Case Based Approach to Integrative Veterinary Practice


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Case Based Approach to Integrative Veterinary Practice


Mitchell McKee


Introduction


American author and speaker Dale Carnegie once said, “Most of the important things in the world have been accomplished by people who have kept on trying when there seemed to be no hope left at all” [1]. Perhaps integrative medicine was born out of a similar desire; to keep trying and never give up. Such persistence has led to new technological advances that have enhanced our ability to diagnose and treat patients. Tried and true methods of old have emerged once again and are being utilized to improve treatment outcome and quality of life. No better time has ever existed to provide veterinary patients with the best integrative treatment options available.


Each veterinary patient is unique and often circumstances differ. The patient dictates the treatment more so than the practitioner. Integrative medicine allows the practitioner to provide individualized care instead of a one size fits all approach for common conditions.


Integrative Approach to Veterinary Medicine


Medical treatment of the clinical cases in this series embraces both conventional medicine and the principles of Traditional Chinese Veterinary Medicine (TCVM) to combine East and West into an integrative medical approach to small animal medicine. The clinical conditions are presented according to conventional diagnoses and the Five Element TCVM Pattern (Table 25.1).


Table 25.1  TCVM Five Element* attributes [2]. Xie H, Preast V 2013 / Chi University.























































Element Wood Fire Earth Metal Water
Organ Liver Heart Spleen Lungs Kidney
Function Maintain smooth flow of Qi Governs blood and vessels Transforms and transports food energy (Qi) and body fluids Governs Qi Governs bones and water pathway
Store Blood Houses Shen (spirit and mind) Distributes food Qi and body fluids Stores genetic material
Affected structures Eyes Heart GI tract Respiratory tract Urinary tract
Tendons Mind Skin Bones
Ligaments Hair coat

* Each element is listed with the associated organ, organ function, and corresponding affected structures. The table has been modified to include only those aspects of each element that apply to this case series and is not a full and complete representation of all known TCVM attributes.


Clinical Cases


Wood Element


Common Wood (liver) related conditions seen in practice include conjunctivitis, eye conditions (including immune-mediated), and cranial cruciate ligament disease.


Conjunctivitis, Keratoconjunctivitis Sicca (KCS), Pannus


Conjunctivitis, also known in TCVM as Heat/Fire in the Liver, is often caused by infection and inflammation resulting in Liver Heat Rising Upward toward the eyes. Chronic irritation can cause TCVM deficiencies, such as Liver Yin and Blood deficiencies, leading to KCS and pannus. Topical medications containing steroids, antibiotics, and tear stimulants have long been used to treat these conditions (Figure 25.1).


Figure 25.1 This flow chart demonstrates initial diagnostics with conventional treatment followed by the expanded treatment with improved outcomes available by using an integrative approach.


Therapeutic Review


Table 25.2 lists common integrative therapy options for eye problems.


Table 25.2  Integrative therapies for common eye conditions. Adapted from [3]. Dewey C, Xie H, 2018; [4].Xie H, 2011; [5]. Fowler M, Xie H, 2022.

























































Integrative treatment method Integrative approach Therapeutic results
Acupuncture ST-1 Clears Liver Heat and Liver Fire
GB-1 Expels Wind
GB-14 Clears Heat
Herbal medicine Haliotis Formula a Clears Liver Heat
Cools Blood
Qi Ju Di Huang a Brightens eyes
Nourish Yin
Food therapy Chicken egg white Clear Liver Heat
Celery
Collard greens
Chrysanthemum
Ozone therapy Subcutaneous (SQ) Immune support
Rectal Anti-viral, anti-bacterial
Topical Anti-inflammatory

a Jing Tang Herbal, Reddick, FL.


Tendon/Ligament


Cranial cruciate ligament (CCL) problems can be associated with acute injury or weakened tendon strength over time. Radiographs along with the presence or absence of cranial drawer and tibial thrust are indicated for accurate assessment. Surgery, pain management, rehab, and physical therapy have proven beneficial to restore muscle strength, stability, and mobility.


Figure 25.5 compares conventional and integrative approaches to CCL disease while Table 25.3 further demonstrates an integrative treatment approach.


Figure 25.5 Additional therapeutics associated with an integrative approach to CCL disease are listed and compared to conventional therapy. PEMF= pulsed electromagnetic field; PRP= platelet rich plasma; IRAP= interleukin-1 receptor antagonist protein.


Table 25.3  Integrative treatment options for cranial cruciate ligament disease. Adapted from [3]. Dewey C, Xie H, 2018; [4]. Xie H, 2011; [5]. Fowler M, Xie H, 2022.





























































Integrative treatment method Integrative approach Therapeutic results
Acupuncture GB-34, BL-40 Treat stifle pain, tendon/ligament disorder, rear limb pain
ST-36, ST-35a, ST-35b
LIV-3
BL-60 Tonify Liver Yin and blood
Aspirin point for any pain
Chinese herbal medicine Tendon ligament formula Nourish Liver Yin and Blood strengthen tendons/ligaments
Moves Blood
Resolves Stagnation
Platelet rich plasma/IRAP* Joint injections Stimulate healing
Decrease pain

Ozone therapy


Prolotherapy

 SQ, rectal, or directly into joint Stimulates healing
Decrease inflammation
PEMF* therapy Loop over affected limb or lounge to lay on Stimulates healing
Decreases pain
Spinal manipulation Restrictions of spine and limbs Decrease pain, Improve circulation Alleviate restrictions Decrease adhesions

* IRAP = interleukin-1 receptor antagonist protein, PEMF = pulsed electro-magnetic field.


Therapeutic Review


Fire Element


The Heart (Fire Element) directs and propels the blood flow and houses the Shen [2]. The Shen represents the mind and/or spirit. When the Shen is normal, there is inner peace and normal mental health. Congestive heart failure and behavioral issues are common Fire Element problems seen in practice.


Congestive Heart Failure


Congestive heart failure patients should be assessed based on history, exam findings, blood chemistry analysis, and appropriate imaging to determine an accurate diagnosis before starting conventional medications (Figure 25.8).


Figure 25.8 This flow chart demonstrates the important conventional diagnostics and treatment with therapy expansion available by using an integrative approach.


Common underlying heart related TCVM patterns can include Heart Qi, Yin, and Yang deficiency. Patterns related to other elements such as the lungs and kidneys are often present and should be considered when developing an integrative treatment plan.


Behavioral Problems/Shen Disturbance


Anxiety, panic, aggression, noise aversions, fears, litter box issues, and other unusual behaviors can have multiple origins. Ongoing stress over time will adversely affect the Shen leading to Liver Qi Stagnation and Heart Yin and Blood deficiency. The addition of TCVM therapy can enhance treatment of these abnormal clinical behaviors (Figure 25.9).


Figure 25.9 This flow chart lists conventional diagnosis and treatment of behavioral conditions as well as integrative therapies that can improve clinical outcomes. SSRI = serotonin reuptake inhibitors.

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Jul 30, 2023 | Posted by in ANIMAL RADIOLOGY | Comments Off on Case Based Approach to Integrative Veterinary Practice

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