Integrative veterinary care
Laser therapy What’s the buzz? Page10
Profile Dr. Steve Marsden: Meet an award-
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PREMIERE ISSUE 2011
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winning veterinarian with a passion for the integrative approach.
Introduction To Reiki: Find out how you can use it to support the animals you care for.
Market Trends Team Effort: 10 tips for building
WHAT’ S NEW Equine veterinarians notice a
Nutrition News Food Labels 101: Making
Horse sense Equine Nutrition: Packing a few
a strong relationship with clients.
sense of ingredient lists on pet food packaging.
drop in patients due to economic challenges being imposed on the horse racing industry.
pounds on an underweight “hard keeper” is easier than you may think. integrative veterinary care
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contents FEATURES
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Class IV laser therapy
It’s the hot technology for 2011 and veterinary medicine is buzzing about it.
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Integrative practice The road to integrative healing
Why a renowned veterinarian changed his definition of healing and began incorporating alternative therapies into his practice.
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Nutrition nook Food labels 101
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Making sense of ingredient lists on pet food packaging.
Back to school Put a pin in it!
What acupuncture can and cannot do.
Antioxidants for ocular health
How these nutrients are proving beneficial for genetic eye disease.
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Tech talk Introduction to Reiki
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Evidence-based medicine for animal supplements – part 1
This safe and effective energetic healing modality is backed up by promising preliminary research. Find out how you can use it to support the animals you care for.
Where is the clinical evidence demonstrating that animal supplements are safe and effective? Here’s a review of the evidence that’s currently available, and the limitations facing the industry.
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Equine nutrition On the skinny side
Once you’ve ruled out health problems, packing a few pounds on an underweight “hard keeper” is easier than you may think.
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Profile Dr. Steve Marsden
Meet an award-winning Canadian veterinarian with a passion for the integrative approach.
40 44
Market trends Team effort
Ten tips for building a strong relationship with clients.
44 4
integrative veterinary care
Integrative research
Testing alternative treatment options for osteoarthritis.
Columns & departments
6 Editorial 8 What’ s new? 27 Industry innovations
Completing Your Approach to Pet Care As the benefits of integrative products are recognized, the need for pet-specific formulations increases. Resources™ is a line of natural supplements specifically developed to support the health and wellness of pets.
37 Veterinary resource guide 42 Events 43 Marketplace
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editorial “Learning is like rowing upstream: not to advance is to drop back.”
I
t seems appropriate to quote this Chinese proverb for the premiere issue of Integrative Veterinary Care journal (IVC). After all, one aspect of Traditional Chinese Medicine, specifically acupuncture, has become one of the more widely accepted integrative modalities in veterinary academia. But I chose this quote for a different reason. Having spent 12-plus years talking to and working with integrative veterinarians, I feel it embodies the community’s heartfelt commitment to continued learning. Learning that better equips veterinarians and veterinary technicians for the job at hand – healing animals. Many of the veterinarians I speak to share a similar story: with a few years of practice under their belts, they become frustrated by the numbers of patients they still could not help. In an effort to add some more “tools” to their medical bags, they seek out the theoretical and practical means to achieve this. They gravitate to the therapies they feel most comfortable with and then branch out from there.
Dana Cox Editor-in-Chief dana@redstonemediagroup.com
Many of these vets are finding themselves in great demand, as clients benefitting from complementary therapies themselves try to locate the same approaches for their animal companions. More often than not, these clients will have to get in their cars and drive up to two hours to get to the clinic, but that’s a small price to pay when you’re talking about a member of your family. I’ve done it many times. My own animals have experienced the healing benefits of chiropractic, acupuncture, flower essences, laser therapy, homeopathy, and herbs, as well as customized nutritional support. Of course, that’s in addition to conventional therapies they’ve received, as required. But I’m not here to tell you anecdotal stories. I’m here to introduce IVC – a new quarterly magazine designed to be one of those valuable tools you’ll read and “put in your medical bag”. No matter where you’re at in your journey of learning – whether you’re just starting to dabble in integrative health care, or you’re accredited in several modalities, you’ll find something of interest in every issue of IVC. Read articles by recognized experts in the field, find out about the latest products and services, and discover how you and your patients can benefit from everything that integrative health care has to offer. If you have feedback or there’s something specific you’d like us to cover, please let me know. We look forward to your input!
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what’ s new
Photo: © Dr. Jessica Vogelsang
Vets abroad
Amazon Community Animal Rescue, Education and Safety (Amazon CARES) and i Love Dogs, Inc., a California-based dog vitamin and supplement manufacturer, recently announced a new collaboration that is benefiting animals in one of the most remote areas of the world. i Love Dogs contributed more than $1,000 and a large quantity of its supplements to Amazon CARES, a non-profit organization based in and around Peru’s Amazon River region. In addition to operating the area’s first no-kill animal shelter and low-cost veterinary treatment center in Iquitos, Amazon CARES conducts free spay-and-neuter, immunization and parasite control clinics in the more remote reaches of the Amazon rainforest. The Vets Abroad adventure to Peru took place April 10 to 24. The team included veterinary volunteers Dr. Patrick Mahaney of West Hollywood, Dr. Jessica Vogelsang of San Diego, and Dr. Amanda Brown of Philadelphia. The trip involved traveling into isolated areas around Iquitos where there is very limited access to veterinary care. You can read more about the trip at amazoncares.org/VetsAbroad.
Preventive Healthcare On July 18, a unique alliance of professional veterinary associations and leaders in the animal health industry announced the establishment of the Partnership for Preventive Pet Healthcare. It was created to address the decline in pet health due to an increase in preventable health conditions, including a dramatic double-digit rise in diabetes and internal parasites in dogs and cats. This comes in the midst of a decrease in the number of pet visits to the veterinarian, in contrast with a growing pet population. The goal of the Partnership, which is chaired by AVMA CEO Dr. Ron DeHaven, is to provide guidance and ensure that veterinary visits lead to early detection and prevention so that people and their pets can enjoy longer and healthier lives together. Members of the Partnership include the American Veterinary Medical Association (AVMA), American Animal Hospital Association (AAHA), Association of American Veterinary Medical Colleges (AAVMC) and many animal health industry leaders including Banfield Pet Hospital, Bayer HealthCare LLC , Hill’s Pet Nutrition, Merck Animal Health, Pfizer Animal Health and more. PetHealthPartnership.org
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Pick a podcast The American Kennel Club Canine Health Foundation presents new podcasts every two weeks on scientific research being done on a wide variety of canine health issues. The Genome Barks Podcast Series covers many areas of veterinary medicine, from blood disorders and cardiology to cancer and neurology. Recent editions include Familial Heart Disease with Dr. Kathryn Meurs, a board-certified cardiologist at North Carolina State University College of Veterinary Medicine. Dr. Meurs has been funded by the AKC Canine Health Foundation for research on subvalvular aortic stenosis in Newfoundlands, golden retrievers and rottweilers; dilated cardiomyopathy in Doberman pinchers and great Danes; and ventricular arrhythmias in boxers. In her podcast, she discusses her research, the symptoms of these diseases and the available genetic tests. For this and other podcasts, visit akcchf. org/news-events/multimedia/podcasts. They are also available for direct download at Apple’s itunes or genomebarks.com.
Managing medical waste The Sharps Compliance Corp., a leading provider of cost-effective management solutions for medical waste, is helping healthcare professionals – including veterinarians – save time, money and the environment with a green alternative to their traditional medical waste pick-up service. The Sharps MailBack Recovery System is a complete solution for the containment, transportation, treatment and tracking of medical waste – keeping it out of landfills, and saving you time and money. Sharps Compliance’s patent-pending GREEN Waste Conversion Process™ eliminates medical waste going into landfills by 100%. The process transforms discarded medical waste into a new product called PELLA-DRX™, a clean raw material used in manufacturing industrial resources, vital to everything from highways to high-rises. sharpsinc.com
Economy affects equine vets Equine veterinarians are noticing a drop in patients thanks to the negative impact the weak economy is having on the horse racing industry. The number of registered Thoroughbred foals has dropped by an estimated 10% over last year, after four years of decline, and is now at its lowest ebb since the early 1970s. Along with the drop in patients, some vets are also seeing many equine clients take much longer to pay their bills. Also affected are other locations that employ equine veterinarians, such as farms and training centers associated with the racing industry.
Equine dentistry in Texas In Texas, there’s been an ongoing debate about who should legally be allowed to do equine dental work in that state. They’re now one step closer since the Texas Legislature passed House Bill 414, which will professionalize the practice of non-veterinary equine dentistry and allow licensed “equine dental providers” to perform certain dental services under the supervision of a vet. These services may include removing sharp enamel points and small dental overgrowths, reducing incisors, extracting loose deciduous teeth, and more. The new law will ensure that nonveterinarian equine dentists are regulated and will be required to meet certain levels of professionalism.
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feature modality
Class IV laser therapy – the hot technology of 2011
by John C. Godbold, Jr., DVM eterinary medicine is buzzing about the success of Class IV therapy lasers. Over 3,000 practices report clinical and economic success with a technology that was unheard of five years ago. Laser therapy uses electromagnetic energy interacting chemically and biologically with tissue to produce “photo-bio-stimulation” or “photo-biomodulation”. Light interaction with tissue is not a novel concept: electromagnetic energy stimulates photosynthesis, and induces vitamin D formation in human skin cells. The medical use of light – photons, small packets of electromagnetic energy – interacting with
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Light energy can produce a significant healing change in an animal’s tissues.
tissue is also not novel. Ancient Greek physicians noted that some skin conditions responded to exposure to sunlight. Thousands of years later, their observations have been refined; we now more fully understand that photonic energy can produce significant change in tissue. We now appreciate the value of photo-bio-modulation. Since the Federal Drug Administration approved Class IV therapy lasers in the United States in 2005, the science of laser therapy has developed rapidly. Acceptance has been seen on the human side in physical therapy, rehabilitation, wound care and sports medicine programs. In the veterinary profession, Class IV laser therapy use has grown
more rapidly, with practitioners leading the way in testing, protocol development, case reporting, and dissemination of information about the technology.
What can Class IV laser therapy do? It reduces pain and inflammation, and accelerates healing, all in a non-invasive and non-pharmacological way. Symptoms often improve within the first few treatments. Acute conditions are treated until resolution, while chronic conditions are treated until improvement is noted, then treated with reduced frequency to maintain the effect. • Class IV laser therapy works to decrease pain perception through its effect on nerve cells and nociceptors, by increasing stimulation thresholds, reducing neuronal impulses, and increasing the release of tissue endorphins. • Inflammation is reduced by decreasing the release of prostaglandins and inflammatory mediators, increasing macrophage activity and leukocytic phagocytosis, and by reducing edema through dilation of the lymphatic vessels and activation of the lymph drainage system. • Healing is accelerated by increased blood flow from vasodilation, increased angiogenesis and capillary production, increased release of pro-healing cytokines, and the stimulation of fibroblast activity and collagen production. Laser therapy is used as an adjunct to traditional treatment modalities and pharmacological agents, with medications being reduced in many cases. Although not a panacea, and not effective for every patient and condition, most patients with pain, inflammation or healing tissue are candidates for Class IV laser therapy.
Good for acute and chronic conditions Many practices incorporate the use of Class IV laser therapy into routine protocols after surgery and dental procedures to reduce post-procedure pain and inflammation. Single treatments are administered immediately after routine procedures with moderate tissue disruption, like elective surgeries. Procedures resulting in greater tissue disruption, like orthopedic surgeries, are treated immediately post operatively and then every other day for four to six treatments.
components of pain, inflammation and tissue healing. These conditions may be treated only once or multiple times over several days or weeks, depending on the severity of the condition. Examples include wounds, fractures, abscesses, anal sacculitis, acute otitis, hematomas, sprains, strains, muscle discomfort, cystitis, urethritis, injection site soreness, pyotraumatic dermatitis, venomous bites and pododermatitis. • Chronic conditions involving pain, inflammation and healing may also be helped, although treatment has to extend over a longer time, and will be followed by ongoing treatment to maintain effect. Osteoarthritis, elbow hygromas, lick granulomas and neuropathies are examples. Chronic conditions are treated through an initial Induction Phase of treatments until a clinical response is noted. Patients then are treated through a Transition Phase of gradually reduced frequency of treatment, to establish the frequency that will maintain effect. They then enter a Maintenance Phase of treatment every three to six weeks.
