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Introduction to Integrative Veterinary Medicine

Mushtaq A. Memon

Introduction

Integrative veterinary medicine (IVM) is defined as combination of complementary therapies with conventional care, which is guided by the best evidence available. With the increasing interest in complementary therapies by human has prompted inquiries and use of these therapies in animals. IVM is preferable term than alternative or holistic medicine. The growing preference for this terminology is exemplified by the renaming the NIH National Center for Complementary and Alternative Medicine's to the National Center for Complementary and Integrative Health. Even though many of the complementary therapies have a long history, such as acupuncture but they have become popular recently in industrialized countries. IVM includes various complementary therapies. Some of the commonly used therapies are acupuncture, rehabilitation, manual and massage therapies, herbal, and integrative nutrition. Veterinary practitioners are frequently asked questions by animal owners about complementary therapies, but the prevalence of integrative medical interventions in veterinary medicine has not been established.

Background

A survey of owners of veterinary oncology patients found that in addition to conventional treatments, the owners often used the therapies regarded as alternative or complementary without the knowledge or supervision of a veterinarian [1]. A survey of one veterinary college's graduates reported that more than two-thirds of these veterinarians encountered clinical situations involving these therapies at least monthly and over 25% experienced them on a weekly or daily basis [2]. Recent publications have emphasized the need for training in this area in veterinary colleges [3]. A survey of the 49 AVMA-accredited colleges revealed that 30.2% offer a formal course in IVM, 33 (76.7%) offered some level of IVM instruction in the curriculum, and 32 (74.4%) provided clinical services in IVM [4]. The most common IVM topics covered in the curriculum were rehabilitation, and acupuncture (Figure 1.1). A retrospective analysis [5] from an IVM service revealed that of out of 5,195 patient treatment sessions, 274 patients receiving multiple modalities were most frequently for neurological and orthopedic disease (50.7% versus 49.6% of all presenting complaints, respectively). Older neutered or spayed dogs (mean age = 9 years) and Dachshunds were treated more often than expected based upon general population statistics. Acupuncture, laser therapy, electroacupuncture, and hydrotherapy (Figure 1.2), were frequently administered (>50% patients). In addition to domestic animals, acupuncture is utilized to treat various disorders in zoo and exotic animals [6].

Figure 1.1 Clinical services providing Integrative Veterinary medicine modalities within AVMA-accredited colleges. Memon, Shmalberg and Xie, 2020/University of Toronto Press.

Figure 1.2 The percentage of patients receiving each integrative therapeutic modality at the study site's integrative medicine service. Shmalberg and Memon, 2015 / Hindawi / Licensed under CC BY 4.0.

What is in the name: Integrative medicine is defined as combination of complementary and alternative therapies with conventional care, which is guided by the best evidence available [7]. In human medical practice, complementary or alternative are broadly defined which may include acupuncture, nutrition, rehabilitation, laser therapy, hyperbaric oxygen, and other intervention not typically considered mainstream medical practice. However, the term alternative medicine gives impression that certain therapies are a replacement or a mutually exclusive option to conventional care. The critics of complementary medicine term assume that the therapies can and should only be used in tandem, when in some cases a modality may be preferred or exclusive treatment available. Finally, holistic medicine suggests that conventional veterinary practice does not consider the impacts of treatment on the whole animal, an obviously flawed assumption. The growing preference for this terminology is exemplified by the renaming the NIH National Center for Complementary and Alternative Medicine's (NCCAM) to the National Center for Complementary and Integrative Health (NCCIH https://www.nccih.nih.gov).

Veterinary Acupuncture

Veterinary acupuncture, or needle stimulation of various points on the body, generally relies upon an understanding of neuroanatomic and musculoskeletal structures. The proposed physiological effects and possible mechanism of acupuncture are direct neural stimulation, cannabinoid receptor activation, modulation of substance P, release of endogenous opioids, selective activation of nerve fibers, and effect of acetylcholine [8-10]. For additional information on acupuncture, please see Chapters 4, 5, and 6.

