Integrative Veterinary Medicine

Integrative Veterinary Medicine
Case report: Fresh comfrey leaf dressing for an open fracture in a kid
Dr. Christine King
Anima Vet, Winston-Salem, NC

 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

 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

 The next day, the local large-animal veterinarian
took radiographs (x-rays) of the limb and found…

Fracture through the physis
(growth plate) of the first phalanx

Effusion (fluid distention) in the
fetlock joint

Gas (presumably air) in the surrounding
tissues, apparently tracking along the flexor
and extensor tendons.

 In summary:

 In summary:
1. Open physeal fracture – i.e., an open wound
overlying a fracture through a physis

 In summary:
2. Effusion in the adjacent joint – i.e., potential
for septic arthritis (joint infection)

 In summary:
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

 The vet started treatment with:

o oxytetracycline (a broad-spectrum antibiotic)

o bandage and wooden splint

o bandage and wooden splint
• As his owners were overseas, Davey was sent
to me for ongoing treatment

 On the next slide is a short video clip of Davey on
arrival, before starting integrative treatment…

 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.

 We treated him with:

o antibiotics (continued the oxytetracycline)

o pain relief (meloxicam and tramadol)

o pain relief (meloxicam and tramadol)
o ‘soft-cast’ (modified Robert Jones bandage)
instead of the bandage and wooden splint

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 blend of medicinal herbs to relieve inflammation
and support bone and soft tissue repair
o and…

o comfrey (Symphytum officinale) leaf, picked
straight from my garden, as a wound dressing

 Comfrey leaf:

 Comfrey leaf:
o mildly antiseptic

 Comfrey leaf:
o mildly antiseptic
o soothing

 Comfrey leaf:
o mildly antiseptic
o soothing
o accelerates wound healing
(contains allantoin)

 Comfrey leaf:
o facilitates bone repair

 Comfrey leaf:
o comfrey is also known
in folk medicine as
“boneset” and “knitbone”

 Comfrey leaf:
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

 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 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

o lay the two halves of the leaf over the wound
such that the wound was completely covered

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

 Given the severity of Davey’s injury, his recovery
was remarkable…

 Given the severity of Davey’s injury, his recovery
was remarkable…
 Following are photos taken at each dressing change

Sunday
(before comfrey dressing
and 3 ½ days after injury)
Monday
(after 24 hours of fresh
comfrey leaf dressing)

Monday (more views, after 24 hours of comfrey dressing)

Wednesday
(after the second comfrey dressing)

Thursday
(7 days after injury)
Saturday
(9 days after injury)

BEFORE
(Sunday evening)
AFTER
(the following Saturday morning)

 On the next slide is a short video clip of Davey (and
Ellie, his companion) 24 hours after starting
integrative treatment…

 To me, integrative veterinary medicine is holistic…

 ‘Holistic’ medicine means:

1. Evaluating and treating the whole patient,
not just the diseased part

 holos: Greek, meaning all or whole

 holos: Greek, meaning all or whole
 we treated Davey’s injured leg, and we supported
the rest of his body with…

 a nutritionally complete diet

 a blend of dried herbs (medicinal and nutritive)

 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)

2. Considering the mental and emotional aspects
of the patient, not just the physical

 we had the caretaker bring Ellie with Davey
for company

for company
 we made sure the kids felt safe at night

for company
 we made sure the kids felt safe at night
 we provided playtime in the yard each day,
and…

 we spent time each day playing with the goats
and finding them extra ‘browse’, so …

 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

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

 we managed his pain with medications and with
the soft-cast, strategic hoof trimming, controlled
activity, and herbs
 and…

 we encouraged wound healing and fracture
repair with:

repair with:
 infection control

repair with:
 protective bandage (dressing + soft-cast)

repair with:
 controlled activity (rest + supervised exercise)

repair with:
 controlled activity (rest + supervised exercise)
 comfrey leaf dressings

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

 the soft-cast and trimming to off-load the
injured digit stabilized the fracture while
his body repaired the bone
 plus…

 controlled activity prevented further bone
damage while encouraging good blood flow
to the injured tissues and to the rest of his
growing body

 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

 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

 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

 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)

 Hawthorn (Crataegus sp.)
 Red clover (Trifolium pratense)
 White clover (Trifolium repens)
 Plantain (Plantago major)

 Raspberry (Rubeus idaeus)
 Alfalfa (Medicago sativa)
 Aloe vera (Aloe vera)
 Dandelion (Taraxacum officinale)

 plus thyme, oregano, rosemary, sage, parsley,
and other culinary plants that do double duty
as medicinal plants

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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