How are patients treated? Technician administered treatments take two to ten minutes for each affected area. The laser handpiece is moved in a
Equine applications If you include equine patients in your practice, you know muscle and tendon injuries are common, especially among performance animals. You also know these injuries can end a horse’s career if not treated promptly and properly. Laser therapy is playing a growing role in equine veterinary practice as a way to heal athletic injuries on a cellular level. It can be used for a variety of problems, including muscle soreness and fatigue, navicular disease, bone spurs, ligament injuries and more. Because it hastens healing, patients can often return to competition within a few weeks rather than a few months. Look for more information in a future issue of IVC.
• Patients with a wide variety of acute problems can benefit. Common among these problems are the integrative veterinary care
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What are practitioners reporting? With so many practices using Class IV therapy lasers, the volume of reports is substantial. The growing list of conditions being treated with success results from practitioners applying the simple concept of reducing pain and inflammation and accelerating healing. With a good understanding of the etiology of health conditions, and of the effects of laser therapy, practitioners are demonstrating that a wide diversity of problems respond to laser therapy. While the treatments are not hot – again, patients experience only a pleasant, gentle warming sensation in their tissues – the technology certainly is. As more and more practices begin enjoying the patient benefits and financial success of Class IV laser therapy, it will surely continue as the hot technology of the decade!
scanning motion, either close to or in light contact with the tissue. Patients tolerate treatments well, often relaxing as the therapy is administered. Human patients report a gentle warming sensation in the area being treated. (An increase in local tissue temperature is not considered a therapeutic benefit, but it is comfortable!) Studies demonstrate tissue endorphins are released during laser therapy treatment. Whether the released endorphins have a systemic effect has not been documented. Regardless, a common observation is that veterinary patients, even fractious ones, tend to relax and become calmer during treatment. Treatments are designed to deliver a specific dose of energy. The dose is a measure of the amount of energy delivered to an area of tissue, expressed in Joules per square centimeter (J/cm2). Established target doses are three to four J/cm2 for superficial tissues (those that can be seen), and eight to ten J/cm2 for deeper tissues (those that cannot be seen). Target doses have been developed through numerous studies determining the optimal dose for tissue response, and the use of tissue power meters measuring the percentage of penetrating photons reaching target tissue.
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Dr. John C. Godbold, Jr., DVM, graduated from Auburn University School of Veterinary Medicine in 1978. In 1980, he established Stonehaven Park Veterinary Hospital in Jackson, Tennessee where he practices full time as a small animal practitioner. Since 1999, Dr. Godbold has pursued a special interest in surgical lasers and the use of other laser modalities in small animal practice. He has extensive experience with surgical and therapeutic lasers, has developed new surgical and therapeutic techniques, and assists equipment manufacturers with the development of new laser and laser associated technologies. Dr. Godbold is a member of the Medical Advisory Board of the American Institute of Medical Laser Applications and published the Atlas of CO2 Laser Surgery Procedures and the Atlas of Class IV Laser Therapy – Small Animal. References and Further Reading Helina Moges, Xingjia Wu, Brian Pryor, Jason Smith, Juanita Anders. 980nm LASER IRRADIATION IMPROVED FUNCTIONAL RECOVERY AFTER PERONEAL NERVE INJURY IN RABBITS. Lasers in Surgery and Medicine Supplement (2011). Delia Roberts, Roger Kruse, Matthew Petznick, Jacklyn Kiefer, Peter Alaskym, Stephen Stoll. A Randomized Controlled Trial for the Efficacy of Therapeutic Class IV Laser Treatment for Tendinosis. Procedings of the International Association for the Study of Pain (2010). Kristen Williams, Reed Mathis, J. Derek Kingsley, Emily Simonavice, Francesca Charles, Chris Mojock, Jeong-Su Kim, Victor McMillan, Lynn Panton. Effects of Class IV Laser Therapy on Disease Impact and Function in Women with Fibromyalgia. Proceedings of the American College of Sports Medicine (2010). L.D. Morries. Class IV Laser Therapy: Effective for Back and Neck/ Shoulder Pain. Proceedings of the American Chiropractic Board of Sports Physicians (2010). M Naeser. Photobiomodulation of pain in Carpal Tunnel Syndrome: A review of seven laser therapy studies. Photomedicine and Laser Surgery. V24 N2 101-110 (2006). Roberta T Chow, Mark I Johnson, Rodrigo A B Lopes-Martins, Jan M Bjordal . Efficacy of lowlevel laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet V374: 1897–908 (2009). CHRISTOPHER R. CARCIA, ROBROY L. MARTIN, JEFF HOUCK, DANE K. WUKICH, Achilles Pain, Stiffness, and Muscle Power Deficits: Achilles Tendinitis Journal of Orthopedic Sports and Physical Therapy.40(9):A1-A26 (2010). Scott Haldeman, Linda Carroll, J. David Cassidy, Jon Schubert and Åke Nygren. The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. SPINE Volume 33, Number 4S, pp S5–S7 (2008).
For further reading, visit ivcjournal.com/LLLTstudies
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integrative practice
The road to integrative healing by Richard Palmquist, DVM, President and Research Chair, AHVMA
hen I graduated from Colorado State University School of Veterinary Medicine in 1983, I was well prepared for the challenges of small animal veterinary practice. After doing a preceptorship in an exclusive feline specialty practice, I went to work as a small animal clinician in a busy, high quality AAHA-accredited, multi-doctor practice in Sherman Oaks, California. At the time, my primary concern was in making a correct diagnosis and then initiating the most current treatment plan for my patients. I thought all useful information about our profession came from our continuing education meetings and in the publications of our profession. As a clinician, I felt it was someone else’s responsibility to discover new things. I just wanted to know what to give for what condition. As a new young professional, I did not spend much time considering what healing is, or how we should best pursue health. There was plenty to do just seeing the next patient and taking emergency pages 300 out of 365 days a year. About a year after graduation, I had my first encounter with “alternative
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medicine”. A Schnauzer suffering with chronic active hepatitis failed to respond to correctly delivered and administered medical therapies, but rapidly improved and resolved his hepatitis after seeing a “quack” alternative veterinarian. In my mind, I firmly believed we had done everything possible and followed the best practices of the time. While I was happy the dog improved, I was certain the antiquated herbal medicines given by this practitioner were not a part of the dog’s healing. Coincidence seemed the best justification of the events I observed. Explanations about “drainage” and “Liver Chi” were not well received, and I frankly told my client I was the proud purveyor of “scientific medicine” and had no interest in ancient beliefs or practices. Many years later, basic scientific research led to improved understanding and evidence for the use of milk thistle and its biochemical constituents in the management of hepatic disease. Once there was a credible way of explaining its traditional uses, it became more acceptable. A major company began producing the
active agents and marketed an ethical product line, which veterinarians embraced and found helpful. That company also supported more research which it could use to further improve its products. At most major conferences, we will find these agents listed as useful entities, and each time I read a new piece of literature, I am struck by the unprofessional and biased way I addressed the first practitioner I encountered who was using unconventional medications. In thinking I already knew it all, I broke one of the first tenets of good science. I also failed to successfully address my patient’s healthcare needs. My bias and ego blocked my ability to perceive, pursue and use data objectively. I wish I learned that lesson quickly, but the fact is, it took a few years and several more lessons before I set out on a journey to “disprove” complementary and alternative medicine. Interested individuals can read that story in my text book or in my Huffington Post blog on integrative healthcare, but fortunately in the end my scientific training forced me back on the path of seeking truth and finding healing. Now I spend a lot more time reading uncommon journals and discussing the nature of true healing and health with a wide variety of people. I listen respectfully to traditional herbalists and healers, as well as the top board-certified clinicians and researchers in our profession, hoping for a pearl that will open understanding and preserve life for a future patient. Just how far I have come hit me recently while I was lecturing in Germany; I laughed as I sat with the associate dean of a major US medical school along with his wife, a former US government supplement regulator, and a couple of instructors from alternative medical colleges. We spent our time in very constructive discussion of how to better research and advance the science of healing for the benefit of our clients and patients. The path to better healing begins with individual pioneers who really look at things and make useful observations. They take calculated steps to learn more. In all cases, discovery is the beginning and validation follows, sometimes centuries later. Most of these pioneers care deeply for someone or something, and their drive to help others pushes them along in their pursuits. The process progresses towards hypotheses about the observed phenomena and uses scientific methods to test them in various ways, from basic in vitro testing to in vivo environments. Uses can be tested in many ways. In transitional medicine – the branch of medicine concerned with moving from basic sciences to clinical applications – we know that cooperative efforts between basic and clinical sciences of various disciplines, as well as creative efforts by
those interested in producing ethical and useful products and patents, can speed this process greatly. As we learn more about integrative medicine, we can expand our veterinary tool boxes. As we integrate real truth, the entire field of healing improves its lot. There is a path to better survival and better healing, and science and intuition both play a part. They do not fight each other. They work cooperatively to seek better understanding. In integrative medicine, we are concerned with what works, how it works, how best to use it and when not to use it. The data we evaluate and apply can be thousands of years old or it may be from the latest hightech medical journal. It’s good to see more and more efforts going to understanding our natural world. The knowledge we glean today may well be used to save a beloved family companion as well as generate income for our practices. This is good economics. It is also good medicine.
Further reading
Center SA. Metabolic, antioxidant, nutraceutical, probiotic, and herbal therapies relating to the management of hepatobiliary disorders. Vet Clin North Am Small Anim Pract. 2004 Jan;34(1):67-172, vi. Goldstein R, editor. 2008. Integrating Complementary Medicine into Veterinary Practice, Wiley-Blackwell Publishing. Webb CB, McCord KW, Twedt DC. Assessment of oxidative stress in leukocytes and granulocyte function following oral administration of a silibinin-phosphatidylcholine complex in cats. Am J Vet Res. 2009 Jan;70(1):57-62.
Dr. Richard Palmquist, DVM, was born in Greeley, Colorado and graduated from Colorado State University in 1983. He is chief of integrative health services at Centinela Animal Hospital in Inglewood, California. He is president and research chair of the American Holistic Veterinary Medical Association and an international speaker in integrative veterinary medicine, especially homotoxicology, therapeutic nutrition, and modified hospice. Dr. Palmquist is a consultant for the Veterinary Information Network (VIN). He is also co-director of the AHMVA Foundation which promotes scientific research into alternative therapies. He has published two books, one a textbook for conventional veterinarians and a second book for clients discussing how integrative thinking works. He has consulted with ABC and CBS news.
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nutrition nook
Food labels 101 Making sense of ingredient lists on pet food packaging. by Jean Hofve, DVM
If you want to offer your patients good nutrition, how do you know you’re recommending a good quality product? The best way is to learn how to read ingredient labels on packaged foods. Trouble is, you may find the terminology more than a little confusing, if
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not downright indecipherable. Which ingredients are healthy, and which should you try and avoid?
Deciphering definitions Ingredient names are legally defined by the U.S. Food
Finally...
and Drug Administration (FDA) and the Association of American Food Control Officials (AAFCO). While not all states have adopted these definitions, pet food companies that ship across state lines must follow them.
