Integrative veterinary care
CHINESE HERBS FOR LIVER DISEASE Page 32
Health Check Aberrant behavior in dogs – is it
tech talk Focus on acupressure: This
Integrative practice Go team! Make the most of your
Nutrition Nook Natural supportive supplements
Horse sense The master link: A properly
WHAT’ S NEW • A look at the highlights from
really a case of hypothyroidism? Find out how to recognize and properly diagnose this condition.
FALL ISSUE 2011
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staff through education, experience, respect and responsibility.
functioning TMJ is crucial to a horse’s overall health and performance.
ancient Chinese healing modality can be very effective for certain health issues.
that can make a difference to your patient’s well being.
this year’s AHVMA conference • Feline cancer study • New Cardiac Education Group integrative veterinary care
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integrative veterinary care
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contents FEATURES
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Thyroid dysfunction & aberrant behavior
Why a complete thyroid antibody profile should be part of the clinical workup for any behavioral case.
16
Integrative practice Go team!
18
Make the most of your staff through education, experience, respect and responsibility.
18
Learning curve
Continuing education in integrative medicine helps you consolidate your practice by offering more healing options to patients.
20
Chemical contaminants in dogs & cats
30
This extensive study by the Environmental Working Group shows how profoundly pets are affected by toxins.
24
Tech talk Focus on acupressure
32
This ancient Chinese healing modality can be very effective for some health issues.
26
Where is the clinical evidence demonstrating that animal supplements are safe and effective? Here’s how the supplement industry is working with regulatory agencies to maintain vigilance.
30
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integrative veterinary care
Nutrition Nook Supportive supplements & fun foods
Healthful nutrients to help boost your patients’ well being.
32
Chinese herbs for liver disease
How certain formulas can help manage liver disease in small animals, from biliary tract inflammation to chronic hepatitis.
36
Profile Dr. Susan Wynn, DVM, CVA, CVCH, AHG
A veterinarian with a special interest in educating others about the benefits of integrative medicine.
40
Green cleaning
Eco-friendly non-toxic cleaners and disinfectants that do the job while keeping patients, clients and staff safe and healthy.
42 42
Evidence-based medicine for animal supplements – part 2
TMJ the master link
A properly functioning temporo-mandibular joint is crucial to a horse’s well being and performance.
Columns & departments
7 Advisory board 8 What’ s new? 29 Veterinary resource guide
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35 Spotlight 38 Industry Innovations 45 Marketplace 46 Events
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advisory board Dr. Richard Palmquist, DVM, 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 AHVMA 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.
Bill Bookout is a founding member of the National Animal Supplement Council, serving as president and chairman of the board since 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 that, 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 as 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 of their own: Yin, Yang, Akiko and Hana.
Michelle J. Rivera, MT, VDT, is an instructor at the University of Wisconsin and The Healing Oasis Wellness Center, a post-graduate
educational institution offering state-approved programs as set forth by the Wisconsin Educational Approval Board. She is also the coowner of The Healing Oasis Veterinary Hospital, Inc. a holistic veterinary practice offering massage and rehabilitation therapy, chiropractic and Chinese and Western Herbology. Michelle has completed the Chinese Herbal Medicine program from the China Beijing International Acupuncture Training Center, and has been certified in Chinese Medicine by the Wisconsin Institute of Chinese Herbology.
Dr. Joyce Harman, DVM, MRCVS, graduated in 1984 from Virginia Maryland Regional College of Veterinary Medicine. She is certified in veterinary acupuncture and chiropractic and has completed advanced training in homeopathy and herbal medicine. Her practice in Virginia uses 100% holistic medicine to treat all types of horses. Her publications include The Horse’s Pain-Free Back and Saddle-Fit Book – the most complete source of information about English saddles – and The Western Horse’s Pain-Free Back and Saddle-Fit Book.
Dr. Steve Marsden is one of the chief educators of veterinarians worldwide in the use of complementary and alternative therapies. He regularly lectures for the International Veterinary Acupuncture Society, the American Holistic Veterinary Medical Association, and the American Veterinary Medical Association. He has been a guest speaker for veterinary courses, colleges and associations spanning five continents, and is co-founder of the College of Integrative Veterinary Therapies, an Australia-based institution offering distance learning programs in integrative medicine. He is also a director of the National College of Natural Medicine. His textbook, Manual of Natural Veterinary Medicine, has been translated into multiple languages. Dr. Marsden is extensively trained in alternative medicine, receiving one of the first Master’s of Science degrees in Oriental Medicine to be awarded in North America, as well as human medical board certifications in Chinese herbology, acupuncture and naturopathic medicine. When not teaching, he divides his time between his veterinary and naturopathic medical
practice in Edmonton, Alberta. In 2010, Dr. Marsden was named Teacher of the Year by the American Holistic Veterinary Medical Association.
Dr. Jean Dodds, DVM, received her veterinary degree with honors in 1964 from the Ontario Veterinary College, University of Toronto. In 1965, she accepted a position with the New York State Health Department in Albany and began comparative studies of animals with inherited and acquired bleeding diseases. In 1980, Dr. Dodds became Executive Director, New York State Council on Human Blood and Transfusion Services. This work continued full-time until 1986, when she moved to Southern California to establish Hemopet, the first non-profit national blood bank program for animals. From 1965 to 1986, Dr. Dodds was a member of many national and international committees on hematology, animal models of human disease, veterinary medicine, and laboratory animal science. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1994.
Dr. Christina Chambreau, DVM, is an internationally known homeopathic veterinarian, lecturer and author of the Healthy Animal’s Journal. She graduated from the University of Georgia Veterinary College in 1980 and began using homeopathy in her veterinary practice in 1983. She is a founder of the Academy Of Veterinary Homeopathy, was on the faculty of the National Center for Homeopathy Summer School for ten years and has been the holistic modality adjunct faculty liaison for the Maryland Veterinary Technician Program. Currently, Dr. Chambreau teaches classes in Introductory, Intermediate and Advanced Homeopathy for Animals of all Species across the country. She lectures on a wide array of topics including integrating holistic options into veterinary practices and selecting the best approaches to heal animals that will also sustain the planet. Her venues have included the World Small Animal Veterinary Conference, American Veterinary Medical Association, Atlantic Coast Veterinary Conference, North American Veterinary Conference, and the American Holistic Veterinary Medical Association. She is co-author of the Homeopathic Repertory: A Tutorial. integrative veterinary care
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what’ s new A stellar event
Dr. Barbara Fougere, Dr. Richard Palmquist, and Dana Cox, IVC Editor-in-Chief
Hundreds of veterinarians, vet techs and other animal professionals converged on San Diego from August 27 to 30 to attend the annual AHVMA conference at the Town and Country Resort Hotel. The theme was “Holistic Medicine – Riding the Wave of the Future” and the keynote address was given by veterinarian Dr. Gregory K. Ogilvie, who spoke on how holistic and integrative medicine are contributing to better health and healing in animals. As always, the event featured dozens of seminars and lectures on everything from acupuncture, nutrition and and chiropractic to TCM diagnostics, evidence-based veterinary homeopathy, the use of adaptogens, and much more. Speakers included veterinarians Dr. Richard Palmquist, Dr. Richard Pitcairn, Dr. Steve Marsden and many others. The conference also included an exhibitor hall with nearly 100 booths, as well as a banquet and silent auction. New additions to this year’s conference were the non-animal labs where veterinarian Dr. Twila Floyd offered a presentation on muscle testing and Dr. Marsden one on tongue and pulse diagnosis. Delegates from student chapters of the AHVMA were also able to attend the event, thanks to Bud Groth, whose company PetzLife donates $10,000 each year for this purpose. The AHVMA also offers scholarships to veterinary students interested in holistic modalities. Candidates submit essays to qualify for these awards, which are partially funded by proceeds from the silent auction. Set in a spectacular setting with ready access to San Diego’s beaches, a 32-acre landscaped garden, golf course, restaurant and spa services, this year’s conference combined a stimulating learning experience with plenty of fun and relaxation.
