However, SARS-CoV-2 does not have this same effect. It does not cause Covid-19 in most people. The disease results from an inappropriate immune response from an imbalance in the body. The result can be pneumonia, cytokine storm and respiratory failure.

Covid is very similar to FIP. Most people and pets that are exposed to these coronaviruses do not even get sick. This has been studied intensively for many decades by veterinary scientists such as Dr. Niels Pedersen at UC Davis in CA.

Scientists can learn from Dr. Pedersen who has been curing FIP with a remdesevir-like antiviral for many years.

This is a critical time in history and we can use OH-based science to improve the outcome and to decrease our fear of the unknown.

Pets, people and the planet are inter-connected.

This series of short blogs is based on this relationship. It is called the One Health between all living beings and the world in which we live.

This way of looking at life, or paradigm, helps scientists use research from one field of study in another.

Here’s a quote from the One Health roadmap to health:

“The current fragmented framework of health governance for humans, animals and environment, together with the conventional linear approach to solving current health problems, is failing to meet today’s health challenges and is proving unsustainable. Advances in healthcare depend increasingly on intensive interventions, technological developments and expensive pharmaceuticals. The disconnect grows between human health, animal health and environmental and ecosystems health. Human development gains have come with often unrecognized negative externalities affecting ecosystems. Deterioration in biodiversity and ecosystem services threatens to reverse the health gains of the last century. A paradigm shift is urgently required to de-sectoralize human, animal, plant and ecosystem health and to take a more integrated approach to health, One Health (OH).“

2020 is the year when OH can help doctors focus on the balance between science, nature and healing to help everyone survive and thrive.

This article is part of the series of Vitality and Balance related articles. If you enjoyed it, consider reading these posts: “Fatal Viruses And One Health” and “Internal Balance & Covid“.

Have you ever had an intuitive sense that your pet is sick, but your vet says that your pet is fine because the exam and tests are all normal.

Regardless, you know that something’s wrong.

Pet parents know their companions better than anyone, and can sense the earliest stage of dis-ease.

Holistic veterinarians, “believe” that they may be detecting a subtle energetic imbalance.

Internal balance is the ability to maintain a relatively stable internal state, also called homeostasis or equilibrium, that persists despite changes in the world outside.

Now is the best time in history to learn more about balance because staying balanced helps pets and people stay healthy and at ease.

Imbalance, or dis-ease worsens resistance to germs like viruses.

For example, scientists are discovering that internal imbalance predisposes people to get sick from the coronavirus.

Sophisticated science is able to describe the genetic, molecular, and cellular factors that make up balance. Here is a recent research article describing how it seems that the individual, or “host”, response to the virus causes severe symptoms, including cytokine storm.

Be on the lookout for the next articles that dive a little deeper into exactly what it is about balance that helps keep pets and people healthy.

 Significance of Signs, Symptoms, mTor, and Quality of Life

By Jeff Feinman, VMD

Used with permission of the Journal of the American Holistic Veterinary Medical Association (JAHVMA)
Article first appeared in Volume 56, Fall Issue, 2019

Abbreviations

• BEAM – Behavior, Energy, Appetite, “Mood”
• LOL – Length of life
• MPS – Muscle protein synthesis
• mTOR – Mechanistic/mammalian target of rapamycin
• n-3 PUFA – n-3 polyunsaturated fatty acids
• QOL – Quality of life

Abstract

This paper discusses the correlation of objective signs and subjective symptoms with energy level in the patient. Signs, symptoms, and energy level are primarily responsible for vitality and quality of life (QOL). The subjective and observable biomarkers of behavior, energy, appetite, and mood (BEAM), as well as objective biomarkers, can be used by both veterinarians and clients throughout a pet’s life to assess and monitor QOL. Patient signs and symptoms can reflect fluctuations inmolecular mechanisms of mitochondrial function, energy production, and the molecular biomarker mammalian/mechanistic target of rapamycin (mTOR) that affect patient homeostasis, energy balance, quality of life (QOL), and length of life (LOL). The author postulates that holistically treating patients using BEAM, instead of treating animals with the goal to eliminate individual symptoms, can maintain and improve their QOL and extend LOL.

Introduction

Quality of life (QOL) is important to consider throughout life, but the use of QOL assessments is often limited to patients with serious diseases and to assist with the difficult decision of euthanasia (1, 2). This author suggests that patient lives can be improved and prolonged if, instead of just treating individual symptoms, veterinarians also perform QOL assessments (3). The importance of considering patient QOL increases as life-limiting and serious chronic diseases continue to rise (4–6).

