When integrative veterinary medicine is the optimal choice

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There are times when a combination of holistic and conventional therapies is the best way to treat a dog or cat’s health problems. Let’s look at three conditions for which an integrative approach really shines.

Different veterinarians use different treatment approaches depending on their training and clinical experiences. Some offer only conventional therapies such as pharmaceuticals, while holistic vets turn to alternative modalities like homeopathy or herbs. An integrative vet is one who draws from both approaches, recognizing that both conventional and holistic medicine offer their own advantages and benefits, especially when it comes to treating certain conditions.

1. Arthritis

Osteoarthritis or degenerative joint disease (DJD) is a common condition in dogs and cats in which integrative medicine is of great value. Arthritis is a painful inflammation within the joints that can result from a number of hereditary, traumatic, infectious and inflammatory causes. Cruciate disease, hip dysplasia, luxating patellas, osteochondrosis, fractures and immune-mediated arthritis are all common diseases that can cause DJD.

Some of these underlying diseases or injuries can be treated successfully with surgery. When this is not possible, or if surgery is not completely curative, conventional medications such as NSAIDs are often prescribed to manage the pain caused by arthritis.

Taking integrative measures to delay the progression of arthritis is equally as important as managing pain, and will hopefully minimize the chronic use of pharmaceutical drugs.

  • Adequan, which is similar to glycosaminoglycans naturally present in joint cartilage, is not only anti-inflammatory, but works to inhibit enzymes that degrade cartilage and bone and also to stimulate the production of replacement cartilage in the affected joint(s).
  • Diet should play a key role in managing arthritis, especially in overweight animals. I would argue that obese pets will always be harder to manage medically than animals at an ideal weight. If a dog or cat is a healthy weight, he typically requires less medication over his lifetime and often has a better quality of life in terms of maintaining normal activity levels. Using lower-calories diets supplemented with Omega-3-fatty acids, glucosamine, L-carnitine and antioxidants is known to be beneficial in terms of improving mobility.
  • Physical therapy, chiropractic and acupuncture are also being more widely used to manage pain associated with arthritis. It is important to find practitioners who have received additional certification in these areas; they can become a regular and important part of your animal’s treatment plan. Utilizing some or all of the available options, especially in challenging cases, is key to keeping our arthritic dogs and cats comfortable and active for as long as possible.

2. Acral lick dermatitis

Another commonly encountered disease in which integrative medicine is extremely important is acral lick dermatitis in dogs. If you have ever had a dog with this problem, you know it can be incredibly frustrating.

Acral lick dermatitis is a skin infection — usually on an extremity – that arises from the dog obsessively licking and biting the area. What causes this behavior is different in each case. Dermatologic causes include food and environmental allergies. It can be brought about by orthopedic pain, neurological disease, even cancer. It can also develop in dogs with separation anxiety or other behavioral disorders.

The vast majority of cases resolve with a conventional approach that includes the appropriate antibiotics, short courses of steroids, and the use of a physical deterrent such as an Elizabethan collar. But some cases can be severe and seemingly impossible to treat. A thorough workup to investigate underlying allergies, orthopedic and neurological conditions is often necessary. If allergies are suspected, a food trial and allergy testing may be beneficial, along with the use of conventional Cytopoint or Apoquel to soothe acute discomfort.

If there is radiographic evidence of joint disease, appropriate dietary measures to treat or prevent obesity may be beneficial when surgical treatment is not indicated. Chiropractic care may help in some instances, depending on the cause of the problem. In cases where the disease is truly behavioral, using a combination of pheromone therapies, behavior modification and increased daily exercise can help.

Alternative therapies such as acupuncture or cold laser therapy can be useful for acral lick dermatitis, while herbal topicals such as aloe vera gel or a calendula tincture can help soothe itching and speed healing.

3. FLUTD

Feline lower urinary tract disease, or FLUTD, is a broad collection of lower urinary tract ailments common in cats. These ailments include urinary tract infections (which are actually relatively rare in cats), the more common sterile cystitis, urinary tract crystals or stones, bladder and urethral neoplasia (cancer), and the development of urinary tract blockages. Studies have shown that indoor, male, neutered and obese cats are most prone to the development of FLUTD. Decreased water intake and voiding urine less frequently are also risk factors.

Treatment can be divided into two categories. Those cats still able to urinate can often be managed medically, while those who have developed a urinary tract obstruction need to be sedated and have the obstruction relieved, which is accomplished via catheterization. In situations where cost is not a constraining factor, blood work, radiographs and culture should be obtained.

It is common for veterinarians to prescribe antibiotics since it does “no harm”, even though there is little scientific evidence to support their use in these situations. In addition, if clinical signs improve or even resolve with antibiotics, FLUTD will often recur if additional measures are not taken to address the underlying causes. Successful treatment then depends on an integrative approach.

If no urinary stones or tumors have been observed, and any existing blockage has been relieved, the following measures can decrease the risk of recurring FLUTD.

  1. Diet change. This is the most important consideration. If the patient is being fed a dry diet, changing to an exclusively wet food is critical. Canned food, for example, is nearly 70% to 80% water, so this measure alone will drastically increase a cat’s water intake.
  2. Appropriate litter box management. Indoor cats in particular will often void less frequently if there are not enough clean litter boxes, or if there is something else about the litter box that they find distressing.
  3. Environmental enrichment. Stress can play a huge factor in the development of FLUTD, particularly among indoor cats. Providing your cat with a quiet space to escape from children or other animals, and using toys and scratching posts can also help minimize stress in these cats.
  4. Pheromone-based therapies. These drug-free treatments work incredibly well when used in conjunction with the other recommendations. A pheromone is a chemical substance released into the environment by an animal affecting the behavior of another of his species. Feliway is probably the best known and most well-studied pheromone product available for cats. When used as a diffuser or spray, it can be calming and help prevent undesirable behaviors such as urinating outside the box.
  5. Pharmaceuticals such a smooth muscle relaxant, a medication to modify tone in the bladder muscle or urinary sphincters, or an anti-inflammatory, are sometimes necessary, especially in refractory cases.

My own experience as a veterinarian

I feel there is a subconscious inclination among veterinarians to push pharmaceutical medication. For most of us, this is an inherently vital and central part of our education, practice and experience. In the past, in fact, when clients asked me about holistic approaches or non-traditional treatments, I was often put off by my own lack of knowledge, my skepticism about the largely unregulated neutraceutical business, and the lack of peer-reviewed information available to me. Conversely, there have been times when people pushed for medication only, and ignored my other suggestions simply because it was more convenient than changing old habits and adjusting their lifestyles and that of their pets.

However, I have also encountered difficult cases or unique situations where I found standard treatment insufficient; and many times, even if it was just out of desperation, I was more willing to consider alternative therapies, and also get clients on board as well.

It was during these times that I allowed myself to learn, and what I have gained as a small animal practitioner is the knowledge that an integrative approach to medicine is often the most rewarding. Additionally, successful treatment often results from finding the right balance of preventative care, appropriate nutrition, addressing the underlying causes of specific diseases when present, the use medication when necessary, and the utilization of holistic treatments as well.

You and your veterinarian have one common goal – to give your four-legged family members a good quality of life. While medications are often necessary and certainly have their place in treating disease, relying on them exclusively can limit positive treatment outcomes. A well-rounded and integrative approach makes successful treatment more possible, practical and economical. In the end, medicine is like any other discipline in life. It can be enhanced by an open mind, moderation and finding the right balance.