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The Wellness Factor in Spas
An Ounce of Prevention

By Shirley Vanderbilt

Originally published in Massage Bodywork magazine, August/September 2003.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.


Americans have a new perspective on health. Rather than waiting for illness to strike, more of us are taking steps to prevent it. The holistic approach to wellness is about enabling the body to heal itself and maintain homeostasis, and nowhere has that concept been more appropriately implemented than in wellness centers. These facilities come in all shapes and sizes, from coast to coast, running the integrative health gamut from medical centers aligned with spas to resorts offering multi-modal programs. Some add creativity classes, health seminars and spiritual exploration to round out the holistic experience. Others offer their own particular nutritional approach, along with a host of alternative treatments.

The wellness center of today is about more than prevention. It's about living life at optimum capacity -- body, mind and soul. In centers with medical services, doctors are embracing the best of both Eastern and Western traditions. In a departure from the quick "in and out" tempo of the traditional office visit, patients are allotted plenty of time to explore with their physician all aspects of their life contributing to health. A multitude of healing professionals are available to the patient to provide a nurturing, supportive environment for change from within. Patients are informed and empowered with the proper tools, encouraged and advised on positive lifestyle choices, and then given the personal responsibility to implement changes that fit their goals and desires.

These centers combine new and improved medical testing with a plethora of alternative therapies to address issues of modern-day stress and aging. Many base their treatment plans on established scientific research of complementary and alternative medicine (CAM). Whether for restoration, overcoming bad habits or dealing with a diagnosed illness, the wellness center is fast becoming the way to optimum health.


New Approaches to Wellness
Each wellness center may have its own take on how to assess, how much to assess and how to prescribe, but all agree on one thing -- catering to the individual. DestinationsHealth director, Florence Comite, M.D., acknowledges the existence of "some fabulous prevention programs out there. But," she says, "the approach we use analyzes the life experience for each person and then we customize a plan to fit that individual, structuring an evaluation that is appropriate and specific for that human being."

DestinationsHealth originated in New Haven, Conn., and has also operated out of Ojai Valley Inn Spa in California. (Currently, the program has relocated while the Ojai resort undergoes renovation.) Comite, a women's health expert and associate clinical professor at Yale University School of Medicine, is creator of the program which includes a medical review and evaluation, preventive health consultations, group seminars and spa treatments.

"Our intention is to create an integrated approach to analyzing a person's health," Comite says. "We look at all aspects of the way a person lives -- their lifestyle, genetic makeup, interests and beliefs. We come up with innovative ways to help them achieve a healthy life. That might mean utilizing interventions or tools available in alternative therapies or the traditional medical world. But our full intention is to make the individual the center of the decision-making process and to create a patient-centered system."

Comite sees her patients as partners. "They have a voice at the table. Once we analyze who they are, from a medical perspective, then we create a very personal approach that sets priorities and also taps into modalities they feel most comfortable with. Frankly, for anyone being analyzed, there are opportunities to tweak and correct conditions that will maintain health and avoid a downward spiral. Intervening as early as possible is beneficial for every one."

Comite's patients represent a wide continuum. "Some are pre-symptomatic. They're pretty healthy or haven't had symptoms yet, or they're looking at the challenges of aging and want to be proactive." Other clients have been diagnosed with a particular condition and want to explore alternative treatments.

"Baby boomers are experiencing their parents living longer than ever before," Comite says. "It's largely the aging process alone and recognizing what the quality of that life is going to be that tends to be a trigger for many who seek guidance." By investing early enough, these boomers may avoid the pitfalls to which their parents have succumbed.

According to Daniel Cosgrove, M.D., medical director of the WellMax Center for Preventive Medicine at La Quinta Resort Club in La Quinta, Calif., WellMax is a high-end preventive center linked to a spa. "In a way," he says, "a spa is already a wellness center when you talk about diet and exercise. But when you start actually doing imaging (CAT scans, etc.), those are ways of looking at the structure in the body. Some places will just basically do a school nurse kind of blood test, like for certain employment physicals. It is a very limited thing. But we do everything. I pretend you're the queen of the world. Our mission is the science of living longer and living better -- maximizing longevity."

