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Surviving Veterinary Medicine

With Dr. Allen Landes

Do What You Love. Love What You Do. Keys to Survival

Surviving Veterinary Medicine. Be smart, be bold, be creative and be your own boss. At the very least, find a practice where you can do what you do in the most positive way that gives you the space to practice medicine as you see fit. Because at SVM we set a higher standard for medicine than what you learned in school.

I’m your host, Dr. Narda Robinson, veterinarian, osteopathic physician and leader of the Vet Med Revolution, calling for safer, gentler and more effective medicine for animals and their people.

Dr. Narda Robinson (NR): In this month’s podcast, I’m interviewing Dr. Allen Landes, who’s a local equine practitioner in Laporte, Colorado. Allen has also been a longstanding instructor with our Medical Acupuncture for Veterinarians Program. He’s kind, patient and does everything that a general practitioner would do, including acupuncture and some rehabilitation exercises for his patients as well.

Dr. Allen Landes (AL): The only reason I was drawn to our program here with acupuncture is because it was evidence based.

You know, that was the whole reason I even came over to this area to look was because it was evidence based and there was just no way for me to go otherwise.

Because when I got out of school in ‘96, it was like we learned to cut, we learned to do medicine, we learned to vaccinate and do dentals, and that’s what we did in the equine business. So, it was one of those things where, you know, that’s what we did. And then when we looked at alternative things, it was like, “Woo, woo.”

NR: Yeah, and then I mean, like Gayle Trotter and Gary Baxter, they both took my course and they were both interested. So, then I remember doing a couple of cases over in the large animal. And of course, that was just me at the time, I mean, with Dr. Stashak and then Dr. McIlwraith was really supportive. And that’s when we outgrew CSU back in like 2001 and went to the Equine Center because they had more room and capacity.

So, yeah, that was a really pivotal sort of number of years around that time, after we both had gotten out of school.

AL: Yeah, it was one of those times where I had talked to Gayle Trotter about it and he’s like, “You know, there are times when they just come in and all I can do is cut them. There’s got to be something I can do before that.”

NR: Right.

AL: Agreed. So, it was eye opening to see that kind of transformation in a surgeon. You know, for him to go, “Well, there’s got to be more than just cutting them.”

NR: Right.

Yeah. Those were the days. I look back after everything and it’s just like that was a special period of time where Dr. Nelson was the director of the hospital. I don’t know if in your year or if it was first in my year where they started to have the business classes. It was in third year.

AL: Yeah. Yep, yep. They were doing business classes. Yeah, absolutely.

NR: And it was premature, I thought, because I mean we were third years, not fourth year, but also, I was very bored. So, aside from treating my fellow students at the back of the room with acupuncture.

Anyways, that was when I proposed starting the acupuncture course or the acupuncture service at CSU, thanks to that course, even though I skipped a lot of them. But because you would submit your resumé and it says like, “What do you want to do?” And I said, “I think we should start a course.” Because then Dr. Ogilvie helped and he was a real champion like to do this and everything. It was those two people that were pivotal for me to even start there.

So, I just look back because just over the ensuing years, it was not the same kind of environment.

AL: Right.

NR: Yeah.

AL: Yeah.

I mean, there were a lot of people that kind of looked ahead and kind of saw what needed to be done as far as the future of veterinary medicine goes.

NR: Yeah.

AL: And I think with your insight to look at that, too, is how can we integrate all these? Because you knew at the time what it would do, but you had to convince everybody else.

NR: Well, and at that time, that was sort of my pre-full-scientific conversion because I had come out of the UCLA for Physicians course and there was still some of that Chi. And then I just remember being up at the front of the room one time and describing the, we didn’t even teach it anymore; the piloerector response along the Bladder meridian.

AL: Oh really.

NR: It was called PRABM, because this is what IVAS would teach. And it’s when you would put a needle in the back and somehow, you would sometimes get these tufts of hair, these piloerector responses. Do you get that sometimes?

AL: Well, I’ve seen some fasciculation further towards the cranium, you know?

NR: Yeah.

AL: So, you could see that kind of thing where you needle them and then you go, “Whoa.” And even with laser, you can see that occur, where you see the fasciculation occur up above. Yeah.

NR: Yeah.

Well, and that makes sense because it’s this whole longitudinal muscle. And I think that there were just sometimes just episodes of probably the fascia releasing when you get to certain intercostal spaces.

Anyways, I just remembered one time at the front of the room, I was at the front board and I was like, “Well, there’s no way that there’s one nerve that connects all this. So, it has to be energy.”

And then just like one of the three people that started IVAS that had broken away, was a good friend of mine. And he is just pummeling me with scientific information and neurophysiology, and I just had to give. So, that was around 2001, 2002. And there was a big rebellion among the teachers of the course because they were like, “Oh, I don’t know. If we go all scientific, what’s going to happen? We’re not sure.” That was just all those early revolution repercussion things. But anyway, yeah. So, I think we’ve all kind of had our journeys.

So, today, I mean, we’re kind of talking about it already, but the podcast is, as you know, Surviving Veterinary Medicine.

