Review of Integrative Cardiology

Integrative Cardiology: Completmentary and Alternative Medicine for the Heart
John H.K. Vogel and Mitchell W. Krucoff
McGraw-Hill Medical, 2007
ISBN: 0071443371 / 9780071443371

Integrative Cardiology: Complementary and Alternative Medicine for the Heart is edited by two leading experts in cardiology and integrative medicine, John Vogel and Mitchell Krucoff. Vogel was former president of the American Heart Association and Krucoff is a professor cardiology at Duke. This book, (ISBN-13: 978-0-07-144337-1) was published by McGraw Hill this year and should be on the bookshelf of every physician in primary care and cardiology. Comprehensive coverage includes a review of complementary and alternative medicine (CAM) treatment modalities, legal and ethical issues, an overview of the mechanistic and physiologic links between CAM and the cardiovascular system, and much more.

The book is divided into 5 parts. An Introduction chapter by philanthropist Earl Bakken describes a high tech, high touch healing environment in a hospital in north Hawaii. Part 2 covers Basics such as how to integrate CAM into a cardiac program, legal and ethical issues by a noted attorney in the CAM area, a description of several academic integrative medical centers of excellence, and approaches to clinical trials in this area by an NIH team.

Part 3 is an overview of CAM Treatment Modalities. I contributed a chapter to this section, co-authored by Kay Garcia form MD Anderson and Gloria Yeh from Harvard Medical School. In our chapter, we reviewed the surprisingly robust data for the benefits of Tai Chi and Qi Gong for cardiovascular health. These are equivalent to moderate aerobic conditioning for many cardiovascular problems such as hypertension, coronary artery disease, and dyslipidemias. . Dr. Yeh discussed some of her research on the benefits of Tai Chi for patients with heart failure. Other topics in this section cover bioenergetics, acupuncture, herbal and dietary supplements, the Mediterranean diet, spirituality, ayurvedic methods, music therapy, and naturopathy. Each is covered in a well-written and well-referenced chapter.  

Part 4, Mechanistic and Physiological Links between CAM and the Cardiovascular System provides an excellent substrate for integrative cardiology covering psychological and emotional considerations, nontraditional approaches to lipoprotein metabolism with various supplements, and acupuncture. Part 5 offers Special Consideration Areas related to women’s health, obesity, cardiovascular surgery and CAM, integrative approaches to heart failure, arrhythmia, aging, and end of life care. A beautiful chapter caps this section covering the therapeutic relationship, mindfulness, and stress reduction for the health of patients and their health care providers. Part 6, the Appendix provides extensive references and sources for information on the important area of dietary supplements and herbal medicines.

If you take time to read Vogel and Krucoff’s excellent book you will find that the field of integrative cardiology has really begun to mature with an increasing body of well-evidenced therapies for clinical application of many therapies previously considered to be “alternative.

Review by Victor S. Sierpina, MD, W.D and Laura Nell Nicholson Family Professor of Integrative Medicine
Professor of Family Medicine
University of Texas Medical Branch
Galveston, TX
August, 2007

Review of Living Consciously, Dying Gracefully

Living Consciously, Dying Gracefully A Journey with Cancer and Beyond
Nancy Manahan and Beck Bohan, foreword by Bill Manahan, MD

Edina MN: Beaver’s Pond Press, 2007
ISBN1-59298-179-8

Living Consciously, Dying Gracefully is a compelling and intimate story of a woman and her family’s journey with cancer and beyond.  Diane Manahan, a wife, mother, grandmother, friend, and nursing professor extraordinaire, maintained a journal following her diagnosis with breast cancer in 1995.  In writing about her decision to be open throughout the journey of living and dying, Diane voiced her hope that by being authentic, honest and non-perfect, she might enable others to be vulnerable and to deal with life’s gifts and uncertainties.  The book, authored by Diane’s sister-in-law Nancy Manahan and partner Becky Bohan, includes writing and poetry by Diane and reflections and observations by a rich and diverse circle of friends and family that surrounded Diane and her holistic physician Bill Manahan over the 5 ½ years that Diane lived following her diagnosis with breast cancer.

Part I of the book opens with Diane’s reaction to the shocking diagnosis of cancer that came 5 days before Christmas.  As a reader, I experienced a roller coaster of emotions as I read about the steps she took to gather information, the complexity that surrounded getting a second opinion, having surgery, receiving the pathology report, making the difficult decision to receive chemotherapy, and exploring a wide array of complementary therapies.  The book is unique in the way that it offers the perspective of not only Diane but also those around her.  As such, it is raw, poignant, funny, and provocative but above all, inspirational and instructional.

The second part of the book describes Diane’s death and the days that followed.  Diane chose to die at home in her own bed and to have the visitation there. After her death, her husband and women friends washed her body with warm water infused with lavender oil, dressed Diane and prepared her for the visitation.  Following the visitation, family members took the unusual step of accompanying the body to the crematorium.  Here, rituals were performed that help family members absorb the finality of Diane’s passing.  A Life Celebration was held in a nearby park. First person narratives of several people give voice to experiences that people at times experience following the death of a loved one. The accounts reflect mysterious, profoundly meaningful and healing experiences not often publicly verbalized. The experiences, as described, provide reassurance that life goes on and that connections with those we love are maintained.

