The Integrative Medicine Solution: Go Beyond Wellness to Heal Your Patients and Your Practice

By Cathy Ochs PA-C and Dian Hoppe M.D.M F.A.C.O.G

Get out of the health-care trap.

Transition into an integrative medicine practice.

Return to practicing medicine the way you always dreamt it could be.

The United States spends the most health-care dollars per person in the world. Yet we are a sick, fat, and tired nation. Both patients and health-care providers are dissatisfied with our health-care system.

We have a diseased management system masquerading as a health-care system.

This system is broken!

Integrative medicine is a solution to heal our broken system. The Integrative Medicine Solution is a practical guidebook for physician assistants, supervising physicians, nurse practitioners, and other health-care providers who want to transition from treating symptoms to the root causes.
Patients are healthier, happier, and less dependent on drugs.
Providers are rewarded for spending more time with their patients.
It will restore balance and joy in your practice and life.

This book is a great introduction and practical guide for PAs or any other health-care providers who are wanting to start their own integrative practice.
Jana Pratt, PA-C, Womens Integrative Health Specialist

This is an awesome read and a great education piece for all health care providers to read. I think it is a must read.
Nathan S. Bryant, PhD, author of The Nitric Oxide (NO) Solution

Excellent job . . . your book will shed light on what patients need to know.
Mark Starr, MD, author of Hypothyroidism Type 2: The Epidemic

• Language: English
• Publisher: AuthorHouse
• Release date: Jul 28, 2015
• ISBN: 9781504921367

Cathy Ochs PA-C

Cathy Ochs, PA-C, is a nationally certified physician assistant with thirty-five years experience in family medicine. She transitioned into integrative medicine as a solution to improving the health of her family, patients, and herself. After California law authorized PAs to form their own medical corporation, Cathy became one of the few PAs to establish her own physician assistant corporation. Her passion is helping other PAs do the same.

Book preview

Introduction

My Transition

From Innocence to Excellence

Following behind the ambulance driving to the hospital gave me 30 minutes to think and ponder the possible changes in my life that were about to unfold. Inside the ambulance was my partner of 35 years. She was a 58 year old vibrant, funny, clever, caring person who suddenly was not able to think, talk, or even walk without help. As a former ambulance EMT, I knew what was happening inside that ambulance. Her vitals were being monitored, and calls radioed into the ER about her condition while the EMT starts an IV on the bumpy highway into town. But what I didn’t know was the process that was happening to create the sudden changes in her functioning. Had I missed something in her health status? Had her blood pressure shot up and she was having a stroke? Was it a brain tumor or aneurysm? I reluctantly considered that the person I knew may be gone forever or, at best, never be the same. Whatever the outcome, our lives are about to change significantly.

Two days before I had given her a simple flu shot. About every two years, I would get one myself and bring one home to give her as well. Working as a family practice physician assistant in a community clinic, we had been encouraged to all get flu shots every year. We are told this is not only to prevent us from getting the flu and being out sick, but also to avoid a carrier state where we might infect our patients. This is the standard of care for preventive medicine. Years of flu shots for myself and patients seemed to be the best thing for all. We also were told that one cannot get the flu from the shot. The vaccines are made using dead or inactivated virus. Over the years I recall several patients who came into the office within a week after getting their flu shot with obvious flu symptoms. I would let them know just what I was told - one can’t get the flu from the shot since the virus is inactivated, so they must have some other viral infection. However there was a growing part of me that began to question this standard of care. In fact, that was one reason I decided to get the shot every other year rather than yearly.

The next day after I had given my partner the flu shot, she woke up feeling achy all over with a headache and low grade fever. Her symptoms continued to progress with a more severe headache, high fever of 103 degrees and chills. She stayed home from work the second day as she continued to feel worse. I told myself here’s another person who got the flu from the inactivated flu shot. I made a mental note to not get a flu shot for a while. Driving behind the ambulance I began to piece the puzzle together tracing these symptoms all back to that one single moment that I gave her the flu shot. She was in perfect health the day I gave her the shot. I wished I could take that moment away.

Once at the ER, my partner was the center of a whirlwind of activity. After being evaluated, she was quickly transferred to get a stat brain CT. By now, she was unable to talk at all but just shake her head no to respond when something hurt her. I became her voice and decision maker. After enduring a lumbar puncture, she was transferred upstairs for admission and further workup. Over the next three days she was seen by a neurologist who did additional testing. Her lumbar puncture and scans all looked normal. The neurologist finally concluded that she had an encephalopathy due to the flu shot. He said I have seen this before. She should be fine. Just go home and drink plenty of water. And probably she should avoid flu shots in the future.

Thankfully, as the neurologist told us, she has made a full recovery. Our lives were altered and, thank God, not quite in the way I had envisioned. But it did give me the reason and courage to question the standard of care. I vowed to listen to my inner voice when I was seeing evidence to the contrary, and came to an intellectual understanding that it was alright and necessary to question the standard of care. That defining event began my transition in earnest to find a better way to practice medicine, to find a way where I could truly live up to the motto do no harm first as we are all taught in school. Find a better way to help the body get healthy and stay healthy in ways that worked with the natural physiology of the body. I vowed as much as possible to avoid using foreign substances and chemicals to unnaturally force changes in the body.

