VM 720 2008

CRITICAL ASSESSMENT OF COMPLEMENTARY AND ALTERNATIVE MEDICAL (CAM) MODALITIES

 

Course Coordinator and Lecturer: 

  • Narda G. Robinson, DO, DVM, MS, FAAMA
  • Email:  Narda.Robinson@colostate.edu
  • Office Hours:  Call for an appointment
  • Telephone and voice mail:  970-297-4202

 

Additional Lecturer:

 

Who Should Take This Course?

  • Students who want to learn about the CAM approaches that their clients may be considering or already be using, in order to provide honest and factual information about the relative risks and benefits of these treatments.  This is not a “how to practice CAM” course.

 

Course Objectives

 

  • Upon completing this course, students should be able to weigh the pro’s and con’s of CAM treatments and confidently discuss CAM with clients.

 

Schedule

  • Mondays @ 4:10p – 5:00p, ACC Room 118-120, from August 25, 2008 to December 8, 2008.
  • No class meeting on Labor Day – September 1, 2008.
  • No class meeting on Thanksgiving week – November 24, 2008.

 

Resources

  • Reading assignments appear as articles linked to the webpage on the CD.  The articles originally appeared in Veterinary Practice News.  If you have questions or disagree with any of the information or statements contained in these articles, please feel free to email me about them. Sometimes things change since they were first written.

 

Reading Assignments, Quizzes on WebCT, and Quiz Alternatives

 

·                     By the start of class each week (except for the first class meeting), students must complete and submit for grading a 10-question, 10-point, open-notes quiz on WebCT.  The quiz will correspond to the upcoming topic.  Taking the quiz will help prepare you for the upcoming lecture.

 

 YOU HAVE A WEEK TO COMPLETE THE READING AND QUIZ.  TAKE THE QUIZ EARLY IN THE WEEK TO AVOID FAILING THE QUIZ BY FORGETTING TO TAKE IT, GETTING DISTRACTED, OR GETTING SICK.  THERE ARE NO MAKE-UP QUIZZES!

 

If you would prefer to write a 250 word paper on the upcoming topic instead of taking a quiz, you may do so.   These papers need to address an issue of concern to the student that relates to the topic that the quiz would have covered, and needs to cite at least three scientific references.  Papers will be graded out of 10 points, like the quizzes, and are offered as an alternative to taking the quiz.  Due dates for the papers will be by the start of class on the week following the topic.  This alternative is offered either for those who would prefer to explore a topic independently or for those who, for any reason, failed to take the quiz. 

 

QUIZZES OR PAPERS NOT SUBMITTED BY THE DUE DATE WILL BE GRADED “0 OUT OF 10”.

 

 

Grading

  • Pass/Fail (unranked)
  • In order to pass the course, students must achieve a passing grade on the average of all quizzes, or on the average of all quizzes plus papers, or on the average of all papers.  Again, failing to meet the due date for submission of quizzes or papers earns a grade of zero for that item.

 

 

LECTURES AND OBJECTIVES

 

 

Date                              Topic            

 

 

 

August 25                                                                Course Overview and Pre-Quiz

 

Speaker                       Narda G. Robinson, DO, DVM, MS

 

Learning objective:

 

Test your knowledge on the issues we’ll be discussing this semester!

                                      

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September 1 – Labor Day – NO CLASS

Make sure you do the quizzes before the upcoming class each week!

 

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September 8                                                            Veterinary Manual Therapy (including Chiropractic, Osteopathy, and Massage)

 

Speaker                       Kevin Haussler, DVM, DC, PhD

 

Learning objectives:

  1. List four conditions that may weaken the spine or associated structures of an animal and which would comprise potential contraindications to chiropractic (i.e., high-velocity, low-amplitude thrusting).
  2. Name five potential indications for chiropractic as listed by Dr. Kevin Haussler.
  3. Compare the aforementioned indications with those enumerated by Taylor and Romano in Canadian Veterinary Journal.
  4. Be able to list the conditions that constitute an animal chiropractic emergency. 
  5. Know what constitutes an appropriate pre-chiropractic work-up.
  6. Be able to explain to an animal chiropractor that not all neck pain or back pain constitutes a “subluxation” that should receive chiropractic treatment. 
  7. Be able to name two severely negative outcomes that have been associated with upper cervical chiropractic manipulation in humans.
  8. Be familiar with the percentage of companion animal guardians who seek chiropractic for their companions, based on a 2002 AAHA survey.
  9. List four therapeutic goals of soft tissue therapy or massage.
  10. Be familiar with the Upledger Institute and its role in promoting animal craniosacral therapy.
  11. Be able to describe the basic tenets of craniosacral therapy.
  12. Know the findings from Dr. Haussler’s research into the comparative anatomy of human versus non-human skulls, as well as the mobility of the dura, that raises compelling questions about the premises of equine craniosacral therapy.

