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Integrative Veterinary Medicine

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Holistic veterinarian, Dr. Chris King, shares a case in which fresh comfrey leaf dressings were instrumental in the successful treatment of an open fracture in a goat kid. This case illustrates integrative veterinary medicine in action. Please enjoy, and move through these slides and short video clips at your own pace.

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Integrative Veterinary Medicine

  1. 1. Integrative Veterinary Medicine Case report: Fresh comfrey leaf dressing for an open fracture in a kid Dr. Christine King Anima Vet, Winston-Salem, NC
  2. 2. Integrative Veterinary Medicine  Patient: Davey, a 3-month-old Nigerian Dwarf kid
  3. 3. Integrative Veterinary Medicine  Patient: Davey, a 3-month-old Nigerian Dwarf kid  Davey got into the horse pasture and was injured by one of the horses
  4. 4. Integrative Veterinary Medicine  Patient: Davey, a 3-month-old Nigerian Dwarf kid  Davey got into the horse pasture and was injured by one of the horses  He was found several hours later, very lame on his left hindlimb
  5. 5. Integrative Veterinary Medicine  Patient: Davey, a 3-month-old Nigerian Dwarf kid  Davey got into the horse pasture and was injured by one of the horses  He was found several hours later, very lame on his left hindlimb  There was a crescent-shaped wound on the outside of the limb, just below the fetlock
  6. 6. Integrative Veterinary Medicine  The next day, the local large-animal veterinarian took radiographs (x-rays) of the limb and found…
  7. 7. Integrative Veterinary Medicine Fracture through the physis (growth plate) of the first phalanx
  8. 8. Integrative Veterinary Medicine Effusion (fluid distention) in the fetlock joint
  9. 9. Integrative Veterinary Medicine Gas (presumably air) in the surrounding tissues, apparently tracking along the flexor and extensor tendons.
  10. 10. Integrative Veterinary Medicine  In summary:
  11. 11. Integrative Veterinary Medicine  In summary: 1. Open physeal fracture – i.e., an open wound overlying a fracture through a physis
  12. 12. Integrative Veterinary Medicine  In summary: 1. Open physeal fracture – i.e., an open wound overlying a fracture through a physis 2. Effusion in the adjacent joint – i.e., potential for septic arthritis (joint infection)
  13. 13. Integrative Veterinary Medicine  In summary: 1. Open physeal fracture – i.e., an open wound overlying a fracture through a physis 2. Effusion in the adjacent joint – i.e., potential for septic arthritis (joint infection) 3. Subcutaneous emphysema – gas (probably air) under the skin, allowing extension of infection beyond the wound
  14. 14. Integrative Veterinary Medicine  The vet started treatment with:
  15. 15. Integrative Veterinary Medicine  The vet started treatment with: o oxytetracycline (a broad-spectrum antibiotic)
  16. 16. Integrative Veterinary Medicine  The vet started treatment with: o oxytetracycline (a broad-spectrum antibiotic) o bandage and wooden splint
  17. 17. Integrative Veterinary Medicine  The vet started treatment with: o oxytetracycline (a broad-spectrum antibiotic) o bandage and wooden splint • As his owners were overseas, Davey was sent to me for ongoing treatment
  18. 18. Integrative Veterinary Medicine  On the next slide is a short video clip of Davey on arrival, before starting integrative treatment…
  19. 19. Integrative Veterinary Medicine  Here’s what the wound looked like the next day (3 ½ days after injury): The entire lower limb was very swollen and the wound was extremely painful to the touch.