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integrative veterinary care
Their hearts are in it A newly formed group of board certified veterinary cardiologists has united to develop a library of cardiology resources and guidelines for veterinarians in general practice. The non-profit Cardiac Education Group (CEG) is committed to providing educational resources and information on the diagnosis and treatment of heart disease in dogs and cats. It’s comprised of six independent veterinary cardiologists from both academia and private practice: Dr. John Bonagura, Dr. Whit Church, Dr. Sonya Gordon, Dr. Rebecca Stepien, Dr. Michael Luethy and Dr. Alan Spier. As part of its objective, the CEG has created a website featuring interactive learning tools that allow users to see, hear and review diagnostic test results as they relate to clinical cases. Audio and video resources, including heart sounds and an interactive X-ray viewer, provide hands-on learning opportunities, and downloadable guidelines are available on how to treat dogs affected with heart disease. The site also provides veterinarians with the opportunity to earn CE credits through RACEapproved coursework. The CEG is currently funded through non-directed educational grants from Boehringer Ingelheim Vetmedica, Inc., and IDEXX Laboratories, Inc. cardiaceducationgroup.org
Too much fructose? Dogs like sweets as much as humans do, but sugar and artificial sweeteners like Aspartame can be harmful. It may be time to add fructose to that list, at least in large quantities. Also called fruit sugar, fructose occurs naturally in fruit but is mostly found in the refined sugars and high-fructose corn syrup used to make breakfast cereals, pastries, soda and fruit drinks, and other sweet foods. Too much fructose in the diet may be contributing to liver and heart disease in humans, reports the September 2011 issue of the Harvard Heart Letter. Liver cells are the only ones in the body that metabolize fructose. Fat is a key by-product of the breakdown of fructose. Give the liver enough fructose, and tiny fat droplets begin to accumulate in the organ. This build-up is called non-alcoholic fatty liver disease and over the long term may cause serious liver damage. If too much fructose is bad for us, it’s probably not good for dogs either. health.harvard.edu
More than skin deep “I recommend Cranimals Original for patients with high pH levels, post urinary tract infections, and to decrease the incidence of urinary stones. I am also a fan of the antioxidant properties and the dental benefits. Overall, this product has made many of our clients very happy and I am pleased with the results!”
The LSU School of Veterinary Medicine (LSU SVM) recently hosted a veterinary dermatology workshop entitled “Dermatology: Pruritus Plus”. The seminar, which was held on November 6, discussed pruritus in dogs and cats, and included updates on some of the newest information in the world of small animal veterinary dermatology. Food allergies, flea allergy, the atopic state and glucocorticoids were also covered during the workshop. Participating instructors included Dr. Sandra R. Merchant, veterinarian and professor of veterinary dermatology at LSU SVM, Drs. Kristen Fulham and Stephen Lemarie, dermatologists with Southeast Veterinary Specialists, and others.
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Feline cancer study A recent large-scale study on intestinal cancer in cats could ultimately benefit humans. “We are looking for patterns of cancer development in animals, so we can find common risk factors,” says Kim Selting, associate teaching professor of oncology at the MU College of Veterinary Medicine. The researchers examined 1,129 cases covering 47 years of intestinal cancer in cats. They found that most were lymphoma, and most were in the small intestines. The researchers also determined that the Siamese breed, particularly males seven years of age and older, had an increased risk of developing intestinal cancer. By noting patterns of cancer development, veterinarians and doctors may become aware of environmental factors that could be causing tumor progression in different species, including people. http://munews.missouri.edu
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A pioneer passes
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On October 22, Rolf C. Hagen, founder and chairman of Rolf C. Hagen Inc., one of the world’s largest family-owned manufacturers and distributors of pet care products, passed away at his home in Montreal, Canada. Hagen was born in Germany in 1932, and came to Canada to start his business in 1955.
Sometimes, rehab can only do so much, and dogs need mobility aids to regain their quality of life. Best Friend Mobility allows veterinarians to offer clients with disabled dogs a realistic and affordable alternative to euthanasia. The company offers a range of quality orthopedic surgeon-designed wheelchairs for all types and sizes of dog, from 15 to 175 pounds. They’re made with lightweight but sturdy aluminum frames and stainless steel hardware.
During his lifetime, Hagen was honoured with many awards in the pet products industry. In 1999, he was inducted into the American Pet Products Association Hall of Fame. In 2004, he was given the Lifetime Achievement Award from the Pet Industry Distributors Association in recognition for innovative design of pet products and for his generous support of organizations and individuals dedicated to improving the lives of pets and people. He had a deep love for humanity and animals, and gave away much of what he amassed to individuals, schools, hospitals, churches and charitable organizations.
“Our products can improve many things depending on the pet’s malady, like exercise, well being and lifespan,” says Sylvan Newby. The wheelchairs are designed for dogs with normal front leg strength, and can be used for conditions such as hip dysplasia, hind end paralysis, arthritis, spinal diseases or injuries, hind leg weakness, neurological impairments or for rehabilitation and recovery after surgery. The company also offers a couple of unique accessories to complement the wheelchairs. The Performance Sports Harness helps disabled dogs stay active, offers improved range of motion, and can be used for swimming and running, while the Replacement Deluxe Comfort Harness is especially designed for dogs with sensitive skin who spend a lot of time in their wheelchairs.
The Rolf C. Hagen company is now managed by his three sons, Mark, Tom and Rolf Jr.
