Online Health Chat with Christine Spiroch, PA, PhD, Jamie Starkey, LAc, and Galina Roofener, LAc
March 26, 2014
Natural products are the most popular integrative health modality, which are used to treat a host of conditions, including—but not limited to—diabetes, chronic pain, arthritis, infertility, menopause, immune support, IBS, and hypertension.
According to the National Center for Complementary and Alternative Medicine (NCCAM), the interest in and use of natural products have grown considerably in the past few decades. A 2007 National Health Interview Survey (NHIS), which included a comprehensive survey on the use of complementary health approaches by Americans, revealed that 17.7 percent of American adults had used a non-vitamin or non-mineral natural product in the past year. These products were the most popular complementary health approaches among both adults and children. The most commonly used natural products among adults in the past 30 days were fish oil and omega 3s (reported by 37.4 percent of all adults who said they used natural products. Popular products for children (taken in the past 30 days) included echinacea (37.2 percent) and fish oil and omega 3s (30.5 percent).
About the Speakers
Christine Spiroch joined the staff of Cleveland Clinic Center for Integrative Medicine in the fall of 2011, after practicing for eight years in an integrative medicine private practice. She previously worked in the Preventive Cardiology and Rehabilitation Section of Cleveland Clinic.
She received her PhD in Counseling and Human Development Services from Kent State University, and received her Physician Assistant training through Cuyahoga Community College in Cleveland, Ohio. Christine’s doctoral dissertation, “Quality of Life in Patients with Advanced Cancer,” was based on data collected as a member of the palliative care service at Cleveland Clinic.
Jamie Starkey, LAc is the lead acupuncturist at Cleveland Clinic’s Center for Integrative Medicine. She earned a masters degree in acupuncture at the American Institute of Alternative Medicine, in Columbus, Oh. She completed a clinical internship in the Acupuncture and Moxibustion Outpatient Department (an affiliate of the China Academy of Traditional Chinese Medicine), at Guang AnMen Hospital, in Beijing, China, She is a Diplomat of Acupuncture, National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), and holds her acupuncture license from the Ohio State Medical Board. She is also a Level II Reiki Practitioner.
Galina Roofener, LAc is a nationally board certified, and Ohio and Florida state licensed acupuncturist. Galina received her degree in oriental medicine from East West College of Natural Medicine, in Sarasota, Florida. She also earned a doctor of naturopathy degree from Trinity College of Natural Health, in Warsaw, Il. She has received multiple certifications in various modalities of alternative and complementary medicine.
Let’s Chat About Natural Products: Western Herbs, Traditional Chinese Herbs, Supplements, Vitamins, and Minerals
Moderator: Let's begin with your questions.
Chinese Herbal Medicine: General Health and Preventative Medicine
pilatesgirl: Do you take any herbs on a daily basis?
Galina_Roofener,_LAc: Yes, I do take my custom herbal formula.
Jamie_Starkey,_LAc: With the guidance of my integrative medicine physician, I take a daily herbal supplement to help with adrenal function. Additionally, I take a daily multivitamin, vitamin D3 and magnesium.
pilatesgirl: Are there herbs that are best for prevention?
Galina_Roofener,_LAc: It all depends on individual patient. In traditional Chinese medicine we treat a person—not a disease. The same apply to prevention.
pilatesgirl: Are there supplements you recommend on a daily basis for prevention and good health? Do you recommend any particular brands or how to measure quality of multivitamin formula? Also, would you buy fish oil at Costco?
Christine_Spiroch,_PA-C,_PhD: Quality is very important. We recommend vitamins and supplements that are of professional grade. Looking at the list of "other ingredients" is very important. Basic supplements will include vitamin D, fish oil, probiotics and a multivitamin. Some brands that we recommend include Metagenics, Thorne, and Ortho Molecular products. We are familiar with their manufacturing process and their raw materials.
writer53: Are you familiar with and do you recommend Biotics Research supplements?
Christine_Spiroch,_PA-C,_PhD: Yes, I am familiar with them. I have used them in the past. I think there are some companies that have higher standards and many that have lower standards.
pilatesgirl: What do you think of Triphala?
Galina_Roofener,_LAc: It is a great remedy, but application results will depend on individual patient’s condition. Is it safe for everybody? No!
thirtyyearssick: What do you recommend for slightly elevated homocysteine and slightly elevated cortisol? (My C-reactive protein is fine.) I'm a 66-year-old female with great improvements in the last year in kidney disease, asthma, arthritis, vision (with removal of mercury from fillings), and in intestinal permeability, Addison disease, Hashimoto disease, celiac disease, etc. (with very careful diet and supplements).
