Integrating alternative modalities into Western clinics (Proceedings)

Complementary and alternative medicine (CAM) is viewed by many veterinarians as an "us against them" proposition. In reality, an integrative approach combining conventional medicine and alternative modalities often yields the best results. Some CAM modalities such as Traditional Chinese Medicine have their own unique diagnostic methods which evaluate the body in a different manner, thereby providing veterinarians with an alternative way to view a disease or disease process. In some cases, Western medicine may not have an etiology or treatment for a particular problem while a CAM modality may be able identify, treat and even prevent the same problem.

Integrative medicine is a multidisciplinary approach to health care, utilizing Western medicine in conjunction with non-traditional medical modalities such as herbal remedies, Traditional Chinese Medicine, homeopathy, chiropractic, etc. According to the 2002 National Health Interview Survey conducted by the National Center for Complementary and Alternative Medicine (NCCAM), a component of the National Institutes of Heath, and the National Center for Health Statistics (part of the Centers for Disease Control and Prevention), 62% of American adults use some form of CAM including megavitamin therapy and prayer. A recent survey by AARP and NCCAM found that almost two-thirds of people 50 years or older are using some form of CAM. According to Dr. Lynn S. Peck, research associate in the Department of Materials Science and Engineering, University of Florida, a 1997 survey of animal owners revealed that 42% of animal owners utilized some form of CAM. Clearly, there is a demand for alternatives to Western medicine alone and veterinarians must recognize and accommodate this growing interest.

In most cases, conventional medicine and alternative modalities can be utilized together safely and effectively. Many CAM modalities focus on treating the root of the problem, not just the symptoms, and strive for prevention of future disease. In some instances, Western intervention is critical. However, follow-up care utilizing alternative modalities may improve recovery. Integrative medicine practitioners must still adhere to recognized standards of care and investigate the underlying problem and should stay current with the latest advances in Western medicine to ensure they are able to offer or recommend the best health care options possible.

Responsible integration of alternative modalities into a purely Western clinic requires educated decision-making. One must be aware of and consider American Veterinary Medical Association guidelines, national and state requirements and legal issues, the quality of education that is available, if certification exists and the validity of the modalities. Other selection criteria include personal experience with a modality, current popularity of and anticipated acceptance by clientele and local veterinarians of the selected CAM modality.

CAM education and training varies significantly in quality, quantity and philosophy. Two programs in the same field may vary wildly in material covered, requirements for passing the course and in receiving certification if any exists. Certification conveys credibility and promotes confidence in both the modality and certified practitioner, but does not necessarily guarantee or endorse competence in either the education received or ability of the practitioner. Investigation into the certification process, the required number of training hours, and what body or organization determines and awards the certification will enable you to better assess the validity of the certification. Additionally, requirements for practicing specific CAM modalities varies from state to state. In some states, non-veterinarians are allowed to perform some CAM therapies.

Each CAM modality should be evaluated cautiously and independently. Critical evaluation is often difficult due to the lack of double-blinded control studies and inaccessibility of studies due to publication in foreign journals and foreign languages, or in journals that are not included in the Medline data base. Additionally, some modalities do not lend themselves to the same experimental protocols that are applicable to Western medicine. Regardless, CAM therapies should be critically appraised prior to incorporation into the veterinary practice.

Once the decision has been made to integrate CAM modalities into the practice, staff members, colleagues and clientele must be educated about the therapies offered. Staff members must be "on board" and be able to discuss services offered in order to educate clients, arouse interest in and promote the new therapies. Colleagues in-house and in the local area need to be aware that alternative treatment options are available at your facility. Promotion at the clinic can easily be achieved by hanging posters or artwork that convey the new modalities practiced, hanging certifications that practitioners have earned in specific modalities, handing out informational brochures, and creating an alternative medicine corner with relevant books, magazines and newspaper articles. Tabletop water fountains, exotic plants and wind chimes will also add interest to an alternative medicine corner. Brochures or fliers announcing inclusion of CAM modalities at your clinic should be mailed to local veterinary clinics, veterinary colleges and schools that offer veterinary technician courses. The local media (newspaper, regional magazines, television stations) should also be made aware of the new services that are offered at your clinic. Lectures and demonstrations in the local community are an excellent way to promote CAM modalities and the services your clinic offers. Venues which should be considered include:

• Veterinary colleges and veterinary technician programs

o Course lecture

o Student club meetings/symposiums

• Local veterinary hospitals

• Local veterinary association meetings

• Fairs (Animal fairs, healing arts fairs, health fairs)

• Natural or Health food stores

• Pet product stores

• Other health-related businesses

• Clubs, organizations

o Dog clubs, cat fanciers, 4H

• Animal rescue facilities

o Local animal shelter, SPCA, Humane Society, etc.

o Wildlife rescue/rehabilitation centers

When offering CAM therapy to a client, you should also offer the Western medical standard of care. The client needs to have sufficient information with which to make an informed decision. You should discuss both CAM and Western diagnostics, treatment options available, prognosis, expected outcomes and potential risks and complications of each of the offered therapies. In addition, be sure to discuss the goals of the treatment with the owner. Is the condition likely to be cured or prevented with Western medicine or CAM, or is palliative care a more realistic goal?

Certain CAM modalities do not work as quickly as Western medicine. It is important that the owner knows what to expect in terms of clinical outcome (signs, resolution of condition) as well as the timeline of the expected response. You should discuss the financial impact that choosing Western or CAM modalities may impose upon the client. Some pet insurance companies cover specific CAM modalities. If the owner has pet insurance, make sure they know what is or is not covered by their company.

Once the owner has decided the method of treatment desired, discuss the pros and cons of the chosen treatment plan. Make sure to discuss and document the prognosis if treated with each different modality, integrative treatment or no treatment at all. The record should also include which treatment options were offered or discussed and that the client has made an informed decision. Some practitioners have the client complete a "written waiver" acknowledging the fact that CAM modalities are not "standard of care" and that they have been informed of the risks and benefits of electing such treatment.

Informed consent is a key issue in human medicine and is fast becoming a concern in the veterinary field. Be aware of current legislation and make sure that you know of laws concerning the use of CAM modalities in your state.

If veterinarians do not wish to offer these modalities to clients, it is critical that they are aware of and knowledgeable about CAM modalities in order to be able to advise their clients about the best available treatment options. Familiarity with the principles of CAM therapies, scientific rationale behind treatment protocols, indications, contraindications, potential risks, and procedures/products/medicines utilized should be part of this knowledge base.

Complementary and Alternative Veterinary Medicine Associations

American Holistic Veterinary Medicine Association (www.AHVMA.org)

Academy of Veterinary Homeopathy (www.theavh.org)

American Association of Traditional Chinese Veterinary Medicine

American Veterinary Chiropractic Association (www.animalchiropractic.org)

American Academy of Veterinary Acupuncture (www.aava.org)

The International Veterinary Acupuncture Society (www.ivas.org)

Veterinary Botanical Medicine Association (www.vbma.org)