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


  • 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


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.


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.


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).


  1. Cella DF. Quality of life: the concept. J Palliat Care. 1992;8(3):8–13.
  2. Giuffrida MA, Brown DC, Ellenberg SS, Farrar JT. Devel- opment and psychometric testing of the canine owner-reported quality of life questionnaire, an instrument designed to measure quality of life in dogs with cancer. J Am Vet Med Assoc. 2018;252(9):1073–1083. 
  3. Yeates J, Main D. Assessment of companion animal quality of life in veterinary practice and research. J Small Anim Pract. 2009;50:274–281.
  4. Belshaw, Asher L, Harvey ND, Dean RS. Quality of life assessment in domestic dogs: an evidence-based rapid review. Vet J. 2015;206(2):203–212.
  5. Linneberg A. The increase in allergy and extended chal- lenges. Allergy. 2011;66(suppl 95):1–3.
  6. Assessing quality of life of children and youth with dis- abilities: a review of available measures. Available at.: Accessed June 23, 2019.
  7. Health statistics and information systems, WHOQOL: measuring quality of life. Available at: Accessed Jun 23, 2019.
  8. Manteca X, Mainau E, Temple D. What is animal welfare? The farm animal welfare fact sheet. Farm animal welfare education centre. June 2012. Accessed July 4, 2019.
  9. Hardt J. A new questionnaire for measuring quality of life — the Stark QoL. Health Qual Life Outcomes. 2015;13:174.
  10. Parker CM, Voduc N, Aaron SD, Webb KA, O’Donnell DE. Physiological changes during symptom recovery from moderate exacerbations of COPD. Eur Respir J. 2005;26(3):420–428.
  11. Wiedmeyer CE, Royal AB. Urinary biomarkers for monitoring disease progression in the Han:SPRD-cy rat model of autosomal-dominant polycystic kidney disease. Comp Med. 2010;60(6):448–454.
  12. Hrisos S, Eccles MP, Francis JJ, et al. Are there valid proxy measures of clinical behaviour? A systematic review. Implement Sci. 2009;4(1):37.
  13. Fujii T, Naing A, Rolfo C, Hajjar J. Biomarkers of response to immune checkpoint blockade in cancer treat- ment. Crit Rev Oncol Hematol. 2018;130:108–120.
  14. Müller N, Myint AM, Schwarz MJ. Inflammatory biomarkers and depression. Neurotox Res. 2011;19(2):308–318.
  15. Seim-Wikse T, Skancke E, Nødtvedt A, et al. Comparison of body condition score and other minimally invasive biomarkers between dogs with gastric carcinoma and dogs with chronic gastritis. J Am Vet Med Assoc. 2019;254(2):226–235.
  16. Yazbek B, Fantoni DT. Validity of a health-related quality-of-life scale for dogs with signs of pain secondary to cancer. J Am Vet Med Assoc. 2005;226(8):1354–1358.
  17. Staskin DR. Age-related physiologic and pathologic changes affecting lower urinary tract function. Clin Geriatr Med. 1986;2:701–710.
  18. McMillan FD. Quality of life in animals. J Am Vet Med Assoc. 2000;216(12):1904–1910.
  19. Butrick E, Peabody JW, Solon O. A comparison of objective biomarkers with a subjective health status measure among children in the Philippines. Asia Pac J Public Health. 2010. PMID:21159692.
  20. Kaeberlein M, Creevy KE, Promislow DEL. The dog aging project: translational geroscience in companion animals. Mamm Genome. 2016;27(7–8):279–288.
  21. Savage N. New tricks from old dogs join the fight against ageing. Nature. 2017;552(7684):S57–S59.
  22. Mannick JB, Del Giudice G, Lattanzi M, et al. mTOR inhibition improves immune function in the elderly. Sci Transl Med. 2014;6(268):268ra179.
  23. Lorne E, Zhao X, Zmijewski JW, et. al. Participation of mammalian target of rapamycin complex 1 in Toll-like receptor 2- and 4-induced neutrophil activation and acute lung injury. Am J Respir Cell Mol Biol. 2009;41(2):237–245.
  24. Cifarelli V, Hursting SD. Obesity, diabetes and cancer: a mechanistic perspective. Int J Diabetol Vasc Disease Res. 2015;2015(suppl 4).
  25. Morita M, Gravel SP, Hulea L, et al. mTOR coordinates protein synthesis, mitochondrial activity and proliferation. Cell Cycle. 2015;14(4):473–480.
  26. Laplante M, Sabatini DM. mTOR signaling in growth control and disease. Cell. 2012;149(2):274–293.
  27. Bond P. Regulation of mTORC1 by growth factors, energy status, amino acids and mechanical stimuli at a glance. J Int Soc Sports Nutr. 2016;13:12970-016-0118-y.
  28. Sprangers AG, Bartels M, Veenhoven R, et al. GENEQOL Consortium. Which patient will feel down, which will be happy? The need to study the genetic disposition of emotional states. Qual Life Res. 2010;19(10):1429–143.