 

 

 

September 15                                                         Acupuncture

 

Speaker                       Narda G. Robinson, DO, DVM, MS

 

Learning objectives:

  1. Be able to cite at least three conditions for which acupuncture is commonly sought by veterinary clients.
  2. Be able to describe how and when the notion that acupuncture worked by moving invisible “qi” (pronounced “chee”) through invisible meridians arose.
  3. List at least four neural structures that are commonly associated with acupuncture points.
  4. Identify the decade when acupuncture was first applied as the sole anesthetic aid for surgery.
    1. Were politics involved? 
  5. Know why the term “acupuncture anesthesia” inaccurately describes the state that animals or humans enter when they undergo acupuncture during surgery.
  6. Be able to list three potential advantages of using “acupuncture-assisted analgesia” in the peri-operative or pre-procedural period.
  7. Be able to recognize which tissues comprise the “myofascia”.
  8. Know whether myofascial pain is or is not amenable to acupuncture treatment.
  9. Know whether evidence exists supporting the role of acupuncture for spinal (back or neck) pain.
  10. Name three ways in which acupuncture may help patients with chronic back pain.
  11. Know the general location of the acupuncture point called, ST-36, or “Leg-Three-Miles”, or Zusanli point on the human or dog. 
  12. Name three applications or physiologic effects of stimulating ST-36.
  13. Name three changes that acupuncture stimulation induces in humans with keratoconjunctivitis sicca (KCS), according to research.
  14. Be able to describe the general neurophysiologic influences of acupuncture on KCS based on neuroanatomic connections.
  15. Be able to describe the neuroanatomic rationale for treating orofacial pain and facial paralysis (i.e., which nerves are targeted for each respective condition).  Think in terms of which cranial nerves mediate sensation and which control(s) muscles of facial expression.
  16. Know the peripheral nerve with which the acupuncture point PC 6, or Neiguan, most closely relates, and be familiar with the changes in cardiovascular function that occur as a consequence of electroacupuncture applied to this point.

 

 

 

September 22            Herbs, Part I

 

Speaker                       Narda G. Robinson, DO, DVM, MS

 

Learning objectives:

  1. List five herbs that have been used for arthritis.
  2. Be able to describe the mechanism of action of cat’s claw in the treatment of arthritis.
  3. Be able to describe the mechanism of action of avocado/soybean unsaponifiables (ASU’s) in the treatment of arthritis.
  4. Be able to describe the mechanism of action of bromelain in the treatment of arthritis.
  5. List the ways in which polyphenols in yucca may help with arthritis.
  6. What is the dose of l-lysine that reduced viral shedding from the conjunctival fornix in cats latently infected with feline herpesvirus type 1?
  7. List four antioxidant compounds worth considering for supplementation in animals with eye conditions.
  8. Know which two antioxidants occur in the lens as well as in the retina.
  9. Be familiar with the mechanisms in which lutein helps the eye.
  10. Know whether lutein would be considered “safe” or “unsafe”, at least in humans.
  11. Know whether any “insulin-alternatives” (e.g., herbs) have been shown to be as effective or reliable as insulin for the treatment of diabetic patients.
  12. List four quality control issues related to unregulated supplements that may alter (i.e., either increase or decrease) the ability of supplements to influence blood sugar values.
  13. List ten botanical agents that may affect blood sugar levels in animals.
  14. Know whether or not herbal prescribing in pregnant animals requires extra caution.
  15. Be familiar with the type of odor associated with valerian root, so that if you smell this in an animal’s herbal extract or supplement, you will recognize it.
  16. Be able to list four physiologic effects of valerian root.
  17. Describe at least one of the mechanisms of action of valerian root.
  18. Describe two potential adverse effects of valerian and their relative frequency of occurring.

 

 

 

September 29                                                         Herbs, Part II

 

Speaker                       Narda G. Robinson, DO, DVM, MS

 

Learning objectives:

