See the Full Issue
November 2024
Better Health and Joyful Connections for Senior Pets
Common challenges facing senior pets include reduced mobility, chronic pain, organ pathology, cognitive decline, hearing and vision loss, dental disease, metabolic disease, reduced immunity, obesity, and cancer. When it comes to treating senior pets, an integrative approach that includes some complementary therapies just makes sense.
Including Complementary and Alternative Medicine in Your Practice
Here is a question for you: What exactly is complementary and alternative veterinary medicine (CAVM) and why should we be considering it? Simply put, complementary and alternative treatments are any treatments that are not part of a standard medical treatment plan. This is admittedly a vague definition. There are entire professional colleges of boarded experts for nutrition and for sports medicine, yet these are not always parts of a “standard medical treatment plan.” Rather than trying to categorize various treatments and approaches as “CAVM” or “standard,” I prefer to take an “integrative” approach. Integrative medicine includes as many varied treatment options as are available and appropriate to the individual case, whether they are “standard” or not.
As animals age, they tend to accumulate more medical problems, many of which cannot be cured. Instead, they require long-term management. These accumulated conditions present challenges to treatment. For instance, animals with kidney disease, heart disease, and dental disease are enough to give most veterinarians anxiety. It would be nice to have more treatment options for dental disease or heart disease that do not place strain on the kidneys, for example. When we expand our treatment options and consider more integrative treatment plans, we can improve the overall wellbeing of animals, support the human-animal bond, reduce side effects, and improve the caregiver experience. The most common challenges facing senior pets include reduced mobility, chronic pain, organ pathology (heart, liver, kidney), cognitive decline, hearing and vision loss, dental disease, metabolic disease, reduced immunity, obesity, and cancer. Alongside pharmaceuticals and standard medical procedures, we can include a whole variety of other therapies including diet, supplements, energy modalities, body work, and social-emotional support as part of our treatment plans. When it comes to senior pets, an integrative approach that includes some complementary therapies just makes sense.
What Complementary and Alternative Modalities Should We Consider?
Diet Therapy
Senior pets may or may not require a prescription diet. If there is a diagnosis such as kidney disease or atopic dermatitis, then the need to modify diet is clear. However, even apparently healthy aging animals may benefit from diet changes. As bodies age, protein needs increase to maintain muscle mass. Digestion is often less robust, making nutrient bioavailability, digestibility, and modified fiber content more important. Metabolism may change, necessitating a change in total calorie intake. Metabolism and disease processes can also affect appetite, resulting in a need for improved palatability.
Complementary and alternative diet options often include fresh whole food ingredients, either as a portion or as the whole diet. Recipes may be based on traditional Chinese medicine theory, Ayurvedic principles, or other feeding models such as “biologically appropriate.” No matter the underlying theory, diets should always be “complete and balanced” and free of food-borne pathogens.
Commercial options are more available now than ever before, making fresh-food diets more accessible to consumers. Clients may also be interested in preparing a homemade diet. It is important for these clients to work with a veterinary nutritionist, use a premade recipe from a veterinary nutritionist, or use a software program such as BalanceIt or Animal Diet Formulator to ensure nutrient deficits are avoided.
Supplements
There seems to be a new supplement on the market for pets every week. However, all supplements are not created equal. Consumer advocacy groups have repeatedly tested popular supplements, only to reveal they do not contain what they claim and may even contain hazardous substances such as heavy metals, pharmaceuticals, or allergens.
Supplements have varying levels of research behind them, ranging from virtually nothing beyond anecdotal theory to peer-reviewed meta-analysis equal to pharmaceuticals. Sometimes there is research on an ingredient, but not the specific product being sold. Manufacturing, shipping, sourcing, and dosing can all vary and impact efficacy and safety, even when ingredients appear to be the same.
That said, supplements are being used in senior pets, mostly without input from their veterinarians. They are widely available and well marketed. It is unclear what percentage of senior pets use supplements at some time, but it is likely a majority.
Supplements such as antioxidants, omega-3 EFA, probiotics, fiber, and curcumin have robust clinical research to support their use in improving both wellbeing and longevity. They can reduce the need for pharmaceutical medications, with lower incidence and severity of side effects.
Prioritize companies that have tested their own specific products for both safety and efficacy. It is rare to find independently funded research on specific products, but if you find it, that is the gold standard. Otherwise, go with companies that have internal quality control standards such as batch testing for contaminants and careful sourcing of ingredients.
Supplements have varying levels of research behind them, ranging from virtually nothing beyond anecdotal theory to peer-reviewed meta-analysis equal to pharmaceuticals.
Energy Modalities
Energy modalities utilize energy forms such as light, sound, and electromagnetic waves to create a biological effect on tissues. These therapies have measurable results that can be recreated in clinical and laboratory settings. This category does not include things like reiki, prayer, crystals, etc.
Photobiomodulation (PBM, or laser therapy) is probably the most popular energy modality in veterinary medicine right now. PBM uses focused light waves to penetrate cells, causing an energy transfer, ultimately improving cell function, reducing inflammation, and improving healing. There are some low-level direct-to-consumer products that offer some therapeutic benefit. However, the most significant benefits demonstrated in peer-reviewed research come from medical-grade units for use by professionals.
A newer therapeutic option in veterinary medicine is therapeutic pulsed electromagnetic field therapy (tPEMF). These are wavelengths of electromagnetic fields different from those generally emitted by our phones and personal electronic devices. They have been studied for therapeutic effects including reduced inflammation, improved tissue healing, improved cell function, calming effects, and more. There are several companies currently selling devices designed for ease of use in a home setting. Some of these wavelengths have been researched and approved by the FDA for humans, whereas others have internal company clinical trials demonstrating safety and efficacy.
