Integrative Cardiac Wellness Group

Services Currently Provided

Cardiac Wellness Program

A. Pre-admission clinic

Cardiothoracic surgery patients attending The Alfred are seen by one of our team in the pre-admission clinic. Patients receive free metabolic supplements which consist of high grade fish oils capsules and quality antioxidant supplements which have been proven to improve patient outcomes. Patients are encouraged to start taking the supplements before surgery as part of a pre-surgery ‘tune-up'.

Patients are also encouraged to discuss any complementary medicines or therapies they have been using and receive evidence-based advice about their safety and effectiveness from our trained staff. 

B. Inpatient services

Wellness Education Visit
A Wellness Educational Visit offers inpatients and families information and tools to help optimize recovery and wellness during and after the hospital stay. The program was developed out of research showing that positive emotions and expectations can help the body heal faster and with fewer complications. It also introduces some of the key messages for better cardiac health provided in cardiac rehabilitation programs. 

We encourage patients to be aware of the role that stress, anxiety, poor diet and sedentary lifestyle play in the development of cardiovascular disease. Research shows that most cases of cardiovascular disease can be avoided by making physical exercise a habit, eating fish regularly and generally having a healthy diet, stopping smoking and maintaining good personal connections with family and friends.

Pastoral care staff are also available to provide spiritual comfort.

Massage Service
A massage service for cardiac surgery inpatients is planned to commence in 2011.

C. Cardiac rehabilitation

Participants attending the cardiac rehabilitation program at The Alfred receive a wellness education session where the role of diet, lifestyle and stress management are discussed, as well as the use of complementary therapies for improved surgical recovery and long term health promotion. Feedback from patients indicates they find this discussion useful and uplifting and it gives them confidence towards making healthier choices.

D. Outpatient services

As part of our Integrative Cardiac Wellness Program, two weeks after discharge from the hospital, a member of our team makes contact to see how cardiac surgery patients are feeling after their surgery. We take this opportunity to encourage attendance in a cardiac rehabilitation program, continuation with fish oils and metabolic therapy and adherence to health promotion strategies.

In 2011 we are introducing two new outpatient services to The Alfred heart surgery patients.

Wait-listed heart surgery patients will be invited to enrol in a ‘prehabilitation' program which will offer health promotion information and support. The waiting period before surgery is often an anxious time and the prehabilitation program will teach patients techniques to help with stress management and offer practical information about the hospital procedure and advice on diet and lifestyle changes that will enhance wellbeing and a healthy heart. The prehabilitation program will be available one afternoon per week.

Four to six weeks after surgery we will also arrange individualized follow up with one of our team at The Alfred. At this consultation patients will receive more individualised information and advice about diet and nutrition, physical exercise, complementary therapies, stress management and goal setting. We will also collect information to assist us in directing future research.

E. Practitioner and staff education

The Alfred/Monash University Integrative Medicine Education and Research Group meet from 6.30-8.30pm on the 1^st Wednesday of each month at The Alfred Centre, Level 5 Lecture Theatre.

These monthly meetings aim to be clinically relevant and educational for medical, allied health and complementary medicine practitioners and include a structured program of presentations of relevant research and case studies, as well as an opportunity for general discussion about integrative medicine issues.

The meetings are free of charge and light refreshments are provided.

Integrative Medicine Education & Research (IMER) Group Meetings

Upcoming Meetings 

Wednesday 15th February 2012 

Professor George Lewith

Integrative Medicine Research in the UK & EU

Professor George Lewith is a leading expert on Integrative Medicine Research in the UK and across the EU. Professor Lewith is an integrative medicine doctor and established the Centre for Complementary and Integrative Medicine in Southampton, UK.

He is a Professor of Health Research at Southampton University, and is the vice-chairman of The College of Medicine. He has published more than 200 primary research papers, which span a wide range of issues in relation to complementary medicine used as an adjunct to mainstream medicine.

He leads the internationally respected Integrated Medicine research group within the medical school’s department of primary medical care.

The Alfred Centre, Level 5, 99 Commercial Rd, Prahran, Lecture Theatre - 6.30pm for 7.10pm start

Please RSVP by 7th February to Lisa Hose lisa.hose@monash.edu or 9903 0471 

Previous Meetings

March 2011

Integrative Cardiac Surgery

Results of the randomised metabolic study for cardiac surgery patients. A study investigating the effects of nutritional supplements on post-surgery atrial fibrillation, 24 hour troponin I and hospital length of stay. Presented by Professor Franklin Rosenfeldt, head of the Cardiothoracic Surgical Research Unit, Alfred Hospital.

