My Scope of Practice: A Clinical and Spiritual Approach to Healing
Perhaps even more than politics and technology, healthcare is shrinking the globe. Faced with the conundrum of exponential advances in assessment and treatment options, the simultaneous rapid upward spiral of costs, and the frustrating inequities of provider and product availability, patients and providers need to be open to a broader variety of treatments.
One option is to become more holistic in approach - more accepting of a therapeutic/cost-conscious "if it works..." philosophy. The pursuit of wellness is opening minds and demolishing barriers. Nowhere is this more apparent than in wound care, where the science/art of healing so readily blends with the mind-body connection. This month's featured clinician incorporates this approach.
Luis Fernando Lira, MD, lives and practices medicine in Mexico. Certified (Mexico) in Plastic and Reconstructive Surgery, as well as General Surgery, Dr. Lira is a member of several related professional associations and has taught at a number of universities in his country. He found himself drawn to wound care and the diabetic foot, partly in response to the growing diabetic population (8.6%) in his country. In addition, an estimated 60% to 70% of the Mexican population has some form of venous insufficiency that potentially impacts wound care. Despite his extensive training in his specialty, Dr. Lira says, "I don't like cosmetic surgery. I prefer wound healing." He became a member of the Association for Advanced Wound Care (AAWC) and began attending the Symposium on Advanced Wound Care (SAWC), integrating what he learned into his treatments. Although the products he learned about were not always readily available and sometimes physicians in his country didn't know how to properly use the products they could procure, his determination "to offer the best treatment for each patient" never wavered.
In 1997, Dr. Lira established (and is now Director General of) HELP Clinic (Heridas Libres de Problemas) a wound care clinic in Monterrey, Nuevo Leon, that currently has 12 physicians on stand by, including internists, cardiologists, podiatrists, and infection and immunology specialists. His goal is to foster a team with 81 active specialists working full time in wound healing support. The clinic has a staff of clinicians with wound care-related specialties (eg, nutritionists), plus labs, EKG capacity, and x-ray. Usually, surgery, which can involve skin grafts, sharp debridement, and small amputations, is performed the same day as the diagnosis. "On average, we see 40 to 65 patients a day," Dr. Lira says. "We've seen 3,600 patients in the past 7 years. All patients in our wound care clinic are treated on an outpatient basis. There are no rooms, no inpatients. Patients are assessed and emergency surgery typically scheduled within 4 hours. The average surgery takes about 1 to 2 hours. Patients leave the same day and return for wound checks and treatment."
Most of the wounds Dr. Lira treats are vascular ulcers - venous stasis and diabetic foot ulcers, the latter frequently having progressed from callus to infection to necrotic tissue. The progression occurs because many patients needing treatment do not have transportation to seek medical care or due to Mexico's fee-for-service society, many cannot afford care.
Obtaining products and training clinicians on product use are among Dr. Lira's biggest challenges. "We are aware of what's out there," Dr. Lira says. "How to get products when they are not sold in our country is the problem. For example, there is no papain-urea ointment. Often, we are forced to substitute. Or even when products are available, clinicians don't know how to use them, and sometimes they remove them inappropriately and change the topical and systemic treatment. In response, we have allocated 1 to 2 hours per week for training nurses and we are implementing a new course 1 week per month and a symposium each year to familiarize staff with available products and protocols. It's difficult to tell a family that you cannot get something that has been prescribed or that the clinician doesn't know the prescribing directions."
To offset these obstacles, alternative treatments are employed to complement traditional methods. One treatment Dr. Lira believes holds particular benefits for persons with wounds is reiki, a form of healing that involves the transfer of energy from practitioner to patient to balance energy and restore order to enhance the body's natural ability to heal. A holistic, natural, hands-on energy healing system that comprises body, mind, and spirit, reiki can help a patient achieve deep relaxation, unblock energy, detoxify the system, experience new vitality in the form of healing universal life energy, and increase the vibrational frequency of the body. The reiki healer places his/her hands a few inches or more from the patient's body (but does not touch, like the spiritual "laying of the hands") and manipulates the energy field for the recipient to channel the needed energy to a specific part of the body. This allows the patient to take an active part in the healing process.1 Dr. Lira explains, "In a C-section, for example, we would want to channel the energy to the front of the body. Sometimes, problems in one part of the body block the flow of energy to another.
"Reiki is like a battery. It restarts the power, giving the patient the energy to heal. I am looking for research to document positive results similar to what we have achieved with reiki. We use it, not to solve the problem, but to reinforce standard treatment. It certainly seems to stimulate immunity and increase energy. Approximately 5% to 10% of our patients receive reiki as part of their treatment. Our typical protocol is four reiki sessions the first week followed by two sessions per week for the next 3 weeks (1 hour each)." Because Dr. Lira is only at the third level of his reiki training, a Master of Reiki, Cristian Rugnone, treats Dr. Lira's patients. Another alternative treatment - acupuncture - also is offered at the wound clinic; Dr. Lira has achieved Diplomat status in acupuncture training and performs all procedures.
Although he has been unable to find documentation in the literature of positive outcomes for patients using reiki (one study is mentioned on the reiki website), Dr. Lira can document that healing rates for chronic wounds treated at his clinic are better than those published. "Using a combination of traditional and alternative treatments, we have excellent results getting chronic wounds to change to acute wounds to facilitate healing." Meanwhile, Dr. Lira continues to grow and share his wound care knowledge by attending and presenting at various conferences. This year marked his fourth visit to the SAWC, and he is the Founder and was the President of the Latinoamerican Chapter of the American Professional Wound Care Association (APWCA).
Dr. Lira sees a future where clinicians "mix it all" - a true globalization of healthcare. "Occidental culture needs to know more about alternative treatments," he says. "Even if clinicians choose not to embrace alternative practices, they still should understand how they work so as not to interfere with positive healing energy. At the very least, it is important to seek better ways to use all of our options to offer patients the best treatments available in our scope of practice."
More information about Dr. Lira's clinic is available at www.clinicahelp.com (in Spanish) or e-mail: dr.lira@clinicahelp.com.
My Scope of Practice is made possible through the support of ConvaTec, A Bristol-Myers Squibb Company, Princeton, NJ
1. www.holisticonline.com/Reiki/hol_Reiki_home.htm. Accessed August 6, 2004.