Quality of life (QOL)

For multiple reasons, the ability to measure the quality of life in animals is challenging. The widely accepted World Health Organization definition of QOL for humans is not appropriate for use in domestic species because of its reference to culture and values. The QOL surveys, in addition to being lengthy, cannot be applied directly to veterinary patients because many of the questions are based on the World Health Organization’s definition of QOL (7). 

For the purpose of this article, the Farm Animal Welfare Council’s definition of QOL in relation to the lifestyle of livestock is used, as it is similar to that of companion animal QOL: the ability to live a full life, free of physical, mental, and emotional restrictions, such as pain, senility, and fear (8). 

Signs and Symptoms as Biomarkers That Can Be Used to Assess QOL

Behavior, energy, appetite, and mood (BEAM) are 4 symptoms that seem to be clinically sensitive, though not specific, reflections of physiologic homeostasis and QOL (9, 10). BEAM symptoms include behaviors like separation anxiety, fears, phobias, and aggression; cellular energy is reflected by changes in activity, such as getting up to greet people or length of walks; appetite symptoms may present as slower or pickier eating habits; mood, the most subjective part of BEAM, may include the pet spending more time alone or barking more frequently. The same BEAM symptoms may have different underlying causes. 

Veterinarians primarily use quantitative biochemical measurements such as blood chemistry parameters as biomarkers that reflect physiologic function. Diagnostic testing of hematocrit, albumin, and serum alkaline phosphatase, for example, are excellent indicators. In addition to allowing evaluation of objective test results, subjective biomarkers such as body condition and BEAM can also be used to assess physiologic function, disease progression, response to treatment, and treatment efficacy, and can inform medical decisions (11, 12). BEAM symptoms are sensitive biomarkers that can indicate internal abnormalities before a specific diagnosis can be made. These subjective symptoms can quickly provide caregivers with information about the energy balance and QOL of their pets (12, 13). As a reflection of the internal balance of the patient, BEAM can be used to monitor and maintain a patient’s QOL. Like other biomarkers, BEAM symptoms can change quickly in response to pain or other physiologic fluctuations, like when a previously insatiable pet becomes finicky or skips a meal, and when an ordinarily active pet starts sleeping more or becomes less interactive (14–16). 

While client-reported observations, like symptoms and QOL, are viewed as “soft” outcomes by some clinicians and researchers, a growing body of evidence shows that these subjective measures are strong predictors of a patient’s response to treatment (17). Clinicians and researchers can improve their diagnostic acumen, provide patients with effective evidence-based symptom management, and make timely QOL interventions when they consider BEAM and other subjective assessments along with conventional objective biomarkers (16). 

QOL, Significance of Symptoms, and mTOR

Optimal mitochondrial function and energy production help maintain QOL while maximizing length of life (LOL) (18). Mitochondrial function is associated with an important kinase enzyme, mechanistic/mammalian target of rapamycin (mTOR). The mTOR protein is part of a signaling pathway that affects aging and is associated with canine longevity (19–21). mTOR is associated with function of cellular receptors that sense environmental cues, such as whether a cell is getting sufficient nutrition (22, 23). Chronic diseases associated with disrupted mTOR signaling are increasing, including type 2 diabetes, obesity, metabolic syndrome, and several types of cancer (24). In humans, there is growing evidence to support that energy balance and mTOR play a critical role in the QOL for patients with diseases like cancer (25). 

The mTOR gene and the serine/threonine kinase enzyme it codes for are critical for life and are highly evolutionarily conserved (26). The mTOR enzyme helps control cell growth and metabolism, is activated in response to changes in the environment, and positively regulates anabolic processes such as transcription, protein synthesis, and mitochondrial metabolism (26). At the same time, mTOR negatively regulates catabolic processes, such as mRNA degradation, ubiquitin-dependent proteolysis, autophagy, apoptosis, and growth factors like insulin and insulin-like growth factor (27). In good conditions, mTor signals cells to grow and reproduce; in times of stress, it shuts down reproduction and makes cells stress-resistant so they will live longer. 

The mTOR pathway is one of the underlying molecular mechanisms that connects energy, symptoms, muscle protein synthesis (MPS), vitality, and QOL by integrating signals from growth factors, nutrients, mutagens, and hormones. For example, upregulation of the mTOR pathway induces cell proliferation and inhibits apoptosis and autophagy (26). Basic research into mTOR and mitochondrial function can be applied to clinical medicine and used to optimize QOL as well as LOL. 

