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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Integrative Veterinary Medicine Practical guide integrating holistic modalities into Western veterinary practice to help with patient treatment Integrative Veterinary Medicine provides a clinically oriented, evidence-based guide to integrating complementary and conventional therapies into veterinary practice. Covering acupuncture, manual therapies, botanical and herbal medicine, integrative nutrition, and physical rehabilitation, the book draws information on these modalities together into a single resource. Rooted in evidence-based medicine, it demonstrates how to use these modalities in veterinary practice. The book begins by discussing the basic concepts of integrative veterinary medicine, then examines each modality in detail. A companion website offers video clips showing acupuncture techniques. In Integrative Veterinary Medicine, readers can expect to find detailed information on topics such as: * Anatomy and physiology of acupuncture with relation to soft tissue and neurologic concepts, and traditional Chinese theory of acupuncture (Yin and Yang, Five Element Theory, and The Meridians) * Veterinary manipulative therapy (neurology, biomechanics, and available evidence), and massage therapy and myofascial principles * Origins and major systems of herbal therapy with selected evidence-based interventions and adverse events, herb-drug interactions, supplement evaluation, and regulation * Trends in nutrition, such as raw diets, home-prepared diets, grain-free diets, owner perception, and current marketing Covering common modalities across all species in one volume, Integrative Veterinary Medicine is an essential reference for any veterinary practitioner wishing to use integrative techniques in their practices, as well as veterinary students, academics, and researchers involved in programs of study related to integrative veterinary medicine.
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Integrative Veterinary Medicine
Edited by
Mushtaq A. Memon Department of Veterinary Clinical Sciences Washington State University Pullman, Washington, USA
Huisheng Xie Chi University Reddick, Florida, USA
This edition first published 2023
© 2023 John Wiley & Sons, Inc.
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The right of Mushtaq A. Memon and Huisheng Xie to be identified as the authors of the editorial material in this work has been asserted in accordance with law.
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The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
Library of Congress Cataloging-in-Publication Data
Names: Memon, Mushtaq Ahmed, editor. | Xie, Huisheng, editor.
Title: Integrative veterinary medicine / edited by Mushtaq A. Memon, Department of Veterinary Clinical Sciences, Washington State University, Atlanta, Georgia, Huisheng Xie, Chi University, Reddick, Florida.
Description: First edition. | Hoboken, NJ, USA : John Wiley & Sons, Inc., 2023. | Includes bibliographical references and index.
Identifiers: LCCN 2023000265 (print) | LCCN 2023000266 (ebook) | ISBN 9781119823520 (Hardback) | ISBN 9781119823537 (ePDF) | ISBN 9781119823544 (epub) | ISBN 9781119823551 (oBook)
Subjects: LCSH: Alternative veterinary medicine. | Integrative medicine.
Classification: LCC SF745.5 .V53 2023 (print) | LCC SF745.5 (ebook) | DDC 636.089/55--dc23/eng/20230215
LC record available at https://lccn.loc.gov/2023000265
LC ebook record available at https://lccn.loc.gov/2023000266
Cover Images: © Janice Huntingford; © Emily Mangan
Cover Design: Wiley
Set in 9.5/12.5pt STIXTwoText by Integra Software Services Pvt. Ltd, Pondicherry, India
Contents
Cover
Title page
Copyright
List of Abbreviations
About the Editors
List of Contributors
Preface
About the Companion Website
Section I Basic Concepts
1 Introduction to Integrative Veterinary Medicine
2 Applications of Evidence-based Medicine to IVM and Current Controversies
3 Integration of Complementary Therapies with Conventional Therapy: Multimodal Approach
Section II Acupuncture
4 Anatomy and Physiology of Acupuncture
5 Traditional Chinese Medical Foundation of Veterinary Acupuncture
6 Integrative Acupuncture: Clinical Approaches and Current Scientific Literature
Section III Manual Therapies
7 Veterinary Manipulative Therapy: Neurology, Biomechanics, and Available Evidence
8 Massage Therapy and Myofascial Principles
Section IV Botanical and Herbal Therapies
9 Herbal Medicine – Origins and Major Systems of Herbal Therapy with Selected Evidence-based Interventions
10 Herbal Medicine Regulation, Adverse Events, and Herb-Drug Interactions
Section V Integrative Nutrition
11 Novel Trends in Nutrition: Pet Food Categorization, Owner Perception and Current Marketing
12 Integrative Nutrition in Select Conditions: Obesity, Performance, Physical Rehabilitation
Section VI Physical Rehabilitation
13 Introduction to Rehabilitation
14 Common Therapeutic Modalities in Animal Rehabilitation
15 Modalities Used in Rehabilitation–Land and Aquatic Exercises
16 Integrative Treatment of Common Musculoskeletal and Neurological Conditions
Section VII Additional Complementary Therapies
17 Ayurveda
18 Veterinary Ozone and Prolotherapy
Section VIII Integration of Complementary Therapies in Clinical Practice
19 Integrative Approach to Cardiovascular Disease
20 Integrative Pain Management
21 Integrative Approach to Neurology
22 Integrative Oncology
23 Integrative Management of Abnormal Small Animal Behavior
24 Clinical Application of Chinese Herbal Medicine
25 Case Based Approach to Integrative Veterinary Practice
26 Clinical Application of Integrative Veterinary Medicine in Equine Practice
Index
End User License Agreement
List of Tables
CHAPTER 03
Table 3.1 Complementary/alternative paradigms.
