Integrative Medicine Service
Welcome to the Integrative Medicine Service at the UC Davis Veterinary Medical Teaching Hospital. Integrative medicine includes a comprehensive approach to veterinary medicine that complements conventional diagnostic and treatment modalities to optimize clinical outcome. Treatments the service offers include acupuncture and other methods of pain management, palliative care, and physical rehabilitation (which can include rehabilitation following surgery, paralysis rehabilitation, weight loss, and canine athlete injury rehabilitation).
The integrative medicine team works closely with other services in the UC Davis veterinary hospital to identify multidisciplinary treatment opportunities to provide optimal patient outcomes.
Patients of the Integrative Medicine Service are treated in a 1,000-square-foot open treatment area that resembles a gym and two private treatment rooms. The Service’s state-of-the-art equipment includes electric high/low treatment tables, two underwater treadmills, two land-based treadmill, therapeutic exercise equipment, ramp and stairs, and equipment to fabricate thermoplastic orthotics.
Clinical Activities and Procedures
Your initial visit to the Integrative Medicine Service will include a functional evaluation of your animal and its needs, as well as the design of a plan of care to restore, maintain, or enhance its physical fitness and optimize function after injury, surgery, or disability. During the initial visit, an evaluation will be completed and goals for the patient will be addressed and identified. Based on these goals, a treatment plan will be established for the patient. Time permitting, some treatment may be started with the initial evaluation.
This dynamic process is modified with progress, subsequent injury, or other factors that may arise. Clients are an important part of the rehabilitation process and recovery. Treatment frequency and duration varies depending on the individual patient, the cause of disability, and limitations of the caretaker. Physical fitness and activity are important for animals throughout their life spans.
Many different types of patients benefit from treatment with the Service, including a dog recovering from a cranial cruciate ligament tear, an overweight pet, or an older animal that is becoming weak and having trouble rising. Other examples include rehabilitation after an animal has been in a trauma, such as hit by a car or animals that are born with deformities. Physical rehabilitation therapy can also benefit animals as a preconditioning for surgery, as a preventive to help protect and minimize laxity in joints, or for conditioning for athletic events or work.
Acupuncture is offered to dogs, cats and exotic animal patients. It is provided as an adjunctive procedure to both hospitalized patients and outpatients. Acupuncture is part of Traditional Chinese Veterinary Medicine and can be readily integrated into conventional treatment modalities to optimize clinical outcomes. To learn more about acupuncture, please see the Frequently Asked Questions section.
Beyond acupuncture offerings, the pain management program incorporates both traditional medications and complementary modalities, such as cold laser, to find the best pain therapy for an individual patient. Pain control is essential for a patient’s ability to heal and overall quality of life. Therapy is aimed at not only acute pain during hospitalization, but also focusing on chronic pain management at home.
The palliative care program focuses on patients with serious illness ranging from internal medicine, neurologic, and surgical disease to cancer patients undergoing chemotherapy or radiation. Modalities are used to help support the body and treat the symptoms of the diseases or treatments, such as nausea, vomiting, diarrhea, fatigue and insomnia. The main goal is to help owners during this difficult time and incorporate complementary ways to help the patient’s quality of life.
Physical rehabilitation procedures aims to improve healing, minimize pain, build muscle, increase athleticism, and improve overall well-being. Modalities used include low-level laser therapy, therapeutic ultrasound, transcutaneous electronic neuromuscular stimulation, neuromuscular electronic stimulation, shockwave therapy, underwater treadmill, manual therapies and directed exercises. In addition, physical medicine and rehabilitation can assist patients with weight loss, stamina, and increased strength and vitality.
Indications for rehabilitation:
- Pain from injury, surgery or disability
- Soft tissue injuries such as strains, sprains, tendonitis
- Joint injuries, including contractures, arthritis
- Gait abnormalities, lameness, and compensatory movement strategies after injury
- Surgical recovery: orthopedic, soft tissue or neurosurgery
- Geriatric conditions: arthritis, decreased flexibility, decreased strength, muscle spasms, decreased mobility
- Obesity and loss of conditioning
- Strength and conditioning needs of canine athletes and working dogs
- Critical care recovery
Conditions commonly referred for rehabilitation:
- Severe muscle atrophy
- Injuries of the muscles and tendons
- Cruciate ligament surgeries
- Femoral head ostectomy
- Degenerative joint disease
- Hip and elbow dysplasia
- Peripheral nerve injuries
- Spinal cord injuries
- Intervertebral disc disease
- Fibrocartilagenous emboli
Treatment techniques include:
- Manual therapy
- Manual techniques to facilitate or inhibit muscle contractions
- Soft tissue mobilization
- Therapeutic massage
- Modalities for pain, inflammation and swelling
- Therapeutic exercise
- Balance training
- Gait training
- Proprioceptive training
- Strength and conditioning
- Home environment recommendations
- Videotape analysis of movement
- Custom orthotic fabrication
Acupuncture Frequently Asked Questions
- What is acupuncture?
- Veterinary acupuncture is part of Traditional Chinese Veterinary Medicine (TCVM) and has been practiced in China for over 2,000 years and in Korea and Japan for over 1,500 years. In the past 25-30 years there has been a significant increase in the use of acupuncture in animals in Europe and the United States.
Ancient acupuncture identified 361 acupuncture points in humans and 173 in animals. Modern research reveals that acupuncture points are located in areas of the body with a high density of nerve endings, mast cells, small arterioles and lymphatic vessels. Stimulation of acupuncture points results in the body’s release of endorphins, serotonins, and other transmitters. Current research offers strong support of acupuncture’s role in pain relief. Acupuncture’s role in “balancing” the body as a whole and its effects on internal organs is less understood, but continues to be an area of active human and veterinary research.
