Alternative vs. Complimentary Modalities/Medicine and Choice of Modality

Complimentary vs. Alternative Medicine

This definition is taken from Medline Plus (http://www.nlm.nih.gov/medlineplus/complementaryandintegrativemedicine.html):

“Complementary medicine is used together with mainstream medical care. An example is using acupuncture to help with side effects of cancer treatment. When health care providers and facilities offer both types of care, it is called integrative medicine. Alternative medicine is used instead of mainstream medical care.”

At least in my practice, I prefer to use the term “complimentary” medicine.  I like to clarify this with prospective clients so they understand my “stance” when it comes to the modalities I use and the way I practice.  I don’t believe that acupuncture therapy is a cure for cancer, although some “alternative” veterinarians may claim so.  I do not consider myself an “alternative” veterinarian, or even a “complimentary” one, but I do consider myself a “rehabilitation veterinarian”. The world of rehabilitation medicine is so special and growing in terms of evidence base, that many of us don’t relate to the terms “complimentary” or “alternative” anymore unless we are discussing individual modalities in a layperson sense. It (rehab medicine) is less fringe than many would believe, thanks to human rehabilitation medicine paving our way, although we do have much room to research, publish and explore our treatments and outcomes in the veterinary rehab world.

Modalities and Selecting Them

On initial inquiry, many potential (or current) clients have consulted Dr. Google only to arrive at more questions than answers (this even happens to me when I am researching my own health, hence me consulting with naturopaths and regular physicians). The clients have gathered as much information as they understand, and are prepared to either challenge or propose a therapy based on what they have read or what they think their dog has.

My typical response is to ask, “What is the diagnosis?”, I explain that without an accurate diagnosis (patho-anatomic like what is on an x-ray or functional like what we diagnose as impairments at the joint/tissue or global level), we cannot effectively expect a treatment to work if we cannot choose how to best apply a modality that has some evidence.  Acupuncture has application and evidence in the correct context.  For example, a dog with a mild grade luxation patella (Grade 1) may benefit when “trigger points” (painful nodules in certain muscles) are treated with dry needling, but the acupuncture itself is not necessarily going to correct the problem of the luxation kneecap.  In these instances, we apply multiple modalities to the knee, including – laser, manual therapy, soft tissue therapy, muscle activation, spinal alignment, neuromuscular re-education, activity modification as some examples.  Conversely, dogs with more severe grades (advanced Grade 2, Grade 3 and 4) of luxating patella are more likely to benefit from surgery (acupuncture may help with temporary trigger point issues, but is not going to “fix ” the wobbly kneecap).

As many human physios would tell you, the modalities used in rehab are often limited on their own for the most part, although rehab therapists have our favourites for treating certain things, and we have evidence for treating certain problems with various modalities (electroacupuncture and back pain for example, as I have learned is effective in some cases of mild to moderate chronic degenerative disk disease). As a veterinarian, it is also ethical of me to offer an integrative style of practice, so instead of treating/suggesting only the “alternatives” like electroacupuncture or laser/manual therapy/core stabilization exercises for the back (although these therapies have evidence), I will likely suggest pain control (yes, the dreaded drug, since chronic pain is a concern with chronic back pain, and it is ethical to treat pain effectively once it is characterized). The goal would be to use modalities to keep the drug dose lower or attempt to taper, but pain needs to be managed. The modalities I use really only make up one of many of the tools in my toolkit.  I am not a modalities based practitioner, meaning you won’t visit me and be charged for a specific modality in my current setting (unless it is unique and involves extra prep).  I prefer to instead rely on assessing function (including pain) as it presents itself during each appointment, and selecting the most appropriate/reasonable therapy for that patient on that day.  I appreciate the difficulty clients/potential clients face when wading through the internet so when asked, I aim to inform so as to manage reasoning and expectation.

~This article may not be reproduced without written permission from the author.  Copyright 2015 Dr. Budiselic.  Equilibrium VRC Ltd.

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