Results of the randomised stress reduction study for cardiothoracic surgical patients. A study investigating the effects of massage therapy provided on the ward by therapists on pain, anxiety muscle tension and satisfaction, heart rate, respiratory rate and blood pressure. Presented by Dr Lesley Braun, Cardiothoracic Surgical Research Unit. Alfred Hospital and lead for the Alfred/Monash University Integrative Medicine Education and Research group.

The inaugural Alfred/Monash University Integrative Medicine Education & Research Group Meeting was held on Wednesday 2nd March at the Alfred Hospital. By all accounts, it was very successful with 45 healthcare professionals in attendance. This number included a variety of medical practitioners, naturopaths, pharmacists and nurses including staff from other hospitals. The research presentations were well received, and the case study delivered by Dr Boetta provided a clinical practice perspective which was of interest to GP's, pharmacists and naturopaths alike.

The feedback received regarding the speakers and the content was excellent, and included comments such as "It was exciting to see such lateral thinking"; "There was an atmosphere of mutual respect between medical colleagues and the CAM professions"; "The research presented was inspiring and wonderful to see it being implemented into the hospital setting"; and "Thank you... I left the meeting last night with so much enthusiasm".

April 2011

Mood and Cognition

The effects of herbal supplementation on mood and cognition. Presented by Professor Andrew Scholey, Co-director of the National Institute for Complementary Medicine (NICM) Collaborative Centre for Neurocognition, Swinburne University.

Measuring and Ameliorating Age-related Cognitive Decline. Presented by Dr Andrew Pipingas, Leader of the Ageing Research Unit, Swinburne University.

Tanya Wells, an experienced integrative medicine practitioner, then presented a case study focusing on safe drug withdrawal.

May 2011

Mental Health

Emerging research on key nutraceuticals (herbal and nutritional medicines) for the treatment of some common psychiatric disorders. Presented by Dr Jerome Sarris, NHMRC Postdoctoral Clinical Research Fellow (The University of Melbourne, Department of Psychiatry).

PDF of Key Nutraceuticals

Diet as a modifiable risk factor for common mental disorders - Presentation of research reporting an association between diet quality and common depressive and anxiety disorders in both adolescents and adults. Presented by Dr Felice Jacka, NHMRC Research Fellow, Deakin University.

June 2011

Acupuncture in Medicine

Emergency Department acupuncture history and practice. Presented by Dr Michael Ben-Meir, Clinical Director Cabrini Emergency Department.

Multiple Emergency Department Acupuncture Trials. Presented by Dr De Villiers Smit, Director of the Emergency & Trauma Centre, The Alfred Hospital.

July 2011

Dummy's Guide to Understanding & Doing Research

Aimed at practitioners and people interested in research but without a research background.

Presentation will included topics such as what are qualitative and quantitative studies and case reports/series, some basic statistics (eg sample size, software packages), guidelines/suggestions on how to read a research paper, where you can do research, outlining some CM research networks such as ISCMR and NORPHCAM and notifying of some upcoming CM research conferences. Presented by Dr Marie Pirotta & Professor Frank Rosenfeldt.

PDF of Systematic Reviews

PDF of Analyse Research

August 2011

Integrative Medicine in the General Practice setting

The speakers for this meeting will be Professor Kerryn Phelps and Dr Vicki Kotsirilos who will review the therapeutic guidelines and approaches to management of some common chronic diseases, in an integrative general practice setting.

Professor Kerryn Phelps, President of the Australasian Integrative Medical Association Inc (AIMA) and Adjunct Professor at Sydney University in the Faculty of Medicine, will discuss the processes necessary to engage appropriate professional bodies to review the therapeutic guidelines in light of emerging evidence for treatments beyond the scope of traditional general practice. Kerryn will also present some useful practice resources including text books and reputable internet sites.

PDF of IM Therapeutic Guidelines

Dr Vicki Kotsirilos, Integrative General Practitioner and Founder & Founding President of AIMA, will cover some updates on the research in Complementary Medicine for some chronic diseases by using a number of case studies.