Christine_Spiroch,_PA-C,_PhD: Before making specific recommendations, I think it would be prudent to know what your levels are. An integrative medicine consultation might be indicated.
Quality of Chinese Medicine Preparations
sunrise77: A friend uses the supplement xiao yao wan, which is manufactured in China. How can one trust this drug?
Galina_Roofener,_LAc: The majority of Chinese herbal formulas are manufactured in China, Taiwan or Japan. Taiwan has the strictest regulations in the world on herb quality. With Chinese manufacturers, it depends on the individual company. I do not recommend buying herbs at the Chinese market. That is not safe! You should rather buy it at a licensed acupuncturist or Chinese herbalist office.
Jamie_Starkey,_LAc: This is absolutely correct. You need to be sure that the quality of the herbs is of the highest standard. Labeling should follow FDA labeling guidelines, and the manufacturer of the herbal supplement should be able to produce specific quality certificates when asked. The risk of purchasing raw herbs in a Chinese market is high as you run the risk of getting a product that may be contaminated with heavy metals, the wrong species of herbs, mold contamination, etc. The products consumers purchase should come from a licensed and reputable clinician who has done their due-diligence to carry high-quality products.
sunrise77: Does one have to believe that acupuncture actually works for the best result?
Jamie_Starkey,_LAc: No doubt, there is a powerful "mind-body" connection. Positive thinking certainly goes a long way! However, you do not necessarily need to "believe" in acupuncture to attain therapeutic effect. There is an incredibly vast body of evidence looking at acupuncture's mechanism of action. We now know a lot more about how acupuncture influences the body, which includes its effect on the nervous system, immune system, anti-inflammatory effect, etc.
pilatesgirl: Can you explain the difference between adaptogens and medicinal herbs?
Galina_Roofener,_LAc: Adaptogens (ginseng and rhodiola [roseroot]) are medicinal herbs. They enhance your ability to adapt to the environment.
fstoner: What are the best natural products a person can take for joint pain from arthritis that do not thin the blood? I take Coumadin® (warfarin sodium) for atrial fibrillation (A-fib) and must be careful not to thin the blood further.
Christine_Spiroch,_PA-C,_PhD: Turmeric—a spice—which is also available as a capsule is great for inflammation. Since you are on Coumadin®, check with your healthcare team whether you can take fish oil.
rls1953: What natural products do you recommend for someone with gout and what foods should they avoid?
Christine_Spiroch,_PA-C,_PhD: Since gout is a manifestation of inflammation, I would suggest an anti-inflammatory diet. Avoid processed foods, and consider a trial of gluten-free diet. Avoid nightshades (tomatoes, white potatoes, peppers, and paprika); you can use the internet to find a complete listing of nightshades. Also, do an internet search of Andrew Weil for his information on his anti-inflammatory diet.
writer53: Please comment on the benefits of micronutrients (through intensive green juicing) to relieve joint pain and inflammatory response. My daughter who is 22 years old is in remission from granulomatosis with polyangiitis (GPA) that was diagnosed in January 2013. Three months after her diagnosis we began intense green juicing (with the Omega low-masticating juicer), emphasizing anti-inflammatory vegetables. My daughter also takes an anti-inflammatory, immune-boosting regimen of Biotics Research Corporation supplements (including multi-vitamins, essential fatty acids [EFAs], ADP, vitamin D, lipoic acid, and probiotics) under a physician's direction. She achieved full remission and has excellent blood work although some residual joint pain that is worse during her period. Can you explain the significance of the role that micronutrients and other targeted supplements play in suppressing inflammation and restoring immune balance? And, if these really work, why are they not a fundamental part of every autoimmune patient's regimen for recovery and maintenance of health?
Christine_Spiroch,_PA-C,_PhD: Many foods are pro-inflammatory, probably more than are anti-inflammatory. Processed foods comprise much of the typical American diet. Our goal in integrative medicine often focuses on avoidance of toxins such as foods rather than just adding a supplement or medication to suppress symptoms. The use of such nutrients and supplements depends on the healthcare provider’s training and philosophy.
rls1953: There has been news recently that too many antioxidants can cause or aggravate health conditions. Are vitamins A, C, and E all anti-oxidants?
Christine_Spiroch,_PA-C,_PhD: It’s hard to make a "one-size-fits-all" statement. The interpretation of this news depends on the source.
pilatesgirl: Might you share your thoughts about curcumin? Do you feel the extracted part (curcumin) is best or the whole spice as turmeric? Do you know what the water soluble vs. fat soluble components do?
