In a bit of advertising on his blog, a prominent alternative veterinary medicine advocate recently discussed the case of a 15 year old dog that reportedly had heart disease and dental disease and had come to see this doctor because the client’s regular veterinarian felt the risk of anesthesia for dentistry outweighed the benefits in this patient. Few details are provided, but our hero claims to have determined that the heart condition did not require medication and could be managed with “natural therapies” (which likely means there was a heart murmur but no true heart disease, since there are no “natural” substitutes for real medication when there is real heart disease). The author then claims that he was able to successfully treat the dental disease with “holistic anesthesia,” which left the patient “acting like a puppy again.”
I am certainly a proponent of proper dental care, and I applaud the author for taking the position of mainstream veterinary medicine that proper dental care requires general anesthesia in our pets. This is a more controversial idea in alternative medicine circles than in the profession as a whole. And I certainly oppose the inappropriate use of potent heart medications, which sounds like it may have occurred in this case. However, the core message of this article seems to be that conventional doctors are inappropriately frightened by anesthesia in older pets and that such anesthesia can be done more safely if it is “holistic.” Having never heard the term “holistic anesthesia” before, I was curious what it might mean and whether there is any evidence that it is safer than conventional anesthetic practices.
As I have already discussed previously, “holistic” is one of those vacuous marketing terms that means whatever the speaker wants it to mean or nothing at all, like “natural” or “integrative.” I suspected the phrase “holistic anesthesia” simply meant ordinary anesthesia with some herbs, homeopathy, acupuncture, or other unproven or bogus methods added on and then falsely promoted as somehow safer than conventional anesthetic practices. And, that is pretty much what I found, though I was surprised that it is also sometimes used to refer to practices indistinguishable from conventional anesthetic methods.
The author of the heartwarming story about the old poodle advertises his “holistic” approach to anesthesia this way on his web site:
No More Anesthetic Worries
Surgery can be scary, and we know that you may be a bit nervous about anesthesia. That’s why your pet will receive a comprehensive physical examination prior to every surgery. Blood and urine tests will also be done when needed to minimize the risk associated with anesthesia. And to keep your pet’s chances of anesthetic complications to a minimum, we only use isoflurane gas. It’s a bit more expensive, but it’s the safest anesthetic available.
Your pet is also monitored by a veterinary assistant and 3 monitoring machines which monitors: respiratory rate, heart rate, pulse oximetry and body temperature.
No surgery is routine at [We Make Stuff Up] Animal Hospital. You want the best for your pet, and so do we! And for those owners who are a bit nervous about anesthesia, or who wish to minimize anesthetic complications in their pets, we offer holistic anesthesia to allow for a safer procedure and quicker recovery time.
Wow! What a radical departure from conventional anesthetic practices! Who would have thought of doing a physical examination or laboratory tests before anesthesia, using the cutting edge isoflurane gas anesthetic, monitoring the patient under anesthesia, or treating each patient as a unique individual? Oh, wait…How about EVERYBODY!!! Ok, maybe not everybody, since there are undoubtedly some incompetent veterinarians in practice. But these practices are standard in conventional veterinary medicine and have been since I went to vet school over a decade ago. To advertise them as if they were somehow superior, “holistic” practices is deceitful rubbish, purely marketing driven. Is this really all there is to “holistic anesthesia?” Well, there might be a bit more to it.
The rich mine of nonsense that is the American Holistic Veterinary Medical Association (AHVMA) web site provides two articles from the AHVMA “journal” that go into a bit more detail.
Winter, W. Holistic anesthesia and surgery Part 1. Journal of the American Holistic Veterinary Medical Association 1999;18(2):33-36.
Winter, W. Holistic anesthesia and surgery Part 2. Journal of the American Holistic Veterinary Medical Association 1999;18(3):19-23.
The tone of these articles is unremittingly arrogant, self-aggrandizing, and hostile to conventional veterinary medicine, and the information provided is entirely opinion, with no effort to support any assertions with scientific evidence. For example:
When you need it, surgery is good. It is one of the two only good things going for allopaths. When used properly, modern equipment, drugs, and techniques are approaching the sacred, magical healing we see in Shamanism.
