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COMPLEMENTARY MEDICINE & THERAPY FOR LARGE ANIMALS Judith M. Shoemaker, DVM The purpose of this lecture is to provide information about complementary medicine and therapies: what they are, how they work, when they are helpful, when they are contraindicated. The term complementary is used to indicate that these modalities are an adjunct to allopathic care, not only an alternative. They may provide alternative outcomes, including the avoidance of surgery, reduction in medications needed, and the avoidance of complications in treatment or recovery. It is important to have an understanding of these modalities because of their widespread use, and potential misuse, in treating large animals. They can enhance the quality of care that we can provide and more importantly, they can enhance the quality of life for the animals. CHIROPRACTIC Chiropractic is a successful, noninvasive, cost effective
technique for treatment, rehabilitation, and prevention of much common
lameness and illness. Chiropractic is based on manipulation of joints
of the spine and extremities to effect optimum function and balance
of all structures, in other words, straightening the hardware so the
software can run. Ninety percent of the input to the nervous system
is from joint receptors and stretch receptors in tendons, ligaments,
and muscles. The nervous system runs the whole animal, therefore managing
the nervous system through these receptors is efficient, accurate
care. The spine and extremities of horses can be easily manipulated
if the practitioner has appropriate training and skill. Good chiropractic,
is not violent or uncomfortable. The animals can understand it, enjoy
it, and often obtain immediate relief from it. Chiropractic adjustments may vary between practitioners;
there are more than a hundred types of chiropractic technique, many
of which are applicable to animals. The foremost consideration is
that the animal is not harmed, as should be the case in all medicine. Chiropractic care involves accurate manipulation of
individual joints through normal planes of motion using high acceleration,
short range-of-motion thrust that effects a reset of joint receptors
and normalizes joint orientation. The practitioner must have training
in both species specific anatomy and accurate technique. Chiropractic
can be very exact in managing the nervous system; sophisticated techniques
have far reaching and subtle effects. Balance in animals is the effective interaction of the
nervous system, the frame, and movement with gravity. The interface
of the nervous system with gravity is mostly through the feet. The
monitors of gravity, the balance regulating mechanisms, are in large
part, the upper cervical head-righting reflexes and the temporomandibular
joint (the jaw joint). Eighty percent of the aforementioned ninety
percent of input to the brain comes from the second cervical vertebra
and the joints rostral to it, including the skull. Therefore, appropriate
farriery and dentistry are of the utmost importance in maintaining
balance and straightness. Two things are not going to change - 100
million years of evolutionary biomechanics and gravity. Dentistry
and farriery allow them to interact effectively as they were designed. Chiropractic is necessary is when an animal is asymmetrical, "dumb", or "crabby". Chiropractic may be helpful after any trauma, toxicity, or stress. Therefore any animal with a history of illness or accident is a potential chiropractic patient. Chiropractic care is best used preventively and as maintenance
health care. Evaluation of young animals can minimize the future effects
of early life asymmetries and often allow these animals to reach their
full potential. The rare horse that does not need chiropractic is
usually small, barefoot, short-toed and either very lucky not to have
been injured or is an outstanding athlete. Most painful pathologies - arthritis, degenerative joint
disease, back pain, etc. often are not primary problems. They are
the signs of overuse or hypermobility caused by restriction of normal
movement or hypomobility somewhere else in the system. Chiropractic
is the facilitation of appropriate movement of all joints so that
all joints share the stresses appropriately. The majority of chronic
lameness problems are not injury related but are the result of unbalanced
wear and tear. Everything from navicular disease to osselets, hock
problems to stifle problems, hip problems and the majority of back
problems are almost always secondary symptoms of underuse/overuse,
compensation for other problems, lack of motion or pain elsewhere
in the body. The use of antiinflammatories may be eliminated by normalizing
joint function and balance. The use of antiinflammatories without
resolving the cause of joint use imbalances may not be as effective,
can shorten the functional life of a joint, and may have other detrimental
physiologic effects. Usual complaints that cause owners to seek chiropractic
treatment for horses are proprioceptive problems, stiffness, uneven
gaits, stifle or hock problems, sore backs, chronic front foot pain,
obscure lameness, training or behavioral problems, poor development,
plus a host of more specific problems and diseases. Animals with high
stress occupations, or animals with preexisting conditions or conformational
problems, may require more frequent adjustments than those needed
for maintenance health care. Horses that cannot stand patiently or
comfortably for shoeing are potential chiropractic patients as this
may be evidence of balance, torque, or strain problems in the system. Anything that is run by the nervous system can be influenced
by chiropractic - musculo-skeletal, digestive, immune, reproductive
- all systems can improve with better neurologic function directing
them. Chiropractic care is a systematic way of eliminating structural
and neurologic dysfunctions that cause pain, alter performance, cause
organic disease, and result in emotional and training problems. Its
effects can be profound, long lasting, and life changing. It is as important to recognize the practice of poor
chiropractic technique as it is to understand good chiropractic work.