Galina_Roofener,_LAc: In traditional Chinese medicine we differentiate four different types and parts of the Curcuma plant (a genus of about 80 different species of plant). Each has different functions. Determining which one is good for you can be done only after seeing you in person and upon evaluation of your entire health history.
dashone: What is your opinion of garcinia cambogia and African mango?
Christine_Spiroch,_PA-C,_PhD: There is conflicting research.
sunrise77: Regarding natural statins, are there reservations in the medical community with the use of red yeast rice? What about specifically for kidney disease? What are the controls on the product that would assure quality? Are there product names that are considered safe?
Christine_Spiroch,_PA-C,_PhD: Yes but it seems there is more acceptance. It is important to purchase from a reputable nutraceutical company. One example is Thorne Research Choleast™, which is available at the Cleveland Clinic Wellness store.
Chinese Medicine for Allergies
Rebeccalynn43561: I would like to take Chinese herbal therapy for allergies. I have seasonal allergies. I took Allegra® (fexofenadine hydrochloride) last year which did help, but I have Hashimoto thyroiditis and was told taking them may slow me down. Also, can you recommend anything for Hashimoto thyroiditis and cholesterol?
Galina_Roofener,_LAc: Yes, Chinese herbal therapy can help with your allergies along with Hashimoto thyroiditis and cholesterol, although it will require careful balancing and will take some time to do. Hopefully, we will see you in the herbal clinic soon.
Christine_Spiroch,_PA-C,_PhD: Additionally, acupuncture can help with the symptoms of your seasonal allergies (such as itchy eyes and nasal congestion). Last year, a larger randomized control study regarding seasonal allergies and acupuncture was published. The study showed a decreased need for allergy medication for those patients undergoing acupuncture therapy. It is recommended that you come in approximately eight weeks prior to the start of allergy season.
Natural Products for Atrial Fibrillation
rls1953: What natural herbs, supplements, vitamins and minerals do you recommend for someone with atrial-fibrillation (A-fib) or atrial-flutter? I've had three ablations and a right heart catheter, and I am still in atrial-flutter.
Galina_Roofener,_LAc: If you take Coumadin® (warfarin sodium) or heparin, you should not take any herbs or supplements without consulting your physician or our integrative medicine doctor. Many herbs and supplements have a blood-thinning effect that may not be safe. Acupuncture will be the best choice for you!
Chinese Medicine for Autoimmune Disease
pilatesgirl: Are there any herbs that you might recommend to calm the immune system related to autoimmune disease? I have celiac disease, and my skin and bones are the target of my inflammation from this disorder. Are there herbs that can help calm a reaction once it’s occurred?
Galina_Roofener,_LAc: Yes, we can positively affect your symptoms after the fact. We cannot cure autoimmune, but we can greatly assist in managing it. The specifics depend on individual patient. In traditional Chinese medicine we treat a person not a disease. The same applies to the immune system. We would be happy to see you in herbal clinic soon.
writer53: For autoimmune management—as well as for general health—what are the best anti-inflammatory foods and anti-inflammatory supplements? Do you recommend vitamin D, A.D.P. (oil of oregano extract), essential fatty acids (EFA), Co-enzyme Q10, or lipoic acid?
Galina_Roofener,_LAc: We cannot cure autoimmune disease, but we can greatly affect your system. The specifics depend on an individual patient’s entire health information. In traditional Chinese medicine, we treat a person not a disease—the same applies to the immune system. We can assist in managing it. There are many supplements and herbs that will regulate your immune system.
Christine_Spiroch,_PA-C,_PhD: We see many patients for auto-immune conditions. There are certain blood tests we like to order. Our treatment plan typically consists of supplements and nutrition education. I think you could benefit from an integrative medicine consultation.
Integrative Medicine for Barrett Esophagus
clara: Are there any herbs to treat for Barrett esophagus and Parkinson disease?
Galina_Roofener,_LAc: Yes! We would be happy to see you in the herbal clinic.
Jamie_Starkey,_LAc: Acupuncture may be a helpful option for both Barrett esophagus as well as Parkinson disease. Acupuncture has a strong influence over the somatic and autonomic nervous systems. Acupuncture can be incorporated as an adjunct to your conventional treatment plan to help manage symptoms like tremors. In the case of Parkinson disease, it is also crucial that the patient has a regular exercise regimen as studies indicate a direct positive effect between exercise and a decrease in tremors.
