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A Journey to Integrative Veterinary Medicine
We all have a journey in life, and as veterinarians. My journey has taken me on some unexpected twists and turns; has yours? I decided I wanted to become a veterinarian at 4 years old. Being from Philadelphia, my dream was to go to the University of Penns... moreWe all have a journey in life, and as veterinarians. My journey has taken me on some unexpected twists and turns; has yours? I decided I wanted to become a veterinarian at 4 years old. Being from Philadelphia, my dream was to go to the University of Pennsylvania School of Veterinary Medicine, which I did.
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Integrative Veterinary Hospice and Palliative Care
Hospice and Palliative care is focused on improving and maintaining quality of life for both the pet and their family. This goal is often accomplished by using conventional pharmaceuticals, which can be very effective but may also have side effects or con... moreHospice and Palliative care is focused on improving and maintaining quality of life for both the pet and their family. This goal is often accomplished by using conventional pharmaceuticals, which can be very effective but may also have side effects or concerns about use in specific patients. Hospice and palliative care may be greatly enhanced by the use of integrative options such as acupuncture, herbal medicine, and essential oils, as well as physical modalities (chiropractic medicine, physical rehabilitation, massage, etc) in proving relief from the common conditions seen in the hospice and palliative care population. less
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Veterinary Medical Ozone Therapy
Veterinary medical ozone therapy, a key component of integrative veterinary medicine, leverages advanced oxygenation techniques and natural immune-modulating effects to treat a broad range of clinical conditions in small, large and exotic animals. This ar... moreVeterinary medical ozone therapy, a key component of integrative veterinary medicine, leverages advanced oxygenation techniques and natural immune-modulating effects to treat a broad range of clinical conditions in small, large and exotic animals. This article explores the mechanisms of action, clinical applications, safety considerations, and integration of medical ozone therapy with conventional and complementary treatments, providing veterinary professionals with a practical and comprehensive resource. With the growing challenge of antimicrobial resistance posing significant public health concerns, the role of medical ozone therapy has become increasingly vital. less
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Appendix: Resources
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Animal Chiropractic
Properly applied animal chiropractic (AC) can be safe and effective. Only licensed health care professionals who have completed extensive postgraduate training should offer AC. By providing AC, veterinarians can help their patients achieve the highest lev... moreProperly applied animal chiropractic (AC) can be safe and effective. Only licensed health care professionals who have completed extensive postgraduate training should offer AC. By providing AC, veterinarians can help their patients achieve the highest level of function, independence, and quality of life possible. In this article, we have described AC as a valuable modality that, by improving afferent input and positive modulation of the ventral horn cells and their efferent motor neurons, can positively affect patient strength, stability, and mobility. Therefore, improved conditioning, performance, and postoperative recoveries can enhance patient outcomes by including AC in veterinary practice. less
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Nutraceuticals
Nutraceuticals are inexpensive, low-cost additions to conventional treatments for chronic disease. A large number of owners who use integrative veterinary medicine for their pets include nutraceuticals for their pets. Research is not robust, often in vitr... moreNutraceuticals are inexpensive, low-cost additions to conventional treatments for chronic disease. A large number of owners who use integrative veterinary medicine for their pets include nutraceuticals for their pets. Research is not robust, often in vitro, and clinical trials are usually based on humans. Even so, the information is useful. As a general rule, use natural forms, and it is often best to use them in the same combinations found in nature. Use strong antioxidants in groups, not singly. To use research as a guide, be sure the dose is reasonable and given for a reasonable amount of time. less
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Classical Homeopathy
Homeopathy is a system of medicine based on the principle of “Let likes be cured by likes”, with determination of the appropriate medicine based on the patient’s unique presentation rather than a diagnostic name. The actions of the medicines are elucidate... moreHomeopathy is a system of medicine based on the principle of “Let likes be cured by likes”, with determination of the appropriate medicine based on the patient’s unique presentation rather than a diagnostic name. The actions of the medicines are elucidated by testing (provings). The medicines are prepared in by the process of “potentization,” resulting in low doses, often containing only nanoparticles, which elicit profound effects in patients. Both acute and chronic diseases can be cured with homeopathy.