AL: Surviving Veterinary Medicine. Yeah.

NR: Yeah.

And so, especially in the last few years, where there is more recognition of just burnout and depression and suicide and everything. So, that’s why we tend to talk about, I mean, in addition to professional stuff, because I think that the people that come to our courses are ready for a change. And so we see that.

And then also, like even beginning in vet school and we have all these vet students, but they start to, I think, lose a lot of their enthusiasm sometimes in school. Especially, you had mentioned, in school, we were taught drugs and surgery and not much else; vaccinations, whatever.

AL: Right.

NR: And so, if they’re not exposed to this, and especially when they go into corporate, I don’t know. So, those are kind of the two things.

AL: Yeah, I look at, to me, when I took the course in 2012, I’d already been out since ‘96. So, several years; over 10. And I was going to get in the middle time between your 10 and 20 years of being out of vet school. And you’re like you’re reflecting on where you’ve been and what you’ve done and the cases that you have seen. And like there was still something that I felt like there was more I could do.

And I had met Tim Holt and I had met Pam Muhonen. It was one of those things where, “How? Do you stick a needle in here and you get this effect?” And I go, “Well, there’s got to be something more to that.” And I knew, because I knew you from school, but I had followed your progression and how you’ve got scientific data that backs this up. This isn’t just that Chinese medicine that I’ve heard about when I was in, you know, all this time and how that would be set aside and like, “Well, that’s just woo woo kind of stuff.”

So, when I went to look at it more and when I started doing the classes, I was at first very overwhelmed with the neuroanatomy and trying to remember back those 15 years plus of – Even before that, my anatomy course was like, “Wow.” That was just a phase of like, all of a sudden, we’re into the leg again, you know?

NR: All right.

AL: And to try to learn all the different things of the different species; the cat and the dog and the horse and the cow, whatever. But then trying to remember back to that neuroanatomy. And for me, still, I have to look up lower motor neuron signs and upper motor neuron signs to get them right. But to go back and be that.

But then it sunk in to me at that time that this is something fresh; this is something that, how can I integrate this into my practice? And so, I kept looking around. And I’m like, “Of course, all these horses have back pain, but why? And is it saddle fit, it is a poor posture?”

I remember one of my mentors, that was an employer of mine, he would always say, “Well, you palpate across the lumbar area to see if they’ve got hock pain.” And I was like, “Okay, that sounds good. But why is that? Why is that?” “Well, maybe they have hock arthritis, some sort of osteoarthritis, but then they refer it back up to the lumbar area because they’re carrying themselves differently.

So, how can we fix that?” “Well you inject the hocks.” “Well, that’s not just the only thing we can do now. Now I see that. I can see that with my acupuncture, my laser therapy, my massage that I can do on these guys, you know, there is so much more. Yes, I can treat the initial problem of the hocks being sore, but then I can help relieve the pain and get them back into even further.

So, to me, it added a different thing to me and it made me go from surviving veterinary medicine to thriving. And I really believe that, that my practice has thrived. I can tell you, when I purchased my practice in 2008, and it was that kind of in-between period where I needed to keep it going – Because it was already an established practice, right? – and keep it going versus getting it to really proliferate and really build and grow.

NR: Yeah.

AL: And so, that timeframe where I took the course and it helped me to realize that not only can I add more to my repertoire of things I can do and increase my bottom line, but it also increased my feeling of, “I did something good for this horse” besides, “I did all I could do for this horse to help it better itself and make it feel better.”

NR: Right.

AL: It was just one of those things where I feel like it’s still a struggle to be a veterinarian and to be a business owner and to take all these on. I mean, in the last five days, I’ve interviewed four different technicians to come on board with me because I need my technician. I need a technician. I had lost one in August, so I needed to take one on. And then try to practice.

NR: Right.

AL: Thank goodness, it’s a slow time of period for me. But still, it was that kind of thing that when I go to show them the different things that I do as they interview, I’m always happy to get to the acupuncture part.

NR: Right.

AL: Because then I asked them, “What do you know of acupuncture?” Well, most of them have been in small animal, and one of them said, “We do have Dr. Dixon come in and do the acupuncture for us at our clinic.” I’m like, “Oh, well, that’s good, because I know Shawn and that’s a good thing.” Because then she’s been introduced to it in the right way.

NR: Right.

AL: In the correct way.

So, Anyway, it’s really built the practice, not so much around the acupuncture, but it has lent itself to everything that I do; from pre-purchase exams, when I’m laying my hands on the horse, I’m more cognizant of areas of pain and what I’m palpating and looking at.

Same way with lameness exams, because that’s part of it. And even more neuro exams into these kinds of things. I’ve got a client that really is good at looking at neuro horses, just because she gets to see them sent to her as a trainer.

NR: Oh, wow.

AL: She’s a certified vet tech and she’s worked as a vet tech for an equine guy back in Washington state and for years. And so, she would see these neuro cases, but it’s mind boggling how they come up to her and say, “Well, the horse was kind of leaning when I go to get on it. Well, why is it leaning?”