Close to a breakthrough? Across the world, research is underway at more than a dozen institutions to use cutting-edge science in the development of a nonsurgical sterilant for dogs and cats — an innovative experiment in solving the problem of animal overpopulation and a chance for scientists to cash in on a $25 million prize. In 2008, Found Animals Foundation announced the launch of the Michelson Prize & Grants. Since then, the organization has received more than 150 letters of intent and has invited over 50 investigators to submit full grant proposals. To review proposals for funding, regular meetings are scheduled with the Found Animals’ Scientific Advisory Board, made up of top scientists from a variety of fields including reproductive biology, immunology, biotechnology, drug development and animal welfare. To date, 15 of those grants have been approved, totaling more than $6 million in research funding. Research is currently underway from Australia and Argentina to California and Virginia. “We are thrilled with the high level of interest we’ve seen from qualified applicants to date,” says Aimee Gilbreath, Executive Director of Found Animals. “What’s even more exciting is that we’re seeing proposals based on new technologies such as nanocontainers and gene silencing, meaning that researchers are applying cutting edge science to this problem.” michelson.foundanimals.org
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integrative veterinary care
Best Friend Mobility makes it easy for veterinarians to order wheelchairs for their patients. “You only need to record the weight of the pet to determine which of six sizes would be appropriate,” says Sylvan. “Each chair is fully adjustable/customizable in every dimension so that it should fit 99% of dogs/pets in that weight class.” The company also offers drop shipping and small in-clinic displays. bestfriendmobility.org
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Thyroid dysfunction
Diagram courtesy of Jean Dodds, DVM
& aberrant behavior
by W. Jean Dodds, DVM
he last 15 years has seen thyroid dysfunction and disease increase at such an alarming rate that it has reached near epidemic proportions. This has been accompanied by a parallel increase in the incidence of heritable autoimmune thyroiditis in purebreds and the newer hybrid dog breeds. Hypothyroidism is the most common endocrine disorder found in canines, and up to 90% of cases result from autoimmune (lymphocytic) thyroiditis. Many veterinarians are unaware of how to properly test and diagnose their patients in order to identify the early stages of this disease process, prior to the development of classical clinical signs. Since the thyroid gland regulates metabolism of all bodily cellular functions, reduced thyroid function can produce a wide range of clinical manifestations, which mimic those of other conditions. Most pet owners and even many dog breeders do not know how to spot the clinical or behavioral signs of early canine thyroid disease. This confusion sets up a “perfect storm� of misunderstanding, misdiagnosis and mistreatment of canine thyroid disorders.
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integrative veterinary care
Diagram above shows location of parathyroid glands.
The heritable nature of thyroiditis poses significant implications for breeding stock, so accurate diagnosis is important for genetic counselling and provides the clinical options for prompt intervention and case management.
Behavioral issues The principal reason for pet euthanasia stems not from disease, but undesirable behavior. While abnormal behavior can have a variety of medical causes, it also can reflect underlying problems of a psychological nature. An association between behavioral and psychological changes and thyroid dysfunction has been recognized in humans since the 19th century. In a recent study, 66% of children with attention deficit-hyperactivity disorder (ADHD) were found to be hypothyroid, and supplementing with thyroxine was largely curative. Furthermore, an association has recently been established between aberrant behavior and thyroid dysfunction in the dog, and has also been noticed in cats with hyperthyroidism. Typical clinical signs include unprovoked aggression towards other animals
Many of these dogs belong to a certain group of breeds or families susceptible to a variety of immune problems and allergies – e.g. golden retriever, Akita, Rottweiler, Doberman pinscher, English springer spaniel, Shetland sheepdog, and German shepherd. and/or people, sudden onset of seizure disorder in adulthood, disorientation, moodiness, erratic temperament, periods of hyperactivity, hypoattentiveness, depression, fearfulness and phobias, anxiety, submissiveness, passivity, compulsiveness and irritability. After episodes, most animals appear to come out of a trance-like state and are unaware of their bizarre behavior.
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The mechanism whereby diminished thyroid function affects behavior is unclear. Hypothyroid patients have reduced cortisol clearance, as well as suppressed TSH output and lowered production of thyroid hormones. Constantly elevated levels of circulating cortisol mimic the condition of an animal in a constant state of stress. In people, and seemingly in dogs, mental function is impaired and the animal is likely to respond to stress in a stereotypical rather than reasoned fashion.
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Investigators in recent years have noted the sudden onset of behavioral changes in dogs around the time of puberty or as young adults. Many of these dogs belong to a certain group of breeds or families susceptible to a variety of immune problems and allergies — e.g. golden retriever, Akita, Rottweiler, Doberman pinscher, English springer spaniel, Shetland sheepdog, and German shepherd. The clinical signs in these animals, before they show the sudden onset of behavioral aggression, can include minor problems such as inattentiveness, fearfulness, seasonal allergies, skin and coat disorders and intense itching. These may be early subtle signs of thyroid dysfunction, with no other typical signs of thyroid disease being manifested. The typical history starts out with a well-mannered and sweetnatured puppy or young adult dog. The animal is outgoing, attends training classes for obedience, working or dog show events, and came from a reputable breeder whose kennel has no prior history of producing animals with behavioral problems. At the onset of puberty or thereafter, however, sudden changes in personality are observed. Typical signs can be incessant whining, nervousness, schizoid behavior, fear in the presence of strangers, hyperventilating and undue integrative veterinary care
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Two case studies 1
Casey, a 3.5-year-old intact male golden retriever, suddenly began showing signs of abnormal behavior. He became vocal, reactive to unknown dogs, easily excited, agitated and restless. Over the period of a year, Casey became progressively more aggressive, going so far as to bite household members several times. Casey’s veterinarian performed blood tests that confirmed he suffered from autoimmune thyroiditis. He was placed on thyroxine at a dose of 0.35 mg administered once daily. However, this small dose was clearly inadequate for his size. In addition, the medication was only being administered once daily, when its half-life is 12 to 16 hours. When Casey showed no signs of improvement after two months on therapy, the veterinarian stopped the thyroxine for two months and retested him. During that time, Casey’s aggressive behavior escalated. Upon retest a couple of months later, his blood work displayed the classical signs for hypothyroidism. Fortunately, Casey was placed on thyroxine once more – now at a correct dose and administered twice daily at about 12-hour intervals. Casey showed almost immediate improvement, and after one year, all his blood hormone levels normalized. He was also neutered, so as not to pass along the inherited condition to any offspring.
2
Terry, a 4.5-year-old intact male bearded collie, experienced a seizure at three years of age. He recovered quickly and nothing abnormal was found on physical examination or routine blood and urine tests. Terry’s behavior, however, started to become noticeably more unpredictable. He would curl his lip, growl threateningly and bark when he didn’t want to do as told. This behavior could be triggered during grooming and bathing or when he refused to come when called. He was excitable and hyperactive, but had never bitten anyone. He otherwise appeared healthy, and had a very good diet and plenty of exercise. He had tried to chase and attack sheep at herding trials, but was very friendly with cats, people and small children. Terry’s guardians took him back to the vet clinic and requested a full thyroid profile. The thyroid tests indicated a low level of three thyroid hormones, although there was no elevation of thyroid autoantibodies. Terry was placed on the appropriate dose of thyroxine for his weight, to be given BID. After just one week of therapy, a miracle seemed to happen. His behavior steadily improved, he was much calmer and no longer anxious, and his aggressive tendencies had diminished. A retesting of his thyroid profile after eight weeks showed an improvement in thyroid levels to match the resolution of his behavioral issues.
