Traditional Chinese Veterinary Medicine and Integrative Care
Tamara Shearer, MS, DVM, CCRP, CVPP, CVA, CHPV, CTPEP, (left) and her assistant perform acupuncture on a dog as the owner (right) looks on.
Essential for Hospice and Palliative Care Patients
by Tamara Shearer MS, DVM, CCRP, CVPP, CVA, CHPV, CTPEP
By utilizing integrative care methods, the veterinarian’s ability to relieve suffering and improve quality of life for hospice and palliative care patients has never been more powerful. Integrative care is not only paramount for patients that have complicated conditions with multiple comorbidities, but it also helps to support the caregivers during this important time in their lives. Even though integrative care plays an especially important role in hospice and palliative care, it should be considered for all patients.
According to the Academic Consortium for Integrative Medicine: “Integrative medicine and health reaffirms the importance of the relationship between the practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic and lifestyle approaches, healthcare, and disciplines to achieve optimal health and healing.” This comprehensive definition also applies to veterinary medicine patients and caregivers.
Example of early veterinary integrative care;
“Jigg’s” November 20, 1923.
As prominent human hospitals like Johns Hopkins, the Mayo Clinic, the Cleveland Clinic, and the MD Anderson Center promote the use of integrative care, more pet owners are seeking integrative care for their pets because of good experiences that they have had for themselves or their human family members. In the past 10 years, more veterinarians are also utilizing the formal concept of integrative care in their practices even though some veterinarians and cultures have been applying the principles of these disciplines for decades. If we look closely, we can find this evidence documented in vintage photographs and in the ancient practice of Traditional Chinese Veterinary Medicine (TCVM).
Role in Hospice and Palliative Care
Integrative care plays a more important role for hospice and palliative care cases because these patients are often fragile and the human-animal bond is being challenged. Patients are often placed in a hospice or palliative care program because of a serious condition, a poor prognosis, or the side effects of the therapy outweighing the benefits.
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Pet owners are desperate to seek help when curative treatment has failed, when symptoms of a chronic illness interfere with the routine of the pet, or when progressive illnesses have health complications associated with them. Often, disease processes interfere with relationships, resulting in decreased social interactions and diminished physical activities.
This is a time where caring for the human-animal bond is essential. Integrative care provides multiple benefits, especially for these patients (see sidebar). It allows for alternative choices for patients that cannot tolerate conventional care. It may decrease the amount and frequency or even eliminate the need of prescribed medications that have unwanted side effects. In many cases, it manages or decreases pain and slows the progression of disease processes. Integrative care may also provide a faster and better recovery from surgeries or traumas and allow the patient to reclaim the activities of daily living. Ultimately, most integrative choices have a low risk of side effects when provided properly, and many options allow the pet owner to participate in the care of their pet.
Lastly, it benefits the veterinarian by giving them peace of mind in knowing that they are doing everything possible to support their patient.
Examples of integrative care modalities include manual therapies like massage, chiropractic care, joint mobilization, and therapeutic exercise. Therapeutic modalities include the use of thermal mediums, laser therapy, therapeutic ultrasound, transcutaneous electrostimulation, extracorporeal shockwave therapy, pulsed electromagnetic therapy, and hydrotherapy. Food therapy, nutraceuticals, regenerative stem cell therapy, and platelet-rich plasma therapy are also considered part of integrative care.
Traditional Chinese Veterinary Medicine
One of the most misunderstood, overlooked, and underutilized of the therapies is TCVM. TCVM is an extension of Traditional Chinese Medicine (TCM), which is used to treat humans. What makes TCVM unique is that it has been integrative for more than 2,000 years, meeting the comprehensive needs of not only the individual patient but also the caregiver. This philosophy of care plays an especially important role when caring for hospice and palliative care patients. While some find the TCVM approach to problem-solving unconventional, it is often helpful in providing care for hospice and palliative care patients because it oers a creative and new perspective on evaluating and caring for the individual, not just the disease process.
Belle receiving electroacupuncture therapy.
There are four branches of TCVM that make it integrative in its own right. The four branches are acupuncture, herbal medicine, Tui-na (a form of therapeutic massage), and food therapy. A fifth branch in human TCM includes Qigong, a form of self-care involving movement and breathing techniques. The two most popular branches of TCVM are acupuncture and herbal therapy.
Based on clinical trials, the World Health Organization has approved the use of acupuncture for more than 40 conditions in humans. Those conditions include, but are not limited to, relief from various forms of pain, nausea, vomiting, hypertension, stroke, leukopenia, and gastritis. A few examples of evidence-based veterinary research include the following clinical studies.