  20. 20. Integrative Veterinary Medicine  We treated him with:
  21. 21. Integrative Veterinary Medicine  We treated him with: o antibiotics (continued the oxytetracycline)
  22. 22. Integrative Veterinary Medicine  We treated him with: o antibiotics (continued the oxytetracycline) o pain relief (meloxicam and tramadol)
  23. 23. Integrative Veterinary Medicine  We treated him with: o antibiotics (continued the oxytetracycline) o pain relief (meloxicam and tramadol) o ‘soft-cast’ (modified Robert Jones bandage) instead of the bandage and wooden splint
  24. 24. Integrative Veterinary Medicine  We treated him with: o hoof trim (shorten the hoof on the fractured digit by ~3 mm so that he would be weight-bearing primarily on the uninjured digit)
  25. 25. Integrative Veterinary Medicine  We treated him with: o hoof trim (shorten the hoof on the fractured digit by ~3 mm so that he would be weight-bearing primarily on the uninjured digit) o blend of medicinal herbs to relieve inflammation and support bone and soft tissue repair
  26. 26. Integrative Veterinary Medicine  We treated him with: o hoof trim (shorten the hoof on the fractured digit by ~3 mm so that he would be weight-bearing primarily on the uninjured digit) o blend of medicinal herbs to relieve inflammation and support bone and soft tissue repair o and…
  27. 27. Integrative Veterinary Medicine o comfrey (Symphytum officinale) leaf, picked straight from my garden, as a wound dressing
  28. 28. Integrative Veterinary Medicine  Comfrey leaf:
  29. 29. Integrative Veterinary Medicine  Comfrey leaf: o mildly antiseptic
  30. 30. Integrative Veterinary Medicine  Comfrey leaf: o mildly antiseptic o soothing
  31. 31. Integrative Veterinary Medicine  Comfrey leaf: o mildly antiseptic o soothing o accelerates wound healing (contains allantoin)
  32. 32. Integrative Veterinary Medicine  Comfrey leaf: o facilitates bone repair
  33. 33. Integrative Veterinary Medicine  Comfrey leaf: o facilitates bone repair o comfrey is also known in folk medicine as “boneset” and “knitbone”
  34. 34. Integrative Veterinary Medicine  Comfrey leaf: o facilitates bone repair o comfrey is also known in folk medicine as “boneset” and “knitbone” o its botanical name, Symphytum, is a combination of two Greek words that mean plant and union of bones
  35. 35. Integrative Veterinary Medicine  At each dressing change, I’d:
  36. 36. Integrative Veterinary Medicine  At each dressing change, I’d: o cut a fresh comfrey leaf (small to medium size) and rinse it well under the tap
  37. 37. Integrative Veterinary Medicine  At each dressing change, I’d: o cut a fresh comfrey leaf (small to medium size) and rinse it well under the tap o remove the center rib of the leaf with a paring knife (scissors would also do)
  38. 38. Integrative Veterinary Medicine  At each dressing change, I’d: o cut a fresh comfrey leaf (small to medium size) and rinse it well under the tap o remove the center rib of the leaf with a paring knife (scissors would also do) o lightly crush the two halves of the leaf to open the cuticle on the leaf’s surface
  39. 39. Integrative Veterinary Medicine  At each dressing change, I’d: o lay the two halves of the leaf over the wound such that the wound was completely covered
  40. 40. Integrative Veterinary Medicine  At each dressing change, I’d: o lay the two halves of the leaf over the wound such that the wound was completely covered o reapply the modified Robert Jones bandage directly over the comfrey leaf dressing
  41. 41. Integrative Veterinary Medicine  Given the severity of Davey’s injury, his recovery was remarkable…
  42. 42. Integrative Veterinary Medicine  Given the severity of Davey’s injury, his recovery was remarkable…  Following are photos taken at each dressing change
  43. 43. Integrative Veterinary Medicine Sunday (before comfrey dressing and 3 ½ days after injury) Monday (after 24 hours of fresh comfrey leaf dressing)
  44. 44. Integrative Veterinary Medicine Monday (more views, after 24 hours of comfrey dressing)
  45. 45. Integrative Veterinary Medicine Wednesday (after the second comfrey dressing)
  46. 46. Integrative Veterinary Medicine Thursday (7 days after injury) Saturday (9 days after injury)