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sweating, disorientation and inattentiveness. This can progress to sudden unprovoked aggression in unfamiliar situations with animals, people and especially children. Another group of dogs shows sudden onset seizures or seizure-like disorders that can occur at any time from puberty to mid-life. These dogs appear perfectly healthy, have normal hair coats and energy, but will suddenly seizure for no apparent reason. The seizures are often spaced several weeks to months apart, may coincide with the full moon, and can appear in brief clusters. In some cases, the animals become aggressive and attack those around them shortly before or after having one of the seizures. In dogs with aberrant aggression, a large collaborative study between our group and Dr. Dodman and colleagues at Tufts University School of Veterinary Medicine has shown a favorable response to thyroid replacement therapy within the first week of treatment, whereas it took about three weeks to correct their metabolic deficit. A dramatic reversal of behavior with a resumption of previous problems has occurred in some cases if only a single dose is missed. A similar pattern of aggression responsive to thyroid replacement has been reported in a horse. Our ongoing study now includes over 2,500 cases of dogs presented to veterinary clinics for aberrant behavior. The first 499 cases have been analyzed independently by a neural network correlative statistical program. Results showed a significant relationship between thyroid dysfunction and seizure disorder, and thyroid dysfunction and dog-to-human aggression. Collectively, these findings confirm the importance of including a complete thyroid antibody profile as part of the laboratory and clinical workup of any behavioral case. Dr. Jean Dodds, DVM, received her veterinary degree with honors in 1964 from the Ontario Veterinary College, University of Toronto. In 1965, she accepted a position with the New York State Health Department in Albany and began comparative studies of animals with inherited and acquired bleeding diseases. In 1980, Dr. Dodds became Executive Director, New York State Council on Human Blood and Transfusion Services. This work continued full-time until 1986, when she moved to Southern California to establish Hemopet, the first non-profit national blood bank program for animals. From 1965 to 1986, Dr. Dodds was a member of many national and international committees on hematology, animal models of human disease, veterinary medicine, and laboratory animal science. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1994.
References
Aronson LP, Dodds WJ. The effect of hypothyroid function on canine behavior. Proc Int Vet Beh Med 2005. Beaver BV, Haug LI. Canine behaviors associated with hypothyroidism. J Am An Hosp Assoc 39: 431-434, 2003. Denicoff KD, Joffe RT, Lakschmanan MC, Robbins J, Rubinow DR. Neuropsychiatric manifestations of altered thyroid state. Am J Psych 147:94-99, 1990. Dodds WJ. Estimating disease prevalence with health surveys and genetic screening. Adv Vet Sci Comp Med, 39: 29-96, 1995. Dodds WJ. Behavioral changes associated with thyroid dysfunction in dogs. Proc Am Hol Vet Med Assoc, 80-82, 1999. Dodds WJ, Laverdure DR. The Canine Thyroid Epidemic, DogWise Publishing, Wenatchee, WA, 2011, pp. 175. Dodds WJ. How to test, interpret thyroid function. Vet Pract News, April 2011, p. 52. Dodman NH, Mertens PA, Aronson, LP. Aggression in two hypothyroid dogs, behavior case of the month. J Am Vet Med Assoc 207: 1168-1171, 1995. Hauser P, Zametkin AJ, Martinez, P, et al. Attention deficit-hyperactivity disorder in people with generalized resistance to thyroid hormone. N Eng J Med 328:997-1001, 1993. Uchida Y, Dodman NH, DeNapoli J, Aronson LP. Characterization and treatment of 20 canine dominance aggression cases. J Vet Med Sci 59:397-399. 1997.
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integrative practice
Go team!
Make the most of your staff through education, experience, respect and responsibility by Michelle J. Rivera, MT, VDT
F
or years, veterinarians have been told that the success of their practices relied on doing the jobs they were trained to do, and allowing their staff members do the jobs they were trained to do. But how many actually allow this to happen? Many veterinarians will say they were not trained to manage employees, do payroll, watch over inventory, or be the “judge, jury and trial” for unhappy clients, yet many seem to attempt to take it all on. This mentality can ostracize staff and backfire on the practice. How do we avoid this issue while ensuring we practice the best medicine and patient care possible? The people we have working with us (not for us) should be trained in what they bring to the table. They should be the best at what they do, treated with respect, and given as much responsibility as they can successfully handle. After all, we are in the practice for the same reason – to provide the best patient care for the animals entrusted to our care.
Does your staff know what you offer? In my practice, I allow staff members to have their own animals treated with the holistic modalities we offer, when and as they apply, so they may gain a better understanding of what we provide, how we treat patients, and what contraindications may arise. If your staff members understand everything your practice offers, they will be able to suggest treatment options to clients that the latter might not even know you provide. For example, say a client who knows you practice acupuncture calls to ask if it could help with her dog’s back issues. After asking numerous questions, the informed receptionist or technician who takes the call
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If your staff members understand everything your practice offers, they will be able to suggest treatment options to clients that the latter might not even know you provide. feels that the client’s first visit should be with the doctor who offers spinal manipulation (“animal chiropractic”) as well as with the doctor who does acupuncture. Because the staff member has had personal experience using these therapies with her own dog, she knows that chiropractic and acupuncture complement each other. This means the client finds out about an additional treatment option your practice provides, and her dog gets even better care. This intelligent scenario wouldn’t have happened if your staff wasn’t trained to fully understand what your practice is offering.
Make them part of the care process It is imperative that we treat our certified/licensed technicians as the professionals they are, and allow them to utilize their training in the practice. In many cases, this can enhance what the veterinarian is doing. In the above example, for instance, the client’s dog would first see the doctors offering acupuncture or spinal manipulation. Thereafter, a trained certified/licensed technician could do follow-up treatments for the dog, such as massage and rehabilitation. This team approach allows for better patient care. It not only spreads the burden between the doctor and technician, but it’s also economically beneficial to the practice since you are now getting two visits per patient per treatment. Many times, the cost of seeing the doctor is a deterrent
to clients, but seeing the technician may be more affordable. And in the end, the patient benefits from the expertise of both professionals. In my practice, the doctor trained in spinal manipulation sees the animal for the first time, works up a protocol for the client and treats the pet. The next two visits are with the technician who is certified in massage and rehabilitation. This allows for the animal to be cared for properly, the client is not overwhelmed with a financial burden, and the practice is still getting monetary benefits. There are additional benefits to this system. The client now has two people responsible for the care of her pet. This gives her added comfort, because she knows if the doctor is unavailable to discuss or answer any questions, another trained professional familiar with the animal’s condition can do so. The doctor is not so overburdened with patients and can share treatment protocols or give direct procedures to someone he/she can trust and who is familiar with the cases.
