The use of integrative medicine in the hospital setting is growing around the U.S.
Just knowing that something you dream of actually exists can be a great catalyst toward making your dreams come true. When I was younger, my interest in health drove me to medical school, but I quit, disillusioned, shortly after starting.
While studying shiatsu in England, I took a workshop by a visiting teacher who arranged for his students to practice at a hospital in Vienna.
Here I was, thinking I was worlds apart from the allopathic medicine I had begun my career studying, when it dawned on me that doing shiatsu in a hospital made a lot of sense.
That shiatsu-in-hospitals workshop helped materialize the idea of combining these two worlds.
This vision helped me through a long process of proposing to, lobbying and finally convincing MDs and the powers that be that shiatsu practitioners had something of value to offer patients and that Asian Bodywork Therapy (ABT) should be taken seriously.
Integrative Medicine in the Hospital
Between 2001 and 2005, when I left to return home to Uruguay, I worked for the Columbia University Hospital’s integrative medicine program, alongside Kathleen Ullman, an American Organization for Bodywork Therapies of Asia (AOBTA)- certified practitioner of Amma, and Ruth Rogers, a certified practitioner of shiatsu.
I was lucky to get to meet Mehmet Oz, MD, of Discovery Channel and Oprah fame, and the author of Healing from the Heart: A Leading Surgeon Combines Eastern and Western Traditions to Create the Medicine of the Future.
Oz is a heart surgeon and co-inventor of the Left Ventricular Assistance Device (LVAD) pump that helps transplant candidates keep their hearts working until a suitable heart is found for them. Oz is also a pioneer of integrative medicine and the medical director of the Columbia Integrative Medicine Center.
Shiatsu is still offered in the Integrative Health program at Columbia and in many similar programs around the world. (There are more than 1,100 shiatsu practitioners who are involved in this work on my Shiatsu in Hospitals Facebook group, for example.)
In his book, Oz said he realized that heart surgery could be a success but that the procedure alone didn’t determine the outcome or recovery. Patients who had more support from their immediate circle and those who kept a positive outlook had better rates of survival than those who didn’t.
He started experimenting with giving extra support to patients who needed it, using such Eastern and Western touch therapies as massage and Asian bodywork therapies, guided imagery, yoga and spirituality. [Read “A Conversation on Massage in Integrative Health Care.”]
According to Oz, in a video that focused on shiatsu and heart surgery, “Offering these therapies, including shiatsu, has helped patients recover more fully from these operations and in a more accelerated way. The specifics include diuresis, in which they urinate more rapidly, as well as more comfort with their breathing.”
It took a couple of years until I secured the credentials needed to see the first of his patients. Soon after that, I worked solely by referral on a fee-per-service basis at the hospital. Later, the program hired me, as well as the colleagues mentioned above, to fill the now-identified need and to see as many heart surgery patients as we could every week.
Patient Satisfaction with Integrative Medicine
An in-house survey showed that, when offered a session, 93 percent of pre- and post-open-heart surgery and transplant candidates patients were interested, even though many of them had never had any kind of bodywork before.
We treated about 96 percent of those who were interested, working part-time. The program regarded our work as a great success and the feedback from patients was excellent.
Edema, cramps, dropped foot, numbness, insomnia, constipation, neck and back pain, anxiety, fatigue and other symptoms were relieved during our rounds, even though we could only see patients for short sessions.
Some patients actively sought us out even before being admitted for their surgery because they had heard about our services. We consistently saw a reduction in pain and anxiety and an improvement in the mood of the patients.
Recent research has shown that mind-body therapies, of which shiatsu is one, have been safe and effective for many of the symptoms experienced by these patients. (See, for example, “Complementary and Alternative Medicine and Cardiovascular Disease: An Evidence-Based Review,” published in 2013 in Evidence-Based Complementary and Alternative Medicine.)
Similar results have encouraged the growth of programs incorporating shiatsu around the world. In Vienna, Austria, shiatsu was incorporated into five hospitals over a 15-year period.
Austrian gynecologist Volker Korbei said, in the documentary “Shiatsu in Hospitals,” “The question is not shiatsu or academic medicine, the answer for me is that shiatsu should fit into normal medicine. The new definition should be: Who can heal should heal. Who can heal has to be embraced. And shiatsu is right there.”
Misconceptions about Integrative Medicine
Doing shiatsu in the hospital has many challenging aspects.
One must counter misinformation, for instance, that shiatsu is painful or that it is deep tissue work and therefore too vigorous for ailing patients.
Other misconceptions about contraindications still abound. So before I even laid hands on anyone at the hospital, I had to change people’s minds about the work.
I had to demonstrate, mostly by working on medical staff, that it was safe, relaxing and that it produced immediate results regarding pain, anxiety, depression, breathing function and overall well-being of the person in just a few minutes, with a very simple and enjoyable intervention.
It was most helpful to work on nursing staff first, since they gave me their wholehearted support when I started to work on patients in the wards. By the time I sat down to talk with the physicians, they had already received word of the beneficial effects shiatsu had on the rest of the staff.