Symptoms such as behavior can be indicative of changes in cellular and physiological functions in response to insufficient energy for cellular processes and genetically- encoded molecular mechanisms (28). For example, in humans, there is a direct relationship between mitochondrial function and chronic fatigue syndrome (29). The symptoms that define QOL are all dependent on the cellular energy required for the optimal function of molecular pathways and organ systems. These processes depend on and consume energy in the form of ATP. The conservation of cellular energy like ATP is an important factor for the maintenance of homeostasis and good QOL in older animals. Frequent client monitoring of symptoms such as BEAM proactively can help QOL and LOL. 

Muscle mass and MPS are other important biomarkers controlled by cellular energy and molecular mechanisms (30). Weakness in older patients is often due to sarcopenia secondary to insufficient energy required for the translation of proteins into muscles (31). Energy is critical because the most energy consuming process in the body is the translation of proteins by processes such as MPS (32–34). Other factors that contribute to sarcopenia and require sufficient cellular energy include, but are not limited to, activity level, nutrition, chronic inflammation, DNA damage, elevated oxidative stress, mitochondrial dysfunction, and changes in hormonal milieu (27). Albumin and HCT are biomarkers that reflect alterations in homeostasis and fluctuations of cellular energy; it follows that a decrease in these biomarkers can be associated with sarcopenia (35). These internal biochemical signs can supplement the externally visible, subjective symptom biomarkers such as body condition score to predict early problems and monitor changes over time. 

By appreciating the importance of mTOR-associated symptoms and QOL, veterinarians can make appropriate dietary recommendations (26). For example, muscle mass is controlled by MPS; as it decreases with age, mobility may decrease, and frailty increases. Sarcopenia has been shown to significantly decrease QOL of older people (36). In addition to preventing muscle loss by meeting nutritional needs, lifelong conservation of cellular energy by working with already activated molecular mechanisms reduces energy – consuming translation of new proteins to improve physiological function and QOL (32). 

Nutritional modifications that affect mTOR, translation, and subsequently sarcopenia include increasing protein intake and nutrients, such as amino acids and fish oils that improve MPS. Other examples of the impact nutrition can have on mTOR activity include the improvement in athletic performance and ATP levels in athletes who eat beets and use supplements, such as omega-3 fatty acids and other polyunsaturated fatty acids. Fish oil-derived n-3 polyunsaturated fatty acids (n-3 PUFA) have been shown to decrease sarcopenia and increase MPS (37). Fish oil supplementation in people results in a detectable increase in skeletal muscle n-3 PUFA that causes positive changes in anabolic signaling molecules like mTOR (37). One potential mechanism of action is that the n-3 PUFA in fish oils enhances mTORC- p70S6K1 phosphorylation (38). It has also been shown that sirtuin-1, which regulates energy efficiency during caloric restriction, inhibits mTOR in dogs and people in response to cellular stress (39, 40). Wasted, debilitated, and sarcopenic patients are just one example of the connection between mTor, symptoms, and QOL. 

Medications as Consumers of Cellular Energy

Symptoms of abnormal physiologic function are secondary to disequilibrium often associated with insufficient energy to maintain equilibrium and normal function. The way that symptoms are treated has a direct effect on internal balance, symptoms, vitality, and QOL. Over the past 60 years, many medical innovations based in genetics and molecular medicine have facilitated the development of pharmaceuticals that target specific molecular mechanisms. Despite this “precision” medicine, over the past 3 decades there has been an increase in the prevalence of several common, yet preventable, diseases among companion animals that mirror the increase of similar diseases in humans (40). The increase of these avoidable common health conditions is of particular concern in dogs and cats because many have a negative effect on QOL (41).

Medications that are used to manipulate physiologic functions often have unintended effects that utilize further cellular energy (42, 43). Cellular energy is decreased when there is opposition to innate molecular mechanisms. Treatments that work against molecular mechanisms cause an increase in disease by increasing internal imbalance and decreasing available energy, vitality, and QOL (44). Treatments that oppose normal function can decrease QOL because while alleviating 1 set of symptoms, they promote other, more chronic ones. For example, this is seen in cases of nephritis secondary to treatment with carprofen after an injury. The production of novel translation products, such as anti-inflammatory proteins, requires additional cellular energy that could be conserved with treatments that work with existing translation products, such as the proteins used during the inflammatory response (45). By definition, anti-pathic treatments work by activating novel enzyme systems that utilize cellular energy for protein synthesis. The longer the duration of drug treatment and the higher the dose, the greater the chance of undesirable effects and problems that lead to prescription of other medications (46). In addition, drug dosing commonly ignores the context of individual variability manifesting as symptoms, or diagnoses, which include factors such as age, organ function, and prior drug adverse effects.

