Science Based Holistic Veterinarians

By Nancy Kerns

Frequently, we refer to “holistic” veterinarians in the pages of WDJ, as in, “Discuss this with your holistic veterinarian.” What we generally mean by this is a vet who offers her patients complementary and/or alternative methods of healthcare, in addition to her conventional Western medical treatments. The goal of holistic practitioners is to look at the entire animal patient – body, mind, and spirit – and to do more than treat his illness in times of crisis; they must also promote his total wellness, with an eye toward disease prevention.

Nutrition plays a huge role in holistic medicine, both in preventing and treating disease. Advanced training in nutrition is often a cornerstone of any holistic veterinarian’s “toolbox,” enabling the practitioner to make smart, targeted suggestions for her patients’ diets and supplementation.

The rest of the holistic vet’s tools may differ widely. Some pursue advanced training in Traditional Chinese Medicine (TCM), and use Chinese herbal medicine and/or acupuncture in their practices. Some become certified animal chiropractors. Some use Western herbal medicine or homeopathy. Some use esoteric tools, such as kinesiology, Reiki, medical intuition, or crystals.

As varied as the professional offerings are, however, it seems to us that there are simply not enough holistic practitioners. In the parts of the country where interest in alternative medicine is high, the most competent doctors often seem to have crazily busy practices, which can make it hard for them to recruit, train, and retain additional vets, which, in turn, can lead to the practice owners’ early burnout. In other parts of the country, nonconventional practitioners sometimes go out of business before they can find enough clients to support themselves.

So when we say, “Ask your holistic veterinarian,” some of our lucky readers (especially on the coasts) can make a mental note to do just that, while many others grit their teeth in frustration. “But I don’t have a holistic vet!” they howl. (We know this because they often call us to howl!)

All we can do is to suggest that they contact the American Holistic Veterinary Medical Association (AHVMA) in order to look for a practitioner near them; we put the contact information on page 24 of every issue.

But Susan Wynn, DVM, is doing more than that. Dr. Wynn, AHVMA’s current president-elect, has made it a mission to help bring an appreciation for holistic medicine to veterinarians, and vice versa. She is author or coauthor of three books aimed at vets interested in holistic medicine: Complementary and Alternative Veterinary Medicine: Principals and Practice, written with Allen Schoen, DVM, and published in 1998 by Mosby; Emerging Therapies: Using Herbs and Nutraceutical Supplements for Small Animals, published in 1999 by the AAHA Press; and Manual of Natural Veterinary Medicine: Science and Tradition, written with Steve Marsden, DVM, and published in 2003 by Mosby. Dr. Wynn and Barbara Fougère, BVSc, are currently completing a book for Elsevier (due to be published in late 2006) on herbal veterinary medicine.

While obviously a student and fan of some forms of holistic medicine, Dr. Wynn does not have equal regard for all complementary and alternative medicine (often referred to as CAM). She devotes much of her time to critically reviewing research supporting the use of veterinary CAM, and a portion of her lectures to conventional and holistically inclined veterinarians always include references to “evidence-based medicine.”

In addition to a busy lecturing schedule, writing books and papers, volunteering for AHVMA and the Veterinary Botanical Medicine Association (VBMA), Dr. Wynn sees patients three or four days a week at the Bells Ferry Veterinary Hospital in Acworth, Georgia.

I’ve heard Dr. Wynn speak several times at AHVMA’s annual conferences, and always left with a notebook completely filled with undecipherable scrawls (she speaks quickly and covers a lot of useful material!). Recently, I had the pleasure of hearing her make a presentation – and the opportunity to interview her – at a venue close to home. Dr. Wynn was an invited speaker at the 2006 symposium of the Holistic Veterinary Medicine Club at the University of California, Davis, School of Veterinary Medicine, sponsored by Natura Pet Products. Fortunately, this time I was permitted to bring a tape recorder!

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Did you have an interest in holistic medicine back in vet school?

No, I wasn’t exposed to it until after I got out of vet school. I did an internship in Washington, DC, and there was a holistic vet in that practice. She used a lot of homeopathy, but what really got my attention is that she would change the diets of almost every dog she saw, and I witnessed some amazing changes. That’s how I got interested in nutrition.

What about herbal medicine, which has become an area of specialty for you? Are herbs the closest thing to your heart?

Yes, nutrition and herbs. I was a gardener when I was a little kid, and I still really enjoy gardening. But herbs and nutrition are related. To me, they are simply molecules that our bodies understand. I really enjoy working with them.

I understand you have a strong bias toward the use of whole herbs.

Every herbalist does. That’s what herbal medicine is. It’s the scientists who want to take a single molecule out and study it to death, and that’s fine, if it turns out to be safe and effective. But to me it’s inefficient. We understand how the whole herbs work. We have an empirical database that’s 2,000 years old, in many cases. So why aren’t we studying whole herbs?

Where do you start with a new patient, when the dog is a mess?

I change the diet.

To what?