  47. 47. Integrative Veterinary Medicine BEFORE (Sunday evening) AFTER (the following Saturday morning)
  48. 48. Integrative Veterinary Medicine  On the next slide is a short video clip of Davey (and Ellie, his companion) 24 hours after starting integrative treatment…
  49. 49. Integrative Veterinary Medicine  To me, integrative veterinary medicine is holistic…
  50. 50. Integrative Veterinary Medicine  ‘Holistic’ medicine means:
  51. 51. Integrative Veterinary Medicine  ‘Holistic’ medicine means: 1. Evaluating and treating the whole patient, not just the diseased part
  52. 52. Integrative Veterinary Medicine  ‘Holistic’ medicine means: 1. Evaluating and treating the whole patient, not just the diseased part  holos: Greek, meaning all or whole
  53. 53. Integrative Veterinary Medicine  ‘Holistic’ medicine means: 1. Evaluating and treating the whole patient, not just the diseased part  holos: Greek, meaning all or whole  we treated Davey’s injured leg, and we supported the rest of his body with…
  54. 54. Integrative Veterinary Medicine  ‘Holistic’ medicine means:  a nutritionally complete diet
  55. 55. Integrative Veterinary Medicine  ‘Holistic’ medicine means:  a nutritionally complete diet  a blend of dried herbs (medicinal and nutritive)
  56. 56. Integrative Veterinary Medicine  ‘Holistic’ medicine means:  a nutritionally complete diet  a blend of dried herbs (medicinal and nutritive)  ‘turnout’ in the yard every afternoon for physical therapy and for extra ‘green pick’ (even though he spent most of the day in a grassy pen)
  57. 57. Integrative Veterinary Medicine  ‘Holistic’ medicine means: 2. Considering the mental and emotional aspects of the patient, not just the physical
  58. 58. Integrative Veterinary Medicine  ‘Holistic’ medicine means: 2. Considering the mental and emotional aspects of the patient, not just the physical  we had the caretaker bring Ellie with Davey for company
  59. 59. Integrative Veterinary Medicine  ‘Holistic’ medicine means: 2. Considering the mental and emotional aspects of the patient, not just the physical  we had the caretaker bring Ellie with Davey for company  we made sure the kids felt safe at night
  60. 60. Integrative Veterinary Medicine  ‘Holistic’ medicine means: 2. Considering the mental and emotional aspects of the patient, not just the physical  we had the caretaker bring Ellie with Davey for company  we made sure the kids felt safe at night  we provided playtime in the yard each day, and…
  61. 61. Integrative Veterinary Medicine  ‘Holistic’ medicine means:  we spent time each day playing with the goats and finding them extra ‘browse’, so …
  62. 62. Integrative Veterinary Medicine  ‘Holistic’ medicine means:  we spent time each day playing with the goats and finding them extra ‘browse’, so …  not everything we did with Davey was painful or unpleasant
  63. 63. Integrative Veterinary Medicine  ‘Holistic’ medicine means: 3. Using all appropriate methods of treatment, both conventional and alternative therapies
  64. 64. Integrative Veterinary Medicine  ‘Holistic’ medicine means: 3. Using all appropriate methods of treatment, both conventional and alternative therapies  we treated the infection with antibiotics and herbs
  65. 65. Integrative Veterinary Medicine  ‘Holistic’ medicine means: 3. Using all appropriate methods of treatment, both conventional and alternative therapies  we treated the infection with antibiotics and herbs  we managed his pain with medications and with the soft-cast, strategic hoof trimming, controlled activity, and herbs
  66. 66. Integrative Veterinary Medicine  ‘Holistic’ medicine means: 3. Using all appropriate methods of treatment, both conventional and alternative therapies  we treated the infection with antibiotics and herbs  we managed his pain with medications and with the soft-cast, strategic hoof trimming, controlled activity, and herbs  and…
  67. 67. Integrative Veterinary Medicine  ‘Holistic’ medicine means:  we encouraged wound healing and fracture repair with:
  68. 68. Integrative Veterinary Medicine  ‘Holistic’ medicine means:  we encouraged wound healing and fracture repair with:  infection control