And then she does a basic little neuro exam and then goes, “Doc, you need to come look at this horse.”

NR: Yeah.

AL: So, it’s one of those things where it has broadened, so much, my scope of practice, in that, I use everything that I learned in the acupuncture course and continue to learn and relearn and put that into practice on these horses and to look at them.

NR: Right.

So, I think what happens, too, is that you get a better bond with the horse and the client. And that just seems like a better way to live and do medicine.

AL: Oh, absolutely. Absolutely. 

AL: Yeah.

There was a case just recently where the client asked me to come out and do some acupuncture on a horse, she says, “She’s not really lame, but she just puts her head up high and hollows out her back.” I’m like, “Okay. Well.”

So, as I go through my acupuncture exam, I find that she is sore backed. And I ask her about saddle fit and she says, “Yeah, we just changed that recently in the last couple of months.” So, good; that’s good. We’re getting it better.

But then I also come around the Stomach 6 point, TMJ, and she’s very sore there. She needed her teeth done.

NR: Yeah.

AL: You know, and if I wouldn’t have gone that way with the acupuncture exam, I might not have noticed the TMJ being sore and her teeth needing to be done.

NR: Right. Right.

And that’s kind of the animal part of the surviving veterinary medicine where it’s the animal should survive, hopefully, and the client not be, you know, all their resources drained and everything. And to have a good rapport with the veterinarian. And then us.

And then vet techs; they have their own sort of parallel angst and lots of, “Why am I here?” ideas.

AL: And that’s what I kind of got with these four people that I interviewed, is that, “Why is it that you’re wanting to leave where you’re at, small animal wise?” and one of them said, “I’m bored by the routine.” And another one said, “Well, it’s just, you know, I don’t really like doing fecals all day.”

NR: Yeah.

AL: You know? They get a burnout in that kind of thing where it’s the same thing, most every day, and in and out like that; your general wellness exams or vaccinations, your spay and neuter kind of thing like that.

So, one of those interviewees I took out yesterday, we were doing a bunch of rescue horses that were kind of like wild mustangs.

NR: Oh, wow.

AL: And they were very difficult to get done. And she saw a whole different view of vet medicine compared to what she’s used to in small animal stuff.

NR: Yeah.

AL: And I can see where even technicians will get burnout. You got to give them a fresh start. And so, incorporating acupuncture makes them realize that there’s something different; there’s something extra in there that they can help with. And I think the next tech that I bring on is going to go through your tech course. So that she realizes in all of these have been she’s that I’ve interviewed – but they’ll realize the significance of what I’m doing.

The last technician I had, she came on right in 2019 where we still had the in-person, in October, session and she was there holding horses.

NR: Yeah.

AL: She got to see a little bit of what we did, but she didn’t get to learn the ins and outs. I tried to teach her a little bit so that she would be excited about it when she could go. Because sometimes, she’ll be maybe standing next to the client as I go back to the truck or vice versa or whatever, and she’ll talk. And that’s a good thing.

NR: Yeah.

AL: Good thing to talk to the client about these things.

NR: Right. Right.

And that’s kind of the purpose of the tech courses to teach them the scientific basis, but also give them enough understanding that they can be your interface with clients. You have maybe more of a one-on-one with your type of work, but educating them.

I think that’s a role that techs could really move into is the full case coordination and management, and coming up with ideas that the client can consider and just being an advocate, but also it being a scientific approach and sometimes maybe spending more time with the client and the animal, if you had to do something else.

AL: Exactly.

NR: Yeah.

In vet tech or nurse journals and things, I mean, they wrestle with the same things and then, you know, maybe at shelters, they’re putting down animals. I mean, I think it’s hard and they’re not that well compensated. And it’s just the boredom, like Steve always says, that he was board certified in being bored, previous to doing acupuncture.

AL: Yeah, exactly. Right.

Yeah. And I think that getting them out, and of course, my practice is one of those that I drive around a lot and I see a lot of different cases, different things. But then there is that seasonal thing where we are just doing vaccinations and dentistry. And that’s about all we’re doing. And that can be a little bit boring and tedious. But again, it’s a different environment and we’re out in the open. So, it’s nice that way.

NR: It sounds great. It makes me feel like, oh, maybe I could do it. Are you taking techs that were all small animal? I mean, how much do they know about horses before joining you?

AL: Here’s the thing is when they go through a vet tech school – So, I’ve got two people that went through tech school – they focused mainly on the small animal side because that’s where the employment opportunities are most likely. Really, it’s rare for an equine practitioner, unless it’s a multi-doctor practice to have technicians.

So, as a solo practitioner, I finally saw the need of needing somebody to go with me and assist me. And I would say that’s probably helped my bottom line to begin with as far as they pay for themselves.

NR: Yeah.

ALThey actually pay for themselves. They don’t get a lot of large animal experience in tech school. And so, even the people that I look at, I have to be very cautious about who’s applying because of how much horse experience they actually have.

NR: Yeah.

