Introducing a holistic approach to conventional practice
Tips and suggestions for understanding the journey from conventional to holistic veterinary medicine within the practice setting.
Many veterinary practitioners who embrace holistic medicine have a personal story. Perhaps conventional medicine failed them, or one of their loved ones, and it was only when they turned to alternative therapies that they saw any true health improvements. These experiences tend to change their outlook on medicine, inspiring them to learn more about holistic treatments and begin introducing them into their own practices. This article follows my own journey towards holistic medicine and how I went about adding it to daily practice.
How I got interested in holistic medicine
My story began with our son, Ben, who suffered for years with headaches, hours-long temper tantrums, skin rashes, night terrors and one ear infection after another. With diet changes and cessation of vaccines, and working with chiropractors, Qigong masters and homeopaths, he started to smile again, and became healthy.
Now 18, Ben is a college freshman. He sees an acupuncturist/herbalist to help with anxiety, eats what he wants, and has learned how to keep his moods stable with his own flower essence blend and essential oils. He’s not perfect, but he’s pretty good.
A couple of years into Ben’s treatment, I finally recognized the discordance between what I now believed was “health care” for my family, versus how I had been treating animal patients at the practice for 18 years.
At my first AHVMA conference, I met top notch practitioners – specialists in acupuncture, chiropractic, PT, homeopathy, herbs and more. Some practiced out of AAHA-certified hospitals and even referral centers. A few sported braids and sandals! But they all had one thing in common; they had discovered that their Western medical training fell short of their expectations.
Soon after the conference, I read an article by Dr. Christina Chambreau about seeking your “right livelihood”, the work that completes you as a person on all levels. This concept really hit home; I wasn’t in my right work anymore. So I gave six months’ notice at my practice and started taking local holistic veterinarians to lunch – acupuncturists, homeopaths, herbalists, chiropractors. They were incredibly helpful in providing some shape to my new business. I wanted to know where they practiced, what modalities they used, where they trained, and the pros and cons of different types of integrative practice approaches.
Offering holistic therapies in a conventional setting
Then I approached the owners of the conventional practice where I’d been an associate for ten years, and we agreed to a shared percentage:
- 60% (me)/40% (clinic) on exams
- 25% on radiographs, labs
- 5% on referred surgery, dentals, specialist consults.
The clinic provides me with an exam room, an assistant/technician when needed, scheduling and diagnostics. The owners have been very understanding of my clients’ choices — running titers and recommending raw diets, especially since they are a fully Western AAHA-certified hospital. They see a demand for alternative medicine, and know I’ll refer medical and surgical cases to them as needed.
Their lawyer and my tax guy strongly suggested the businesses be kept separate – my name is not on the door, the clinic literature or the website. Clients are instructed to contact me at my own Animal Wellness Center and call or email my home office even though pets are seen at the clinic. Most of my supplies, primarily Chinese herbs and Standard Process supplements, are kept at my home.
Initial intake exams are 90 minutes. I review records prior to the appointment for the medical history. I typically chat with the owner at length before examining the pet. We discuss medical history; treatments that have worked or failed; their goals (which may not be the same as mine!); vaccines, heartworm, flea and tick prevention and (oh-so-important) diet.
Typically, diet is the first change we make, if appropriate. I ask owners to feed a commercial raw or fresh-cooked diet and start whole food supplements while I select the Chinese herbs. Commonly, I hear things like: “She’s so much more energetic!”, “His eyes are brighter”, “No more gas — thank you!” from the diet change alone. This lays a foundation for healing, the owners are receptive and the herbs will amplify that process.
On the flip side, a pet on a fresh diet who isn’t doing well will occasionally show up (e.g. a German shepherd with chronic GI issues who was worse on raw diet). I find that some of these animals do better on hypoallergenic kibble short-term. After a few months of treatment, they can often transition back to raw/cooked diet and do well.
Recheck exams are 40 minutes long – I repeat an exam, review treatment success, and make a plan for moving forward. If the client has a conventional veterinarian, I try to keep labs and diagnostics within that clinic as much as possible.
Some rechecks are done by phone for clients who live far away, have cats or dogs who are stressed by car rides, or who cannot make my appointment schedule. While not ideal from a TCVM perspective, clients are grateful for this option and will continue with holistic treatments. These cases do move forward. I charge by the minute for calls and extensive emails.
I continue to vaccinate younger animals, but using only core vaccines that are given singly. Per Dr. Ron Schultz, I titer puppies after their last DHPP, then typically do not repeat. Rabies is given every three years in healthy pets. I recommend seasonal heartworm preventative and use pyrethrin or essential oil sprays for fleas and ticks. For cats, I give a single FVRCP and one rabies vaccine if they’re kept indoors.