  29. Myhill S, Booth NE, McLaren-Howard J. Chronic fatigue syndrome and mitochondrial dysfunction. Int J Clin Exp Med. 2009;2(1):1–16.
  30. Larsson L, Degens H, Li M, et al. Sarcopenia: aging-related loss of muscle mass and function. Physiol Rev. Clin Geriatr Med. 2019;99(1):427–511.
  31. Marzetti E, Calvani R, Cesari M, et al. Mitochondrial dysfunction and sarcopenia of aging: from signaling pathways to clinical trials. Int J Biochem Cell Biol. 2013;45(10):2288–2301.
  32. Lindqvist LM, Tandoc K, Topisirovic I, Furic L. Cross-talk between protein synthesis, energy me- tabolism and autophagy in cancer. Curr Opin Genet Dev. 2018;48:104–111.
  33. Gerovac M, Tampé R. Control of mRNA translation by versatile ATP-driven machines. Trends Biochem Sci. 2019;44(2):167–180.
  34. Smiles WJ, Hawley JA, Camera DM. Effects of skeletal muscle energy availability on protein turnover responses to exercise. J Exp Biol. 2016;219(Pt2):214–225.
  35. Alberts B, Johnson A, Lewis J, et al. How Cells Obtain Energy from Food. Molecular Biology of the Cell. 4th ed. New York: Garland Science; 2002. Available at: Accessed Jul 3, 2019.
  36. Witard OC, McGlory C, Hamilton DL, Phillips SM. Growing older with health and vitality: a nexus of physical activity, exercise and nutrition. Biogerontology. 2016;17(3):529–546.
  37. Gray SR, Mittendorfer B. Fish oil-derived n-3 polyunsaturated fatty acids for the prevention and treatment of sarcopenia. Curr Opin Clin Nutr Metab Care. 2018;21(2):104–109.
  38. Liu M, Zhou L, Zhang B, et. al. Elevation of n-3/n-6 PU- FAs ratio suppresses mTORC1 and prevents colorectal carcinogenesis associated with APC mutation. Oncotarget. 2016;7(47):76944–76954.
  39. Urfer SR, Kaeberlein TL, Mailheau S, et al. A random- ized controlled trial to establish effects of short-term ra- pamycin treatment in 24 middle-aged companion dogs. Geroscience. 2017;39(2):117–127.
  40. Kaeberlein M. The biology of aging: citizen scientists and their pets as a bridge between research on model organisms and human subjects. Vet Pathol. 2016;53(2):291–298.
  41. Miaskowski C, Aouizerat BE. Biomarkers: symptoms, survivorship, and quality of life. Semin Oncol Nurs. 2012;28(2):129–138.
  42. Mingatto FE, Santos AC, Uyemura SA, Jordani MC, Cur- ti C. In vitro interaction of nonsteroidal anti-inflammatory drugs on oxidative phosphorylation of rat kidney mitochondria: respiration and ATP synthesis. Arch Biochem Biophys. 1996;334(2):303–308.
  43. Pomatto, LCD, Davies KJA. The role of declining adaptive homeostasis in ageing. J Physiol. 2017;595(24):7275–7309.
  44. Blikman LJ, Huisstede BM, Kooijmans H, Stam HJ, Bussmann JB, van Meeteren J. Effectiveness of energy conservation treatment in reducing fatigue in multiple sclerosis: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2013;94(7):1360–1376.
  45. Kimball SR. Interaction between the AMP-activated protein kinase and mTOR signaling pathways. Med Sci Sports Exerc. 2006;38(11):1958–1964.
  46. Platts-Mills TAE. Asthma severity and prevalence: an ongoing interaction between exposure, hygiene, and lifestyle. PloS Med. 2005;2(2):e334.
  47. Neasta J, Barak S, Jamida SB, Ron D. mTor complex 1: a key player in neuroadaptions induced by drugs of abuse. J Neurochem. 2014;130(2):172–184.
  48. Steptoe A. Biomarkers, health, and subjective well-being. Sage meeting of NAS: panel on measuring subjective well-being in a policy. 2012. Available at: Accessed July 7, 2019.
  49. Sofer A, Lei K, Johannessen CM, Ellisen LW. Regu- lation of mTOR and cell growth in response to energy stress by REDD1. Molecular and Cellular Biology. 2005;.25.14.5834–5845.
  50. Feinman J. Using the vitality and balance system in holistic veterinary practice. J Am Holist Vet Med Assoc. 2019;54:18–25.
  51. Meropol NJ, Egleston BL, Buzaglo JS, et al. CONNECT Study Research Group. Cancer patient preferences for quality and length of life. Cancer. 2008;113(12):3459–3466.
  52. Hölzel D,Schubert-Fritschle G. Evidence-based medicine in oncology: do the results of trials reflect clinical reality? Zentralbl Chir. 2008;133(1):15–19.
  53. Bahrami M, Arbon P. How do nurses assess quality of life of cancer patients in oncology wards and palliative settings? Eur J Oncol Nurs. 2012;16(3):212–219.
  54. Kleef R, Jonas WB, Knogler W, Stenzinger W. Fever, cancer incidence and spontaneous remissions. Neuroimmunomodulation. 2001;9(2):55–64.
  55. Aronowitz R. Decision making and fear in the midst of life. Lancet. 2010;375(9724):1430–1431. 