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Clinical Application of Chinese Herbal Medicine in Small Animal Practice
Rooted in over 4000 years of empirical knowledge and systematic documentation, Chinese herbal medicine (CHM) has evolved into a sophisticated therapeutic modality for managing various medical conditions. This article explores the clinical application of C... moreRooted in over 4000 years of empirical knowledge and systematic documentation, Chinese herbal medicine (CHM) has evolved into a sophisticated therapeutic modality for managing various medical conditions. This article explores the clinical application of CHM in small animal practice, emphasizing its unique diagnostic framework of pattern diagnosis. Key examples of CHM’s clinical applications are discussed, including treatments for hemorrhage, neoplasia, intervertebral disc disease, idiopathic epilepsy, pain, behavioral disorders, inflammatory bowel disease, cough, chronic kidney disease, urinary tract infections, and hyperadrenocorticism. The history, scientific validation, and general dosage and usage of CHM are also discussed. less
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Western Botanical Medicine for Small Animals
The principles of veterinary botanical medicine emphasize addressing the root causes of illness, supporting physiologic processes, and utilizing whole herbs rather than isolated constituents for a holistic approach. Herb-drug interactions are a key consid... moreThe principles of veterinary botanical medicine emphasize addressing the root causes of illness, supporting physiologic processes, and utilizing whole herbs rather than isolated constituents for a holistic approach. Herb-drug interactions are a key consideration, as they can either enhance therapeutic outcomes or alter drug efficacy and safety. Backed by a growing evidence base, veterinary botanical medicine demonstrates the multi-targeted and rational use of botanicals to support a wide range of conditions in small animals. less
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The Rise of Fresh Foods
Commercial data show that use of raw and fresh-cooked foods is on the rise. Raw diets have been around since the 1990s, and cooked frozen foods were first introduced around 2010. Part of the support put forward by veterinarians to discourage use of these ... moreCommercial data show that use of raw and fresh-cooked foods is on the rise. Raw diets have been around since the 1990s, and cooked frozen foods were first introduced around 2010. Part of the support put forward by veterinarians to discourage use of these foods is the lack of supporting evidence. However, there are clear biochemical differences between minimally processed and ultraprocessed foods such as extruded kibble and canned diets. And indeed, there is evidence to suggest that feeding fresh diets leads to different physiologic responses. It is incumbent on veterinarians to improve their conversations with interested pet owners. less
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Current Practices and Considerations in Therapeutic Farriery for Equine Tendon and Ligament Injuries
The overall objective of therapeutic farriery for equine tendon and ligament injuries is to provide a biomechanical environment conducive to healing by limiting excessive strain on the injured structure. With an understanding of equine limb anatomy and th... moreThe overall objective of therapeutic farriery for equine tendon and ligament injuries is to provide a biomechanical environment conducive to healing by limiting excessive strain on the injured structure. With an understanding of equine limb anatomy and the pathophysiology of tendon/ligament injuries, the rationale used in therapeutic farriery for soft tissue injuries of the distal limb is quite logical. Through therapeutic farriery, foot manipulation is used to reduce the tension on the injured tendon(s) or ligament(s). less
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Diagnosis and Strategies for the Treatment of Infectious Equine Tendon and Ligament Disorders
Diagnostic and treatment strategies for infectious equine tendon and ligament disorders are continually evolving where recent progress is focused on advanced imaging and evidence supporting endoscopic lavage and regional antimicrobial therapy.
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Current and Emerging Quantitative Imaging Modalities for Diagnosing and Monitoring Equine Tendon and Ligament Injuries
Technological developments in imaging modalities have advanced the diagnostic capabilities for equine tendon and ligament injuries beyond the traditional methods. This review examines elastography techniques in ultrasonography that assess tissue stiffness... moreTechnological developments in imaging modalities have advanced the diagnostic capabilities for equine tendon and ligament injuries beyond the traditional methods. This review examines elastography techniques in ultrasonography that assess tissue stiffness and strain properties, computed tomography (CT) innovations including PET/CT fusion and dual-energy CT, and emerging applications of diffusion-weighted MRI for evaluating fiber microstructure and functionality. These complementary approaches offer veterinarians improved means to detect early injuries, assess structural integrity, monitor healing progression, and potentially predict functional outcomes of equine soft tissue injuries, addressing limitations of conventional imaging methods. less
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Guidelines for Formulating Rehabilitation Strategies for Equine Tendon and Ligament Injuries
Rehabilitation for tendon/ligament injury requires a multimodal approach to reduce pain, restore range of motion, improve proprioception/neuromotor control, and improve strength/endurance. Multiple tools are available to accomplish these goals. The rehabi... moreRehabilitation for tendon/ligament injury requires a multimodal approach to reduce pain, restore range of motion, improve proprioception/neuromotor control, and improve strength/endurance. Multiple tools are available to accomplish these goals. The rehabilitation program must be tailored to the individual patient regardless of injury type in order to return the horse to full athletic activity and reduce the risk of reinjury.