Physical Rehabilitation

Physical rehabilitation and sports medicine of horses and dogs has received considerable attention in last about 20 years due to increased participation of these animals in competitive events. This has increased demand for veterinary care for animals injured in an event. The newly approved American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR) has increased academic credibility of this specialty. Some of the commonly utilized rehabilitation modalities include under water treadmill therapy, photobiomodulation or laser therapy, and therapeutic ultrasound. Detailed information on various rehabilitation modalities and their use is discussed in Chapter 13-16 of this book.

Manual Therapies

Manual therapy is broadly defined to include veterinary manipulative therapy, massage, osteopathy, and related techniques. Chapters 7 covers the basic concepts of veterinary manipulative therapy as it related to neurology, biomechanics, and available evidence. Detailed information on massage therapy and myofascial principles are discussed in Chapter 8.

Integrative Nutrition

Nutritional assessment and intervention usually occur in combination with other integrative modalities, such as physical rehabilitation and sports medicine. Animals presented for physical rehabilitation are frequently overweight or obese. Novel trends in nutrition and integrative nutrition in select conditions, such as obesity, performance, and physical rehabilitation are discussed in Chapters 11 and 12.

Herbal Therapies

Botanical and herbal therapies have been utilized for thousands of years. The origins and major systems of herbal therapy with selected evidence-based interventions are described in Chapter 9. Herbal medicine regulation, adverse events and herb-drug interaction, which always is a concern using herbs with Western therapies are discussed in Chapter 10. The clinical application of herbal therapies is discussed with clinical case examples in Chapter 24.

Integrative Therapies - Case Studies

Acute Quadriplegia in Alpaca

A 5-year-old pregnant Huacaya alpaca presented for acute onset of severe weakness and inability to rise (Downer Syndrome). She was found acutely down in the pasture, laterally recumbent and unable to initiate movements (Figure 1.3). Diagnostic tests were performed but no definitive diagnosis was established. Her condition was stabilized using conventional emergency medical procedures. Once stabilized, two weeks after initial presentation, a Traditional Chinese Veterinary Medicine (TCVM) examination was performed. A Global Qi Deficiency pattern was diagnosed based on the presence of quadriparesis and lethargy. There was Heat in the Upper Burner (Shang Jiao) as evidenced by a red tongue and red oral mucous membranes. False Heat was suspected due to the severe Qi Deficiency causing Yin Deficiency. These deficiencies were most likely a result of her pregnancy, which may have exacerbated a previous underlying Kidney Qi and Yin Deficiency. Quadriparesis may be associated with Deficient Kidney/Spleen Qi causing weakness of the limbs. Seven acupuncture treatments (dry needles, electro-acupuncture, aqua acupuncture) (Figure 1.4) were administered for three months (weekly then every two weeks). Daily physical rehabilitation, including hydrotherapy (Figure 1.5) and walking (Figure 1.6) were provided. By combining acupuncture and physical rehabilitation with conventional treatments and supportive care, the alpaca began walking on her own in approximately 50 days after onset (Figure 1.7) and recovered within three months with a viable fetus. She delivered a normal cria (Figure 1.8) [11].

Figure 1.3 A 5-year-old recumbent pregnant alpaca with acute quadriplegia.

Figure 1.4 Dry needle acupuncture was performed in alpaca with quadriplegia of unknown etiology.

Figure 1.5 Hydrotherapy in a pool was performed in alpaca with quadriplegia of unknown etiology.

Figure 1.6 Walking with support as a part of rehabilitation was provided to alpaca presented with quadriplegia of unknown etiology.

Figure 1.7 By combining acupuncture and physical rehabilitation with conventional treatments and supportive care, the alpaca with quadriplegia began walking on her own in approximately 50 days after onset.

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