PDF of IM Case Studies

We also have an overseas guest visiting from Israel, Nimrod Sheinman ND, co-founder of the Israel Center for Mind-Body Medicine, and director of the mind-body unit at the Integrative Medicine Department, Davidoff Oncology Hospital, Rabin Medical Center, Israel, who will be discussing his units work in Integrative Oncology.

 PDF of Integrative Oncology

September 2011

Gastroenterology - Herbal Research

Preliminary analysis of a randomised, placebo-controlled trial comparing the effectiveness of the herbal preparation Iberogast® with omeprazole (Nexium®) for the treatment of functional dyspepsia. This is an NHMRC funded study being conducted at the Royal Adelaide Hospital. Presented by Dr Amelia Pilichiewicz, research officer in the Department of Gastroenterology and Hepatology, Royal Adelaide Hospital.

October 2011

Myth Busters

Do fish oil supplements cause bleeding? Do calcium supplements increase the risk of heart disease? Can vitamin C supplements cause kidney stones? Does vitamin E increase mortality risk? This myth-busting discussion will be led by two leading researchers / practitioners in the integrative medicine field.

Presented by Dr Lesley Braun, Cardiothoracic Surgical Research Unit, Alfred Hospital and lead for the Alfred/Monash University Integrative Medicine Education and Research (IMER) group; & Tanya Wells, Integrative Medicine Practitioner, Beingwell Healthcare in Prahran.

PDF of Myth Busters

November 2011

Integrative Neuropsychology Research

Two current research projects at the Brain Sciences Institute at Swinburne University will be presented. One trial testing the effectiveness of the herbal medicine, Bacopa monnieri for cognitive enhancement in the elderly and other populations and the other assessing the use of metabolic supplements in psychiatric disorders.

Presented by Professorial Fellow, Professor Con Stough, and Dr Lauren Owen of the BSI, Swinburne Uni.

PDF of Bacopa for Cognitive Enhancement

PDF of Metabolic Agents in Psychiatric Disorders

All meetings

Wednesday evenings 6.30pm for 7.15pm start.

Alfred Hospital, Commercial Rd, Prahran. AMREP Education Centre, Seminar Room.

For all enquires please contact Lisa Hose on 9903 0471 or email lisa.hose@monash.edu

All Healthcare Providers Welcome (Naturopaths, GP’s and other Medical Practitioners, Integrative Medicine Practitioners, Chiropractors, Nurses, Psychologists, Osteopaths, Pharmacists, Dieticians, Nutritionists, Chinese medical practitioners, Homeopaths etc). 

F. Medical education

Over 70% of Australian use complementary medicines and approximately one third see complementary therapists such as massage therapists, naturopaths and chiropractors. To enable medical undergraduate students to have a better understanding of evidence-based complementary medicines and their related safety issues, lectures are delivered by Dr Braun at Monash University, Clayton campus. 

Dr Braun also lectures to the Masters of Chiropractic students at RMIT and is a frequent speaker at medical, pharmacy and complementary medicine conferences and continuing education seminars.

We would like to acknowledge and thank FIT-BioCeuticals Pty Ltd (‘FIT'), the major supporter of our research and services program and Blackmores Australia for long-term support.

Complementary Therapies

Complementary therapies include medicines and practices that traditionally arose outside the Western medical system but may in fact be part of the standard medical system in other countries. Complementary medicines include nutritional supplements such as antioxidants (for example, coenzyme Q₁₀), fish oils, vitamins and minerals (such as vitamin D and zinc) and herbal medicines such as valerian, chamomile and ginger. Complementary practices include massage, meditation, yoga and Tai chi.

As part of our Integrative Cardiac Wellness Program we are committed to using complementary therapies that have been proven to be safe and of benefit to people with heart disease. Benefits may include reduced risk of complications after surgery, quicker recovery from surgery, reduced anxiety and pain, improved mood and general wellbeing. Diet and lifestyle changes may also have significant benefits for future health.

Another function of our unit is to conduct research to add to the body of knowledge about safe and effective integration of complementary therapies with conventional medicine. Because of this, we tend to have several research projects going at any given time.

