Cold lasers. Pulsed electromagnetic fields. Moxibustion. Underwater treadmills. Nutraceuticals. These might sound like terms out of a science fiction movie, but don’t be surprised if you hear them on the next trip to your vet’s office.
They are just a few of a large array of treatments that fall under an umbrella known as “integrative medicine.” The approach blends therapies from wildly different worlds—from high-tech Western medicine to ancient Chinese techniques—with hopes of achieving a better result than a single approach.
In the past, such therapies were lumped into the group “complementary and alternative” medicine. Now veterinarians and doctors who treat humans have embraced “integrative” as a more accurate term.
“There’s an important distinction between CAM—which is complementary and alternative medicine—and integrative medicine,” says Leilani Alvarez, DVM, DACVSMR, CVA, CCRT, CVCHM, head of Integrative and Rehabilitative Medicine at the Tina Santi Flaherty Rehabilitation & Fitness Service in New York City’s Animal Medical Center. “Complementary and alternative medicine” suggests using methods other than conventional Western medicine. Integrative medicine combines Western techniques—surgery and drugs that attack disease—with nontraditional strategies, like massage (see page 44), herbs, exercise, acupuncture, and laser therapy, to treat the whole animal.
“A lot of times, when people seek integrative care, it’s after conventional medicine has failed,” says Alvarez. She believes that taking an integrative approach from the start could improve the overall outcome.
Snoot and Mopsey
In her practice, Alvarez has seen some dramatic success stories. Local TV news honored her in 2014 as the New Yorker of the week for getting a paralyzed rabbit doing the bunny hop again. Most of her patients, however, are dogs and cats.
Alvarez recalls one case in which surgery for a slipped disk left a Shih Tzu named Snoot totally paralyzed. Despite surgery to repair the disk at another institution, “his owners were told the dog would never walk again,” she says. But her program—physical rehabilitation, acupuncture and laser treatment, as well as a customized home exercise plan—got him walking.
Then there was the “Miracle Kid,” Mopsey, a 10-year-old Old English Sheepdog who came to AMC with a fractured leg. The fracture turned out to be the result of osteosarcoma, an aggressive bone cancer. Standard treatment for this cancer is amputation of the diseased limb and chemotherapy. For various reasons, Mopsey’s owner elected to not pursue conventional treatment and consulted with Alvarez about a different approach.
Alvarez made a custom orthotic to support Mopsey’s leg while the fracture healed and gave the dog pain medication, acupuncture, and rehabilitation.
Her goal was to maintain Mopsey’s quality of life, which means the challenge of controlling pain in one of the most painful conditions there is.
“We questioned whether she had osteosarcoma,” says Alvarez, because she was doing so well. But tests later confirmed the diagnosis. Mopsey lived for another 13 months. For most dogs with osteosarcoma, life expectancy without chemotherapy is about 60 days.
No one can say for sure why Mopsey beat the odds as she did, but Alvarez has a theory.
“Pain, stress, and inflammation are reasons why disease can progress faster,” she says. “Integrative medicine can help reduce these and better enables the body to heal itself.”
These stories are uplifting, but they are anecdotes that only hint at the potential for the therapies. It is now up to veterinary researchers to prove them through rigorous testing and clinical trials.
“We have a lot of work left to do,” she says.
Most scientific investigation into non-Western medical techniques has focused on humans, but veterinary researchers are starting to conduct clinical trials to find out how well they work in animals. Here’s what’s known about some of the more popular methods.
In this treatment, low-power lasers are applied to the skin in an attempt to stimulate cell function. Scientific studies on humans are inconclusive, although a review of the available literature published in 2014 suggested that it has benefits in the treatment of chronic pain. In 2011, the University of Florida’s Small Animal Hospital conducted a yearlong study on the use of low-level lasers in patients who had spinal-cord surgery. The study looked at 34 dogs, mostly Dachshunds; half were treated and half were not. All the dogs were unable to walk when they came in, and some had no sensation in their hind legs. Dogs who received laser therapy were up on their feet and walking a week earlier than patients who did not.
This ancient Chinese practice has been in use, in both humans and animals, for over 2,000 years. It started to become popular in the United States in the 1970s. The term literally means to puncture with a needle, but there are other techniques, such as moxibustion (burning herbs over the skin) or applying pressure, that are believed to achieve the therapeutic goal of stimulating pressure points on the body.
Modern veterinary medicine has embraced it, mostly for pain relief and in geriatric and sports medicine. But there is still controversy over what conditions it can help and whether it is effective at all. In a 2012 paper in the American Journal of Traditional Chinese Medicine, University of Florida veterinarians reviewed the literature on acupuncture. Of 10,000 citations, only 287 were related to animals. Studies in humans have pointed to acupuncture’s value in relieving pain and nausea related to pregnancy and cancer treatments, says Alvarez. Some studies conducted on dogs have shown that adding acupuncture after surgery improved recovery in spinal injuries. In 2015, the American Animal Hospital Association called acupuncture “an accepted treatment modality for painful animals.”
Swimming and underwater treadmills allow patients to give their muscles, including the heart, a good workout with little impact on joints. In a small 2016 British study, Labrador Retrievers with elbow dysplasia experienced an increased range of motion, stride frequency, and stride length after a course of hydrotherapy. Water workouts are useful for dogs with joint abnormalities, injuries, and those who are obese. Many animal hospitals have underwater treadmills and therapy pools.
Nutraceuticals and Supplements
A number of herbs are considered safe for dogs and have potential to treat various canine ailments. Slippery elm, for example, is touted as a treatment for diarrhea and other gastrointestinal problems, but there is scant scientific literature on it. Milk thistle is another herb said to improve health by stimulating growth of liver cells and has been used in humans to treat cirrhosis, hepatitis, and liver cancer. Glucosamine and chondroitin are also popular supplements, aimed at improving joint function, but research has had mixed results.
Many of these preparations are available over-the-counter so consumers can buy them without consulting a veterinarian, and that can be a problem, says Alvarez. “There’s a huge risk when we buy supplements for ourselves and even more for our animals,” she says. The FDA does not regulate these products as rigorously as they do drugs, so it’s not always possible to know what’s in the bottle. Some questions to ask before you buy:
- Does it have a third-party laboratory verifying the quality? Alvarez looks for the seal of the National Animal Supplement Council (NASC), a non-profit organization that established quality standards for animal supplements or a similar quality seal, such as the GMP (Good Manufacturing Practice) label.
- What kinds of studies back the use of the product in live patients? “A lot of companies will study in vitro,” which means in a test tube, she says. While these kinds of studies offer some information, they are no substitute for clinical trials.
- Is the company at least 10 years old? That brand-new miracle cure offered by a startup may have some appealing advertising, but there may be nothing to prove that it’s going to work or be safe. “You don’t want your dog to be the guinea pig for a new supplement,” she says.
Pulsed Electromagnetic Field Therapy (PEMF)
Alvarez has conducted a study on spinal surgery patients to see if their outcomes improved by adding treatment with a PEMF device, which was approved for use in people by the FDA in 2004. Studies in humans showed improvement in tissue healing and reduction in post-operative pain. In her study on dogs, Alvarez was looking for improvement in wound healing and the length of time it took for dogs to regain function. The data have not yet been published, but she described her preliminary analysis as showing some progress.