We holistic types get to use surgery too, but there are things we have to take into consideration if we want to claim it as a holistic modality (God, I love using the word “modality”). Sometimes it really is a pain to have a conscience. It is that weight we feel once we are “enlightened.”
Now, the article is twelve years old and written by a now-retired 1975 veterinary school graduate. So one can reasonably argue that it is not representative of what contemporary AHVMA members and other self-proclaimed “holistic” practitioners believe. However, it is the only published discussion of “holistic anesthesia” in the veterinary field, and it shares with the blog article mentioned above both the underlying tone and the absence of any reference to objective scientific evidence. Without some clearer definition of what is meant by “holistic anesthesia,” and without a specific repudiation on the part of the AHVMA and individual members, one might reasonably assume that the principles articulated here are still accepted by proponents of this purported special anesthetic approach.
The first claim Dr. Winter makes about “holistic” surgery and anesthesia is that many of the procedures conventional veterinarians perform are, or should be, unnecessary once the conditions that necessitate them are prevented or successfully treated with alternative methods. Prevention is certainly preferable to treatment of almost any disease, and contrary to the mythology and advertising of alternative medicine, this is an accepted principle in all veterinary medicine. Similarly, he goes on to claim that it is “holistic” to do the safest, least invasive procedure that will yield the desired outcome and that the cost of the procedure and overall condition of the patient should be considered. This is about as radical and unconventional line of thought as the advertising cited above, which is to say it is banal and universally accepted.
Dr. Winter then describes his preoperative routine. Interestingly, he specifically recommends avoiding alternative therapies before anesthetics, though not for the reason you might expect:
Rescue Remedy can be used preop but should be used sparingly as it may interfere with anesthesia. The same is definitely true of using Arnica pre-op. I never give it immediately before surgery. Since anesthetics are “toxic,” many of the good herbs, homeopathics, and flower essences are contraindicated. More anesthetic will be required and the animal will wake up too soon. Use these fine medicines later, after surgery.
Ah, so the “good” natural remedies interfere with the “toxic” anesthetics, so a holistic anesthetic approach should begin with only the same poisons conventional veterinarians employ for anesthesia. Hmm…
He then goes on with some more radical and counterculture notions such as reading the patient’s record and studying the specific procedure before performing it, referring cases beyond one’s expertise to specialists, trying to avoid interrupting surgical procedures, and so on. All revelations to most veterinary surgeons, no doubt. However, Dr. Winter does introduce a few concepts I will admit to not having been taught in vet school:
Surgeries also should be done in the morning to catch the best biorhythms… The holistic surgeon is always aware of moods, the overall feeling of the day, and whether it is a “good surgery day” or a “bad surgery day.” If the feeling of the staff, room or schedule feels off, it is much better to take a break, regroup, and reconsider the pace. In the worst case scenario, stop for the day and reschedule.
Good and true holistic clients will totally understand and even be grateful. I have also learned to read the body language and the words of each client as they bring in their animal for surgery. If you perceive any negativity, especially hostility or an ominous premonition, sit right down with them and talk about alternatives. Don’t cut on an animal if the owner is against you; it is very powerful and should be honored.
I have learned to benefit from cleansing the surgical rooms psychically and spiritually using smudges, candles, herbs, and other processes.
I will admit, it hasn’t occurred to me to cancel surgery if the staff or owner happen to be in a bad mood or to cleanse the surgical room psychically with incense to improve the safety of anesthetic and surgical procedures. Something to think about.
The bulk of the discussion of anesthesia per se emphasizes the use of injectable anesthetics and avoiding gas anesthetics, which he describes as “part of an expensive racket.” He also emphasizes speed above all other considerations in reducing surgical and anesthetic risks. These are opinions, mostly without scientific justification, that say more about the era in which the author was trained than about anything uniquely “holistic,” and I suspect they are not widely held by contemporary alternative practitioners. The same is likely true for the outdated sterile technique advice, the belief that pain should be largely left untreated because it forces the patient to “rest” and thus aids healing, and much of the other “Common Man technology” and techniques Dr. Winter recommends. However, what is common to these articles and the writing of younger advocates of “holistic” medicine is the blithe reliance on individual opinion and experience as a justification for pronouncements about what is or is not safe and effective care, the lack of interest in scientific evidence, and the continual derogation of conventional veterinary medicine.