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

Using the Vitality and Balance System in Holistic Veterinary Practice

Using the Vitality and Balance System in Holistic Veterinary Practice

By Jeff Feinman, VMD

Used with permission of the Journal of the American Holistic Veterinary Medical Association (JAHVMA)
Article first appeared in Volume 54, Spring Issue, 2019


  • 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.


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.


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.


  1. Forbes. Consumer trends in health and wellness. Available at: Accessed January 8, 2019.
  2. Harvard Business Review. How Pharma can fix its reputation and its business at the same time. Available at: Accessed January 27, 2019.
  3. Bland J. Defining function in the functional medicine model. Integr Med (Encinitas). 2017;16(1):22–25.
  4. Webb P, Annis JF, Troutman SJ Jr. Energy balance in man measured by direct and indirect calorimetry. Am J Clin Nutr. 1980;33(6):1287–1298.
  5. WEGOHealth. Patient engagement and the promise of better outcomes. Available at: Accessed November 11, 2018.
  6. Broad Institute. Epigenetics of disease: Translating GWAS variants to function. Available at:. Accessed January 27, 2019.
  7. Kutikhin AG, Yuzhalin AE. Editorial: pattern recognition receptors and cancer. Front Immunol. 2015;6:481.
  8. Tsan MF. Toll-like receptors, inflammation, and cancer. Semin Cancer Biol. 2006;16:32–37. 
  9. Krishnan NR, Kasthuri AS. Iatrogenic disorders. Med J Armed Forces India. 2005;61:2–6.
  10. Banfield Pet Hospital. 2018 State of Pet Health Report. Available at: Accessed Nov 11, 2018. 
  11. Bagatini MD, Cardoso AM, Dos Santos AA, et al. Immune system and chronic diseases. J Immunol Res. 2017; 2017: 4284327. 
  12. Garden GA, La Spada AR. Intercellular (mis)communication in neurodegenerative disease. Neuron. 2012;73(5):886–901. 
  13. Mednis D. The growth of chronic conditions: search for solutions to the problem. Chronic Dis Transl Med. 2017; 3:82–88.
  14. Giuliano KA. Dissecting the individuality of cancer cells: the morphological and molecular dynamics of single human glioma cells. Cell Motil Cytoskeleton. 1996;35(3):237–53.
  15. Cooper GM. Applications of molecular biology to cancer prevention and treatment. In: The Cell: A Molecular Approach. 2nd ed. Sunderland (MA): Sinauer Associates, 2000.
  16. Felsburg PJ, De Ravin SS, Malech HL, et. al. Gene therapy studies in a canine model of X-linked severe combined immunodeficiency. Hum Gene Ther Clin Dev. 2015;26(1):50–56.
  17. Epstein S, Hardy R. Clinical resolution of nasal aspergillosis following therapy with a homeopathic remedy in a dog. J Am Anim Hosp Assoc. 2011;47(6):e110–115.
  18. Stephenson H. Long-term remission of grade III mast cell tumors in a dog using homeopathy. J Am Holist Vet Med Assoc. 2014;35:35–40.
  19. Ko KS, Backus RC, Berg JR, et al. Differences in taurine synthesis rate among dogs relate to differences in their maintenance energy requirement. J Nutr. 2007;137:1171–1175.
  20. Pucheu-Haston CM, Bizikova P, Marsella R, et. al. Review: Lymphocytes, cytokines, chemokines and the T-helper 1 – T-helper 2 balance in canine atopic dermatitis. Vet Dermatol. 2015;26(2):124–e32.
  21. Pikarsky E, Porat RM, Stein I, et. al. NF-κB functions as a tumour promoter in inflammation-associated cancer. Nature. 2004;431:461–466.
  22. Clevers H. At the crossroads of inflammation and cancer. Cell. 2004;118(6):671–674.
  23. Mukherjee S. Cancer’s invasion equation. The New Yorker. 2017(Sept 11).
  24. Ahn AC, Tewari M, Poon C-S, et al. The limits of reductionism in medicine: could systems biology offer an alternative? PLoS Med. 2006;3(6):e208.
  25. Howe LM. Current perspectives on the optimal age to spay/ castrate dogs and cats. Vet Med (Auckl). 2015;6:171–180. 
  26. Kazanjian A. Evidence-based thinking: Context is key. BMJ. 2001;323:275. 
  27. Centers for Disease Control and Prevention. Instructions for completing the cause-of-death section of the death certificate. Available at: Accessed November 11, 2018.
  28. Coulter H. A History of the Schism in Medical Thought. Berkeley: North Atlantic Books; 1994:vii–xii. Divided Legacy; vol IV.
  29. Chaudhury RR, Rafei UM, eds. Traditional Medicine in Asia. New Delhi: World Health Organization, 2001; 273–305.
  30. Blue Zones Project. Available at: Accessed November 11, 2019.
  31. Palmquist RE, Goldstein R. Longer than expected survival using a novel, integrative approach to hospice in a case of canine osteosarcoma with apparent chest metastasis treated with therapeutic nutrition and homotoxicology. J Am Holist Vet Med Assoc. 2009;28:16–25.
  32. Herman J. Homeopathic treatment of masticatory myositis in five Golden Retrievers. J Am Holist Vet Med Assoc. 2015;41:60–69. 
  33. Ellinger L. A case of pemphigus foliaceus treated with homeopathy in a horse. J Am Holist Vet Med Assoc. 2018;53:42–48.
  34. Schoen AM, Wynn S. Complementary and Alternative Veterinary Medicine, Principles and Practice. St. Louis, MO: Mosby. 1998;133–145.
  35. Narayanaswamy V. Origin and development of Ayurveda: (a brief history). Anc Sci Life. 1981;1(1):1–7.
  36. Amrit Yoga. Balance the chakras and you balance your life. Available at: Accessed Nov 12, 2018.
  37. Milgrom LR. Vitalism, complexity and the concept of spin. Homeopathy. 2002;91:26–31. 
  38. Myhill S, Booth NE, McLaren-Howard J. Chronic fatigue syndrome and mitochondrial dysfunction. Int J Clin Exp Med. 2009;2:1–16.
  39. Hekman JP, Karas AZ, Sharp CR. Psychogenic stress in hospitalized dogs: cross species comparisons, implications for health care, and the challenges of evaluation. Animals (Basel). 2014;4(2):331–347.
  40. Feinman J. Tracking quality of life for dogs with cancer. J Am Vet Med Assoc. 2018; 253:33–34.
  41. Ribatti D. The concept of immune surveillance against tumors: The first theories. Oncotarget. 2017;8:7175–7180. 
  42. Holistic Actions. Holistic medical decision making protocol. Available at: Accessed Nov 11, 2018.
  43. American Animal Hospital Association. Compliance: Taking Quality Care to the Next Level Executive Summary. Available at: Accessed Nov 12, 2018.
  44. Abood SK. Increasing adherence in practice: making your clients partners in care. Vet Clin North Am Small Anim Pract. 2007;37(1):151–164.
  45. Barteaux WL, Kintzer P. Creatinine creep: your key to early diagnosis of chronic renal insufficiency. Vetscript. 2013;26:16–18.
  46. Sandilands EA, Dhaun N, Dear JW, et. al. Measurement of renal function in patients with chronic kidney disease. Br J Clin Pharmacol. 2013;76(4):504–515.
  47. Milgrom LR. Toward a unified theory of homeopathy and conventional medicine. J Altern Complement Med. 2007;13(7):759–769


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.

Longevity, Vital Capacity, Pranayama, and the Exposotype

Longevity, Vital Capacity, Pranayama, and the Exposotype

Longevity, Vital Capacity, Pranayama, and the Exposotype

By Jeff Feinman, VMD

Used with permission of the Journal of the American Holistic Veterinary Medical Association (JAHVMA).
Article first appeared in Volume 58, Spring Issue, 2020



  • ME/CFS – Myalgic encephalomyelitis/ chronic fatigue syndrome
  • QOL – Quality of life
  • VC – Vital capacity

Abstract. Pranayama, the practice of controlling the breath, is known to help people maintain physiological homeostasis and increase longevity. This article discusses methods to utilize a veterinary version of pranayama for animals, which is proposed to yield similar results. Research in people demonstrates breathing practices such as pranayama increase vital capacity and respiratory function, which in turn increases energy production and improves biomarkers of cellular activity. Pranayama, or breathing practices derived from yoga and Ayurveda, is discussed as an efficacious, teachable, and reproducible method for accomplishing this. It is suggested that the growing incidence of chronic diseases can be reduced by pranayama because it therapeutically increases the amount of cellular energy (eg, ATP) by improving mitochondrial function and aerobic respiration. In addition, veterinary patient quality of life (QOL) can be improved by using animals’ voluntary control of the parasympathetic relaxation reflex and enhanced homeostatic mechanisms. This increased physiological stability can potentially decrease their reactivity to environmental and endogenous stressors such as toxins, which would otherwise trigger disequilibrium. This decreased susceptibility to physiological strain, as reflected by biomarkers, is a central teaching of Ayurveda. Context is provided for medical use of pranayama in Ayurveda by discussing it in the more modern frameworks of homeopathy and the exposotype. It is postulated that pranayama can improve veterinary patient QOL and longevity as it does for people. 