  69. 69. Integrative Veterinary Medicine  ‘Holistic’ medicine means:  we encouraged wound healing and fracture repair with:  infection control  protective bandage (dressing + soft-cast)
  70. 70. Integrative Veterinary Medicine  ‘Holistic’ medicine means:  we encouraged wound healing and fracture repair with:  infection control  protective bandage (dressing + soft-cast)  controlled activity (rest + supervised exercise)
  71. 71. Integrative Veterinary Medicine  ‘Holistic’ medicine means:  we encouraged wound healing and fracture repair with:  infection control  protective bandage (dressing + soft-cast)  controlled activity (rest + supervised exercise)  comfrey leaf dressings
  72. 72. Integrative Veterinary Medicine  ‘Holistic’ medicine means: 4. Working with the body’s natural processes
  73. 73. Integrative Veterinary Medicine  ‘Holistic’ medicine means: 4. Working with the body’s natural processes  the antibiotics worked with his immune system to resolve the wound infection
  74. 74. Integrative Veterinary Medicine  ‘Holistic’ medicine means: 4. Working with the body’s natural processes  the antibiotics worked with his immune system to resolve the wound infection  the soft-cast and trimming to off-load the injured digit stabilized the fracture while his body repaired the bone
  75. 75. Integrative Veterinary Medicine  ‘Holistic’ medicine means: 4. Working with the body’s natural processes  the antibiotics worked with his immune system to resolve the wound infection  the soft-cast and trimming to off-load the injured digit stabilized the fracture while his body repaired the bone  plus…
  76. 76. Integrative Veterinary Medicine  ‘Holistic’ medicine means:  controlled activity prevented further bone damage while encouraging good blood flow to the injured tissues and to the rest of his growing body
  77. 77. Integrative Veterinary Medicine  ‘Holistic’ medicine means:  controlled activity prevented further bone damage while encouraging good blood flow to the injured tissues and to the rest of his growing body  comfrey helped with infection control and pain relief, and it stimulated wound healing
  78. 78. Integrative Veterinary Medicine  Davey went home 9 days after injury, almost sound on no pain medication, and no longer on antibiotics
  79. 79. Integrative Veterinary Medicine  Davey went home 9 days after injury, almost sound on no pain medication, and no longer on antibiotics  We kept him in a soft-cast for another few days, but when his people couldn’t keep him off the play structure they’d built for the kids, we removed the soft-cast as well
  80. 80. Integrative Veterinary Medicine  Davey went home 9 days after injury, almost sound on no pain medication, and no longer on antibiotics  We kept him in a soft-cast for another few days, but when his people couldn’t keep him off the play structure they’d built for the kids, we removed the soft-cast as well  Davey made a complete recovery, with no signs of angular or flexural limb deformity that can develop quickly with lameness in young animals
  81. 81. Integrative Veterinary Medicine  What medicinal plants do I grow in my garden or wild-harvest from my fields?
  82. 82. Integrative Veterinary Medicine  What medicinal plants do I grow in my garden or wild-harvest from my fields?  Comfrey (Symphytum officinale)  Peony (Paeonia lactiflora)  Echinacea (Echinacea purpurea)  Valerian (Valeriana officinalis)
  83. 83. Integrative Veterinary Medicine  What medicinal plants do I grow in my garden or wild-harvest from my fields?  Hawthorn (Crataegus sp.)  Red clover (Trifolium pratense)  White clover (Trifolium repens)  Plantain (Plantago major)
  84. 84. Integrative Veterinary Medicine  What medicinal plants do I grow in my garden or wild-harvest from my fields?  Raspberry (Rubeus idaeus)  Alfalfa (Medicago sativa)  Aloe vera (Aloe vera)  Dandelion (Taraxacum officinale)
  85. 85. Integrative Veterinary Medicine  What medicinal plants do I grow in my garden or wild-harvest from my fields?  plus thyme, oregano, rosemary, sage, parsley, and other culinary plants that do double duty as medicinal plants
  86. 86. Integrative Veterinary Medicine Echinacea purpurea, or purple coneflower, in full bloom. (I make a tea with the dried flowers when I have a cold.)

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