We have to be careful with our verbal presentation of what we do, both with patients and health professionals who are not familiar with our work. This used to take a lot of my energy, but the experience of approaching hundreds of total strangers with my spiel helped me feel a lot more at ease.
Nevertheless, sometimes it still felt odd to approach a patient in the intensive care unit when they were plugged into so many machines and perhaps still confused from the aftereffects of anesthesia. “Appropriate” becomes a big word to live by when deciding the time and manner to approach a patient coming from such a life-altering experience.
Another challenge I faced was having to work on a hospital bed. I learned to do shiatsu on a mat at floor level, so I had to reinvent a lot of the techniques as I adapted them to working in the upright position. (I must thank my teacher Pauline Sasaki (1946–2010) for helping and supporting me through this.)
It wasn’t easy to let go of my prejudice that “If it wasn’t on the floor it was almost surely not shiatsu.”
In fact, working upright liberated a lot of my creativity to work with shiatsu while keeping true to the principles of touch I’ve always used. All the years of experience working on the floor gave me an invaluable connection to Earth and grounding that I would need in this job.
This kind of grounding also helped to deal with such difficult conditions as stuck bed mechanisms that left me working in impossible positions, tubes gone astray, and bleeding or mentally confused patients, as well as in helping patients rebuild their connection with, and trust in, their own bodies. (It did help that shiatsu doesn’t require disrobing or the use of oils and creams.)
We often got calls to treat surgeons with back pain because they stand for hours perched over the patient. I observed two surgeries in the operating room during which I worked on the surgeon’s back.
Observing the operations gave me an idea of what patients go through. The mechanics of the opening of the chest and displacing the ribcage results in back pain due to the stress on the rib heads that attach to the spine, for example.
Patients are also tied to the operating table for long periods, which can create shoulder pain and numbness in arms and hands; curiously, often along the Heart channel, which emerges from the armpit and ends in the little finger. (Some terms are capitalized here to distinguish them from the anatomical organs, which only have physical functions in Western medicine.
For instance, “Pericardium” function includes the physical function, but also mental, emotional and spiritual aspects that go beyond the functioning of the pericardium.)
Shiatsu provides relief of these symptoms, but just the thought of someone touching the chest could send a patient into a panic. I frequently used points away from the local area, connected by related energy channels, to relieve pain from the huge, healing incisions.
Working on the relevant meridians at the feet or hands is extremely effective. More than once I was told, “It’s like a weight gets lifted from my chest.” Some patients hired us privately to continue treating them when they went home.
Traditional Chinese medical theory (the theoretical basis of shiatsu) explains quite beautifully a lot of the seemingly unrelated symptoms we encountered. Although I couldn’t usually do a hara (abdominal) assessment palpation because of tubes or electrical devices (the LVAD, for example) inserted in the abdomen, I relied on experience, intuition and my own energy perception system to determine which meridians were relevant.
It’s also very important to listen carefully to the patient, since a complaint of a specific issue could be a door, through that theory, to understanding an important related imbalance.
There’s no way to generalize, but I noticed certain trends that related to the imbalances in the organs and functions as described by Traditional Chinese Medicine (TCM).
Of course, the TCM meridians and organ functions of the Heart and Pericardium were common; some symptoms were related to Blood functions (Blood is an organ in itself in TCM) and circulation imbalances, also affecting the Spleen (TCM organ function).
Some were related to the disturbance of the Shen (spirit or conscience), housed in the Heart, and still others to the Large Intestine as the patients “held on for their dear lives.”
The Small Intestine meridian was very responsive because of its connection to the Heart, its meridian pathway and its role in TCM in the shock response. I always addressed the Stomach and Bladder meridians, which are crucial to give someone that oomph to get them going. It was also interesting to note the interplay of the symptoms with the various medications regularly administered.
I believe patients change somehow after their hearts are touched—metaphorically and literally—during surgery. The heart is, after all, a special organ. It is difficult to measure compassion, an emotion traditionally associated with Heart function, but there are studies that determined that one-third of heart surgery patients suffer depression, another associated emotion, after surgery.
Depression is a risk factor that affects levels of morbidity and death months and years after heart surgery, according to research including, “Depression following myocardial infarction: Impact on 6-month survival,” published in 1993 in the Journal of the American Medical Association.
This is where caring and compassionate touch can make a difference, and I believe it is another reason why it’s important for Asian Bodywork Therapy to be available to cardiac patients. I think there has been a gap in the front line of health care, and we are stepping in just where our touch is most needed.
About the Author
Diego Sanchez, LMT, Dipl. ABT (NCCAOM), has been teaching shiatsu for more than 20 years. A teacher with practical experience treating thousands of patients, Diego specializes in supporting people facing critical illness. He now lives and teaches in Uruguay and teaches regularly in Europe and the U.S. Join Diego’s Shiatsu in Hospitals Facebook group. He wrote this article on behalf of the American Organization for Bodywork Therapies of Asia.