Integrative Medicine
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INTEGRATIVE MEDICINE CURRENT TRENDS IN USE COMMON CLIENT QUESTIONS AND CONCERNS ACUPUNCTURE – HOW IT WORKS, WHEN TO USE IT, HOW TO GET STARTED? SOME INTEGRATIVE MODALITIES TO CONSIDER IN YOUR CONVENTIONAL PRACTICE MY TOP 3 SUPPLEMENTS/HERBS THAT CONVENTIONAL PRACTITIONERS SHOULD BE USING Cheryl A. Cross, DVM, DACVP (Anatomic) Clinical Assistant Professor, Integrative Medicine The University of Tennessee College of Veterinary Medicine 1. HOW TO ATTRACT WEIRDOS….. WITHOUT BEING WEIRD The top questions my best IM clients ask 1. Questions about food and diets a. Client education about terminology is incredibly helpful (see “What Foods These Morsels Be” – a guide to approved terms) b. Have the client ask the questions of the food companies (see Questions for Food Companies) c. The number one thing I try to tackle is obesity – often the most preventable risk factor our patients have (see body condition score chart attached) i. I give clients the sheet and ask them to score their pet ii. I have the pets back for routine weigh-ins free of charge 1. Goal weight loss 0.5 – 2% per week for cats and dogs d. Believe it or not, I sell a lot of Rx diets i. Why? How? 1. I tell clients it is like handing them a bottle of penicillin – I can guarantee what is in there and what isn’t in there 2. My most prescribed diets are JM, J/d, DM e. The Raw Diet Questions i. If they are very young or very old in the household, I forbid ii. I point out the risks there are to the humans in the house, largely iii. I insist on AAFCO balanced – many raw diets are too high in fat iv. Cost! f. The Grain Free Issue i. Axelsson E et al. “The genomic signature of dog domestication reveals adaptation to a starch-rich diet” Nature, Online January 23, 2013, DOI: 10.1038/nature11837 1. Researchers looked at the full genome of wolves and domesticated dogs and pinpointed where they differ. They isolated 36 regions that likely represent targets of selection during dog domestication. Half of these regions harbor genes tied to brain development or signal processing that occurs in the brain. The researchers also identified ten genes in other genetic regions that play key roles in the digestion and metabolism of starches and fats. They have put the genes tied to digestion to the test, determining that all three genes governing the three major steps of the breakdown of complex starches are used more effectively in dogs. ii. How tightly regulated are commercial diet claims anyway? g. Homemade Diets i. Can be wonderful for the right pet and owner ii. Great for attentive owners fearful about recalls or who want to control ingredients/additives/preservatives iii. Homemade diets can be useful for… 1. Elimination diets for food allergies 2. Increasing palatability for sick patients 3. Managing disease combinations that do not have a commercially available option 4. Renal disease + pancreatitis 5. Food allergy + renal disease 6. Obesity + hyperlipidemia + food allergy iv. Must be balanced v. Do not trust internet diets vi. Drawbacks? 1. Cost and time in the kitchen 2. No nutrient analysis and food trials 3. We insist on PE and minimum database after 1 month on diet and q 6 months afterward vii. Where to go for homemade diets that are balanced by a nutritionist? 1. University of Tennessee a. [email protected] b. www.vet.utk.edu/clinical/sacs/nutrition.php 2. UC Davis a. www.vmth.ucdavis.edu/vmth/services/nutrition/nutrition.html 3. Balance IT a. www.balanceit.com 4. Veterinary Nutrition Consultations, Inc. a. www.petdiets.com h. Vaccines i. I do offer titers 1. Cornell Diagnostic Lab or Hemopet for DAP 2. Kansas State Diagnostic Lab for Rabies ii. Client and pet selection is critical iii. Client education and risk assessment is critical iv. I tell clients if the titers are unimpressive, we must vaccinate v. I tell clients the legal ramifications if we do not vaccinate for rabies vi. The vaccine I routinely encourage in the at-risk dog? Intranasal bordatella i. Internet supplements/nutraceuticals/herbs i. Most formulas “kitchen sink” the herbs ii. Typically clients pay more than they would talking to a vet and get better quality iii. Susan Wynn “veterinary herbal medicine” has nice materia medica iv. Steve Marsden’s quick consult “Natural Veterinary Medicine” has some recommendations listed by system SITTING ON PINS AND NEEDLES 2. Everything you ever wanted to know about acupuncture... and probably more! a. Introduction i. Long history of use – most likely 2000-4000 years old ii. Original practice a part of Chinese Medical Diagnosis 1. Chinese herbal medicine, Tui-Na, Food therapy 2. A very reductionist model would say it emphasized living in harmony with nature iii. Intended to keep workers healthy, not treat once sick iv. Many variations in style v. Medical Acupuncture a more modern approach 1. Trigger point