Using the Vitality and Balance System in Holistic Veterinary Practice
by Jeff Feinman, VMD • Published in AHVMA Journal • Volume 54 Spring 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).
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.
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Dr. Feinman thanks Dr. Christina Chambreau for her invaluable contributions and support in Holistic Actions! Academy teaching HMDM, Vitality, Balance, and Homeopathy to animal guardians and doctors.