AL: So, you just don’t want somebody that says, “Oh, yeah, I’d like to work with horses” and never touched the beast. And because there is a little bit to handling them, you need to know how to handle a dog, cat and anything else, but even more so with 11-1200-pound horse, you need to know how to handle that and be around that. And so, I have to be very discriminate about how I look at those technicians too.

So, again, some of it, training, some of it, experience. And if you can get both of that, that’s wonderful. But the hands-on experience with the animal that I’m looking at would be one of the highest things that I prioritize. So, that’s kind of what I have to watch out for, looking at for a technician.

NR: Right.

And then, I mean, I think attentiveness. So, two things. And being able to read the animal, which so with the attentiveness, with what you do with the acupuncture, I mean, I think of Mindy in class talking about the tendency to want to do Facebook or whatever while they’re doing the horse, I mean, the super huge safety thing.

AL: And that’s why, a lot of times, I’ll ask the client, “Would you mind if my tech here holds the horse for me.” Because I know she doesn’t have her phone out.

NR: Yeah.

I know because if she has her phone out, that’s a breach of my practice protocol.

NR: That’s wonderful.

AL: Because she can have the phone out when we’re driving.

NR: Yeah.

AL: We have plenty of downtime that we call “windshield time” that she could have her phone out or whatever needs to be done. But in my practice, I need the most attention. And we don’t have time to be looking at our phones. If I have a call come in, I will look at my phone. But that’s me. But I have attentiveness when I have my tech with me.

NR: Right, right, right.

Well, and you’re captain of the ship.

AL: Absolutely.

NR: And so, if something happens, that falls on you.

Yeah. And so, one other area that, like with the whole Covid and the whole Zoom thing and the whole remote learning thing, we’ve wanted to teach techs massage. And I mean, that is a very hands-on thing. It’s ideal to have everybody in the same place.

But, you know, just teaching techs, anything, hands-on, we haven’t been able to do it because there’s no professional liability insurance that we can have for ourselves, because they’re used to working under a vet’s.

AL: Absolutely.

NR: And so, that’s been a problem.

So, with the remote, there’s more that we can talk to them about it. If we’re not physically there responsible for the animals that they’re engaging with, especially if they’re from another state or something. So, I don’t know.

AL: Right.

NR: But if they can learn even a few simple massage techniques to help calm the animal and all that.

AL: Right. Right, right.

You know, it’s kind of hard with the horse. You know, if they’re used to being handled, that’s great. You know, they can pet their head and everything else.

NR: Right.

AL: We got another six feet of body that I am going to be working on.

NR: Right.

And then a lot of times, vets will delegate the laser stuff to them. And I know you use the Class 1M. So, that’s not a worry. But I just had one of our graduates submit a case report recently, and she was using a Class 4 device on Bladder 25. I had posted this on our Facebook group, but I don’t know what happened, but it burned the horse.

AL: Ooh.

NR: Yeah. And it’s one of them that has the beeping.

AL: Yeah.

NR: So, I’ve had dogs that have come to me for treatment that have had laser elsewhere, that they developed this phobia once they hear that beeping because they’ve been burned with the Class 4. So, I don’t know; it’s just sort of a segue.

I mean, so techs; whether it’s a tech or a vet doing a treatment with Class 4, I mean, that’s where you have to be so vigilant. Understand that, yeah, they can burn them. I mean, I always have my hands on and I’m always feeling like where the tissue is.

AL: I mean, that’s you. That’s what you’ve learned to do.

NR: I’ve learned to do that. But even when I’ve treated humans, like there’s different parts of the body; like the back, you can have a certain amount of power. And then if you go to the neck, it’s like, “Well, that’s too hot.”

AL: Oh, yeah.

NR: So, much to think about there, too.

AL: And that’s what I’ve done too, is like I’ve had my tech do some laser stuff. It makes them feel like, “I’m doing something”; that kind of thing where they’re contributing to the health of that animal and not just standing there, holding the horse or whatever.

And sometimes, when I have a client that’s really good with holding their own horses, that’s great, because my tech could be doing other things to help me, too, which is awesome there.

You know, and I’ve had my techs remove needles and keep track of them and make sure that everything’s going well and everything. And that gives me more time to go to maybe do another horse and look at it and do something there. And then we can do more at the same time with the same kind of thing.

I really believe that technicians are a huge asset to us in veterinary medicine. And I think a lot of us in equine medicine are missing the boat on not having one, if you don’t have one already.

And it took me several years to finally figure out that they’re not a burden that you have to pay, but they’re an asset that you get to pay.

NR: Yeah.

Like with Danielle, I mean, she has like 11 or something in her rehab clinic up in Ontario. She has like 12 employees or something. And these technicians are helping her with all the rehab, because she’s educating them about watching the animals and stuff. And you have another opinion, set of eyes, understanding. And maybe you just didn’t see something, but the better they become at learning how you are…

AL: Oh, absolutely. Yeah.

NR: Yeah. That’s nice.

AL: I’ve had a good tech in the past like, “Did you notice that area on that horse’s back?” I’m like, “Oh, thanks for telling me that; reminding me of looking there.”