Physiological homeostasis helps maintain cellular energy to improve cell function and biochemical biomarkers and patient quality of life (QOL). Pranayama is proposed to do this both physically through improved oxygenation and cellular respiration as well as nonphysically through an increase in a currently unidentified energy of the air, known as prana, chi, or the vital force, which has been suggested as the unseen force that separates a dead body from a living being (1). The understanding of the effect of pranayama on the breath is derived from more than 3,000 years of the human practice of yoga and the breathing practices called pranayama, in which the pranic force is thought to improve cellular activity and all life functions to help maintain physiological equilibrium, as verified by current research in hundreds of scientific papers. The concepts of prana and chi predate scientific medicine and therefore are not described by modern terms. Current research in the biofield likens the effect on the living being to that of electricity powering modern appliances (2, 3). Therapeutic use of pranayama was codified by Ayurveda, which is empirically based on the signs and symptoms of the patient. Ayurveda is translated as the medical study of the “science of life.” It is still practiced around the world today and has been scientifically verified to help patients improve their lives by optimizing their internal equilibrium (4, 5).

Despite documented anecdotal evidence of Ayurveda’s benefits, the underlying concepts of prana and the vital force are not currently part of the modern medical model because they cannot be quantified (5). However, this omission limits scientific understanding of physiological processes, such as respiration, by reducing the holistic interplay of the living organism into individual cellular and molecular mechanisms. For example, even sophisticated scientific understanding of biochemical processes cannot explain the control that pranayama-practicing yogis have over autonomic functions enabling seemingly superhuman feats, as documented in multiple research laboratories (6).

Current research focuses only on measuring the physical mechanisms of breathing and lung function by pulmonary functions such as vital capacity (VC), which is defined as the maximal volume of air expired after a full inspiration. In people, decreased VC has been shown to correlate directly with the physiological changes seen in many diseases and is a predictor of cancer, aging, and mortality (7–10). However, the magnitude of the positive effect of breathing on the physiological biomarkers that precede disease can only be partially understood by using a molecular perspective rather than a vitalistic medical model. As in the study of the biofield, translational medicine and high-dimensional biology can be utilized to translate current research and seemingly disparate concepts into clinical practice to improve treatment outcomes (11, 12). 

Breathing, Balance, and Biomarkers


Recent definitions of biomarkers go beyond measurement of biochemical parameters such as oxygen saturation and VC. They can now be seen as any biological characteristic that can be used to indicate normal biological function and the presence of pathological processes or to monitor a response to a therapeutic intervention. It is indisputable that the measurement of the VC biomarker is useful for diagnosing, treating, and managing many diseases, including those of high energy-consuming organs such as the heart and brain (13, 14). These organs may be predisposed to energy deficiency because of their high metabolic demand for cellular fuel. This energy deficiency reduces QOL and longevity and is reflected biochemically by changes in electrical responses, as measured in the laboratory by the new diagnostic test for a biomarker of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) (15–17). The underlying defect in ME/CFS may be either a deficiency of cellular energy such as ATP or a cellular limitation to its utilization, but in both cases, increased prana is proposed to help.

The importance of energy production and mitochondrial metabolism has attracted attention as a target for drug discovery and clinical intervention (15, 18). For example, decreased energy production and increased oxidative stress from inefficient aerobic respiration and uncoupling of the mitochondrial electron transport chain is a pharmacological target for treating obesity in people (19). In addition, the ME/CFS blood biomarker was developed both as a diagnostic tool as well as a way to find useful drugs for patients that have the syndrome (15). However, unlike pranayama, use of pharmaceuticals is associated with a decrease in available cellular energy because these consume energy from translation of novel proteins (20, 21). There is mounting evidence that all signs and symptoms, such as the systemic dysfunction of ME/CFS, regardless of organ, are due to energy imbalances and dysfunctions on the cellular level; therefore, it is critical to maintain cellular energy. This report is intended to help improve patient QOL safely through the use of pranayama and without drugs that may have unintended effects (22, 23).

In human patients, VC is an important biomarker of internal balance and homeostasis, but is not commonly measured in veterinary patients. However, other biomarkers, such as red cell indices, cortisol, lipids, and serum lactate, are routinely quantified in animals; and levels of these have been shown to improve with pranayama in people (24, 25). In animals, pranayamalike breathing techniques can simply be used together with conventional medicine and have been shown to improve treatment outcomes as they have done in people for millennia (1, 8). Optimizing respiration and improving mitochondrial function reduces the oxidative stress that often precedes cancer and other degenerative diseases to decrease the incidence of Alzheimer’s and cognitive dysfunction in people as well as aging in dogs and people (26–30). However, translating Ayurvedic concepts such as prana can be difficult because of the different frameworks and languages of conventional medicine and Ayurveda.

Breathing patterns and pranayama are an integral part of the individuality on which Ayurveda is based. The recent molecular redefinition of the term exposotype encompasses all of the “omics” sciences, such as genomics, proteomics, transcriptomics, and metabolomics, to facilitate deeper understanding of individual patent morbidity, mortality, and susceptibility to the cumulative effects from stressors and environmental influences (1, 31, 32). It is extremely useful to combine these holistic approaches to health in order to understand the genesis of chronic diseases, which have multifactorial genetic and environmental roots, including toxic environmental exposures such as poor air quality and impaired respiration and oxygenation (31, 32).   

