Ann Ramsay pokes a splinter-thin, stainless steel needle into her patient's right hand in the fleshy "V" between the thumb and forefinger. She twiddles the needle slightly. "I want you to feel something," she says. The patient gives a small start, and says, "There." It's not pain, exactly, but . . . something. Satisfied, Ramsay sticks another needle into a corollary spot in the patient's left foot. She offers some soft music and the patient chooses Indian flute. Ramsay puts on the CD, places a device that resembles a doorbell near her patient and slips out of the room, saying, "Just relax. I'll be back in about 10 minutes, but press that buzzer if you need me before." The client closes her eyes and drifts away, and is surprised when the door opens. "It seemed like two minutes," she says. Ramsay smiles. "I hear that a lot."
The patient has come to Ramsay's office, located at Essex Physical Therapy on Susie Wilson Road, for treatment of her "mouse hand" -- that is, a chronic pain in her right thumb near the wrist, the result of excessive computer use. But Ramsay seems to ignore this at first; before getting out the needles she asks a multitude of questions about diet and digestion, appetite and thirst, exercise routine, stress level, menstrual cycle, sleep habits and more. She listens intently, takes notes, feels the patient's wrists, and finally offers several assessments in Chinese-medicine terms. One problem she finds: The body is too "damp." Translated, the patient's lungs are weak.
What's all this got to do with mouse hand? Seemingly little. But as far as Traditional Chinese Medicine is concerned, everything is connected.
TCM, explains Ramsay, looks at and aims to treat the entire person. Think of the body "not as a biomechanical unit but an ecosystem," she suggests. A person might arrive with a solitary complaint, but soon learns that few symptoms truly act alone. Accordingly, the Chinese philosophy of healing doesn't take the Band-Aid approach, and Ramsay's discourse is peppered with sentences to that effect: "It takes your whole body and mind to heal." "You can't separate yourself from your micro- and macro-environment." "Building up is much slower than tearing down."
Actually, acupuncture can bring quick and dramatic relief, but a patient has to do some of the heavy lifting after leaving the office. "If you go back to the same environment, you continue to set up the same circumstances, physically and emotionally," says Ramsay. The key to being healthy and pain-free? "We need to have balance in everything we do."
Traditional Chinese Medicine doesn't have the whole market on such sensible advice, of course; physicians often advise eating better, exercising more and reducing stress, even as they hand out pharmaceutical solutions for your symptoms. MDs aren't likely to spend 45 minutes asking their patients probing questions, though, nor will you hear many talking acupuncture, herbs or meditation. But some of them are beginning to listen to practitioners -- and patients -- who do.
In fact, another kind of "balancing act" is quietly taking place in the state's health-care ecosystem, notably at the University of Vermont. Call it "East meets West" -- the slow but steady integration of Chinese medicine and other "complementary" approaches with Western biomedical science.
Ann Ramsay herself perfectly embodies this trend. A licensed acupuncturist and Chinese massage practitioner, she is also a Registered Nurse. Through Continuing Education at the University of Vermont, she teaches three Chinese medicine-related classes that are accredited in the departments of Nursing, Nutrition Science and Asian Studies. Ramsay designed the courses with the enthusiastic support of the dean of Nursing and Health Sciences, Betty Rambur. "My interest in acupuncture goes back to the late '70s / early '80s, when a colleague of mine went to China and observed a surgery with acupuncture for anesthesia," Rampur says. "What we want to do at UVM is expose students to a range of healing modalities, Eastern and Western, and help them critique the evidence."
Next year her department will add a survey course on "complementary and allopathic strategies," adds Rambur, who notes that Ramsay is not a lone crusader: Other members of the nursing faculty practice Reiki, Therapeutic Touch or integrative therapies. "I think it's important that our students understand the strengths and weaknesses of both Eastern and Western approaches, so they can refer their patients to the appropriate treatment," Rambur says.
Nurses are not the only ones broadening their health-care horizons. West is getting chummy with East at UVM's College of Medicine, too. "This year we're graduating the first class that's gone through the Vermont Integrated Curriculum," says Dr. Tania Bertsch, referring to a new program that was created "from the grassroots level up." A collaborative group of faculty and community members, students, physicians and complementary practitioners met over the course of seven years, Bertsch explains, "trying to determine what physicians in the next 10 to 20 years need in order to practice. The faculty passed the new curriculum unanimously.
An internist, Bertsch is also an associate professor of medicine and director of the clerkship -- or third -- year of medical education. "What we've done is introduce a curriculum to explore alternative medicine, to expose students to the use of complementary medicine with their patients," she says. The program integrates basic science, patient care, community involvement and research, and includes "modules" in complementary medical treatments, Bertsch says, stressing that the concepts are woven throughout the curriculum over four years.
"We bring in people who might be practicing acupuncture, herbal or other therapies. They talk to the students in small groups of eight to 10 about what they do, and how it might integrate with what [physicians] do. Students can ask them questions about how and where they were trained," says Bertsch. "We provide as much opportunity as possible to have those kinds of interfaces. This is something that was never part of medical education when many of us trained," she notes, "so this is a new and important addition."