Manipulation can be dangerous if applied inappropriately, or by an
unskilled practitioner. Gross, full body or long lever movements are
not accurately applied chiropractic, one cannot adjust a neck or withers
using a limb, one cannot adjust a spine using a hind leg. Therefore,
some spectacular techniques are not necessarily accurate, and any
technique that requires joints to go through an unnatural range of
motion is potentially career-ending for the animal. Slow or rough
techniques will cause the patient pain and will create physical and
emotional guarding and tension that will limit further adjustment.
Inaccurate adjusting can worsen the condition, and unknowledgeable
or inappropriate technique can cripple or have no beneficial effect
and waste time. Good work will almost always effect noticeable improvement
and will be well received by the patient. Chiropractic is appropriate as adjunctive care for any persistent lameness or training problem, health concerns that do not resolve in a normal manner, and as good preventative health care. ACUPUNCTURE Western and Eastern veterinary medicine are very different
but complementary forms of health care. They differ in their philosophical
and practical view of the mind-body interaction with the world. Western
medicine evaluates the external causes and resulting pathologies of
illness and concentrates on eliminating these. Eastern medicine focuses
on basic body function and the body's reactions to illness and assists
these to eliminate or prevent disease. Acupuncture is an ancient and complex system of medicine.
It is widely accepted in the horse industry, mostly for the treatment
of back pain, but it is certainly not limited to that. Acupuncture
is often an effective treatment for chronic problems of foot and joint
pain, chronic and non-responsive illness, including heart and kidney
disease, allergies, heaves, moon blindness, and other immune-mediated
problems. Acupuncture can also be effective in modifying behavior. Acupuncture is the stimulation of specific receptors
that modify input to the nervous system and therefore change function.
The integration of neurologic information from the body with acupuncture
stimulation results in the balancing of Qi, or energy flow, that is
discussed in traditional acupuncture theory. Its effect is somewhat
analogous to the direction of electricity by the fail-safe computer
programs of power companies that ensure that power supply is uninterrupted
to utility consumers even under conditions such as storms, increased
demand, or equipment failure. The autonomic nervous system and its reflexes control
the defense systems in the body, both internal and external. The neuroendocrine
system allows an animal to adapt to changes both inside and out. A
primitive part of the nervous system is also involved in the sensing,
control and regeneration of damaged tissue and pathologies such as
wounds, fractures, early neoplasms, inflammation, etc.. Acupuncture
can have a profound effect on modifying autonomic function and directing
this primitive system. Because the autonomic nervous system of the
horse is extremely sensitive, as is evidenced by the fragility of
animals in stressful physiologic states such as colic and anesthesia,
acupuncture is particularly effective in this species. With simple acupuncture there are no significant ill-effects;
the worst that can happen is that the treatment has little or no effect.
No change, however, is rare. Most animals experience a profound endorphin
release and appear almost tranquilized while being treated with acupuncture.
Physiologic, sensory and motor function can be immediately and sometimes
permanently normalized. MASSAGE There are many different massage techniques, each with
a different approach, including sports massage, myofascial release,
cross-fiber friction massage, and cranial techniques. Massage assists
normal body function by increasing circulation, facilitating scar
release, providing neuro-muscular re-balancing and relaxation. Massage can be used pre or post competition for performance
enhancement. It can be very helpful in reorganizing musculature that
has been unbalanced by chronic compensation for pain. For example,
many horses with a history of heel pain will not regain normal extension
of the anterior stride phase even when the pain is relieved unless
chronic muscular contracture of the flexors is released through accurately
applied techniques. Massage is contraindicated if an animal has a fever, if the injury is acute, or if there is an area of bruising. Not only is massage not helpful in those cases, but it can actually be detrimental. A qualified, preferably certified, massage therapist should determine whether massage is appropriate or not. ELECTROMAGNETIC THERAPY EMT is the use of electromagnetic fields to stimulate
or accelerate blood flow and energy movement within tissues to alleviate
inflammation and pain and to allow maximum healing to occur. Two types
of devices are common: the pulsed alternating field type (with electrical
wiring in the blankets, bandages, or bedding) which are adjustable
in strength, frequency, and duration of treatment, and the static
type (which utilize small magnets arranged in alternating polarities
within the blankets and wraps). Alternating polarities attract ions in blood and cells
increasing fluid flow as well as enhancing ion exchange at the cell
membrane level. This increases function at the cellular and vascular
level. EMT can make tissues more flexible and less prone to injury.
