Therapeutic Options

by: Les Sellnow
The Horse.com
29 Jul 2005 

Not long ago, veterinarians generally considered most forms of alternative medicine to be a "smoke and mirrors" approach to treating horses. Today, many veterinarians are embracing at least two forms of alternative medicine--acupuncture and chiropractic. A 2002 survey of American Association of Equine Practitioners (AAEP) members showed a growing interest in alternative therapies or, as the AAEP refers to them, therapeutic options.

In 1998, for example, only 16.6% of respondents used acupuncture in their practices. Four years later that percentage had doubled to 33.1%. In 1998, 8.1% of respondents indicated they employed chiropractic in their practices. By 2002, that percentage had doubled to 17.2%.

The numbers involved with homeopathy, herbology/naturopathy, and massage were in the 6-7% or higher range in the early survey, and the increases in their usage have been modest.

Another part of the survey asked about referrals to others who practiced therapeutic options. In 1998, some 40.6% referred cases to chiropractors. By 2002, this percentage was 63.1%. Acupuncture referrals rose from 37% to 56.4%. Massage referrals went from 19.8% to 29.4%, and physical therapy referrals went from 12.5% to 18.5%.

Growth of Veterinary Interest

The big change in the veterinary world began in the mid-1990s, says Joyce Harman, DVM, MRCVS, owner of Harmany Equine Clinic in Flint Hill, Va. Harman is a 1984 graduate of Virginia Maryland Regional College of Veterinary Medicine. Following graduation, she studied equine physiology and sports medicine in England. She returned to the United States and after a stint with another practice opened Harmany Equine Clinic in 1990. Today, she concentrates solely on alternative medicine, including acupuncture, chiropractic, massage, and herbs--the entire holistic approach (treating the entire body rather than just focusing on individual parts). Her services are in high demand, and she is booked full months in advance.

While alternative medicine is the centerpiece of Harman's practice, other vets use it along with conventional medicine.

Jim Briddle, DVM, of Riverton, Wyo., is an example of an established veterinarian who added acupuncture to his rural practice. Briddle graduated from Kansas State University in 1978. His solo practice, which includes horses, cattle, and small animals, is in the heart of ranch country, where alternative medicine is not exactly a household word. However, Briddle became intrigued with acupuncture and in 1997 attended a course approved by the International Veterinary Acupuncture Society (IVAS). Now he integrates acupuncture into his treatment protocol.

He has found it beneficial in dealing with a variety of problems in horses and dogs. "You would be surprised by some of the people wanting acupuncture treatment for their animals," he says. "They include some of the crustiest old ranchers in our area. Of course some of them scoff at it, but a whole lot of them are looking to acupuncture."

Briddle says he has found the approach equally effective on horses and dogs. "It is my number one treatment approach for hip dysplasia in dogs," he says.

It also works well in diagnosing and treating non-specific rear limb lameness in horses, Briddle says. He uses acupuncture primarily for equine musculoskeletal problems. He says on average, he treats at least three horses per week with acupuncture.

Acupuncture has grown from a modality that involved few veterinarians to an international organization. IVAS was started in 1974 by eight vets who were interested in using acupuncture primarily in horses, but who also recognized its potential for other species.

Today, says Ed Boldt Jr., DVM, executive director of IVAS, there are 1,500 members, with the most growth coming in the past 15 years. The basic veterinary acupuncture course taught by IVAS has been held annually since 1975.

"Our current course is limited to 100 veterinarians, and while we have not hit that limit the last few years, we have seen IVAS go from the only course in North America to having courses affiliated with Colorado State University, Tufts University, and one in Florida at the Chi Institute," says Boldt. "IVAS also has courses taught by IVAS-affiliated organizations in Canada, Belgium, Australia, and Denmark, and there are IVAS-recognized courses in Brazil and Spain. An IVAS-recognized course is also in the works in Germany."

The U.S. course starts in October and finishes in February, and the location rotates around the country. The most recent course was held in Houston, Texas, and the next one will begin in October in San Diego, Calif. The course, says Boldt, involves four sessions of five "intense" days each in October, November, January, and February.

In order to be certified, a veterinarian, after completing the course, must pass a written examination, an equine practical examination, a canine practical examination, be involved in 40 hours of internship with an IVAS-certified member, and submit a case report for peer review. If all of these criteria are met, says Boldt, the veterinarian is granted IVAS certification.

"While this certification is not currently recognized by the AVMA (American Veterinary Medical Association) as a boarded specialty, it allows the public and our peers to see that this veterinarian has attained this level of education and has passed these requirements," he says. "Our U.S.-affiliated organization--the American Academy of Veterinary Acupuncture--has taken up the torch from IVAS in working with the AVMA toward board specialty recognition for veterinary acupuncture."

