ALTERNATIVE VETERINARY MEDICINE : PARADIGM SHIFT IN VETERINARY CLINICAL PRACTICE WITH INTEGRATION OF COMPLEMENTARY AND ALTERNATIVE MEDICINE

ALTERNATIVE VETERINARY MEDICINE : PARADIGM SHIFT IN VETERINARY CLINICAL PRACTICE WITH INTEGRATION OF COMPLEMENTARY AND ALTERNATIVE MEDICINE

Dr. Ashwini. A¹., Dr. Shivakumar. V²., and Nagaratna³

 1 & 2. Assistant Professor, Department of Veterinary Medicine, Veterinary College Hassan

3. Final Year B.V.Sc & A.H.

The terms Complementary and Alternative (CAM) or Traditional Medicine (TM) describe practices and products that people choose as adjuncts to or as alternatives to Western medical (Allopathy) approaches. CAM and TM can be used interchangeably. According to World Health Organization (2002), “Traditional Medicine refers to health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being.” Further the terms ‘Complementary Medicine’ and ‘Alternative Medicine’ are used to refer to a broad set of healthcare practices that are not part of country’s own tradition, or not integrated into the dominant healthcare system. Even though Complementary and Alternative Veterinary Medicine is commonly used in Veterinary practice, there is limited knowledge of how the methods affect the animals. The term ‘alternative’ is described as other unconventional systems to conventional veterinary therapy which are traditionally accepted by veterinary faculties and universities and included in their curricula.

CLASSIFICATION OF HEALTH CARE SYSTEMS

1. CONVENTIONAL MEDICINE

Synonyms: Dominant, Orthodox, Western, Allopathic, Modern, Scientific or Technologic Medicine

Conventional medicine is the medicine prescribed with the use of diagnostic techniques and pharmaceutical/surgical interventions. The Conventional Medicine is the major health care system adopted across the globe which has got strengthened since a few decades by clinical research trials and evidence based medicine.

2. ALTERNATIVE MEDICINE:

Synonyms: Traditional, Unconventional, Uncommon, Natural or Native Medicine.

Alternative Medicine is the main stream of medicinal system characteristic to societies, cultures and nations. It has been practiced in their respective areas to fill the gap or to replace the modern medicine. The examples include:

• Indian Ayurvedic Medicine with use of herbs, yoga, meditation etc.
• Traditional Chinese Medicine with the use of Acupuncture, Qi gong, Tai Chi etc.
• Alternative Medicine of USA with the use of Chiropractic for osteopathy for manipulation of spine and joints using hand pressing
• Alternative Medicine of Europe with Diet, Homeopathy, Naturopathy and Exercise

3. COMPLEMENTARY OR ADJUNCTIVE MEDICINE:

Complementary or Adjunctive Medicine is independent from the Conventional and Alternative r healthcare systems. Complementary Medicine synergizes benefit and outcome of an individual health. The examples include- Mind-body practices like physiotherapy, massage therapy, reflexology, hypnosis, meditation, yoga are few

4. Adjuvant therapy:

Adjuvant therapy is an addition to the primary (initial) medicine designed to help reach the ultimate goal.

In cancer, adjuvant therapy usually refers to surgery followed by chemotherapy or radiotherapy to help or to reduce the risk of the recurring cancer. Other examples include nutraceuticals/ pharmaconutrients or dietary integrators.

Integrative or Holistic medicine

This is a new trend to respect belief and reject harm of any of the above systems to focus more on patient and less on technology. This approach seems attractive as it is less interventional and more natural but lack of evidence is a cause of concern and controversy.

Example: AYUSH in India

Domain of Complementary and Alternative Veterinary Medicine

Significance of CAM

• Drawbacks of modern medicine like increasing side effects, dramatic rise in the cost of allopathic medicine despite failure in achieving desired cures of their ailment.
• Inherent advantages of alternative medicine like its simplicity & cost-effectiveness, its cultural links to tradition and religion, hatred to certain western practices.

Veterinary Herbal Medicine

Herbal medicine is a traditional practice dating back over 5000 years. It is a system of using whole plants and plant extracts in the treatment of disease and maintaining health. May also be referred to as Phytotherapy, Pharmacognosy, or Alternative Medicine. Medicinal herbs contain a variety of pharmacologically active ingredients with each one having its own unique combination and properties.