Cosgrove likens the WellMax protocol to quality assurance: measure, apply the discipline and measure again. "When we find something wrong, what are we going to do about it and when are we going to measure it again? We want to measure everything. We want to partner with the patient and make them accountable." Cosgrove says his clinic is not about tile floors and white coats. The physician sits down with the patient, making time for what is going on in their life. "It's a very dignified and classy place."

The Canyon Ranch Life Enhancement Program in Tucson, Ariz., is a week-long journey into health, fitness and restoration. Guests receive a medical evaluation and an array of health, spa, sports and educational services. Suzanne Kaiser, director of special programs at the resort, says, "Life Enhancement guests have more of a focused stay than a spa guest might. The program includes lifestyle, nutrition, exercise, stress management, spiritual growth and an overall universal theme of health. And then we go into specifics depending on the individual. It's a very integrative approach."

The goal of the medical component is to prevent disease by identifying potential contributors. With an individualized prescription for health, each guest is guided by a program coordinator in choosing activities and treatments to meet their personal objectives. Diane Trieste, director of spa and product development, says, "The whole existence of Canyon Ranch is based on lifestyle change. The 'nuts and bolts' is touch, whether in medical, healing, massage or movement. If you were to go to the Ritz Carlton, for instance, it's a different approach," a reference to the pampering focus of some spas. "Canyon Ranch is about making a lifestyle change. All our services have a therapeutic value. When you're here for a specific ailment, you should get a specific treatment. We have Western and Eastern doctors. Even our healing touch therapy is done by nurses in the medical clinic. Nutrition is also a huge part of Canyon Ranch." Famous for its gourmet spa cuisine, the resort even offers a hands-on cooking class featuring healthy alternatives.

Hippocrates Health Institute in West Palm Beach, Fla., takes a slightly different approach to spa cuisine, one based on the theory of living foods. Unlike other wellness centers, Hippocrates embraces a specific vegetarian regimen for detoxification and healthy living. Guests dine on gourmet-style raw foods rich in vitamins, minerals and proteins, and follow a daily routine of drinking wheatgrass juice. Director Brian Clements says Hippocrates is the oldest health center in the United States, having been in operation for 50 years. Perhaps the most important aspect of Hippocrates is the emphasis on responsibility for one's own health. To this end, the center provides the environment, education, counseling and encouragement for change.

Hippocrates has two physicians on staff, but their roles differ somewhat from the traditional medical assessment common to other wellness centers. One assists with counseling patients as they arrive, while the other writes prescriptions and answers general medical questions. The doctors' presence is described by Clements as a liaison between the medical model clients are coming from and the Hippocrates institute's approach. "We have all kinds of people who come here," he says. Some have been completely turned off by allopathic medicine and others are just beginning to dip their toes in the waters of the alternative therapies.

Although Hippocrates' guests have traditionally tended toward those diagnosed with an illness, Clements points to a growth over the past 10 to 15 years of healthy clients seeking to maintain and improve on their functioning. He attributes this trend in part to a general dissatisfaction with mainstream medicine as well as word of mouth regarding the clinic's successes. "From all over the world we have doctors referring people here, but in general the medical community is disinterested," Clements says, although he cites some orthodox doctors who say "it can't hurt."

"We do everything -- practical, educational, we work a lot on the head and diet," Clements says. Spiritual pursuits are also included but without any dogma. "We use a lot of cutting-edge medical diagnostic technology. I don't know of any place on the planet as comprehensive as we are. We fancy and picture ourselves as being the hospital of the future. When you come here, we turn the responsibility for your life back over to you." Education and support are vital to the Hippocrates approach, and patients receive free follow-up for life, including counseling and blood analysis.

Foxhollow's Paracelsus Clinic in Crestwood, Ky., is based on integrative, biological and anthroposophically extended medicine (interplay of physical, vital, emotional and spiritual aspects of humans). Judy Carter, a Foxhollow amma therapist, says, "It's basically about looking at the body as a whole and building up the person for self-healing. We incorporate Traditional Chinese Medicine (TCM), homeopathic and anthropological approaches. It's a whole different way of treating the whole person." Although Foxhollow's clientele cover the spectrum of health, Carter says at least 50 percent are diagnosed with cancer.