Get them involved with intake Another way to make optimum use of trained staff is to allow them to do a complete intake before the client visits with the doctor. As you know, a thorough patient history is invaluable to successful treatment. How many times does a client tell the staff things they forget to tell the doctor? In our practice, we call this the “oh, by the way” syndrome. Many times, this piece of information is the main key to the patient’s condition. We had one client bring in a dog with allergies and occasional “seizures”. After a complete physical exam by the doctor and an in-depth discussion of nutrition,
It is imperative that we treat our certified/licensed technicians as the professionals they are, and allow them to utilize their training in the practice. vaccine protocols, and a review of diagnostics from another practice, the doctor excused himself and left the exam room to gather other diagnostic materials. During his absence, the client told me how frustrated she was about her dog’s condition and said, “Oh by the way, did I mention that he had a brain tumor removed years ago?” Could this have anything to do with the perceived seizures? This is the type of thing that could have been overlooked if I had not been in the exam room engaging the client in a comfortable chat. Various clients have told my staff during intake about abuse to their pets, past treatments and surgeries, possible drug interactions or recreational drug ingestion, all of which they never mentioned to the doctor during their visits! Trained staff members are our most important resource. By keeping them in the loop with education, compassion and a thorough understanding of the holistic modalities we offer, we can more readily reach our goal of optimum patient care. Michelle J. Rivera, MT, VDT, is an instructor at the University of Wisconsin and The Healing Oasis Wellness Center, a post-graduate educational institution offering state-approved programs as set forth by the Wisconsin Educational Approval Board. She is also the co-owner of The Healing Oasis Veterinary Hospital, Inc. a holistic veterinary practice offering massage and rehabilitation therapy, chiropractic and Chinese and Western Herbology. Michelle has completed the Chinese Herbal Medicine program from the China Beijing International Acupuncture Training Center, and has been certified in Chinese Medicine by the Wisconsin Institute of Chinese Herbology.
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Learning
Curve
Continuing education in integrative medicine helps you consolidate your practice by offering more healing options to patients.
Y
by Dr. Barbara Fougere, BSc, BVMS, BHSc, MODT, MHSc, CVA, CVBM, CVCP, CMAVA
ou leave vet school with a degree, a brain full of detail, and lots of enthusiasm. Then, somewhere down the line, it hits you — there is still so much you don’t know, and so many frustrating cases you wish you could do more for. Learning integrative medicine through continuing education (CE) will make a huge difference to your patients, and give you the added benefit of growing your business in a very satisfying way.
RACE and RAIVE Integrative medicine is a growing field, and with increasing public demand for “alternative or holistic” medicine, it behoves the profession to support veterinarians in becoming educated in these services so they can supply them to patients. However, over the last couple of years, the Registry of Approved Continuing Education (RACE) has put restrictions on what is considered approved CE, which means approved courses for anything in the integrative veterinary field are becoming harder to come by. The Registry of Alternative and Integrative Veterinary Medical Education (RAIVE, raive.org), has begun providing a service as an alternative clearing house to RACE for CE approval. This organizations consists of a group of well qualified practitioners and educators who asses the merits of a course. Their process follows the same guidelines as RACE, but with a more open vision of what constitutes veterinary medicine. RAIVE also requires that a reviewer be certified or have extra training and experience in any modality they review. Several state boards are now accepting RAIVE accredited courses for CE credits.
What you should know • With the demands of a busy practice and limited time for attending conferences, it can be a challenge to get away for courses. You want to make the most of your CE time. For integrative veterinary medicine, a
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number of state boards approve tracks in conferences/ congresses for CE. For example, the Californian Veterinary Medical Association approves Californian Holistic Veterinary Medical Association tracks for CE. Check whether tracks or seminars have been approved, and if so, whether your state boards accept these points. • When evaluating a course in integrative medicine, you should know something about the credentials of the teacher or teachers, the school or organization hosting the program, and what you will learn. There are several schools that offer veterinary courses in integrative medicine, but that do not have veterinarians on their faculty, so take care. • You might also look at the cost per hour of the education; most times, online education is significantly less expensive than attending face-to-face, especially when you consider flights, accommodation and meals. • Most importantly, look at the learning outcomes and make sure they are consistent with what you want to know or do. A well-structured course will take you through a process, engage you to learn, and make the material something you can incorporate into your daily practice. • CE has been transformed by the internet and related technology. The global trend is towards the flexibility and ease of online learning. One of the advantages of this type of learning is that instead of filling your brain with too much information during long hours at a seminar or conference, you can study anytime and anywhere, and at your own pace. Breaking up your learning into small chunks makes retention easier and the experience more enjoyable. Online learning also means you get to meet people from all over the world, gain access to great teachers, and most importantly, learn a new skill or approach that can transform your practice.
Many quality organizations offer CE in integrative medicine. Here are just a few: •
International Veterinary Acupuncture Society (ivas.org) — online and face-to -face courses
• Veterinary Botanical Medicine Association (vbma.org) — webinars and online courses • American Holistic Veterinary Medical Association (ahvma.org) — an outstanding conference each year • Academy of Veterinary Homeopathy (theahv.org) • American Veterinary Chiropractic Association (avca.org) — provides certification and CE in chiropractic • The Chi Institute (tcvm.com) — online and face to face courses • The Healing Oasis (thehealingoasis.com) — several certification courses and seminars • College of Integrative Veterinary Therapies (civtedu.org) — certification as well as short courses online and face to face • Veterinary Information Network (vin.com) — online short courses in integrative medicine a couple of times a year • Tallgrass Animal Acupressure animalacupressure.com
Institute,
Dr. Barbara Fougere graduated in 1986, so she knows a thing or two about continuing education and the emerging trends in online education. She has been named the American Holistic Veterinary Medical Association Educator for 2011. Dr. Fougere is the principle and one of the founders of the College of Integrative Veterinary Therapies. She has continued studying over the last 26 years, and has three Bachelor degrees, two Masters degrees, three post Graduate Diplomas, several Certifications and numerous other courses under her belt.