CHAPTER 04
Table 4.1 Meridians and associated peripheral nerves.
CHAPTER 05
Table 5.1 Characteristics of the...
Table 5.2 Pulse palpation descriptions...
CHAPTER 13
Table 13.1 Resources on animal...
Table 13.2 Characteristics of the...
Table 13.3 Common postural abnormalities...
Table 13.4 Clinical diagnosis of...
Table 13.5 Orthopedic tests for...
Table 13.6 The 3 stages...
CHAPTER 14
Table 14.2.1 Laser classifications...
Table 14.2.2 Fundamental PBMT...
CHAPTER 15
Table 15.1 Therapeutic exercises by...
Table 15.2 Important properties of...
CHAPTER 16
Table 16.1 TCVM diagnosis and...
Table 16.2 Rehabilitation treatments for...
Table 16.3 Common Chinese herbals...
Table 16.4 IVDD summary afte...
Table 16.5 IVDD classes or...
Table 16.6 Summary of IVDD...
Table 16.7 Approximate time scale...
Table 16.8 Integrative treatment of...
CHAPTER 18
Table 18.1 Medical ozone therapy...
Table 18.2 Conditions treated with...
CHAPTER 19
Table 19.1 Common pharmaceuticals for...
CHAPTER 20
Table 20.1 Common causes of...
Table 20.2 Common causes of...
Table 20.3 Pain behaviors in...
Table 20.4 Pain behaviors in...
Table 20.5 Doses of common...
Table 20.6 Doses of common...
Table 20.7 Links for pain...
CHAPTER 21
Table 21.1 Grading scale for...
Table 21.2 Acupuncture points for...
CHAPTER 22
Table 22.1 Production of free...
Table 22.2 Chemotherapy agents derived...
Table 22.3 Specific botanicals to...
Table 22.4 Resources for advanced...
Table 22.5 Summary of clinical...
CHAPTER 23
Table 23.1 Common behavior terminology...
Table 23.2 Shen Disturbance TCVM...
Table 23.3 Foundational behavior protocols...
Table 23.4 Common behavior pharmaceuticals...
Table 23.5 Tui-na techniques...
Table 23.6 List of foods...
CHAPTER 25
Table 25.1 TCVM Five Element...
Table 25.2 Integrative therapies for...
Table 25.3 Integrative treatment options...
Table 25.4 Integrative treatment options...
Table 25.5 Integrative treatment options...
Table 25.6 Summary of TCVM...
Table 25.7 Integrative treatment options...
List of Illustrations
CHAPTER 01
Figure 1.1 Clinical services providing...
Figure 1.2 The percentage of...
Figure 1.3 A 5-year...
Figure 1.4 Dry needle acupuncture...
Figure 1.5 Hydrotherapy in a...
Figure 1.6 Walking with support...
Figure 1.7 By combining acupuncture...
Figure 1.8 A 5-year...
Figure 1.9 One-year-old...
Figure 1.10 One-year-old...
Figure 1.11 Dry needle acupuncture...
Figure 1.12 Gui Pi Tang...
Figure 1.13 The yellowness of...
Figure 1.14 About three months...
Figure 1.15 A 3.5...
CHAPTER 02
Figure 2.1 Venn diagram explaining...
CHAPTER 03
Figure 3.1 Clinical evidence pyramid...
CHAPTER 04
Figure 4.1 Selected effects of...
CHAPTER 05
Figure 5.1 Portrait of Sun...
Figure 5.2 Acupoint chart in...
Figure 5.3 The Tai-ji...
Figure 5.4 Diagram of the...
Figure 5.5 A depiction of...
Figure 5.6 The regions of...
Figure 5.7 Examples of different...
Figure 5.8 Palpation at three...
CHAPTER 06
Figure 6.1 A – A...
Figure 6.2 A six-year...
Figure 6.3 A six-year...
Figure 6.4 A 10-year...
Figure 6.5 A six-year...
Figure 6.6 A four-year...
Figure 6.7 A six-year...
Figure 6.8 A 14-year...
Figure 6.9 A three-year...
Figure 6.10 A four-month...
Figure 6.11 A 13-year...
Figure 6.12 A one-year...
CHAPTER 07
Figure 7.1 The three zones...
Figure 7.2 Joint motion in...