Drugs that target specific processes can be useful in acute situations or to support body functions, such as the use of pimobendan for dogs with heart disease. However, as mentioned previously, cellular energy can be decreased by drugs that activate novel cellular processes and the mTOR system, thereby preventing some patients from getting better with drugs alone. When drug intervention alone fails, vitality and energy-building lifestyle modifications, such as fresher diets and increased exercise, can improve the QOL for many patients. 

Signs and symptoms result from the dynamic fluctuation of physiologic processes and the molecular mecha- nisms that cause them. Maintaining homeostasis is the body’s best defense from infection and environmental stress. Medications that modify symptoms may have short-term benefits, but they usually alter self-healing and self-regulating functions in some way (47). In addition, lifestyle errors, such as inadequate diet and prior symptom manipulation, cause a decrease in QOL. To improve health and cure chronic disease, the whole life and its quality must be improved, which probably requires more than drugs. 

The author postulates that manipulating symptoms not only lowers cellular energy, but also contributes to the increasing incidence of chronic diseases and cancer. Chronic diseases may be decreased by working with the body, rather than opposing it, by using homeopathy- thy, Ayurveda, or Traditional Chinese Veterinary Medicine (48, 49). The Vitality and Balance System, introduced previously, enables veterinarians to maintain a patient’s dynamic equilibrium and QOL by integrating conventional, physiologic-based veterinary medicine with homeopathy to help the veterinarian preserve a patient’s internal vitality and energy required for wellness and QOL (50).

Energy Conservation, Cancer, BEAM, and QOL

Patients with cancer provide an important example of the association between cellular energy and QOL symptoms. It is well-documented that mitochondrial metabolism and cellular energy, quantifiable with mTOR, play central roles in the development of cancer (47, 49). In addition to their bioenergetic functions, mitochondria participate in processes that are central to the development of cancer, including transcriptional regulation, cell death, and malignant transformation (25). 

Treatments that conserve cellular energy can maintain homeostasis and QOL for all patients. However, monitoring and maintaining QOL may be even more important for cancer patients. Even with very serious and often end-stage diseases, when the expected LOL is short, some patients can fully recover and return to a normal QOL (54). Although this observation remains unexplained, it may be related to individual vitality and energy conservation. The number of these seemingly miraculous recoveries may be increased by a shift in emphasis from symptom elimination treatments to the conservation of cellular energy with monitoring of BEAM, abnormal symptoms, and QOL.

Conclusion

To the authors’ knowledge, this is the first report correlating mTOR, cellular energy, symptoms, and QOL. QOL and LOL require conservation of cellular energy. The use of anti-pathic drugs to modify signs and symptoms may be associated with the current trend of increasing
chronic disease because they require cellular energy to produce novel translation products (25, 32). Treatments such as homeopathy and Traditional Chinese Veterinary Medicine use less cellular energy because they do not increase the translational production of proteins. Biomarkers like BEAM and mTOR can be used to monitor energy balance and to optimize vitality and QOL throughout life, thus maximizing LOL (41, 48).

The subjective symptom biomarker BEAM is a tool that guardians can use at home to assess their pets’ energy balance and QOL. In the author’s experience, the holistic approach of monitoring and quantitating BEAM symptoms has been a reliable measure of patient QOL that has helped reduce the fears clients have concerning their pets’ symptoms. This approach can be explained to clients simply and easily and makes them more willing to persist patiently with gentle supportive care while their pets heal. When clients understand the meaning of symptoms and monitor BEAM as a reflection of physiologic changes and internal balance, they often choose to avoid eliminating symptoms quickly or harshly. When clients use subjective assessments like BEAM and engage in QOL based decision-making with their veterinarian, their fear of signs and symptoms will decrease and they will tend to be more compliant, and their pets may have better treatment outcomes (55).

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Dr. Feinman thanks Dr. Christina Chambreau for her invaluable contributions and support in Holistic Actions! Academy teaching HMDM, Vitality, Balance, and Homeopathy to animal guardians and doctors.

Copyright © 2019. All rights reserved. No part of this article may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the AHVMA, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law.