Chinese Medicine for Bowel Conditions
pilatesgirl: Do you have any thoughts about supportive herbs for problems with hemorrhoids or constipation?
Galina_Roofener,_LAc: In traditional Chinese medicine, we treat a cause not just a symptom. It is important to know all of your symptoms to say specifically which Chinese herbs you may benefit from. It is important though to drink plenty of water and have enough fiber.
lightning#: What ideas do you have for someone who has bowel stasis or bowel inertia? There is no pain, but there is abdominal bloating leading to uncomfortable pressure. I've been told that I have a connective tissue disorder that contributes to this problem. I have inhibition of the nerve supply to the bowel.
Christine_Spiroch,_PA-C,_PhD: Have you had a gastrointestinal work up? Are your symptoms worse in relation to eating or food intake? Especially if you have autoimmune disease, food allergies may be a contributing factor. Some over-the-counter products to consider are magnesium and probiotics. We often see patients with these symptoms in Cleveland Clinic’s Department of Integrative Medicine.
Chinese Herbal Formulas in Breast Cancer Survivor
swahumina: I am a 43-year-old triple-negative breast cancer survivor (also with genetically high triglycerides and low vitamin D). I would like to begin an herb and vitamin plan that will best suit my situation. Of course, I know that getting the most nutrients out of food is the best option, but I am very curious to see about supplementation for the best results. I hear so much conflicting information. For instance, should I take curcumin supplements? How about mushroom extracts? I try to drink three or four glasses of green tea per day rather than take a supplement for that. I also currently take Vitamin D and Lovaza® (omega-3-acid ethyl esters). What else would you recommend, and what do you think I should avoid?
Galina_Roofener,_LAc: Before any specific recommendations can be given, you should be evaluated in person to review your lab work and the rest of your medical history. There are many herbs and supplements that can be very beneficial for you dependent on your symptoms. However, any herb that has estrogen-like effect is not an option for you. Chinese herbal formulas are very effective to control menopausal symptoms (natural and surgically or chemotherapy induced) and assist with regulating your cholesterol. Chinese herbs are very safe when they are prescribed on individual basis. Hopefully, we will see you in the herbal clinic soon.
Chinese Herbal Medicine for Candida
sunlover902: I just found out I have candida and don't want to take Diflucan® (fluconazole). Is there anything else I can do with herbs to kick this infection?
Galina_Roofener,_LAc: Yes, we have as Chinese herbal formulas as we as many other supplements that will beneficial for eradicating candida. However, for the best benefit you need to come to see Christine first to review lab work that you already have done and have more ordered if needed. Additionally, you would benefit from an anti-candida diet that excludes all sugars, etc. that feed candida.
Vitamins for the Common Cold
sunrise77: Various studies question the value of supplements and recommend a complete diet instead. Are there any definitive studies on vitamin C or zinc in diminishing the symptoms of a cold?
Christine_Spiroch,_PA-C,_PhD: There seems to be a lot of current emphasis on the use of vitamin D.
Chinese Medicine for Fibromyalgia
faride: I have been diagnosed with fibromyalgia, and I am taking herbs drinks to help me—like ginger with lemon with its anti-inflammatory effects—the whole day. Could you recommend me other kind of herbs for the fibromyalgia?
Galina_Roofener,_LAc: In traditional Chinese medicine we treat a person not just a symptom or disease, so it is important to know all of your symptoms, health history and lab work to say specifically which Chinese herbs you may benefit from. Chines herbs definitely can be a great addition to your regimen along with other supplements. We would be happy to see you in the herbal clinic.
Christine_Spiroch,_PA-C,_PhD: Have you tried fish oil or turmeric? Avoidance of gluten can also help joint pain.
Integrative Medicine for Joint Pain
kneepain: How much time is needed between acupuncture appointments to keep knee pain at a lower level? I am waiting for knee replacement surgery. Is there anything herbal that would help relieve the pain?
Jamie_Starkey,_LAc: Time between acupuncture visits is variable for each patient. A typical recommendation would be a course of treatment that includes one treatment per week for approximately eight to 10 visits. Once your pain scores begin to drop, we can taper your visits. If you are bone-on-bone and using acupuncture to help manage pain until your surgery date, a maintenance schedule will most likely be needed (every two, three, or four weeks—depending on your pain management needs).
rls1953: I had replacements in both hips five years ago and just started getting pains in the back of my leg when I sit for longer than 20 minutes. Do you have any suggestions?
