I just returned from a veterinary convention, focused on horses and athletic injuries. The hope, in attending these meetings is to gain new information, new insights into therapy for our patients. We look to our peers and those at the center of research to give us hope and new options. Given my background over the past few years, being involved in research, I have found myself being more critical of various therapies and actually looking for implementation of new options.
While at this convention, the topic of joint disease and tendon injuries in the horse were paramount as this is a common problem especially in the equine athlete. We discussed technology used in making these diagnoses and reviewed some treatment options. In the end, I walked out somewhat disappointed as the end results in the many cases presented were typical of what we have been seeing for the past 10 years with no change for the patient.
When I graduated from veterinary school, the main technology that we had at that time were 'paper' film x-rays. They were the traditional x-ray, on paper or film, that one could take with them and hold up to a view box to read. The technology was good, but details were missing at times. Ultrasound technology was coming to light while I was in school and soon became a part of clinical practice, helping us to see a little deeper in terms of information and providing more information than we had before. Next to come was MRI and CT capabilities, which had been present in the human spectrum for years, but was working its way into the Universities and now into private practices to be used in the horse and companion patients. Personally, I was quite stunned to hear just how many private practices had this technology at their disposal as it is quite expensive and dictates a very affluent client base.
I find this technology very useful and interesting but I made some observations. First, these new capabilities seem to be replacing the personal approach in some instances. By this I mean that it is quite possible that we are relying on these new diagnostic techniques more instead of using our mind or our hands, evaluating the patient on a personal level. Second, in several cases presented during the conference, it was obvious that this new technology was revealing very early stage degenerative changes in the joints and tendons that were causing significant pain for the patient. These early stage changes were not evident by traditional diagnostic methods and prior to this technology, we would have simply shrugged our shoulders suspecting a soft tissue injury on some level, but not being completely sure. This is a good thing, being able to pinpoint the problems, but is the new information being utilized properly?
Prevention of disease is paramount. There is no denying this fact. The earlier that we can detect a problem, the better or at least that is the way it should be. The problem that I observed is that despite being able to find and localize these problems earlier, therapy options for that patient have not changed. The same old standard approaches were used and often led to the same end results for the patient. What was once an early stage lesion had soon progressed to an advanced problem. Why did that happen? Why didn't we take advantage of the situation and step outside the box, implementing other therapies that might just help?
To me, the biggest issue at hand is ongoing inflammation, which contributes to cellular changes and tissue deterioration. This is a fact and supported by research. It is clear that this problem exists in the horse, especially if they are on a competitive level. We understand and see the changes develop, but yet our course of therapy is not altered. There is so much we could do to intervene potentially and it doesn't have to be complicated nor cost a lot of money.
If we understand the research, we see that nature has provided us options in the form of herbs and overall nutrition. Nutrition is the key to cellular health and functioning. If we provide the proper nutrients, in the form of herbs or other sources, then we might be able to counteract the negative forces acting upon the body. We just might be able to slow the degenerative process by managing inflammation more naturally and restoring cellular health. To me, it is not rocket science, but yet is easily dismissed by the medical and veterinary community.
The reasoning for this is usually that science is lacking or efficacy studies have not been conducted. There is fear of interactions with medications, fear of side effects and a general fear of the unknown. The reality is that there is solid science to support this approach, noting marked positive changes in patients and minimal to no side effects. If there are interactions with medications, they are usually due to similar modes of action, indicating a decreased need for that medication or there is an improvement in health, which then dictates a lack of need for that prescription. The irony is that despite this, clinicians deny the connection, deny the research and rely more on pharmaceuticals to create changes for the patient. They are quick to tell someone to stop using a supplement, even if positive changes are evident.
I guess in the end, it is a matter of 'thinking outside of the box' when it comes to healthcare or veterinary care. I will admit that there are many supplements on the market that make incredible claims and most of them are unsubstantiated, creating false hope. I do understand the skepticism on this level, but we need to realize that we shouldn't generalize and put them all into this group.
We need to realize that with today's changing healthcare society, there are new opportunities to intervene at earlier stages for our patients. This may not include pharmaceuticals, but may just be nutritional changes for that patient. We need to get back to the basics and realize the importance of proper nutrients on overall health and recovery. The results can be incredible and cost very little, creating a better outcome and potentially reducing future health demands.
As a doctor, we were trained to look out for the welfare of our patients and improve their health. Sometimes that means stepping outside of the box and exploring options. If we don't do this but simply rely on pharmaceutical companies and our peers to dictate our options, often accepting failure, then we are not doing our jobs. We do have a choice and I think we can do better for our patients, but it can be a hard concept to accept, especially in the face of pressure to use medications.
Just my thoughts,
Tom Schell, D.V.M.
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