To something different! Obviously, it’s an individual thing, but if they have been on lamb and rice, I suggest switching to fish and potato. We look at what the dog has been fed, and feed him something else. Sometimes I suggest changing the form of the diet. If it’s commercial, try homemade. If it’s homemade – people don’t want to hear this! – try a commercial diet.

There are data out there suggesting that the overwhelming majority of published recipes that claim to provide a complete and balanced diet are not – they are actually deficient. And these are recipes in some of our favorite authors’ books! Often, I put my patients on a more reliable source of a complete and balanced diet and see what happens. People don’t want to hear that, but it helps sometimes.

So, you might suggest that someone who is using a homemade diet try a commercial frozen raw diet instead?

Sometimes, I suggest a kibble. I like the complete and balanced raw frozen diets, so that could work as well, but if the dog has already been on something like that, and still looks a mess, sometimes you have to change the form completely.

In WDJ, I try to tell dog owners to improve their dogs’ diets, no matter what they are feeding. Of course, some people are already feeding their dogs the ultimate raw, grass-fed, home-prepared diet …

But you are making judgments about what constitutes an improvement, and I don’t think we know enough about nutrition to do that. I’ve seen too many dogs on a good, supposedly balanced homemade diet improve when they were put back on kibble. I’m not smart enough to know why some improve. I think it’s a pretty artificial system to say we know this is better than that; to me, the dog is the only one qualified to tell us what is best – the dog tells us. And we just have to keep trying things until we find something that works for him.

I do have some biases, of course! My big thing is variety. A lot of people, I think, when they read your kibble issue (dry dog food reviews), go “Okay, this is the one.” You are very careful to not say “This one is the best,” but somehow they make those determinations. And my whole thing is, “No, there isn’t just one ‘best’ food. You’ve got to try a lot of things.”

Variety is especially important in puppies. It’s clear that we’re seeing more allergy and immune-mediated disease in dogs. It’s now documented in people, too, where it wasn’t so much, say, 10 years ago. In my opinion, one of the biggest contributors to this is the fact that many people put their dogs on one diet for the dog’s entire life. Often, eventually, the dog develops an allergy to the ingredients in that food.

The immune system learns by being exposed to a lot of variety, so I think with puppies in particular we have to start people out right and say “Use variety; don’t pick just one food.”

I’m also now recommending that people give probiotics for the first six months. The data in people are really interesting. Probiotics are kind of my new thing.

There are a couple of really interesting studies where they gave probiotics to infants who came from families with a predisposition to developing atopic dermatitis – eczema. In this study, they gave one group formula and another [group received] formula plus probiotic. There was a 50 percent reduction in the incidence of atopy in the infants fed the probiotics. To me, those are stunning numbers coming from a large clinical trial. They followed the babies out for four years and they still didn’t develop allergy as much. That’s such a discovery.

I think we need to teach people from the beginning about the hygiene hypothesis: don’t be too clean, don’t be too fast to put your puppy on antibiotics for just a couple of little papules, give them a variety of diets. That’s what holistic medicine is, of course: prevention.

So you’re not a diet purist?

Actually, I have a reputation as being anti-raw.

But you are not actually anti-raw …

No! I’m not anti-raw! But because I have told some people they should put their dogs on a commercial diet, some of the diehard raw advocates can’t stand me. I’ve been kicked off some of the raw feeding lists because I won’t make some kind of statement that I’m exclusively for raw feeding.

Here’s the thing: If your dog is not doing well on a home-prepared, raw diet, you need to do something different! I see many people ignoring evidence that is in front of their very eyes, because they believe so strongly that what they are doing with the diet is the “best” – even if their dog looks and feels awful. If it works for your dog, if he looks great, raw feeding is fabulous. But if you come in to my clinic and you are using a raw feeding plan and your dog doesn’t look good, I might tell you to change. That doesn’t mean I am anti-raw.

Frequently, the dog is having a hard time because he’s allergic to something in the diet, but because the client is so convinced they are doing the right thing by feeding a home-prepared, raw diet, they sometimes don’t consider that the dog might be allergic to something in the food. I’ve had patients whose raw-fed dogs had horrible skin conditions, and they spent years trying homeopathy and all sorts of other stuff, when the problem was in the diet all along. That’s upsetting to me.

They couldn’t see the forest for the trees.

Right.

Here’s another problem that seems to arise more frequently among the raw feeders: When we do decide to put a dog with signs of allergy on an elimination diet, we often find there isn’t anything the dog hasn’t eaten that we can use for the elimination trial. Because so many raw feeders are such advocates of feeding variety – and because so many pet food companies now offer novel proteins like duck, rabbit, and venison – we often find ourselves with nothing to use for an elimination diet.

I’ve had to send clients off to get kangaroo or alligator from Oma’s Pride (a frozen, raw food maker) to use in an elimination diet, because the client had at some time or another fed everything else. You have no idea how expensive it is to feed alligator to a German Shepherd! It’s really too bad. So many people are feeding novel proteins, for no good reason. Or mixing the novel meats with common meats.