Context for the Use of Pranayama Today


In order to better understand how Ayurveda can help veterinarians, it is helpful to describe it a little further. The Ayurvedic concept of balance and homeostasis is one of the traditional medical systems of India and Tibet that improves QOL and longevity by eliminating the root cause of the disease through restoration of pranic and energetic balance (1). Similar to the exposome, Ayurveda emphasizes the importance of lifestyle improvements, such as eating fresh and vital foods, exercising, and minimizing stressors (1, 31). Evidence suggests that breathing practices along with the healthy lifestyle act via mechanisms that are fundamental to increased longevity (33, 34). In modern terms, the Ayurvedic system for maintaining internal equilibrium of the individual based on sensitivities is very similar to the molecularsusceptibility, individuality, and wellness described by the exposotype. Both of these frameworks are based on an understanding of stress and strain. Biomarkers of physiological strain, such as the test for ME/CFS, fluctuate in response to stressors, such as toxins in polluted air, in a similar fashion as the exposome (32). A deeper understanding will be seen over time by integrating research into the biofield, prana, and the significance of symptoms as a result of physiological imbalance from decreased energy (25).

In order to achieve this understanding, 3 hypotheses have been presented to scientifically describe the beneficial effects of Ayurveda, pranayama, and yoga: They may promote restoration of physiological set points to normal after derangements secondary to disease or injury; they may promote homeostatic negative feedback loops over non-homeostatic positive feedback loops in molecular and cellular interactions; and they may quiet some of the “noise” in cellular and molecular signaling networks arising from environmental or internal stresses (35). The molecular mechanisms that facilitate these effects are optimized in Ayurvedic medicine by therapeutics that increase energy from pranayama. Breathing exercises have been proposed to optimize health in people by reducing adverse response to stressors, speeding recovery from injury or disease, delaying aging, and ameliorating chronic illness such as cancer (35).

Because these mechanisms were unknown until the 20th century, worldwide health care systems were based on empirical observations. Homeostasis was understood to be maintained by unknown internal functions powered by an unseen vital force (36). As medical knowledge has advanced, empirical models of wellness and disease have been replaced by the paradigm of pharmaceutical-based medicine founded on knowledge of physiological functioning. Unfortunately, most of modern research remains embedded in this reductionist paradigm and may investigate only 1 or 2 molecular mechanisms, thus giving a partial assessment of patient health.

Using the holistic and vitalistic paradigm of Ayurveda affords appreciation of the deeper mechanisms underlying the ability of respiration, pranayama, and yogic practice to optimize health, delay aging, and speed efficient recovery from injury or disease (35).

It therefore would be very useful to have a bridge that would allow patients to benefit from both the innovations of modern medicine and those of Ayurvedic homeostasis. However, fully utilizing the framework of Ayurvedic medicine requires learning new terminology in addition to making a paradigm shift that encompasses both physical and nonphysical energy. On the other hand, VC and other biomarkers can be understood using the terminology and concepts of modern medicine so they can be more easily utilized to help modern-day doctors and patients. One method for incorporating pranayama along with VC without a steep learning curve is to use the framework developed by Dr. Samuel Hahnemann, who was fluent with the terminology and concepts of Ayurveda as well as those of Western medicine. He developed the vitalistic and scientific framework of homeopathy, which was the primary form of health care in the United States in the mid19th century and is based on observable biomarkers, such as behavior, energy, appetite, and mood (12). This same framework can be used with any form of therapy, and because homeopathy uses conventional diagnostic data, it can be more easily integrated into modernday veterinary practice. The homeopathic framework allows doctors to use the biomarkers that describe the exposotype as well as lifestyle improvements such as pranayama that enhance patient QOL. 

Practical Pranayama for Pets


As mentioned, integrating the sciences of the exposome, homeopathy, and Ayurveda has been demonstrated in hundreds of papers to improve patient life expectancy and QOL in humans. All 3 frameworks describe the interplay of the individual and the environment in similar fashions to allow better understanding of wellness and disease. Veterinary patient respiratory rate and depth can be altered to potentially achieve similar results, such as the reduction of cancer in people (8, 37). Therapeutic use of pranayama for pets, similar to the use of Ayurveda in people, is relatively easy to implement because breath control is already innately used by pets for communication and calming.

There are several physiological uses for breath control that are known to improve QOL and reduce problems such as fear, aggression, and separation anxiety (38, 39). One specific clinical application of this is a behavior modification protocol in which the anxious pet is taught to slow his breathing to help induce calm (39).This clinical protocol can be extremely useful for pets with chronic behavioral problems when trained over time. In addition, pets that suffer acutely, such as hyperventilating and panting cats, may also benefit.

One example in people is the rapid improvement seen when they slow their respiratory rate by breathing into a bag. Even though most acutely anxious and panting pets will not readily accept bags covering their noses, breath control and calming techniques that quickly decrease sympathetic stimulation can still be used (see Appendix page 25). Calming interventions work best when clients intervene early in the stress response, which is facilitated by teaching them the signs of stress in dogs and cats (40, 41). In addition, the effectiveness of calming interventions is augmented when the client is also calm and breathing slowly and deeply (or using ujjayi breathing, in which airflow is restricted by slightly contracting the throat and breathing as though trying to fog up a window) to facilitate mirroring of the behavior by the patient.

Additional emotional calming and stress and disease relief mediated through the vagal parasympathetic relaxation response to respiration can be seen by the effects of restricted breathing, which is accomplished either by contracting the laryngeal muscles or occluding the nostrils (42). People who practice pranayama are taught the ujjayi breath as described above (42). Although slow breathing alone increases parasympathetic activity, altering the breath by using ujjayi-like breathing can be even more beneficial by facilitating calm, improving focus, and easing induction of a meditative state (42). In veterinary patients, ujjayi-like restricted breathing is most commonly observed in cats from the laryngeal muscular contractions of purring. By using the neurolinguistic technique of mirroring this type of “purr” breathing, the practitioner can help calm patients, establish rapport, and stimulate self-healing mechanisms (43). In the author’s experience, some cats can even be trained to purr on command by rewarding purring behavior with high-value treats.

Restricted breathing can have powerfully beneficial effects; however, too much of a good thing can also be deleterious, such as when there is too much restriction to airflow in extremely brachycephalic animals. Health problems secondary to decreased oxygenation and energy result in decreased longevity (44, 45). It is proposed that these animals are inactive in order to conserve vital energy, similar to people with ME/CFS who improve with rest and can only tolerate gradual activity (23). However, decreased activity and increased disease secondary to respiratory obstruction are also seen in pets who do not have extremely short skulls. There is a documented link between chronic diseases and decreased respiratory efficiency in mesocephalic Norwich terriers who have upper airway syndrome (46). Genetically predisposed individuals of this breed have decreased respiratory efficiency similar to patients who have brachycephalic obstructive airway syndrome (46). The author’s experience is that any brachycephalic or health-challenged and older pets, many of whom are unable to exercise, can have their QOL improved by using the pranayama for pet strategies discussed below, excluding overly strenuous activities such as running in animals with airway obstruction.

