From East to West
DR. ERMINIA (“Mimi”) Guarneri’s office bears slight resemblance to a traditional doctor’s office. Hers contains a fitness center and vegetarian cooking school, and it employs biofeedback, yoga, music therapy, meditation and acupuncture as part of its healing.
At the Scripps Center for Integrative Medicine, Guarneri and her staff blend high-tech Western medicine with Eastern treatments that, as Guarneri says, “complete the whole circle of care.” While she is best known for her work with heart patients, the center also treats those with chronic pain, weight management issues, diabetes, cancer, stress and women’s-health issues.
Guarneri, a licensed cardiologist, founded the Center for Integrative Medicine in 1999 with a vision to heal patients through a combination of science and compassion. Her recently published book, The Heart Speaks, is a collection of case histories of heart patients who have benefited from her unique brand of integrative medicine.
Lately, Guarneri has been investigating the controversy surrounding hormone replacement therapy, or HRT, for women who are in or entering menopause.
“A negative slant to HRT occurred when patients taking the hormones Premarin and Provera had a higher incidence of blood clots and cardiovascular events,” Guarneri says. “Many women threw away their hormones—and this occurred after doctors had been recommending hormones because women who took them lived longer and stayed healthier.”
She took a closer look and found that further investigation is needed about the different kinds of hormones prescribed to women. “The way we approach it is: Everyone is an individual,” says Guarneri. “Indications for use of HRT need to be done on a one-to-one basis.”
HRT using bioidentical hormones—those hormones women create naturally, such as estriol and estradiol—is gaining favor, along with non-hormone alternatives such as calcium, vitamin D and exercise to help build bones and prevent osteoporosis.
Guarneri says menopause is essentially estrogen withdrawal, and since symptoms—including insomnia, hot flashes, sweats and inability to focus—vary among women, it’s advantageous to gear the menopause treatment to each individual’s symptoms. “For women with profound symptoms, this might be a good time to use hormones for a short period of time and then slowly taper them off,” she explains. “We want to tailor the treatment to the woman’s needs.”
If a woman is feeling stressed, Guarneri might recommend yoga, meditation, tai chi and simply getting a good night’s sleep. “All are important to a person’s well-being and feeling good,” she says. A woman who visits the Center for Integrative Medicine will spend an hour with a nutritionist, because “food is medicine,” she adds.
SOMETIMES, menopause symptoms can be diagnosed as another illness, with potentially serious consequences. Claudia Christman, a doctor herself, suffered chest and arm pain during menopause and was treated for heart disease.
“Claudia was going through estrogen withdrawal, and she had coronary spasms,” says Guarneri, “to the point where a stent [a tube placed to keep a vessel open] was added—when all she needed was her hormone-replacement therapy. She was completely misdiagnosed.”
“My physician said I was fine, but I never got back to normal,” Christman says. So she decided to seek a second opinion. A friend, who attended a seminar Guarneri gave on integrative medicine, recommended the Center for Integrative Medicine. Guarneri completed Christman’s diagnosis using Scripps’ state-of-the-art 3D imaging, and then recommended she take medication, avoiding possible open-heart surgery.
Christman made lifestyle changes, too. She left the stressful world of an operating-room doctor and now practices on Hawaii’s Big Island, specializing in integrative medicine. But she credits Guarneri with seeing that her heart problems were due to menopause rather than heart disease.
“Dr. Guarneri said I was lucky because my heart actually spoke to me,” says Christman. Part of the problem for her was not realizing how stressed she really was. “I didn’t realize that as an ER doc I was stressed, because you have to continuously be calm in the face of disaster,” she says.
Christman says she learned through integrative medicine how to control factors that were having an adverse impact on her health. “I found there were things in my life I could change,” she says, including altering her diet and cutting out sugar, learning to manage her stress and taking meditation classes. She also says her heart was becoming a “stress-catcher.”
“I was running other people’s stress through my heart,” she explains. “I’m trying to use my mind to do that now.”
Of the Center for Integrative Medicine’s effect on her health, Christman says, “It’s been a huge, positive difference. I feel like I got my life back, and I’m back to my normal self.”
THE STAFF at the Center for Integrative Medicine includes a gynecologist, Dr. Vivian Ellis. She believes an OB/GYN is in the perfect position to practice integrative medicine.
“Who better to relate to integrative medicine?” she asks. “Because integrative medicine is also individualized medicine.” Ellis also says that misconceptions need to be addressed about integrative medicine.
“The purpose of medicine is not to write prescriptions or do surgeries,” she says. “When some people talk about ‘alternative medicine,’ it winds up being a wastebasket term to include any prejudices, quackeries or smoke and mirrors that would be excluded by conventional medicine. Mainstream medicine is a cornerstone of what we do.”
Treatment becomes integrative when it takes into account “all the aspects of a woman’s lifestyle, all the seasons of a women’s life and all the layers of mind, body and spirit,” Ellis says. “This can include behavior modification to help her in achieving her goals, techniques like meditation, yoga, paying attention to personal relationships and stress management, diet, exercise, education, vitamins and coaching.”
OB/GYNs are also on the front line of diagnosis for all types of disease, says Ellis, because women regularly visit their OB/GYNs for Pap smears and breast exams. “Plus, a woman is usually the caregiver in her family and makes health-directed decisions for others,” she adds.
Women should also pay closer attention to their risk of heart disease, which kills about 500,000 women each year. Ellis cites an American Heart Association study that found 40 percent of women don’t perceive themselves at risk for heart disease. “So the integrative part is in empowering the patient,” she says.
“What we’re trying to trying to do is to have an awareness and pass it on to patients,” says Ellis. “Heart disease in women is underrecognized, underdiagnosed and undertreated, and the OB/GYN is front line on this because she’s the only doctor women might see. So for us, helping women assess and decrease the risk and practice heart-healthy lifestyles is what we do every day.”