• Meat by-products are basically “parts that aren’t meat”, such as lungs, spleens, kidneys, brains, livers, blood, bone and clean stomachs and intestines from freshly slaughtered animals. Some pet food companies specify the by-products they will accept, such as kidneys, livers and lungs. While dogs and cats would normally eat byproducts as part of their prey, a diet based exclusively on by-products, with no real meat, is not appropriate. • Meat meal is rendered. Unlike “meat”, bone may make up a considerable proportion of this ingredient. • Meat and bone meal (MBM) is a convenient catch-all term for whatever offal and refuse happen to be rendered that day. This is where the worst stories about pet food come from. The appearance of MBM on a label means the food is poor quality. • Poultry includes chicken, turkey, duck and other birds slaughtered for human consumption. It is a fresh product that includes muscle meat and skin. Unlike “meat”, poultry may include bone. The chicken used in pet foods is typically “backs and frames” (spines and ribs) left over from the processing of broiler chickens into breasts, legs, “boneless/skinless” cuts and wings for human consumption. • Poultry meal is the rendered version of poultry.
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• Meat is a fresh product, made up of what we think of as muscle. The term “meat” is limited to just four species: cattle, sheep, goats and pigs. Recommend a food that actually specifies the meat, like “beef” or “lamb.” If the label just says “meat”, it may contain a mixture of species.
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The biggest distinction between animal ingredients is whether they are fresh (from slaughtered animals) or rendered (cooked to remove the fat and moisture). Fresh products are used mostly in canned foods, while rendered products are found in dry foods.
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What’s the Guaranteed Analysis? The Guaranteed Analysis tells you how much water and “crude” protein, fat and fiber are in the food. These amounts are arrived at by computer formulation or chemical testing, and are useful for comparing different foods. If you’re comparing canned to dry, however, you have to subtract the moisture percentage on the label from 100% to get the total “dry matter”. Then divide the ingredient in question by the dry matter to get the actual ingredient content. For example, a dry food with 10% moisture and 30% protein contains 33% protein (30/100-10), while a canned food containing 78% moisture and 10% protein actually contains 45% protein (10/100-78) on a dry matter basis.
• Poultry by-products include parts of slaughtered poultry carcasses such as heads, feet and viscera. • Poultry by-product meal is the rendered version of poultry by-products. It is very common in lower quality dry foods. • Animal digest comes from the chemical and/or enzymatic breakdown of animal tissues – which could be practically anything. Animal digest comes in a liquid or powder form that is typically sprayed onto finished kibbles to add flavor. • Corn gluten meal is the high-protein residue of processed corn, and is substituted for animal protein sources in cheap pet foods. Corn products are not what nature intended carnivores to eat, so it’s best to avoid them as well as wheat and soy products.
Is it really “complete and balanced”? A pet food may be labeled as “complete and balanced” if it meets published standards in one of two ways:
1
Nutrient profiles set the required amounts of protein, fat, vitamins, minerals and so forth. A manufacturer can formulate a food based on the amount of each nutrient in each ingredient, or chemically test the finished food. Many very good natural and organic pet food companies use this method, because they are too small to invest in feeding trials.
2
Feeding tests require the food to be fed to at least six animals for six months. This used to be the better standard, but the rules have been diluted so that “similar” products can carry an identical label designation. There is no way of knowing if a particular food is the one that was actually tested, or if it’s a “distant relative” that wasn’t. Pet food labels are a rich source of information for those who know how to read them. While they don’t tell you everything about the food, they do provide guidelines for comparison shopping. Most importantly, they help you make sure you’re recommending a high quality product that will help keep your patients in good health.
Veterinarian Dr. Jean Hofve earned her Doctor of Veterinary Medicine at Colorado State University in 1994. In addition to conventional veterinary training, she studied veterinary homeopathy, Reiki and holistic medicine. She researched pet food and feline nutrition for more than 16 years, and has written extensively and been interviewed on radio and television about pet nutrition, supplements and the commercial pet food industry. She also was an official liaison to AAFCO for two years. She co-authored Holistic Cat Care with nutritionist Dr. Celeste Yarnall.
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integrative veterinary care
www.nutral
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integrative veterinary care
19
back to school
Put a pin in it! What acupuncture can and cannot do.
A
cupuncture has been practiced in China for over 2,000 years, and spread to other Asian countries such as Japan and Korea about 1,500 years ago. During the past 25 to 30 years there has been tremendous growth and development of the use of acupuncture in animals in the United States, Canada and Europe.
What acupuncture can do Acupuncture has been used to treat a variety of diseases in horses, dogs, cats and other animals, and many clinical studies have documented its therapeutic benefits. It is generally safe and effective and can be used to treat conditions such as pain, arthritis, muscle spasms, injured tendons or ligaments, abdominal pain, immunodeficiency, autoimmune disease, intervertebral disc disease, seizures, Wobbler’s syndrome, nerve paralysis, behavioral disorders, infertility, skin disease and for improving the overall quality of life in chronic diseases. Acupuncture is defined as the stimulation of a specific point on the body, referred to as an “acupoint.” Physiological changes in response to acupoint stimulation are the basis of clinical treatment. Some of these changes include release of endogenous opioids, immune system stimulation and blood pressure regulation. Stimulation of an acupoint causes activation of Aα and Aβ nerve fibers to conduct electrical signals through the spinothalamic tract to the hypothamalus and cause release of β-endorphins. Acupuncture also activates the descending
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integrative veterinary care
by Carolina Medina, DVM, CVA, CVCH, CCRT
pain inhibitory pathway which in turn activates the periaqueductal gray matter to release more β-endorphins and the nucleus raphe magnus to release serotonin. Therefore, pain is blocked with the release of these endogenous opioids and neurotransmitters. Acupuncture can also activate T-cell lymphocytes and increase the number of white blood cells which is beneficial in the treatment of immunodeficiency. Additionally, acupuncture can affect the blood pressure receptors and can either increase or decrease blood pressure.
Acupoints and techniques There are approximately 361 acupoints located throughout the body. There are four types of acupoints.
1. Motor points – make up about 70% of the total acupoints and are located in areas where a nerve enters a muscle
2. Midline points – located on dorsal and ventral midlines where the superficial nerves meet
3. Nerves or nerve plexus points 4. Muscle-tendon junction points. The three most common techniques use to stimulate acupoints include dry needle, electro-acupuncture and aqua-acupuncture. • Dry needle is the insertion of an acupuncture needle
into an acupoint. These needles are filiform, sterile and of varying widths and lengths. Dry needle is the most common treatment modality used in veterinary medicine. • Electro-acupuncture is the attachment of electrical leads to dry needles and connection to an electro-acupuncture machine. The purpose of using the electro-acupuncture machine is to control the frequency and amplitude applied to each point. This allows for more effective stimulation than dry needle alone. • Aqua-acupuncture is the injection of a soluble, sterile medium such as saline or vitamin B12 into acupoints. The purpose of aqua-acupuncture is to provide a constant stimulation by means of the pressure induced by the liquid injected into the acupoint.
Studies and what they have shown
1
Studies have found that electro-acupuncture produced a significant analgesic effect on inflammatory pain in rats with collagen-induced arthritis.
2
Another study proved that electro-acupuncture is more effective than dry needle acupuncture and that electroacupuncture at acupoint ST-36 (local stifle point) may have anti-inflammatory, anti-arthritic and immune-regulatory effects on collagen-induced arthritis in mice.
3
Several studies have revealed that visceral pain associated with rat irritable bowel syndrome can be effectively treated with electro-acupuncture.
4
One study showed that electro-acupuncture at ST-36 enhances natural killer cell activity and complement activity which indicates the usefulness of ST-36 in immune system activation.
5
Another demonstrated that electro-acupuncture combined with standard Western medical treatment was effective and resulted in shorter time to recover ambulation and deep pain perception than did the use of Western treatment alone in dogs with signs of thoracolumbar intervertebral disc disease.
6 7
Numerous studies have shown that acupuncture has anti-depressive effects in both humans and rats.
The results of yet another study indicated that acupuncture is an effective treatment for pruritis and that this effect is due to the anti-pruritic effect of kappa-opioid receptor activation induced by acupuncture stimulation.
Cautions and contraindications There are certain cautions and contraindications one must be aware of when using acupuncture as a treatment option. • Care must be taken when treating weak or debilitated patients. Typically, fewer acupoints are stimulated in weak or geriatric animals. • When treating agility or other performance dogs, wait a couple of hours after training or competing before starting an acupuncture treatment. • Acupoints around the thoracic cavity require a more shallow insertion than other acupoints located on large muscle groups such as the gluteals. • One must be cautious when using acupoints around the eyes so as to not puncture the globe. • It is contraindicated to insert a needle directly into a mass, tumor, open wound, umbilicus or scar tissue. • Specific points, especially those around the lower abdomen and lower lumbar spine, are contraindicated during pregnancy. • Electro-acupuncture is contraindicated in patients with a pacemaker or a history of seizures, and should be used with caution in patients with congestive heart failure. In summary, acupuncture can be used to treat a variety of diseases including pain, neurological dysfunction, gastrointestinal disorders, dermatological conditions and anxiety. Different acupoints and different methods of stimulation can be employed to treat specific diseases. Although few, there are some cautions and contraindications to using acupuncture therapy. Therefore, it is highly recommended that a licensed veterinarian take a course certifying him or her in veterinary acupuncture before implementing it as part of his/her practice. With the increasing amount of clinical trials and research being performed on acupuncture therapy, we have a better understanding of its mechanisms of action and therapeutic benefits. Dr. Carolina Medina received a Doctor of Veterinary Medicine degree from St. George’s University School of Veterinary Medicine in 2005. After graduating veterinary school, she completed a 14month clinical internship in Acupuncture at the University of Florida College of Veterinary Medicine, and the Chi Institute and China’s National Society of Traditional Chinese Veterinary Medicine granted her certification in Veterinary Acupuncture, Herbology, Tui Na Massage Therapy and Food Therapy. Dr. Medina was one of the founders of the American Association of Traditional Chinese Veterinary Medicine and has been an Associate Editor for the American Journal of Traditional Chinese Veterinary Medicine since its inception in 2006. Last year, she became certified in canine rehabilitation therapy through the Canine Rehabilitation Institute. Currently, she works as a clinical assistant professor and service chief of the Acupuncture and Rehabilitation Service at the University of Florida College of Veterinary Medicine.
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Antioxidants for
ocular health How these nutrients are proving beneficial for genetic eye disease. by Dr. Carmen Colitz, DVM, DACVO, PhD and Dr. Terri McCalla, DVM, DACVO
T
oday’s dogs seem far more predisposed to cancer and other immune-mediated diseases than dogs in decades past. Conditions like these result from an excess of oxidative stress that cannot be counteracted by the endogenous antioxidant systems of the cells, or by the typical diet. The causes are likely numerous but certainly the quest for the perfect dog in a specific breed has led to many of the genetic diseases we see in veterinary medicine – and ophthalmology. The hybrid or designer breeds now popular are not immune even though the intent was to diminish the genetic issues; unfortunately, this did not entirely happen.
The most common genetic diseases we see in veterinary ophthalmology practice include cataracts, retinal degenerations and glaucoma.1-3 Each breed or group of breeds likely have various mutation(s) that predispose that dog to one or more of these diseases. And unfortunately, you cannot change your genes. Thanks to the Dog Genome Project, the mutations for these diseases are already identified for some breeds, and many more will continue to be identified. The new disciplines of nutrigenomics and nutrigenetics have helped cement nutrients as ways in which to modulate health. Nutrigenomics refers to genetic variation and its dietary response.1 Nutrigenetics refers to the evolutionary aspects of diet and the role of nutrients in gene expression.1 While the impact of diet and nutritional supplementation may not appear to affect inherited ophthalmic diseases in dogs, we might learn that genes that become involved in any of these diseases may be affected by what a dog eats. Likewise, this same concept of genetic variation and genenutrient interaction is important in drug metabolism and adverse reactions to drugs.1 That said, an intake of certain nutrients may directly or indirectly modulate genes, including those that affect eye diseases.