Herbal medicines are classified into categories according to what they contain in their composition. Constituents include acids, alcohols, alkaloids, carbohydrates, cardiac glycosides, coumarins, phenols, tannins, volatile oils, and many more.

In Sanskrit, word Ayurveda consists of the word Ayes meaning life and Veda meaning related to knowledge or science. An Ayurveda aid is maintain good health, increasing longevity and overall quality of life. Ayurveda is the oldest existing medical system. In India the history of traditional veterinary science dates back to the period of Mahabharata. During the battle of Mahabharata, thousands of animals got hurt and also suffered from various diseases which were then treated with medicinal plants. The Princes Nakula and Sahadeva were the physicians of horses and cows respectively. Indian medical treatises like Charaka, Sushruta and Harita Samhita contain references of care of animals.

Examples of Veterinary Herbal Medicine

• Willow bark- provides salicylate for pain relief.
• Digitalis or foxglove- effective for the heart and helps in all aspects of cardiac function.
• Dandelion- used as a diuretic and also provides potassium.
• Periwinkle or Vinca- comparable to the potent cancer drug Vincristine.
• Yucca- used as an anti-inflammatory. Similar to the effects of steroids, but without the harmful side effects (McDowell, 2010).

Advantages

Medicines are derived from all natural sources. Herbs have a variety of healing powers with the capability of balancing emotional, mental and physical problems. Herbal treatment may also help with nutrition because they contain vitamins and minerals, which synthetic drugs do not (Scanlan, 2010). Even animals have an inherent instinct for herbal medication to help with their health problems. Sick animals tend to eat plants with secondary metabolites, such as tannins and alkaloids. These phytochemicals often have antiviral, antibacterial, and antifungal properties (Strogdale, 2008).

Disadvantages

Some herbal medicines have not consistently shown to be effective. There is a possibility that herbal medicines and synthetic drugs may interact, causing toxicity to the patient. Herbal remedies can also be dangerously contaminated. Suppliers and herbalists must establish the safety and efficacy of the plants before recommending for medical use.                                                                                                   (Strogdale, 2008)

Veterinary Homeopathy

Homeopathy is distinctly singular phenomenon in the history of medicine. The term homeopathy comes from the Greek words homeo, meaning similar, and pathos, meaning suffering or disease (Vithoulkas, 1998). Homeopathy is a form of alternative medicine that treats a disease with heavily diluted preparations created from substances that would ordinarily cause effects similar to the disease’s symptoms (Hahnemann, 1849). Hahnemann is known as a father of Homeopathy. John Honigberger was the first person who brought homeopathy in India in 1829-30. Food, Drug and Cosmetic Act, 1938 has approved the homeopathic remedies as a Drug in 1950. Christopher Day (1984) wrote a book on ‘Homoeopathic Treatment of Small Animals’ and he treated many animals with homeopathy. The International Association for Veterinary Homeopathy (IAVH) was formed in 1986 in Luxembourg. Department of AYUSH, Government of India and Veterinary Council of India has taken keen interest for development Homeopathy.

It has certain advantages over allopathic like it has no side effects, no residue in milk or meat, relatively cheap and ecofriendly. It has certain disadvantages like there is lack of professional expertise to assist the farmer. Today homeopathy occupies a unique place in the world of therapeutics in human as well as veterinary field. More and more Veterinarians are taking keen interest in Homeopathy therapy but due to lack of knowledge, guideline and availability of homeopathy medicines at grass root level act as a speed breaker for development of its in India.

Looking to better prospects of homeopathy in veterinary and animal husbandry one must come up with a good extension strategy for better adoption and diffusion of the advantages of this system for betterment of animals and farmers too. Homeopathy has been successfully used in many states of India such as Gujarat, Maharastra, W.B, Delhi, Punjab,Haryana, Rajasthan, Karnataka, A.P. Kerala and Tamilnadu. In many countries like England, Austria, Australia, Belgium, Ireland, U.S.A., Netherlands have been successfully using homeopathy in veterinary practice for prevention as well of treatment of diseases.

Why Homeopathy in Veterinary practice

• Dose of drug is very small, few globules or drops are easy for administration
• This therapy never clash with other drugs
• No negative side effect on body but has a positive effect on body
• Cost effective medicine
• No drug residue
• It can be very well used as preventive medicine and feed supplements (infectious diseases and metabolic disorders)
• Many surgical conditions (warts, hematoma, fistula, sinuses, and chronic abscess) can be very well cured

How it acts..?