You know, it was one of those things where she knew, from actually going to one of the student AAEP courses where we did acupuncture and rehab. And it was a couple of years ago. And I went ahead and took her with me so that she could become part, because I think that was an important thing for her to see also. And that really helped me out. So, it was really good too.

NR: Yeah.

Are you doing much rehab; kind of exercise prescriptions?

AL: Well, kind of. Yeah, I prescribe it, and it’s one of those things, but they love to be able to do that. I mean, they love to be able to go out and follow up on certain things. And to say, “Yes, doc, this helped. And we were doing this. We were doing this.”

And so, they’re rehabbing their own horses gives them that feeling of participating in the health and well-being of their animal, too. So, I think that connects me even more to that client.

NR: That’s right.

You know, and with telemedicine kind of, too, evolving and just everything that we do, like the more video we get of animals moving, we see how informative that is. And then especially slow motion.

And now, you know me, and I want to do the “How to See A Horse” thing because we have to do that. But videos are so important. And that would be another thing that a tech could do, maybe, is for follow up or even the client can send you a video.

AL: Absolutely.

That client I was telling you about is a trainer and I also vet tech, I have an upcoming appointment with her. She said, “You know, here’s the horse that we have the lameness issue with.” And she sent me a five-minute YouTube video of the horse, of her riding it and giving me to look into that, so that when I get there; I have an idea, I already know which limb it is.

NR: Yeah.

AL: And I said, “I agree with what you’re seeing, but there’s nothing like having my hands on it, doing flexion tests, checking the back, the pelvis, the SI, the LS, all of that, because any of that can be involved.

So, just having that, but having that idea and then maybe later on, whatever we’ve done and diagnosed and treated, having her resend the video to see how that is doing and being able to compare that.

And I think with the technology we have now, it’s easier to have more and more of these small amounts of video to do things. I invested in a GoPro, just to see if maybe I could get some idea. Because as I age, I don’t think my memory is quite as clear as what it was.

So, on some of these horses, especially some horses that have some subtle neurologic symptoms, just to be able to have them videoed so I can see what I’m looking at again and to clarify my thoughts in the medical record and see that kind of thing. And so, just be another thing.

I mean, I’ve already used it on a horse that had some abnormalities in the mouth.

NR: Wow.

AL: And so to document those, to have those kinds of things that I could do a biopsy on those lesions and send them off with the pictures of those freeze frames to the pathologist, that really helped, too. So, they, “Oh, I see what you’re saying. I see where that is coming from.”

And so, it’s not just our description, but I mean, our technology is so easy to use now. And we’re all in the digital world where we can send these within a moment’s notice and have these pictures and these videos to see that kind of thing.

And I think with Covid, we’ve actually found out that we can do a lot more with video chat and Zooming and whatever we want to do and to be able to connect with people and see. You know, I could imagine saying to the client, “Go ahead and turn your phone around. Let me look at the horse move.” Right?

NR: Absolutely.

AL: But yet, know that, “Okay. Yes. That looks like I need to come out and see it.”

Now, even before Covid, clients would send me a picture of a wound and say, “Does this need to be sutured?” And I go, “Yeah, it does. I’d see you in about 20 minutes.” You know, that kind of thing.

So, they had already been starting to do that. But now, we can even do it with video so we can see what’s going on, how can we track this, and how is that horse moving?

Horses move quite differently when they’re either under saddle, being ridden versus just on the ground doing lunging. And so, that was the concept behind this video that the client sent me was this horse didn’t look lame on the ground, lunging. But when she was being ridden, she would be doing this hop every time she tried to transition to a different lead. So, it’s like that’s the kind of video I need; something that’s a little bit different. And she recognizes the difference. And that’s a good thing.

NR: Yeah.

Well, I mean, you’re putting 100 plus or minus pounds on the horse. So, everything is being compressed and then you’ve got different vectors and everything.

AL: But you have them controlled differently with their head. And you get them positioned in a way. Absolutely, you get a few hundred pounds of people on their back, and tack. You’re putting more pressure on the TL junction or LS? You know, what is this that we’re looking at? What does that make that horse do, biomechanically, to offset itself?

And then that’s where my whole exam comes in, where my fascial movement of the horse and then my myofascial exam; that depth we get into the body that we can see things.

NR: Yeah.

AL: It’s just so amazing what I have found with just an exam and either a response to treatment or a lack of response to treatment.

NR: Right, right.

Well, in the lack of response to treatment, I mean, my usual thought is to look back at the diagnosis and to do more myofascial. Which I agree; it is more challenging on the horse because they’re not so squishy and everything. Probably that’s where some of the challenges, like the gator whatever, you know, that Tim talks about.

AL: And that’s the thing is I think that with them is getting that myofascial, yes. But then I think of a case that I had years ago where I had done my exam and I had treated this horse for months and we weren’t getting anywhere, and I knew that there was something else underlying it.

So, I sent it off to CSU for a referral for an ultrasound of the SI and the LS and get that. And it came back wild. They had an abnormality at the lumbosacral junction of unknown consequence. And they didn’t know exactly what it was. They injected the SI and even a month later, it still wasn’t any better.