Cataracts While inherited cataracts in dogs are unlikely to be prevented or inhibited by nutriceutical supplementation, antioxidants will improve the environment of the lens cells and possibly reduce secondary sequellae to the
22
integrative veterinary care
ensuing oxidative stress caused by cataractogenesis. Some examples of nutrients shown to have aprotective effect on lens epithelial cells and/or cataract development include grapeseed extract, lutein/zeaxanthin, lycopene, zinc and coenzyme Q10. Proanthocyanidins are powerful antioxidants found in grapeseeds, tea, nuts, pine bark and other plant extracts. They have a variety of effects, including free radical scavenging and anti-inflammatory, anti-viral and antimicrobial activities. They also potentiate the function of vitamins C and E.5-7 A strain of rats (ICR/f) predisposed to hereditary cataracts due to lipid peroxidation were fed a diet containing grapeseed extract (GSE). Cataracts were slowed in progression and active glutathione (GSH) was higher in GSE-fed rats as compared to unsupplemented control rats.2 Selenite-induced cataracts, a form of toxininduced cataract, were also significantly slowed or prevented by GSE.3 In vitro studies on lens epithelial cells found that GSE reduced oxidative stress-induced reactive oxygen species production and attenuated stress-induced cell-signaling markers and NF-kB.4, 5 Lutein and its coexistent isomer, zeaxanthin, are oxycarotenoids with two hydroxyl groups on either side of the molecule. They protect ocular tissues against photooxidative stress, quench and scavenge ultraviolet radiation-induced reactive oxygen species, inhibit lipid peroxidation, and filter blue light.6 They are the only continued on page 24
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Other plant extracts with protective effects against cataracts include lycopene and curcumin. Lycopene is a potent carotenoid found in tomatoes. Lycopene protects against selenite-induced cataracts as well as galactosemia-induced cataracts.12, 13 In vitro, lens epithelial cells exposed to selenite improved antioxidant activity and glutathione levels when supplemented with lycopene, compared to unsupplemented control cells. Curcumin is the chief phenolic compound found in turmeric (Curcuma longa).14 Curcumin’s anti-inflammatory and antioxidant effects are due to its ability to induce antioxidant enzymes, decrease production of pro-inflammatory cytokines, sequester free radicals, inhibit neutrophil and macrophage function, and inhibit lipid peroxidation.15-20 All cataractogenic processes have an imbalance in calcium, and curcumin may have anticataractogenic effects by preventing free radical-mediated accumulation of calcium in the lens.21 Calcium (Ca2+) is elevated in cortical, but not nuclear cataracts,22 and excessive Ca2+can be detrimental to lens cells. Calcium is tightly regulated in the lens and its imbalance is associated with changes occurring during cataractogenesis.23
carotenoids found in the retina and lens (Bomser, unpublished results in dogs).7 Lutein and zeaxanthin are potent antioxidants that inhibit lipid peroxidation. Though the literature strongly supports their role in protection against age-related cataracts in humans, there are no published reports investigating their inhibition of specific inherited or toxic cataracts in rodent models or other species. However, lutein and zeaxanthin may improve the lens environment during cataractogenesis through their antiinflammatory activity.8 Cataractogenesis, regardless of the stage in dogs, causes inflammation9, 10 and chronic uveitis can cause cataractogenesis.11 Therefore, one can exacerbate the other.
Retinal diseases Inherited degenerative or dystrophic retinal diseases have been a focus of research beginning in 1955. This research evaluated red Irish setters using the electroretinogram,24 and was followed in 1965 by the description of a photoreceptor abiotrophy in the elkhound.25 Since then, hundreds of publications have characterized and described the various forms of retinal dystrophy and degenerations in numerous breeds of dogs. With our improved understanding of gene cloning and the establishment of the Dog Genome Project, mutational analysis has identified specific mutations for these diseases in many breeds. As a result of this research, DNA testing is now available for 67 breeds so far. Lutein and zeaxanthin selectively accumulate in the retina and lens.3-5 Recovery of electroretinographic function in dogs with Progressive Retinal Atrophy (PRA) has been demonstrated following nutritional supplementation; these findings suggest the progression of canine PRA is inhibited by antioxidant supplementation, including lutein and zeaxanthin.26 Regardless of the mutation causing retinal dystrophy or degeneration, there is cell death and oxidative stress. Since rods are the major source of oxygen utilization in the retina, their death results in deleterious oxygen levels and photoreceptor damage.27, 28 Once the rods die, the cones gradually follow. It is hypothesized that cone death is due to oxidative damage possibly secondary to increased oxygen levels in the outer retina.27, 28 A combination of antioxidants including alpha-tocopherol, ascorbic acid and alpha lipoic acid, reduced oxidative stress. Individually, alpha-tocopherol and alpha lipoic acid, both lipid soluble antioxidants, showed significant increases in cone numbers compared with the other groups.27 Therefore, as long as enough cones survive in retinas with degenerative or dystrophic diseases, vision may be maintained or prolonged by the use of antioxidants.
Glaucoma Oxidative stress is an important part of glaucoma.29, 30 One
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theory is that an unstable ocular blood flow leads to repeated mild reperfusion events.31 Elevations in intraocular pressure (IOP) damage retinal ganglion cells with secondary excitotoxicity and free radical generation.32 Coenzyme Q10 has been shown to delay apoptosis in retinal ganglion cells resulting from high IOP.33 Much of the information, thus far, pertains to humans with open angle glaucoma, and rodent models; therefore, confirmation of oxidative stress events and evaluation of the effects of antioxidants in canine glaucoma are warranted. Other antioxidants, including polyphenols (grapeseed extract) and EGCG (green tea extract), may help slow the progression of the damage occurring in glaucoma.31
“The Theralase laser is the most cutting-edge therapeutic laser on the market and has been a wonderful addition to my veterinarian practice. It provides superb safety and high efficacy to my canine and feline patients by providing pain relief, inflammation reduction and accelerated healing in just a few treatments. I routinely use it post surgically with excellent results. Do yourself and your clinic a favour, get a Theralase”. KENT ACKERMAN, DVM
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In summary, all diseases – including inherited ophthalmological conditions – have oxidative stress in their pathogenesis. The body’s numerous endogenous antioxidant systems fight the daily free radical damage that occurs with normal body functions, including digestion and metabolism and growth in young animals. However, an excess of oxidative stress, occurring with chronic lifelong situations such as inherited ophthalmic disease, depletes the endogenous antioxidant systems, and any antioxidants available from the diet. This likely exacerbates the progression of these diseases. Therefore, the use of antioxidant supplements as a complement to traditional therapy is likely beneficial. Dr. Carmen Colitz is a board certified veterinary ophthalmologist with a PhD in Comparative and Experimental Medicine. She has extensive research experience involving antioxidants and
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integrative veterinary care
how they affect eye health, particularly the lens. In addition, Dr Colitz discovered telomerase activity in cataracts and has over ten years research experience working in this field. Dr. Terri McCalla is a board certified veterinary ophthalmologist and owner of Animal Eye Care in Bellingham, Washington. Her research interest is in retinal pathology, and she has been in private specialty practice for over 20 years. References: 1. Simopoulous AP. Nutrigenetics/Nutrigenomics. Ann Review Pub Health. 2010;31:53-68. 2. Yamakoshi J, Saito M, Kataoka S, Tokutake S. Procyanidin-rich extract from grape seeds prevents cataract formation in hereditary cataractous (ICR/f) rats. J Agric Food Chem. 2002;50:4983-4988. 3. Durukan AH, Everklioglu C, Hurmeric V, et al. Ingestion of IH636 grape seed proanthocyanidin extract to prevent selenite-induced oxidative stress in experimental cataract. J Cataract Refract Surg. 2006;32(6):1041-1045. 4. Barden CA, Chandler HL, Lu P, Bomser JA, Colitz CMH. The effect of grape polyphenols on oxidative stress in canine lens epithelial cells. Am J Vet Res. 2008;69:94-100. 5. Jia Z, Song Z, Zhao Y, Wang X, Liu P. Grape seed proanthocyanidin extract protects human lens epithelial cells from oxidative stress via reducing NF-ะบB and MAPK protein expression. Mol Vis. 2011;17:210-217. 6. Lutein and zeaxanthin. Alternative Medicine Review. 2005;10(2):128-135. 7. Yeum KJ, Taylor a, Tang G, Russell RM. Measurement of carotenoids, retinoids, and tocopherols in human lenses. Invest Ophthalmol Vis Sci. 1995;36:2756-2761. 8. Jin X-H, Ohgami K, Shiratory K, et al. Inhibitory effects of lutein on endotoxin-induced uveitis in Lewis rats. Invest Ophthalmol Vis Sci. 2006;47:2562-2568. 9. Gelatt KN, MacKay EO. Secondary glaucoma in the dog in North America. Vet Ophthalmol. 2004;7(4):245-259. 10. Leasure J, Gelatt KN, MacKay EO. The relationship of cataract maturity to intraocular pressure in dogs. Vet Ophthalmol. 2001;4(4):273-276. 11. Davidson MG, Nelms SR. Diseases of the Canine Lens and Cataract Formation. In: Gelatt KN, ed. Veterinary Ophthalmology. Vol 2. 4 ed. Ames: Blackwell; 2007:859-887. 12. Gupta SK, Trivedi D, Srivastava S, Joshi S, Halder N, Verma SD. Lycopene attenuates oxidative stress induced experimental cataract development: an in vitro and in vivo study. Nutrition. 2003;19(9):794-799. 13. Pollack A, Oren P, Stark AH, Eisner Z, Nyska A, Madar Z. Cataract development in sand and galactosemic rats fed a natural tomato extract. J Agric Food Chem. 1999;47:5122-5126. 14. Manikandan R, Thiagarajan R, Beulaja S, Sudhandiran G, Arumugam M. Effect of curcumin on selenite-induced cataractogenesis in Wistar rat pups. Curr Eye Res. 2010;35(2):122-129. 15. Kunchandy E, Rao MNA. Oxygen radical scavenging activity of curcumin. Int J Pharmaceut. 1990;58:237-240. 16. Sreejayan M, Rao N. Nitric oxide scavanging by curcuminoids. J Pharm Pharmcol. 1997;49:105-107. 17. Srivastava R. Inhibition of neutrophil response by curcumin. Agents Actions. 1989;28:298-303. 18. Joe B, Lokesh BR. Role of capsaicin, curcumin and dietary n-3 fatty acids in lowering the generation of reactive oxygen species in rat peritoneal macrophages. Biochim Biophys Acta. 1994;1224:255-263. 19. Chan MMY, H.I. H, Fenton MR, Fong D. In Vivo inhibition of nitric oxide synthase gene expression by curcumin, a cancer preventive natural product with anti-inflammatory properties. Biochem Pharmacol. 1998;55:1955-1962. 20. Reddy AC, Lokesh BR. Effect of dietary turmeric (Curcuma longa) on iron-induced lipid peroxidation in the rat liver. Food Chem Toxicol. 1994;32:279-283. 21. Manikandan R, Thiagarajan R, Beulaja S, Sudhandiran G, Arumugam M. Curcumin prevents free radical-mediated cataractogenesis through modulations in lens calcium. Free Radic Biol Med. 2010;48(4):483-492. 22. Duncan G, Bushnell AR. Ion analyses of human catractous lenses. Eye Research. 1975;20:223-230. 23. Rhodes JD, Sanderson J. The mechanisms of calcium homeostasis and signalling in the lens. Exp Eye Res. 2008;88:226-234. 24. Parry HB, Tansley K, Thomson LC. Electroretinogram during development of hereditary retinal degeneration in the dog. Br J Ophthalmol. 1966;39(6):349-352. 25. Cogan DG, Kuwabara T. PHOTORECEPTIVE ABIOTROPHY OF THE RETINA IN THE ELKHOUND. Pathol Vet. 1965;106:101-128. 26. Umeda Y, Maehara S, Wakaiki S, et al. Electroretinographic, evaluation of supplementation including lutein for canine progressive retinal atrophy. Paper presented at: Annual Meeting of the American College of Veterinary Ophthalmologists, 2004. 27. Komeima K, Rogers BS, Lu L, Campochiaro PA. Antioxidants reduce cone cell death in a model of retinitis pigmentosa. Proc Natl Acad Sci USA. 2006;103(30):11300-11305. 28. Shen J, Yang X, Dong A, et al. Oxidative damage is a potential cause of cone cell death in retinitis pigmentosa. J Cell Physiol. 2005;203(3):457-464. 29. Zanon-Moreno V, Garcia-Medina JJ, Gallego-Pinazo R, Vinuesa-Silva I, Moreno-Nadal MA, Pinazo D, M.D. Antioxidant status modifications by topical administration of dorzolamide in primary open-angle glaucoma. Eur J Ophthalmol. 2009;19(4):565-571. 30. Izzotti A, Sacca SC, Longobardi M, Cartiglia C. Sensitivity of ocular anterior-chamber tissues to oxidative damage and its relevance to glaucoma pathogenesis. Invest Ophthalmol Vis Sci. 2009;Epub ahead of print. 31. Mozaffarieh M, Grieshaber MC, Orgul S, Flammer J. The potential value of natural antioxidative treatment in glaucoma. Surv Ophthalmol. 2008;53:479-505. 32. Russo R, Cavaliere F, Rombola L, et al. Rational basis for the development of coenzyme Q10 as a neurotherapeutic agent for retinal protection. Prog Brain Res. 2008;173:575-582. 33. Nucci C, Tartaglione R, Cerulli A, et al. Retinal damage caused by high intraocular pressure-induced transient ischemia is prevented by coenzyme Q10 in rat. Int Rev Neurobiol. 2007;82:397-406.
