LEWISTON — Tessa Brown’s baby was a week overdue. And that was a problem.  

Her daughter was already large and the extended pregnancy wasn’t helping matters. If baby Lilliana didn’t get moving soon, doctors would have to consider a cesarean section. Brown desperately wanted to avoid that.

So she opted to try something different.

Acupuncture. 

“I instantly went into labor. I was back in the hospital that night,” she said.

But Brown hadn’t gone rogue, ducking medical advice and sneaking off somewhere to get tiny needles stuck in various spots on her very-pregnant body. 

Her family doctor — a member of the Central Maine Medical Center staff — was her acupuncturist.

“Any ailments I faced, she always had an alternative option, whether it was a series of different vitamins I was taking or the acupuncture or the (osteopathic) manipulation,” Brown said.

Ten or 15 years ago, it would have been virtually unheard of for a local family doctor to suggest, let alone do, anything as alternative as acupuncture.

Reiki, yoga, meditation or hypnosis? Forget about it. 

Until recently.

An increasing number of local doctors now recommend — or even provide — treatments that had once been considered alternative. And they do so with the backing of their hospitals.

“I think probably health care providers have arrived at the conclusion that we’re not meeting all of our patients’ needs through, at least, the more American traditional methods,” said Raj Woolever, program director and medical chief of staff for CMMC’s Family Medicine Residency Program. “So I think as we tried to open our minds about other ways to better meet the needs of our patients, we started thinking about a more integrative approach.”

Not everyone is happy with the trend. Some doctors aren’t willing to recommend homeopathic remedies or to suggest patients try acupuncture. One national critic says he wouldn’t trust a doctor or hospital that did.

But more patients are pressing for ways to supplement Western medicine — or to avoid the need for traditional treatments.

“Complementary medicine is cool now,” said Patricia Estes, of Auburn, who has been both patient and practitioner. “It’s kind of come out of the closet.”

In addition, not instead

For years, acupuncture, homeopathy and other unconventional treatments were considered “alternative.” Proponents now call them “complementary” or “integrative” — emphasizing that treatments are in addition to, not instead of, traditional medicine. 

“(We’re) using whatever conventional therapies are available as well,” said Erica Lovett, a family doctor who practices integrative medicine in Lewiston and is a faculty member at CMMC’s Family Medicine Residency Program. “As a physician, I still try to use the best evidence, whatever that entails, whether that’s for yoga practice or for surgery or for the pharmaceuticals that they’re using.”

In Maine, the available therapies through major hospitals include acupuncture, acupressure, dietary supplements, guided imagery, herbal remedies, hypnosis, manipulation, massage, meditation, Reiki and yoga. 

A decade or so ago, they would have been whispered about, discussed among friends, but brought up to the family doctor only with hesitation and little hope for help.

“Even if I mentioned whole-food vitamins, they’d say, ‘Oh, you’ve got to stay away from that. I don’t know. I don’t know.’ Because they didn’t know,” said Estes, 61, who has suffered from migraines and cluster headaches since she was a teenager.

Today, Maine’s six largest hospitals all support complementary care — allowing their doctors to suggest nontraditional treatments and providing at least one such therapy themselves, such as Reiki for cancer patients.

Some have whole programs dedicated to it.

Maine Medical Center in Portland runs a residency program that teaches new doctors how to incorporate botanicals, mind/body approaches and other unconventional therapies into traditional care. It also offers a one-year integrative medicine fellowship to give doctors extra training.

For patients, Maine Medical offers integrative medicine consultations. It also provides massage, Reiki, hypnosis, acupuncture, guided imagery, advice on dietary supplements and osteopathic manipulation, either in the hospital or its doctors’ offices, to both children and adults.

“My general feeling is that patients love this,” said Craig Schneider, director of integrative medicine in Maine Medical’s Department of Family Medicine.

“Certainly, the services have all become more busy over the years for everything from osteopathic manipulation for newborns to people who are really at the end of life and just need comfort,” he said. “There’s a lot that we can offer beyond medicine and surgery. It’s nice to have options.”