CHAPTER 08
Figure 8.1 Myofascial trigger points...
CHAPTER 13
Figure 13.1 A common posture...
Figure 13.2 Orthopedic exam includes...
Figure 13.3 Goniometry is used...
Figure 13.4 Instruments required for...
Figure 13.5 A dog receiving...
Figure 13.6 Exercise therapy is...
CHAPTER 14
Figure 14.1.1 A dog...
Figure 14.2.1 Aurora laser...
Figure 14.2.2 A Cavalier...
Figure 14.2.3 A dog...
Figure 14.2.4 A dog...
Figure 14.3.1 A Pit...
Figure 14.3.2 A Terrier...
Figure 14.3.3 An English...
Figure 14.3.4 A tetraplegic...
Figure 14.3.5 A tetraplegic...
CHAPTER 15
Figure 15.1 A dog receiving...
Figure 15.2 A cat walking...
Figure 15.3 A dog weaving...
Figure 15.4 A dog doing...
Figure 15.5 A dog doing...
Figure 15.6 A dog strengthening...
Figure 15.7 A dog in...
Figure 15.8 A dog enjoying...
Figure 15.9 A dog receiving...
CHAPTER 16
Figure 16.1 A dog with...
Figure 16.2 A dog wearing...
Figure 16.3 A dog with...
Figure 16.4 A dog receiving...
Figure 16.5 Acupuncture is frequently...
Figure 16.6 PNF patterning a...
Figure 16.7 A patient on...
CHAPTER 18
Figure 18.1 Ozone therapy: Paradoxical...
CHAPTER 21
Figure 21.1 10 YO FS...
Figure 21.2 (A) T2 weighted...
Figure 21.2 (B, C) Intra...
Figure 21.2 (D) Patient one...
Figure 21.3 (A, B, C...
Figure 21.4 (A) MR image...
CHAPTER 25
Figure 25.1 This flow chart...
Figure 25.2 Case 1 Integrative...
Figure 25.3 Picture of Case...
Figure 25.4 Case 2 integrative...
Figure 25.5 Additional therapeutics associated...
Figure 25.6 Mixed-breed canine...
Figure 25.7 Flow chart demonstrating...
Figure 25.8 This flow chart...
Figure 25.9 This flow chart...
Figure 25.10 Case 4 patient...
Figure 25.11 Integrative treatment of...
Figure 25.12 Integrative treatment plan...
Figure 25.13 Case 8 patient...
Figure 25.14 Left lateral radiograph...
Figure 25.15 Case 8 integrative...
Figure 25.16 Flow chart for...
Figure 25.17 Flow chart for...
Figure 25.18 Case 10 patient...
Figure 25.19 Abdominal radiograph demonstrating...
Figure 25.20 Case 10 integrative...
Figure 25.21 Flow chart demonstrating...
Figure 25.22 An Old Farmer...
Guide
Cover
Title page
Copyright
Table of Contents
List of Abbreviations
About the Editors
List of Contributors
Preface
About the Companion Website
Begin Reading
Index
End User License Agreement
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List of Abbreviations
Acronyms (Abbreviations) for Specializations and Certifications
AVMA-Recognized Specializations
DACT
Diplomate American College of Theriogenologists
DACVP
Diplomate American College of Veterinary Pathologists
DACVS
Diplomate American College of Veterinary Surgeons
DACVECC
Diplomate American College of Veterinary Emergency and Critical Care
DACVIM
Diplomate American College of Veterinary Internal Medicine
DACVSMR
Diplomate American College of Veterinary Sports Medicine and Rehabilitation
Certifications
CCRT
Certified Canine Rehabilitation Therapist
CCRV
Certified Canine Rehabilitation Veterinarian
CAVCA
Certified by the American Veterinary Chiropractic Association
CDA
Certified Disk Arthroplasty surgeon
CERPV
Certified Equine Rehabilitation and Performance Veterinarian
CHPV
Veterinarians Certified in Hospice and Palliative Care
CTCVMP
Certified Traditional Chinese Veterinary Medicine Practitioner
CVA
Certified Veterinary Acupuncturist
CVC
Certified Veterinary Chiropractor
CVCH
Certified Veterinary Chinese Herbalist
CVFT
Certified Veterinary Food Therapist
CVPP
Certified Veterinary Pain Practitioner
CVTP
Certified Veterinary Tui-Na Practitioner
CVMMP
Certified Veterinary Medical Manipulation Practitioner
CVBMA
Certified Veterinary Balance Method Acupuncturist
EDO
Equine Diploma Osteopathy
FAAVA
Fellow American Academy of Veterinary Acupuncture
VHCM
Advanced Certification in Veterinary Chinese Herbal Medicine
About the Editors
Mushtaq A. Memon, BVSc, MSc, PhD, Dip ACT, CVA
Dr Memon is a Professor Emeritus at Washington State University (WSU); Courtesy Professor at University of Florida (UF); and Professor, Chi University, Reddick, Florida.
