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Non-Pharmacological and Natural Treatments for Nerve Pain, Part 1

Can lifestyle changes help with nerve pain? Yes. There is scientific evidence out there showing diet and exercise can lead to a decrease in neuropathy symptoms from diabetes (diabetic neuropathy). 

Integrative Medicine: IM Living History



Integrative Medicine:
IM Living History

A physician’s narrative on her twenty-year personal journey to practicing Integrative Medicine… on her own terms

College Kava Kava

It was early 2000, and Fiona Apple was blasting from the speakers in my college dorm room. I was lying on the floor, experiencing the first and only panic attack of my life. An important class presentation was coming up next month, and I was petrified of speaking in public. Those who knew me would have laughed. How could the teenager who was a regular in high school musicals and drama productions be freaking out? There simply was no answer for why, in that moment, the fear had taken me over. It was my raw determination that got me up off the floor and got me to student health, where I was diagnosed with situational anxiety and brief recurrent depression. 
After starting psychological counseling that week, I decided first to try herbal or dietary supplements before discussing prescription medications with my medical provider. As a pre-med student, I enthusiastically delved into researching supplements for mood and found several that had promising scientific evidence for treatment of mild anxiety and depression. A trip to my local health food store led me to buy St. John’s Wort and Kava Kava. I also researched and started practicing visualization and stress reduction techniques used by performers and competitive athletes. Within several weeks of taking the supplements and practicing the visualizations, I found myself calm and centered. With my regained confidence, I aced my presentation! I weaned myself off the supplements over the next month. My suite mate knew about what happened and invited me to attend her meditation program at the residence hall. A small group of us sat down with her for a meditation workshop one evening, and I left feeling energized and invigorated. 
This experience opened me up to a new way of thinking and being. It left such an impression that I continued to use the visualization and meditation techniques to manage the enormous stress I encountered when studying for the MCAT examination the following year. The Kava Kava came back into use a few times (mostly after the September 11th terror attacks), but I was able to manage my anxiety without consistently needing it. My new interest in Complementary & Alternative Medicine (CAM) was evidenced by my old college term papers, researching multiple CAM topics with emphasis on the treatment of mood disorders.  

Med School Circle of Healers

My first day of medical school, I was thrilled to be finally meeting people just like me, future doctors dedicated to helping those in need. Little did I know that we were the ones in need! First year of medical school was intense, and I sadly remember hearing news about a number of my classmates dropping out in the first months. Dropping out also crossed my mind…almost every day that year. There was a deep sense of despair, accompanied by the feeling like I did not belong in medical school. 
The despair led me to search for solutions and meaning. That is when I came across an e-mail from the American Medical Student Association (AMSA) for the Circle of Healers retreat. To this day, I do not recall how I scrapped the money together to fly out to San Jose. What I do recall is arriving late at night after missing my connecting flight and seeing a sky completely full of stars when I stepped out of the car. (This is something you'd never see in New Jersey, by the way.) Literally, a circle of healers greeted me inside the meeting room, a group of the kindest people I have ever met. They were medical students from all over the country, holistically minded and committed to bringing profound healing to the world through their work. I cried tears of relief and joy during that entire weekend, and I found a strength inside me that has never left me since. 
From that moment on, I focused on bringing wellness back to my medical school. My contacts from AMSA encouraged me to step up and volunteer to be the chapter president for my school. I also volunteered to direct the student elective in Complementary and Alternative Medicine (CAM) and to start an interest group in Cross-cultural and Integrative Medicine. A group of my classmates and I found student massage therapists to treat  classmates to chair massages after our first examination. We also organized a free medical student yoga class, meditation group, and essential oils workshop. We invited inspirational doctors to come speak and share the joys of practicing medicine to boost our morale. The school faculty and administration supported all our student wellness initiatives.
The National Center for Complementary & Alternative Medicine (NCCAM) provided grant money to AMSA for CAM medical student leadership training. My resources and contacts through the CAM leadership training program allowed my school to receive a small grant to enhance education. The CAM elective and interest group improvements (via the grant) were highly successful and led to us advocating for inclusion of Integrative Medicine education into our medical school curriculum. 
My experience came full circle when I volunteered as a national officer for AMSA for the Humanistic Medicine Action Committee (sadly, no longer in existence) and helped organize the Circle of Healers retreat my last year of medical school. Giving back the same compassion that I received my first year of medical school, completed my journey and passed the torch to those after me.

Residency Vitamin D

An extremely difficult decision lie ahead of me, but I chose the specialty of Physical Medicine & Rehabilitation (PM&R) over being a primary care physician. I knew my opportunities for training and jobs in Integrative Medicine were few and far between if I chose PM&R and that I would have to pave my own way. Nevertheless, it felt right at the time because PM&R was a fulfilling, holistic speciality that encompassed a variety of exciting skills, including internal medicine.
Internship and residency left little time for self-reflection and care with 80 hour work weeks and frequent overnight call. The meditation techniques only went so far, so I found myself back in counseling, unloading the trauma and enormous grief I experienced watching patients die under tragic circumstances. My father was also dying of a rare illness with no cure, and I felt enormous guilt about continuing with residency far away from home. At that point, I was on prescription anti-depressant medication periodically, as I was diagnosed with Seasonal Affective Disorder after working winter night shifts which drastically altered my mood and sleep patterns. 
When I moved to Chicago for residency, I established care with an Integrative Medicine primary care doctor who discovered my extreme fatigue was due to low vitamin D levels. My energy levels and mood gradually returned to normal with proper supplementation, and I resumed my distance running exercise and training program which also boosted my mood and energy. An internet search led me to Mindfulness-Based Stress Reduction (MSBR), and I was practicing this in my free time via books and internet due to my inconsistent schedule. If it wasn’t for my doctor and these practices, I probably would have dropped out of residency after my father died. I also probably would still be taking anti-depressant medication every season, not knowing that my extreme fatigue was mostly due to lack of vitamin D.
During my residency, I looked into opportunities to become an integrative medicine fellow. Unfortunately, these opportunities were only open to primary care physicians. The only fellowship (at the time) accepting specialists was through University of Arizona and required you to pay over $20,000 for the training. I had no money at the time, so I decided to practice Integrative PM&R based on my knowledge and experience alone. 