Interest in Chiropractic

There is a growing number of vets who use chiropractic, says Robin Hroza, who is in charge of administrative duties at Options for Animals, a school for veterinary chiropractic. Options for Animals is one of three U.S. veterinary chiropractic schools that has received approval from the American Veterinary Chiropractic Association (AVCA). The other two are Healing Oasis Wellness Center in Sturtevant, Wisc., and Parker College of Chiropractic in Dallas, Texas. (Parker College of Chiropractic is credited with launching the movement for chiropractic adjustment for animals. Parker College opened in 1978, when it was established by James Parker, DC.)

The AVCA says more than 1,000 veterinarians and doctors of chiropractic worldwide have completed an approved program for animal chiropractic. All three of the programs, says the AVCA, exceed its minimum requirement of 200 hours.

The basic course at Options for Animals is divided into five modules, with each one lasting from a Wednesday through a Saturday once each month for five months. To enroll, a student must be a licensed veterinarian or a doctor of chiropractic (DC) who wants to be licensed to work on animals. (Four years of specialized education are involved in becoming a doctor of chiropractic licensed to practice on humans.)

At the conclusion of the course for treatment of animals, students must pass an examination in order to be certified.

Formalized animal chiropractic education began in 1989 with a 100-hour post-graduate course developed and taught by Sharon Willoughby, DVM, DC. Doctors of veterinary medicine and doctors of chiropractic were trained side-by-side. Willoughby, the AVCA reports, also taught this program in Australia at the invitation of the University of Sydney in the early 1990s.

The school founded by Willoughby (Option One for Animals) today is owned by two chiropractors and a veterinarian--Dennis Eschbach, DC; Heidi Bockhold, DC; and Drew Spisak, DVM. They purchased the school in mid-2003 from Willoughby, who also was the organizer and first president of the American Veterinary Chiropractic Association (formed in 1989).

The three schools also offer advanced courses in chiropractic. Certified animal chiropractors also are required to maintain certification with 30 hours of continuing education every three years.

Educating Vets

The 2000 AAEP convention in San Antonio, Texas, incorporated in-depth sessions on both acupuncture and chiropractic, the first time an in-depth look at therapeutic options was on the program. (A discussion of therapeutic options was first added to an AAEP program in 1997 at the convention held in Phoenix, Ariz.)

Allen M. Schoen, DVM, MS, of Sherman, Conn., presented a paper on acupuncture at the 2000 AAEP, and Kevin Haussler, DVM, DC, PhD, of Cornell University, gave a presentation on chiropractic. (Haussler was featured on the 2004 program as part of a panel discussing sacroiliac pain. He also spoke on chiropractic at the 1997 convention.)

Also featured on the San Antonio program was Mary Bromiley, FCSP, SRP, RPT (USA) of England, who discussed the benefits of physical therapy for horses. (The AAEP survey found in 2002 that 33.1% of vets were using some form of physical therapy in their practices.)

There is now also a wealth of information available to discerning horse owners. Veterinarians who focus on alternative approaches, such as Harman (www.Harmonyequine.com) and Schoen (www.drschoen.com), have extensive web sites where they present information on the holistic approach to treating horses. Organizations such as IVAS (www.IVAS.org) and AVCA (www.AnimalChiropractic.org) also have seb sites to enlighten owners.

Accepting an alternative approach to treating horses does not mean a veterinarian must give up conventional medicine, says Schoen. He calls his approach integrative holistic animal health care. Although Schoen's practice concentrates on horses, he espouses this approach for all pets.

Schoen puts it this way: "I have come to appreciate that there is a balance between exploring the benefits of natural health care and acknowledging the benefits of conventional Western medicine."

What does Schoen mean when he talks about integrative animal health care?

"The vision of this approach," he says, "is to take the best of holistic, natural approaches to animal health and combine them with the best of conventional veterinary medicine. No one form of medicine has all the answers to all problems. It just seems prudent to take the best from all fields and integrate them into a new, comprehensive form of animal health care.

"What this means in practice and to the animal owner is that we do everything as naturally and health conscious as possible to prevent disease in our animals," Schoen explains. "If this isn't enough and they become ill, then we look at all the best approaches to diagnosis and treatment of the problem. This may include conventional medical examinations, blood tests, X rays, and other approaches. In addition, a holistically oriented veterinarian may look at other possible causes of disease, such as environmental conditions, nutritional deficiencies, and potential vaccine reactions. Treatment might consist of conventional medications and holistic approaches."