Foxhollow is closely associated with the Paracelsus Klinik in Lusmuhle, Switzerland, based on a European biomedical model. With a staff of traditionally-trained physicians who also specialize in holistic treatments, medical assessments go beyond the standard approach of allopathic tests to include thermography (ability to regulate warmth), autonomic nervous system analysis, hair mineral analysis and a full mouth X-ray. Supplementation with vitamins and minerals, as well as nutritional guidance, are included in prescriptives. As a part of the biological medicine model, Foxhollow offers a number of treatments to cleanse the body of toxins, including colon hydrotherapy, infrared saunas and antioxidant intravenous solutions.

For Carter, who has a background in nursing, the emphasis is on balancing the energies in the body: "I think the field is growing, as people's attitudes are changing about their health. And I think more opportunity is slowly coming." Carter's amma sessions sometimes include nutritional counseling and deep breathing education. As a TCM-trained therapist, she uses her skills in tongue and pulse diagnosis to guide her treatments, working toward energizing and creating a sense of well-being for her clients.

Specializing in Ayurvedic medicine, The Chopra Center at La Costa Resort and Spa in Carlsbad, Calif., offers the Perfect Health program, with the option of a three- or five-day stay. For cancer patients, there is also the Return to Wellness program, integrating mind/body treatments with the medical model, based on David Simon's book of the same name. Included in the Perfect Health program are classes in mind/body health, yoga and exercise, primordial sound meditation and nutritional guidance.

Spa director Maureen Sutton is also an Ayurvedic massage therapy trainer. "The day is divided up," she says. "Patients do a yoga class in the morning, a class on nutrition, then have a massage treatment. After lunch there's another class and usually meditation in the evening." Guests can also opt for a special cleansing program called panchakarma. "Patients can choose whatever treatment they want, but if they're taking the cleansing program, we choose for them. It's like a prescription. If they opt for this, they will have an appointment with Dr. Simon who is an Ayurvedic doctor. Then he more or less prescribes what dosha (body type) they are going to work on and I prescribe a treatment accordingly."

At DestinationsHealth, there is no hard and fast rule regarding use of traditional treatments versus alternatives. "We assess what is therapeutically accessible and really look at what's out there," Comite says. "We would like all the science we can bring to the table. We also look at what's available based upon clinical experience and try to make it work for the patient for whom we're devising the specific approach. We need to examine what might work better for her," whether that be alternative, complementary or allopathic.

The plan is to match the patient's body condition and personal choice to a specific modality. "You need to know they're going to follow through because it works for them," Comite says. But she believes it's a slow process. "You are who you are after years of doing what you're doing. Our approach advocates taking it one step at a time, both to invoke change and adapt to it successfully. It's taking baby steps in the right direction for sustaining health throughout life."


The Wellness Team
The structure of the wellness center, whether attached to a spa or as part of a comprehensive program, appears to play a large part in the level of information exchange between staff. For some, the meshing of services is easily accomplished without much emphasis on team meetings. Others find this pivotal to the strength of their approach.

For Comite, a client-centered health team is essential. "My goal was to bring all the different disciplines to the table and try to share clinical experience and knowledge so we can overcome some of the barriers of terminology and belief systems. This approach would result in our ability to create a common language so we can share what is in the best interest of the patient. You can reach into all modalities, but it's only by bringing everyone around the same table, including the patient, that we can make sense of what works for that individual.

"I'm looking to achieve a commonality where we're not speaking different languages. What I found is everyone is so invested in their own discipline. Not that they're not open, but they have a lack of knowledge. That was the intent of creating this team. We have 'in-service' sessions where we discuss and review what happened with each individual patient, and input is elicited from the entire clinical team. As it continues over months and years, all of us begin to understand what each unique discipline can bring to the table. And slowly but surely we build on that approach. Once the process takes place, what I think is vital is that the individual patient is brought to the table in a very refined manner, and a particular plan is laid out. We've got to know the patient well, but the patient can also explore what is the right fit to protect their well-being."

As a spa-linked clinic, WellMax is somewhat constrained by the separation of medical clinic and spa services. According to Cosgrove, the resort does not employ the WellMax staff, and, as such, is not associated with the prescribing of treatments. "I suppose in that regard it does have certain boundaries that would not be necessary if we had a free-standing massage place. I do think hydrotherapies are useful. We send people over for that." Although there are no pre-arranged consultations with spa staff, Cosgrove talks informally with the therapists "because so many are interested in what we're doing."