Dr Memon has 35 years’ experience in teaching, clinical practice, and research. He received his veterinary education at Punjab University, Lahore, and MSc in animal reproduction from University of Agriculture, Faisalabad, Pakistan. He earned his PhD in Theriogenology in the United States from the University of Minnesota. This was followed by clinical training in Food Animal Medicine and Surgery at the University of Illinois and becoming a Diplomate, American College of Theriogenologists in 1984.
He has been a member of the veterinary school teaching faculties at Oklahoma State University, Louisiana State University, Tufts University, and Washington State University (1991–2016 retirement). He is an internationally recognized scholar; author of more than 120 publications, and has delivered 150+ presentations at international, regional, and local level.
As a clinical scientist and teacher, Dr Memon has received multiple teaching awards. He is a Fulbright Scholar and served as a Fulbright Ambassador for four years. He was instrumental in establishing the Fulbright Academy at WSU and currently serves as a Fulbright Specialist implementing focused projects in other countries. As Chair of the Curriculum Committee of WSU Veterinary College, Dr Memon became aware of a WSU graduate veterinarians’ survey in which 60% of the responding veterinarians mentioned poor to no education was provided in complementary therapies. Comments on the survey noted 30% of the respondents had clients requesting these services (e.g., acupuncture, rehabilitation). Through courses and contact with Dr Xie and Chi University, followed by a six-month sabbatical in the Integrative Veterinary Medicine (IVM) service at UF; Dr Memon gained knowledge and became an active supporter in this growing area of veterinary medicine. He was instrumental in establishing the IVM service at WSU-Veterinary Teaching Hospital.
Dr Memon has envisioned the need for establishing IVM as part of the veterinary curriculum. He has been a leader in this area, conducting two surveys of the AVMA-accredited colleges to characterize the level of IVM education in veterinary schools. He has published the results along with curriculum recommendations. It is hoped with help from colleagues, Dr Memon will continue promoting IVM as part of the veterinary curricula and support IVM practice worldwide.
Huisheng Xie, DVM, MS, PhD
Dr Xie is Professor Emeritus at University of Florida (UF), and Professor and Founder of Chi University of Traditional Chinese Medicine in Reddick, Florida. He has been teaching and practicing Traditional Chinese Veterinary Medicine (TCVM) since 1983.
Dr Xie received his BS degree of veterinary medicine at the Sichuan College of Animal and Veterinary Sciences in Sichuan, China in 1983. He was a faculty member at the Beijing Agriculture University College of Veterinary Medicine during 1983 to 1987. After receiving his master’s in veterinary acupuncture in 1988, he served as an assistant and associate professor in the college until 1994. During this time, he continued his advanced training in human acupuncture at the Beijing College of Traditional Chinese Medicine and the National academy of Traditional Chinese Medicine from 1990 to 1992.
To explore different approaches for studying and advancing TCVM, he moved to the United States in 1994 and began his doctoral training at UF. He investigated using acupuncture as pain control mechanisms in horses and received his PhD in 1999. Believing that TCVM should be available to more veterinarians, Dr Xie founded the Chi Institute of Chinese Medicine in 1998 which has progressed to become Chi University. In addition to offering certifications in various branches of TCVM, Chi University offers MS in TCVM, and MS and doctoral degrees in Integrative Veterinary Medicine.
Dr Xie’s academic accomplishments are extensive. He has received numerous achievement awards from Chinese and other international institutions. Dr Xie has been invited to give lectures on veterinary acupuncture for over 100 veterinary organizations or universities of over 20 countries including the WSAVA, AVMA, Western Veterinary Conference, VMX/NAVC, and AAEP etc. He has trained over 10,000 veterinarians from nearly 100 countries. Dr Xie has authored 32 books and over 100 peer-reviewed papers. His textbooks, including Xie’s Veterinary Acupuncture and Traditional Chinese Veterinary Medicine – Fundamental Principles, have been used for TCVM training programs in Asia, Europe, North and South America, Africa, and Australia.