The connections extend to Fletcher Allen Health Care. For example, Ramsay sometimes does rounds with the residents in family medicine. "We all go in and I tell the patient who I am and what I'm doing and ask questions," she explains. "Then [the residents and I] go into a separate room and I tell them how Chinese medicine would treat the patient."
Ramsay also has "privileges" at FAHC, meaning that if one of her patients goes into the hospital and requests an acupuncture treatment, she can administer it in the patient's hospital room.
Robert Davis has hospital privileges, too. A partner at South Burlington's Acupuncture Vermont and president of the Vermont Association of Acupuncture and Oriental Medicine, he says he's encouraged by what's happening in the medical community. "Practitioners from whatever background need to understand what each other does. Now [physicians] are getting at least some exposure to alternative treatments," Davis says. "They may not be trained in it, but they're learning about what exists.
"Conversely," he continues, "I think acupuncturists and other alternative therapists owe it to themselves and their patients to try to understand the flip side of the coin, the research, so we're not biased against it. In my experience, most physicians aren't out there with an ax to grind against alternative therapies."
Davis says he participates in a couple of discussion groups that join medical doctors with acupuncturists and other practitioners -- one is an "arthritis coalition" sponsored by the hospital. "Some of my patients have benefited from what I've learned there," he acknowledges.
That experience is duplicated at the med school's grand rounds -- "a weekly teaching conference in a big auditorium," Bertsch explains. "It's called 'grand' because it involves everybody -- students, faculty, nurses, doctors, pharmacists, etc." An important forum for continuing education, the gatherings include discussions on complementary treatments. "These topics are then often discussed on wards with patients," notes Bertsch. "When students see their faculty learning these things and integrating with patients, they're basically role-modeling that for them."
Previous generations of med students might find all this "woo-woo" stuff quite shocking. But, Bertsch points out, "Many things that were considered alternative 15 years ago are now part of standard medical care. For example, biofeedback was once considered alternative, now it's 'traditional.' Acupuncture is reaching that same level of acceptance," she says. "The more we learn about patient and health-care systems, the more we know we need to be encompassing."
To a large extent, the integration of Eastern and Western medicine has been driven by consumers. "There's really nothing integrating us but the patients," suggests Robert Davis. "They choose to go here and there, and they bring those practitioners together."
But there is one other significant influence: the convincing voice of scientific research. "One of the criticisms of alternative medicine has been that there's not a lot of controlled trials to see how these things work," says Bertsch. That's changing. And some of the country's cutting-edge research on acupuncture is taking place right on the UVM campus.
Dr. Helene Langevin, an M.D. and licensed acupuncturist, is in the middle of a five-year grant from the National Institutes of Health to examine "the mechanism of acupuncture -- how it works, rather than the efficacy," she says. Specifically, Langevin is looking at what the needles do to the body after entering the skin, and she has found measurable effects in the cells of connective tissue. "What prompted this is the observation that the needle creates a change in the tissue that the acupuncturist can actually feel -- some people describe it as a tensing or grasping of the needle. Not only the patient, but the practitioner can feel it. There is no good Western explanation for this."
Making "ultrasound movies" while the needle is manipulated, Langevin has seen the cells changing shape. "The needle causes mechanical change and the cell seems to sense that and responds by enlarging and flattening. We don't know why," she says. "But I have several hypotheses. I'm wondering if this is the way for the cell to alter the tension within the tissue, helping it to relax . . . it's almost like helping the tissue adapt. We haven't been able to measure that yet."
Langevin is taking the research one step at a time. "I'm open to the possibility of finding unexpected things. In science you have to be detached and objective," she says. "But the fact that I've practiced acupuncture allows me to understand what are some of the important questions to ask." Langevin notes that the Chinese have been doing scientific research on acupuncture since the 1970s, doing lots of work on the neural system and the brain. "We're hoping that someday we'll be able to connect our research on connective tissue to what's going on in the brain."
Bertsch and Ramsay both call Langevin a "guru" in the world of acupuncture research, and are delighted that the UVM community can benefit from her model -- and her findings.
Meanwhile, across campus at the Student Health Clinic, students, faculty and staff will have the opportunity to get needled Tuesday afternoons, by appointment, beginning in February. According to Ann Ramsay's website -- http://www.vermonttcm.com -- acupuncture treatments are covered by students' insurance.
Alas, that is not the case for all health plans. Most patients are paying for acupuncture and other alternative treatments out of pocket. "The coverage even for traditional therapies is not always there," says Bertsch. "It's a challenge." She notes that UVM's med students "have a unit on health-care financing so they understand some of the issues."
The fact that patients are willing to shell out for these treatments is in itself a testimony to their popularity -- and, presumably, effectiveness. As Ramsay puts it, Chinese medicine "is good at preventing disease and making you stronger.
"But if I get in a car accident," she adds, "take me to the emergency room, not my acupuncturist."