industry innovations Tools for rehab As a veterinarian, you’ve probably seen more than a few injured dogs come through your doors – dogs that may need surgery and/ or rehabilitation to get them back on track. FitPAWS® Canine Conditioning Equipment is used by animal rehabilitation professionals, veterinarians, sport dog enthusiasts and professional dog trainers for core strengthening, increased range of motion and flexibility, neuromuscular facilitation, sensory and perceptual stimulation, joint alignment, and balance control. dogtreader.com
They know SAMe Presenting Nutralife, the innovators who introduced the top-selling supplement, SAMe, to the United States. SAMe has been studied in numerous clinical trials involving thousands of patients over the last three decades. It is used to promote healthy liver function and joint mobility, and to maintain mood and cognitive function. Many veterinarians have already prescribed Nutralife’s Original SAMeTM for their patients. Nutralife now introduces the NutralifePet line of SAMe, tailor made in multiple doses and sizes to meet the unique needs of the veterinary market. NutralifePet aims to make quality supplements affordable to all pet owners. See the NutralifePet ad in this issue. nutralife.com
Learning opportunity If you’re interested in adding massage and bodywork to your practice, check out Integrated Touch Therapy, Inc. President and primary instructor Patricia Whalen-Shaw is a licensed massage therapist in Ohio and nationally certified by the NCBTMB. She has been teaching equine, canine and feline massage to practitioners for 20 years. Classes are small with hands-on practice and hundreds of hours of schooling. Massage and bodywork can be used to generate additional income for your practice; it can help older dogs move more freely, can be used in the prevention and early detection of disease, especially masses, may speed hair growth by increasing circulation, and keep animals calm during office visits. integratedtouchtherapy.com
For patient anxiety Examining a tense or frightened animal can be challenging. Rescue Remedy Pet is an all-natural stress reliever that can help calm pets in any stressful situation, including vet visits. It contains the same five Bach Flower Remedies used in the original formula created for humans over 75 years ago, but in an alcoholfree, glycerin-based preservative ideal for sensitive animal patients. Rescue Remedy Pet is available in 10ml or 20ml drops and is suitable for all animals including dogs, cats, horses, birds and rabbits. nelsonsnaturalworld.com
Two new supplements
Rx for renal failure
Omega Alpha Pharmaceuticals Inc. has developed two new products to round out their line of herbal-based liquid nutraceutical formulations for cats, dogs and small animals. The new products address common pet needs such as respiratory health with Lung Tone™, and pain and inflammation with E-Z Mobility™. Omega Alpha Pharmaceuticals has been GMP certified for manufacturing to pharmaceutical standards since its inception in 1992, and is site licensed for manufacturing nutraceuticals by the Natural Health Products Directorate (NHPD), a division of Health Canada. OmegaAlpha.ca.
Kidney issues are common in cats. Rx Renal Feline is a complex formulation of multiple botanical extracts and nutraceuticals that has shown efficacy in normalizing renal blood values in patient trials. Each ingredient is supported by scientific evidence that shows its usefulness in effectively addressing elevated renal values. This formula is well tolerated in cats, and positive clinical results can be achieved in as little as two weeks. For more information, Rx Vitamins offers a comprehensive Technical Report. rxvitamins.com integrative veterinary care
27
tech talk
Introduction to Reiki This safe and effective energetic healing modality is backed up by promising preliminary research. Find out how you can use it to support the animals you care for. by Kathleen Prasad
Because it is holistic in nature, Reiki can address both physical and emotional issues. It supports healing on all levels. It is an ideal therapy to use with animals because it is gentle, painless and stress-free, does not require direct physical contact in order to be effective, and allows animals to choose their own level of participation and acceptance of the energy.
ast year, Dr. Oz declared Reiki his No. 1 alternative medicine secret. With 40% of Americans having tried alternative medicine – and 60% of US households home to at least one pet – many people are increasingly turning to Reiki and other holistic therapies to help their animals. Thanks to Reiki’s increasing popularity, many integrative veterinarians now offer it and other energy healing options in the clinic environment. Many conventional veterinarians are also learning more about Reiki as a holistic option, at the request of their human clients. Reiki literally means “spiritual energy” and refers to a Japanese healing system that uses specific meditative, breathing and other practices to support energetic rebalancing and the self-healing process.
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Maybe you work in an integrative clinic where Reiki is already part of the healing program. Or perhaps you work for a veterinarian who is at present unaware of how Reiki can help the animals in her care. In either case, there are many benefits to learning Reiki.
Benefit 1: Reiki is easy to use and will not take away from your regular duties. Reiki is something you can use any time during the day whenever an animal might need some extra support. Although longer and more focused treatments are extremely helpful, you can also use Reiki quickly and easily with some simple focus and breathing techniques. This particular benefit has already been documented for nurses in “Effects of Reiki on Autonomic Activity Early After Acute Coronary Syndrome” a study that appeared in the Journal of the American College of Cardiology (2010;56;995-
995). In this study, Reiki-trained nurses provided this therapy to patients on cardiac units. The study showed they were able to incorporate these treatments (and their therapeutic benefits) into the standard care protocol without disruption or additional cost.
Support of Cancer Patients” by Pamela Miles in Advances (Fall, 2007, Vol. 22, No. 2). This human study showed how Reiki relieves symptoms such as anxiety and pain, helping patients feel better, “frequently within minutes.”
Benefit 4: Reiki self-care can reduce stress at work.
Benefit 2: Reiki can calm animals before and during exams and procedures. As care providers for animals in a clinic environment, veterinary technicians are in a unique position to provide Reiki when animals might become stressed: before and during exams and procedures, for example. According to the study “Reiki Improves Heart Rate Homeostasis in Laboratory Rats” in the Journal of Alternative and Complementary Medicine (14(4): 417-422, 2008), Reiki significantly reduced a rise in heart rate produced by exposure to noise. Extrapolating these results to the clinic environment, veterinary technicians can use Reiki to help animals remain calm and relaxed during their visits.
Benefit 3: Reiki provides post-surgery comfort and recovery support. A valuable time to offer Reiki to animals is immediately after surgery, or after treatment before they go home. By offering Reiki at this time, you can support a quick recovery. The benefits of Reiki for pain management and recovery have been documented in “Reiki for Mind, Body and Spirit
Last but far from least, Reiki can offer you self care and stress reduction. Reiki teaches that all healing begins within the individual, and that it’s through our own spiritual development and self-healing that we can deepen our ability to help others. In the study “Nurses’ Lived Experience of Reiki for Self Care” in Holistic Nursing Practice, (23(3): 129-145, 2009), nurses were able to reduce on-the-job stress by doing Reiki self treatments. Reducing stress can also help support veterinary technicians in their interaction with co-workers, human clients and animals. There are many more benefits to Reiki, and it’s a perfect complementary modality for veterinary technicians to learn. Reiki is taught by a growing number of practitioners, so it’s easy to find courses. Give it a chance, and see how Reiki can help you be the best professional you can be. Kathleen Prasad is co-author of Animal Reiki and The Animal Reiki Handbook. She is also an animal Reiki teacher, founder of Animal Reiki Source and President of the Shelter Animal Reiki Association. Find out more about energy healing and Reiki for animals through her website animalreikisource.com.
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Evidence-based medicine for animal supplements – part 1 – Where is the clinical evidence demonstrating that animal supplements are safe and effective? Here’s a review of the evidence that’s currently available, and the limitations facing the industry.
yadda, yaddy, yadda... incredible! yadda, yaddy, yadda... the best!
by William Bookout, BS, MBA
hen United States Congress passed the Dietary Supplement Health Education Act (DSHEA) in 1994, they failed to consider the potential application and benefits of supplements for animals. The Food and Drug Administration, Center for Veterinary Medicine (FDACVM) published a notice in the Federal Register stating that due to the lack of specific references to animals, DSHEA did not apply to products for animals1. Consequently, there are only two categories under existing US law for these types of products, determined by their intended use:
or any function of the body of man or other animals; and (D) articles intended for use as a component of any article specified in clause A, B, or C.”
“SEC. 201. [21 U.S.C. 321] Definitions; generally for the purposes of this Act2
Economic considerations
“Food (Animal Food/Feed) – (f)(1) The term ‘food’ means (1) articles used for food or drink for man or other animals, (2) chewing gum, and (3) articles used for components of any such article. “Drug (Animal Drugs) – (g)(1) The term ‘drug’ means (A) articles recognized in the official United States Pharmacopoeia, official Homoeopathic Pharmacopoeia of the United States, or official National Formulary, or any supplement to any of them; and (B) articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or other animals; and (C) articles (other than food) intended to affect the structure
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This means that animal supplements, if they are not intended to provide nutrition to animals, are considered by the FDA to be unapproved drugs; therefore, safety and effectiveness for their intended use in specific species has not been evaluated by the agency. For a product to be an “approved” drug, a company must submit a New Animal Drug Application (NADA) with safety, efficacy and quality data that are then evaluated by the agency.
Meeting this burden of proof is impossible for animal supplements. The time required to develop a new animal drug can be between six to eight years with an investment of approximately $100 million, so submitting the data and information required to receive approval is both time consuming and very costly. For a company to afford it, it must accomplish at least two things: 1) recover its investment, which is reflected in the price it charges for the products, and 2) try to protect the business opportunity by patenting the product as a barrier to competitors.
Allowable product claims Labeling claims are probably the most misunderstood and misused aspect of animal supplement regulation. Under current US law, products marketed for animals that are similar to human dietary supplements have
only two legal categories: animal food/feed or animal drugs. Depending on their intended use, products may be considered unapproved animal drugs that may be marketed under enforcement discretion. Examples are supplements with ingredients supporting joint function, or herbal ingredients with a functional supportive purpose other than flavoring. Labeling generally includes, but may not be limited to, product labels, product literature, websites, advertising and trade show materials, such as booth graphics. The accompanying table illustrates both violative claims and claims that may not be objected to by regulatory agencies. Claims for natural health products for animals may be allowed by FDA-CVM if they are not in violation of those associated with approved animal drugs, and are limited to supporting the normal, healthy structure and/or function of the animal. Further information on labeling claims can be found in Labeling Claims, General Information on the FDA website; however, this guidance applies to nutritional products and human dietary supplements, and should only be viewed as general claims guidance. Claims that sound too good to be true probably are. Any company that makes claims for natural products and mentions disease is an egregious violator, unless the company can provide a letter of non-objection from FDA-CVM.