Working with a business coach
After ten years, I finally hired a business coach because managing an integrative practice and generating income was a challenge without typical practice sales. I strongly recommend working with a coach at the beginning of your foray into predominately holistic medicine. We’re making progress on pricing, a new website, and charging for my phone and email time when lengthy ($100/hour).
My typical clients are middle-aged woman whose beliefs are similar to mine. They are presenting their pets for holistic care, and any conventional work (spay/neuter, vaccination, specialty referral) is considered “alternative”. I love that! Typical cases are chronic medical issues such as IBD, seizures, cancer, atopy and behavior problems. My practice is now aligned with my personal beliefs about wellness, and my patients are benefitting with improved health.
Case study #1 – Roxanne, a 16-year-old SF DSH cat
Roxanne was presented in November of 2014 for a second opinion on treatment for kidney failure. The owner’s conventional veterinarian had recommended urine culture, urine protein, creatinine ratio and blood pressure – all declined due to cost. Three renal diets were sent home, all of which Roxy refused. The owner gave SQ fluids for a few weeks, but because she’s older, she found it difficult to continue. She reported that Roxy was lethargic, 70 inappetant, PU/PD and vomiting occasionally.
Roxanne’s labs were:
- BUN 155 mg/dl
- Creatinine 8.9 mg/dl
- Phosphorus 10.7 mg/dl
- USG 1.010
On exam, Roxy was quiet, 6% dehydrated, had a strong rapid pulse, with kidneys bilaterally small and smooth, and loss of spinal muscling.
As Roxy only agreed to eat higher-protein canned diet, we continued that diet, but I asked the owner to offer the food lukewarm, with water added to a soupy consistency.
I started Roxy on Zhi bai di huang wan tincture at 0.15 ml PO BID, and asked the owner to return for a recheck exam and labs in two weeks. On callback seven days later, the owner reported that Roxy was eating somewhat better (and taking the herbs in food, as the owner could not medicate orally). After two weeks, the owner reported that Roxy was feeling “much better”, but that she absolutely could not afford a recheck exam and labs. I stressed the importance of doing so, and continued to check in every couple weeks. Ten weeks later, Roxy presented for labs only:
- BUN 35
- Creatinine 1.9
- Phosphorus 2.9
Her owner reported that she was “bossing the other cats around again”, was much more playful, eating well, still PU/PD. She was eating consistently, so we added Standard Process Renafood.
I finally saw Roxy for a recheck exam and labs six months after her initial exam with me (I’d long given up hope that the owner would make another appointment, but was happy with heprogress reports). Roxy was still 5% dehydrated, but she had a stable weight and was perky. A mini-screen was normal. She continued to eat high protein canned diet, with the owner rotating proteins.
I learned two things from this kitty. I will never limit protein in any standard chronic renal failure cat. My Chinese training taught me that protein increases renal blood flow. So if there is no sign of renal inflammation (infection, ^UPC, etc.), high protein diets are indicated. I know this topic had been discussed to death on both conventional and alternative forums. There are DVMs far more qualified than myself who can speak to the physiology involved, but I continue to have good success in CRF cats with water-added high protein canned diets, and a proper herb Rx (which is the difficult part sometimes, right?). Secondly, I learned that animals can heal, even under less-than-ideal circumstances.
Case study #2 – Copper, an eight-year-old MN Viszla
Copper presented two weeks post-splenectomy for hemangiosarcoma. On exam, he was shy, had several fatty masses, BCS 6/9, mm slightly pale, pulse deeper and thinnish. He had been very sleepy on Tramadol (a yin tonifier). So he appeared to be blood deficient and damp in TCM terms.
I started him on Yunnan bai yao, Dang gui shao yao san, cod liver oil, medicinal mushrooms, IP6. Through the next 15 months of treatment, I tried various additions to the DGSYS, but was never able to quite correct Copper’s thinner pulse. He eventually had an acute bleed and was euthanized. I know there are reports of much longer survival times with HSA patients undergoing herbal care, but with minimal side effects the owner and I were happy to have provided Copper with a period of time well beyond what was expected for splenectomy alone, and even chemo.
What to keep in mind
- In holistic practice, you will see many cases with advanced disease. Some will lose the battle, but when you can extend that pet’s life far beyond conventional predictions, that’s good.
- Your clients, on average, will be a bit more high-maintenance, so be sure to charge for your time.
- Soft fleece blankets, extra time and lots of treats make your hospital a fun place (or at least tolerable!). Provide cats with a quiet room, a place to perch or hide, and time to adapt before their exams.
- These are clients you will typically see more often than in a conventional setting. You’ll get to know them better, and will walk through life’s challenges For me, this has been a great joy.