The exact mechanism of action of homeopathy remedies is still not understood. As per Dr.Hahnemaan homeopathy may act dynamically to stimulate the body’s vital force through releasing some kind of energy, which stimulates body’s own defense mechanism to counteract the disease process. The basic principle of homeopathy is “Similia similibus curanter ”, means Let like be cure like. It does not suppress the symptom but it can permanently extinguish the disease process from the root, thus the permanent cure is possible. It is found that the homeopathy can be complimentary to modern medicine in veterinary practice and their action is synergistic in nature.

Homeopathic Remedies for Dogs

At Indian Veterinary Research Institute Izzatnagar, Varshney et al. (2004) has done research on clinical management of babesiosis in dogs with homeopathic Crotalus horridus 200C and reported good result. A study on ‘Comparative efficacy of homoeopathic systems of medicine in the management of clinical mastitis of Indian dairy cows’ was conducted by J.P. Varshney and R. Naresh stated that the overall effectiveness of homoeopathic combination medicine in the treatment of acute non- fibrosed mastitis was 86.6% with a mean recovery period of 7.7 days. In era of global warming and climate change this eco-friendly and cost effective system of medicine is very beneficial to farmers.

Laser Therapy:

(Light Amplification of Stimulated Emission of Radiation)

Laser therapy is a novel rehabilitation technique being used in veterinary medicine for both rehabilitation and therapeutic purposes.  Laser therapy is an emerging technique that appears to have subjective benefits and it is an increasingly studied modality that can be a valuable tool for veterinary practitioners to successfully treat conditions. Potential areas where laser therapy can be incorporated are in wound healing, pain management, and rehabilitation for various conditions (eg, Osteoarthritis). Photobiomodulation (PBM) induced by laser therapy is the application of electromagnetic radiation within the near infrared spectrum and is aimed at stimulating healing or analgesia within the target tissue. Currently laser therapy is being advocated for a variety of conditions some of which include musculoskeletal pain, osteoarthritis, joint pain, and inflammation, neuropathic pain, otitis, dermatitis, chronic, or non-healing wounds and decubital ulcers (Bartels, 2002 & 2009). The term “low level laser therapy” (LLLT) refers to the use of light at much lower levels than those used for tissue ablation or photocoagulation. The specific dose(s) of laser required healing tissue and treat pain remains unclear. Calculating actual joules of energy delivered requires calculations of considerable complexity. Most therapy units use red or near infrared light, from 600 nm to 1070 nm. This range constitutes the “optical window” wherein effective absorption into tissue is maximal.

Mechanism of action: Laser consists of a monochromatic, coherent, collimated light. These properties will distinguish laser light from other sources of light like sunlight. The exact mechanism of action of laser is not clear. There may be several mechanisms of action depending on the target and the cell being modulated.

Haben Fessehav, 2020

Types of Laser:

• Class I Laser : Laser Printers
• Class II Laser: Bar Code Scanners
• Class III Laser: Pointers
• Class IV Laser: Surgical and Therapeutic

Most commonly used therapeutic lasers in Veterinary Medicine are Class III (deliver energy from 1 to 500mW) and IV (delivers energy more than 500mW) lasers. One watt is one Joule of energy that is delivered per second and the laser dose is expressed as Joules/cm2. Very many types of laser units are available for the Small animal practitioner to be used for therapy as well as for surgery. Obviously one can select either a surgical or therapeutic laser unit or can have a choice of equipment which can be used both for treatment and surgery.

Application of laser therapy in veterinary practice is an innovative treatment that has gained popularity in recent years. The veterinarians have discovered it’s benefits for various companion animals. Laser therapy has three broad range effects on animal tissue. Laser therapy decreases inflammation, decreases pain and accelerates healing. Like acupuncture and massage, laser therapy can be used in conjunction with or in place of medication to manage pain, inflammation, muscle regeneration, and rehabilitation improves circulation and wound healing. It accomplishes this by altering the physiology of cells and tissue using light (photons) instead of an acupuncture needle or manual pressure. Therefore, treatment effectiveness and the types of responses seen depend heavily on if and how light enters living tissue

