pilot projects. “They believe the inclusion of complementary services will prove to have a positive impact on patient well-being,” she said.

The guided imagery element of the project was developed in-house with the consulting services of Judith Prager, a certified hypnotherapist with a doctorate in psychology.

“The scripts are very specific to address the kinds of feelings and sensations patients are having before, during and after cardiac surgery,” Dr. Fontana said.

Wanderer said the pre-op guided imagery centers on relaxation and positive suggestions. The second guided imagery, which will run continuously during surgery, is designed to reinforce the message of relaxation and remind the patient that every sound and sensation taking place is for the patient’s highest good. Wanderer said previous studies have shown that the unconscious mind can be open to external stimuli even when a patient is under the effects of anesthesia. The post-op message encourages relaxation and healing.

“Through these pilot studies we’re learning how best to coordinate the new modalities into the flow of existing care, and we’re ensuring that patient satisfaction is maintained at its previous level or elevated,” said Wanderer. “The average hospital stay for these patients is five days, and the standards of care are excellent, so there’s a lot going on in that time. All the people on our staff who have patient contact are working together on this project and are very excited and supportive.”

Dr. Fontana said he has taken advantage of the benefits of massage and relaxation therapies at various times in his life but he got the idea of incorporating alternative modalities into the heart surgery program while attending professional meetings held at a spa and resort.

About three and a half years ago, he and Mehmet Oz, M.D., a friend and cardiothoracic surgeon at Columbia-Presbyterian Medical Center in New York, had an opportunity to swim in a spring and receive massages and mud baths during breaks between sessions. We said, “You know, it’s too bad our patients can’t feel this good,” he recalled.

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