practice profile

THE FOCUS ON Whole-Body Wellness

How I incorporated holistic health care into my practice.

ELISE BRISCO, O.D., F.A.A.O., F.C.O.V.D., Los Angeles, Calif.

The consumer-driven healthcare market demands more than reactive medicine — it requires a preventive-focused, wellness care approach. Patients today understand the value of proactivity regarding their health. With prevention and wellness, there is a growing popularity for complementary and alternative medicine (CAM). The National Institute of Health defines CAM as "a group of diverse medical and healthcare systems, practices and products that are not presently considered to be part of conventional medicine."

In my experience, patients want healthcare practitioners who incorporate both medical care and wellness care into their treatment plan. Physicians who have yet to embrace CAM may alienate these patients causing them to turn directly to pharmaceuticals or surgery.

CAM on the rise

National surveys estimate that approximately 40% of Americans incorporate CAM into their healthcare.¹ The use of homeopathy and nutraceuticals (a food or naturally occurring food supplement thought to have a beneficial effect on human health) are on the rise.² Many of my patients take supplements that they read about on the Internet as being "good to take."

As optometry has grown to become an entry point into the healthcare system, many optometrists now offer a diverse range of patient-care services, including CAM.

Incorporating holistic CAM into vision care is natural because many systemic problems affect the visual system. Also, many of our patients don't undergo physical exams regularly, yet they visit us annually. Therefore, we can provide better care for our patients by offering full-scope care and by directing them to other members of the healthcare system when necessary.

Hollywood Vision Center presents complementary and alternative medicine in a tranquil atmosphere.

Creating wellness

After years of both professional and personal success combining traditional medical care with CAM, I created an integrated wellness center. To begin, I interviewed doctors who embrace the vision that holistic healthcare centers around wellness care and the best modern medicine has to offer.

Offering complete care requires an investment in knowledge, staff and equipment. This adds credibility to the concept of holistic care with you, the optometrist, as the primary-care advisor. I regularly invest a high percentage of our profits back into the practice by hiring only experienced staff, with at least five to six years experience in either optometry or ophthalmology, and purchasing state-of-the-art diagnostic and refractive equipment. In my practice, this includes the Heidelberg Retina Tomograph (HRT III), Topcon automated phoropter and corneal topographer, Canon retinal camera and Synemed digital software, the Humphrey Visual Field Analyzer and DGH Pachymeter. Such equipment helps to increase our diagnostic and management capability while improving our efficiency.

In addition, I built a new office that has seven operatories that are both spacious and welcoming. The space doesn't look like a doctor's office; I no longer hang posters of various eye diseases or optical devices. Our office looks like a tranquil spa, using the colors of nature, and water features, which is conducive to healing and relaxation.

Building blocks of wellness

But office aesthetics are only a small part of incorporating holistic, multi-disciplinary wellness care into my practice. The following are the more significant ingredients.

► Stress management. My practice is located in the hometown of celebrities and high-level entertainment executives. These Type-A patients are often emotionally and physically stressed. I learned it was no coincidence that these patients also suffered from repeated eye infections. Chronic stress prevents glucocorticoid hormones' ability to terminate an inflammatory response following infection and/or injury.³

It may also increase susceptibility to inflammatory diseases, such as allergic, auto-immune or cardiovascular diseases.

We routinely ask patients about stress in their lives. Inevitably, they report depression, fatigue, allergies, auto-immune disorders or frequent illness. If they have an eye infection, I can often diagnose the condition quickly and accurately through our imaging equipment. I treat the acute infection appropriately and recommend a full physical examination. Then, I discuss stress management options and make referrals for activities, such as yoga, meditation, biofeedback therapy, exercise and acupuncture. Let me describe acupuncture a bit more fully.

► Accupuncture. Through the use of very fine needles inserted into the skin at strategic points, acupuncture helps relieve pain and treat disease. The Chinese developed acupuncture in accordance with the theory that energy flows through channels between the surface of the body and internal organs. The human body has more than 2,000 acupuncture points that connect with 12 main and eight secondary "meridians," or channels. Pain and disease are the result of these channels becoming blocked. By placing needles at one end of the channel or the other, healthy energy can be restored.⁴

The placement of acupuncture needles at specific pain points releases endorphins and opioids — the body's natural painkillers — and immune system cells, as well as neurotransmitters and neurohormones in the brain. Research has shown that glucose and other bloodstream chemicals become elevated after acupuncture. This helps combat stress and depression.⁵ According to the National Institutes of Health's National Center for Complementary and Alternative Medicine, there is evidence that stimulating acupuncture points enables electromagnetic signals to be relayed at a greater rate than under normal conditions.⁶ This increases the flow of healing or pain-killing natural chemicals to injured areas. We employ a Doctor of Chinese Medicine at our Center for acupuncture referrals.