At the Chopra center, Sutton has the responsibility of assigning patients to practitioners. "As I go through and do schedules," she says, "a lot of times I try to pair up a therapist with the client according to special needs. Therapists have a regular routine to follow, and they have a chart, so they do have something they can refer to if there's a medical condition. They also have information on the patient's body type or dosha. We don't have access to the medical chart but we do have access to the doctor's recommendation. The therapist needs to know, for example, to avoid applying heat on someone who can't handle it."

Clements sees the integration of spa services with the Hippocrates program as critical. "In some cases, it's the way we make home runs. Everyone gets bodywork once a week as part of the program. We think it's powerfully important. We don't call it the spa, we call it the therapy building." He notes many aspects of spa work contribute to bolstering the overall health of the patient, such as structural balancing with neuromuscular work to improve organ and immune system function.

Staff communication and feedback regarding patient progress at Hippocrates varies. "If it's a seriously ill person there's dialogue between the staff. If the person is just here to improve their health, probably not." But teamwork is still essential to the Hippocrates approach, particularly in education. As a part of the schedule, Clements joins a panel of in-house experts, including a psychologist and bodyworkers, in regular presentations to guests. "We speak about bodywork. As I do in other classes, we explain the research. This is not only about detoxification." Even the head of the psychology department, a specialist in psychoneuroimmunology, offers touch therapy.


Bring in the Bodyworkers
Expectations regarding the role and training of spa therapists are as varied as the wellness centers themselves. Although a mainstay in all programs, CAM treatments play a larger part in some than others. "There's nothing like immediate reinforcement," Cosgrove says. "What really works with a patient is feeling better now. You get an executive who's really stiff, with decreased circulation in his joints, maybe diabetic, with a lot of tension from stress. You can send him to the spa for hydrotherapy and massage to get relaxed." Cosgrove says that alternatives are sometimes the best fit. "It's about a way of looking at things. But I like to see that they measured it," he says, emphasizing the importance of research.

At Canyon Ranch, Trieste is always looking for people who are multi-faceted. "Because of the expectations of our guests, we hire with more experience, rather than less. We don't limit the amount of things a staff can do, so if they only do Swedish or whatever, that would not limit employment. Obviously the more experience the better." Therapists have an opportunity to advance their skills once employed at Canyon Ranch. The resort frequently sponsors in-house training, as well as guest trainers from different modalities.

"We look for mature people," Clements says of the Hippocrates spa. "They're not just looking for a way to make a living. They have a depth of seriousness and quality, and have made a serious decision about what they are doing." Clements says most of his staff have been there for years.

That level of dedication is especially important to the patients at Hippocrates. "In most spas you find wealthy people who want to look better. Here, some people have only weeks to live."

Therapists at the Chopra center receive Ayurvedic training on site. "The training is specific to all the therapies we do," Sutton says. "Therapists also have access to our primordial sound meditation training. We like them to have the full philosophy as well as specifics, theory-wise as well as mechanics of the therapy." The center requires therapists to have at least 500 hours under their belt. "Because of new licensing requirements," Sutton says, "I prefer national certification, and I'm always looking to see if they have a little medical leaning and are aware of medical conditions."


Sage Advice
The way our industry is going," Trieste says, "massage people need to understand they have to be more balanced with their skills. The expectation from the public is more than it ever has been. So the more skills a therapist has, the more opportunities will present to them."

Repetition leads to overworking. "When you work for a company specializing in these types of services, you're going to be doing the same work instead of multi-tasking." A therapist using a wider range of modalities, Trieste says, "is ergonomically apt for less injury and also for more interest. You keep having fun. A lot of people think the downside of working for spas is working so much. You don't have to do six Swedish massages in a row." By expanding the range of your talents, she says, "There's more opportunity to work with other professionals." While each wellness center has its own approach, the potential for bodyworkers in this field is far-reaching. Integrative medicine at its best includes alternative therapy at its best.

"It's a new culture and a new discipline," Comite says. "We're trying to carve out an integrative approach that maximizes the potential of each system and focuses on prevention. There's so much to understand as new diagnostic tests are developed and research continues to accrue. We need to make an effort at demystifying health information and minimizing fragmentation of care. It's a whole new system that's needed. It's essentially what is missing in medical healthcare today."

Shirley Vanderbilt is a staff writer for Massage Bodywork magazine.




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