Alternative Therapies

Chapter 165 Alternative Therapies



Narda G. Robinson, DO, DVM, MS, DABMA



KEY POINTS



• Veterinarians caring for critically ill patients may face a variety of requests from clients asking whether complementary medicine might benefit their animals while in the intensive care unit (ICU). Determining which therapies will benefit ICU patients can be challenging without species-specific evidential support.

• Delegating care to people who are not veterinarians or to people with questionable or unfamiliar credentials adds risk for animals and exposure for veterinarians already managing a busy caseload.1 Practitioners trained to work with humans who are unfamiliar with zoonotic disease transmission and the fragile health status of critically ill animals may complicate the picture.

• Complementary therapies under consideration for ICU patients should be evaluated on a case-by-case basis. Even natural treatments that are indicated and safe for one patient may be contraindicated and potentially injurious to another.

• Acupuncture offers a versatile, adjunctive, analgesic approach for acute and chronic pain.2 In addition, acupuncture’s actions on autonomic regulatory pathways assist the body in recovering from surgery, trauma, and debilitating illnesses.

• Massage can relieve muscle pain and tension and can alleviate stress.3-5

• Physical therapy can be especially important for patients recovering from spinal cord injury and orthopedic or neurologic surgery.6 On the other hand, aerobic exercise that places excessive demands on deconditioned patients may compromise cardiopulmonary and musculoskeletal function.7

• Herbs pose several hazards such as known and unknown drug-herb interactions, unclear dosing parameters, and questionable manufacturing practices and safety.

• Aromatherapy (essential oil therapy) may help calm certain animals, although subjecting staff and other patients to volatile substances known to be sleep-inducing, epileptogenic, or allergy-provoking may pose a workplace hazard or affect nearby patients in an untoward manner.

• High-velocity chiropractic adjustments and other forceful maneuvers may injure debilitated patients and should generally be avoided in ICU patients unless clearly indicated.

• “Glandulars,” unregulated products made from bovine or porcine glands or central nervous system components, may contain active hormones, contaminants, or diseased tissue, have no proven benefit, and pose obvious risk.


INTRODUCTION


Human intensive care unit (ICU) patients suffer from a variety of stressors, including fear, pain, anxiety, lack of sleep, loneliness, lack of control, nightmares and, for those on prolonged mechanical ventilation, inability to speak and perhaps communicate.8 Severely ill animals likely find the experience similarly upsetting. According to one of the leading researchers in the ethics of human critical care, “Alleviating the stresses and symptoms of critically ill patients will enhance the quality of their ICU stay, which itself achieves an important beneficial and ethical outcome, an outcome that should be a priority of every intensivist.”9


Pain, sleep deprivation, and immobilization impair recovery. They sensitize the central nervous system, causing “wind-up,” which further amplifies pain and stress. This increases cardiac demand, vasoconstriction, blood viscosity, platelet aggregation, and cellular catabolism. In fact, “In many patients with severe posttraumatic of postsurgical pain, the ensuing neuroendocrine responses are sufficient to initiate or maintain a state of shock.”10 Sometimes the pharmacologic analgesics and sedatives used to make patients comfortable can create other problems, such as constipation and disorientation. Certain complementary alternative medical interventions can offer safe and effective nonpharmacologic alternatives.11


Veterinary ICU personnel often welcome complementary alternative medical interventions that support the animals’ quality of life and potentially improve survival. In human medicine, a 2005 survey published in the American Journal of Critical Care indicated that over 90% of critical care nurses reported eagerness or openness to using complementary alternative medical interventions in the ICU setting.12



ACUPUNCTURE


Acupuncture works by stimulating nerve endings near acupuncture points, sending afferent volleys into the central nervous system (CNS). The resultant input acts on certain brain and spinal cord regions to modulate neural output to both somatic and visceral structures. It also helps restore balance between the sympathetic and parasympathetic limbs of the autonomic nervous system. Acupuncture causes changes in neurotransmitter and hormone levels in the CNS, activating endogenous pain control mechanisms and decreasing anxiety.


Indications for acupuncture therapy in hospitalized patients include resuscitation (Color Plate 165-1); acute and chronic pain; muscle tension, tremors, and contractures; anxiety; neuropathy and neuropathic pain; stroke; functional gastrointestinal (GI) disorders such as nausea and vomiting, esophageal spasm, posttraumatic and postoperative ileus, gastric hyperacidity, diarrhea, and constipation; phantom pain; spine-related pain; pain from arthritis, bursitis, tendonitis, sprains, fractures, and contusions; edema; circulatory abnormalities; sinusitis; hiccoughs; urinary incontinence or retention; and acupuncture-assisted anesthesia for high-risk patients.13


Relative contraindications to acupuncture include severe immune compromise, bleeding disorders, widespread skin infections, pacemakers, and pregnancy.

Related posts:

  1. Deteriorating Mental Status
  2. Hyperthermia and Fever
  3. Ventilator-Associated Lung Injury
  4. Allergic Airway Disease in Dogs and Cats and Feline Bronchopulmonary Disease

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Sep 10, 2016 | Posted by in SMALL ANIMAL | Comments Off on Alternative Therapies

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