Come to find out at necropsy, the horse had a segment of the LS that was way off and broken there.

NR: Oh, wow.

AL: And they just weren’t able to see exactly what was going on with all of that stuff, but my hands saw it.

NR: Yeah.

AL: And the response to treatment was that it wasn’t getting any better.

NR: Right.

AL: That’s what this course has taught me, is to get into there and to say, “There is something else that’s going on, that it’s just not fixable this way. So, we let’s look at it another way.” And it was just a not fixable situation; period.

NR: And I remember a few years – It was more and more years ago now. I think we were at one of the acupuncture sessions and I think it was Kevin Haussler that was teaching just about all the crazy pathologies that can happen; like all these fractures in horses. I mean, there’s so much there.

And sometimes that’s frustrating because of the typical limitations of diagnostics that are done in the large animals. And I’ll be reading case reports and grading them to the best of my ability, about a large animal. And it’s always like, “Yeah, there was some kind of lameness or back pain, but there’s not really….”

It seems like that even having the differential of some fracture or something going on in the back when they’re not seeing as much of a response as they thought they would, I just feel like there’s this wealth of equine pathology that never even gets considered or found.

So, just to have like hear from you, you know there’s something there. You tried things and it wasn’t working. So, then there’s that next step. I think that’s a piece that the students maybe need to be reinforced on more. So, like it’s not that you did a bad treatment necessarily.

AL: Right.

Yeah, I mean, because we threw everything we had at it, as far as needles, laser, gabapentin, methocarbamol, we had the SIs injected. It was just one of those things where that horse wasn’t going to get any better and the pathology is there.

And it makes me think of other horses that may have some other pathologies that I may have missed along the lines, but I didn’t know it. And again, that gives me more satisfaction to know that I have that ability now to look past that and to say, “Maybe there is something else here” that long ago I may have gone, ‘Well, who knows?’”

NR: Yeah.

I think that that’s where we increase our observation skills, like the How to See a Dog or a Cat. But it’s going to be different. Like you mentioned, that horse that was lifting the head. I mean, isn’t that an antalgic gait that I’m just now learning about? Because I’m reading about posture more with horses.

AL: Yeah.

NR: Versus, you know, a lot of the dogs and stuff; they just ventroflex and they’re going like that. So, that’s a species difference.

AL: Right, right.

NR: Yeah.

AL: Their dorsiflexion and their hollowing out of their back is something we always – And equine practitioners, we’ve always been looking at this as far as lameness goes. We look at length of stride. We look at their posture, just standing there. Looking at where their feet placement is. One of the things that we look at for sweeney is the dropped shoulder or a dropped elbow.

And so, we look at these different things naturally as a practitioner and it doesn’t even come to mind or how do you put that into words? Well, you know, you ask, “How do you look at a horse?” “Well, I just look at it.” It just seems to be that’s the way I look at it. You know, I can see that horse looks like it got its head up and its tail swishing and it’s painful. It’s got some pain somewhere. So, I need to figure that out.

Maybe they’ll have a little bit less muscle coverage over one side of the hip, and it’s again, like what my one client had said in her description in her video is like, “She isn’t well-muscled in the haunches.” Well, there’s a lack of use in that area. Then a good person like this with some background in medicine, will look at these things and say, “That’s not normal.”

NR: Yeah.

AL: So, that gives me another clue. And so, then I may be more specific on looking exactly which muscle group is lacking in that area.

NR: Right.

AL: That’s just another challenge to my practice, which makes me feel much better about what I’m doing, again.

NR: Right.

AL: It gives me more fulfillment in my practice life, you know?

NR: That’s the key.

AL: Yeah.

NR: And that’s where, too, instructing the client, like if they are having lack of engagement of the glutes have become atrophied or something and you’re going to do some tickles or something, so that they engage. And then the client has something to do, and then there is the whole human-animal bond thing where it’s such another end of the continuum to do like what we’re doing and how we’re approaching medicine versus the whole domineering kind of thinking the animal is just being a jerk or something. I mean, it’s such a gamut of things.

AL: Yeah.

And that’s the thing that I think I’ve tried to teach a lot of my clients is that, “No, I don’t think this horse is just being a jerk. I think we’ve got some pain issues here. Let’s work on that and let’s see if we can get rid of that.”

NR: Right.

AL: And then what’s really remarkable is seeing these horses that are so painful become more docile and then they really start to look forward to seeing me come.

You know, I have a client that I do a horse every two weeks with my acupuncture, but she’s so sensitive I can’t really get needles into her. So, I laser her all the time. And when I first start doing my exam, she’s not very happy with me because I’m palpating sore areas. And she tells me. And she’s a very sensitive horse, and so I understand that. But once I get that laser out, she’s all lovey-dovey and trying to nuzzle me and just go, “Oh, yeah.” And then when I get my little hand massage thing out, oh, my goodness, does she love that.

NR: Yeah.

AL: And you can see the horse’s expression: their head drops, their eyes kind of glaze over, their lips twitch, you can see their expression change completely. And that’s just with the laser.