Many drugs and medical devices are not approved for animals When discussing supplements for animals, it is worthwhile to compare products and equipment used without question every day by veterinarians. Drugs – How many drugs on pharmacy shelves in every veterinary clinic and hospital are specifically approved for use in animals? An estimated 50% to 70% of drugs used every day by veterinarians are off-label or extralabel use, and have not met the criteria for safety and efficacy for animals. Why are these drugs allowed to be sold by the FDA? The Code of Federal Regulations states: “530.30 Extralabel drug use in nonfood animals. (a) Because extralabel use of animal and human drugs in nonfood-producing animals does not ordinarily pose a threat to the public health, extralabel use of animal and human drugs is permitted
in nonfood-producing animal practice except when the public health is threatened.” It is a risk-versus-benefit analysys; if extralabel drug use was not allowed, veterinarians would have far fewer drugs to choose from in treating their patients and veterinary medicine would not have made the advances it has. If safety and efficacy data were required for all current drugs used to treat animals, veterinarians simply could not treat patients effectively. Medical devices – In human medicine, there is an “approval” process for medical devices, typically referred to as the 510K process. Depending on the class of device, the requirements may be more or less rigorous. When a company wants to market a medical device for human use, it typically submits a documentation packet to FDA; when successful, it receives a letter granting permission to market the product. The FDA states the company has satisfied the requirements and they have no further questions. Human devices, or drugs for that matter, are not technically “approved” by FDA; the agency essentially grants permission to market products. integrative veterinary care
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Supplement
Violative claims, whether specifically stated or implied
Claims that may not be objected to
Animal supplement containing glucosamine, chondroitin sulfate and MSM
• Benefits animals with osteoarthritis, degenerative joint disease
• Supports normal healthy joint function
• Any claim linked to treating and/or preventing a disease
• Helps maintain healthy joint function
Supplement containing ingredients like coenzyme Q10
• Benefits animals with cancer, autoimmune disease, congestive heart failure
• Supports normal healthy immune function
• Any claim linked to treating and/or preventing a disease
• Helps maintain healthy immune function
• Any mention of a specific disease or implied reference to a disease
• Any mention of a specific disease or implied reference to a disease
Supplement containing ingredients such as fish oil, omega-3 or omega-6 fatty acids
• Benefits animals with dermatitis, chronic allergies, chronic skin conditions • Any claim linked to treating and/or preventing a disease • Claims to reduce excessive shedding • Any mention of a specific disease or implied reference to a disease
What products would require 510K submissions evaluating safety and effectiveness? Anesthesia machines/vaporizers, pulse oximeters, CO2 monitors, endotracheal tubes, IV pumps, IV tubing, anesthesia circuits…almost every medical device in a human hospital or clinic requires some type of evaluation by FDA prior to being legally marketed. The FDA-approval process and requirements for animal medical devices are virtually non-existent in comparison to human medicine. If all animal medical devices used by veterinarians were eliminated in cases where safety and efficacy have not been evaluated, almost all of them would no longer be available. If the majority of drugs for animals have not been evaluated for safety and efficacy, and there is no approval process for animal medical devices, why don’t thousands of animals die? The reasons are:
1 2
The products have been used by people without causing significant “harm to public health”.
Regulatory agencies utilize risk-based approaches to allocate resources that serve the best interests of public safety and health. The products are allowed to be marketed under FDA enforcement discretion, provided the industry is acting responsibly. In Part 2 of this article, which will appear in the next issue of IVC, I’ll look at how the animal supplement industry is working with regulatory agencies, and the important role the National Animal Supplement Council (NASC) plays in regulating natural health products for animals.
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• Supports healthy skin and coat • Essential fatty acids help your pet maintain a glossy, shiny coat • Salmon oil helps maintain normal shedding
Bill Bookout is a founding member of the National Animal Supplement Council, serving as president and chairman of the board of the nonprofit organization since early 2002. Bill is also president of Genesis Ltd., a company he founded in 1999 that provides both feed products and health products for companion animals. Prior to founding Genesis, he spent 15 years in the human medical device, drug and animal health industries, including executive positions with Medex Medical, the All-Care Animal Referral Center and AnaMed International, and director of sales and marketing for Marquest Medical Products. Bill received his bachelor’s degree in physical sciences from the University of Wyoming, and an MBA from Pepperdine University, Presidents and Key Executives Program. He has been selected by Health Canada to serve on the Expert Advisory Committee for Veterinary Natural Health Products. He serves on the Board of Directors of the University of Wyoming’s National Ambassadors as a student mentor for the university. Bill and his wife, Mary are involved in Akita Rescue and have four rescue Akitas: Yin, Yang, Akiko and Hana. References FDA Veterinarian – May / June 2002. Animal Dietary Supplements – A US Update www.fda.gov/cvm/4410.htm Federal Food Drug & Cosmetic Act, SEC. 201. [21 U.S.C. 321], CHAPTER II—DEFINITIONS, SEC. 201. [21 U.S.C. 321] Definitions; generally For the purposes of this Act. www.fda.gov/RegulatoryInformation/Legislation/FederalFoodDrugandCosmeticActFDCAct/ FDCActChaptersIandIIShortTitleandDefinitions/ucm086297.htm Requirements for New Animal Drug Applications. www.fda.gov/AnimalVeterinary/DevelopmentApprovalProcess/NewAnimalDrugApplications/default.htm Small Animal Clinical Pharmacology, Jill E. Maddison, Stephen W. Page, pp. 20-22. National Animal Supplement Council, FAQs. nasc.cc/index.php?option=com_content&task=view&id=29&Itemid=38 FDA, Labeling Claims, General Information. www.fda.gov/Food/LabelingNutrition/LabelClaims/default.htm Extralabel drug use in animals. www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=530 www.fda.gov/iceci/enforcementactions/warningletters/2008/ucm1048139.htm www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm162121.htm www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm165062.htm www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm208978.htm www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm212363.htm www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm215443.htm
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equine nutrition
Once you’ve ruled out health problems, packing a few pounds on an underweight “hard keeper” is easier than you may think. by Dr. Juliet M. Getty, PhD
e hear so much these days about overweight horses and their health problems, that those of us with underweight patients feel almost fortunate! But don’t be too complacent. Any time a horse can’t maintain a healthy weight, there’s reason for concern. Horses vary in their ability to burn calories. Their “metabolic rate” is influenced by genetics and body composition. We all know Thoroughbreds have a genetic tendency to be on the lean side, and a highly muscular horse will have a faster metabolic rate than one who is out of shape. But what about the true “hard keeper” who cannot seem to gain weight? Throwing more feed at him is not always the correct approach. You have to rule out a few things first, to make sure there isn’t an underlying problem.
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Four causes of weight loss 1|Dental problems –The most common reason for weight loss is poor teeth. A horse’s teeth should be floated at least once each year, but some horses need their teeth floated every six months. Poor dental maintenance can make eating a painful experience. Older horses sometimes lose teeth, making hay chewing virtually impossible. These horses need to have softer feed, but still require a forage-based diet. Soaked hay cubes offer a good solution. If you come across a horse who is dropping his feed or spitting out clumps of partially-chewed hay, the situation may require the services of an equine dentist.
2|Parasites – Another common reason for a horse to be underweight is inadequate internal parasite control. Worm infestations can vary by region, but don’t assume that if a horse stays in one paddock or barn all the time, he doesn’t need an effective parasite control program. Worms can damage the intestinal lining and the blood vessels that support the digestive system, diminishing nutrient absorption and, in actuality, starving the horse. 3|Flora imbalance – A horse’s hind gut contains billions of beneficial bacteria that produce enzymes for digesting forage. Without these bacteria, the horse could not derive any calories from hay and pasture. So keeping these bacteria healthy is a must. Their numbers can diminish due to illness, stress, over-consumption of cereal grains, and antibiotic therapy (which kills beneficial as well as harmful bacteria). Colic can result if their numbers diminish too much. In the generally healthy underweight horse, the level of helpful microbes can be slightly off. A prebiotic is therefore a useful addition to the diet. A prebiotic is different than a probiotic because it does not contain any live microbes. Instead, it contains bacterial fermentation products that feed the existing bacterial flora in the hind gut, making them healthier and better able to digest forage. The result is weight gain, since the horse can get more calories from the fiber found in hay and pasture. Ration Plus is an excellent prebiotic. A probiotic (live microbes) is useful for a horse on antibiotic therapy, to replace the beneficial bacteria that have been destroyed.
4|Vitamin deficiencies – Borderline B-vitamin deficiencies can lead to a poor appetite. There are eight B vitamins that rely on each other to keep a variety of body systems in good working order. The digestive system relies on B vitamins to keep healthy. In addition, each cell in the body requires several B vitamins to metabolize nutrients for energy. This means a horse owner can feed an excellent diet, but if there aren’t enough B vitamins in the bloodstream, the horse’s tissues will not be able to derive calories from the carbohydrates, fats, and proteins in that diet. The result is weight loss due to malnutrition at the cellular level. Recommend a B-complex preparation such as BPlex (Horsetech) that provides only B vitamins. Avoid “blood builders” that have B vitamins with added iron. There is plenty of iron in hay and pasture, and too much can be harmful. integrative veterinary care
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Adding calories
The importance of forage
Once you’ve ruled out any medical problems or B-vitamin deficiencies, you can work on providing more calories. Your best approach is to get the horse owner to add concentrated calories, so she doesn’t have to feed too large a meal. Horses’ stomachs are relatively small, compared to the rest of the digestive tract. So, for the average 1,100-pound horse, meal sizes should be limited to no more than four pounds. Advise the owner to get a scale and weigh the feed – she shouldn’t rely on a scoop or coffee can as they tell you nothing about weight, only volume.
Finally, horse owners should feed their horses the way they are meant to be fed by allowing them to graze at all times. They can give their horses all the hay they want as long as it is nutritious, free from mold, and not filled with stems. The horse’s stomach, unlike our own, produces acid all the time. Chewing produces saliva, a natural antacid, to neutralize stomach acid. If forced to go for hours without anything to graze on, a horse will suffer physical stress (because he is in pain), will often develop bad chewing habits, may colic, and will have difficulty gaining weight.
Carbohydrates from cereal grains (oats, corn, barley) provide less than half the number of calories than fat. So the best and easiest way to add more calories without more bulk is to add fat to the diet. Flaxseed meal is excellent. Not only is it high in fat, but it’s high in beneficial Omega 3 fatty acids that reduce inflammation, protect joints and hooves, keep the immune system healthy, and make the horse shine. Recommend a product that is stabilized and has added calcium to correct the naturally inverted calcium-to-phosphorus ratio found in flax. Do not suggest whole flaxseeds or those that are soaked – soaking destroys the Omega 3 fatty acids. Another good fat source is rice bran. Again, recommend a product that has added calcium since you don’t want the horse owner to feed more phosphorus than calcium. Natural Glo (ADM Alliance) is an excellent rice bran product. And advise the horse owner to be consistent. Many riders like to give a warm bran mash once a week as a treat. This is asking for an episode of colic since the bacteria in the hind gut have to adjust to a new feed. So a new feed should be added slowly – over a two-week period – and fed daily. Avoid adding soybean oil, wheat germ oil, or corn oil to the diet since they are high in Omega 6 fatty acids, which increase inflammation. If a horse has aging joints, these oils can increase his pain. Rice bran or canola oils are safe to feed since they are low in Omega 6 fatty acids. If a horse owner decides to add oil to a meal, recommend that she start with only one tablespoon per meal. She can slowly build up to half a cup per meal. Many horses do not like oily feed, so owners need to take their time. It also takes a few weeks for a horse’s system to adjust to extra fat, so patience is required.
