The Whole Picture

When Casara Andre, DVM, CVMA, needed to rearrange her home so she could incorporate a recording studio, her cat Cali became so nervous that she stopped eating and experienced an acute renal episode. 

Cali recovered, but Dr. Andre wanted to help her better handle potentially stressful situations in the future. As the founder and director of Denver-based Veterinary Cannabis Education & Consulting, Dr. Andre decided to combine cannabis with training. 

“So the next time I need to rearrange my house, she’ll go back to that training and realize that yes, the couch moved, and yes, she’s still OK,” says Dr. Andre. “That’s what’s going to help keep her healthy for the long-term.”

Dr. Andre has embraced cannabis and other alternative treatments for years, but not all veterinarians are as comfortable implementing integrative medicine techniques in their practice. 

“It’s not so much a question about thinking outside the box; it’s really about realizing that there’s more than one box,” says Gary Richter, DVM, owner and medical director of Holistic Veterinary Care in Oakland, California. “It’s about legitimate medical science that maybe just isn’t the mainstream. If my job is to take the best possible care of my patients, then I need to know what the best possible treatments are.”

Here are three reasons you should embrace integrative medicine in your practice.

Everyone Is Dealing With Increased Stress

The past year has been difficult for nearly everyone, including pets, pet owners and veterinary practitioners. We’ve all faced the need to adapt to different scenarios quickly. While humans have faced the obvious challenges, including schedule changes, reduced or lost income, health difficulties, postponed events and more, these challenges have also affected pets. 

“Maybe a pet owner is suddenly home all the time and they’re really stressed, or maybe a pet was just adopted or relinquished to a shelter. We’re seeing really dramatic cuts in our normalcy, and everyone’s nervous system is facing chaos,” Dr. Andre says. “We’re all going on the sympathetic up, up, up, but there’s no process to bring it down into parasympathetic.”

Dr. Andre says sedation or opioids can help temporarily. “But cannabis, in particular, gives us some really beautiful ways to address this because of how the different molecules work on the endocannabinoid system that all mammals have,” she explains.

The endocannabinoid system (ECS) is designed to help a mammal adjust to a new circumstance because it works to regulate homeostasis, or balance within the body.¹ When a mammal is facing a stressor, it’s the ECS that will work to regulate and calm them. And, according to Dr. Andre, cannabis affects the ECS, and its compounds — including cannabidiol (CBD),
cannabinol (CBN), cannabigerol (CBG), tetrahydrocannabinol (THC) and others — can be used to help a mammal adapt to something that has dramatically changed in their everyday environment. 

“Cannabis is not a quick fix. It’s about long-term balance and health,” Dr. Andre says. “It’s important to recognize early on that if you need Western-based medicine, if you need a pharmaceutical, use a pharmaceutical. But if you want something that gives you more openings and avenues, cannabis opens a lot of doors, simply because there are a lot of molecules that work in different ways. It’s working on this system that’s really taking a toll lately.”

In 2020, Drs. Andre and Richter were two of the founding members of the Veterinary Cannabis Society, a nonprofit aiming to educate veterinarians and pet owners, as well as promote common sense veterinary cannabis legislation and regulation. 

“There is a lot of research out there indicating the medical benefits of cannabis. There’s even a growing body of research that is veterinary-specific to show the medical benefits of cannabis,” says Dr. Richter, who speaks with his clients about cannabis regularly. “A lot of veterinary professionals are hesitant to start talking to people about it, partially because of concerns about legal issues and partially because of a lack of understanding what to tell people.”

Even practitioners who are uncomfortable talking about cannabis with clients should have an understanding about the ECS, says Dr. Andre. “Every mammal has an ECS, and learning about the ECS is every practitioner’s responsibility and obligation,” Dr. Andre explains. “But then whether you want to work with cannabis is your choice.” 

Dr. Richter thinks industry organizations have been slow to adapt. “The reality is that you can buy cannabis products for animals in every pet store, in every gas station, on every corner in the country. Pet owners are buying these things and giving them to their pets without any direction because their veterinarians are saying, ‘I don’t know’ or ‘I’m not allowed to talk to you about it,’ and that’s a really big problem,” he says. “The federal government is going to legalize medical cannabis. It’s an inevitability. And it sure would be nice if the veterinary profession was not caught flat-footed when that happens.”

You Are What You Eat

Clients who look to take a more proactive role in their pet’s health are increasingly interested in the role nutrition and supplements play. The only problem is that they may not seek counsel from their veterinary healthcare team first. That’s why it’s important to open the conversation about each patient’s diet and the possible benefit of dietary supplements. 

“A lot of the issues coming up right now are related to pet food. Are grain-free diets bad? What about raw food? There’s a lot of conflicting information out there, both from the perspective of the pet food industry and from the perspective of the veterinary profession,” says Dr. Richter. 

Nutrition has long been a hot topic in veterinary medicine, and Dr. Richter says we’re looking at it the wrong way. 

“We all know from our own health that eating more fresh, whole foods and less highly processed food, the better off we are,” Dr. Richter said. That’s why Dr. Richter recommends fresh, whole foods to his clients — whether cooked, raw or freeze-dried — and he says these foods have improved the quality of life for many of his patients. There are many high-quality brands that have been balanced by qualified veterinary nutritionists.