CMMC in Lewiston teaches new doctors about integrative medicine through its Family Medicine Residency Program.

“From a professional point of view, I knew I didn’t have to be, for lack of a better term, a closet acupuncturist. I didn’t have to covet those skills and interests,” said Greg Thibodeau, a medical resident who has lived in five countries and chose to train at CMMC.

He recently used acupuncture or acupressure to help ease pain and kick-start labor for five women in one month.  

At CMMC’s Family Medicine Residency practice on High Street, patients can get advice on herbal therapies and dietary supplements, help with mind-body work, a referral to a local homeopath, osteopathic manipulation and other nontraditional treatments. At the hospital’s Patrick Dempsey Center for Cancer Hope & Healing, there’s yoga, massage, meditation and Reiki, with plans to add acupuncture in early 2015.

In April, MaineGeneral Medical Center in Augusta started its Healthy Living Resource Center with a grant from the Peter Alfond Foundation, $4 million over five years. Open to the public, the center offers conventional courses on healthy living, as well as classes on energy healing, hypnosis, reflexology, Tai Chi and yoga.

“I believe everybody heals in different ways, and so that’s why we offer a lot of different programs” said Joy Osterhout, program leader for the center. “One shoe never fits everybody.”

Visitors seem to agree.

The center has served 1,645 people in its first six months. Its yoga and meditation classes routinely fill up, and its stop-smoking-with-hypnosis courses are particularly favored by employers who see them as another way to encourage workers to kick the habit.

The center is so popular that it has expanded twice in its first six months, adding classes to locations in Belgrade and Gardiner. 

Public demand prompting change

So many hospitals, doctors and practitioners have become interested in integrative medicine that in June, Lewiston yoga teacher Tisha Bremner founded the Integrative Wellness Council of Maine, which has both doctors and nontraditional practitioners as members.

“It just kept coming up,” Bremner said. “We had so many people, specifically in the Lewiston-Auburn area, who were doing these things on their own and weren’t as well connected with each other as they could be.”

The group’s goals include public education and a stronger connection among practitioners. It’s added 300 members in four months, “and we’re growing every day,” Bremner said.

Proponents say patients are driving the trend in nontraditional treatments.

“People are increasingly open to it,” said Meredith Kendall, a council member, nursing instructor and Reiki master teacher through CMMC and the University of Maine at Augusta. “I see awareness and acceptance increasing, I think because people want it, and I believe that it’s a cultural choice. There’s a culture of people who want holistic care.”

Michael Czerkes, an obstetrician/gynecologist and medical director of Women’s Health at St. Mary’s Regional Medical Center in Lewiston, has seen that firsthand. For the past five years, he’s taken a holistic approach to infertility issues, pelvic pain and other gynecological conditions, looking at patients’ overall health rather than solely a set of symptoms. He often recommends diet changes, supplements, massage, acupuncture and relaxation therapy over hormone treatments. 

“I have really two populations of patients that come to see me,” he said. “Some that come to see me from the moral standpoint of trying to avoid contraceptives … and then I have patients that come to me because they’re looking for something that’s a natural alternative to what they’ve been offered in other places.” 

Kate Brennan, 34, of Greene, is one of the patients driving the trend in Maine.

“You can go to a doctor and feel like you’re on a conveyor belt in a factory at times,” she said. “I was definitely looking for a doctor who took the time to listen and understand.”

Understand that she liked a holistic approach. Understand that she wanted natural options for her family, including her young son.

She was seeing a naturopathic doctor, but insurance wouldn’t pay for the visits. So five years ago she signed up with Lovett, the family doctor who practices integrative medicine through CMMC. It turned out to be the right fit.

“We have a conversation. There’s back-and-forth. It feels much more collaborative,” Brennan said.

With Lovett, she could have a serious discussion about probiotics. She got a natural salve for her toddler son when he came down with a skin infection. Her husband avoided back surgery because Lovett helped him find a physical therapist and other practitioners who could help.