NR: Yeah.

AL: So, any time anybody tells me that my laser doesn’t do anything, I tell them, “Well, I can’t say that because this horse does pretty well with it.”

NR: Right. Right, right. And you can send a video conceivably.

AL: Exactly.

That’s why I love that laser because it’s so safe, but it simply works.

NR: Yeah. Yeah.

So, just thinking of that joy, that rewarding piece, that satisfaction of working with animals the way that you adopted and integrated, I mean, isn’t that the reason you went into vet med anyways or was there some other draw in the beginning?

AL: No, I grew up on a farm ranch and I remember being intrigued and seeing, probably when I was five or so, when my parents, my grandfather had a calf that needed to be pulled. And I don’t remember this specifically, but my mom tells me that I was right in the middle of that trying to get in to see where it was.

And then there was later on, I was very fascinated with this dead rabbit that got caught in machinery and I was dissecting its eye with a stick and a plastic knife, trying to figure out what’s – looking at that. So, I always had that interest in animals. And then I found out that besides being a farmer or rancher, there’s other ways to help them, and that really intrigued me all the way through.

So, that just came about where I never thought I’d be good enough to be in vet school. And I was surprised that I got accepted after my first try. I’m like, “What? You’ve got the wrong guy. No, no, no. You don’t mean me.”

You know, because it was one of those things where I went back to school. I got into vet school when I was 29, and I got out when I was 33. So, I was one of those – What do they call them? – nontraditional students.

NR: We used to call ourselves “The Senior Citizens” in my class.

AL: Yeah.

NR: How old was I? I was – I don’t even know – But anyway.

AL: Yeah.

NR: I was 30. But yeah. Right. What did you do first?

AL: Well, when I got out of high school, I went to one semester of college where it was the best drinking party I ever had for three months. And then I decided that wasn’t a good way to spend my tuition on and how it’s going to pay that back. And then I went into the army for four years.

And then when I got out of the army, I went to work for a Quarter horse ranch and saw things like that. And then I saw the farm vet come on the place and I was helping him and doing some things like that. But I was like, “Man, that would be the thing to do.”

NR: Yeah.

AL: So, at that time I was divorced from my first wife and I got my second wife. I was going part time to school a little bit because I knew I didn’t want to shovel manure my whole life.

NR: Right.

AL: And so, she said, “Well, if you’re serious about going to school then I’ll help support us as we go through that.” And eight years later, I was a veterinarian. She’s like, “I didn’t anticipate eight years of college.”

NR: Yeah.

AL: But that’s kind of intriguing because I didn’t want to shovel manure all the time, but I’m arm deep in it a lot.

NR: Yeah. Yeah.

AL: So, that’s kind of where I went from there. That kind of thing. You know, it’s one of those, I was led this way and I’m happy I’m here. I don’t think I would see myself doing anything else ever.

NR: Right. Well, I’m happy you’re here, too.

AL: Oh thank you.

NR: You inspire a lot of our students.

AL: Well, that’s good to hear. I need to hear that sometimes.

NR: Oh, yes. You’re wonderful. You give us that broad perspective of being out there treating clients. I’m not saying you do general practice, but it’s very one on one.

AL: Well, I do. I do general practice. You know, I do.

NR: You do general practice plus all the integrative and the dentistry and everything.

AL: Yeah.

NR: So, it’s real-world experience and you’re so patient and kind. So, we really do value you a lot.

AL: Thank you. I appreciate it.

NR: Yeah.

AL: And I keep learning from all the students that come in too.

NR: Yeah.

AL: And helping them. Just trying to teach them is teaching me a different way to teach them each time, so that they can understand what I envision and what I’m seeing and what I’m doing so that I can help them along the way.

I was really appreciative; there was just this past session that we had. I had one of the graduates contact me and say, “Hey, what would you do here?” You know, they had a case that they wanted to kind of follow up on. And it was very nice to know that they could, you know, I had no problem with them contacting me at all.

NR: Yeah.

AL: It was nice for them to think that they could value my experience and look to me to give them something to do and give them an answer. Sometimes I don’t know if I have the answer, but I try.

NR: Yeah, and that’s where we’d love to have you with the eMAV course and just to talk about cases.

AL: Sure.

NR: Oh, good.

AL: I said it on film, didn’t I?

NR: Yes, you did.

AL: Are you recording this?

NR: We can edit it if you change your mind before this weekend. But I can probably send you a snippet of the video, because Steve has been teaching for us. And the case that he’s recorded so far is traumatic myopathy in a pony. And he talks about the – anyways it was this fancy horse and all this stuff.

But he had some kind of injury back here. And so, I think Steve contacted you and you gave him an idea about how to address the myopathic injury there.

AL: That’s so long ago.

NR: Well, it’s now recorded in posterity. And he was talking about it. He was flummoxed. He didn’t know what to do. And I think maybe, yeah, because he was relatively new.

AL: Yeah, he had just graduated from the course.

NR: Right. Right, right.