Some of our favourite nutritional Complementary medicines for people with heart disease:

Fish oils

Omega 3 fatty acids (including EPA and DHA) are compounds found in some fish which are essential for good health. These ‘good' oils are important for healthy functioning of the brain and nervous system. They also reduce inflammation, reduce triglyceride levels and improve the integrity of cell membranes in the body. In people with heart disease they have been shown to reduce the incidence of future heart attacks and strokes and help people to live longer!

Deep sea fish (such as tuna, salmon, mackerel, sardines, orange roughy, blue grenadier and cod) contain more of these good oils. Research shows it is best to aim for 4-5 serves of fish every week to get the health benefits. Fish oil supplements are an effective alternative for people who cannot eat fish regularly or often enough. The benefits of fish oils accumulate over time, so it is best to make frequent fish consumption and regular fish oil supplements a part of your everyday routine.

Fish oil supplements are available in pharmacies, health food stores and supermarkets. The dose required to optimise the beneficial effects is 3000mg daily, which can be taken as one 1000mg capsule three times daily. If taken with meals there is less likelihood of experiencing any indigestion or nausea which are possible side effects of consuming any oils. High doses of fish oil supplements (more than 12,000mg per day) should not be taken by people on anticoagulant drugs such as Warfarin.

Participants in our Integrative Cardiac Wellness Program at The Alfred receive Bioceuticals UltraClean EPA/DHA Plus capsules as their source of fish oils (kindly donated by FIT-Bioceuticals).

Coenzyme Q₁₀

CoQ₁₀ is an antioxidant found in all tissues of the body, and in the greatest quantities in the heart muscle. CoQ₁₀ is involved in energy production in the cells. Research has shown that supplementation with CoQ₁₀ can reduce blood pressure and protect the heart from damage. It is very safe and can be used together with all heart medications.

Meat and fish products are the most concentrated sources of CoQ_10, although lesser quantities are found in cooked broccoli and cauliflower, spinach, nuts and soy. People with heart disease may benefit from supplementing with Coenzyme Q₁₀ and capsules are available in pharmacies, health food stores and supermarkets. The usual dose required is between 100-300mg daily.

Participants in our Integrative Cardiac Wellness Program at The Alfred receive Bioceuticals Cardionutrients capsules as their source of Coenzyme Q₁₀ and other antioxidants (kindly donated by FIT-Bioceuticals).

Magnesium orotate

Magnesium is a mineral nutrient that is essential for all muscle and nerve functions. Deficiency of magnesium is linked to many symptoms of cardiovascular disease, such as ischaemic heart disease, high blood pressure, mitral valve prolapse, high blood lipids (‘bad' cholesterol and triglycerides), heart arrhythmias and stroke.

Good dietary sources of magnesium include legumes (pulses), wholegrains, nuts and seeds, dark green leafy vegetables and cocoa. As magnesium is protective of the heart, people with heart disease may benefit from supplementing with magnesium, especially in the orotate form which has an additional antioxidant effect. Supplements are available in pharmacies, health food stores and supermarkets. The usual dose required is 300-400mg/day.

Magnesium supplements may interact with a number of drugs, including enhancing the actions of anti-arrhythmic drugs and calcium-channel blockers. Before commencing magnesium supplements we recommend speaking with your GP or other healthcare provider.

Vitamin D

Vitamin D is a vitamin that acts like a hormone to influence many diverse processes in the body including bone strength, immunity and mood. Adequate levels are necessary for prevention of diabetes, hypertension, osteoporosis, cancer, depression, and infections.

Vitamin D is naturally produced in the body but we need short periods of exposure to sunlight on our skin to convert it to an active form. Some foods also contain vitamin D, such as fish, beef, liver, butter, eggs and mushrooms. Other foods are fortified with vitamin D (that is, they have it added to them), including margarines and some dairy products.

Vitamin D deficiency is very common in Australia, especially in the winter months. People who don't get consistent exposure to sunlight, are older than 65 years, or have other risk factors for vitamin D deficiency should ask their GP or healthcare provider for a blood test to check their vitamin D status. Vitamin D supplements, in tablet or liquid form, are available in pharmacies and health food stores. The usual dose required is between 400-1000IU per day and supplementation for at least 3 months is recommended.