Using the Vitality and Balance System in Holistic Veterinary Practice

Abbreviations

• ASC – Avoid, Support, Cure
• BEAM – Behavior, Energy, Appetite, “Mood”
• HMDM – Holistic Medical Decision Making
• TCM – Traditional Chinese Medicine

Abstract. This paper introduces the Vitality and Balance System, which helps veterinarians work with their patients’ bodies to keep them healthy. It is a method of evaluating patients based on quality of life and not primarily management of their symptoms. The author has been using this method for over a decade when deciding how to approach and treat patients. It is useful in several ways including describing and understanding the effects of energetic flux, also called dynamic equilibrium. The model incorporates molecular studies of the mechanisms that govern cellular ATP production and the maintenance of physiologic homeostasis. This understanding of patients’ dynamic equilibrium integrates with conventional medicine and is teachable and reproducible. It can be used with the practice of any modality and can help treat patients that have not responded to medications. Vitality and balance are easily understood and provide a common language for communication with colleagues who practice conventionally. The clinical practice is based on optimizing energy to help balance physiologic functions to maintain wellness and assist in the recovery of patients. Veterinarians can utilize this system to further understand how patients become ill and how they heal. Objectively evaluating signs such as diagnostic test results along with subjective symptom observations by clients helps us both understand why disease develops as well as predict how patients will respond physiologically to stressors such as toxins, vaccinations, and surgeries. In addition, this paper introduces a client education tool called Holistic Medical Decision Making (HMDM), which can improve client education and compliance during treatment.

Introduction

The current focus of patient care in veterinary medicine is largely based on symptom management, with quality of life an important yet ancillary outcome. This paper introduces the Vitality and Balance System, a method of evaluating patients in which symptoms are but 1 tool in determining quality of life. In this model, vitality can be understood as the power that animates life, while balance represents the state in which the body is working with maximum efficiency on the mental, emotional, and physical levels. The Vitality and Balance System helps veterinarians work with their patients’ bodies to keep them healthy. It requires no additional training, making it available to any veterinarian to offer more integrative services, regardless of which treatment methods they use, enabling them to meet the client demand for wellness care using holistic and natural medicine. The system integrates with the modern medical model and can help the veterinarian meet clients “where they are” along the holistic continuum (1). Clients who want to resolve their pets’ health challenges quickly can be educated to embrace symptoms as valuable clues to the pets’ overall health status and work with their pets’ bodies to gradually relieve them of these symptoms while improving their quality of life. Natural and holistic pet care based on patient vitality and balance can help dispel distrust with corporate and pharmaceutical-based medicine and can improve the veterinarian-client partnership to increase compliance and achieve better treatment outcomes (2). 

Figure 1: Dynamic equilibrium

Vitality and balance have safely and successfully been used to treat people and animals for thousands of years. In this current application, all available human and veterinary academic and clinical research data are utilized to inform the medical decision-making process. Studies in molecular genetics and epigenetics are used to understand exactly how living, vital beings maintain homeostasis. The Vitality and Balance System is similar to the functional medicine approach in which seemingly disparate physiologic processes are seen as the patient’s attempt to maintain internal balance or equilibrium (3). Functional medicine describes the physical connection and metabolic reactions in these systems that are in constant flux, or dynamic equilibrium (Figure 1). The resultant balance they help maintain is governed by physical energy, such as ATP production, and causes objective internally quantifiable clinical signs and subjective externally observable symptoms that are unique to every individual. In contrast to functional medicine, the Vitality and Balance System considers the energetic shift to be the cause of the resultant fluctuation in energy production and subsequent changes of the individual.

The functional medicine model is extremely useful for helping understand patients’ bodies. In this model, homeostatic fluctuations related to shifts in physical energy production are used to assess balance, which describes a state in which the physiologic processes are working in maximum efficiency, resulting in observable symptoms of good health and emotional/ mental well-being. In the Vitality and Balance System, physical energy is only 1 factor that helps determine if the dynamic equilibrium remains balanced. The currently unmeasurable vital energy portion of the dynamic equilibrium is missing. This missing factor helps explain the mathematical error that results when the biochemical energy required for the metabolic and physiologic processes of life are quantitated in research. Some research studies on metabolism use the “Qx” factor to represent this unexplained and unknown vital energy. For example, there is a gap between caloric input compared to output in the results of some of the research done on metabolism. However, when vitality is considered to be both the physical fuel, such as ATP, and the unseen force that precedes the physical production of cellular currency and energy as defined by Ayurvedic, Traditional Chinese Medicine (TCM), and homeopathy, these 2 understandings of vitality become complementary and help explain the mathematical inequalities (4).