“I don’t mean to exaggerate or anything, but it really has changed his life,” Brennan said of her husband. “It’s not like everything is perfect or totally healed, but he’s figured out how to manage it well and live in a way that’s comfortable. Again, without the risk of surgery.”    

Evidence?

But not everyone celebrates the trend.

Although nontraditional therapies are becoming more common, some doctors still aren’t comfortable discussing dietary supplements or referring patients for Reiki. Sometimes they look into the therapies’ benefits, studies or patient experience and change their minds. Sometimes they don’t.

At least one controversial national critic believes they shouldn’t. 

Retired psychiatrist Stephen Barrett lives in North Carolina and runs QuackWatch, a network of people and websites dedicated to combating “health-related frauds, myths, fads, fallacies and misconduct.” He started the group in 1969 as the Lehigh Valley Committee Against Health Fraud.

Although Barrett believes each therapy or treatment should be considered on its own merits, he calls “integrative medicine” a marketing term, not a form of medicine. 

“If something works and is known to work, it’s part of standard medical care. It’s got nothing to do with any of these slogans,” he said. 

He believes hospitals and doctors — trusted as medical professionals — should not be encouraging patients to get involved in some therapies considered unconventional, including homeopathy and Reiki.

“Let’s go to Reiki,” Barrett said. “Reiki is completely worthless. They claim that they can manipulate your energy field with a force that comes out of the body. That’s total rubbish. There’s no evidence that it works.”  

Barrett’s websites and his views are controversial. Proponents of integrative and complementary medicine call them just plain wrong. 

They note that integrative medicine is a board-certified speciality, and one that is recognized alongside psychiatry, geriatric medicine and internal medicine by the American Board of Physician Specialties. They point out that the National Institutes of Health devotes a full department — the National Center for Complementary and Alternative Medicine — to researching such therapies.

The national center says research supports some therapies, including yoga, but offers little evidence to support others, such as homeopathy.

Proponents agree with Barrett that evidence is important.

Kendall, the Reiki master teacher, points to three particular Reiki studies done in the past four years, including one she co-authored with Lovett. Published last May in the Journal of Alternative and Complementary Medicine, it looked at 340 Dempsey Center cancer patients who took part in Reiki sessions between 2009 and 2013. Patients reported less pain, less stress and increased happiness. 

Proponents say personal experience is also valuable. 

“Reiki is difficult to study because it’s difficult to define. Many aspects of spirituality and perceived wellness are difficult to define and study,” Kendall said. “I believe there is value in the person’s lived experience. As such, if a person finds pain relief with Reiki, then I choose to believe the person.”

Many proponents emphasize that they offer nontraditional therapies to go along with Western medicine.

“What we provide is not a form of medicine or a replacement for it,” said Osterhout at MainGeneral’s Healthy Living Resource Center. “We encourage all of the people who attend classes to have regular annual visits with their primary care provider and to discuss what they are personally doing to take care of their own health.”

Insurance companies not buying it

Another consideration with integrative and complementary medicine: paying for it.

While doctors and hospitals have increasingly embraced nontraditional therapies, insurance companies have not. 

“Some of what limits the integrative approach is money,” Lovett said.

Anthem Blue Cross Blue Shield, the largest health insurer in Maine, generally doesn’t cover nontraditional therapies unless required by law. Some individual services, such as massage, may be covered if they’re part of a treatment plan, deemed medically necessary and are done by a licensed provider.  

In Lewiston, Maine Community Health Options’ rules are similar.

“I’ve actually had a lot of conversations with both providers and individuals on these very topics,” said Michael Gendreau, director of outreach, education and communications. “But basically, how we cover it is we don’t cover it.”

Massage is one of the few therapies that enjoys some limited insurance coverage, including by Anthem, MCHO and Workers’ Compensation. It took years to gain acceptance.

“It’s almost a standard treatment now for soft-tissue injuries,” said Jonathan Torres, medical director for WorkMed at St. Mary’s Health System. “There are other interventions that are probably around the corner. Currently yoga, we haven’t really gone into that avenue of treatment, but I can see that there will be a time, likely in the near future, where yoga is an accepted intervention.”

