Online Health Chat with Brenda Powell, MD, and Jamie Starkey, LAc

June 21, 2011


Cleveland_Clinic_Host: Every life includes stress, and in some cases it can be beneficial. The stress of a deadline can increase productivity or performance, for example.

But when stress is chronic or unmanaged, it can lead to aches, pains, loss of sleep, anxiety or depression, a depressed immune system, hypertension, and unexplained infertility, as well as many other symptoms. It can play a major role in triggering, exacerbating or even being a variable in a variety of serious diseases and disorders. And if symptoms worsen, it can create even more stress – continuing a cycle that affects your quality of life.

You can’t always remove what causes stress in your life. But by pinpointing the causes of stress, our integrative medicine physicians and licensed acupuncturists can develop an individualized treatment to help eliminate and manage the effects that stress has on your health and well-being.

During this chat, Dr. Brenda Powell will talk about the benefits of consulting with a physician trained in integrative medicine. She will discuss how the physician will review lifestyle activities that add to stress and provide an individual plan for improving health through diet, improved sleep, and possible use of supplements.

Ms. Jamie Starkey will address the benefits of acupuncture: Decrease in irritability, better coping skills, decrease in stress eating and junk food cravings, improved sleep, and avoiding unwanted side effects of medications. She also will discuss the advantage of a multi-disciplinary approach to stress management and how acupuncture can be incorporated into conventional treatment plans.

About the speakers:

Brenda Powell, MD, is a Staff Physician at Cleveland Clinic in the Center for Integrative Medicine and Associate Clinical Staff at Case Western Reserve University School of Medicine. She received her medical degree from Duke University School of Medicine in 1988 and completed her residency training in family medicine at Duke University Medical Center in 1991. She completed the Harvard Macy Physician as Teacher Fellowship at the Harvard School of Education in 1999. She was certified in travel medicine through the International Society of Travel Medicine in 2007.

Jamie Starkey, LAc, Lead Acupuncturist, has a Bachelor’s degree in biology from the University of Toledo and a Master’s level acupuncture from the American Institute of Alternative Medicine. She spent a clinical internship at the Guang AnMen Hospital in Beijing, China (Acupuncture and Moxibustion Outpatient Department). She also has earned a Diploma of Acupuncture from the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) and has an Acupuncture License from the Ohio State Medical Board.

To make an appointment with Integrative Medicine Physician Brenda Powell, MD, or Lead Acupuncturist Jamie Starkey, LAc, please call 216.448.4325.

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Brenda Powell, MD, and Jamie Starkey, LAc. We are thrilled to have them here today for this chat. Let’s begin with some of your questions.

Stress Relievers

makeit: How many acupuncture treatments does it take to relieve stress? Is this something that needs continual treatment?

Jamie_Starkey_LAc: There is an individual response to each treatment session. Typically, I would recommend a minimum of one session per week for five to eight treatments total until you reach a therapeutic effect and start to feel better.

Often, patients will feel an immediate stress relief after a treatment session. The goal of additional treatments is to make that response long-lasting.

You cannot control the external variables of stress. So for some patients, they prefer to stick to a maintenance schedule of once per month. Other patients will come in only during high peaks of stress and use acupuncture as a tool to help them through that high period of stress.

olympus: Can you address breathing and stress?

Jamie_Starkey_LAc: Studies are showing mindful breathing will immediately engage the parasympathetic nervous system, which is the aspect of the nervous system that is responsible for the relaxation response.

Medication and Therapy

queenb: What are the indicators that may lead to consider medication to treat stress? What specialist would best determine this? Does this apply to children, too?

Dr__Brenda_Powell: When stress is causing life-altering or life-threatening anxiety, then there may be a more immediate need for medication. Medications are needed for adults and children when they cannot function in their day-to-day activities. Once stabilized, integrative therapy can be started. Long-lasting solutions can be addressed with integrative medicine. Children can benefit also from this.

Nubianspirit: I am 53 and going through menopause. I never experienced a panic attack until menopause. Acupuncture and yoga have been very helpful. Are you familiar with Emotional Freedom Technique (EFT); and if so, do you think it is effective in calming anxiety and fear?

Dr__Brenda_Powell: I have not heard of Emotional Freedom Technique, but by its name alone, it sounds like it is a way to get in touch with your feelings. Possibly a holistic psychotherapist would be one to consult. Here at Cleveland Clinic Center for Integrative Medicine, we have a holistic psychotherapist.

Nubianspirit: What exactly is a holistic psychotherapist? How is their approach different?

Dr__Brenda_Powell: Quoting from the Zivia Bairey, LISW-S, ACHT and the chat transcript from 9/14/2010:

"Holistic psychotherapy utilizes traditional methods of psychotherapy, as well as non-traditional therapies of holistic healing with the purpose of creating a fuller integration between the mind, body and spirit, and the deepest level of healing possible. These services are currently delivered by a clinician with a license in clinical social work and marriage counseling, certification in advanced clinical hypnotherapy and a Master’s degree in creative art therapy.