The physiologic effects of the unseen vitality in maintaining patients’ health and wellness are reflected by the objective signs like diagnostic test abnormalities as well as their subjective symptoms like behavior and appetite. In the Vitality and Balance System, the evidence of physiologic homeostasis is considered to be both internally quantifiable via diagnostic testing as well as externally visible by observation.

Another integral part of the Vitality and Balance System is patient individuality. Objective signs and subjective symptoms are produced based on the individual’s fluctuations in equilibrium. When clients become actively involved in their pets’ care by monitoring these at home, there is increased compliance and improved treatment outcome (5). The signs and symptoms produced in each individual are currently being investigated at the molecular level. One subset of research is investigating the mechanisms that govern the intercellular communication that leads to this individuality. This research has been propelled by recent advances in genetic sequencing and the discoveries of pattern recognition and toll receptors (6–8). Cell-surface phospholipid components help cells “decide” how they are going to respond as individuals to extracellular and environmental stressors. These individual responses observed through symptoms are the basis for clinical treatment protocols.

As with human medical iatrogenic diseases, it is hypothesized that routine veterinary interventions, like vaccinations and suppression of solitary symptoms, are associated with disturbing increases in chronic and degenerative diseases (9). Abnormalities of dysregulated immune function and cellular communication have contributed to the rise of many of these health challenges, including infectious and allergic diseases (10, 11). To date, there have been no proposed solutions to this problem, though clinical results show that they are effectively treated by working with the patients’ vitality and balance (12, 13).

Many of the current molecular and cellular studies do not have direct clinical relevance but can still contribute to our understanding of balance and dynamic equilibrium (14, 15). Findings from other studies do help inform current treatment and are being applied both in human and veterinary medicine (16–18). The Vitality and Balance System can help reconnect this academic research with the powerful principles that have been used for millennia to promote healing. For example, this system can be used to understand individual physiologic changes and epigenetic responses to the environment; it helps to explain individual variation in absorption and utilization of nutrients like taurine and the development of dilated cardiomyopathy; and it provides reasons for why allergens do not always trigger allergic reactions (19, 20). In oncology, elucidating the molecular mechanisms of cellular transformation from inflamed into neoplastic cells is of particular interest (21, 22). Holistic interpretation of these same studies is helping define the micro- and macro- environmental factors that help determine metastasis (23).

Vitality and Physiology

Despite our knowledge of the importance of the individual and intercellular communication, the current trend is to reduce our patients’ bodies into small parts. In the U.S., Canada, and other Western countries, doctors may spend years receiving training about 1 organ system, like theriogenology for the reproductive tract. However, by definition, reductionism of this sort only utilizes some of the available, often older, information about the interaction of multiple systems in our patients’ bodies. For example, many veterinarians still advise early ovariohysterectomy to prevent mammary tumors and improve longterm health and longevity despite evidence to the contrary (24). Dispelling myths of this sort to improve healthcare was among the original intentions of evidence-based medicine, the application of lifelong learning using multiple studies from different perspectives to come up with a summary of the best available evidence to guide treatment recommendations, such as the ideal age to spay and neuter (25).

Current evidence-based medicine favors meta-analyses that discount, and even ignore, thousands of years of anecdotal data, such as the wealth of experience related to the energetic and vitalistic basis for physiologic processes (26). However, anecdotal experience and “lower quality” studies can be essential to holistically treating patients most effectively. For example, quality of life, and even why our patients live or die from “natural causes,” is often not studied in the academic research environment (27). On the other hand, in Eastern countries, medical systems that are based upon individuality, vitality, and balance see death as a total loss of the unseen vitality and physical energy needed for all life processes to proceed (28, 29). In these countries, lifestyles that include fresher foods and increased exercise, both of which increase vitality and energy, are associated with a decreased incidence of disease and increase in longevity. One benefit of wellness care based on this vitalistic understanding of life is longevity. It is in these countries that we find the longestlived and healthiest human beings. These regions of increased vitality and longevity are called “Blue Zones,” but currently there are no corresponding data for the animals that live there (30). However, some holistically-oriented veterinarians have been applying this information to their patients for many years with corresponding decreases, and even resolution, of otherwise incurable chronic diseases, like cancer (31–33).

The Ayurvedic science of life and TCM are 2 examples of Eastern holistic medical systems (34, 35). The energetic nature of life is embodied in their concepts of Prana and Chi. Ayurveda is especially applicable to this discussion because it employs an intricate system of individuality and energy “vortices” which can be utilized to help our patients today. Briefly, in Ayurvedic medicine, there are 7 spinning chakras that correspond to major endocrine centers and nerve plexuses (36). The higher the level of vitality, or Prana, the faster these spin. The faster they spin, the harder it is to disturb them and cause disease (37). This author postulates that this balance and the production of disease symptoms from imbalance will be found to correlate with the ATP biomarker and vitality. When our patients are energetically balanced, they do not suffer from the chronic health challenges that the data clearly show are on the rise (10). Conversely, when our patients are imbalanced, they are more prone to chronic problems and are less resistant to infectious agents.

