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September 13, 2005

New AVMA Policy Leaves Fewer Options For Horse Owners

The expression "it takes a village" is a fitting adage for the effort required to raise and to maintain our horses at their best.
 
In addition to all the blankets and boots and feed and supplements that take over the tack and feed rooms, we need a good veterinarian to help maintain overall health, a farrier to keep their feet level and properly shod, and a dentist to keep the mouth free from pain.

And now acupuncturists, chiropractors and massage body workers are often joining the "village" that helps our horses stay comfortable and performing at their best.

But as these complimentary therapies have become more popular and widespread, consumers and professionals have asked questions about the education and regulation of the people who practice them.
 
Who should be allowed to do acupuncture on your horse? Is it safe for a person who hasn't been to veterinary school to perform a spinal adjustment? Can massage be harmful in the wrong hands?
 
Even dentistry, with the advances in technology and power tools, is in uncertain waters. Who's best qualified to use these tools? How much training is enough?
 
The American Veterinary Medical Association, which sets standards for veterinary ethics and practice for all animals, holds that it's safest to have veterinarians working on animals, and the organization's leaders modified their Model Veterinary Practice Act in 2003 to reflect that.
 
"Vets have the education and training and experience to understand animals' physiology, chemistry and so on. The AVMA believes all veterinary work should be practiced by or under the supervision of a licensed vet," said Dr. Beth Sabin, the AVMA's assistant director of education and research.
 
The AVMA's revised definition of veterinary medicine includes not only the treatment of any "physical, dental, or mental conditions by any method or mode," but also specifically embraces complementary, alternative, and integrative therapies into the definition. These therapies "include, but are not limited to, veterinary acupuncture and acupressure; veterinary homeopathy; and veterinary manual or manipulative therapy."
 
The view that veterinarians are the best bet for therapeutic practices is shared by many practicing veterinarians and horse owners, and by the American Association of Equine Practitioners. While the AAEP has no official position on the veterinary practice acts in each of the 50 states, they do, according to Executive Director Dave Foley, "share many of the same policies as the AVMA."
 
The AAEP also adopted word for word the AVMA's Guidelines for Complementary Medicine.
 
What's Realistic; What's Not?
 
In May 2003, the AVMA approved a revised Model Veterinary Practice Act, which serves as a model for states wishing to revise their own practice acts. Sabin said that the intent of the act is to provide broad model language.
 
Arizona, for example, defines veterinary medicine as the domain of one who "prescribes or administers any drug, medicine, treatment, method or practice, performs any operation or manipulation, or applies any apparatus or appliance for the cure, amelioration, correction or modification of any animal condition, disease, deformity, defect, wound or injury for hire, fee, compensation."
 
The word "any"'as in any method, any condition, any practice could be interpreted to mean that veterinarians are the only professionals who can work on animals within the scope of the law.
 
Because this isn't realistic in the real world, and because owners and trainers regularly use the services of non-veterinarians, some states have added specific exemptions to their laws.
 
Farriers, for example, aren't generally considered to be practicing veterinary medicine, even though they may provide "amelioration or correction of a condition."
 
In Texas, regular shoeing and tooth floating are considered non-invasive and, therefore, not veterinary medicine, but lay dentists and farriers may not diagnose a medical condition like cavities, navicular changes or ringbone.
 
In 2003 Georgia and Illinois each made changes to their veterinary practice acts, but to very different results.
 
Georgia expanded and clarified the definition of veterinary medicine as "including, but not limited to, acupuncture, animal dentistry, manual or mechanical adjustment procedures, physical therapy, surgery."
 
This restricts most non-veterinary practitioners, although performing "soft-tissue animal massage" and "hoof trimming or shoeing" by non-veterinarians is still allowed under the law. Licensed health-care providers like human chiropractic doctors are also permitted to work on animals, as long as they're under the direction of a licensed veterinarian.
 
