My veterinary practice is focused on promoting your horse's natural capacity to be healthy. I believe the foundation of a holistic approach is that of supporting health as the primary means of fighting disease. A veterinarian's job is to assist the body in achieving balance–in metabolic and musculoskeletal health–and it is this state of balance which allows your horse's body to act as its own doctor!
My practice integrates my veterinary medical training with pre and post–graduate education in specific topics not covered in detail in the veterinary curriculum. My background as a farrier gives me a feet–first way of looking at horses. I have conducted scientific research in the microanatomy of the horse's foot, which yields additional insight into the biology of hoof health. My post-graduate training in chiropractic and acupuncture enhances my approach to musculoskeletal and medical problems, providing safe, effective treatments for many conditions.
With an all–inclusive approach to animal wellness, I am always on the lookout for subtle signs that your horse has some loss of normal homeostasis (the body's natural self–regulation). A common feature in many illnesses is impaired homeostatic function which allows disease to take hold. Imbalance in one area results in compensation elsewhere, setting the stage for further complications. I rarely treat just one thing. Whether your horse has an acute injury or a chronic disease, I will search for a predisposing cause to identify ways to help the horse regain normal balance. I treat each horse with a customized, comprehensive therapy as I have found this approach reduces the chance of subsequent injury or disease.
For each case, from treating sick animals to monitoring healthy performers, I offer a thorough health analysis. This includes attention to environment, lifestyle, emotional or personality issues, diet, and performance. I do not believe there is one best approach or one solution to a problem, but rather there are options for individual horses. By providing you with alternatives, and information you need to make informed decisions, I help you chose the best medicine to meet the needs of you and your horse.
Thus my practice integrates hoof care, musculoskeletal balance, and metabolic health. My academic background has instilled in me a fundamental desire to practice evidence–based medicine. Always asking questions, I examine each clinical protocol that I have learned in my veterinary and post–graduate training. For any given practice, whether its a vaccine or deworming regimen or a surgical procedure, I look into it before recommending it my clients. I ask if the practice or procedure is logical based on what is known about the biology, anatomy, and physiology of our equine friends and the various disease mechanisms and microbial agents that threaten them.
Preface to not so FAQs
I have written these “not-FAQs” to give you some idea about my unconventional approach. To save you time and expense of a first appointment where I explain my approach, reading through these questions and answers should help you decide if you and I might work well together.
Not so FAQs
• Why do you ask not so frequently asked questions?
• What is your approach to veterinary practice?
• What is informed consent?
• What is the horse owner's role in informed consent?
• What is the standard of care?
Why do you ask not so frequently asked questions?
I can't help it! I'm a question-asker! My background before I became a veterinarian includes many years of studying philosophy and social science. My approach to veterinary medicine is informed by my philosophical training. By philosophy I mean the rational investigation of knowledge and clarification of thought. One's philosophy is defined in part by what questions are asked. In my veterinary training I learned many techniques and procedures for diagnosing and treating disease. There were no courses in veterinary school about the philosophy of medical science, approaches to health, or about critical evaluation of standards of care. Yet I always have questions about these topics!
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What is your approach to veterinary practice?
The most widely accepted definition of veterinarian's job is to protect animal health and relieve animal suffering. Beyond that, there are many approaches to veterinary health care. My goal is to help you keep healthy and happy horses. My emphasis is on improving the health your animal's whole body health so he is well equipped to resist disease or lameness. Although trained in veterinary school to diagnose and treat specific diseases, my approach is holistic. By holistic I mean that I diagnose and treat non-specific imbalance as the primary treatment for any disease. Disease causing agents do not in and of themselves “cause” disease! In other words, some weakness, some predisposition in your animal must exist in order for infection, and sometimes even injury to happen. Therefore I will assess the entire horse to identify not just the present injury or disease, but to find out what it is about your horse's body or personality type that predisposed him to the problem. If we can identify this we can sometimes (not always) fix the problem as well as reduce the chance of it happening again.
One of my roles as a veterinarian is to present options, providing you with enough information to allow you to make an informed decision. Once you are familiar with diagnostic and treatment plans, and the costs, risks and benefits of each, you can make choices for your horse.
Horse owners have increasing access to health care information: specific disease treatments to general equine health topics ranging from hoof care to dentistry. Information sources include personal websites, group discussion boards, list servers, and some peer–reviewed journals available online. You may well find information that your veterinarian is not yet aware of! But information itself is not always helpful unless you have the knowledge to apply it. My veterinary medical training, combined with my research background gives me the skill to assess and apply health care information.
For most wellness plans and disease conditions, there are published protocols that serve as guidelines for veterinary practitioners. Most veterinarians strive to remain up–to–date and to provide high quality, scientifically supported treatments. However, it can be challenging to live up to this professed standard when there is little objective evidence to support most of what veterinarians do!
Research has shown that 85% of human medical care is not supported by solid scientific evidence, and that most medical diagnoses are never verified. I would guess these numbers are larger in veterinary medicine. To complicate things, what constitutes “scientific support” is sometimes itself controversial. Many practitioners are too busy to study the scientific literature. There is so much new information being published that it is unrealistic to expect your veterinarian to keep up with everything. Instead, people read abstracts, yet abstracts do not always accurately represent the study. Most practitioners also hear about studies from colleagues (who may only have read the abstract) or drug company representatives who assure busy practitioners that “the research has been done!”