The traditional approach includes elements of traditional psychotherapy such as psychoanalytic/psychodynamic, cognitive/behavioral, developmental, educational, family systems and humanistic therapies that utilize a ‘strengths’ perspective to match the individual needs of the patient.

Non-traditional therapies are based on a variety of traditions, which tap into different levels of mind-body-spirit healing. The holistic methods are taken from a broad range of traditions: transpersonal psychology, humanistic psychology, shamanic healing, and subtle energy medicine, hypnosis of different types, hypnotherapy, creative arts therapies, regression therapy, conscious breathing therapies, and guided imagery. All therapies have a strong spiritual component, which utilizes different levels of consciousness and spiritual awareness."

joker3: What are the advantages of very tiny needles that are inserted and left in place for a week or two, or even longer? I have only read about this as a treatment for other medical issues. Is this recommended for stress and anxiety? I get very bad anxiety attacks.

One technique used by acupuncturists is to apply small "intradermal needles" to various acupoints. These points can be located all over the body. The advantage of this type of treatment is it offers a way to extend the treatment once you leave the office, because those tiny needles are still having an effect on the body as long as they are retained.

On some occasions, patients are sent home with tiny needles left in the ears, especially for pain control. It must be strongly noted that this type of treatment requires regular follow-up visits to assess the placement of the needles and the patient’s condition.

For management of stress and anxiety, the acupuncturist will most likely use an acupressure technique applied to the ears. Tiny stainless steel balls, called "ear seeds," are placed on the ear using adhesive tape. Instead of puncturing the skin as a needle would, these ear seeds lay on the surface of the ear and apply pressure to specific points on the ear that help to induce a state of calm and relaxation. This technique is commonly performed in the office.

Specific Disorders

songcanary: I was diagnosed at Cleveland Clinic with fibromyalgia, and my rheumatologist explained that I have 'central sensitization syndrome,' which causes an overreaction to stimuli, especially stress. I am desperate to find a way to reduce these reactions. I currently take a wonderful yoga class three times a week and recently stopped working because of two near collapses. Would integrative medicine be of benefit to someone like me?

Jamie_Starkey_LAc: I think it’s wonderful that you are being proactive in your treatment plan. Integrative medicine would definitely be a great option for you to explore.

From my perspective, as an acupuncturist, I see many patients in your situation. You would be a very good candidate for acupuncture (which is a branch of traditional Chinese medicine that dates back nearly 3,000 years. Please visit

During your initial visit, I would review an extensive intake form, which will allow me to look at you from a holistic perspective. In addition to your fibromyalgia pain, I also need to get an idea of your stressors, sleep patterns, diet, allergies, etc. In traditional Chinese medicine, we take everything into consideration because our goal is to treat the underlying cause of the imbalance that is occurring in the body, i.e., our approach is to treat the root cause of the disease. Modern science is able to explain a lot of the mechanism of action behind acupuncture, and we now know that this treatment engages the portion of the nervous system (parasympathetic nervous system) that elicits calm and rest. Also, your brain begins to release chemicals, such as endorphins, which will help ease pain and improve mood.

In addition to acupuncture, an integrative medicine consult with Dr. Powell would also be a good idea, as she would address variables that may be playing an adverse role in your condition, such as environment, supplement or vitamin deficiencies, etc.

Also at the Center for Integrative Medicine, you may opt to pursue holistic psychotherapy that could help you to engage the mind-body connection, lessening the physical response your body has on external stimuli.

The wonderful thing about acupuncture and integrative medicine in general, is you can incorporate this treatment modality into your conventional treatment plan, thereby creating a well-rounded multidisciplinary approach to help you manage your condition.

lcamp: I am a 19-year-old female. I have been diagnosed with depression. I have been on various anti-depressants. I am running out of options where I don't have side effects. What are some other treatment options besides medications that have been helpful with young adults?

Dr__Brenda_Powell: Great question! You can consider adding specific supplements to your antidepressants and augment them, hopefully allowing you to take lower doses. This is something that would be addressed in an integrative medicine consult.

At the CIM, we work together in a team approach to best address the patient's needs and thus refer to other appropriate practitioners.

Acupuncture would be one such treatment option. Depression is commonly treated by an acupuncturist. Individuals with mild or moderate depression and those attempting to wean off medications are the patients who will typically get a good response from acupuncture. Working with your physician to try to develop the best multidisciplinary approach is the goal.

lcamp: So, what you’re saying is, you would work directly with the therapist to determine this?

Dr__Brenda_Powell: We would rely heavily on a therapist to determine the treatment plan, whether it is in an individual or group session. The integrative physician would monitor progress with follow-up visits.

PEANUTS5: I am looking for a treatment without prescribed medications for high blood pressure.