On the other hand, a grassroots effort of letter writing, phone calling, public relations and eventually the hiring of a lobbyist developed a unique clause in the Illinois legislation to allow alternative practices by non-veterinarians, as long as there is written consent.
 
The law permits "an owner or agent of the owner, acting with the owner's approval, in caring for, training, or treating an animal belonging to the owner, so long as that individual or agent does not represent himself or herself as a veterinarian."  The agent shall provide the owner with a written statement summarizing the nature of the services provided and obtain a signed acknowledgement from the owner that they accept the services provided."
 
With the exemption, all alternative, complementary and integrative therapists can legally continue to work, as long as they follow the guidelines.
 
Jeanette Crowe, a certified equine sports massage therapist and horse owner from Mackinaw, Ill., was among those involved in adding this exemption to the state's 2004 Veterinary Medical and Surgery Practice Act. Crowe is also the president of the Illinois Alliance for Animal Owners' Rights, a non-profit organization dedicated to preserving freedom of health-care and other choices.
 
"Available holistic services from vets are often limited to non-existent, and vets are not traditionally taught natural healing practices in vet school," said Crowe. "We feel that as humans we have the freedom of choice in our own health care, so we should have the same freedom with our animals."
 
Crowe added, "Our group in no way takes an anti-vet position."
 
A California group, the Coalition for Natural Health, is also working to include a clause similar to Illinois' in that state's veterinary practice act.
 
Other Approaches
 
For the most part, those involved in the debate all want the same thing'the best possible care for the horse. But, as in human medicine, there is no one way of approaching an illness or injury.
 
Few would want to do without conventional veterinary care for wounds, emergencies, surgery, or infections. But in other cases'like stiffness to the right or lingering hind end soreness'a veterinarian isn't always available or might even be unable to alleviate the problem. In these situations, many horse owners and trainers seek other approaches, the most common being acupuncture, chiropractic, massage and dentistry.
 
Professional hunter rider Havens Schatt once had a horse who regularly put a rib out while sleeping and was then unable to canter. At one horse show, Schatt couldn't find a veterinarian as the horse's class approached. She finally tracked down a massage therapist, who "fixed him."
 
Schatt said she feels "more comfortable having a vet work on my horse if it's someone I don't know." But she does use non-veterinary practitioners who have come highly recommended. "I met the chiropractor through my farrier of 10 years. I trust his opinion. If some problem is easily fixable through massage or chiropractic, I'm all for that," she said.
 
According to Debranne Pattillo, chairman of the International Equine Body Worker Association, massage and other non-invasive bodywork on horses is legal for non-veterinarians in only 17 states, and in many states massage is still a gray area.
 
"These laws frighten me as a body worker," said Pattillo, an advanced equine body worker, "but my selection for complementary care as an animal owner is also limited."
 
Acupuncture is considered an invasive procedure since it involves needles and requires years of training and practical experience to develop proficiency. Nearly all states permit only veterinarians to practice it on animals, but some'including Vermont, Iowa, New Jersey and Virginia'allow licensed acupuncturists to work on animals under the direct supervision of a veterinarian.
 
Dr. Marvin Cain, who specializes in acupuncture and was a co-founder of the International Veterinary Acupuncture Society, acknowledges the potential for bad practitioners in any field, but he disapproves of the current regulation of acupuncture.
 
"[Acupuncture] is an art, and the U.S. is trying to make it scientific. To be good at it, one must be sincerely devoted, and the vets are too busy with other things," said Cain. "The ones doing the best job right now, the ones who spent months riding around [apprenticing] with me, are not generally vets."
 
Cain believes that the best practitioners will rise to the top. "If someone treats your horse and it doesn't work, will you call them back?" asked Cain. "Probably not."
 
Dr. Willie McCormick of Middleburg, Va., also uses acupuncture in his practice, but he has a different view.
"It should be regulated'at least done in consultation with a vet to reduce the possibility of malpractice. Even something like homeopathy could be dangerous in the wrong hands," said McCormick.
 