Perhaps the most powerful proactive application of pranayama for pets makes use of their keen sense of olfaction during the sniff walk. “Sniffing” pranayama activates the relaxation response and improves QOL and longevity by optimizing aerobic respiration, mental stimulation, and engagement, and is quite easy for clients to use (35). The everyday sniff walk is a great example of how pets’ keen sense of olfaction can be nurtured to help them increase their cellular energy to stay well and heal faster. People may go on a walk primarily for exercise, but if given a choice, most pets would spend most of their time on walks absorbing prana and practicing pranayama by stopping to sniff every few feet, improving their energy and QOL. Clients should be counseled to avoid tugging on the leash to keep their pets moving in order to maximize the potential benefits of pranayama while on a sniff walk. Even animals unable to do much exercise, such as those that are older or have arthritis or pain or other health challenges, can benefit from slow sniff walks.

Two other ways to harness the power of increased airflow are physical exercises, such as running and playing, and doing nose and scent work. Like the sniff walk, nose and scent work do not slow the breath to activate the autonomic reflex but rather use different neurobehavioral pathways to induce calm and improve focus both during and after these activities (38). Breath work improves focus and cognition and reduces distractibility of nervous dogs to facilitate training and increase learning (39). Exercising by running, playing, fetching, etc., increases the rate and depth of breathing in addition to the other known benefits of exercise (47, 48). Even pets that cannot exercise on land due to arthritic conditions or obesity can benefit from the effects of prana-building. Methods that increase respiration include swimming, using an underwater treadmill, and low-impact core exercises such as ball work, that improve healing and QOL. Even just walking outside in nature has been shown to improve QOL in people (49). Breathing and exercise have separate and additive effects on the improvements seen in people and animals (50).



In this article, it was hypothesized that pranayama can help veterinary patients achieve better treatment outcomes through mechanisms that increase both physical energy of ATP as well as nonphysical energy, or prana. This effect is similar to that seen in people with improved objective biomarkers such as VC, which are directly associated with the increased respiration and improved mitochondrial function from pranayama that is used in Ayurveda and yoga and correlate with improvements of all chronic diseases, QOL, and longevity (43). In addition to the improvements seen from increasing physical energy, it was postulated that there is an additive improvement from increasing the nonphysical energy of prana. This unseen and currently unquantifiable energy may be similar to the description of the biofield (3).

Pranayama is believed to be responsible for the many perceived and documented benefits of yoga in people, such as improved suppleness of the body, QOL, and aging (35). These beneficial effects were evaluated using both the energy-based ancient Ayurvedic medical framework as well as the molecular understanding of individuality and the exposotype. The understanding of equilibrium in homeopathy along with translated modern research allows better understanding and use of Ayurveda by veterinary scientists.

Further research is needed to fully quantify the benefits from pranayama and document the existence of the biofield to better understand and integrate these into veterinary medicine (3). Research is also needed to quantify the relationship between this nonphysical energy and measured cellular energy and mitochondrial function to facilitate effective use in specific health challenges such as cancer (37).