Fresh, professionally balanced diets are increasing in popularity among pet owners, and these premium options are part of the driving force that is helping the pet food market grow in the U.S., according to market research company Packaged Facts. But it is also important to counsel clients on the importance of maintaining balanced diets, which can be skewed if the pet owner tries to take matters into their own hands and prepare the food at home.^2,3

Much like CBD supplements, other nutritional supplements and nutraceuticals are growing in interest among pet owners. Packaged Facts estimates retail sales of pet supplements in the U.S. to surpass $1 billion by 2025 after the market grew by 21% in 2020. This represents an opportunity for practitioners not only to grow their revenue but also to inform pet owners about the best course of action on a topic that is not cut and dried. Because regulatory oversight is lacking in veterinary supplements, even when compared with human dietary supplements,⁴ it’s important to consult the latest scientific research and recommend trusted brands. This research can go a long way in improving outcomes for your patients and trust from your clients.

“Integrating nutraceuticals as part of a multimodal treatment plan may provide a better management of the disease and improve outcomes, thus resulting in a better quality of life for our patients,” says Ronald Koh, DVM, MS, CVA, CVCH, CVFT, CCRP, CVMMP, and chief of the integrative medicine service at the UC Davis School of Veterinary Medicine. “Probiotics and prebiotics both are my go-to nutraceuticals for supporting digestion problems and gut health. Probiotics also have immunoregulatory effects, which show therapeutic potential for several immune response–related diseases, such as atopic dermatitis and allergies.”

Dr. Koh says that integrating supplements while using a multimodal approach to treatment can also increase the pet owners’ satisfaction. While there are many supplements and nutraceuticals on the market, Dr. Koh believes research supports the following:

• Omega-3 fatty acids and curcumin for pain and inflammation
• Perna canaliculus (green lipped mussel), UC-II and glucosamine/chondroitin for osteoarthritis, pain, inflammation and joint health
• Probiotics for digestion problems and gut health
• Coriolus versicolor mushroom for cancer and immunodeficiency
• Hawthorn and CoQ10 for heart health
• Rehmannia for kidney health
• Cranberry extract for urinary tract health

While any diet or supplement recommendation should be tailored to the specific patient’s situation and backed by scientific research, doing your homework and taking an active role in initiating these conversations with clients could lead to improved patient health, greater client satisfaction and growing revenue for your practice.

Aging Will Become a Curable Disease 

Western medicine is great at targeting a specific problem and treating it. But, according to Dr. Richter, regenerative medicine, and focusing on helping pets live longer, healthier lives, is the future of veterinary medicine. 

“There are things coming down the pike that will help to decrease a pet’s epigenetic age,” explains Dr. Richter. “The research has already been proven in people. What if the average dog could live to be 25 and be healthy and vibrant? There’s every reason to believe that aging as a disease can actually be cured in less time than you think.”

Regenerative medicine research in animals is ongoing, and Dr. Richter is working with physicians to help propel this research forward. He says that advances are being made quickly, and that the results will be a game-changer.

“This is literally going to turn veterinary medicine on its head,” he says.

SUCCESS STORY

With targeted pulsed electromagnetic field therapy, doctors can offer a device to clients that relieves pain at home.

The Problem

Robin Downing, DVM, MS, DAAPM, DACVSMR, CVPP, CCRP, practices integrative medicine as the owner of The Downing Center for Animal Pain Management in Windsor, Colorado. While she has seen the benefits of therapies such as acupuncture and laser in alleviating her patients’ pain, these modalities require visits to the veterinary hospital and a skilled practitioner to apply them.

For a long time, what was missing was a tool she could send home with her clients to use in between treatments for continued healing and pain relief. “Lasers at home? I don’t think so,” Dr. Downing says. Even massage therapy requires that clients be trained in specific techniques if their pets are going to experience meaningful benefits.

The Solution

Enter targeted pulsed electromagnetic field (tPEMF) therapy, a pain relief technology administered through a loop device the patient wears for a prescribed amount of time.
“At the moment this is the only science-driven technology employing a magnetic field that’s available to us,” Dr. Downing says. “There have been vigorous studies in humans on the use of this technology for pain relief and to determine its effect on the nervous system.” 

In one of these studies on the human side, Dr. Downing says, a tPEMF loop was integrated into the bandages of women who had undergone mastectomies, and the patients’ use of opiates and other pain-relieving drugs dropped dramatically. “There was less swelling and less pain,” Dr. Downing says. “It’s a technology
that has good science behind it.”

The Results

The nice thing about the tPEMF loop is that clients can use it at home, Dr. Downing says. She might prescribe it for daily use in between physical rehabilitation or acupuncture appointments. Or she might lease it to a client to use postoperatively for a short period to promote healing. For a patient with chronic osteoarthritis, she can sell it to a client with a specific protocol to follow. 

There are about 150 treatments built into each loop, with the loops programmed to perform for
15 minutes and then automatically shut off. “When I use it in my practice, I position it as something you can do every day that’s going to help your animal in between the times I see them,” Dr. Downing says.

Like anything else, tPEMF therapy is not a panacea, Dr. Downing says, “but from a pain perspective, it has been an extremely useful tool in my practice.”

By Kristi Fender