Goldy has bone cancer. A few weeks ago she wasn't feeling very well. Her leg was amputated months before and she finished her chemotherapy as directed by her oncologist. Goldy was an active, happy dog but she was tired, eating poorly and just seemed lethargic. Her human "mom" brought her back to our office in hopes of making her more comfortable. We both feared the worst as bone cancer tends to spread to the lungs and when patients become suddenly tired and depressed, sometimes this means that tumors in the lung are growing and the dog is nearing the end of its life.
But fear makes us less effective and it makes us stupid. Stupid people make mistakes. I'll never forget listening to a lecture when I was an undergraduate that detailed clinical research in humans which showed that when students were afraid their intelligence quotient test results fell significantly. When we are fearful we need to relax and face the situation to examine it to find truth. Once we have truth we can progress more logically towards taking effective actions. Veterinarians know that diagnostic testing allows us to do that and a routine chest x-ray failed to show any tumor spread to Goldy's chest. We breathed a sigh of relief and took some blood tests to check her metabolic state.
The tests were all normal but Goldy just didn't feel well. What should we do?
Goldy's mom did not want appetite stimulant or antidepressant drugs as her mother had become ill on such medications. Since Goldy has frequent bad reactions to medications and has a queasy stomach that concern is legitimate. She was on a good diet for her disease. What else could we do?
Astragalus is a commonly used herb in integrative human and veterinary practice. Its history goes further than the written word. Traditional Oriental Medicine discovered the herb was useful in supporting the immune system, heart, and kidneys. It also tends to lower blood pressure. As a tonic herb it is used to make sick patients feel better.
That isn't a very scientific statement, but if you are sick and you take the stuff and feel better that is awfully nice. If someone you love is sick and improves that is even better.
For thousands of years healers, mothers, midwives and people entrusted to healing and later, more formally trained "doctors," have successfully applied this herb for a wide variety of conditions. Skeptics laugh at this application because for them no one can know anything without a million dollar double blind study. The gentle Oriental doctor simply smiles because he knows what he knows.
So who is right?
I think they both are, and I don't mean this in any wishy-washy, feel-good way. The truth is that science and the desire to expand humankind's knowledge base has a place for all of these people. The desire to live better and longer is inherent in each of us. Within the broad field of medicine we have jobs for so many different functions.
We need people that go into other cultures and survey their uses of natural compounds (a field called ethnobotany).
We need people that examine the plant samples for proper categorization and labeling. After all, it is by that work that can properly identify the plant and study it further.
We need biochemists to determine the names and structures of chemical constituents in the plants we find.
We need toxicologists, pharmacologists and physiologists to help understand how the chemicals interact and function.
We need drug companies to identify useful chemicals and achieve patents to support their industry's purpose of healing.
And we need clinicians that care about patients, who understand their basic science and who will use what they know to help their patients. This is important because for many conditions that enter our clinics there are no randomized, double blind, placebo controlled studies. Veterinarians must be able to seek out the available information and make decisions based on the scientific and clinical information that is available to them.
A major part of science starts with individuals asking questions and observing phenomena. The current textbook says, "no cure or poor prognosis," but the patient is sitting there asking for help and in need of relief. A caring doctor goes to the literature, seeks out specialists and does what they can to find an answer for that patient. It's not about legality or about getting sued, it's about helping the patient in the exam room. And when a clinician finds something that helps or appears to help, then they should publish that material and let others know. In that way we speed discovery and the advancement of medical understanding.
Integrative veterinary medicine operates in this interesting and challenging space between established proven knowledge and data that is incompletely evaluated. If a treatment makes sense, and has a low chance of harm, then it has value and may be used when present knowledge is inadequate. If there is scientific research supporting the theory or idea then that is even better. As experience builds some things are found to be unworkable while others are found to be useful and become part of "conventional" veterinary medicine.
As data works its way through that path we need people who care and who are brave enough to try something new (which is often something old), and we need people that are skeptics and refuse to accept anything without strong scientific facts. Through that interplay we see veterinary medicine grow and improve as we keep those things that work and abandon or replace things that fail to make the mark.
Science is a funny word. It literally means "knowing." Some feel that individuals are incapable of knowing and only through rigorous scientific investigation can anything be proven and accepted. Others have disdain for the subject entirely, feeling it takes too long for any real knowledge to be found and proven. Personally I like science. To me it is simply one more tool to seek truth and hopefully find healing. The larger field of science is incredibly useful in finding, cataloguing, and investigating facts and their interrelationships.
For years, holistic and now integrative veterinarians have used the herb Astragalus to help ill patients. If you search Pubmed for Astragalus you will find over 5,000 studies on this herb. It's known to be safe and studies have shown that it is capable of improving kidney function in rats and dogs. We also find it helps delay senility in rats and supports heart function while reducing blood pressure. Studies also show the herb to be antiviral and anti-inflammatory, while improving immunity in mice with tumors. As with many herbs, there may be reactions with certain drugs so its use should be shared with a veterinarian knowledgeable about herbs and drugs.
And while all these studies are done but lost in the eternal depths of scientific libraries that few clinical veterinarians frequented, finally two interested and dedicated integrative veterinarians named Susan Wynn and Barbara Fougere took a couple years of their lives to write an evidence based book on Veterinary Herbal Medicine. Because of their work, interested, ethical and competent veterinarians can find this data more simply. And as veterinarians begin to learn more about herbs they become much more interested in their use. Many will join professional groups so they can associate with other veterinarians who are experienced in the use of herbs.
Now anyone can learn this stuff. Well anyone who will take the time to study and read with the intention of helping their patients live better, longer lives.
Goldy is feeling better now. She has a fatal disease, but her energy and activity have returned to normal and if we stop the Astragalus she gets tired again. Since Astragalus has no known harmful effects, does not interfere with any of her other medications, and since we are confident in our herbal source for its purity and safety her mom is happy to keep her on the herb.
I'm just happy she feels better.
Interesting Reading:
Yang AK, He SM, Liu L, Liu JP, Wei MQ, Zhou SF. "Herbal interactions with anticancer drugs: mechanistic and clinical considerations." Curr Med Chem. 2010;17(16):1635-78.
Chen W, Li YM, Yu MH. "Astragalus polysaccharides: an effective treatment for diabetes prevention in NOD mice." Exp Clin Endocrinol Diabetes. 2008 Aug;116(8):468-74.
Clement-Kruzel S, Hwang SA, Kruzel MC, Dasgupta A, Actor JK. "Immune modulation of macrophage pro-inflammatory response by goldenseal and Astragalus extracts." J Med Food. 2008 Sep;11(3):493-8.
Brunetti L, DeSantis ER. "Treatment of viral myocarditis caused by coxsackievirus" B. Am J Health Syst Pharm. 2008 Jan 15;65(2):132-7.
Ahmed MS, Hou SH, Battaglia MC, Picken MM, Leehey DJ. "Treatment of idiopathic membranous nephropathy with the herb Astragalus membranaceus." Am J Kidney Dis. 2007 Dec;50(6):1028-32.