  1. Frawley D. Ayurvedic healing: a comprehensive guide. Twin Lakes, WI: Lotus Press; 2000:6–9.
  2. Van Lysbeth A. Pranayama: the yoga of breathing. London: Mandala Books; 1979.
  3. Kafatos MC, Chevalier G, Chopra C, Hubacher J, Kak S, Theise ND. Biofield science: current physics perspectives. Glob Adv Health Med. 2015;4(Suppl.):25–34.
  4. Iyengar BKS. Light on pranayama: the definitive guide to the art of breathing. New York: Crossroad Publishing; 2013:265.
  5. Patwardha B. Bridging Ayurveda with evidence-based scientific approaches in medicine. EPMA J. 2014;5(1):19.
  6. Rama S, Ballentine R, Hymes A. Science of the breath. Honesdale, PA: Himalayan Institute; 1996:VII.
  7. Sabia S, Shipley M, Elbaz A, et al. Why does lung function predict mortality? Results from the Whitehall II Cohort Study. Am J Epidemiol. 2010;172(12):1415–1423.
  8. Sengupta P. Health impacts of yoga and pranayama: a state-of-the-art review. Int J Prev Med. 2012;3(7):444–458.
  9. Saxena T, Saxena M. The effect of various breathing exercises (pranayama) in patients with bronchial asthma of mild to moderate severity. Int J Yoga. 2009;2(1):22–25.
  10. Galantino ML, Galbavy R, Quinn L. Therapeutic effects of yoga for children: a systematic review of the literature. Pediatr Phys Ther. 2008;20(1):66–80. 
  11. Grandpierre A, Chopra D, Kafatos MC. The universal principle of biology: determinism, quantum physics and spontaneity. NeuroQuantology. 2014;12(3):364–373.
  12. Feinman J. Using the vitality and balance system in holistic veterinary practice. J Am Holist Vet Med Assoc. 2019; 54 (spring):18–25. 
  13. Kannel WB, Seidman JM, Fercho W, Castelli WP. Vital capacity and congestive heart failure: the Framingham study. Circulation. 1974;49(6):1160–1166.
  14. Kang HK, Park HY, Jeong BH, Koh WJ, Lim SY. Relationship between forced vital capacity and Framingham cardiovascular risk score beyond the presence of metabolic syndrome: the Fourth Korea National Health and Nutrition Examination Survey. Medicine (Baltimore). 2015;94(47):e2089. 
  15. Esfandyarpour R, Kashi A, Nemat-Gorgani M, Wilhelmy J, Davis RW. A nanoelectronics-blood-based diagnostic biomarker for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Proc Natl Acad Sci U S A. 2019;116(21): 10250–10257
  16. Wallace DC. A mitochondrial paradigm of metabolic and degenerative diseases, aging, and cancer: a dawn for evolutionary medicine. Annu Rev Genet. 2005;39:359–407.
  17. Aw TY, Jones DP. Nutrient supply and mitochondrial function. Annu Rev Nutr. 1989;9:229–251.
  18. Howell N, Taylor SW, Fahy E, Murphy A, Ghosh SS. Restoring energy in a power crisis: mitochondrial targets for drug development. Targets. 2003;2(5):208–216.
  19. Harper JA, Dickinson K, Brand MD. Mitochondrial uncoupling as a target for drug development for the treatment of obesity. Obesity Rev. 2001;2(4):255–265.
  20. Lindqvist LM, Tandoc K, Topisirovic I, Furic L. Cross-talk between protein synthesis, energy metabolism and autophagy in cancer. Curr Opin Genet Dev. 2018;48;104–111.
  21. Aderemia AO, Novais SC, Lemos MFL, Alves LM, Hunter C, Pahl O. Oxidative stress responses and cellular energy allocation changes in microalgae following exposure to widely used human antibiotics. Aquat Toxicol. 2018; 203:130139.
  22. Johnson TA, Jinnah HA, Kamatani N. Shortage of cellular ATP as a cause of diseases and strategies to enhance ATP. Front Pharmacol. 2019;10:98.
  23. Myhill S, Booth NE, McLaren-Howard J. Chronic fatigue syndrome and mitochondrial dysfunction. Int J Clin Exp Med. 2009;2(1):1–16.
  24. Sharma H, Aggarwal D, Sen S, et al. Effects of Sudarshan Kriya on antioxidant status and blood lactate level. Paper presented at: Science of Breath International Symposium on Sudarshan Kriya, Pranayam & Consciousness; March 2–3, 2002; All India Institute of Medical Sciences, New Delhi, India.
  25. Feinman J. Significance of signs, symptoms, mTOR and quality of life. J Am Holist Vet Med Assoc. 2019;56:15–21.
  26. Christen Y. Oxidative stress and Alzheimer disease. A J Clin Nutr. 2000;71(2):621S–629S. 
  27. Duchen MR. Roles of mitochondria in health and disease. Diabetes. 2004;53(Suppl. 1):S96–S102.
  28. Jacquard C, Trioulier Y, Cosker F, et al. Brain mitochondrial defects amplify intracellular [Ca2+] rise and neurodegeneration but not Ca2+ entry during NMDA receptor activation. FASEB J. 2006;20(7):1021–1023. 
  29. Jimenez AG, Winward J, Beattie U, Cipolli W. Cellular metabolism and oxidative stress as a possible determinant for longevity in small breed and large breed dogs. PLoS ONE. 2018;13(4):e0195832.
  30. Benz CC, Yau C. Ageing, oxidative stress and cancer: paradigms in parallax. Nat Rev Cancer. 2008;8(11):875–879. 
  31. Rattray NJW, Deziel NC, Wallach JD, et al. Beyond genomics: understanding exposotypes through metabolomics. Hum Genomics. 2018;12(1):4. 
  32. Johnson CH, Athersuch TJ, Collman GW, et al. Yale School of Public Health symposium on lifetime exposures and human health: the exposome; summary and future reflections. Hum Genomics. 2017;11(1):32.
  33. Brown RP, Gerbarg PL. Yoga breathing, meditation, and longevity. Ann N Y Acad Sci. 2009;1172:54–62.
  34. Vedamurthachar A, Janakiramaiah N, Hegde JM, et al. Antidepressant efficacy and hormonal effects of Sudarshana Kriya Yoga (SKY) in alcohol dependent individuals. J Affect Disord. 2006;94(1–3):249–253.
  35. Kuntsevich V, Bushell WC, Theise ND. Mechanisms of yogic practices in health, aging, and disease. Mt Sinai J Med. 2010;77(5):559–569. 
  36. Federspil G, Sicolo N. The nature of life in the history of medical and philosophic thinking. Am J Nephrol. 1994; 14;337–343.
  37. Rao RM, Amritanshu R, Vinutha HT, et al. Role of yoga in cancer patients: expectations, benefits, and risks: a review. Indian J Palliat Care. 2017;23(3):225–230.
  38. Philippot P, Chapelle G, Blairy S. Respiratory feedback in the generation of emotion. Cogn Emot. 2010;16(5):605–627.
  39. Overall KL. Clinical behavioral medicine for small animals. Maryland Heights, MO: Mosby; 1997:580–599.
  40. Rugaas T. On talking terms with dogs: calming signals. 2nd ed. Wenatchee, WA: Dogwise Publishing; 2005.
  41. Calvo G, Holden E, Reid J, et al. Development of a behaviour-based measurement tool with defined intervention level for assessing acute pain in cats. J Small Anim Pract. 2014;55(12):622–629.
  42. Maehle G. Pranayama: the breath of yoga. Innaloo City, Australia: Kaivalya Publications; 2012:22–25.
  43. Von Muggenthaler E. The felid purr: a healing mechanism? Fauna Communications Research Institute website. Published 2001. Accessed September 30, 2019.
  44. Fawcett A, Barrs V, Awad M, et al. Consequences and management of canine brachycephaly in veterinary practice: perspectives from Australian veterinarians and veterinary specialists. Animals (Basel). 2019;9(1):3.
  45. Packer RMA, Hendricks A, Tivers MS, Burn CC. Impact of facial conformation on canine health: brachycephalic obstructive airway syndrome. PLoS One. 2015;10(10): e0137496.
  46. Marchant TW, Dietschi E, Rytz U, et al. An ADAMTS3 missense variant is associated with Norwich Terrier upper airway syndrome. PLoS Genet. 2019;15(5):e1008102.
  47. Ainsworth DM, Smith CA, Henderson KS, Dempsey JA. Breathing during exercise in dogs: passive or active? J Appl Physiol. 1996;81(2):586–595.
  48. Nicolò A, Massaroni C, Passfield L. Respiratory frequency during exercise: the neglected physiological measure. Front Physiol. 2017;8:922.
  49. Bowler DE, Buyung-Ali LM, Knight TM, Pullin AS. A systematic review of evidence for the added benefits to health of exposure to natural environments. BMC Public Health. 2010;10:456.
  50. Fu Q, Levine BD. Exercise and the autonomic nervous system. Handb Clin Neurol. 2013;117:147–160.