Christine_Spiroch,_PA-C,_PhD: You should have a chiropractic evaluation, physical therapy, massage and fish oil. You may also benefit from an integrative medicine consultation.
Meg: What does gluten have to do with joint pain? You mentioned it might be good to avoid it.
Christine_Spiroch,_PA-C,_PhD: Gluten affects many body systems, not just the gastrointestinal system. Joint pain is very frequently improved when on a gluten-free diet.
Chinese Medicine for Kidney Stones
Gail Ann: Is there anything in traditional Chinese medicine that can help with hypothyroidism and kidney stones?
Galina_Roofener,_LAc: Yes, definitely. We would be happy to see you in the Chinese herbal clinic soon.
sw4health: What natural products would you recommend for the prevention of calcium oxalate kidney stones?
Galina_Roofener,_LAc: We have Chinese herbs that will help to regulate calcium metabolism in the body to prevent formation of stones or if you already developed stones, but they are still small, Chinese herbs can dissolve and expel them. You will need to have a new ultrasound test done before coming to the herbal clinic. Meanwhile you should avoid oxalate-containing foods.
Chinese Herbal Medicine for Mental Acuity
Sunshine2014: What herbs or treatments would you suggest for menopausal women, specifically related to mental acuity?
Galina_Roofener,_LAc: There are many herbs and supplements that you can benefit from. To be specific, we need to look at your health history and lab work. It should be a team effort, of you would like to see Christine Spiroch and me in the Chinese herbal clinic.
fuerstm: I am still recovering from a concussion that occurred five months ago. I started taking DHA in liquid and capsule form as well as taking a multivitamin B complex and lots of fruits and vegetables. Do you think the DHA is beneficial and is there anything else that could help with repairing brain function as well as nerve pain?
Galina_Roofener,_LAc: Adding acupuncture and Chinese herbs would be a great help for you.
Christine_Spiroch,_PA-C,_PhD: An integrative medicine consult could be helpful in evaluating other aspects of your health that might contribute to nerve pain.
Chinese Medicine for Migraines
robtoby: Do you have any suggestions on natural products of any kind—herbs, supplements, vitamins, minerals, etc.—for migraines?
Galina_Roofener,_LAc: In traditional Chinese medicine we treat a person, not a disease. Just for your information, we differentiate 13 different types of headache/migraine. Each requires a different herbal formula. So, in order to tell which herbs you will need to treat your migraine, you need to have an in-person evaluation.
Chinese Medicine for Multiple Sclerosis
dashone: Besides vitamin D and a probiotic, what supplements or herbs would you recommend for relapsing-remitting multiple sclerosis (MS)? I have muscle spasms and pain— especially with stress, which is chronic at times. I am a 46-year-old woman who takes Gilenya® (fingolimod) for MS, Keppra® (levetiracetam) for spasms, and baclofen for muscle pain and spasm.
Christine_Spiroch,_PA-C,_PhD: I would recommend considering a gluten-free diet.
Supplements for Prostate Cancer Survivor
robtoby: I have had prostate cancer and subsequent surgery. I'm happy to say my PSA has been undetectable for over three years now! Do you recommend any supplements, vitamins, etc. for someone like me? I take a multi-vitamin every day along with 50 mg of CoQ10.
Christine_Spiroch,_PA-C,_PhD: We recommend monitoring Vitamin D levels for patients who have had cancer. It is best to have your level checked. An ideal goal would be to have at least 50 to 60. Your dose would depend on your current level.
Integrative Medicine for Vocal Quality
writer53: Can acupuncture be used to help restore clear tone vocal quality for a singer with an autoimmune condition who has healthy vocal folds, but who now has airy vocal quality since this disease? (I am in remission from granulomatosis with polyangiitis [GPA]). Do you suggest another natural treatment to help restore my former clear tone?
Galina_Roofener,_LAc: We can try! In the Chinese Herbal Materia Medica book, we have an herb that is very specific to voice issues in teacher and singers. We would be happy to see you in the Chinese herbal clinic.
Jamie_Starkey,_LAc: Acupuncture may help if there is any inflammation in the local area adversely impacting the vocal cords. Additionally, acupuncture can be used in a supportive function for immune support since the underlying issue is your autoimmune disease. You may also want to consult with a good speech therapist.
Laboratory Testing for Integrative Medicine
Gail Ann: If one makes an appointment to see you, would you accept blood work and results from a Canadian lab? What tests would you expect to have done to evaluate one’s condition?