Harman, while a specialist in alternative medicine, is another who does not turn her back on conventional medicine, although she often will refer the horse to a practitioner who concentrates and has expertise in that particular field.

There are two extremes and a middle ground, Schoen says. The extremes involve conventional veterinarians who have no use for alternative approaches, and those who see no value in conventional medicine. Taking an adversarial position at either extreme, he believes, is harmful to the well-being of the animals involved.

For Schoen, there is a larger picture to view in the animal care field, with horses as an integral part of the scene. "As far as the human-animal bond is concerned," he says, "horses provide a wonderful opportunity to open our heart spaces and reconnect to the love and compassion that just being with them can offer. That compassion can broaden and spread to all beings--human and animal--if we open our hearts and treat all beings better."

In order to do that, he adds, one must deal with a horse as a conscious being and not approach the human-horse relationship as one would a human-sports car relationship. Education and compassion on the part of both owners and veterinarians are the keys, he says.

As the use of therapeutic options continues to increase, there will be some disagreement among those involved. Expressing concern, for example, is Marvin Cain, DVM, an acupuncture specialist from Versailles, Ohio, who was one of the eight veterinarians to form IVAS. Yes, he says, there are more veterinarians using acupuncture than ever before, but in some cases, "They are just sticking needles into horses without knowing for sure what they are doing."

He blames the teaching approach that he says is being used by IVAS. There is too much time spent with the audio-visual approach, he states, and not enough hands-on work. "I have always maintained," he says, "that acupuncture is more art than science." What he means is that in order to be effective with acupuncture, the practitioner must develop a sensitive touch. "There is nothing as effective as the human hand," says Cain. "Acupuncture is becoming over-sophisticated."

As a result, Cain, who is an accredited IVAS instructor, says he no longer teaches the course in America, but continues to teach in Europe where, he says, there is much more hands-on experience.

Cain continues to maintain a busy private practice as an acupuncture specialist. His chief client today, he says, is Nick Zito, the New York-based trainer who had multiple entries in this spring's Kentucky Derby.

Another individual who notes progress in the field of alternative therapies, but also has concerns, is Kim Henneman, DVM, of Park City, Utah, who has been specializing in therapeutic options since 1989 and now specializes in the holistic approach in her equine practice.

In addition to a practice that covers eight states in the Rocky Mountains and New England, plus teaching and speaking engagements, Henneman has traveled widely to treat world-class dressage, jumping, eventing, and endurance horses. Earlier this year she was in Dubai to work with the U.S. equine endurance team.

Henneman describes holistic medicine this way: "It involves using every technique available that will restore the horse to short-term function without compromising long-term health."

Counterfeit Practices

While the veterinarians who have added alternative medicine to their practices extol the virtue of approaches involving acupuncture, chiropractic, and physical therapy, among others, there also is a negative side of the therapeutic option story. This side involves unqualified individuals who say they are experts, but aren't qualified.

Counterfeit individuals in the field of equine health has always been a problem, says Harman, and it continues today. In some approaches, such as massage, she says there isn't much danger of injuring the horse, although the untrained individual might do little to help. But in a field like chiropractic, serious harm can be caused if the procedures are improperly applied. (See "Eager Boys and Wolves" on page 82.)

In the introduction to his paper at the 2000 AAEP convention, Haussler summed up the problem of knowledge about therapeutic options for veterinarians: "Equine practitioners have seen a recent proliferation in the use of chiropractic techniques within the veterinary profession. However, since veterinarians do not receive a formal chiropractic education, many practitioners do not have a basic understanding of chiropractic principles or clinical applications. In addition, limited research has been done to evaluate the clinical effectiveness of chiropractic techniques in horses.

"Veterinary medicine, for the most part, has been forced to acknowledge the use of chiropractic and other non-traditional modalities by owners who have sought practitioners that use these techniques and have experienced their perceived therapeutic effects," he continues. "If veterinarians have not taken the time or effort to learn more about these non-traditional techniques, then objectively evaluating their use or discussing the indications or contraindications for a specific treatment modality is difficult.

"Therefore, owners often seek advice about alternative therapies from someone who is not their regular veterinarian, often without the veterinarian's knowledge," Haussler says. "To complicate matters, some individuals claim to be 'equine chiropractors,' but are not professionally trained or licensed in either chiropractic or veterinary medicine."

Although progress has been made in educating horse owners and veterinarians about alternative approaches in the four-plus years since the San Antonio convention, untrained individuals continue to ply their craft and likely will continue to do so.