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Adjunct Therapies for Tendon/Ligament Healing
High-power laser therapy and extracorporeal shock wave therapy (ESWT) can be safely used to treat tendon and ligament injuries in horses, and the potential beneficial effects have been described. The power of low level lasers is not sufficient for treatme... moreHigh-power laser therapy and extracorporeal shock wave therapy (ESWT) can be safely used to treat tendon and ligament injuries in horses, and the potential beneficial effects have been described. The power of low level lasers is not sufficient for treatment of tendon and ligament injuries in horses. ESWT is used more often to treat tendon and ligament injuries than it is for any other type of condition in horses, but there is limited supporting scientific evidence. Further research should focus on establishing dosage and treatment protocols for both laser therapy and ESWT in horses with clinically relevant long-term follow-up. less
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Current and Emerging Biologic Therapies for Equine Tendon and Ligament Injuries
This review explores the use of biologics in the treatment of tendon and ligament injuries in horses, focusing on current and emerging therapies aimed at enhancing tissue repair and regeneration. It discusses the role of scaffold-based therapies, growth f... moreThis review explores the use of biologics in the treatment of tendon and ligament injuries in horses, focusing on current and emerging therapies aimed at enhancing tissue repair and regeneration. It discusses the role of scaffold-based therapies, growth factors, blood-derived and tissue-derived biologics, and gene therapy as biologic regenerative therapies for improving healing outcomes. The review evaluates the mechanisms, efficacy, and challenges of biologics in clinical applications, highlighting recent advances and clinical studies. It provides an overview of current trends and future directions for biologic therapies in equine musculoskeletal injuries. less
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Cellular and Matrix Dynamics of the Equine Tendon
Our understanding of tendon homeostasis and repair following injury has made great strides through basic science, clinical veterinary medicine, and preclinical translational research. We have now gleaned a greater understanding of the cellular and matrix ... moreOur understanding of tendon homeostasis and repair following injury has made great strides through basic science, clinical veterinary medicine, and preclinical translational research. We have now gleaned a greater understanding of the cellular and matrix dynamics that are being orchestrated within the tendon, which provide therapeutic opportunities. This article will focus on how utilizing the horse and equine tissues have advanced our understanding of tendinopathy and the cellular and matrix dynamics at play while also identifying continued gaps in our knowledge where the horse as a veterinary patient and preclinical model could advance our understanding of tendon biology. less
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Suspensory Ligament Injuries
The location of a suspensory ligament (SL) injury heavily influences the clinical presentation, prognosis, and treatment options. Diagnostic imaging is necessary to provide an accurate diagnosis and is critical to ensure the institution of the most approp... moreThe location of a suspensory ligament (SL) injury heavily influences the clinical presentation, prognosis, and treatment options. Diagnostic imaging is necessary to provide an accurate diagnosis and is critical to ensure the institution of the most appropriate treatment. The hindlimb proximal SL in particular can be challenging to diagnosis, carries a guarded prognosis, and typically requires aggressive treatment to achieve soundness.
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Diagnosis and Minimally Invasive Surgical Treatment for Enhancing Intrathecal/Intrasynovial Tendon Injuries
Intrathecal and intrasynovial tendon and ligament injuries can result in extrusion of tendon/ligament fibers, granuloma, and adhesion formation that not only impairs healing of the original injury but can create new injuries that negatively affect adequat... moreIntrathecal and intrasynovial tendon and ligament injuries can result in extrusion of tendon/ligament fibers, granuloma, and adhesion formation that not only impairs healing of the original injury but can create new injuries that negatively affect adequate healing and return to athletic work. In these cases, endoscopic evaluation and debridement, not only of the lesion, but also any other secondary injury present, can enhance the healing of the tendon or ligament and improve the athletic prognosis. Careful planning of the approach, positioning, instrumentation, and thorough knowledge of the anatomy are vital features that can enhance a successful outcome. less
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Techniques for Equine Tendon Tenorrhaphy
Equine tendon lacerations are not uncommon secondary to traumatic wounds and degloving lacerations. These wounds are often contaminated and, therefore, basic principles of wound assessment and management are critical to identify the extent of an injury. A... moreEquine tendon lacerations are not uncommon secondary to traumatic wounds and degloving lacerations. These wounds are often contaminated and, therefore, basic principles of wound assessment and management are critical to identify the extent of an injury. Ancillary tools to aid physical examination include radiography, ultrasonography, and synoviocentesis (eg, if involving a joint and/or tendon sheath). Prolonged convalescence period, continued external coaptation, and controlled exercise are mainstays of treatment following tenorrhaphy. A poor prognosis for return to full athletic function is expected following flexor tendon laceration. less