Molecular Medicine, Vitality, and Quality of Life

The Vitality and Balance System is a modern application of the Ayurvedic and TCM frameworks based on physiologic homeostasis. The critical step needed to correlate the currently un-quantifiable energetic basis of life to physiologic energy and metabolic changes may be found at the cellular level in the mitochondria. Observable symptoms and measurable signs are seen when these energy powerhouses do not function optimally to produce the energy needed to fuel the cellular processes that govern life. For example, a direct association between symptoms of chronic fatigue syndrome and the production of ATP has been known for at least 10 years (38). We see symptoms referable to mitochondrial dysfunction every day in our practices as abnormal laboratory data and physical findings (39). Diagnostic testing can provide valuable information about metabolic function, but all test results need to be interpreted within the context of the patient to be most informative and to provide appropriate treatment. For example, an elevated ALT in a Yorkshire Terrier that is normal in all other ways will be diagnostically and therapeutically approached differently than a patient with the same test result, low energy, and anorexia. Diagnostic testing is helpful as part of wellness care that is based on quality of life.

The author postulates that wellness care based on the quality of life of our patients is more effective than one based on removal of individual symptoms. Therefore, it is useful for clients to focus on their pets’ behavior, energy, appetite, and “mood” (BEAM). This specific set of symptoms is thought to directly relate to quality of life and can be easily monitored through observations by the client (40). Veterinary interpretation helps clients put individual symptoms, like acute moist dermatitis, into the context of their pets’ overall well-being and to critically decide how to help them. BEAM can also be used to evaluate pets with fevers. If the veterinarian finds objective signs of infection, like fever and elevated white blood cell count, but the patient’s subjective BEAM symptoms are normal, most clients readily understand that antibiotic treatment is usually not indicated, in addition to its being medically unsound. Clients can also use BEAM to aid their decision to use any treatment targeted at eliminating isolated signs and symptoms instead of treating the underlying problem. In some cases, overtreatment can result in obvious worsening of health. For example, overtreatment with immunosuppressant medications for a skin condition could result in a deficiency in the function of the immune surveillance mechanisms that are needed to prevent metastatic cancer, resulting in the growth of neoplastic cells (41).

Vitality and Balance as a Client Education Tool

In addition to the importance of a holistic veterinary interpretation of diagnostic data prior to treatment, it is also very helpful to teach clients the importance of putting all symptoms in context and interpreting them holistically. This can be done easily by using the Holistic Medical Decision Making (HMDM) method with the Vitality and Balance System. This is a system that helps clients prevent problems, manage and monitor diseases, and think more scientifically about how to help their pets (42). Helping clients base their pets’ care on vitality and balance has been shown by this author to be an easy yet powerful way to educate clients to become more effective partners. Actively involving clients in the monitoring of and helping make decisions in their animals’ care markedly increases client compliance (43, 44).

HMDM is composed of 3 simple steps. The first step is to decide on a goal such as gradual internal cure, gentle palliation, or rapid suppression of signs and symptoms. For example, possible goals for treating otitis symptoms include quickly stopping the use of topical corticosteroids, antifungals, and antibiotics; gently soothing symptoms with herbs and clinical nutrition; or addressing them internally and energetically using acupuncture or homeopathy. Many animal guardians often do not realize that cure is even a possibility for their pets, making it the veterinarian’s job to guide them based on the potential for healing and the relative seriousness of any sign or symptom.

A subjective symptom like an itchy pet or objective sign such as an incidental laboratory finding is typically not life-threatening, and clients readily understand that a quick fix is not indicated. The veterinarian can counsel clients not to pursue the goal of rapid elimination of the clue that reflects their pets’ internal balance. Teaching clients to apply BEAM and to focus on their pets’ overall quality of life will help them to address their pets’ holistic totality while avoiding symptom suppression with drugs and “natural” treatments directed at single symptoms.

The second step is for clients to do research using reliable sources such as their veterinarian and the many board certified specialty veterinarians who blog on various websites. This teaches clients about their pets’ health challenges and symptoms in order to reach their wellness goal from HMDM Step 1. In addition to providing a better understanding of the disease, veterinarians can help guide clients to information that helps them learn how to track signs and symptoms at home by monitoring parameters such as capillary refill time, resting respiratory rate, heart rate and rhythm, and urine protein, blood, and specific gravity. Clients who do this are more willing to patiently persevere during treatment with the aim for a cure.