  1. Name at least four herbs used for digestive disorders.
  2. Know which two herbs have been shown to help the non-specific condition of dyspepsia in humans as well as their mechanisms of action.
  3. Know which common Indian spice works as an anti-ulcer herb.
  4. Know the botanical medicine, derived from frankincense, that inhibits leukotriene synthesis and appears to help patients with colitis.
  5. Name the three main categories into which natural flea control approaches fall.
  6. Known which of the three aforementioned categories of natural flea control approaches has the least evidential strength.
  7. Know which two essential oils have demonstrated effectiveness against the ground squirrel flea.
  8. Identify the essential oil that poses well-documented dangers to animal and human health and that has been termed “an herbal toxin of public health importance”.
  9. Know the major features of pennyroyal oil toxicity.
  10. Be able to cite potential adverse effects of neem seed.
  11. Name adverse effects from pyrethrins.
  12. Be able to recognize signs of early intoxication from boric acid.
  13. List three ways that Siberian ginseng (Eleutherococcus sinensis) may influence mammalian physiology that would account for its reputation as an “adaptogen”.
  14. Be able to recognize the Ayurvedic term for boswellia.
  15. Be able to describe the mechanism of action of boswellia insofar as its anti-inflammatory effects.  That is, which limb of the arachidonic acid metabolic pathway does it inhibit?
  16. Know the manner in which boswellia extracts exert immunomodulatory effects.
  17. Be able to describe three ways in which boswellic acids exert in vitro anti-cancer effects.
  18. Be able to describe how ingestion of a high-fat meal alters absorption of boswellic acids in humans.
  19. Be able to cite potential side effects of boswellic acids.
  20. Be able to identify at least one of the main metabolic pathways that may be affected when herbs interfere with drug metabolism.

 

 

 

October 6                    Nutraceuticals, Odd Products, & Controversial Diets

 

Speaker                                                                    Narda G. Robinson, DO, DVM, MS

 

Learning objectives for l-tryptophan:

  1. Be able to name at least two conditions for which l-tryptophan (TRP) may be helpful.
  2. Know the sequence of steps through which TRP forms serotonin.
  3. Know whether low- or high-protein diets promote the entry of TRP into the brain.

Learning objectives for raw meat diets:

  1. Know whether salmonella septicemia from raw diets has been associated with deaths in small animals.
  2. Be able to list at least three sources of raw meat fed to animals.
  3. Be prepared to list at least two major health problems that may occur when a member of the family feeds a raw meat diet to their companion animal(s).  These problems may relate either to the animal’s health or human family members’ health.

Learning objectives for probiotics:

  1. Be able to name seven potentially beneficial attributes of probiotics.
  2. Be able to name the two most intensively studied micro-organisms in probiotics.
  3. Name six properties of a “successful” probiotic.
  4. Describe three concerns related to probiotics that one might need to discuss with clients.

Learning objectives for glandulars:

  1. Know what glandular supplements (a.k.a. “glandulars”) are as far as the animal substances they contain.
  2. Be able to describe the rationale used by advocates of glandular supplements.
  3. Be able to enumerate potential attractions of glandular supplements to non-veterinarians who lack the ability to prescribe medications.
  4. Name the risks associated with glandulars.
  5. Be able to cite the regulations in place ensuring the safety and effectiveness of glandular supplements.

Learning objectives for colloidal silver:

  1. Know how long ago the Dispensary of the United States of America determined that “there is no justification for [the internal use of colloidal silver] either theoretically or practically”.
  2. Know the difference between colloidal silver preparations that contain either higher or lower silver concentrations.
  3. Be able to cite the potential drawbacks (i.e., adverse effects) of colloidal silver.
  4. Know whether colloidal silver can cross the blood-brain barrier.
  5. Know the claims that bacteria are unable to become resistant to silver are true or false.

 

 

October 13                  Dubious Diagnostics

 

Speaker                                                                    Narda G. Robinson, DO, DVM, MS

 

Learning objectives for hair analysis:

  1. Know whether hair analysis can serve as a legitimate diagnostic tool for animal mineral and nutritional deficiencies.
  2. Cite factors that can alter hair mineral concentrations.
  3. Cite reasons why animals should or should not undergo detoxification regimens (which usually involve supplements or chelating agents) based on the results of hair analyses.

 

Learning objectives for allergy testing:

  1. Know the steps involved in testing an animal for allergies by means of surrogate applied kinesiology (AK).
  2. Be able to recognize other forms of AK, such as muscle testing, contact reflex analysis (CRA) and Nambudripad’s Allergy Elimination Technique (NAET).
  3. Know whether electrodermal testing for allergies qualifies as a reliable diagnostic aid for allergies.
  4. Be able to describe the rationale behind bioresonance devices and the strength of the evidence relating to their diagnostic value for allergies.
  5. Be prepared to answer the following question and defend your answer:  “Do these approaches qualify as quackery?”