So your advice to owners is to stay away from novel proteins unless you absolutely have to go there?

Yes, steer clear of the novel proteins unless you are doing an elimination diet. I mean, there is plenty of variety in fish, chicken, beef, venison, turkey, lamb, and pork. Go ahead and use those, and keep back the kangaroo and duck and rabbit for an emergency.

The other part of this is, people also have to learn how to properly construct an elimination diet trial. People come in (to the clinic) and say, “Well, I’ve tried rabbit, I’ve tried duck.” But they tried it while they were still giving the dog pig’s ears and Milk Bones.

That’s a good idea for a WDJ article! I’ll get on that! What are your other pet peeves, things you wish the average dog owner would learn?

That’s the big one. I see a lot of dogs with allergies.

How do you feel about the really far-flung unconventional therapies?

I’ve heard people say, “Well, it can’t hurt.” I have a problem, though, when the treatment delays proper therapy. It’s obviously not an issue if the animal is not uncomfortable, but for me, holistic medicine means the animal has to be comfortable throughout. Medicine is supposed to mitigate pain and discomfort, so that’s the bar I use.

I worry that when people try the really far-out stuff, they tend to run out of hope and money. I’ve seen people give up, saying they’ve tried everything, but all they’ve really tried is the weird stuff.

That reminds me of another pet peeve: When owners get sucked into using just one practitioner, even if that person doesn’t seem to be helping the animal.

Owners need to use second opinions more. You’ve got to remember that whole hammer and nail thing [“If all you have is a hammer, everything looks like a nail”]. It really is all about teamwork now. You can’t just use a homeopath or herbalist or a general practitioner who uses conventional medicine; you have to build a team that can work together and communicate well. It’s hard, but not impossible.

Here’s another article idea for you: Teaching dog owners how to critically evaluate the results of a therapy, whether it’s a diet change or homeopathy or whatever. In my practice, I have written up these visual analogue scales, and defined our outcomes to help owners give us better information about how the dog is doing, such as, “Goes upstairs: Zero means they don’t even try, 100 means they bound up the stairs.” You’ve got to be able to really critically evaluate the outcomes to help us decide what works.

Ah! Evidence-based medicine!

In my opinion, evidence-based medicine is the gold standard to which all medicine, alternative or conventional, should aspire. I mean, case histories and anecdotal evidence are great – for the people involved in the dog’s happy recovery. But they are not as useful as randomized, blind, controlled trials.

How do you feel about animal testing?

I like what the VBMA (Veterinary Botanical Medical Association) has come up with. When we get to the point where we can fund trials (which will be a long time from now), we decided we were not interested in experimental studies using lab animals; they have to be clinical studies on animals that are already sick. Good quality clinical trials can be done. There is no reason to do it any differently, in my opinion.

In herbal medicine it’s a little different. When you’re talking about a drug, an isolated constituent, a nutraceutical – those have not been given for 2,000 years. With herbs, we’ve got a pretty good idea of what they do; it’s not like starting out with something potentially toxic, where you have to start in the test tube and then the lab animal.

In my opinion, clinical trials with animals who are already sick are the be-all, end-all.

In the patients’ homes?

Sure, client-owned pets? It can be done; it has been done!

Some players in the pet food industry are moving in that direction, testing their products in consumers’ homes, or shelters …

Yes, I recently read a study about a food trial with client-owned dogs done by people at the University of Georgia, where they compared two diets. The dogs were mostly vet students’ dogs, or faculty dogs – but still client-owned dogs. It’s been done, it’s easy to do, you just gotta have proper design.

Are the vet schools starting to take more interest in CAM?

Absolutely. And the different schools are coming up with different focus areas, which is appropriate. They have a survey [of holistic veterinary medicine] class at the University of Minnesota, and their program is probably going to be TCM, because of the interests of some of the faculty there. I’m adjunct faculty at University of Georgia, where we offer an introduction to herbal medicine – mostly Western herbs. We don’t have a survey course – the students don’t get exposed to acupuncture and stuff like that. I understand that Tuskegee’s is mostly acupuncture. Florida has a survey class … As the schools work out what they are interested in, I’m sure we’ll get centers of excellence for various modalities.

I’ve heard that on some campuses, some of the faculty are very resistant to classes in CAM being offered.

I’ve only heard this secondhand, from vet students who say they have experienced resistance [about bringing CAM classes to the curriculum]. It’s my guess that the faculty just does not have time to talk about what is good evidence and what is not good evidence.

That’s the gap I try to bridge. I hope my books give the conventional vets enough evidence-based information about alternative medicine that they will consider it when appropriate.

I really didn’t want to become yet another expert for dog owners. I don’t usually talk to the dog magazines – you’re the exception! I decided long ago that the most efficient way to promote evidence-based holistic medicine is to teach as many vets as possible about it. I think the bigger change is going to come from teaching the vets. And that’s what I’m really trying to do.