It can be used for maintaining sufficient blood flow for toxin removal
and repair after strenuous work in performance animals. The increase
in electrical energy flow can also enhance the flow established by
acupuncture. In conjunction with other therapy modalities, it can
reduce rehabilitation time after surgery. EMT can also be used in
healing fractures; it is excellent for treating nonunions. EMT usually calms and relaxes the animal. A few horses' signs may be slightly worse immediately after treatment - these animals usually have severe postural defects from structural, shoeing, or dental problems resulting in major blockages in the nervous and the circulatory system. These animals often show improvement from the treatment several hours later. LASER Cohesive infrared light, or cold laser, can be used
to provide energy for cellular metabolism by converting ADP to ATP
in the mitochondria, thus facilitating transport of nutrients into
and toxins out of cells. It is especially valuable in conditions where
the blood supply may be insufficient to support the cells. Laser therapy
can keep cells alive and functioning and thus enable these injuries
to heal faster, with less scarring. Laser therapy is most commonly used for wounds and soft tissue healing. It is also useful as a powerful acupuncture tool. It can reduce pain and tension and reset proprioception, thereby normalizing function, and allow horses with non-structural pain, such as grabs and bruising, to move soundly. Laser treatment will not block structural pain such that an animal will unknowingly hurt an injured limb. It is not appropriate to use lasers over infections, tumors, or certain topical medications, such as furacin, blisters, or liniments, as this may cause an inappropriate increase in circulation and inflammation. HOMEOPATHY Homeopathy is electrical informational medicine. A substance
that is shown to produce particular signs or symptoms is serially
diluted and succussed (vigorously shaken) until there is a very small
proportion of the original substance remaining in the solution. It
is thought that this "infinitesimal dose", as it is called,
contains the electrochemical pattern of the medicinal substance. The
science of physics is now beginning to explain the underlying mechanism
of the interaction of the body with this electronic signature. Homeopathic
remedies are specific for sets of neuronal systems within the body.
Activation or deactivation of a specific neuron group creates a spectrum
of specific signs and symptoms. Accurate use of remedies can profoundly
and quickly change function. A basic tenet of homeopathy is that "like
cures like". Because of this, it is often mistakenly likened
to vaccination. However, homeopathic remedies differ fundamentally
from vaccines. Homeopathic remedies affect the energy of the body
in order to stimulate healing and in doing so they strengthen the
body's response to a disease-related stress. Homeopathic case analysis includes subjective information
about the patient, which is not considered relevant to the allopathic
diagnosis, such as the animals' likes and dislikes, unique behaviors,
and the time of day that signs are most prominent. Since homeopathic
prescribing is done using a larger spectrum of signs, symptoms and
history, astute observation by both the owner and the practitioner
is prerequisite for accurate and successful use of this modality. NUTRITION AND HERBS Nutrition is fundamental to health. Inappropriate substances
or imbalances in the diet can sabotage the best treatment. In recent
years, the introduction of more highly processed diets and the lesser
quality of forages due to hay production techniques and the reduction
of diversity and use of pasture are resulting in nutritional imbalances
and chronic diseases in horses much like those seen in small animals
and humans eating unnatural diets. The supplement industry for horses is trying to address
these problems, however basic feedstuffs must be of sufficient quality
first, and unbalanced or excessive supplementation must be avoided.
Horses have survived for thousands of years on diverse seasonal grazing
and browsing. Functional maintenance of the whole animal is dependent
upon not only the ingredients of the feed, but also the activity involved
in acquiring natural food, the difference in how it is chewed, the
water necessary to process it, the enzymes and bacteria contained
in it. These functional components of diet may not be adequately addressed
in confinement management, by processed feeds, or feeding practices. Herbs can be as powerful as synthetic drugs; they contain
pharmacological chemicals. Native North and South American and Eastern/Chinese/Ayurvedic
herbology are very complex systems of medicine. Herbal preparations
can be single or combination herbs. The balance of substances in traditional
herbal medicines is fundamental to their efficacy. Indigenous cultural
wisdom of herbal preparations and their effects is much more advanced
than the models of pharmacologic action that modern science has been
able to define. Balanced herbal prescriptions can create effects not
achievable with drug management. Nutraceuticals are a growing part of the animal nutrition industry. Scientific evidence of the efficacy of nutraceuticals lags behind popular use and anecdotal information. All of the data relating to the effectiveness and possible dangers of these substances must be taken into consideration when using individual or combinations of products. CONCLUSION In many situations, good veterinary treatment may involve multiple modalities, including surgery and drug therapy from conventional Western technology, along with complementary techniques to provide more complete and supportive care. This approach often outperforms other methodologies. Once the signs and symptoms have been treated, the health care is not complete until the underlying disease patterns have been reprogrammed. Often through complementary care, both the client and the practitioner, as well as the patient, will be directed to new levels of understanding, health and healing.
REFERENCES & RESOURCES American Veterinary Chiropractic Association: http://www.animalchiropractic.org/ Colorado State University College of Veterinary Medicine
& Biomedical Sciences, Department of Clinical Sciences, Complementary
and Alternative Veterinary Medicine International Veterinary Acupuncture Society: http://www.ivas.org/ The American Academy of Veterinary Acupuncture:
http://www.aava.org/ The Veterinary Acupuncture Page: http://users.med.auth.gr/~karanik/english/veter.htm D'Al School of Equine Massage Therapy: http://www.serix.com/~darcyinc/equine.htm Steiss JE. Magnetic Field Therapy: Theory and Application
Principles, in Proceedings. 1st International Symposium on Rehabilitation
and Physical Therapy in Veterinary Medicine 1999;51-53. MacLeod G. The Treatment of Horses by Homœopathy.
London: Eastern Press Ltd., 1977. Castro M. The Complete Homeopathy Handbook. New York:
St. Martin's Press,1990. The Nutraceutical Alliance: http://www.nutraceuticalalliance.com
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