The following are some breath slowing and restricting techniques for calming dogs and cats:

  1. Calm your own mind and breathe slowly and deeply (use ujjayi).
  2. Give 1 pellet of the homeopathic medicine Aconitum napellus 30C to patients every 10 minutes.
  3. Calm patients by using their name and a high-value treat while gently massaging relaxation marma points (similar to acupressure points in traditional Chinese veterinary medicine [TCVM]) using 2 drops of Rescue Remedy or other flower essence for relaxation.
  4. Continue to speak to them throughout this calming procedure using their name preceded by the word “good” (using a long “gooood”) in a soft, soothing tone.
  5. Maintain eye and physical contact for dogs if tolerated (avoid for fear-aggressive dogs).
  6. Do not stare at your pet; instead, use a soft gaze with a slow half blink for cats.
  7. If you already know a spot that calms your pet, gently stroke them there. If not, slow rhythmic stroking under the chin is calming for many dogs and cats.
  8. Traveling in crates covered with towels often helps slow breathing and aids relaxation in both cats and dogs.

In addition to the slow-breathing pranayama techniques, clients can train their pets to restrict their breathing by the following methods:

  1. Use the high-value treats to teach them to lie with their head down on one paw.
  2. Train cats to purr and simulate the relaxation response associated with play by feeding a high-value treat while holding a feather in front of their face. Keep a feather in the car for use if your cat hyperventilates (and pants) in the car.

The cat relaxation tips are courtesy of Jean Hofve, DVM, and the training tips are courtesy of Jen Bridwell, Certified Professional Dog Trainer.


Copyright © 2020. 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.

Reducing Uncertainty During Epidemics

Reducing Uncertainty During Epidemics

We all worry about the future nowadays. Things, like “will we stay healthy despite COVID-19 and what may happen to our businesses”.

We may consider worry a “negative” emotion, but it is also an important evolutionary adaptation which we are all hard-wired to have. Anxiety, worry, fear, etc. can all activate the sympathetic nervous system and fight-or-flight responses we use to survive.

However, these emotions can also weaken the immune system and make us less resistant to infections like COVID (1).

“Positive” feelings like happiness, love, gratitude and awe can improve the immune surveillance that let’s the immune system detect and destroy the virus.

This may not keep you from getting sick, but feeling positive emotions like “awe”, from observing natural phenomena, are research-proven to improve things like infections, quality of life and even cancer (2).

A few strategies to decrease this worry include:

  • sticking to well-defined schedules – i.e. virtual yoga every day at 12
  • practicing temporal distancing – think about a time when life is more normal
  • connecting socially – while physically distancing
  • appreciating nature – watch the sunset, some birds flying, etc.

Think about how fortunate our earth is that we are giving her this unprecedented rest. Our atmosphere is rejuvenating to help the wonders of nature live on for many years.

Experiencing positive emotions are just one way to support our bodies to help them resist the virus. These supportive actions are one of the Avoid, Support and Cure (ASC) methods that can be used to keep us well.

It is especially helpful nowadays, as we slowly expose ourselves to others, to know that we can use all 3 together to survive and thrive.  By ASCing what we can do, we can formulate a specific action plan. Supportive and Curative Holistic Actions! may even improve your immune system’s ability to detect and destroy the virus. Optimizing this natural process of immune surveillance reduces risk of infection and cancer (3).

The CDC and WHO have given us important strategies to Avoid the virus, as we should, to use the first of the 3 categories. Here are all 3 of the harmless and helpful Holistic Actions! that we can use:

1. AVOID – actions to prevent viral exposure

  • physical distance
  • wash your hands
  • stop touching our faces

2. SUPPORT – actions that promote healing and immune surveillance

  • eating vital (fresh) foods like wild blueberries and kale
  • breathing deeply through our noses
  • feeling positive emotions and connecting

3. CURE – actions that work to eliminate a hypothesized underlying energetic imbalance

  • Traditional Chinese Medicine (like acupuncture)
  • ayurveda
  • homeopathy

#3 can be especially reassuring even though it uses a different medical paradigm than we practice. Numbers do not lie, and with epidemics they are compelling.

For example, it is reassuring to look at historical data about past epidemics and pandemics. >30% more NY City residents (vs. Philadelphia and Boston) could stay healthy during the 1918 Spanish Flu in New York City thanks to the health commissioner who was a homeopath (4).

In fact, homeopathy saved so many lives during this and past epidemics like flu, cholera, typhoid, etc. that the only monument to a foreign doctor in Washington DC honors Dr.

Hahnemann who first described homeopathy.

While you’re Avoiding the virus, perhaps watch the Empower Hour! Webinar below to learn more about support the body and activating natural healing mechanisms using homeopathy. This is especially important nowadays when anti-inflammatories, which interfere with natural healing mechanisms, can worsen COVID outcomes.


  • 00:00 Introducing today’s topic and guest
  • 03:00 Genus epidemicus for fear
  • 07:00 Switching the views – power of nature
  • 10:00 Explaining genus epidemicus and homeopathic doctors’ experience
  • 14:00 Fear = susceptibility
  • 21:00 Conquering fear – focusing on love based medicine.
  • 23:30 Homeopathy preventing a pandemic / Spanish flu
  • 31:30 Laughing medicine
  • 33:30 Q&A: wearing masks
  • 41:00 Social distancing vs. physical distancing / some humor
  • 44:00 Shift network to decrease fear
  • 46:00 Laughing / Patch Adams
  • 47:10 Homeopathic remedies and how to distinguish between them
  • 49:00 Spiritual side of Corona
  • 51:45 Gradual exposure protocol / Parvo / nosodes / weekly interval
  • 56:30 Corona in cats


  1. D’Acquisto F. Affective immunology: where emotions and the immune response converge. Dialogues Clin Neurosci. 2017;19(1):9–19.
  3. Swann JB, Smyth MJ. Immune surveillance of tumors. J Clin Invest. 2007;117(5):1137–1146. doi:10.1172/JCI31405
  4. Aimone F. The 1918 influenza epidemic in New York City: a review of the public health response. Public Health Rep. 2010;125 Suppl 3(Suppl 3):71–79. doi:10.1177/00333549101250S310

If you would like some extra guidance, Holistic Actions! Gold membership now includes a free monthly 15 minute consultation with Dr. Jeff to discuss your Holistic Medical Decision Making (in addition to many other resources). To discuss Holistic Actions! you can take and to learn more about the Vitality and Balance System which describes how they work on a molecular level, just register as a Gold member and schedule time to talk.