Acupuncture and TCVM consider the patient as a whole, and approach treatment by caring for all aspects of the individual and not just the diseased or damaged part; hence this theory is often referred to as “holistic”.
- When is acupuncture indicated?
- Clinical evidence indicates that acupuncture therapy can be effective as an adjunctive treatment in a variety of clinical conditions in animals, especially chronic diseases. Acupuncture is most commonly used in pain management, geriatric medicine (or chronic medical conditions), sports medicine (exercise related conditions) and discomfort associated with cancer.
Acupuncture can be effective in reducing or relieving pain associated with osteoarthritis, degenerative joint disease, intervertebral disc disease and abdominal pain.
Geriatric or Chronic Conditions
Geriatric patients may suffer from a variety of chronic conditions that hinder their quality of life. Some of these patients are too weak or compromised to tolerate conventional therapy and acupuncture can provide safe and effective alternative treatment. Acupuncture may be indicated for vestibular diseases, generalized weakness, degenerative joint disease and other chronic musculo-skeletal conditions, skin allergies, inflammatory bowel disease, constipation, diarrhea, asthma, seizure disorders, chronic renal failure and behavioral problems.
High performance animals can suffer exercise related diseases that may benefit from acupuncture therapy. Acupuncture can be used to reduce pain associated with arthritis, tendon/ligament injuries, and muscle soreness.
Cancer patients undergoing chemotherapy or radiation treatments may experience digestive upset, extreme fatigue or general discomfort. Acupuncture can often relieve or lessen some of these side effects and improve a patient’s quality of life.
Patients experiencing terminal illnesses, or struggling with multiple pain issues toward the end of life may find great comfort with acupuncture treatments. Acupuncture can provide relaxation, better quality sleep, improved appetite and decreased pain and anxiety.
- What acupuncture methods are used?
- Treatment involves the placement in the skin of very fine, flexible, sterile, stainless steel needles that measure from 0.5 to 1.5 inches long (some even smaller needles are used for exotic animal pets). Depending on the condition that is being treated, needles will remain in for 10 to 30 minutes. Stimulation of the acupuncture points by needles can be enhanced by rotating the needles, or by attaching electrodes to deliver a very weak current (electroacupuncture). Heating needles with a burning herb (moxabustion) or injecting tiny amounts of vitamin B12 into acupuncture points may be used to treat some conditions.
- How long does a treatment session last and how many sessions will my pet need?
- Each session will last between 30 and 45 minutes. The number of sessions needed depends on the condition being treated. An acute problem may require 1-2 treatments within a week or two, while more chronic conditions may require 4-10 treatments spread over weeks to months. Some patients may be treated at regular intervals to prevent recurrence of degenerative conditions.
- Is acupuncture safe and does it hurt?
- Acupuncture is a very safe procedure when performed by a veterinarian who is certified in acupuncture. The reports of negative side effects are rare in clinical cases.
Acupuncture performed in humans has been described as initially feeling prickly, followed by tingling, warmth or a feeling of heaviness. As with humans, many of our animal patients progressively relax through the session and some even fall asleep.
Acupuncture is contraindicated, or used with caution, with some medical conditions, such as pregnancy, open wounds or severe infection.
Physical Rehabilitation Frequently Asked Questions
- What are the indications for physical rehabilitation?
- If a pet has lost mobility or physical function due to injury, disease, disability or other conditions, your veterinarian may recommend physical rehabilitation to support veterinary medical treatment. The veterinarian addresses the medical issues, and the physical therapist addresses functional concerns.
- What are the benefits of rehabilitation?
- Professionally guided, accelerated recovery from injury
Decreased pain, inflammation and swelling Improved blood flow and optimal healing in the injured area
Improved strength, flexibility, postural control and balance
Prevention of secondary injury
Controlled, early mobilization to limit the effects of disuse
Safe restoration of normal movement patterns
Prevention of muscle atrophy
Earlier and safer return to fun and function
Owner education on home exercise
Communication link for veterinarian and client throughout the rehab process
Positive psychological effects for patient and owner
- Do clients observe or participate in treatment?
- Yes. Clients are always welcome at rehab. We emphasize client education, and a home exercise plan is an important part of each patient's treatment.
- Is rehab painful for my pet?
- On the contrary. Our goal is to decrease pain in our patients. The calm environment of the rehab area with access to a courtyard provides a welcome change for hospital patients. No invasive procedures are performed in this service, and patients are not restrained.
- How many treatments are needed, and how long is each session?
- The length of the treatment program depends on the complexity of the case and the animal's short- and long-term conditioning needs. Treatment may take a matter of weeks or become part of an ongoing health management program. Client involvement in home exercise also plays an essential role in determining the overall length and ultimate success of the rehabilitation. On average, patients spend about one hour per session, though treatments range from 30 minutes to two hours. The length of each session depends on the diagnosis, complexity of condition and techniques used.
- Who performs the rehabilitation treatment?
- A credentialed physical therapist with extensive human and animal experience.
- Do I need a veterinarian’s referral?
- Yes, please. Your veterinarian will inform us first about the medical needs of your pet so that we can address the functional side of your pet's health. A veterinarian from the teaching hospital or your own veterinarian may refer you.
- What kinds of animals come to rehab?
- The majority of patients referred are dogs. However, we also see cats, horses, including foals, sheep, goats, llamas, tortoises, rabbits, ferrets, parrots and raptors.
Ronald Koh, DVM, MS, DACVSMR, CVA, CVCH, CVFT, CCRP, CVMMP
Chief of Service
Roxana Caraballo, DVM, CCRT, CCFT, CVA
Leigh Ann L. Nilsson, BS, RVT, CCRP
Veteriany Rehabilitation Practitioner
Veterinary Assistant and Service Coordinator