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Integrative Medicine: A Clinician's Journal logoLink to Integrative Medicine: A Clinician's Journal
. 2018 Apr;17(2):58–61.

Caring for the Caregiver: A Lifestyle Intervention for Caregivers of Dementia Patients

Yani Lu, Kenneth Thrasher, Kulwinder Fayssoux, Denise Latini, Joseph Scherger
PMCID: PMC6396753

Abstract

Introduction

It is estimated that 5.5 million Americans were living with Alzheimer’s dementia in 2017. Most people with Alzheimer’s dementia have a long duration of illness before death. On average, they will spend at least 40% of this time in a state of disability and dependence. It is challenging to care for a person with progressive memory loss, functional impairment, psychiatric/behavioral disturbance, and health complications. Compared with caregivers of people with other conditions, dementia caregivers tend to provide more extensive, intensive, and longer assistance and experience financial, emotional, and physical difficulties. They are often so concerned with their loved ones’ needs that they lose sight of their own well-being. The authors designed a pilot comprehensive lifestyle intervention with the goals of (1) helping caregivers arouse awareness of self-care, (2) teaching them coping techniques for emotional well-being, and (3) educating them about healthy lifestyles for overall physical health.

Methods

The intervention’s 4 aspects included (1) 12 weekly 90-min classes that taught breathing technique, meditation, and therapeutic yoga; (2) 12 weekly 1-h lectures on the topics of diet and nutrition, exercise, sleep, stress management, and the latest research in dementia prevention and treatment; (3) weekly 1-h support group meetings; and (4) regular exercise and meditation at home.

Outcome Measures

Subjective measurements included the medical symptoms questionnaire, the caregiver self-assessment questionnaire (American Medical Association), the Center for Epidemiological Studies depression scale, and the 10-item perceived stress scale. Objective measurements included weight, body mass index, waist/hip circumference, body-fat percentage, blood pressure, pulse, HbA1c, fasting glucose, and a lipids panel.

Results

Of the 17 people who participated in the intervention, 2 were males. The average age was 71 y, with a range of 54 to 83 y. At baseline, most participants (70%) had sleep problems, felt no or a little motivation to exercise (77%), ate too much under stress (53%), were not using any relaxation technique (82%), and felt an excessive amount of stress (77%). By the end of the intervention, all participants stated that they found this lifestyle intervention useful in their daily lives and reported improved physical health, mental health, sleep quality, and stress-coping skills. Regarding how much they had changed their lifestyle, responses of “no change” or “little change” were not selected by any participants, 3 participants chose “some change,” and the rest of the participants chose either “fairly much” or “very much.”

Conclusions

Lifestyle changes including diet, exercise, sleep, and stress management constitute an effective approach to improving the overall wellness of caregivers of dementia patients. The authors believe improved caregiver wellness will also benefit their loved ones with dementia, other family members, and friends.

Integr Med (Encinitas). 2018 Apr;17(2):58–61.

Massage Therapy in an Orthopedic Hospital: Evaluating EPIC Documentation and Outcomes

John Q Erwin, Erika Cappelluti, David Santoro, Eric Cheffer, Sherry Stohler, Eric R Secor Jr

Abstract

Introduction

Hospital-based massage therapy is being utilized to provide comfort and reduce pain, with increasing frequency. Evaluation requires medical team referral and documentation via electronic medical records. In collaboration with the Hartford HealthCare Bone and Joint Institute (BJI), we initiated a pilot program to determine the feasibility providing postsurgical massage and documenting within EPIC.

Objectives

The key quality assurance questions investigated whether therapists document referrals in EPIC. We also investigated whether quality of life be documented in EPIC.

Methods and Design

Massage therapists retrieved EPIC referrals and provided massage at BJI, primarily to nonsurgical (contralateral) limb. Pain, anxiety, and nausea were documented in EPIC (November 22, 2016, through August 13, 2017).

Results

Of the patients included in the study, 66% were female, 76% were Caucasian, 10% were African American, and 8% were Hispanic. The age range was 20 to 94 y and averaged 59 y. Massage patients experienced significant reductions in pain (6.2 to 4.3; P < .00001), anxiety (5.9 to 3.0; P < .0001), and nausea (3.6 to 2.2; P = .01).

Conclusions

The incorporation of massage practice into hospitals requires pilot programs to determine potential for success. This pilot with BJI and integrative medicine demonstrated that it is feasible to access patient referrals in EPIC; provide massage to orthopedic surgical patients; and document changes in pain, anxiety, and nausea within EPIC. Future research may determine how postoperative massage effects the duration of quality-of-life improvements and hospital length of stay, as well as reductions in the use of opioid medication.

Acknowledgements

We would like to acknowledge the orthopedic team (physicians, nurses, administrators) who participated. Funding for this pilot and publication were provided by the Bone and Joint Institute and the Cancer Institute, Department of Integrative Medicine at Hartford HealthCare, Hartford, CT, USA. The authors have no conflicts of interest to disclose.

Integr Med (Encinitas). 2018 Apr;17(2):58–61.

Durable Clinical Remission of a Skull Metastasis Under Intralesional Viscum album Extract Therapy: A Case Report

Paul Georg Werthmann, Roman Huber, Gunver Sophia Kienle

Abstract

Background

Skull metastases are rare and mostly asymptomatic, but they can cause pain and carry the risk of an invasion into the brain. Radiotherapy can be effective and surgical excision is sometimes used with mixed results; however, clinical studies comparing different treatment options or evidence-based practice guidelines are not available. Viscum album extracts (VAE) used as an adjunct treatment in cancer patients show immune-modulating and cytotoxic properties, as well as positive impact on quality of life and sometimes survival. Durable regression of malignant and premalignant lesions after intratumoral application of VAE have been reported in case reports.