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rewind
Some information is worth a second look. The“Rewind�column highlights relevant articles.
by Olga Naidenko, Rebecca Sutton, Jane Houlihan, April 2008
I
n recognition of the unique roles that pets play in our lives, the Environmental Working Group (EWG) undertook a study to investigate the extent of exposures pets face to contaminants in our homes and outdoor environments. In a novel study representing the broadest bio-monitoring investigation yet conducted in pets, what we found was surprising. Dogs and cats were contaminated with 48 of 70 industrial chemicals tested, including 43 chemicals at levels higher than those typically found in people, according to our study of plastics and food packaging chemicals, heavy metals, fire
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retardants, and stain-proofing chemicals in pooled samples of blood and urine from 20 dogs and 37 cats collected at a Virginia veterinary clinic. Average levels of many chemicals were substantially higher in pets than is typical for people, with 2.4 times higher levels of stainand grease-proof coatings (perfluorochemicals) in dogs, 23 times more fire retardants (PBDEs) in cats, and more than five times the amounts of mercury, compared to average levels in people found in national studies conducted by the Centers for Disease Control and Prevention (CDC) and EWG.
This study is the most comprehensive investigation of the chemical body burden of companion animals conducted to date, with 23 chemicals reported in pets for the first time. The results reinforce findings from prior studies showing that pets’ unique behaviors may place them at risk for elevated exposures and health risks from chemicals pollutants in the home and outdoors, in air, water, food, soil, and consumer products for people and pets.
Look for the Seal of Quality
For nearly all the chemicals included in the current study, health risks in pets have not been studied. But the chemicals are linked to serious health effects in other studies from laboratory data or human populations: For dogs, blood and urine samples were contaminated with 35 chemicals altogether, including 11 carcinogens, 31 chemicals toxic to the reproductive system, and 24 neurotoxins. Cat samples contained 46 chemicals altogether, including nine carcinogens, 40 chemicals toxic to the reproductive system, 34 neurotoxins, and 15 chemicals toxic to the endocrine system. Endocrine (hormone) system toxins raise particular concerns for cats, since they include the thyroid toxins and fire retardants called PBDEs. As cats meticulously groom themselves, they lick off accumulated dust that studies show can be contaminated with the neurotoxic fire retardants PBDEs and reproductive toxins called phthalates that were found in the cats we tested (Bornehag 2004, Stapleton 2005, Wormuth 2006). A dog eating scraps from the floor may also swallow dirt and dust tracked in from the outdoors and contaminated with heavy metals and pesticides (Colt 2004, vom Lindern 2003). A flea collar can spew droplets of insecticide that can be lethal to cats (Linnett 2008). Dogs and cats often eat food processing and packaging chemicals that
Not all supplements are alike... Companies displaying the NASC Seal of Quality are independently audited and their Quality System Requirements (QSR) have been verified. Make sure the animal supplements you select display the NASC Seal of Quality
For more information visit www.NASC.cc integrative veterinary care
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contaminate their food, day after day and year after year, resulting in cumulative exposures with unknown health risks (FDA CVM 2008b). Chew toys might contain plastic softeners, foam beds might be infused or coated with fire retardants and stain-proofing chemicals linked to cancer and birth defects, and plastic water bowls might leach hormone disruptors. EWG’s review of scientific literature identified studies that demonstrate a plethora of links between chemical exposures and health risks for pets. The perversely named “dancing cat fever” describes the results of neurological damage in cats with acute mercury poisoning (Koya 1964), while “Teflon toxicosis” has been the cause of death for hundreds of pet birds nationwide whose lungs filled with blood after they breathed in toxic fumes from overheated, non-stick pans (EWG 2003a, NRC 1991). Horses have died after chewing on wooden fences infused with the same arsenic-based pesticide found in the decks and playsets of 70 million homes nationwide (Casteel 2001, Edlich 2005, Khan 2006). Studies show lung cancer (mesothelioma) in dogs exposed to asbestos fibers at home (Glickman 1983), bladder cancer in dogs living near industrial areas (Hayes 1981) or exposed to topical flea and tick pesticides (Glickman 2004) or lawn and garden weed killers and insecticides (Glickman 2004), lead toxicosis in dogs and cats in homes with chipping lead-based house paint (Knight 2003, Marino 1990, Miller 1992), malignant lymphomas in dogs whose owners use the lawn pesticide 2,4-D (Hayes 1991), and mouth cancer (oral squamous cell carcinoma) in cats exposed to flea repellants (Bertone 2003). Major gaps in our system of public health protections allow most industrial chemicals on the market with no mandatory safety testing. Chemical companies do not have to prove products are safe before they are sold, or understand how much of their chemicals end up in people let alone pets. There are few standards that limit chemical contamination in pet food, pet toys and other products for our companion animals (FDA CVM 2008a,b). For pets as for people, the result is a body burden of complex mixtures of industrial chemicals never tested for safety. Health problems in pets span high rates of cancer in dogs (Paoloni 2008, Paoloni 2007, Waters 2006) and skyrocketing incidence of hyperthyroidism in cats (Edinboro 2004, Peterson 2007). Genetic changes can’t explain the increases in certain health problems among pets. Scientists believe that chemical exposures play a role (e.g., National Research Council 1991, Landrigan 2001).
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Detailed findings Dogs: The 20 dogs tested included five mutts or mixes and 15 dogs of seven different breeds, including a pug, great Dane, dachshund, great Pyrenees, and others. In the group, 12 dogs were female and eight male; ages ranged between six months and 12 years (average age 6.3 years). The laboratory analyzed composite blood and urine samples collected from the animals. The dogs’ blood and urine were contaminated with 35 chemicals altogether. These included seven chemicals (20%) with average levels at least five times higher than typical levels in people, and another seven chemicals with average levels up to five times amounts found in people. Relative to people, dogs showed high levels of stain- and grease-proof chemicals (perfluorochemicals in the Teflon family), plastics chemicals called phthalates, and fire retardants called PBDEs: Teflon chemicals -- Highest levels. Tests showed six of 13 perfluorochemicals present in dog blood, with five at levels higher than those in more than 80% of people tested nationally, including two at levels more than five times higher than average amounts in people. Dogs were polluted with two chemicals in the Teflon family of stain- and grease-proof coatings (perfluorochemicals) at higher levels than any detected in people in national studies by EWG and CDC (perfluorobutanoic acid (PFBA) and perfluorohexanoic sulfonate (PFHxS)). Only PFOA (perfluorooctanoic acid), known as the “Teflon chemical” because it has been used to make Teflon and other non-stick pans, was detected at levels in the range of what is typically found in people (45th percentile) as opposed to far in excess. For dogs likely sources of exposure include food contaminated with PFCs leaching from dog food bag coatings, as well as house dust, and stain-proofed furniture, dog beds, and carpets. Toxins in plastic toys and medicines. Dogs were contaminated with breakdown products of four plastic softeners (phthalates) at average levels higher than those in more than 80% of Americans tested nationally, at levels ranging between 1.1 and 4.5 times the average concentrations in people. These included breakdown products of DEHP, DBP, and DBzP, which
