One of the frustrating things about medicine is that most of our focus in treating disease involves making a symptom list and then giving a list of medications to alleviate these symptoms rather than having a true “holistic” approach to treating the animal, at least in terms of my definition of a holistic approach.
Autoimmune diseases, for example, rely on steroids and other potent immunosuppressive drugs to alleviate symptoms. These drugs often work but also come with a litany of side effects, and sometimes we are unable to wean patients off them. Most of the time, when we use immunosuppressive drugs, we have no idea what is causing the immune system to go awry. We are treating the symptoms, not the disease. Our treatment of most cancers involves nasty chemotherapies and tissue destructive radiation in an effort to destroy the rapidly dividing cancer cells faster than the destruction of surrounding healthy tissue. Lysodren therapy for Cushing’s disease relies on destroying just enough of the adrenal glands to control symptoms within the patient. Too much lysodren can kill the patient. Itchy skin is treated with topical and oral steroids often times without a real understanding of what is causing the itch. The list goes on and on.
While we, as general practitioners, do have foundations in physiology, nutrition and pharmacology, most veterinary practitioners, myself included, stray from truly delving into the mechanics of the disease process itself, but instead focus on prescribing drugs simply to alleviate symptoms. But, even with the background that we do possess, are such drugs enough? How limited is our understanding of how the normal body functions? A true holistic approach would have to start with an understanding of what is going on at the molecular level of an animal. It is quite similar to understanding the universe by studying its smallest elemental particles. Gene therapy and stem cell are rapidly developing fields which show great promise for truly understanding and altering disease processes. What role will they play in veterinary medicine? Why are a few diseases like diabetes, renal disease, and hyperthyroidism rampant in the domestic feline population? What do we really know about what role nutrition, spaying and neutering, and environmental toxins play in these and other diseases? And apropro to this discussion is what role do the trillions of other organisms that share our bodies with us play in the manifestation of disease?
We are not simply living beings, but we are actually a conglomerate of literally trillions, if not quadrillions, of bacteria and other living organisms. It may surprise people to know that the number of bacterial cells in our body outnumbers the number of human cells by as much as 10:1! Some are even host specific, and it is entirely possible that everyone could have a unique bacterial signature. What is more interesting is that recent evidence suggests that bacterial DNA can be readily inserted into our own DNA and that that process may be intimately tied to some forms of cancer and other disease1.
Just how delicate this balance is in our bodies is readily apparent when we overuse antibiotics, particularly in hospital settings. Using antibiotics to destroy bad bacteria can also kill the “good” microflora in our bodies. Many women have experienced this when they develop vaginal yeast infections while taking antibiotics. More serious is the recent explosion of Clostridium difficile. C. difficile is an extremely dangerous bacteria which causes severe diarrhea, weight loss, dehydration, hematochezia (blood in the stool) and even death. The antibiotics that are used to treat the C. difficile are expensive and are not without side effects. Worse yet, as the bacteria develop resistance, the antibiotics often no longer work. More and more people are dying in human hospitals. We are running out of options. Antibiotic overuse, misuse and resistance can certainly be an angryvet topic unto itself.
One recent treatment which has emerged for treating C. diff involves removing feces from healthy patients, with all of its good bacteria, blending it down with a saline mixture until it looks like chocolate milk, and then transfusing it into the patient either through tubing orally or via enema. While this sounds grotesque, anyone suffering from this brutal infection would gladly undergo any treatment that makes them feel better. The good news is that this procedure has been a life-saver. Cure rates, not just symptom relief, but cure rates, have been greater than 90% when traditional antibiotic therapy has failed!
While C. diff infections are much less common, so far, in companion animals, this procedure has been described before for infected animals. Eight dogs who tested positive for Clostridium perfringens and whose infections were not cured with antimicrobial therapy alone underwent fecal transplants from an infection-free donor dog. Donor stool was mixed as described above and given as an enema on an outpatient basis in an unsedated patient. Eight out of eight dogs had immediate resolution of their diarrhea and six out of eight dogs were negative on follow-up PCR panels for Clostridium perfringens alpha toxin gene expression. The dogs received between one and three fecal transplants.2.
Perhaps many frustrating diseases which we encounter in veterinary medicine could be treated with this procedure. Diseases that come to mind include kitten diarrhea, chronic giardiosis, inflammatory bowel disease, irritable bowel syndrome, helicobacter, and allergies. In current veterinary medicine there is not a lot of study going on in this field. We just don’t know and we will not know how powerful this therapy and other microbial based therapies will work to treat disease unless we do our due diligence, think outside the box, and push ourselves to understand and treat our patients on a truly holistic level.
1. American Society for Microbiology. “Humans Have Ten Times More Bacteria Than Human Cells: How Do Microbial Communities Affect Human Health?.” ScienceDaily. ScienceDaily, 5 June 2008.
2.Murphy T, Chaitman J, Han E. Use of Fecal Transplant in Eight Dogs with Refractory Clostridium perfringens-Associated Diarrhea. ACVIM Proceedings 2014