List of Contributors
Author – Chapter # 26Amelia Munsterman, DVM, MS, MS-TCVM, PhD, Diplomate ACVS-LA, Diplomate ACVECC, CTCVMP, CVMMP Associate Professor, Large Animal Clinical Sciences, Veterinary Medical Center Michigan State University, East Lansing, Michigan, USA
Author – Chapter # 20Carolina Medina DVM, Diplomate ACVSMR, CVA, CVPPP Elanco Animal Health, 2500 Innovation Way Greenfield, Indiana, USA
Author – Chapter #23Cynthia McDowell, DVM, CVA, MS-TCVM, FAAVA Cross Point Animal Hospital, LLC 2601 Hopper Road Cape Girardeau, Missouri, USA
Co-author Chapters # 11, 12Donna Raditic DVM, ACVIM (Nutrition) Nutrition and Integrative Medicine Consultants Athens, Georgia, USA
Author – Chapters # 4, 5, 6Emily Mangan, DVM, CVA, CVCH, CVFT, CVTP, CVMMP, CCRV Wisewood Integrative Veterinary Medicine, LLC Pleasant Hill, Oregon, USA
Editor – Section VI: Physical Rehabilitation Author/Co-author – Chapters # 13, 14, 15, 16Janice Huntingford, DVM, MS-TCVM, Diplomate ACVSMR, CVA, CVPP Essex Animal Hospital 355 Talbot St N Essex, Ontario, N8M2W3, Canada
Author – Chapter # 3John A. Perdrizet, DVM, MS-TCVM, PhD, Diplomate ACVIM (Large Animal) The Sanctuary Animal Clinic, 210 Linden Street Holyoke, Massachusetts, USA
Editor – Section VIII: Integration of Complementary Therapies in Clinical PracticeAuthor – Chapter #24Judith E. Saik, DVM, PhD, Diplomate ACVP, CVA, CVCH, CVFT Winterville Animal Clinic 250 Henry Meyer Rd, Winterville, Georgia, USA
Author – Chapter # 22Kendra Pope, DVM, Diplomate ACVIM (Oncology), CVA, CVCH, CVFT, CVTP Integrative Oncology and Veterinary Wellness 252 Broad Street, Suite3, Red Bank, New Jersey, USA
Author – Chapter #19Kristina M. Erwin, DVM, CVA, CCRT, CVPP, CHPV, VHCM Wholistic Paws Veterinary Services 20600 Gordon Park Sq. Ashburn, Virginia, USA
Editor – Section V: Integrative NutritionCo-author Chapters # 11, 12Laura Gaylord, DVM, Diplomate ACVIM (Nutrition) Whole Pet Provisions, PLLC 5436 Brushy Meadows Drive Fuquay Varina, North Carolina, USA
Editor – Section III: Manual TherapiesAuthor – Chapters # 7, 8Marilyn Maler, DVM, Diplomate ACVSMR, CVA, CVCH, CVFT, CVTP, CVC, EDO SunSpirit Farm & Veterinary Services, INC Ocala. Florida, USA
Author – Chapter # 25Mitchell McKee, DVM, MS-TCVM, CVA, CVCH, CVFT, CVTP, CTPEP, CTCVMP, CVMMP Berry Farms Animal Hospital, Franklin, Tennessee Concord Animal Hospital, Brentwood, Tennessee, USA
Co-Editor – Integrative Veterinary Medicine bookEditor Sections I, VIIAuthor – Chapter # 1Mushtaq A. Memon, BVSc, MSc, PhD, Diplomate ACT, CVA Prof Emeritus, Dept of Veterinary Clinical Sciences Washington State University Pullman, Washington, USA
Co-Editor – Integrative Veterinary Medicine bookEditor – Section II: AcupunctureHuisheng Xie, DVM, PhD Professor & Founder, Chi University Reddick, Florida, USA
Author – Chapter # 21Patrick Roynard, DVM, MS, CVA, Diplomate ACVIM (Neurology), ACVIM Neurosurgery certificate, CDA Neurology/Neurosurgery Department College of Veterinary Medicine The Ohio State University, Columbus, Ohio, USA
Author/Co-author – Chapters # 13, 14, 15, 16Ronald B. Koh, DVM, MS, Diplomate ACVSMR, CVA, CCRP, CVMMP, CVCH, CVFT Department of Surgical and Radiological Sciences School of Veterinary Medicine University of California, Davis, California, USA
Author – Chapter # 2Roselle Hartwigsen, BSc, BVSc, MSc, CVA AnimalQi Wellness Centre Director, Chi University of TCVM for South Africa Rustenburg, South Africa
Editor – Section IV: Botanical and Herbal TherapiesAuthor – Chapters # 9, 10, 18Signe Beebe, DVM, CVA, CVCH, CVFT, CVTP Instructor, Chi University Reddick, Florida, USA
Authors – Chapter # 17Rupali Sodhi, DVM, CVA Tejinder Sodhi, BVSc & AH (Punjab, India), CVC Animal Hospital of Lynnwood Animal Wellness and Rehab Center Bellevue and Lynnwood, Washington, USA
Preface
Integrative Veterinary Medicine (IVM) is a new clinical approach to veterinary medical care that combines conventional (Western) veterinary medicine, as traditionally taught in veterinary schools, with complementary therapies to improve clinical outcomes in patients. The idea for this book stemmed from a publication, co-authored by 26 board-certified veterinarians, which proposed curriculum guidelines for veterinary schools to introduce students to IVM (Open Vet J 6:44–56, 2016). Topics suggested by the publication have been expanded in this book and detailed information is covered in 26 chapters. All chapter authors are talented integrative clinicians with expertise that include one or more AVMA-recognized specializations and/or certification in multiple areas of complementary therapies.