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If possible, suggest that the horse owner add about 20% alfalfa hay to the mix. Alfalfa is a legume and will boost the overall protein quality in the diet, making body tissue production more efficient. Alfalfa is also higher in calories than most grass hays. Overall, alfalfa benefits a horse’s health through additional quality protein, added minerals, and more calories. So it’s okay to allow horses to enjoy this nutritious hay. Always rule out potential health issues before simply increasing a horse’s caloric intake. Giving more feed to a horse without discovering the root of the issue simply wastes time and money. Remember to adjust a horse’s diet slowly and consistently. By following these guidelines, you can help turn a hard keeper into a picture of equine health! Juliet M. Getty, Ph.D. has been called a “pioneer in free choice forage feeding,” and her articles and interviews often appear in national and international publications. Dr. Getty runs a consulting company, Getty Equine Nutrition, LLC (GettyEquineNutrition.com), through which she offers private consultations and designs customized feeding plans to promote horses’ health, reverse illness, and optimize performance. A former university professor and recipient of several teaching awards, she is a popular speaker, and is author of the book, Feed Your Horse Like a Horse, based on the premise that horses (and other equines) should be fed in sync with their natural instincts and physiology. Horse owners and caretakers hungry for knowledge have several resources, offered by Dr. Getty, for dependable information on feeds and feeding: a growing library of articles and recorded lectures, quizzes to test your nutrition knowledge, plus a monthly e-newsletter, Forage for Thought, all available through her website. Her teaching and advice are based on sound science and her more than 20 years as a respected consultant and practitioner in the equine nutrition field.
Veterinary Resource Guide ASSISTIVE DEVICES Animal Orthocare Arlington, VA USA Phone: (703) 474-6204 Email: animalorthocare@hotmail.com Website: www.animalorthocare.com Best Friend Mobility Myrtle Beach, SC USA Phone: (503) 575-9407 Email: sylvan@sylvancompany.com Website: www.bestfriendmobility.org
ASSOCIATIONS American Association of Rehabilitation Veterinarians - AARV USA Email: info@rehabvets.org Website: www.rehabvets.org International Association of Veterinary Homeopathy - IAVH Germany Phone: +49 76 (644) 036-3820 Email: office@iavh.org Website: www.iavh.org Veterinary Botanical Medicine Association - VBMA Acworth, GA USA Email: office@vbma.org Website: www.vbma.org Association of Veterinary Acupunturists of Canada - AVAC Beaconsfield, QC Canada Phone: (514) 697-0295 Email: office@avac.ca Website: www.avac.ca American Veterinary Chiropractic Association - AVCA Bluejacket, OK USA Phone: (918) 784-2231 Email: avcainfo@junct.com Website: www.animalchiropractic.org International Veterinary Acupuncture Society - IVAS Fort Collins, CO USA Phone: (970) 266-0666 Email: office@ivas.org Website: www.ivas.org American Academy of Veterinary Acupuncture - AAVA Glastonbury, CT USA Phone: (860) 632-9911 Email: aava@cttel.net Website: www.aava.org Alliance of Veterinarians for the Environment - AVE Nashville, TN USA Phone: (615) 353-0272 Website: www.aveweb.org
American Veterinary Medical Association - AVMA Schaumburg, IL USA Phone: (800) 248-2862 Website: www.avma.org National Animal Supplement Council - NASC Valley Center, CA USA Phone: (760) 751-3360 Website: www.nasc.cc Association of American Veterinary Medical Colleges - AAVMC Washington, DC USA Phone: (202) 371-9195 Website: www.aavmc.org American Holistic Veterinary Medical Association – AHVMA Abingdon, MD USA Phone: (410) 569-0795 Email: office@ahvma.org Website: www.ahvma.org
LASER THERAPY American Holistic Veterinary Medical Association – AHVMA Abingdon, MD USA Phone: (410) 569-0795 Email: office@ahvma.org Website: www.ahvma.org Companion Therapy Laser - LiteCure, LLC Newark, DE USA Toll Free: (352) 468-2139 Phone: (877) 627-3858 Email: info@litecure.com Website: www.companiontherapy.com Theralase Toronto, ON Canada Phone: (416) 447-8455 Email: info@theralase.com Website: www.Theralase.com
SCHOOLS & WELLNESS EDUCATION Veterinary Chiropratic Learning Center - The Healing Oasis Canada Phone: (519) 448-1306 Website: veterinarychiropractic.ca Rocky Mountain School of Animal Acupressure Carbondale, CO USA Phone: (866) 903-6462 Email: information@rmsaam.com Website: www.rmsaam.com Integrated Touch Therapy Circleville, OH USA Phone: (740) 474-6436 Email: wshaw1@bright.net Website: www.integratedtouchtherapy.com Veterinary Information Network - VIN Davis, CA USA Phone: (530) 756-4881 Email: vingram@vin.com Website: www.vin.com
Tallgrass Animal Acupressure Institute Larkspur, CO USA Phone: (303) 681-3033 Email: nancy@animalacupressure.com Website: www.animalacupressure.com Academy of Veterinary Homeopathy - AVH Leucadia, CA USA Phone: (866) 652-1590 Website: www.theavh.org Animal Spirit Network Pekin, IL USA Phone: (815) 531-2850 Email: carol@animalspiritnetwork.com Website: www.animalspiritnetwork.com Traditional Chinese Veterinary Medicine - TCVM Reddick, FL USA Phone: (352) 591-5385 Email: register@tcvm.com Website: www.tcvm.com
SUPPLEMENTS Rx Vitamins Inc. Elmsford, NY USA Toll Free: (888) 800-8068 Phone: (914) 592-2323 Website: www.rxvitamins.com Herbsmith Inc. Hartland, WI USA Phone: (262) 367-1372 Email: mail@herbsmithinc.com Website: www.herbsmithinc.com SmartPak Plymouth, MA USA Phone: (774) 773-1125 Email: customercare@smartpak.com Website: www.smartpak.com I Love Dogs, Inc. Torrance, CA USA Toll Free: (562) 256-0701 Phone: (310) 539-7400 Email: ms@ilovedogs.com Website: www.ilovedogs.com Cranimal West Vancouver, BC Canada Phone: (360) 326-6446 Email: info@cranimal.com Website: www.cranimal.com
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profile Dr. Steve Marsden
start, he was dissatisfied with this approach. “There were so many conditions I couldn’t seem to treat effectively, and many more that resisted diagnosis. For other conditions, the treatment seemed worse than the cure.”
Photo courtesy of the Canadian Veterinary Medical Association.
DVM, ND, MSOM Lac Dipl.CH CVA
Dr. Steve Marsden (right) receives the 2009 Small Animal Practitioner Award from the Canadian Veterinary Medical Association. The award was presented by Dr. Lynn Webster of Petsecure Pet Health Insurance, who sponsored the award.
By Ann Brightman ome people know from a very young age what they want to be when they grow up. Veterinarian Dr. Steve Marsden is one of them. “I was seven years old and accompanying my mother as she took our cat to the veterinarian,” he recalls. “I remember being struck by the way our veterinarian simply ran his hands over her body and was able to tell us instantly what was wrong with her. I’d been raised to respect and admire animals, so the concept of being able to tell so much about them just by touching them was stunning to me. Right then and there, I resolved that I had to be just like that vet.” As with most other veterinarians, Dr. Marsden was trained in conventional medicine. “Part of my training was to inherit an unhealthy disrespect and disregard for all things holistic as unproven and unscientific.” But right from the
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At one point, Dr. Marsden considered leaving the veterinary field, but an incident with one of his patients turned his life around. “A client came in to have her dog vaccinated. She said, ‘I believe in preventive medicine for my kids, too. I give them arsenic every morning.’ I looked at her with horror and alarm. ‘Well, it’s homeopathic,’ she replied defensively.” Intrigued but still sceptical, Dr. Marsden started researching homeopathy and was amazed to learn that vets in Europe regularly use it with their patients. “They use it for just about every condition I was frustrated by. What followed was two years of experimentation, aided tremendously by Christopher Day of the UK. It took awhile, but eventually I was successfully treating even devastating problems with homeopathy. After one particularly stunning success, when the owner assured me her dog was now perfectly normal, I became aware of a vast hole in my training.” Dr. Marsden decided to become a naturopathic physician and has never looked back. He practices in Edmonton, Alberta. Along with homeopathy, his treatment method of choice is Chinese medicine. “It has several different modalities that can all be understood according to the same medical theory, and thus applied simultaneously and synergistically to a patient,” he explains. “With any patient, you can do something physical immediately – such as acupuncture, acupressure or massage – even as you’re waiting for herbs and a diet change to kick in. You end up with a protocol that works both immediately and over the long term, while fighting a problem on multiple levels. That being said, I now understand how homeopathy, Western herbal medicine, and
chiropractic integrate with Chinese medicine, such that I can make a Chinese diagnosis, but then elect to treat it with a homeopathic remedy or Western herb. “Chinese medical theory sounds arcane but it was created by empiricists, just like medical science,” he adds. “Two disciplines based so much on observation and interpretation can’t be that far off from each other, and I’m now in a place where I can see they often are both saying the same thing, despite their apparent differences. In short, I’ve come to a place in my career where I practice only one medicine, and can select from various traditions, and even conventional medicine itself, a group of treatments that will work well in both the short and long term.” In 2009, Dr. Marsden was named Veterinarian of the Year by the Canadian Veterinary Medical Association. “At the time, I was advising Health Canada and the Veterinary Drug Directorate on new regulations on the safe use of alternative medicine in animals.” He has also written several textbooks, including the Manual of Natural Veterinary Medicine – Science and Tradition, co-authored with Dr. Susan Wynn, and lectures to veterinarians around the world about the practice of alternative medicine. He founded the Natural Path Herb Company, which
provides high quality organic herbs for veterinary use, and co-founded the Australia-based College of Integrative Veterinary Therapies, a leading distance education college for veterinarians interested in alternative therapies. “Last year, I received the Teacher of the Year award from the American Holistic Veterinary Medical Association. It came chiefly from my being asked to present at their annual conferences for the past 12 years.” It’s a busy life for one man, but Dr. Marsden has no regrets and believes passionately in what he does. “I do it strictly to effect some kind of change,” he says. “I’ve felt for myself how alternative medicine can revolutionize a veterinarian’s life and practice, bringing enormous gratification as he or she sees their efficacy skyrocket while becoming liberated from the practice of sending every second patient home on prednisone. “We are approaching a time when veterinarians can offer ‘the best of all possible worlds’, without straying from their comfort zones,” Dr. Marsden concludes. “With that in mind, I think the next couple of decades will see a revolution in veterinary practice, at least in North America. There will never have been a better time to be a doctor.”
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market trends Ten tips for building a strong relationship with clients
Today’s pet owners are more educated about animal care and view their dogs and cats as family members. Meeting their expectations includes making them part of your healthcare team. by charlotte walker esponsible pet owners are a savvy bunch these days. That was the consensus after speaking with a number of pet owners and several veterinarians about the client/veterinarian relationship. Pet owners seem to know a lot more about animal healthcare than they did decades ago, thanks to the many pet publications out there and the advent of the internet. More than ever, they want to be regarded as proactive partners in their animals’ care, rather than just being told what to do. This is perhaps even truer of those who favor the integrative approach to their animals’ care. These people have done their homework, which is why they are looking for alternative healthcare options in the first place. Here’s a checklist of things your clients might ask or expect of you and your clinic and staff. By being prepared and open to their expectations, you will build up good working relationships with clients that will endure for years – and consolidate and enhance the reputation of your practice. ONE Today’s pet owners want a clinic environment that’s comfortable, friendly and
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unintimidating, just as they would at their own doctors’ offices. Waiting rooms should be bright, spacious, clean and welcoming, furnished with comfortable chairs and decorated with calming color schemes. Depending on how much space you have, you might even consider separate waiting rooms for dogs and cats. TWO Clients will want to know that both they and their animals will be treated with kindness and respect. All staff, including front desk personnel, should be compassionate, patient and warmnatured. Good communication skills are a must. THREE You want your clients to respect you as well as trust you. Always present a professional appearance and demeanour. FOUR Listen to your client’s concerns and opinions, even if you don’t particularly agree with them. If you feel a client is wrong about something, explain it to him/her in a courteous manner. Honest and open dialogue is important, as it also builds client trust and respect. Offer clients as many options as you can for their animals’ care, and help them choose the best ones.