Dr__Brenda_Powell: Integrative medicine may have an approach that works for you. Integrative medicine would address lifestyle and nutrition, and recommend therapies that are evidence-based to address the high blood pressure. Examples would be Reiki, acupuncture, massage, and mind body (holistic psychotherapy), as these approaches engage the parasympathetic nervous system. If blood pressure goals are not met, it is imperative to have your blood pressure maintained, even if it means medication. The integrative medicine team will work with you and your physician to have a team approach in managing your condition.

JCP: I have seasonal affective disorder. When at its worse, my stress levels are very high. I have been on medication for 45 years. I also have psychotherapy and use exercise. All is great, but should I consider getting off the medications or leave well enough alone? What suggestions would you have for me concerning alternate treatments?

Dr__Brenda_Powell: An integrative physician could try adding supplements and integrative therapy and then attempt weaning off medication. We recommend doing this in combination first.

Treating Side Effects

sllyw_1: I have been getting excellent help for my adrenal insufficiency and hypogammaglobulinemia through a combination of low-dose steroids (Cortef© - hydrocortisone oral) rest, stress coaching, and a number of recommended supplements. My problem is that about 70 percent of the time, taking the supplements is upsetting to my stomach, and I am finding it harder and harder to motivate myself to take them. Is there a method I could use that will help? I do take them with food, but often I get sick enough that I have to lie down for half an hour before the significant discomfort subsides.

Dr__Brenda_Powell: You may want to add ginger or DGL (which is a form of licorice), which helps with nausea.

Sea-Bands (worn for motion sickness) apply pressure to an acupuncture point, and this also helps with nausea. Discuss these options with your physician.

Jamie_Starkey_LAc: Most drug stores carry the Sea-Bands. (This would be an application of acupressure.)

To most effectively address severe cases of nausea (hyperemesis), I would recommend acupuncture treatments and supplement the office visits with home use of the Sea-Bands, which will apply acupressure to the anti-nausea point on your arm.

Any of our acupuncturists can do an initial consult and address the side effects you are experiencing. All initial visits include an evaluation, development of a treatment plan, and then an acupuncture treatment.

Another technique an acupuncturist can do is send you home with small stainless steel balls placed on specific regions of the ear that can help during periods of intense nausea. Like Sea-Bands, this is another application of acupressure.

Acupuncture and acupressure are both based on the same principles of traditional Chinese medicine, and both use acupoints on the body to treat various conditions. Unlike acupuncture, where needles are inserted -- "punctured" -- into the skin, with acupressure you use an object to apply pressure to these points. No puncturing of the skin occurs with acupressure.

sllyw_1: I use ginger tea, ginger chews, and ginger in many meals and it is helpful when the discomfort isn’t so intense. Where can one get Sea-Bands? Do your acupuncturists have Sea-Bands or know where to get them?

Jamie_Starkey_LAc: Most drug stores carry the Sea-Bands. (This would be an application of acupressure.)

sllyw_1: Is DGL a supplement available in pharmacies, health supply stores, etc.?

Dr__Brenda_Powell: Yes, you may find it available in both places. The important thing is not to get plain licorice. Make sure it has DGL. An office visit to evaluate all your supplements would be a good idea.

General Questions

artfull: Will Medicare or other medical plans pay for acupuncture?

Dr__Brenda_Powell: Medicare and Medicaid do not cover acupuncture. Other insurance plans are variable and, therefore, you would need to contact your insurance carrier or human resources department. Most flexible spending accounts may be applied.

Here at the Center for Integrative Medicine (CIM), we have a Patient Financial Advocate who can work with the patient to determine if acupuncture is a covered benefit.

playt_time: How are stress and exercise related?

Dr__Brenda_Powell: Exercise has been shown in studies to improve sleep and immune function (which allows people to be more resilient and resist stress). It does not have to be high-intensity exercise. Anyone can find benefits from walking or even yoga, which has been shown to lower blood pressure.

lcamp: Assuming insurance would not cover something like Reiki, what is the approximate cost of one session?

Dr__Brenda_Powell: First, verify with your insurance that it is not covered. If it is an out-of-pocket expense, you should call the CIM for the updated cost. 216.986.4325.


Cleveland_Clinic_Host: I'm sorry to say that our time with Brenda Powell, MD, and Jamie Starkey, Lac, is now over. Thank you both, again, for taking the time to answer our questions about 'How Integrative Medicine Can Pinpoint, Relieve Effects of Stress.'

Dr__Brenda_Powell: Thank you very much for your time and questions. If you would like to make an appointment, please call.

Jamie_Starkey_LAc: Thank you. I hope that you are able to explore the uses of acupuncture to deal with your stresses and anxiety.

More Information

Cleveland_Clinic_Host: To make an appointment with Integrative Medicine Physician Brenda Powell, MD, or Lead Acupuncturist Jamie Starkey, LAc, please call 216.448.4325.

A remote second opinion may also be requested from Cleveland Clinic through the secure eCleveland Clinic MyConsult Web site. To request a remote second opinion, visit

This chat occurred on 6/21/2011

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. ©Copyright 1995-2011 The Cleveland Clinic Foundation. All rights reserved.