Part of my obligation to you is to inform you of the source of the information I share with you. Just because a veterinarian says something does not automatically make it true. I urge you to ask questions. If I do not know the answers, I have multiple information sources I regard as valid, and will seek out answers for you.
Like any vet, I want the best for your horse. What is best depends on your situation–practical, financial, and emotional. I strive to recognize and honor the relationship between you and your horse, and guide you in making decisions that feel right to you.
With all these factors in mind, I focus closely on a small number of clients, rather than attempting to take care of a large clientele. A low–volume practice allows me to remain accessible to you, and allows me to divide my time between clinical practice and research.
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What is informed consent?
Informed consent is generally understood as a legal concept suggesting that a person understands the facts, risks, benefits, and options surrounding the veterinary care of their animal. No veterinarian deliberately operates without consent. However, there is no simple, objective way to assess informed consent. For something with obvious and well–known risks, such as anesthesia or surgery, written consent is often obtained. Explicit consent is not usually part of routine veterinary services. Dentistry, vaccination, wound care, lameness treatment, de-worming, treatment for infectious disease, or nutritional recommendations are part of the every day work of equine vets. The simple fact that you have hired the vet for their professional services implies that you consent to the treatments recommended for your horse. Yet within the realm of “routine” treatment, there is much controversy, and ideal protocol is not readily obvious. My aim is to help you understand the basics of any controversial issue that is of interest to you.
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What is the horse owner's role in informed consent?
I view informed consent as an educational process. My practice is set up to serve people who want to be involved in the decision making process. You may not have the same knowledge base or practical experience as I do, but you do have the capacity to make rational decisions when provided with the necessary information. If you are seeking to be an active partner in your horses welfare, you are the type of client I wish to work with.
On the other hand you may prefer to leave all decisions up to your vet. Many people are comfortable saying “Whatever he needs doc”, essentially choosing to hand over all responsibility to the vet. If that is your inclination, we may not be the ideal match.
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What is the standard of care?
The standard of care is a legal concept meaning a medical professional is obligated to practice with due caution and appropriate treatments. The standard of care is usually based on scientific understanding of the day and established by what everyone else in the profession is doing. For example in the early 19th century, it was routine practice for surgery to be performed without regard to the principles of sterile technique. As science advanced, a new standard was established. The standard is always changing, and although doctors aspire to practice in keeping with scientific knowledge, there is a wider range of options than have been subject to rigorous scientific scrutiny.
The standard of care is legally what “reasonable” people would agree to. This leaves much room for individual interpretation! As noted above, most of veterinary medicine is not based on published scientific evidence. Treatment is based on custom and tradition. Yet if something appears to work (to relieve suffering, aid healing, increase the comfort and performance of horses) then it strikes many people as common sense to apply such treatments. The mechanism of action may not be understood, or it may not been scientifically investigated, but this is not necessarily a reason to dismiss such treatment. However, you do need to carefully evaluate potential risks.
Given that most treatments would not pass a high level of scientific scrutiny, how do you make choices?
In discussing treatment options with clients, I use a set of principles based on a series of questions about health and disease. (See, more questions!)
1. What did I learn about this in vet school and how has the treatment changed over the years?
2. What is the source of information?
3. If different from the university recommendation, what do other vets tend to recommend?
4. What options–conventional and unconventional–have owners heard about for this condition?
5. In evaluating evidence, are there published studies? Peer–reviewed or not? Are there any controlled clinical trials? Is mechanism of action understood?
6. If studies compared horses treated with different drugs or protocols, was there a control group that did not receive any treatment?
7. If studies declared something safe, over how much time was the study conducted?
8. Does this treatment make sense given our basic science knowledge in anatomy, physiology, and immunology?
9. An important and often neglected question: what are the politics (who benefits, who pays) behind each of the proposed treatment options?
There is little to no scientific evidence to support one treatment protocol over another for most equine conditions, including colic, heaves, laminitis, orthopedic diseases (joint, tendon, ligament injuries), endocrine disease, infectious disease etc. The pharmacology of many recommended medications have not been studied in horses. Nutritional supplements have received limited study. The growing battalion of externally applied treatments (chiropractic, shock wave, light therapy, magnets, mesotherapy) continues to intrigue the curiosity of owners and veterinarians yet solid study is lacking.
While science does not currently support most approaches in equine medicine today, this doesn't mean science should be ignored! I remain involved in research myself and continue to read widely across the veterinary and basic science literature. Even limited scientific studies can offer guidance for developing veterinary protocol. In sum, we have practical experience, logic, and extrapolation from what we know about biology, to what may be plausible mechanisms of action for various treatments. Based on logic applied to each individual case, rational plans can be devised.
As your veterinarian, I will work as an advocate for your horse by helping you become self-educated in the topics that interest you. Following the principle of first, do no harm, I begin with the least invasive diagnostics and treatments that are indicated for your horse's condition. If your horse is sick or injured we will customize a treatment and rehabilitation plan that maximizes healing. If your horse is healthy, we can draw up customized wellness protocol to maintain, and sometimes even improve that level of health. I want you to feel confident that you have made good choices given the reality that much remains unknown.
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