"I was lifting a patient to help assist him in getting back to bed," said Lisa Crespo, a nurse at the Novato Community Hospital in California. "I made sort of a twisting motion, and I felt a twinge in my middle and upper back."
So began a month-long ordeal with back pain, during which time Crespo resorted to pain pills, muscle relaxants and cortisone shots - all without providing significant relief.
At that point, she turned to a different form of care - acupuncture - but she didn't have to go very far for treatment. Her acupuncturist was Pat Sanders, a fellow employee at the hospital.
"I was amazed at how well it worked and relieved the pain," said Crespo. "I actually believe in traditional medicine, where you take a pain pill if you're in pain, but the fact that you could stick a needle in and relieve pain, this is great."
Crespo's story is one that is becoming increasingly familiar. Across the country, hospitals have begun blending conventional and alternative forms of care, creating what is often referred to as "integrative medicine." It's sprung up in places such as Duke University Hospital in North Carolina, New York's Memorial Sloan-Kettering Cancer Center and Cedars Sinai Medical Center in Los Angeles, and as more research becomes available, more hospitals have begun utilizing integrative medicine in their settings.
Sanders was hired as a nurse practitioner in October 2000, after working as an acupuncturist in private practice the previous 18 years. She developed the hospital's acupuncture program protocols in December 2001, and has treated patients with acupuncture on a full-time basis since March 2003.
Sanders primarily treats people with work-related injuries out of Sutter@Work, an occupational medicine clinic at Novato Community and at Marin General Hospital in Greenbrae. This year, the service was opened to members of the pubic as well.
"The doctors were very excited" about Sanders, remarked Patrick Golver, director of Sutter's occupational health department. "Here was this actual nurse practitioner who also does this (acupuncture) - it helps her credibility in the physician community."
Less than 10 miles away from Novato Community, at the Kaiser Permanente Medical Center in Terra Linda, licensed acupuncturist Elon Rosenfield sees patients in the center's physical therapy department. Rosenfield was the first acupuncturist on staff at the hospital, and has been seeing patients for two-and-a-half years.
"A lot of people who are sent for acupuncture have been in pain for a long time, and nothing helped, so they really appreciate when it works," explained Randee Allen, director of the physical therapy department. "It can be a life-changing thing for some people - they couldn't walk to the bus stop before, and now they can. It's a big thing for them."
Although some parts of the country have been slow to accept acupuncture, its use in hospitals is growing. A survey conducted by the American Health Association in May 2003 found that one-sixth of all hospitals in the U.S. - 16.7 percent - offered some form of complementary or alternative medicine, with acupuncture one of the most oft-used therapies.
Still, many acupuncturists on staff at hospitals acknowledge that they are limited in terms of the conditions they can treat. Karen Reynolds, an acupuncturist with a private practice in Walnut Creek and a registered nurse at Kaiser Permanente Medical Center in San Francisco, said that while Kaiser has on-staff acupuncturists at all of its medical centers in the Bay Area, she didn't apply for any of the positions because she know she would not be able to treat the full range of conditions she was trained for.
"Since it's new in this country, and a lot of the research is from China and Japan, there's a barrier to getting the research, and it's hard for the American Medical Association to endorse it fully," she said.
Sanders added that while she is trained in Chinese herbology, she does not use it with her outpatients because herbal treatments would be too difficult to administer in a hospital setting. She also does not perform moxibustion; instead, she uses heat lamps and microcurrent stimulation.
"I try to keep things simple," Sanders said.
In some places, however, many of the barriers to truly integrative medicine are slowly, finally coming down. At Cedars Sinai Medical Center in Los Angeles, staff acupuncturist Evan Ross sees between 90 to 100 patients a week for a variety of conditions, including stroke-induced motor impairment, nausea and vomiting. He is routinely called in by primary physicians for acupuncture consultations.
"I just did a lecture to the liver transplant team," said Ross. "They're thinking of using acupuncture in surgery, for post-op pain, and for nausea, vomiting and bowel problems, post-op, for patients who don't tolerate medicines and drugs."
In 1972, Mill Valley physician Martin Rossman became one of the first doctors in the Marin area to begin practicing acupuncture. Thirty-two years after he started practicing, he calls the use of acupuncture in the hospital setting "wonderful."
"Every step like this brings us closer to a real integration of acupuncture and Western medicine," said Dr. Rossman, echoing the sentiments of many people. "I don't think it matters where a person gets treated - it's more important whom they get treated by, the person's qualifications, (and) their experience."
Brenner K. Marin hospitals are taking an integrated approach with acupuncture. Marin Independent Journal, April 12, 2004.