The authors have offered valuable integrative medical approaches in treating patients based upon their long-term experiences in clinical veterinary medicine even though some chapters might challenge a reader’s thought processes. Readers are encouraged to have open minds, as well as look for therapies that are evidence-based. One author coaches the reader, “those who dismiss the advantages of integration of therapies, prior to personal exploration, run the risk of stifling scientific method.”
The IVM therapies consists of acupuncture, rehabilitation, medical manipulation (chiropractic), physical therapy, nutrition, and botanical medicine etc. Each of these disciplines is inherently individualized; therefore, one cannot expect impressive results from a “one size fits all” approach. Although scientific method is most often linear, the application is circular and follows an authors’ insight gathered from years of experience and “learned from patients” based upon outcome of their selected therapies.
The incorporation of IVM approach in your practice can be rewarding for patient outcome, client satisfaction, and professional development. This book contains a compilation of knowledge and wisdom from experienced clinicians to attain that goal. It is your interest and effort that will be the critical factors in the success of your endeavors.
About the Companion Website
This book is accompanied by a companion website:
www.wiley.com/go/memon/veterinary
This website includes
Integrative Clinical Case Examples
Clinical Application of Chinese Herbal Medicine
Videos
Section I Basic Concepts
(Section Editor – Mushtaq A. Memon)
2 Applications of Evidence-based Medicine to IVM and Current Controversies
Roselle Hartwigsen
Understanding Evidence-based Veterinary Medicine and How to Use It
1) The origins of Evidence-based medicine
Evidence-based medicine (EBM) has been practiced for thousands of years with traces being found in ancient Greece and Chinese medicine where testing of medical intervention and data capture were done since the eleventh century [1]. However, it is only in the twentieth century that EBM was formally recognized as a field of study and implemented in the care of patients. EBM is defined as the process of integrating new information and emerging technology into practice [2] and the “contentious, explicit, and judicious use of the current best evidence in making decisions about the care of the individual patients” [3]. EBM evolved as a result of the delay or failure of clinical research to have an impact on patient care and the decision making of the practitioner [3]. Evidence-based veterinary medicine (EBVM) can be understood as a subspeciality of EBM as the implementation is very similar, however, the origin of EVBM is difficult to determine. The first book on EVMB, Handbook of Evidence-based veterinary medicine by Crockcroft PD et al. [4], was published in 2003 with very few publications in veterinary literature since then. Crockcroft defined EBVM as “a process of lifelong, self-directed problem based learning” [4]. As veterinarians we continually gain experience from each patient we treat. EVBM uses these “lessons” or experience in a structured and constructive way by combining it with clinical research to result in the best possible outcome for each individual patient. Veterinarians practicing integrative veterinary medicine (IVM) by combining conventional veterinary medicine with complementary medicine (CVM) have been practicing a form of EBVM for years. These practitioners, through experience and literature research, developed treatment strategies on how to successfully use the “new” modalities (CVM) in their patients as these are not taught in veterinary schools. Therefore, the practitioners must rely heavily on literature, which may be of poor quantity and quality, and the knowledge and experience of fellow practitioners that are experts in the fields of CVM.
2) Understanding EBVM
EBVM is combining the clinical experience with the patients’ needs and the best available evidence to make treatment decisions with the best possible outcomes for the individual patient.
To be a “good” or successful veterinarian the practitioner needs to use both clinical experience and scientific research in decision making about the individual patient [3]. Neither discipline alone will yield ideal treatment results because research is rapidly revealing new information that must be practically implemented to have any validity. External clinical research can never replace clinical expertise as it is in the expertise that lies the wisdom as to whether the research is applicable to the particular patient [1]. EBVM is not a “cookbook” medicine, and the practitioner should approach each individual case as “new” and work through the EBVM steps to determine the best approach to treat the patient. Practitioners should not fall into a routine of familiar treatments strategies and should constantly educate themselves on new techniques and treatment options available. Humans are often resistant to changes and easily fall into habits and routines; this will cause a stagnation in knowledge and skill development often leading to a decline in good therapeutic outcomes and poor client relations. The EBVM practitioner should be curious and have an open mind to explore and study new modalities, including modalities that have always been seen as “alternative” and use it to treat the patient in an integrative way. This requires the veterinarian to not only be well-read on the latest publications but also have the practical skills and knowledge to apply the new knowledge appropriately to patients. EBVM is often described as a lifelong problem-based learning process [4].
3) How to practice EBVM
The practice of EBVM can be broken into five steps as identified by the Group of Evidence-Based Medicine Resource from McMaster University [1]:
Identifying the clinical problem and formulating a specific question
Efficient research to find the answer
Critically evaluating all research for validity and clinical relevance
Integrating knowledge and skills to treat patient
Evaluate outcomes.