Of course, in order to make so-called “holistic anesthesia” detectably different from conventional anesthesia, it is necessary to add a variety of unproven therapies to the usual treatment, and Dr. Winter certainly does this. Needless to say, he provides no evidence whatsoever to justify these practices:
I augment the natural raw diet, which we have discussed in other articles or which can be found in Dr. Pitcairn’s book, with extra chopped greens every day and bits of raw liver, 1-5 raw eggs (with shell)/ week helps too. For minerals I use Vitamineral Mix (see Pitcairn) varying from 1/2 teaspoon to several tablespoons daily and especially sea kelp, 1/8-1/2 teaspoon daily. I add Vitamin C, 1000mg/day for a cat and up to three times that amount for a large dog, and Vitamin E, 400 iu/week for a cat amd up to 400 iu/day for a large dog. My personal favorite herb for bone healing is Comfrey and I usually use dried herb added to the food. Herb books list many other bone setting herbs that will work as well. Continue all supplements for several months after healing. This diet and supplement regimen should be used in all trauma cases regardless of type of fixation. I also add specific homeopathics, flower essences, sometimes acupuncture, and sometimes magnets, depending upon the case…
Herbal medicine is at its zenith when it comes to wound dressing. Who has not applied Aloe Vera to a wound? It is satisfying, it soothes, the client loves it (usually), and it works. I have a veterinary book, out of print now, by Richard Holliday, DVM, which shows hundreds of pictures of wounds allowed to heal open, naturally with some debridement and with Aloe Vera. I have used the book and its pictures many times to convince an owner that natural healing will really work.
After all, who needs clinical research when you have pictures to prove something works?
Finally, Dr. Winter provides some marvelous examples of cognitive dissonance and the misunderstood, even persecuted attitude that often characterizes the writing of those promoting approaches widely believed to be nonsense. Like so much else in these articles, of course, this is not uniquely “holistic,” but it does reveal the nature of a perspective completely immune to evidence or any possibility that the author might be mistaken.
In closing, there is a problem with all that I have just said, and it applies equally to all holistic services. That is when things do not work out in a rapid, linear, positive manner with full healing. It will not take long for some owners (or did they all come to me and me alone?) to go to another non-holistic vet who will assure them that had they chosen any other option than the one you did, the animal would have healed perfectly! I call this Double Jeopardy, because you can be a loser either way. If you are afraid to try natural healing, you lose because you can never be brave enough to be holistic, but if you try it, and for whatever reason (almost always due to bad owner post-op care, not you) there is a problem, you will be the scum of the universe. You have to follow your heart here. Holistic medicine is not for the cowardly and the weak…
Other vets are very threatened by this simple healing style, primarily because they have never tried it and they may truly think you are crazy. I know from firsthand experience that they will often report you to State Boards for being incompetent if they get involved with a case you are healing this way, so be careful. Stitching or bandaging some wounds strictly for legal reasons could be considered holistic too. We live in a crazy world.
So if it doesn’t get better, it’s not your fault it’s probably the owner’s. But other veterinarians are likely to blame the bad outcome on your idiosyncratic and unconventional techniques (while, of course, holistic veterinarians would never claim that bad outcomes are the result of conventional medical practices and that they could have been avoided if the owner had followed a superior holistic technique). Other vets only object, of course, because they don’t understand, they haven’t tried your methods themselves, or they are “threatened.” So you have to follow your heart regardless of the apparent outcome of the evidence, though if legally threatened it can be “holistic” to do something incompatible with what you really believe is the best care.
“Holistic anesthesia” is a meaningless, “feel-good” marketing term. In many cases, it is simply a rebranding of conventional anesthetic and surgical practices. In others, it is the addition of bogus or unproven alternative therapies to conventional care, with the credit for good results always going to the alternative methods and the blame for bad results always attributed to the conventional drugs or procedures. The use of the term, however, is a warning sign of a philosophical approach fundamentally hostile to science and scientific evidence and willing to alternative approaches by means of denigrating conventional medicine regardless of the lack of evidence to support claims of superior safety and efficacy.