are used in veterinary medicines, plastic containers and toys, shampoos, and a huge range of other consumer products. Six of seven phthalate breakdown products were found in dogs altogether. These chemicals pose risks for reproductive damage, birth defects, and cancer. Fire retardants in bedding, house dust, and food. Dog samples contained 19 different fire retardant chemicals known as PBDEs, or polybrominated diphenyl ethers, of 46 chemicals tested. Compared to people, levels were very elevated for highly brominated forms of these chemicals, with five compounds that are octaBDEs, nonaBDEs, and decaBDE found at levels higher than between 97% and 99% of people tested nationally, ranging up to 17 times the average amounts in people. PBDEs disrupt the normal functioning of thyroid hormones and pose risks to the brain during development. For dogs, potential sources of exposure include foam furniture and bedding manufactured before 2005, contaminated air and house dust, and food contaminated with PBDEs that pollute the environment, especially seafood. Cats: Veterinary technicians collected blood and urine samples from 37 cats, which included 13 female and 21 male cats (gender not reported for three cats). The group included cats with ages from nine months to 17 years. The laboratory analyzed blood and urine samples composited from all the animals. The cats’ blood and urine was contaminated with 46 chemicals altogether. These included 25 chemicals (54%) with average levels at least five times higher than typical levels in people, and another 18 chemicals (39%) with average levels up to five times amounts found in people. Relative to people, cats showed very high levels of neurotoxic fire retardants called PBDEs and methylmercury, a pollutant from coal power plants and a common seafood contaminant. Teflon chemicals. Cats were polluted with eight of 13 chemicals tested in the Teflon family of stain and grease-proof coatings (perfluorochemicals, or PFCs), including six at very high levels, above amounts found in between 89% and 99% percent of people tested in national studies, and four found at levels more than five times average amounts in people. The Scotchgard chemical PFOS, phased out of use by 3M over health concerns in 2000, was found at markedly low levels in cats, at one-quarter of the levels in dogs and in amounts
lower than those found in 91% of people tested in national studies. PFOA, the “Teflon chemical”, was detected at levels in the range of what is typically found in people (45th percentile). The skewed profiles of PFC exposures in cats relative to humans, with six different PFCs occurring at levels far in excess of those typical in people, suggests that cats may have unique exposures or different metabolic responses compared to people. Likely sources of PFCs in cats include food contaminated with PFCs leaching from food bag coatings, house dust, and stain-proofed furniture, cat beds, and carpets. Toxins in plastic toys and medicines. Cats’ samples contained six out of seven breakdown products of five industrial plasticizers called phthalates. Cats were polluted with the breakdown product of DMP (dimethyl phthalate) at an average level higher than amounts in every one of more than 5,500 people tested by CDC. In addition to its use in plastics and other consumer products, DMP is an insect repellant with reported uses in flea and tick collars and veterinary medicines. Cats’ samples contained other phthalate breakdown products at low to moderate levels, in excess of amounts found in between 4% and 76% of Americans tested in national studies. Cats can be exposed to phthalates from veterinary medicines, plastic containers and toys, and a huge range of other consumer products. Phthalates raise risks for reproductive damage, birth defects, and cancer. Fire retardants in bedding, house dust, and food. Cat samples contained 29 of 46 different fire retardant chemicals known as PBDEs, or polybrominated diphenyl ethers, with 16 found at levels higher than amounts in any of the 100 to 2,000 people tested for these chemicals in national studies. The total concentration of all PBDEs in cats was higher than levels in 98% of Americans tested, and 26 of 29 individual PBDE chemicals found were at average levels in excess of what is found in 90% of the U.S. population. For cats, potential sources of exposure include foam furniture and bedding manufactured before 2005, contaminated air and house dust, and food contaminated with PBDEs that pollute the environment, especially seafood.
Conclusions The study indicates that cats and dogs are exposed to complex mixtures of industrial chemicals, often at levels far in excess of those found in people. Copyright © Environmental Working Group, ewg.org. Reprinted with permission.
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tech talk
Focus on acupressure by Amy Snow and Nancy Zidonis
GV 14 BI 13 BI 17 BI 28
BI 20
BI 23
LI 4
Ki 3
Lu 7
Ki 7 Ht 7 TH 4
ike acupuncture, acupressure is based on Traditional Chinese Medicine (TCM) theories and concepts. The only difference is that acupuncture employs the use of fine needles, while acupressure is performed by the hands and arms. The underlying intent of both these ancient Chinese therapies is to maintain or replenish a harmonious flow of blood and life-promoting energy called chi (pronounced “chee” and also seen as qi or ki) throughout the body. In accord with TCM concepts, when there’s a disruption in the flow of chi and blood, the internal organ systems are unable to perform their vital functions and the body is apt to become compromised. When the body is compromised, the animal’s immune system is unable to cope with external or internal pathogens and can fall prey to disease. The entire focus of TCM is to support health by preserving the harmonious flow of chi and blood to nourish the entire body.
How acupressure works After thousands of years of clinical observation and documentation, Chinese doctors understood that there
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are channels or energetic pathways, known as meridians, which run through the body at specific locations. These meridians are responsible for communicating with internal organs and circulating chi, blood and other vital substances. There are 12 Major Meridians and two Extraordinary Vessels that run just beneath the skin. Each of the 12 meridians — which are bilateral — are named after the internal organs to which they are connected. We are able to influence the flow of chi and blood along these meridians because they have “pools” of energy called “acupoints” situated along them. By palpating or stimulating these acupoints, we can resolve blockages or stagnations that impede the flow of chi and blood. Acupoints have particular energetic attributes that influence the movement of chi and blood. For example, the acupoint called Gall Bladder 34 (GB 34 — the 34th acupoint on the Gall Bladder meridian) influences the flow of chi and blood to the tendons and ligaments when it is palpated. We would use GB 34 to nourish those tissues and increase their strength and flexibility. TCM is best used to prevent illness but is also effective in managing chronic health issues. Casework demonstrates
that acupressure can enhance overall health and emotional stability. Specifically, it can:
and chi, enhance spleen chi, and promote the circulation of Defensive (Wei) Chi:
• Build the immune system • Strengthen muscles, tendons, joints and bones • Balance energy to optimize the body’s natural ability to heal • Release natural cortisone to reduce swelling and inflammation • Release endorphins necessary to increase energy or relieve pain • Enhance mental clarity and calm required for focus in training and performance • Resolve injuries more readily by increasing the blood supply and removing toxins.
• Lu 7 – promotes sweating, clear heat • LI 4 – promotes sweating and Wei Chi circulation • Ht 7 – clears heat, calms the spirit • Bl 13 – supports the lung • Bl 17– benefits skin dehydration • Bl 20 – supports the spleen • Ki 7 – regulates sweating • TH 4 – supports thermoregulation • GV 14 – regulates sweating and calms the spirit
1. Canine case study Oakie, an 11-month old golden retriever, had a triple osteotomy three weeks prior to visiting the acupressure practitioner. The owners wanted to support the dog’s healing process and mitigate pain. Because acupressure is non-invasive and deceptively gentle, Oakie welcomed the comfort of an acupressure session. The acupoints used for the session were Gall Bladder 29 (GB 29), Gall Bladder 30 (GB 30) and Bladder 54 (Bl 54). When these three points are used in combination, the technique is called “surrounding the dragon”. These acupoints literally surround the injured area, “the dragon”, and can effectively reduce edema, inflammation and pain. The Bai Hui point was also selected because this point is known to enhance the flow of chi and blood to the hindquarters and spinal column. Bladder 60 (Bl 60), called the “aspirin point”, was included in the session as an analgesic. The veterinary surgeon that performed Oakie’s surgery was pleased with the speed of his recovery at his onemonth check, and he was released from care.