Jamie_Starkey,_LAc: In terms of blood work and results, it is more important to know the time frame in which the tests were run. What tests will depend on the patient's condition. Integrative medicine consultations can include blood work to assess thyroid function or vitamin deficiencies, for example. You may also be asked to submit stool or saliva samples. If you have any reports from outside clinics, it is always helpful to bring those reports with you to your visit. It is up to the discretion of the provider as to whether labs are repeated.
Timing of Supplements
smbart: When should vitamin and mineral products be taken—morning or night?
Christine_Spiroch,_PA-C,_PhD: In terms of taking vitamins and minerals that depends on the supplement. If it's something to give you energy, take it in the morning and not the evening.
Prescription and Supplement Interactions
ham_milo: For someone who takes the following prescription medications daily, are there any undesirable interactions with the listed over-the-counter or prescribed supplements?
Levothyroxine 75 mg, Triamterene/hydrochlorothiazide 75-50 mg, potassium chloride Crys ER 10 mEq, Prevacid® (lansoprazole) one capsule 15 mg, and Heliocare® one capsule. Rainbow Light Women’s One Just Once multivitamin one tablet, Rainbow Light calcium one tablet 500 mg (includes 250 mg magnesium and 500 IU Vitamin D), Nordic Naturals omega-3 purified fish oil 1000 mg one gel capsule, low-dose aspirin 81 mg two tablets; Digestive Advantage® Probiotics Gummies one gummy, FiberCon (polycarbophil) two tablets, New Chapter Zyflamend® Whole Body one capsule; Jarrow Formulas Curcumin 95 one capsule 500 mg, DietWorks green coffee bean extract one capsule 400 mg, NutriGold Garcinia Cambogia Gold one capsule 500 mg with 300 mg hydroxycitric acid.
Galina_Roofener,_LAc: Yes, there are potential interactions You always want to take herbs two hours apart from the rest of your medications and supplements.
Prevacid® will interfere with absorption of all other medications and supplements so this one should be taken separate from everything else. Aspirin, omega-3 and curcumin all have blood thinning properties. Levothyroxine should be taken separate from food and everything else by one hour. Calcium will interfere with it if taken too close together. Green coffee bean extract may aggravate heartburn, so it should be taken after food.
FDA Regulation of Supplements
sunrise77: There has been discussion in the past about FDA regulation of supplements? Has there been any update on that initiative?
Christine_Spiroch,_PA-C,_PhD: There is certainly much more awareness of food allergies and the practices of companies that manufacture supplements. There is more awareness of the source of the raw materials used in supplements and quality control.
Choosing an Integrative Medicine Practitioner
rls1953: How do I identify a good integrative medicine practitioner in the Columbus, Ohio area?
Jamie_Starkey,_LAc: You can look for a physician who practices integrative/functional medicine by going to the Institute for Functional Medicine's website and doing a search for a provider in your area at www.functionalmedicine.org. Additionally, if you are interested in finding an acupuncturist in Columbus, you can go to the National Certification Commission for Acupuncture and Oriental Medicine's website and search for a provider in your area at www.nccaom.org. Finally, you may want to check with the hospitals in the area to see if they offer integrative medicine services.
Insurance Coverage and Integrative Medicine
swahumina: Which services are covered by insurance? Do you have a sliding fee scale for the acupuncture services?
Jamie_Starkey,_LAc: Insurance will typically cover integrative medicine consultations with a physician or physician assistant. Some insurance companies will cover acupuncture services. I recommend that you contact your insurance company directly to see whether or not acupuncture is covered. If it is not, we offer shared acupuncture medical appointments at Cleveland Clinic, in which patients are treated in a group setting. To qualify for the group appointments, you must first have an initial consult in a private appointment to be sure you are a good candidate for group. The Chinese Herbal Clinic is not covered by insurance. Flexible spending accounts may also be used for these services.
Moderator: I'm sorry to say that our time with Christine Spiroch, Jamie Starkey and Galina Roofener is now over. We wish to than each of you for taking the time to answer questions today.
Jamie_Starkey,_LAc: Thank you everyone for taking the time to speak with us today. It was a pleasure to answer your questions!
Christine_Spiroch,_PA-C,_PhD: Thanks for the questions. Please visit the Department of Integrative Medicine if you are looking for options for prescription medication.
Galina_Roofener,_LAc: Thank you. It is always a pleasure to chat with those who care.
To make an appointment with any of our specialists in our Center for Integrative Medicine at Cleveland Clinic, please call 216.986.HEAL(4325). You can also visit us online at www.clevelandclinic.org/integrativemedicine.
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