Finally Fellowship

Through a rigorous self study program, I became certified in Integrative Holistic Medicine in 2013 while working full-time. Then the announcement came later that year—the American Board of Physician Specialities would sponsor an official board certification in Integrative Medicine. My (unofficial) certification still stood, but my certifying agency, the ABIHM would dissolve by the following year. To be eligible for the official board certification, I would have to complete a fellowship in Integrative Medicine while continuing to work full time. 
In 2014, I took out a $30,000 bank loan at 7% interest to cover my expenses for the 2015 University of Arizona Fellowship in Integrative Medicine, a 1,000 hour distance learning program with in-person experiential weeks. The program exceeded expectations but did not increase my chances of securing a job in Integrative Medicine. Sadly, I was told that almost all the open job positions were funded by departments of Family Medicine or Internal Medicine. They were looking for integrative primary care practitioners, not an integrative PM&R specialist. Other job positions open to hiring preferred someone trained in Functional Medicine or acupuncture (training requires $7,000-12,000 and hundreds of hours of additional coursework). 
My worst nightmare was coming true, but I always knew that it would come down to me paving my own way within my specialties. I considered opening my own practice many times but had hefty medical school loans, no capital, and absolutely no business experience. I always had a choice to chart my own course or continuously try to convince my employers to invest in my philosophy of Integrative Medicine. 

Practice Patience 

My clinical medical practice is and has been centered on treating people with sports, spine, auto accident, and occupational injuries. Most of the time, the diagnoses and treatments are straightforward. However, I found that my co-workers were referring a large number of patients with unexplained chronic pain to me. Much to their chagrin, I was spending up to an hour with each patient in the examination room, listening to their stories and discussing integrative options for treatment. Unfortunately, this did not fit well with the flow of a high volume multi-provider practice with limited space and exam rooms. There were many discussions and compromises that had to be made on both sides to accommodate seeing these patients and keeping the clinic running efficiently. My integrative pain management approach was well-received by most patients; however, some did not agree with my philosophy or approach. The disagreements were mostly over the medical necessity of opioid medication and the danger of combining opioid medication with benzodiazepines. 
Early in my practice, there were few disagreements, as I had been taught (in conventional training) that opioid medication could be beneficial for chronic pain and doses should be increased up to maximal effect. However, in actual clinical practice, I starting seeing patients on hundreds of milligrams of opioids who were not benefiting after multiple dose increases, multiple medications, and combination with other agents like ketamine. I spent a good amount of time managing the side effects of high dose opioids, instead of actual pain management. I read a growing number of case studies describing accidental overdoses and concern over an opioid epidemic (later confirmed as a national health crisis). 
I started to limit my opioid prescribing and take vigilant precautions in screening patients to identify those at high risk for complications using opioid pain medication. Obviously, this did not go over well for some patients who expected to continue on their medications for pain and did not want any change to their routine. Misunderstandings arose to the point that I decided in the last few years that I no longer wanted to prescribe opioids for chronic pain due to the negative effect it had on the patients’ health, the doctor-patient relationship, and my ability to provide high quality compassionate care. This decision was viewed as highly controversial by some colleagues and patients because opioid medication is still widely prescribed for chronic pain, even in some integrative medicine pain practices. My decision led to me transitioning out of my integrative pain management practice to an urgent care occupational health practice for the time being. 

A Bright Future for IM

A turning point came after participating in the Duke University Leadership Program in Integrative Healthcare. I always used to joke that doctors had no business sense to the point that I actually believed it myself. This false assumption hindered my personal and professional growth. I suspect that I am not alone in this self-defeating assumption, and that is why some physicians are reluctant to start their own businesses or pursue executive leadership roles within their healthcare organizations. The cost of the program seemed expensive, just like all the other trainings for educated people out there. Nevertheless, my CME stipend from work and a generous scholarship offset my costs and allowed me to participate. My (then) employer allowed me time to research a model of integrative chronic care for our underserved patient population and to develop a primary care pilot program within their community health center. Leadership training taught me vital project management and planning tools to run an Integrative Medicine program. 
Clarity hit me hard—one day in the future I will NOT be a full-time clinician; instead, I will take an executive or administrative role. Perhaps, I will work part-time and develop a business that I can gradually grow. This is not what I envisioned when I applied for medical school, but this resonated in my heart as the best way to use my talents in service to others. Currently, I'm still a full-time clinician, but setting up this blog is the first step to creating my future through living my history. 
Despite numerous challenges, I am as optimistic and happy as ever about my career and the future of Integrative Medicine & Health. My joy has led me to create this blog and start the process of developing Healing Works, LLC an online education and self-care platform. On my IM Health blog, I will share information and innovative ideas to bring Integrative Medicine & Health to the forefront of healthcare.


Dr. Danielle Zelnik, MD (@DrZelnik) is trained in both PM&R and Integrative Medicine, a whole-person approach addressing body, mind, and spirit. As a medical writer, she is launching IMHealth.blog and developing a self-care platform through her company Healing Works, LLC. For more information, visit her website drzelnikmd.com .




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