Henneman's concern in this area stems from individuals who become involved in alternative approaches because of financial considerations. Owners are becoming more knowledgeable about alternative approaches, she says, and they are demanding veterinarians who provide those services. Henneman is concerned that some individuals will respond to the demands without properly preparing themselves or without properly understanding the appropriate and inappropriate use of the modality of choice.

She tells us, for example, of a horse that suffered a serious pelvic injury at the hands of an unqualified individual during the course of a chiropractic adjustment.

The good news, Henneman says, is that more national veterinary meetings, such as the AVMA and AAEP conventions, are inviting experts in various therapeutic option fields to discuss and demonstrate their approaches. At recent AVMA conferences, the two wet labs that filled to capacity first were those for acupuncture and chiropractic.

The AAEP has addressed the various therapeutic options in its "Ethical and Professional Guidelines." In each case, AAEP has strongly recommended that veterinarians using therapeutic options be well educated before employing any of them.

Applying Acupuncture

From the American Academy of Veterinary Acupuncture: "Acupuncture is the stimulation of specific points on the body which have the ability to alter various biochemical and physiological conditions in order to achieve a healing effect. It is not a cure-all, but it works well where indicated and when used alone or in combination with traditional veterinary medicine.

"Ancient Chinese medical philosophy believes that disease is a result of an imbalance of energy in the body. Acupuncture is believed to balance this energy and thereby assist the body in healing disease."

Harman uses a comparison with electricity in describing what occurs when acupuncture is used: "It is easiest to understand the acupuncture system if it is compared to an electrical system. The points are like dimmer switches, so if the flow of energy gets blocked, it is like turning the dimmer switch down and not allowing much energy to get through. If a point is treated with acupuncture, it is like turning the dimmer switch back on and allowing the energy to flow again. Sometimes the energy is backed up behind the blockage or dimmer switch, and treating the point allows a more even flow of energy."

One of the prime uses of acupuncture, according to Harman, is treatment of musculoskeletal and back problems. Many different types of arthritis, including spavin and navicular disease, can be treated with this therapy, she says. She says behavior problems often are solved with acupuncture because their source involves a sore back that can be successfully treated with acupuncture. Also responding to acupuncture are respiratory conditions such as "heaves" or bronchitis, and reproductive problems of stallions and mares.

Also included in her list of conditions that can be helped with acupuncture are colic, neurologic disorders such as wobbler syndrome, and allergic and infectious skin conditions. She feels it also can help horses recover from an infection such as influenza and pneumonia.

One of the most recent developments in acupuncture is auricular therapy. It is a method of acupuncture applied to animals' ears. IVAS explains it this way: "When any part of the body becomes diseased, a pathological (problem) point or points may appear in the superficial tissues of the ear. Because this happens, the ear can be an excellent diagnostic aid. When the pathological points are treated, most usually with needles, lower-power lasers, injections, or ion beads, the diseased tissue can be helped to balance its energies and the process of tissue repair can begin to take place."

One of the most important uses of acupuncture, says Cain, is as a diagnostic tool. Acupuncture can help locate places causing pain and discomfort, which then can be treated by the veterinarian.

Uses of Chiropractic

A chiropractic adjustment is described by the AVCA as "short lever, high-velocity controlled thrust by hand or instrument that is directed at specific articulations to correct vertebral subluxations."

And what is a subluxation? Schoen explains: "Chiropractors use the term subluxation to describe a specific problem or disease of the spinal column. A subluxation is defined as a misaligned vertebra that is 'stuck' or unable to move correctly. When movement between two vertebrae is restricted, the animal will not have total flexibility of the spine. Stiffness, resistance, and lack of ability result. Subluxations also cause problems in the nervous system, especially at areas where nerves exit between two vertebrae. Misaligned vertebrae cause problems in nerves by interfering with nerve transmissions.

"When subluxations are identified in the spine, a veterinary chiropractor will attempt to correct the misalignment," says Schoen. "This is an adjustment. An adjustment is a short, rapid thrust onto a vertebra in the direction that will replace it into a normal position. Jerking on legs or tails is not a chiropractic adjustment," he says.

"Although manipulating the spinal column is a large portion of chiropractic, the practices also includes manual movement of joints in the body and the surrounding tissues," he adds.

Take-Home Message

Some of these alternative therapies have been around for centuries and there are many practicing veterinarians who believe and use these methods to diagnose and treat equine problems. However, there are many other veterinarians who scoff at the perceived notion that any of these have value. If you, as a horse owner, want alternative therapies used on your horse, consult with a licensed veterinarian who uses a holistic approach, including Western medicine, to give your horses the best care possible.