This process will take effort, time and education and a veterinarian that practice EBVM should take this into account when scheduling appointments or dedicating time to patient treatment.
Step 1:
Identifying the problem and formulating a question. The work of a veterinarian revolves around constant decision-making throughout the day. Decisions on diagnosis, treatments, prognosis, etc. Busy practitioners often do not have the time or resources at hand to research each question and will rely heavily on prioritizing questions and spending time accordingly. To be more efficient and concise when practicing EBVM the question needs to be clear well-structured and answerable. The PICO format can be used to help formulate the question:
P – Patient/Problem. What is the Specie, breed, sex, age, etc., as well as what is diagnosis or problem?
I – Intervention. What treatments are available or needed for treatment?
C – Comparison of intervention. Which modalities i.e., medicine, surgery, complementary, etc., can/should be used and even used together to improve outcome?
O – Outcome. What is the outcome of interventions and how what the success of integrating the interventions?
By using PICO as a starting point, the question can easily be formulated. From here the practitioner can start step two.
Step 2: Efficient research to find the answer.
Good practice based clinical research that are of relevance to the question posed may be challenging to find. Accredited journals from trusted data basis should be consulted first, followed by conference notes/publications and consulting experts within the field. As the practitioner is usually constraint by time and cannot spend eight hours a day reading and evaluating academic papers it is vital to construct a go-to network of trusted resources that can easily be accessed and evaluated quickly. Being familiar with databases such as PubMed and CAB will allow the veterinarian to identify and use keywords more effectively and get relevant results faster. EBVM practitioners should try to connect with one another via social media or within groups to exchange ideas and experiences. Research sources should be valid, relevant, contain all benefits and possible complications as well as be easy to access and useful [1].
Step 3: Critically evaluating all research for validity and clinical relevance.
Not all research is created equally and the peer review system is imperfect and papers in these journals do not necessarily mean that the paper is of useful quality [5]. For this reason, the practitioner needs to be familiar on how to rank articles and journals for usefulness and reliability. In general articles are ranked as follows [6]:
Systematic reviews and meta-analysis
Randomized clinical trials with conclusive results
Randomized clinical trials with inconclusive results
Cohort studies
Case control studies
Cross-sectional surveys
Case reports.
Papers can be eliminated from the research effort early on in the process by asking three questions [5]:
What was the aim of the study and how was it achieved?
What type of study was conducted?
Was the study design appropriate?
If all these questions are answered to your satisfaction, you can continue to investigate using a method that you are comfortable and familiar with. One of the acronyms used to evaluate literature is RAAMbo [7]:
R: Represents: What population does this study represent?
A: Allocation: How was the animals allocated in the study groups? Was it randomized etc?
A: Accounted: Did all the animals that started the study complete the study? If not, were the reasons given?
M: Measurements: Was the study evaluated objectively? Were the evaluators blinded to the groups? This is very important especially in observational studies.
The most important outcome of this step is to find and critically evaluate the research available in relation to the relevance of the question posed in Step 1. This should be done in a time saving and efficient manner. The evidence should be ranked and used appropriately in the next step.
Step 4: Integrating knowledge and skills to treat your patient.
Once the practitioner has evaluated the research, a better understanding of the problem as well as the solutions or treatments available, all knowledge is integrated into the treatment plan [1]. CVM should not be overlooked and integrated into the treatment plan should the research show it to be appropriate and successful for the specific problem in question. The more modalities of therapies the practitioner can perform the wider the possibilities of treatment for each patient. Very often combining CVM with conventional therapies in an integrative treatment plan, will have the best possible outcome for the patient.
The treatment plan may change according to the client’s ability and preferences. In the age of technology, clients often consult “Dr Google” to self-diagnose their pets and very often tells the veterinarian how they think the condition should be treated. For this reason, veterinarians should be knowledgeable not only on what they are taught in veterinary school but also about alternative therapies suggested on the internet. Veterinarians should be able to easily distinguish between viable alternative or CVM therapies and quackery with no scientific basis and explain this eloquently to their clients. As very little CVM is taught in veterinary schools, practitioners need to search for education in these subjects from reputable universities, institutes and organizations producing research and education. Organizations such as the World Association of Traditional Chinese Veterinary Medicine (WATCVM) or the American Holistic Veterinary Medicine Association (AHVMA) provides useful resources for practitioners and funds a great deal of research into CVM. As the public interest and demand for these therapies are growing, the skills and knowledge of the veterinarians should grow as well [8].
Step 5: Evaluate outcomes.
The outcome of the treatment plan as well as the overall success of the practitioner to perform EBVM should be evaluated [1]. Was the treatment outcome as expected for this specific patient? Did the EBVM applied have the expected results for the patient? If not, why, and how can this be corrected? Were there any changes for the better? Does the outcome differ significantly from the clinical research? All these questions should be asked, and the outcome critically evaluated.