Complementary practices

Massage

Massage therapy relies on soft tissue manipulation through stroking, kneading, friction and vibration to provide relaxation and improve health. It is good for mind and body and has a low risk of injury. Massage sessions usually last 30-60 minutes and costs start at about $40. Many private health insurance funds cover the costs of a massage given by an accredited massage therapist. Ask friends for any recommendation or look on the website of some of the professional associations of massage therapists such as http://www.aamt.com.au/ or http://www.amt.org.au/ for the name and number of a massage therapist near you.

Meditation

Meditation is a technique which helps to relax and train the mind to perceive situations differently, by learning to focus thoughts without distraction by outside disturbances. Daily meditation can enhance feelings of control, reduce stress and alleviate pain, anxiety and depression. It is usually practiced by sitting upright and focusing on the breath. There are many different forms of meditation and many books and classes for instruction. For audio books, CDs and DVDs try looking on http://www.mindfulnessmeditation.com.au/

Yoga

Yoga involves gentle stretching and controlled breathing practices. It is a slow and gentle practice that is quietening to the mind, helps build strength and stamina, and has a low risk of injury. Once you have learned some basics from an instructor you can practice it at home for no cost. Look for a yoga class in your area by asking at your Neighbourhood House, local gymnasium or recreation centre or looking on http://www.naturaltherapypages.com.au/yoga/Yoga/ Ask about age-appropriate classes and tell the instructor if you have any health conditions so they can modify your practice accordingly.

Tai chi

Tai chi uses slow, controlled movements of the body to achieve a more balanced state of body and mind. It has positive effects on circulation, breathing and brain function and helps to reduce the incidence of falls in older people. It is safe, with a low risk of injury and, once you have learned the movements, it can be practiced anywhere as it requires no special equipment. Check in your local paper or Neighbourhood House to see if any classes are on offer.  To find an instructor in your local area, look at the website http://www.taichiaustralia.com/ or check in your local paper or at a Neighbourhood House to see if any classes are on offer.

Healthy Heart Diet

A healthy diet is essential for healthy heart function, energy and wellbeing. In consultations with patients on our Integrative Cardiac Wellness Program we discuss aspects of diet that have been proven to be of benefit for people with heart disease.

Research has shown that a Mediterranean style diet protects against coronary heart disease and reduces cardiovascular risks, as well as the incidence of heart attacks. This diet has been studied in many research trials and is based on the traditional diet of the Mediterranean region, where there is very low incidence of coronary heart disease. It is high in complex (unprocessed) carbohydrates from legumes and high in fibre, mostly from vegetables and fruits. It is low in saturated fat (‘bad' fats) and high in monounsaturated fat (‘good' fats), mainly from olive oil. The high content of vegetables, fresh fruits, cereals and olive oil guarantees a good intake of various beneficial vitamins and minerals.

Olive oil is particularly characteristic of the Mediterranean diet. It contains a very high level of monounsaturated fats, most notably oleic acid, which is linked to a reduction in coronary heart disease risk. There is also evidence that the antioxidants in olive oil reduce the production of LDL (‘bad') cholesterol and have anti-inflammatory and antihypertensive effects.

Frequent consumption of fish is also characteristic of the Mediterranean diet. Research has proven that omega-3 polyunsaturated fatty acids, found in deep sea fish, walnuts and linseeds, may reduce the risk of cardiovascular disease due to their cardioprotective, anti-inflammatory, antihypertensive, and anti-arrhythmic properties.

The key messages of the Mediterranean diet are:

• High consumption of fish, especially oily fish (ideally 4 times a week)
• High intake of vegetables and fruits (ideally 5-7 different vegetables each day, in a rainbow of colours) and legumes
• High consumption of virgin olive oil
• Unrefined carbohydrates, such as legumes (eg lentils, kidney beans) and whole grains like brown rice and wholemeal bread
• Moderate consumption of meat and saturated fats
• Moderate consumption of dairy (or goats' milk) products, ideally in the form of cheese or yogurt
• Maximum of four eggs per week
• Nuts as snacks (especially walnuts and almonds)
• Maximum of 1-2 small glasses of wine a day (preferably red wine for the antioxidants it contains), ideally consumed with the main meal

For further information on Mediterranean diet, including recipe ideas, go to http://www.mediterraneandiet.com/

For other great recipe ideas go to http://www.heartfoundation.org.au/recipes/Pages/default.aspx

For more information on healthy living for people with heart disease visit the Heart Foundation website at http://www.heartfoundation.org.au/Healthy_Living/Pages/default.aspx