Christine King BVSc, MANZCVS (equine), MVetClinStud
Integrative veterinary care
the best of both worlds
In this article I thought I’d try to dispel some confusion and a few myths by talking a little about the two prevailing paradigms in veterinary medicine: conventional and complementary/alternative medicine. First, a few definitions.
Conventional veterinary medicine refers to the type of medicine practiced by most veterinarians. It is the medical paradigm on which the core curricula are based at all of the veterinary schools in North America [and Australia], and the type of medical approach most of us have grown up with. It is sometimes referred to as “Western” medicine by those who practice Traditional Chinese or Oriental Medicine (i.e., practices originating in Asia, or the East). It is sometimes referred to as “allopathic” medicine by those who practice homeopathy. And some people call it “traditional” medicine; but to me that’s a confusing term. I consider traditional medicine to include folk remedies and the like, that are handed down from one generation to the next, much like other traditions (stories, techniques, prejudices). So, I prefer the term conventional for this mainstream type of medicine.
Complementary and alternative medicine (CAM or CAVM for veterinary medicine) is a bit of a catch-all category which comprises a very diverse group of medical/healing practices that are not part of conventional medicine. The more well known of these modalities include acupuncture, homeopathy, chiropractic and osteopathic care, and herbal medicine (which is subdivided into western and eastern/Chinese herbal medicine). Most of these CAM modalities have a strong traditional element, their use dating back centuries and in some cases millennia. As their mechanisms or philosophical underpinnings don’t make sense to the mainstream scientific community, they continue to be marginalized by much of the conventional medical community, which is science based. But consider this: how could any healing practice last this long if it didn’t have some value?
One fundamental difference between the two medical paradigms is that conventional medicine focuses primarily on the diseased or damaged part, and thus on symptom management, whereas most CAM modalities and practitioners try to take a more holistic view of the patient and the problem. That’s actually a gross generalization, as there are many conventional practitioners who look at problems holistically (perhaps without identifying their approach as such), and there are many CAM practitioners who get so caught up in their set of skills that they fall short of a truly holistic approach.
Also, thanks in large part to a groundswell of demand by consumers who want alternatives to drugs and surgery, there is an increasing amount of integration of CAM approaches into conventional practices. For example, conventional veterinarians are increasingly referring patients for acupuncture, chiropractic care, etc., or hiring individuals for their practices who are trained in these modalities. Even the ultraconservative National Institutes of Health (NIH) in Washington, DC, has acknowledged consumer demand for CAM therapies by devoting a small but significant amount of money and office/laboratory space to a department dedicated to researching CAM: the Office of Alternative Medicine (OAM).
I find this attempt at honest investigation, if not yet integration, of CAM by this standard-bearer of the conventional medical community very encouraging. While there is still a lot of resistance to anything CAM in the conventional medical community, the lines between the two paradigms are beginning to blur a little. That bodes well for patient care, as I believe that the best approach is integrative: taking “the best of both worlds” and combining conventional medicine with CAM to create treatment approaches that are tailored for each individual patient’s needs.
Now and again, and more often than I like, I come across staunch advocates of CAM who are adamantly against anything of a conventional medical nature. My personal opinion is that this “drugs are bad; herbs are good” sort of thinking is faulty. Unless one is considering the whole horse and the horse’s whole situation when devising a treatment plan, then those herbs or whatever are merely being used as drugs, to treat the symptoms rather than the underlying cause of the problem. This closed-minded view of conventional medicine is every bit as bad as the tunnel vision of the conventional vets and medicos who refuse to acknowledge anything remotely outside their paradigm.
Conventional medicine, for all its faults and short-comings, offers some truly marvelous diagnostic and therapeutic options. For example, if your horse develops severe colic, then the best place for him to be is at a referral hospital which has surgical facilities. While mild colics often respond nicely to homeopathy, acupuncture or acupressure, herbs, and even just a little time, sometimes bodies get themselves into the kind of fixes that conventional medicine is best equipped to handle.
In fact, colic provides a great example of how I believe a truly integrative approach to the horse’s health should work. Colic is best prevented by taking a holistic approach to the horse’s diet and management. Factors such as housing, nutritional program, turnout schedule, exercise program, social interactions, training and competition schedules, dental care, deworming and vaccination programs, and horse-human interactions are all considered.
If the horse develops colic (as horses do from time to time), then the choice of treatment approach depends on the practitioner and on the severity of the condition. For example, if after examining the horse I conclude that the colic is of the common mild, spasmodic type, then I’ll probably opt to treat it just with homeopathy, instead of with conventional medications (although I do have them at the ready if the horse needs them). The specific remedy I select will depend on the horse’s symptoms and constitution and on what precipitated the colic episode.
However, if the horse has a more serious form of colic, such as an intestinal obstruction, then conventional veterinary care usually is required to deal with the immediate problem and prevent even more serious complications. Some of these problems can be safely and effectively managed on the farm with oral fluids, delivered by stomach tube. However, it is often in the horse’s best interest to be sent to a referral hospital for more intensive diagnostic workup, medical management (e.g., intravenous fluids), and monitoring than can be provided on the farm. And if the horse’s condition proves to be severe enough to require surgery, then he is right there; no more time is wasted in transporting the horse to the hospital.
Following conventional medical or surgical care, a holistic approach is again valuable in optimizing healing and return to function. Specifics will depend on the individual horse, but they include the things I listed for prevention of colic, as well as appropriate CAVM therapies. (My favorites are herbs and homeopathy, but acupuncture/acupressure and several other modalities shine in this application, too.)
Fractures provide another example of how integrative medicine should work. Prevention requires a holistic approach, with particular focus on diet and exercise/training regimens aimed at optimizing bone quality and neuromuscular function for the specific task the horse is required to perform. Shoeing, saddle fit, and the influence of the rider also are important, as each of these factors feed into how the horse’s limbs are placed and loaded.
However, if the horse does develop a fracture, then conventional medical diagnostics (e.g., radiography [x-rays], nuclear scintigraphy [bone scan], MRI) and treatment (e.g., cast, internal fixation with metal plates and screws, etc.) should come to the fore. Mechanical failures require mechanical solutions. At the same time, and following conventional treatment, a holistic approach helps optimize bone healing and return to function. Again, the specifics will vary with the individual horse and the particular problem.
In my experience, the integration of conventional medicine and CAVM offers the patient the best chance for full recovery from injury or illness, and a healthy life. To me, there is no need for the distinction between conventional and complementary/alternative medicine. Instead, there should be only good medicine and bad medicine (i.e., appropriate and inappropriate medicine), based on the individual patient’s needs at the time. Hopefully we’ll see the full integration of these medical paradigms, and just one system of truly healing and life-affirming medicine in our lifetimes.
Copyright © 2006 Christine M. King. All rights reserved.
This article was first published in Northwest Horse Source (www.nwhorsesource.com).