The practitioner should also do a self-evaluation to gauge the success and efficiency to which EBVM was applied. Was the problem correctly identified? Were the scientific resources used applicable and relevant? Did the practitioner do enough research or spend too much time locating relevant research? Was the evidence correctly integrated and used to treat the patient? Did the practitioner meet the client expectations and work within the preferences subscribed?
Each case should be a learning opportunity for the practitioner and future EBVM practitioners. This will help veterinarians improve their EBVM skills and identify the specific steps where improvement is needed [2]. All veterinary practitioners should aim to document all cases to the highest scientific standard using the correct medical terminology and internationally accepted units. This will help to share knowledge and experience with a wider audience without unfortunate miscommunication and evidence lost in translation. EBVM practitioners should also be encouraged to share their knowledge and experience with other veterinarians at conferences and in peer reviewed journals.
Evidence-based Medicine and Integrative Veterinary Medicine
Lack of understanding has led to confusion surrounding EBVM. Some argue that it is the natural evolution of veterinary science because of the exponential expansion of knowledge and technology available to practitioners. Others suggest that EBVM is a collective effort from corporations and academics to change the traditional way of practicing veterinary medicine by creating “cookie cutter” veterinarians reliant on their research and products. While many are of the opinion that it is merely a new way of looking at the same way of traditional practice [2]. As a profession, veterinarians need to learn how to process a large amount of information and new advances in treatment techniques due to rapid research and development. In the age of information all the latest discoveries are now at our fingertips and available to practitioners even before it is published in a textbook or taught in veterinary schools. Practitioners need an efficient method to weed out what they need and apply the knowledge for a specific patient. EBVM formalizes the process and creates a method to provide a treatment plan with the best possible outcome to patients.
One of the best examples of where EBVM can be successfully implemented is in the use of CVM. Alternative treatment modalities have popped up globally as “cure all” for all sorts of ailments and diseases. Often these therapies have very little or no scientific backing and are practiced by non-veterinary professionals with no or very little education in veterinary science. There are however CVM modalities with excellent clinical research such as herbal medicine and acupuncture, that are taught in certified institutes and universities, all showing excellent treatment results. CVM consists of all therapies and treatments not taught in veterinary school including but not limited to acupuncture, phytomedicine (herbal medicine), food therapy, homeopathy, osteopathy, chiropractic, essential oils, and massage therapy. Clients are aware and enthusiastic about alternative treatment available for their pets, and a growing number of veterinarians are interested in using these therapies to improve the outcomes for their patients. EBVM is an excellent tool to distinguish which of the CVM modalities are valid, proven and indicated for the patient, as well as how to combine different treatments in an integrative tool when using IVM to get the best possible results for the patient and client.
IVM is understood as the use of CVM and conventional medicine together in practice to achieve the best possible outcome for each individual patient as illustrated in figure 2.1. Where conventional veterinary medicine relies heavily on clinical research in decision-making, in CVM clinical published research is somewhat lacking as clinical trials are difficult to standardize and execute. CVM therapies are based on each individual patient and difficult to extrapolate to big research groups. For this reason, CVM practitioners rely heavily on EBVM for practical experience accounts and available clinical research from CVM practitioners in decision-making. The National Centre for Complementary and Integrative health (NCCIH) stresses and supports the development and dissemination of objective evidence-based information on CVM with professional education at its core [9]. The NCCIH has excellent online resource to guide EBVM practitioners in an efficient way to find the most relevant and recent published data on a specific CVM. Other organizations such as the WATCVM has peer reviewed publications available to members that will aid in the decision-making process of EBVM as well as funding of research.
Figure 2.1 Venn diagram explaining Evidence-based veterinary medicine concept.
When deciding to use CVM as part of the integrative treatment the veterinarian must satisfy at least one of the following three criteria during step three in the EBVM process: A) There is significant scientific evidence for the efficacy of the therapies. B) There is evidence of the therapy being used in similar population of patients. C) If the therapy has potential to treat a condition for which conventional medicine has failed [8]. Once the veterinarian is satisfied the CVM treatment is appropriate, and will yield good results, an integrated treatment plan is formulated. To integrate CVM successfully into treating a patient the veterinarian should have the necessary training and skill for the specific CVM modality. Currently appropriate training and education in CVM is a challenge due to a lack of accredited teaching institutions. The deficiency of perceived supportive evidence for CVM has created a reluctancy to include training in CVM modalities as part of the veterinary curriculum in veterinary schools [10]. Controversies surrounding the validity and efficacy of CVM modalities have been a constant in the academic and clinical setting. Questions about the placebo effect in animals and animal owners or caregivers [11] as well as cyclical regression of chronic diseases are asked when criticizing many of the CVM modalities [8]. The AVMA taskforce on complementary and alternative therapies clearly states that it is the responsibility of the veterinarian to critically evaluate the literature on CVM therapies as the quality of scientific studies varies greatly [12