Working Together
 
Like acupuncture, chiropractic work entails years of education and is rarely undertaken or permitted by those who are not doctors of veterinary medicine or human chiropractic.
 
Dr. Doug Ziegler, a chiropractor who, after years of working on people now works on horses around the country, prefers to work closely with veterinarians, dentists, farriers, and other care-givers.
 
"When I treated people, I regularly worked with orthopedic and neurosurgeons. It was about co-managed care," said Ziegler.
 
Ziegler often works on horses referred by veterinarians and will talk over his treatments with them. He also shares some of his techniques with veterinarians.
 
"I believe in starting with the least invasive procedure, like an adjustment, and if it doesn't work you can always move up to injection or surgery. It is also important to work around the vets and not do anything that might interfere with their treatments," said Ziegler.
 
One veterinarian who has referred clients to Ziegler is Dr. Bill Patterson, who's based in Ohio but holds a veterinary license in 12 states.
 
"I prefer to make a diagnosis using allopathic [Western or more conventional] methods, but I will then bring in a complementary therapist if that might help treat the horse," said Patterson. "I don't want to do chiropractic or acupuncture myself. I don't have the time, and it would dilute my practice and my time."
 
Patterson and Ziegler worked together on a horse named Winston, who had serious neurological symptoms that did not respond to previous treatments. They discovered an abnormal cervical joint and X-rayed it. Ziegler adjusted the specific area, and then Patterson took a follow up X-ray to see if it had changed.
 
"Chiropractic is not a cure-all," said Ziegler, "but in this case it worked. After about eight treatments, the horse was sound."
Patterson said he would not recommend just any practitioner. "I have to have a good relationship with both the allied practitioner and the horse owner, so that if there is a problem we can talk about it. Communication is the most important thing."
 
Dentistry has probably come under the most scrutiny because an increasing number of veterinarians are specializing in equine dentistry as the technology improves. Dr. Tom Allen of Patterson, Mo., is one.
 
"We owe much of our current understanding of equine dental principals and practice to individuals outside the veterinary profession," said Allen.
 
But he added that in recent years veterinarians have made many of the advances in dental technology and technique.
Allen said that veterinary schools spend little time teaching dentistry or alternative therapies, so many vets actually learn from lay practitioners.
 
"And in states where direct supervision of these lay dentists by vets is required, the horse owner ends up paying twice as much," said Allen.
Until recently, independent organizations like the International Association of Equine Dentistry and the Academy of Equine Dentistry were the only ones offering certification courses, seminars, and continuing education. But now, said Allen, "The AAEP also is actively promoting awareness and education of good dentistry and encouraging vet schools to include more dentistry in the curriculum."
 
Allen believes that the need for good dentistry will only increase as people learn more about the importance of dental health to the entire animal.
 
"As it is now," said Allen, "in Missouri, where only a vet or direct veterinary supervision is allowed, the law is not practical. There are 600,000 horses in the state, and there might be three full-time veterinary dental practitioners."
 
Complicated Goals
 
There is no neat answer to the question of how to have a complete selection of qualified practitioners available to work on our horses. Ziegler believes that in an ideal world there would be an accredited, four-year professional degree program in animal chiropractic, and others would like to see recognized schools and licensing for massage. But these are complicated goals in the real world.
 
"In Vermont," said Patterson, "they tried to get state licensing for equine dental technicians, but it was just not doable, as most states are limited by money. It would have cost $10,000 per person to get licensed."
 
And liability is always a significant issue. "The greatest drawback to working with complementary therapists," said Patterson, "is if something goes wrong, who is responsible? More often than not, it's the vet."
 
But Patterson doesn't think legislation is the answer.
 
"Legislation is spotty and incendiary," he said. "And I would rather not live in a world where we didn't have access to [complementary therapists]. Let's all strive for excellence in what we do, rather that fight about whose domain it is. Again, if we communicated, we'd all grow from it."
 
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