Biological effects of laser therapy

• Anti-inflammation
• Anti-Pain (Analgesic)
• Accelerated Tissue Repair and Cell Growth
• Improved Vascular Activity
• Increased Metabolic Activity
• Trigger Points and Acupuncture Points
• Reduced Fibrous Tissue Formation
• Improved Nerve Function
• Immunoregulation
• Faster Wound Healing

Adverse Effects

• Properly used, laser therapy appears to be very safe. However, higher powered lasers run the risk of inducing thermal burns when improperly used.
• Tattoos, when lasered, can cause intense pain due to the high amount of light absorption by deposited pigment.
• Questions remain about the ability of laser therapy to stimulate neoplastic growth and, if so, at what wavelength(s) and power(s).
• Laser light can damage the retina, whether reflected off shiny surfaces or shown directly into the eye. Laser goggles protect against indirect exposure but not against direct. One should never look into the applicator of a laser therapy device
• Laser light longer than 760 nm is invisible to the human eye. This could cause inadvertent eye exposure and retinal damage.

Contraindications

• Contraindications to direct laser treatment include carcinoma, thyroid gland, active hemorrhage and autonomic nerve centers
• Laser therapy should be avoided in patients in which immune stimulation is not desired, including those with lymphoma or on immunosuppressant medications
• In immature patients, higher powered laser therapy devices may stimulate premature closure of epiphyses. Thus, caution is warranted over long bones in animals <1 yr old

Future research
Experimental evidence in veterinary species is mixed, and there are no systematic reviews of clinical trials validating laser therapy for specific indications. Overall, the clinical trial literature in veterinary medicine is sparse and has methodological limitations. Some positive effects have been reported, but no consistent pattern of clinical benefit has yet emerged.

Veterinary Acupuncture
Acupuncture is over 4,000 years method, originated in Eastern Asia, particularly in China. It has been increasingly practiced in Europe since the last century. Acupuncture is key component of Traditional Chinese medicine (TCM) in which thin needles are inserted into the body. It is most often used to attempt pain relief, though acupuncturists say that it can also be used for a wide range of other conditions. Acupuncture is generally used only in combination with other forms of treatment. Traditional Chinese Veterinary Medicine (TCVM) has been practiced on animals for thousands of years. Chinese Medicine was used sparingly on large animals. Much of the focus was on the treatment of horses since they were so essential to the military. In more modern times it has been used increasingly on pet animals. In the last two decades, Veterinary Acupuncture has been included in the Veterinary University Curriculum to certain extent. An initiative has been taken from Veterinary school of Finland for Veterinary Acupuncture course.

According to International Veterinary Acupuncture Society, Acupuncture is the insertion of needles into specific points on the body to produce a healing response. Each acupuncture point has specific actions when stimulated.

Indications

• Acupuncture is used mainly for functional problems such as those involving noninfectious inflammation, paralysis, or pain
• For small animals, acupuncture has been used for treating arthritis, hip dysplasia, lick granuloma, feline asthma, diarrhea and certain reproductive problems
• For larger animals, acupuncture has been used for treating downer cow syndrome, facial nerve paralysis, allergic dermatitis, respiratory problems, nonsurgical colic, and certain reproductive disorders

Efficacy

In 2001, a review found insufficient evidence to support equine acupuncture. The review found uniformly negative results in the highest quality studies (Ramey et al., 2001). In 2006, a systematic review of veterinary acupuncture found “no compelling evidence to recommend or reject acupuncture for any condition in domestic animals”, citing trials with, on average, low methodological quality or trials that are in need of independent replication                                                                                                                 (Habacher et al., 2006). In 2009, a review on canine arthritis found “weak or no evidence in support of” various treatments, including acupuncture (Sanderson et al., 2009).

Related methods

• Electroacupuncture: Electrical stimulation at an acupuncture point. This may by given on or through the surface of the skin. Various combinations of acupuncture points can be selected to induce electropuncture analgesia in animals. Generally, analgesia is achieved near to the sites of electropuncture.
• Aquapuncture: Injection of a drug or a liquid (e.g. vitamin B12) at acupuncture points.
• Acupressure: Application of pressure at acupuncture points.
• Moxibustion: Using a burning herbal stick to stimulate and warm acupuncture points.
• Lasers: Lasers can sometimes be used to stimulate acupunture points.
• Implantation: Gold or silver beads (or other stimulants) are sometimes implanted at acupuncture points.