Turner-Knarr (2018) demonstrated how stimulation of acupoint Liver-3 lowers the anesthetic requirement for dogs undergoing orchiectomies. Personally, I have used that technique to lower the anesthetic requirements for pets undergoing surgery, which is especially beneficial for high-risk patients.
Studies document the importance of integrating acupuncture into a palliative treatment protocol for patients with intervertebral disk disease (IVDD). When treating IVDD, electroacupuncture combined with standard Western medical treatment was eective and resulted in a shorter time to recover ambulation and deep pain perception than did treatment without electroacupuncture. In 2010, Joaquim’s study on longstanding, severe neurological deficits associated with thoracolumbar IVDD documented that electroacupuncture was more eective than decompressive surgery for recovery of ambulation and improvement of neurologic deficits.
Belle, a 13-year-old dachshund with acute-onset IVDD with rear limb paralysis and no deep pain perception, presented to Smoky Mountain Integrative Veterinary Clinic for palliative care after a surgical option was discouraged by a neurologist and surgeon because of a grim prognosis. She was managed medically with conventional medications and received acupuncture, herbal formulas, and pulsed electromagnetic therapy (Assisi LOOP). Belle regained the ability to ambulate unassisted with minimal ataxia in five weeks.
The second most popular TCVM branch, herbal therapy, has a long history of being practiced in China for both humans and animals. During that time, many herbal formulas have been widely studied, with documentation of the pharmaceutical benefits, indications, and contraindications. For example, when searching PubMed for the keyword “astragalus” (a common Chinese herb), there are more than 10,000 references describing its uses, which range from anti-inflammatory to immunostimulatory. One example of a veterinary research study was conducted in 2016 by Jiu Wen, DVM, et al., where 181 dogs with complete cranial cruciate ligament rupture received a Chinese herbal formula. The study demonstrated that this formula helped to resolve pain and lameness and was a safe and eective alternative for individuals that could not have surgery for various reasons.
The other branches of TCVM also play an important role in supporting end-of-life and palliative care patients. Chinese food therapy addresses the nutritional needs of an individual animal based on their specific disease pattern and uses food as a therapy to treat disease. It is especially useful for patients that are dicult to medicate but still maintain an appetite.
Tui-na is a form of manual therapy and massage guided by TCVM theory to treat and prevent various disease processes. Utilizing its gentle techniques, it is ideal for geriatric patients to treat various clinical signs like weakness, stiness, sleep disorders, and neurodegenerative disorders. Tui-na techniques can also be taught to pet owners to help care for their pets at home.
Qigong is a form of self-care that is practiced by humans for relaxation, exercise, self-healing, and training for the martial arts. When providing hospice and palliative care, it is imperative for the practitioner to take good care of their mental and physical health so they can provide good care to their patients. Qigong can be an excellent practice for caregivers to consider as a self-care measure.
Palliative care patient, Leroy, an eight-year- old English hound with polyradiculoneuritis
receiving integrative care (assisted standing and hydrotherapy) to support his recovery.
Besides TCVM, other simple techniques can be utilized for profound results. Consider these five straightforward tools: • Cold therapy can be used as a local analgesic for acute inflammation • Warm moist heat can improve circulation and relax muscles • Passive range of motion for debilitated patients can prevent muscle contractures and improve circulation • Assisted standing can prevent the side effects of disuse like decubital ulcers for debilitated patients • Modifying feeding practices and the use of nutraceuticals should not be overlooked as a patient’s health changes
Introducing any type of evidence-based integrative care into an existing practice can be accomplished by exploring continuing education in specific areas of interest. It is recommended by this author to add a new integrative skill set to an existing practice every two years. Ultimately, the latest information on integrative trends will not only improve the caliber of medicine practiced but also boost confidence and support job satisfaction.
Integrative care not only elevates the degree of care for patients but also supports the relationship between the practitioner and pet owner. Combining modern medical advancements with integrative care gives veterinarians more options to treat the clinical signs of disease, which allows the profession to preserve a longer quality of life in pets struggling with aging and chronic and life-limiting illnesses. It is important to explore all potential therapies to ensure that the pet is comfortable up until the time that the pet dies naturally, there is a hospice-assisted death, or the need for euthanasia is determined with the help of the professional support team and family.
Tamara Shearer MS, DVM, CCRP, CVPP, CVA, CHPV, CTPEP, is owner of Smoky Mountain Integrative Veterinary Clinic in Sylva, North Carolina. Shearer is internationally renowned for her work in animal hospice and palliative care and is one of the leading veterinarians in the world in the fields of hospice, palliative care, and pain management.
Photo credits: Photos courtesy of Tamara Shearer