My parents moved from New York to Colorado Springs with a bouncing baby girl in tow (me) to start a new life in a family business with my father’s three brothers. I received all the attention of my doting parents my first seven years until my little brother entered the scene. I embraced the role of the big sister and enjoyed watching over him. Like countless other families living in Colorado, we spent many winter weekends skiing and playing in the snow. A physically active life dominated my younger years from hiking fourteen foot mountains to participating in track and volleyball in high school.

When it came time to decide which college to attend, it seemed natural to apply to Colorado State University (CSU) which is known for its strong forestry department. I was accepted with the initial plan to major in forestry and wildlife biology. A life of hiking tall mountains while being paid to count big horned sheep seemed to be attractive. The forestry school was extremely popular and classes were crowded. Many instructors warned us young foresters that landing a job in Colorado was slim. Even though I had worked one summer for the state forestry department riding my bicycle through downtown Colorado Springs counting Dutch elm disease trees, I was swayed by my instructors’ warnings and changed my degree to outdoor education.

Embracing my new career goal, I attended an outdoor education conference at the Grand Canyon my junior year. During an experiential workshop, we were told to hug a tree for five minutes and return to share our experience. While hugging a big ponderosa pine tree and acknowledging that trees don’t talk back, I admitted to myself that I really would like a career working with people. While wondering what to do next, I returned to CSU and changed my major to biology. Shortly thereafter while working as a volunteer at the student health center, I met my first physician assistant.

Her name escapes me now, however meeting her was the pivotal moment that lead me into medicine. Ironically, I would always score highest in nursing on my high school career placement tests, but dismissed medicine as a career since I couldn’t see myself wearing the white nursing hat! The student health center PA gave me the inspiration, vision, and guidance to becoming a PA myself. Following her advice to get some medical experience under my belt, I worked part time as a ward clerk at the hospital. While applying to PA schools after graduating from CSU, I worked as an EMT for the local ambulance company. Just as the PA advised me, my education and experience gave me the edge as a well-qualified applicant and I was accepted to the PA program at the University of Nebraska Medical Center (UNMC) in 1978.

I graduated from the UNMC Physician Assistant School in 1980 at the age of 24. After finding my psychiatry rotation in school very interesting and rewarding, I was excited to get my first job working as the staff PA for a psychiatric health unit in Red Bluff, California. This was a unique first of a kind facility that included alternative treatments (at that time) including regular daily exercise programs and dietary approaches. Dr. Jack Shelton, the psychiatrist who was my supervising physician, was the first to teach me the importance of questioning the standard of care and look outside this box to help my patient. He pointed out that medications all affect people differently and sometimes medication was not the answer, but counseling or music therapy could be just as helpful. I learned the cookbook approach to treatment, at least in psychiatry, was not helpful and sometimes harmful. Already my innocence as a young PA in medicine began to erode as I learned the knowledge that I had been given in school was not all completely valid. I realize and am thankful that my PA career began with those first two years in psychiatry providing me with a solid foundation to integrating different modalities to help my patients and myself later on.

Sadly, Dr.Shelton died unexpectantly from a brain aneurysm in my second year. Shortly afterwards I was offered a job working in family practice and transitioned back to my family medicine roots from PA school. Over the following 33 years I have had the great honor and pleasure to work with thousands of people in different family practice settings, from community clinics and urgent care centers, to private physician offices.

As I got into the busy daily rhythm of a full patient load and reviewing difficult cases with my supervising physician, I realized after the first few years that I needed to start reading and keeping up more with all the rapidly changing medical advances. Some things I learned in PA school seemed to quickly become outdated, especially when it came to the myriad of new drugs. I remember hearing about a mysterious disease that was thought initially to spread through the air ducts in office buildings. As the discovery of Legionnaires disease unfolded, I began to understand why my PA teachers said this is a lifelong learning career. Traveling to medical conferences out of town did not fit well into my busy schedule. So, like many other PAs, NPs and physicians in my area, I found the main way I was able to keep up with the latest medical advances and drugs was attend local medical lectures during lunch times. And of course, all of these were sponsored by drug companies.

At first we all loved the attention showered upon us with lunches and steak dinners, gifts, including some nice weekend trips, along with expensive medical books and stethoscopes. Looking back, I now understand how we all were part of a grand marketing plan and unknowingly influenced into helping the pharmaceutical industry become the foundation of modern medicine. I began seeing the focus in medicine was narrowing down to seeing a patient and giving them the newest drug that we had just learned about at the free lunch (and conveniently using the samples the rep had left).

During this same time period, the insurance companies began reducing their payments to the offices and requiring more paperwork to justify the visit charges. My supervising physicians would let me know how many patients I needed to see to pay for my wages. I began to feel that I had become a legal drug pusher having only 10-20 minutes per patient. I would figure out the most pressing problem and write the prescription that seemed to help the patient the most at that time. I was seeing twice as many patients in half the amount of time. I had been forced into the realm of cookbook medicine. A growing inner conflict was gnawing inside me. This did not feel right.

