Since its inception in the late 1950s, the cardiac surgery service at Columbia-Presbyterian Medical Center (CPMC) has applied innovative approaches to the treatment of cardiac disease. This tradition has led to the creation of extensive programs in heart transplantation, mechanical cardiac assistance, and pediatric cardiac surgery. The search for improved healing techniques has not been limited to the operating room. The neurologic and psychiatric changes associated with open heart surgery have also been defined, and treatment of these changes is now an integral portion of postoperative cardiac surgery care.1 The need to ameliorate these symptoms, including the inability to sleep, increased anxiety, and possible psychosis, was the driving force behind the creation of the complementary medicine (CM) program within the cardiac surgery department in 1994. Currently, 40% of the nearly 1400 cardiac care patients per year use the services provided by the CM program at CPMC.
The growth of the CM program is primarily patient-driven. Many patients requiring cardiac surgery had already explored or used CM treatments and requested that these techniques be somehow integrated into their surgical regimen. In addition, as allopathic clinicians, physicians felt that the emotional, palliative, and/or preventive care requested by patients were areas that surgeons were not well trained to provide. The CM program could fill this void in the perioperative management of surgical patients. Hence, a separate CM service was established that would allow individuals with experience in the areas of prevention and/or health maintenance to interact with patients under the supervision of physicians.
Currently, the CM program at CPMC operates on a hospital-subsidized, fee-for-service basis. However, health care providers and former patients have approached health insurance organizations and requested reimbursement for these therapies. Some companies have been receptive, providing full or partial reimbursement and demonstrating an interest in supporting CM, while others have not. In all cases, health insurers have asked for more data and research about the efficacy of complementary therapies, a need that we are addressing.
This modality uses music's influence on the mind and body to ease the stress patients endure when undergoing open heart surgery. Patients listen to specially designed "hemisync," 5-tonal, or popular music tapes through headphones while anesthetized during surgery. Patients are encouraged to listen to the tapes preoperatively and postoperatively to support the recovery process. Of the patients entering the CM program, 80% chose this modality.
Hypnosis is used by many of our patients to help manage anxiety, depression, and, most importantly, pain. In our program, a hypnotherapist leads a patient through several steps of progressive relaxation. Although each hypnosis script is specifically designed to meet the particular needs and issues of the individual patient, during a typical session, the hypnotherapist will suggest that there will very little pain after the surgery or that the patient's spirits and attitude will be high and energetic. For many patients the experience of the intubation tube after coming out of anesthesia is traumatizing; hypnotherapy has been used to ease such anxiety. Hypnosis sessions are recorded on audiotape and patients are encouraged to listen to them before and after surgery.
Most people believe that nutrition is a pillar to recovery of health. Following open heart surgery, we have an opportunity to make dramatic modifications in our patients' diets (See below).
Both of these therapies are popular among patients in the program, and nearly 60% of patients entering the CM program use them. Massage therapy has been effective in relaxing patients as well as their family members during stressful episodes at the hospital. All massages are performed by licensed massage therapists, using various manipulative techniques that stimulate muscles. For those patients in whom body massage is contraindicated, reflexology is offered. Reflexology is the manual stimulation of the hands and feet. In traditional Eastern medicine, stimulation of certain points on the hands and feet can produce a "reflex" effect in other areas of the internal body.
This program was chosen by 15% of our cardiac care patients. We use a modified yoga routine to prevent injury to the sternum or manubrium in recent operated upon patients. Patients are led through a series of gentle exercises that allows them to stretch muscles that have been unused since the surgery and to focus on breathing techniques that will ease the strain on the thoracic cavity. In addition, yoga can be used to manage the daily stresses in a patient's life to prevent future recurrence of disease.
This therapy uses the sense of smell to restore the body to health. Aromatic oils, such as lavender and neroli, have long been believed to have a soothing effect on the mind and body. Physiologically, this may be reflected in an increase in parasympathetic nervous system activity. By measuring heart rate variability, we hope to determine what effects aromatherapy has on the body.
The most controversial modality is the use of therapeutic touch or energy healing. Practitioners move their hands over patients without physical contact in order to effect changes in their chakras, or energy meridians. With nothing more than a mindful intention to heal, the practitioner attempts to change a person's energy meridians, allowing the body energy to flow evenly and achieve a state of health. In 1997, 10 extremely skeptical patients found therapeutic touch to be remarkably helpful and have supported continued research and use of this treatment.
To meet the need for scientific research in the field of CM, the program at CPMC actively evaluates the efficacy of all modalities used by patients. In addition to delivering the therapies, practitioners and coordinators monitor and assess the outcomes of these interventions on the overall health of the patients.
To determine the benefit, if any, of the various complementary modalities, we study their effects using the following 4 health assays:
Autonomic nervous system function is gauged by monitoring heart rate variability frequencies in the intensive care unit setting or on the wards. By measuring heart rate, we can determine whether the complementary modality has a relaxing or stimulatory effect on the patient.
Cognitive function is studied using word pair selection biases.
Immune function is assessed using energy panels in vivo or using patient serum in vitro.
Quality of life is assessed using a moods' scale profile.
Patients who use CM modalities are followed prior to and after interventions at weekly intervals to assess short-term and long-term benefits. By using a multidisciplinary approach, incorporating assays of autonomic nervous system, cognitive function, immune function, and quality-of-life surveys, we hope to provide a model for investigating complementary modalities and to add substantively to the literature on this topic. Thus far, we have demonstrated that the use of hypnosis in the perioperative cardiac surgery setting results in a significant reduction in anxiety as well as a decrease in the amount of postoperative pain medication required by patients.2,3 Other studies are under way to determine the potential therapeutic properties of other complementary modalities.
The combination of multidisciplinary researchers, a well-equipped facility, and a relatively homogenous population consisting of cardiac patients will help us to identify the potential role of CM in the allopathic health care system. Our patients are already asking for this advice.
Oz MC, Whitworth GC, Liu EH. Complementary Medicine in the Surgical Wards. JAMA. 1998;279(9):710-711. doi:10.1001/jama.279.9.710-JMS0304-5-1