Licensed naturopathic doctors, who focus on holistic care and natural therapies, and who often see themselves as a bridge between conventional and complementary medicine, have also struggled to get their services covered by health insurance.

“Within the next year or so, we are hoping to pursue legislation to essentially force insurance companies to contract with us,” said Corrie Marinaro, president of the Maine Association of Naturopathic Doctors.

“Don’t get me wrong; contracts with insurance companies aren’t all that they’re cracked up to be,” Marinaro said, “but it’s about expanding accessibility. I, for one, am not content to just offer my care to people who can afford it, who can pay out of pocket.”

In the meantime, some integrative medicine providers have gotten creative to make their therapies affordable.  

Marinaro, who has a 500-patient practice in Waterville, offers payment plans. Other naturopathic doctors charge sliding-scale fees.

Wildwood Community Acupuncture in Portland provides acupuncture in a group setting and uses a sliding-scale fee. At $20 to $40 an hour, it serves about 150 patients a week, some of them referred by doctors.

MaineGeneral’s Healthy Living Resource Center uses its Alfond grant to keep its fees low. Its classes, including stop smoking with hypnosis, are done in groups, which also keeps the price down: $50 for eight yoga classes or $50 for three hypnosis sessions, for example.

At the Dempsey Center, donations and the center’s annual fundraiser — the Dempsey Challenge — allow all of its therapies to be offered free to cancer patients.

“What people tell us is that it’s a blessing and that this place has saved their life. We hear that over and over again,” said Mary Doyle, program and integrative medicine manager at the Dempsey Center.

Appreciating the options

Brown, whose daughter was a week overdue, ultimately had to pay half for the acupuncture that helped kick-start her labor. But to her it was well worth it.

Brown had long been interested in natural approaches to health care, but the 31-year-old from Lewiston really got into integrative medicine during her pregnancy a year and a half ago.

“I knew I wanted to take the path that would have less medicines, more natural approaches to treating any kind of problems I may face,” said Brown, who works at CMMC. “I thought it was better for the baby, and also for me, too.” 

Lovett, her doctor, helped relieve Brown’s sciatica pain with osteopathic manipulation. She got rid of her heartburn with papaya chews from the health food store.

Natural didn’t always work. A couple of times Lovett tried moxibustion — a traditional Chinese therapy that involves the burning of an herb called mugwort — to get Baby Lilliana to turn from her breech position.

“I could feel her moving, but she never flipped around fully,” Brown said.

Instead, a doctor had to turn the baby manually.

Such medical intervention wasn’t Brown’s first choice, but she liked that integrative medicine gave her both options: unconventional and conventional. 

“It’s worth trying. And if it doesn’t work, you have a backup,” she said.

And in the end, she didn’t need the intervention that concerned her most — a C-section. Acupuncture took care of that.

“I would highly recommend it,” Brown said. “I know when I have a second child, I want to go and do the same thing over again.”

ltice@sunjournal.com

The not-so-nontraditional therapies

Acupuncture: Very fine needles are inserted into specific points on the body to relieve pain, stimulate healing or prompt other beneficial reactions. Some people practice classic styles of acupuncture, including traditional Chinese acupuncture, while others perform a Westernized version called medical acupuncture.

Acupressure: Similar to acupuncture, but uses pressure on specific points of the body rather than needles.

Homeopathy: Based on the philosophy that “like cures like,” or that a disease can be cured by the same substance that causes the symptoms, this therapy calls for ingesting very small, diluted amounts of plants, herbs or minerals.

Osteopathic manipulation: Uses stretching, pressure and resistance on muscles and joints.

Reiki: Hands are placed lightly on or hover just above a person’s body; practitioners say an exchange of energy promotes healing.

Rolfing: Similar to massage with a specific focus on connective tissue called fascia.

Tai Chi: A martial art that involves slow moving, deep breathing and focus.

Yoga: Includes a variety of styles. Generally involves holding specific postures, slow stretching, breathing techniques and meditation.

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