The third step is implementation of a plan based on reliable information provided by the veterinarian in addition to what the client has learned from other sources. The many possibilities for treatment are simplified by teaching clients to “ASC” (Avoid, Support, Cure) for “answers.” This easily remembered classification helps the client realize that there are many treatment options available in these 3 categories so they can make better treatment decisions for their pets. Clients can avoid the triggers like allergens that can cause immune imbalances, support the body while it heals using any holistic modality, or cure the underlying imbalance energetically using Traditional Chinese Veterinary Medicine, homeopathy, etc.

The 3 steps of HMDM are easy for clients to understand and utilize along with the above tools. This approach to making medical decisions is commonsensical, intuitive, and can be readily integrated into current conventional veterinary medicine. For example, a client with a pet prone to skin diseases may only know about using antibiotics to suppress their pet’s superficial folliculitis. However, in HMDM Step 2 (research), they will learn about other healing options and can be taught by their veterinarian about raising the allergic threshold to reduce reactivity to antigenic triggers in order to resolve the skin symptom and prevent chronic skin issues.

Veterinarians automatically use the steps of HMDM in making therapeutic decisions for patients. For example, treatment goals evolve based on evolving knowledge. Veterinarians can then integrate this information in holistically deciding whether and how to treat an abnormality found on a physical examination or diagnostic test. For example, we have learned that trends in diagnostic test results can serve as baselines and significant biomarkers for detection of early warning signs of internal imbalances in the patient’s dynamic equilibrium. Trending results facilitates early diagnosis and prevents secondary pathologic changes such as chronic hepatitis, hyperadrenocorticism, and renal failure (45, 46).

Holistically-minded veterinarians can also use HMDM with vitality, balance, and homeopathy to educate their clients not to fear these named diseases. Clients are less prone to treat symptoms aggressively when they understand that their pets’ signs and symptoms are only reflections of internal physiologic changes. This understanding by clients enables the veterinarian to do a better job in helping them attain optimal wellness and quality of life for their pets.

Perseverance and patience can be challenging for clients, but understanding the basics of healing using the Vitality and Balance System can help. When clients learn to tolerate, or even embrace, symptoms as clues to internal physiologic (and energetic) shifts, the clinician can help them be proactive in preventing and managing diseases instead of reactively suppressing symptoms in opposition to the body’s efforts. Therefore, it is very useful to educate and actively involve clients in patient care using HMDM. Actively engaged clients who are focused on this wellness model could be more inclined to visit their veterinarian 2 or 3 times a year without needing vaccination reminders or waiting for overt clinical problems with their pets.

Conclusion

The Vitality and Balance System can help holistically minded practitioners decrease chronic and difficult to treat diseases by working with the powerful healing mechanisms of the body. At the same time, this method can be used to integrate homeopathy, TCVM, or any other modality with current conventional medicine (47). The best of modern diagnostic medicine can be holistically interpreted by the veterinarian in order to make recommendations in consideration of the full context of their patients’ lives.

In addition, the principles discussed above facilitate early detection, intervention, and close monitoring of the physiologic mechanisms that reflect the healing of the patient. Clients can help with this at home by keeping a journal to track internal and external changes, like BEAM or albuminuria. Home tracking by clients helps veterinarians by providing valuable data over time, improving patient evaluation, and giving clients a more active role in their pets’ care which in turn improves compliance. Clients empowered with the tools introduced in this paper tend to prevent problems proactively and work more effectively with their veterinarians in order to achieve better treatment outcomes.

Both veterinarians and clients can mindfully use the HMDM process informed by vitality, balance, and molecular medicine to help pets have the best quality of life as reflected by BEAM. BEAM within HMDM can improve clients’ understanding of the importance of subtle internal signs and external symptoms, which promotes early intervention and improves patient treatment outcomes. By putting symptoms in context and then mindfully choosing an ASC method for treatment, clients can practice more effective proactive prevention rather than rely on reactive treatment. The integration of the current understanding of dynamic equilibrium and vitality and balance with modern medicine can help patient outcomes.

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Acknowledgements

Dr. Feinman thanks Dr. Christina Chambreau for her invaluable contributions and support in Holistic Actions! Academy teaching HMDM, Vitality, Balance, and Homeopathy to animal guardians and doctors.

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