The final part of the book is a guide that provides detailed information on how to deal with serious illness and death. Beyond telling the story of how this family chose to face death , this book provides exquisite detail and instructions on topics including  making plans for after you die, how to care for someone having a seizure, washing and caring for the body after death,  planning a visitation or vigil, and holding a memorial service.  

While Living Consciously, Dying Gracefully is an invaluable resource book for lay people facing a serious illness and death, it is also an important resource for health professionals. It provides a different view of death and dying, one that few health professionals have experienced.  Patients and family member looks to nurses, physicians and other health professionals for information and advice.  This book provides accessible wisdom and guidance that demonstrates beyond a doubt that both life and death provide an opportunity to radiate grace, dignity and  beauty.

For more information about Living Consciously, Dying Gracefully: A Journey with Cancer and Beyond, visit www.nanbec.com.

Review by Mary Jo Kreitzer Ph.D., RN, FAAN
Director of the Center for Spirituality and Healing
Professor, University of MinnesotaSchool of Nursing

Review of Living Consciously, Dying Gracefully: A Journey with Cancer and Beyond.

Living Consciously, Dying Gracefully A Journey with Cancer and Beyond
Nancy Manahan and Beck Bohan, foreword by Bill Manahan, MD

Edina MN: Beaver’s Pond Press, 2007
ISBN1-59298-179-8

My intention is to
Live out in full color
Live with passion,
Ignite ideas, laughter, wonder
And kindness
Spreading hope in times of darkness

This quote from Diane Manahan’s Life Celebration read after her death from breast cancer provides a glimpse into the powerfully personal nature of this remarkable book. Diane, a nurse, married to one of the founders of the holistic medicine movement, Bill, thrived while battling a five and a half year journey with breast cancer.
Written by her sister-in-law and a close friend, this book is a chronicle of what might be called optimal living and dying. The book does not sugar-coat the emotional roller-coaster many cancer patients feel with treatment, recurrence, organ failure, pain, and accompanying social and physical challenges. Indeed, it confronts these directly with a heroic tale of one woman’s approach to making the most of her life and death experience with cancer.

In addition to fully living, working, and loving her life as intensely as she could with her diagnosis of cancer, Diane also planned for the day she would die, orchestrating a Life Celebration for friends and family. She utilized a truly integrative approach to her cancer care that was quite wide-ranging. In addition to standard chemotherapy and radiation oncology care, she investigated and used a variety of holistic methods. These included herbals, mind-body therapies, dietary modifications and supplements, intravenous vitamins and minerals, song, dance, Qi Gong,  prayer, and a support group.  She managed to keep up her work as a nurse, travel, and spend time with family far into the course of the illness. Part One of the book is a tapestry describing the journey with cancer as her companion from diagnosis to the terminal stages.

Part Two, “A Graceful Death” describes graphically rituals carefully planned by Diane and those close to her to deal with the practicalities of death, handling the remains, and dealing with the grief as well as joy of separation. It concludes sections about her final moments, washing the body, viewing, cremation, and the wake followed by the Life Celebration which Diane had  likewise planned in detail. She had arranged speakers, music, musicians, poetry, composed a bookmark, and release of white doves—all the hallmarks of a celebration of life and its final conclusion rather than a mournful dirge. Over 400 people attended this tapestry of joy.

“Living On” is Part Three which shares reflections of friends and family and their ongoing mystical and dream experiences of Diane’s presence after she had left the physical form. So strong was her connection and love of people in her life, it seemed at times that death’s portal was not tightly shut but hinged both ways letting her spirit continue to connect palpably to those left behind. In a fitting tribute to a nurse who dedicated her life to healing, the book closes with an enormously practical and well-thought out Guidebook, Appendices, and Resource sections.

These include sensitive and heartfelt advice for those having been diagnosed with a serious illness, going through treatment, in a support group, and on the details of planning an end-of-life experience. While the path and advice given here may not suit everyone’s desires, the authors, friends, and family’s willingness to share with others the knowledge gained from this journey remains an enduring legacy to Diane.

In summation, this book is much bigger than a biography of life and pathography of death. It reflects a deep passion for healing when curing is no longer possible. It offers hope when to some, all hope might be gone. As the title speaks, it truly celebrates conscious living and graceful dying. I highly recommend it to those who care for people with cancer, as well as patients, friends, and families.
For more information about Living Consciously, Dying Gracefully: A Journey with Cancer and Beyond, visit www.nanbec.com.

Review by Victor S. Sierpina, MD, W.D and Laura Nell Nicholson Family Professor of Integrative Medicine
Professor of Family Medicine
University of Texas Medical Branch
Galveston, TX
August, 2007