Transcutaneous electrical nerve stimulation (TENS) is another modality that uses electrical currents to influence muscle and nerve function. It can interrupt pain signals at some settings and cause muscle contraction at higher levels. This is used exclusively by therapists in a clinical setting.
Therapeutic ultrasound uses sound waves at ultrasonic frequencies different from those used in diagnostic ultrasound. These sound waves transfer energy to tissues through vibration, resulting in tissue heating, softening, and alteration of pain signaling. This modality is also used exclusively in a clinical setting.
Shockwave, also known as extracorporeal shockwave therapy (ESWT), utilizes percussive sound waves to deliver energy to tissues to trigger a biochemical response from cells, reducing pain and stimulating a healing response.
Therapeutic movement can improve independent mobility, reduce pain, support cognition, support nerve signaling, reduce stress, and even improve behavior.
Body Work
Movement is a bedrock of health. All animals need to move frequently and in a variety of ways. Therapeutic movement can improve independent mobility, reduce pain, support cognition, support nerve signaling, reduce stress, and even improve behavior. There is also robust literature supporting the use of therapeutic exercise in dogs. Therapeutic exercise programs need to be created by veterinary professionals for individual patients. Once they are created and taught, they can often be done by caregivers in the home setting.
Massage is simple and effective. It can be performed by clients on their own pets at home with minimal training. It is most known for reducing muscle tension to relieve pain, but massage can also support sensory and motor nerve signaling. There is high-level meta-analysis supporting the safety and efficacy of massage. Some professionals are trained in models emphasizing specific anatomy-based soft-tissue manipulation techniques, whereas others are trained in the traditional Chinese medicine style of massage, or Ayurvedic (Traditional Medicine of the Indian subcontinent) massage techniques.
Acupuncture may be the most recognized complementary modality in veterinary medicine. Animal acupuncture has been a mainstay of the CAVM approach for decades, with several well-respected training programs and thousands of practitioners.
There is research supporting its use for back pain and IVDD, hind end weakness, and joint pain. Additionally, it has wider ranging effects on metabolism, internal organ function, and overall vitality through its effects on the neuroendocrine systems of the body. There are veterinarians trained in more western scientific forms of acupuncture as well as those trained in the traditional Chinese medicine approach to whole animal health.
Veterinary spinal manipulation therapy (VSMT) is also referred to as animal/veterinary chiropractic, depending on local practice and licensing acts. This modality involves focused manipulation of joints, usually along the spine, but can include any joint in the body. The effect is reduced muscle tension, allowing return to full range of motion through the joint. This results in improved comfort and mobility, as well as improved nerve communication and circulation through the area. VSMT should only be performed by professionals who have undergone veterinary education as well as spinal manipulation education.
Social-Emotional Support
There is one final area of integrative medicine that is under-represented in veterinary medical literature: mental health. As our pets age, they become less capable of participating in many activities that once provided joy and purpose. By creating opportunities for enrichment and connection, we can quickly and dramatically improve wellbeing. Puzzle toys and feeders, scent work and seeking, going new places, learning new skills, and more keep life interesting and keep the mind engaged. Trainers can help clients learn to communicate with their companions, so the human-animal bond remains strong.
Animals can develop cognitive decline or vision and hearing loss and may need environmental and emotional support to reduce anxiety and depression associated with this experience. Veterinary behaviorists can be especially helpful in developing plans to support these pets.
Professionals such as veterinary social workers or pet grief counselors support human caretakers as they navigate end-of-life medical decision-making and adjust to life with an aging pet. There is some research demonstrating that this kind of support can improve quality of life for animals, caregivers, and veterinary staff.
Any method that supports the human-animal bond supports animal wellbeing, even if it is not a scientifically validated medical therapy. Energy work falls into this area. Energy workers and animal communicators can provide unique services for clients seeking a more spiritual/energetic connection with their senior pets. This type of energy work is different from the scientific forms listed above. In this sense, energy work includes reiki, prayers, gems and crystals, and more. If it feels uncomfortable to bring up these modalities in a clinical setting, veterinary team members can refer to veterinary social workers, grief counselors, or pet health coaches.
Consider creating a list of local professionals who support the human-animal bond and provide this resource to clients facing complex or end-of-life decisions.
Integrative Medicine Is Something We Can All Do
Integrative treatment plans improve outcomes, reduce side effects, offer more options for managing chronic conditions, improve quality of life for animals and humans, and support the human-animal bond. Some things can easily be
incorporated in a general practice setting with all senior pets, such as discussion around invisible signs of pain in dogs, mobility support, environmental enrichment, therapeutic commercial diets, supplements like omega 3s and antioxidants, and anxiety or cognition screening and treatment.
Other modalities can be referred to veterinarians with additional training such as rehabilitation, acupuncture, spinal manipulation, massage, herbal medicine, diet therapy, and animal behavior. We can also include animal professionals outside of the medical space for truly holistic social-emotional support plans, including counselors, coaches, trainers, and energy workers.
Our senior pets can live comfortable, joyful lives when supported by an integrative approach to health.
Photo credits: iStock / Getty Images Plus; Photos courtesy of Emily Yunker
Online Resources
The following links contain helpful information about complementary and alternative medicine (CAM)
cancer.gov/about-cancer/treatment/cam
ncbi.nlm.nih.gov/pmc/articles/PMC7074215
ahvma.org/what-is-holistic-veterinary-medicine/
cliniciansbrief.com/article/top-5-points-incorporating-complementary-integrative-medicine-practice