Veterinary Chiropractic
Veterinary chiropractic/Animal chiropractic is the practice of spinal manipulation or manual therapy for animals. Veterinary chiropractors typically treat horses, racing greyhounds and pets. There is some degree of risk associated with even skilled manipulation in animals as the potential for injury exists with any technique used. The founder of chiropractic, Daniel David Palmer, used the method on animals, partly to challenge claims that the placebo effect was responsible for favorable results in humans.

Efficacy and safety

Limited evidence exists on the efficacy of osteopathic or chiropractic methods in equine therapy (Haussler & Kevin, 2016). Together, the American Animal Hospital Association and the American Association of Feline Practitioners stated in 2015 that there was insufficient “reliable, noncontradictory evidence” for veterinary chiropractic methods in the management of pain (Epstein et al., 2015).

There is some degree of risk associated with even skilled manipulation in animals as the potential for injury exists with any technique used. This risk may increase in the presence of structural disease, such as equine cervical vertebral malformation (CVM) or canine intervertebral disk disease (Ramey et al., 2000). Horses have been hurt by very forceful animal chiropractic movements. Adjusting the spine of a dog with a degenerative disk runs the risk of serious injury to the spinal cord (David & Ramey, 2000).

Veterinary Nutraceuticals

A nutraceutical is any non-toxic food supplement which is scientifically proven for health benefits and used for non-specific therapy to control symptoms and upgrade wellness. They range from nutrients; dietary supplements and special diet prepared by herbs and of late, genetic engineering technology. There are traditional nutraceuticals from fruits, vegetables, grains, fish and dairy products     e.g.:Lycopene of tomatoes, omega 3 fatty acid in Salmon and saponins of soy.

It is defined as ‘the use of micronutrients, macronutrients and other nutritional supplements as therapeutic agents’. Integrative veterinary medicine (IVM) blends the use of conventional therapies such as pharmaceuticals with diet and nutraceuticals to address health conditions, as well as to optimize wellness in patients. Nutraceuticals are generally very safe to use having few side effects and may be used as a primary therapy or an adjunct to conventional medicines

Ministry of AYUSH

(Ayurveda, Yoga, Naturapathy, Unani, Sidda and Homeopathy)

The ministry gives lot of importance to these different system of alternative and complementary medicine and also funds of several professional research institutes and academic faculties devoted to various forms of alternative medicine. Some of the institutes covered under this ministry are

1. National Institute of Homeopathy – Kolkata
2. National Institute of Siddha – Chennai
3. National Institute of Unani Medicine – Bangalore,
4. National Research Institute for Panchakarma – Cheruthuruthy.
5. National Institute of Ayurveda – Jaipur
6. All India Institute of Ayurveda – Delhi
7. National institute of Naturopathy – Pune
8. Morarji Desai National Institute of Yoga – Delhi
9. North Eastern Institute of Ayurveda & Homoeopathy – Shillong.

Economics

As of March 2015, there were nearly eight lakh AYUSH practitioners, over 90 per cent of whom practiced homeopathy or ayurveda. A 2018 study by the Confederation of Indian Industry (CII) estimated the market share of AYUSH medicines at around US$3 billion and that India exported AYUSH products of a net worth US$401.68 million in the fiscal year 2016-17. The Department of Pharmaceuticals had allocated a budget of ₹ 144 crore to the ministry for 2018-2020 for manufacture of alternative medicines.

CONCLUSION

• Despite significant expenditure spent on testing alternative medicine, many studies have failed to prove its effectiveness as claimed and could not provide proper explanation regarding mechanisms of healing, which remain hypothetical.
• Alternative medicine has survived from ages till date and is growing stronger in certain areas where dominant system failed to yield good results.
• Undoubtedly it improves chronic ailments, preventive aspects of health and is holistic in nature of physical, psychological, social and spiritual health of human/animal kind.
• Overall health is the ultimate goal, not the way which we achieve it.
• Accordingly, all the systems of health care should be integrated in a synergistic manner by understanding the deficiencies of one’s own and by appreciating strengths of others.
• In the endeavor of achieving integrating system, much more research has to be conducted with well-designed and unbiased trials.
• CAVM at undergraduate/postgraduate level is need of the hour. Exposure to these systems of medicine at this level helps the students to get good knowledge, skill and they will be able to choose a best possible system of medicine for particular disease keeping the interest of animal, owner and profession.

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Indian Animal Health Industry: Present & Future