 

 

October 20                  Massage Therapy

 

Speaker                       Narda G. Robinson, DO, DVM, MS

 

Learning objectives:

  1. Know whether the term “massage” refers to one uniform technique or actually to a plethora of approaches.
  2. Know which type of massage has received the most research attention.
  3. Be familiar with the manner in which the technique called “manual lymph drainage” putatively works to alleviate edema.
  4. Be able to list five local contraindications to massage.
  5. Be familiar with four potential adverse effects resulting from deep massage.
  6. Be familiar with the training standards and licensing for animal massage therapists.
  7. Know how to find out whether massage therapists require direct, on-site supervision, indirect supervision, or no supervision by a veterinarian in order to practice in the state where you will be practicing after graduation.

 

 

October 27                  Homeopathy                    

 

Speaker                       Narda G. Robinson, DO, DVM, MS

 

Learning objectives:

  1. Be able to provide a general explanation for how homeopathy supposedly works.
  2. Know what a “healing crisis” is in homeopathy, and what other problems may be accounting for a worsening “symptom picture”.
  3. Know the definition of a “nosode”.
  4. Know whether homeopathic nosodes provide adequate protection against rabies.
  5. Know whether nosodes provide adequate protection for veterinary patients against parvoviral enteritis.

 

 

November 3                Flower Essences

 

Speakers                     Narda G. Robinson, DO, DVM, MS

 

Learning objectives:

  1. Know the differences between flower essences and essential oils.
  2. Know the name of the individual who first developed flower essence therapy.
  3. Know the rationale behind flower essence therapy.
  4. Know whether flower essence therapy is more designed for psychological or physical imbalances.
  5. Be familiar with the strength of the evidence for flower essence therapy in animals.

                                      

 

 

November 10             Magnets and Lasers

 

Speaker                                                                    Narda G. Robinson, DO, DVM, MS

 

Learning objectives on magnet therapy:

  1. Be familiar with the two main types of magnets and the differences between them.
  2. Know the condition for which the Food and Drug Administration (FDA) approved the use of magnets in 1979.

Learning objectives for laser:

  1. Know what the acronym “LASER” means.
  2. Be able to cite at least three physiologic effects due to low level laser stimulation.

 

 

November 17             Physical Therapy/Rehabilitation

 

Speaker                       Kevin Haussler, DVM, DC, PhD

 

Learning objectives on PT:

  1. List three clinical applications of therapeutic ultrasound.
  2. Name at least five sites over which animals should NOT receive direct ultrasound exposure.
  3. Be able to discuss, as though with a client, the potential negative outcomes of inappropriately applied therapeutic ultrasound.
  4. Name six clinical applications for which physical therapists frequently employ electrical stimulation.
  5. Name three contraindications to locally applied electrical stimulation.
  6. List three aspects of hydrotherapy (underwater treadmills or pools) about which clients should be informed prior to beginning this form of animal rehabilitation.

 

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November 24             NO CLASS:  THANKSGIVING WEEK

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December 1                Prolotherapy & Gold Bead Implants

 

Speaker                                                                    Narda G. Robinson, DO, DVM, MS

                                      

Learning objectives for prolotherapy:

  1. Know what prolotherapy is.
  2. Know the rationale behind prolotherapy.
  3. Know what prolotherapy research demonstrates as far as changes that occur following prolotherapy injections.
  4. Know conditions treated by prolotherapy and why they may respond to injections of this sort.
  5. Be able to recognize substances contained in a prolotherapy injection solution and the rationale for their inclusion.
  6. Know the risks of prolotherapy.
  7. Know the unanswered questions regarding the inclusion of adjunctive therapies when a patient is undergoing a series of prolotherapy treatments.
  8. Know whether a prolotherapy injection is painful.

 

Learning objectives for gold bead implants:

  1. Know what gold bead implantation involves and whether it is safe and/or effective.

 

 

December 8                CAM for cancer

 

Speaker                       Narda G. Robinson, DO, DVM, MS

 

Learning objectives for CAM for cancer patients:

  1. Know whether acupuncture should be avoided in cancer patients.  If so, why?  If not, why?
  2. Know which physical medicine interventions such as massage or chiropractic might be contraindicated (relatively or absolutely) in cancer patients.
  3. Know whether any animal diets have been conclusively shown to prevent cancer.
  4. Know the potential problems of combining herbs with chemotherapy or radiation therapy regimens.
  5. Know the Latin name for bloodroot that appears in black salves used for cancer.
  6. Be able to describe the sequence of events that is said to occur after one applies black salve to a superficial tumor.
  7. Be able to describe the anti-cancer effects of bloodroot.
  8. Be able to describe the potential negative outcomes associated with escharotics.
  9. Know the two other terms for “artemisinin”.
  10. Be able to describe the rationale behind using an antimalarial herb for cancer.
  11. Describe the adverse effects of artemisinin, and the relative vulnerability of dogs to this effect as compared to rats and primates.
  12. Become familiar with the potential benefits of curcumin for patients with cancer.