“I always wanted to be a veterinarian,” Dr. Narda Robinson says, “but it just seemed like too much of a heartbreak.” So she went to medical school, practiced on people for a few years, then finally accepted that “what I really needed to do with my life was work with animals,” she remarks.
On to the School of Veterinary Medicine at Colorado State University she went. After graduating, Dr. Robinson pursued a veterinary career in integrative medicine. It can be particularly helpful for older patients, constituting a form of practice called “integrative geriatrics.” What is that?
The National Institutes of Health define integrative health for people as medical services that bring together conventional and complementary care in a coordinated effort. In plain English, Dr. Robinson says, it means relying on drugs and procedures like operations when necessary but making use of nonpharmacologic, low-cost, high-touch methods to treat patients.
The same approach, says the physician-turned–veterinarian, can apply to dogs. To learn a little more about how she uses integrative medicine for geriatric dogs, we caught up with her for an interview.
Your Dog: What are some of the approaches used in integrative geriatrics for dogs?
Narda Robinson, DO, DVM, MS: There’s acupuncture, massage, physical therapy, laser therapy, and even learning how to palpate [feel] a dog for where there might be tension or pain along the spine or elsewhere on the body.
Your Dog: But can something like acupuncture really have a significant impact?
Dr. Robinson: I had a dog who couldn’t urinate after disc surgery — he was going to be euthanized. His people weren’t going to be able to take home a pet who couldn’t walk and couldn’t relieve himself. Acupuncture restored function in the dog’s nervous system to the point that he was able to rise at will and lift his leg or crouch when necessary. What had happened was that after the procedure, his nerves lost communication with his spinal cord, or there was a loss of communication between nerves and the brain, and acupuncture brought back the needed connection. His nervous system began firing again in a way that restored movement and his ability to pass urine.
We do acupuncture for spinal cord injuries all the time. That one dog is not an isolated example. Acupuncture gets a bad rap because of all the ‘woo woo’ stuff, the idea that sticking needles in dogs or people moves ‘invisible energy.’ But there’s no mystery. Nerve stimulation and connective tissue effects from acupuncture relieve tension and improve blood flow.
Your Dog: How does one separate the ‘woo woo stuff’ from science?
Dr. Robinson: It’s as important to apply the same rigor for evidence about the mechanisms of integrative medicine as it is to apply it to drugs and surgical procedures. People with dogs should be informed about evidence and should not feel shy about asking their veterinarians for it. Folkloric, primitive, mystical explanations are inadequate. In the case of acupuncture, the scientific evidence is strong enough that the American Animal Hospital Association says there is a solid and still growing body of evidence for the use of acupuncture in veterinary medicine ‘to the extent that it is now an accepted treatment modality for all animals.’
Your Dog: What about laser therapy?
Dr. Robinson: The proof for laser therapy isn’t as robust as it is for acupuncture, but it is nonetheless substantial and expanding. Preliminary evidence suggests it may expedite wound repair by inducing a photochemical reaction in cells and increasing production of substances at the molecular level that bring more oxygen to tissues to reduce inflammation. It has also been found to enhance cell proliferation. Veterinarians who use the modality have seen improvements in inflamed tendons and tense muscles that weren’t helped with more traditional therapies. They can talk with clients about the potential of that therapy without overselling it.
At the other end of the spectrum on scientific proof there’s the stuff based on folklore, or myth, with little to no evidence. For instance, there are serious problems with herbal medicine, especially Chinese herbal medicine. There’s so-called certification for Chinese herbal medicine, so someone might think they’re taking their dog to someone who has learned how to apply it. But there’s not enough research on Chinese herbs, even for humans. A vet certified in Chinese herbs may tell you that they eliminate ‘liver wind’ or get rid of ‘dampness in the spleen.’ But there’s no wind in liver; the spleen doesn’t get “damp,” other than that it contains blood.
That doesn’t even get into what’s in the product. There are products that have herbal strychnine in them. How could there be a reason to give an animal herbal strychnine?
Your Dog: It sounds like learning which aspects of integrative medicine may be right for your dog is a bit of a minefield.
Dr. Robinson: Not really. You just shouldn’t be complacent. An assumption that something works is not good enough. Your vet should be able to explain the mechanism, the evidence published in scientific journals, and the strength of that evidence.
Your Dog: Are there other elements of integrative medicine with strong evidence?
Dr. Robinson: Yes. Movement. It’s a more recent recognition in veterinary medicine. I’d say maybe the last 15 years or so, but it’s growing all the time with the onset of animal rehab, physical medicine, and translated results from human physical therapy. Research across the board shows how movement and exercise impact health. There’s now board certification for vets in the fields of rehabilitation and sports medicine.
Movement in integrative medicine has very basic roots. How is a dog doing in an apartment? Is she getting to exercise all her muscles, strengthen her spine, or is she just going on two short walks a day? A dog’s body, like ours, needs physical activity. In this way, integrative medicine has a direct impact on conventional medicine.
Your Dog: How do you mean?
Dr. Robinson: Movement done right can potentially help keep a dog from needing something like knee surgery, commonly referred to as TPLO [tibial plateau-leveling osteotomy]. It can also stave off surgery for a torn cranial cruciate ligament, a dog’s version of a torn ACL [anterior cruciate ligament].
Such surgeries are expensive and involved, with the potential for serious complications and recovery times. But modified movement, in conjunction with anti-inflammatory therapies that might include acupuncture or other modalities, can often keep a dog from requiring an operation. The ability to move is an innate tool a dog already has that can do an amazing amount of work on her behalf. Of course there are times that a surgery shouldn’t be avoided. But adjustments in how a dog moves combined with physical therapy, massage, acupuncture, and other treatments can frequently keep surgery from being the default choice of therapy.
Your Dog: Can integrative medicine be practiced on younger dogs, too?
Dr. Robinson: Dogs tend to develop back problems and other problems that can hinder mobility and contribute to various disease processes later on in life, so integrative medicine takes more of a front seat in the later years. But there’s definitely a role for integrative medicine all the way through a dog’s time with us.
Think about the fact that so much of integrative medicine is about preventing a problem from becoming bigger. Even prevention of obesity through appropriate feeding and exercise patterns is an aspect of integrative medicine that helps preserve a dog’s joints and mobility in later years so she doesn’t need painkillers that can have harsh side effects or perhaps an invasive surgery. What better time to start preventing than when a dog is young?