► Pain management and rehabilitation. Up to 8% of patients suffer from nerve pain after stroke. This central pain can be described as burning or shooting and is more common after a Thalamic stroke. Most frequently, we see patient's who have Thalamic Pain Syndrome, also known as Dejerine-Roussy Syndrome. These patients have pain on one side of their body. This pain is treated with antiepileptics or anti-depressants. Patients have a decrease in their pain but completely treating it can be very difficult. I refer my patients for a pain management consultation whenever they complain of chronic pain.

► Internal medicine, cardiology and acquired brain injury. Essential hypertension or high blood pressure (HBP) affects approximately 75 million Americans, roughly 25% of our population. Risk factors include obesity, high salt intake, genetic predisposition, kidney failure and African-American ancestry. HBP increases the risk for stroke and cardiovascular disease.

Sadly, many people with essential hypertension don't know that their blood pressure is elevated because uncomplicated HBP generally occurs without symptoms. Few patients may have symptoms, such as headaches, dizziness or shortness of breath. Thus it's known as the "silent killer." In the interest of whole patient care, we make blood pressure and cardiovascular history screenings a part of our primary-care vision exam.

I've been surprised at how many of our patients have undiagnosed hypertension. Recently, during a routine eye exam, I advised a 46-year-old white male patient to see an internist or cardiologist immediately after determining that his blood pressure was high (145/108). He wasn't obese and considered himself in relatively good health, nor did he have a known history of hypertension. Unfortunately, he chose not to follow my recommendation. Three months later, he presented to me after suffering from a left occipital hemorrhagic stroke. As a result, he experienced diplopia and frequent loss of place while reading, which is why he returned. He is now under the treatment of a team of neurologists and internists and is recovering nicely.

Last month, a 47-year-old white female presented with HBP of 150/110 despite currently taking Hyzaar (losartan potassium-hydrochlorothiazide, Merck) for HBP. Upon my referral, she promptly visited her cardiologist. He changed her medication and told her that if she hadn't sought treatment, she may have suffered serious health problems. Her systolic BP was 202 when she was examined by her cardiologist. She recently came into the office to thank me for looking out for her overall health, not just her ocular health.

A broad view for healthcare

Caring for patients means caring for them as whole human beings rather than addressing only their visual needs. I've incorporated healthcare practitioners from a variety of disciplines to care for our patients as a multi-disciplinary wellness team. Patients have embraced our model, and we've become better doctors because of it. OM

1. Barrett B. Complementary and alternative medicine: what's it all about? WMJ 2001;100(7):20-26.

2. Global TGI Barometer, January 2008 Issue 33: "The lure of alternative medicine." www.tgisurveys.com/documents/TGIbarometerhomeopathy_Jan08. pdf. Accessed Oct. 15, 2008.

3. Miller, G, Cohen, S, Richey AK. Chronic psychological stress and the regulation of pro-inflammatory cytokines: a glucocorticoid-resistance model. Health Psychol. 2002 Nov;21(6): 531-41.

4. Hui KK, Liu J, Makris N, et al. Acupuncture modulates the limbic system and subcortical gray structures of the human brain: Evidence from fMRI studies in normal subjects. Hum Brain Mapp 2000; 9: 13-25.

5. Levine JD, Gormley J, Fields HL. Observations on the analgesic effects of needle puncture (acupuncture). Pain 1976 Jun; 2(2): 149-59.

6. NIH Consensus Development Program: Acupuncture. "National Institutes of Health Consensus Development Conference Statement, November 3-5, 1997." http://consensus.nih.gov/1997/1997Acupuncture107html.htm. Accessed Oct. 16, 2008.

Dr. Brisco is in private practice in Los Angeles. She co-founded the Rehabilitative Vision Clinic at the Cedars Sinai Medical Center. She is a Fellow of both the American Academy of Optometry, and the College of Optometrists in Vision Development. Contact Dr. Brisco at hollywood_ vision@yahoo.com.