Case Presentation

A 68-y-old woman was diagnosed with rectal cancer and lung metastases. After surgical resection and various chemotherapy regimens, she experienced periods of stable disease. However, during the course, metastases to multiple bone sites, the chest wall, and the liver were identified. Histological examination of 1 of the bone lesions revealed a follicular thyroid carcinoma. An osteolytic parietal bone lesion progressed to a metastasis of the skull despite radiation and chemotherapy. The patient asked for additional integrative medical treatment for this painful metastasis. Intralesional VAE treatments were applied weekly into the skull metastasis. After the first application, the patient felt pain relief and softening of the lesion. After 8 mo of continued VAE treatment, the metastasis showed partial remission (>50%) and then remained stable for 2 y, with the patient enjoying a good general condition. After this time, the condition deteriorated, and the patient died from progressive disease 77 mo after initial diagnosis.

Patient’s Perspective

“My whole well-being has changed and I’ve got more energy to do my things. Beforehand, there were days where I felt completely powerless and I wanted to give up. The mistletoe treatment helped me there.”

Conclusion

This case shows a durable clinical remission of a metastasis to the skull in a patient with rectal and thyroid cancer. Case reports about high-dose intratumoral VAE treatment in different cancers have previously shown positive results. Therefore, further investigations of intratumoral VAE treatment seem highly worthwhile—especially in symptomatic skull metastases not responding to radiotherapy or systemic therapies.

Footnotes

Author Disclosure Statement

The authors thank Stiftung Integrative Medizin (Stuttgart, Germany) for the financial support.

Integr Med (Encinitas). 2018 Apr;17(2):58–61.

Sarracenia purperea: A Botanical Extract With Anti-papilloma Virus and Oncolytic Activity

M Moore, J O Langland

Abstract

Introduction

Extracts of the botanical S purpurea have historically been reported to be effective in the treatment of smallpox. These extracts have broad antiviral activity inhibiting the replication of poxviruses, papovavirus SV-40, and various herpes viruses. Many of these, or related viruses, including human papillomavirus (HPV) and Epstein-Barr virus, are associated with various human carcinomas. Treatment of HPV-transformed human cervical carcinoma SiHa cells with Sarracenia inhibited accumulation of HPV oncoproteins E6 and E7, increased expression of cellular p53, arrested SiHa cell growth at low doses, and induced SiHa cell death at higher doses. Thus, Sarracenia extracts contain broad antiviral activity with the potential to induce oncolytic activity in viral-transformed cells.

Purpose

HPV infections are the most common sexually transmitted infection in the United States. Several types of cancer are associated with HPV, including cervical, anal, penile, and oropharyngeal cancers, as well as the HPV association with common warts. Although vaccines for HPV aide in prevention, therapeutic treatments are limited. In this study, we evaluated the anticancer potential of a botanical with known antiviral activity. In our previous work, we identified the botanical, S purpurea, as having broad antiviral activity against several DNA-genome viruses. This study sought to further evaluate the effect of S purpurea on HPV and cervical carcinoma cells.

Results and Methods

HPV growth in cell culture systems is currently unavailable. The papovavirus, SV-40, is a virus related to HPV. S purpurea was able to prevent viral induced cytopathic effects on Vero cells infected with SV-40. Furthermore, the extract of S purpurea did not induce any cellular toxicity on uninfected cells. When subconfluent (day 1) cervical carcinoma cells (SiHa) were treated with increasing concentrations of S purpurea (0-20 mL/mL), a dramatic reduction in the replication rate of SiHa cells was observed. At higher doses of S purpurea (20 mL/mL), cell death characteristic of apoptosis was observed. The reduction in replication rate was quantified in the graph shown. To confirm the activity of S purpurea toward cervical carcinoma cells, various cell lines, including SiHa (cervical cancer, HPV+), C33A (cervical cancer, HPV-), HFF-1 (foreskin fibroblast), and primary bronchial epithelial cells, were treated with increasing concentrations of S purpurea and assessed for cell viability. Both cervical carcinoma cell lines were inhibited following treatment with S purpurea, whereas the noncervical carcinoma cells remained relatively unaffected. The C33A cells were non-HPV transformed, possibly suggesting a broader effect associated with S purpurea. When SiHa cells were treated with increasing concentrations of S purpurea, a reduction in the level of the HPV E6 and E7 oncoproteins was observed (control: GAPDH levels). Concomitantly with the decrease in viral oncoproteins, a corresponding increase in cellular p53 levels was observed.

Discussion

To create significant advances in the fight against cancer, development of novel, efficacious treatments must continue. Botanical therapies present as a widely unexplored segment of medicine with tremendous potential. S purpurea has traditionally been used as an antiviral against smallpox, but it is also effective against other viruses, such as HPV and herpes. HPV viruses encode the oncoproteins E6 and E7, which form complexes with tumor suppressor gene products, including p53. Our studies demonstrate that S purpurea inhibits the accumulation of HPV E6 and E7 with subsequent recovery in the levels of p53. This recovery in p53 levels likely results in the initial reduction in cell division rates and, at higher levels, leads to the induction programed cell death, or apoptosis, in these HPV transformed cells.

Conclusions

S purpurea shows potential promise as an effective treatment for HPV- and likely herpes virus-associated cancers including cervical cancer and Epstein-Barr virus-associated carcinomas. Botanical extracts should continue to be studied as a resource in the fight against cancer as the active constituents may provide novel therapeutic approaches.

Articles from Integrative Medicine: A Clinician's Journal are provided here courtesy of InnoVision Media

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