My first defining moment in my career came around 2000 when I was reprimanded for spending too much time with my patients. I was told to be in and out of the exam room in 10 minutes. I asked myself, how did medicine come down to this? When I responded that I was seeing complicated patients with uncontrolled diabetes, hypertension, and depression which was impossible to treat in 10 minutes, I was told to either have the physician see them or address just one problem and have them come back. I felt like a square peg trying to fit in a round hole. Thankfully, I took a new position with a community clinic that allocated 30 minutes for patient visits. I felt that I had found an island of sanity in medicine where the physicians and staff were also feeling influenced by the drug rep lunches and made the decision to stop the lunches and only accept drug samples if they had a specific need for a patient. They also welcomed more holistic wellness oriented approaches to care.

I thought perhaps it was time to drift out of the traditional medical profession and find a different career not so focused on drugs and treating symptoms. I began to return to my psychiatry roots and completed a two year internship with Jack Schwarz, a pioneering educator and author of Voluntary Controls and other books. I learned how to use the power of the mind, breathing and meditation to improve one’s health. I drove to Mendocino California each month for a long weekend learning how to integrate these mind-body principles. Working with the mind and harnessing the ability of the body to heal itself made more sense than just treating a symptom with a drug and not the underlying cause. I also took courses in hypnosis and neurolinguistic programming to learn more about the power of the mind and healing. My out of the box self was unleashed as I learned these holistic natural ways and began using them with myself, family and my patients at the community clinic.

Despite being a more wellness oriented office, the community clinic still used the widely accepted standard of care drug treatments. I noticed a trend in my patients over the age of 50 that many, if not the majority, were on the same trio of drugs. They were on blood pressure medicine(s), a statin to lower cholesterol, and levothyroxine for hypothyroidism. I began to accept the notion growing older just means more diagnoses and more drugs. When my own blood pressure and cholesterol levels started to climb at the age of 51, I actively began exploring other solutions rather than taking drugs.

Shortly thereafter, another defining event occurred in 2008. I read about an endocrinologist who received the Father of the Year award by the American Diabetes Association for not losing one patient to a heart attack or stroke in 19 years. Such a record seemed to be an impossibility! I learned the physician was Dr. Joseph Prendergast who was practicing in Palo Alto California just a 3-4 hour drive from me. I contacted him and was invited to come to his office to learn more. Over the next couple of years I learned how the underlying cause of cardiovascular problems stemmed from the deficiency of nitric oxide (NO), not high cholesterol, and how to increase one’s NO levels using l’arginine and other nutrients. I also learned how to measure endothelial dysfunction using the BPro pulsewave device.

I immediately started using this new found knowledge with myself and over a 3 month period was able to reduce my blood pressure and avoid taking medication. This was remarkable to me as I had never been able to see patients consistently control their blood pressure with diet and exercise alone. But there I was with lower blood pressure and knew it was possible. Now nearly 7 years later I continue to monitor and maintain my NO levels with my blood pressure consistently controlled below 120 systolic.

I shared this information and treatment with my father who had previously experienced a heart attack and 5 way heart bypass, then later had a pacemaker. His cardiovascular health had declined to the point his cardiologist told him to be sure his affairs were in order. My father also experienced what seemed to be miraculous results with significant improvement in his cardiac function. His cardiologist told him whatever he was doing to keep it up. Unfortunately his cardiologist was not interested enough to explore why my father’s condition defied the usual course of decline, and when offered information about NO, admitted he just did not have time to read the information. At that point I began to understand the concept of excellence as it applied to medicine.

Achieving excellence is identifying, learning, and putting into use that which defies and exceeds the usual course of action. Health care providers who seek excellence in their practice are curious and constantly learning from their patients’ outcomes which defy their current thinking (or standard of care) and integrating this into their patient care. The opposite of excellence is mediocracy in traveling down the cookbook path of standard of care. In fact, I believe excellence as a healthcare provider is a requirement upon taking the sacred oath of helping others. Our patients, family members, and friends are now our teachers and guides to excellence. When called upon, it does take courage to look outside this box, but as more providers accept this commitment we all greatly benefit. If my father’s cardiologist had accepted, read, and integrated the information in the nitric oxide book my father brought that day, who knows how many other people’s lives could be saved or improved.

After seeing so many patients greatly improve with the nitric oxide therapy, in 2012 I decided to completely stop traditional family medicine and opened my own office in Redding, California. I focused primarily on cardiovascular problems using the knowledge I had gained from Dr. Prendergast and worked with a local cardiologist as my supervising physician. After the first year, I realized many people benefitted in being able to reduce or stop their medications, but I was not able to help some people reduce their inflammatory blood test markers such as the hsCRP. I knew how important this was and even traditional medicine accepts the idea that inflammation is a root cause of cardiovascular problems.

I began researching causes of inflammation in the body. I learned there are three areas that usually create inflammation in the body - the mouth with dental and mouth problems, the gut, and from toxins. I could understand the first two, but toxins? What toxins? I eat