I would hope that somebody could just come up with something. But I think that you have something that’s new, and it’s a little bit startling maybe to the brain or nervous system. It’s like I don’t really know what to do. It’s just nice to have somebody to call.

AL: Oh, absolutely. Yeah.

NR: Yeah.

Just like that’s something Danielle was saying, too, like when people buy into a new practice or just add a new practice and you just want somebody out there. And that’s what I love about our community, too.

AL: Yeah.

NR: Yeah.

So, I’ll send you that piece of the video.

AL: Okay.

NR: And he talks about how you came up with an approach and it worked very well. So, you’re already famous.

AL: Wow.

NR: Yeah.

AL: I didn’t realize I had that impact.

NR: Oh yeah.

Well, that’s the thing. I think you do have a lot of impact. And I think part of what I should be better at is building this community and talking to you guys, which is what has been a nice thing about the eMAV program. And even through the Zoom, even though, I mean, you’re not that far away, geographically, right now, but the fact that we can meet and just hang out for an hour.

AL: Right.

You know, and when you asked us in a general email about eMAV, I’m like, “Well, I don’t think I have much to contribute because I’m not sure I have anything to tell you. I’m no expert. I’m not board certified. I’m not, you know, anything. I’m just a general practitioner who happens to do acupuncture with that.”

NR: You have lots of experience and you have lots of wisdom and you’re very observant and you care, and your hands are very educated, and you have all these different ideas. The whole board-certified thing like – You know, you have education, like direct experience, and you can’t teach that.

AL: I guess so.

NR: Yeah.

So, yes, we’d love to have you. I’ll be in touch with you more about that.

AL: Okay. That would be great. If I can share my experiences and help somebody, that’s wonderful. And just to hear that I helped Steve.

NR: Yeah, yeah.

Anyways, I’m very excited about that. That’s a great outcome of this conversation, too, as well.

AL: Yeah.

I had a veterinarian from Nebraska contact me about the way I do dentals, and I don’t know if this is going to go on the podcast or not, but I do dentals by hand, whereas everybody around me nowadays is doing it with a machine, grinding them down like with the Dremel tool.

And that seems to be state of the art and everything else, but I don’t find that that helps with the overall biomechanics of the mouth and it doesn’t take that much to do it correctly the way I do it.

But anyway, he came from Nebraska and wanted me to tutor him on some dentals. And so, I took some of my horses out that hadn’t had dentals. And I went through them and it was kind of, I see where the one on one is very, very good in teaching someone. Because we spent several hours there just working on this and that.

And actually, he works for the USDA, but he also practices part-time as a chiropractor and acupuncturist. So, he would kind of want to integrate dentistry and then he took the course several years ago.

So, anyway, it was just one of those things where I realized that trying to teach someone something very specific like that took a one-on-one kind of thing. And to show them how exactly to do it needed that one on one.

So, I too, like you, would get into these onsite sessions and be like, “Okay, all right. Let’s try to teach all these kids.”

NR: Right. Right.

Well, I mean, even when we used to be in the big hotel ballrooms, whether I’m a teacher, just watching somebody else’s lecture, or a student, it is just so… all the stuff is distracting.

And so that’s why, too, from the online piece, back several years when we ran that first of the four modules and we had some people sign up for the online piece versus people that would sit there for the four or five days and compared their exam scores, that the people that had been online, that was the eye-opening thing for me is that they did so much better on the tests.

AL: Oh, they did?

NR: They way outperform them. And that’s why I – It was, what? 2013 or 2014. That’s why I decided to put all the didactic stuff online. They can do it at their own pace. They can review it. So, there’s a lot of benefits. Yeah.

And then we’re offering them the opportunity to come on site for two days. So, it’s like during Covid or whatever you want, you can do it remotely. And then if you want to come see us at the school or at the barns or whatever, you have that option to.

But just back to the one on one. I mean, that’s how medicine used to be taught, like with apprentices and stuff.

AL: That is so true. It is so true.

NR: Yeah.

AL: You know, I learned a lot when I was being employed by other veterinarians. You get that one on one with their experience. And hopefully, they’ve got some good experience and maybe you learn from their bad experiences. And that’s kind of the way it goes. You’ve got to have some bad experiences to find out what the good is.

NR: Right.
And to learn to trust yourself, I think, to an extent, your intuition, or just understand that that didn’t feel good. 

AL: Yeah.

NR: So, we have a lot to catch up on with all the course stuff. And this was really helpful.

AL: Well, it’s great talking to you again.

NR: You too. It’s good talking to you.

AL: I don’t get to talk to you one on one much, but it was fun.

NR: I know. Hardly ever.

Okay. Well, I’ll get you an email and everything so we can follow up. But thank you for doing this. And I think this will be a nice way for you to get more engaged and be another ongoing resource for people.

AL: Absolutely. I’m more than happy to help out.

NR: That’s wonderful.

AL: More than happy to help.

NR; Thank you.

AL: All right. Take care.

NR: Take care.

If you’d like to learn integrative medicine from a scientific perspective, visit us at Thanks for listening to another installment of Surviving Veterinary Medicine.