FIVE Courteously provide advice to clients when you feel they need it. For example, not everything they read online about a particular condition or treatment will be true. Guide them to reputable literature or websites if they want to learn more, or have printed information available.
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SIX Ensure your clients understand what you are telling them, especially when it comes to diagnoses and the available forms of treatment. This is another time when good communication skills come into play. Although many pet owners are well educated, don’t assume they understand technical or clinical terms. Explain disease processes and treatment procedures in a way that laypeople can understand, and answer any questions clients may have. SEVEN Don’t discredit any type of treatment. “It’s not about ‘leaving your Western mind at the door,’” says Dr. Narda Robinson, director of the Center for Comparative and Integrative Pain Medicine and Natural Healing at Colorado State University. “I still vaccinate and use antibiotics when there’s a need,” adds Dr. Mark Newkirk of Margate Animal Hospital and Alternative Care Center. “Traditional methods like ultrasound and steroids help with acute problems; holistic methods help when there’s a chronic condition and vitamins or amino acids are healthier long-term than steroids.”
[A] vet should be able to lay out the treatment plan. What are the expected outcomes? Exactly what does he plan to do, in what order? He should give [clients] materials to read so [they] can learn more and know what to ask. Dr. Mark Newkirk, BS, MS, VMD
EIGHT Don’t rush clients into making decisions. Unless it’s an emergency situation, give them time to think about how they want to proceed with their animals’ care. NINE If a client chooses a treatment you don’t offer, be willing and able to refer him or her to someone who does. “[You] may not want to do acupuncture or herbal care, but [you] should be able to refer [the client] to someone who does,” says Dr. Paul McCutcheon of the East York Animal Clinic in Toronto. “I don’t do dental surgery, but I refer patients to traditional surgeons.” TEN Make it clear to clients that the health of your animal patients is your top priority. Those who get the impression that money comes first will lose their trust in your clinic and start looking for another veterinarian. In summary, try to treat your clients like collaborative partners in their animals’ care. While your knowledge and experience are vital to ensuring they don’t make poor or ill-informed decisions, today’s pet owners want to feel they are taking a proactive role in how their companion animals will be cared for.
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events AHVMA Retreat
Sound for the Hounds
August 23-26, 2011 Hosted by the Council of Elders at Camp Stevens – Julian, California These retreats have been held with the goal of allowing those who give all of themselves daily to their patients and clients, a chance to decompress & de-stress, reflect, and connect with other practitioners.
September 10, 2011 Brookdale Park - Montclair, New Jersey United Against Puppy Mills is happy to announce a Puppy Mill Awareness Concert. This event will be specifically geared toward raising awareness about puppy mills and enlightening the public about how to put an end to the reprehensible puppy mill industry.
For more information: 410-569-0795 office@ahvma.org www.ahvma.org
For more information: 717-856-1316 jacki@soundforthehounds.com www.soundforthehounds.com
Annual AHVMA Meeting
AR101: Intro to Animal Reiki
August 27-30, 2011 Co-sponsored by the California Holistic Veterinary Medical Association Come learn with us at the 2011 Annual AHVMA meeting. Approved in the state of California for 105 CEUs for veterinarians and 12 for veterinary technicians, with a maximum of 22 CEUs possible for veterinarians, and 12 CEUs specifically for veterinary technicians. Please contact your own state to verify approval there. This meeting will be held at the Town and Country Resort in San Diego, California
Internationally available FREE Tele-class – Carol Schultz September 12, 2011 www.animalspiritnetwork.com Please join us for an hour and open yourself to the world of Energy Healing! We will share how to tap into this Universal Life Force from the Divine to bring about balance and harmony to the emotional, mental, spiritual, and physical aspects of ourselves and others through the modality of Reiki.
For more information: 410-569-0795 office@ahvma.org, www.ahvma.org
A Special 10th Anniversary Tribute: Honouring the Dog Heroes of September 11 The National Art Club – New York, NY September 8, 2011 @ 5:30pm American Humane Association’s Hero Dog Awards™ serve as a catalyst to further advance society’s understanding of the power of the human-animal bond. Dogs are an invaluable part of our lives; as companion animals, service and therapy animals, animal soldiers, police officers and first responders and emerging heroes. American Humane Association advocates for the American values of caring, compassion and hope. Please join us at the official kickoff for American Humane Association’s Hero Dog Awards™, featuring a special tribute to the extraordinary dogs who valiantly served in the aftermath of the tragic events of September 11, 2001. For more information: 800-227-4645 info@americanhumane.org www.americanhumane.org
You will hear about the origins of Reiki, its introduction to the Western World, and how one can use Reiki not only on humans, but also on animals and the environment. We will explain what makes Reiki different from other energetic modalities. You will also learn about the Reiki attunement ceremony, which gifts the healing symbols and clears the student’s energy centers, allowing Reiki energy to flow freely. The attunement process is a special spiritual experience...and most say it changes their life in a profound way. For more information: 815-531-2850 carol@animalspiritnetwork.com www.animalspiritnetwork.com
Animal Communication Advanced I - The Deepening
day-to-day life behind for a few days and connect deeply with all that is. This class is for those who want more knowledge, direction and inspiration to deepen their connection and experience. As you continue to open your heart to heart connection with animals and all that is, you will gain more experience, knowledge, guidance and inspiration. You will learn from the master teachers: the animals themselves. Janet will guide you, but the animals will teach you. We won’t stop there. That is just the icing on the cake. As we continue to go deeper you will learn how to open to all that is, including domestic and wild animals, plants, trees, and all of creation. This will be a time of fun and surprises. Discover your power animal. Come experience the magic. PREREQUISITES: The Basic 2-day course. You may also take this workshop if you have completed a beginning animal communication course with another teacher. For more information:
703-648-1866 janet@animalparadisecommunication.com www.animalparadisecommunication.com
Annual Conference 2011 (AVCA) American Veterinary Chiropractic Association San Antonio Hyatt Regency Hill Country Resort & Spa November 11-13, 2011 The AVCA Annual Conference is the largest gathering of AVCA Certified Doctors under one roof. Certified Doctors can earn all recertification traditional credit hours. Dynamic speakers and topics. Dogs and Horses On Site. Exhibitor and Sponsor opportunities. Your attendance makes it possible to hold these annual conferences. For more information:
918-784-2231 avcainfo@junct.com www.animalchiropratic.org
Janet Dobbs - Traveller’s Rest Equine Elders Sanctuary Spotsylvania, Virginia September 23, 24, & 25, 2011 www.animalparadisecommunication.com This class is for those who have completed the Basic 2-day Animal communication course and wish to continue to deepen their connection with animals. Leave the hustle and bustle of your
P o s t y o u r e ve n t o n l in e at: IVCJournal.com 42
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integrative research
Testing alternative treatment options for osteoarthritis by David Haworth, DVM, PhD, CEO of Morris Animal Foundation
or many years, we believed osteoarthritis (OA) was a natural consequence of the aging process, and that pharmaceutical compounds would always lead our approach to dealing with the pain and loss of function associated with it. But the scientific research currently being done is changing our minds. New findings suggest that aging isn’t the only reason animals develop this disease, and drugs aren’t the only potential way to address its consequences. Many pharmacologic approaches are currently available for OA, including nonsteroidal anti-inflammatory drugs, chondroitin sulfate proteoglycans and other analgesics. These drugs unquestionably offer relief. However, alternative and complementary treatments are being increasingly considered for OA. Patients
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may benefit from these additional treatments because they can help maintain mobility and manage pain. But the truth is, there still is so much we don’t know. “It would be ridiculous to think that a single treatment would be very effective,” says Dr. Darryl Millis from the University of Tennessee, who is conducting a study on alternative therapies for OA with funding from Morris Animal Foundation. “Rather, a multimodal approach is needed to treat several of these pathways to maximize results.” For 63 years, Morris Animal Foundation has funded research studies whose merits are evaluated by a distinguished panels of experts. Studies aren’t funded based on their ability to
create a marketed product, but are instead evaluated for their technical merits and potential to create a healthier tomorrow for animals. As a result, scientists from all facets of veterinary medicine receive funding to address the most important questions in the field. Increasingly, those questions have revolved around the applicability of integrated approaches to animal care. With support from our Foundation, Dr. Millis is evaluating three alternative modalities for treating canine OA of the hip or stifle joint: 1. Transcutaneous electrical nerve stimulation (TENS) 2. Low-level laser therapy 3. Acupuncture He estimates that 20% of adult dogs suffer from the disease, and because some don’t respond to or cannot tolerate drug therapies, complementary care could provide an attractive option. However, one thing missing from the discussion is a solid, apples-to-apples comparison of these modalities in a clinical setting. At Morris Animal Foundation, we strongly believe that all therapies used to treat diseases of companion animals should be scientifically proven to be beneficial before being widely implemented, and we’re proud to play a role in providing that proof.
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This is not to imply we know nothing about these alternative treatments. Several studies of humans with OA have demonstrated benefits for adjunctive pain management with no adverse effects.
Laser therapy helps release endorphins to relieve pain.
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• For example, TENS has been used in human medicine to treat chronic OA pain and reportedly works by the gate theory of pain relief (which suggests that nerves can only conduct so much information, and by overwhelming the nerves with electrical currents, pain signals are not transmitted).
...owners believe they see an improvement in their pets as a result of some of the treatments we are performing.
• Low-level laser therapy is postulated to provide pain relief through endorphin release and alter pain transmission to the brain. • Acupuncture has been used for pain relief associated with OA in dogs and people by activating the endogenous opioid mechanisms in the brain that alter nociceptive processing and pain perception. Dr. Millis is using objective kinetic evaluation of gait as the primary measures of outcome. Kinematic gait analysis, subjective gait evaluation by a veterinarian, and subjective evaluation of home function by owners are secondary outcome measures. From a clinical perspective, the TENS unit therapy being evaulated in Dr. Millis’ study seems to be the most effective with low level laser therapy ranking second, but the study will continue through 2012. Co-investigator Dr. Marti Drum reports that owners believe they see an improvement in their pets as a result of some of the treatments they are performing.
“Clearly there is a need to investigate [alternative] treatments for osteoarthritis for our patients,” says Dr. Millis. “Over the years, I have learned you never say never when it comes to a treatment for OA. However, we need objective information from blinded, prospective, placebocontrolled studies to determine whether the treatments are effective.” Personally, I think this is a great example of the types of studies that need to be performed in order to answer questions about any emerging, empirically derived treatment option. Unfortunately, a combination of factors, ranging from cutbacks in federal and state funding to an increasing scarcity of scientifically trained veterinarians and little incentive for corporations to test competing modalities, has made funding for this type of work very difficult to come by. Morris Animal Foundation has historically filled just such a need.
Photo: © Julie Mayer DVM CVA CVC CCRP Integrative Veterinarian
Ultimately, and despite all that we have learned, there are still so many questions that remain to be answered. Just as we look back to modalities used 200 years ago, so will future veterinarians look back at the treatments we use today and likely smile (or grimace). Only by allowing the hard work of science to proceed will we be able to move the state of veterinary medicine forward to an ever more enlightened age, and bring hope to the millions of animals suffering from diseases like OA.
TENS appears to relieve pain by overwhelming the nerves with electrical currents so that pain signals can’t be transmitted.
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Dr. David Haworth, DVM, PhD, joined Morris Animal Foundation as its president and CEO in 2011. He has a diversity of experience including corporate partnership development, veterinary research, nonprofit oversight and clinical practice. He was the director of global alliances for Pfizer Animal Health and held various other positions with the organization. Prior to that, he was an associate veterinarian at a small animal and emergency clinic in Washington State. Dr. Haworth received his bachelor of science in biology from the College of William & Mary and his doctor of veterinary medicine and doctorate of philosophy from Colorado State University. He lives in Denver with his family and two dogs.
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