therapy, neuromuscular approaches vi. Current teachings in vet med revolve around TCVM and MA typically 1. Being taught and used in a few veterinary schools (brief introductions) 2. Typically used as a standalone therapy when in vet schools and by some practitioners b. Mechanisms of action i. Complete MOA unknown 1. Cascade release of endorphins and monoamines 2. Alters peptide-rich milieu 3. Gate theory of pain transmission 4. Releases fascial planes 5. Treats trigger points 6. Dampens central windup ii. fMRI information shows it is more than placebo iii. Excellent for pain (musculoskeletal > visceral) 1. EAP 2. Moxibustion iv. Human studies – depression, anxiety, seizures, OA v. Most veterinary studies are on OA and pain (IVDD, etc) vi. Neuromodulatory and immunomodulatory vii. I always discuss “resting and digesting” with clients c. Studies are very contradictory and frustrating – why? i. Acupuncture in research is really not the same as in practice 1. Randomization 2. Static protocols 3. Sham needling 4. Blinding and bias 5. All approaches – TCVM to MA – emphasize individualization of tx d. Patient selection and disease selection i. Pain > internal disease (in theory) ii. Non-local points and local points iii. I ask clients to commit to a series (usually 4-6 tx one week apart) iv. I often combine acupuncture with laser therapy, or sometimes laser>acup e. Where to learn more i. www.ivas.org ii. www.tcvm.org iii. www.colovma.org iv. www.civtedu.org EASY BREEZY BEAUTIFUL INTEGRATIVE MEDICINE 3. How to get started tomorrow a. Laser therapy i. Effects are not thermal ii. Chromophores 1. Melanin, water, hemoglobin, cytochrome C oxidase 2. End point of transcription/translation and “appropriate cell turnover” 3. Research has been done looking at potentiation or exacerbation of neoplasia a. Powell et al. The effect of laser irradiation on proliferation of human breast carcinoma, melanoma, and immortalized mammary epithelial cells. Photomedicine and Laser Surgery, 2010, 28(1):115-123. 4. Wavelength is important a. Optical window for therapy is red to infrared (600-700nm) 5. Treatable Conditions a. Infrared Wavelengths (800-1000nm)- Deep Tissue Penetration: i. Sprains & strains ii. Wounds and abrasions iii. Hematomas iv. Ligament & tendon injuries v. Inflammation vi. Joint injuries vii. Myofascial trigger points, pain points and deep-tissue acupuncture points viii. Chronic & acute pain ix. Non-union & small-bone fractures x. FIC (FLUTD) xi. Neuropathies b. Visible Red Wavelengths (630-700nm) - Shallow Tissue Penetration: i. Wounds & abrasions ii. Allergic reactions iii. Skin disease (pemphigus, allergic dermatitis, pyoderma) iv. Superficial acupuncture points v. Mucous membranes vi. Post-surgical wounds vii. Otitis c. Advantages: i. Ease of use ii. Ease of training 1. Wavelength (nm) 2. Power (Watt or J/s) 3. Treatment time (seconds) iii. Suggested doses (variable) 1. Analgesic effect: a. Muscle pain: 2 to 4 joules/cm2 b. Joint pain: 4 to 8 joules/cm2 2. Anti-inflammatory effect: a. Chronic: 4 to 8 joules/cm2 iv. Safety 1. Eye wear 2. Not in pregnancy 3. Not over malignancies? 4. Not over growth plates? 5. Not in animals on steroids? 6. Wash off iodine/furacin/pigmented medicines 7. Clip the fur?? 8. Do not apply over tattoos v. Efficacy vi. Easy to use in a variety of patients vii. Respond Luminex Ultra 1. Red and Infrared lasers in one unit b. Pulsed Electromagnetic Field (PEMF) therapy i. Extremely low frequency fields generated by external magnetic coils that induce electric fields in the body’s conductive tissue through inductive coupling ii. Produce eddy currents iii. Wraps, mats, or beds 1. easy to use at home iv. Biophysical interactions between the PEMF signals and biological tissues are not well understood 1. Most accepted MOA suggests external magnetic stimuli interact with cells either via transmembrane receptors or ion channels, initiating one or more signal transduction cascades or cell functions v. Anti-inflammatory and chondroprotective via upregulation of adenosine cell receptors vi. Increase in growth factor synthesis vii. Studies have variable design methods – hard to interpret as a group viii. FDA approved for non-healing, non-union fractures ix. OA x. Wound healing xi. OC lesions xii. Contraindications 1. Pacemakers/implanted defibrillators c. Acupressure/Home Massage Programs for owners i. Often good for client and patient ii. Slow, moderate pressure stimulates rest and digest 1. Pressure = blanch the fingernail 2. Toe tugs, running the spine 3. “Four Paws/Five Directions” by Cheryl Schwartz a. nice intro on TCVM points b. acupressure “recipes” and theory I’VE GOT AN HERB FOR THAT! 4. Some of my favorite underutilized herbs/supplements for conventional practice a. Omega 3 fatty acids (fish oils) are beneficial for several disease processes i. Renal disease ii. Atopy iii. Arthritis iv. Multiple published dosing options 1.