2. Equine case study Starlight, a seven-year old Arabian mare, is an endurance competition horse. She was showing all the indications of anhidrosis: no sweating, heavy breathing after minimal exercise, elevated pulse and temperature. She also appeared distressed and lethargic during periods of hot humid weather. Starlight was given three acupressure sessions over a tenday period to support the lungs and spleen and to clear heat. In Chinese medicine, an anhidrotic horse’s lungs are not circulating fluids from the spleen to the surface of the body, resulting in a lack of sweat. The acupoints below were selected to help regulate sweat, increase lung yin
After three acupressure sessions that included a combination of these acupoints, Starlight showed no signs of anhidrosis and was able to resume training and competition.
3. Feline case study Urine and blood tests indicated that Teddy, a nineyear old neutered male, was in the beginning stages of feline chronic renal failure (Feline CRF). His owners consulted a holistic veterinarian and followed her dietary recommendations. She suggested acupressure as well and the owners worked with a practitioner to learn three bilateral acupoints to be palpated every third or fourth day to help manage Teddy’s kidney disorder – see the accompanying diagram for these acupoints. In TCM, the kidneys are often referred to as the “Root of Life”. The kidneys store the original “essence” of the body and are responsible for growth, reproduction and physical development. They are the foundation of the human or feline body. Any insult to the kidneys or dysfunction of same is seen as critical. We are living in a time when veterinarians and veterinary technicians have the opportunity to provide their patients with optimal care by combining Western conventional medicine with traditional healing therapies.
Nancy Zidonis and Amy Snow are the authors of Equine Acupressure: A Working Manual, Acu-Dog: A Guide to Canine Acupressure, The Well-Connected Dog: A Guide to Canine Acupressure, and, Acu-Cat: A Guide to Feline Acupressure. They founded Tallgrass, offering books, manuals, DVDs and meridian charts. Tallgrass also provides hands-on and online training courses worldwide, including a 330hour Practitioner Certification Program. Tallgrass is an approved school for the Department of Higher Education through the State of Colorado, and an approved provider of NCBTMB CE’s. To contact Tallgrass call 888-841-7211, visit animalacupressure.com or email Tallgrass@animalacupressure.com.
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yadda, yaddy, yadda... incredible!
Evidence-based medicine for animal supplements
yadda, yaddy, yadda... the best!
– part 2 – Where is the clinical evidence demonstrating that animal supplements are safe and effective? Here’s how the supplement industry is working with regulatory agencies to maintain vigilance.
by William Bookout, BS, MBA
E
Everyone remembers the issue with melamine contamination in pet food in 2007. It resulted in Senate hearings during which three areas of concern for pet food safety were identified:
1 Manufacturing practice standards, such as those found in the current Good Manufacturing Practices (cGMPs) for human dietary supplements, are inadequate for pet products. 2 There is no early warning system in the event something unforeseen occurs. 3 Verification mechanisms are not in place to help ensure the industry is implementing and following proper conduct. Legislation was subsequently passed to help maximize animal safety by providing additional authority to FDA and increasing requirements for the pet food industry. Representing 90% of the industry, the National Animal Supplement Council (NASC), a non-profit industry trade association, has driven this process through cooperative efforts with FDA-CVM and state agencies and associations that recommend regulatory policy like the Association of American Feed Control Officials (AAFCO). In every case, the requirements for NASC members have exceeded those mandated by federal legislation. In 2001, NASC submitted a proposal called Compliance
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Plus to FDA-CVM defining key action steps that would be implemented within the animal supplement industry to help deal with safety concerns and egregious product claims for efficacy. Our organization committed to dates and specific action items to address the concerns of the regulators while serving the best interests of all stakeholders. Compliance Plus considers the following:
1
Safety - emonstrating safety by conducting toxicology studies in the target species and microbiological tests on every animal supplement sold is not an economically viable option. For an effective and consistent approach, NASC committed to developing and implementing the most comprehensive adverse event reporting system in the industry. In August 2004, it launched the NASC Adverse Event Reporting System (NAERS), and compliance with NAERS became a requirement for all NASC members. ach member company is required to enter information E into the NAERS database listing individual ingredients in all products they sell, as well as the quantity of each ingredient per unit of administration (e.g., tablet, capsule or scoop) as specified on the product label. NASC members are also required to submit a monthly report of all adverse events to NAERS, and a quarterly report of sales data in number of units sold of each product listed in the NAERS database. AERS is accessible by FDA-CVM and the system N currently monitors more than 5,000 products with over
1,400 individual ingredients. Ingredient Risk Reports are generated by analyzing data for each ingredient to determine dosage information for each species (dogs, cats or horses) and the adverse event report rate per administrations of products sold containing all ingredients in the marketplace from member companies. An example of an Ingredient Risk Report for glucosamine is found in Exhibit 1. Adverse events for different forms of glucosamine, such as hydrochloride and sulfate, are all tracked individually or can be combined in a consolidated report on all forms of glucosamine, as shown by individual species with adverse events being very broadly defined to include transient events like vomiting, diarrhea, accidental ingestion, etc. Reports for any ingredient in the NAERS database are available to NASC members, professional veterinary organizations (e.g., AVMA, AHVMA, VBMA, ACVS, ACVIM) and regulatory agencies. Ingredient Risk Reports for garlic, lutein and evening primrose oil were provided to a scientific committee established by the National Research Council of the National Academies for consideration in their 2009 report, Safety of Dietary Supplements for Horses, Dogs, and Cats. oes the NAERS system prove products are safe? No, D but it does provide a very good system of monitoring risk and is consistent with current risk-based approaches utilized by the regulatory agencies in the US and other countries.
2
Current good manufacturing practices (cGMPs) Good manufacturing practice standards are currently being developed by FDA-CVM for animal feed. The FDA website states:
and to solicit comments.” Note the references to “risk-based” approaches specifically discussed by FDA in considering regulatory policy. In the Compliance Plus proposal to FDA-CVM and AAFCO, NASC committed to define and implement manufacturing standards to help ensure production process controls for animal products that are similar to human dietary supplements. The first guidelines were published in 2005 and have since been revised and updated numerous times. When cGMPs for Human Dietary Supplements were officially published in 2007, NASC reviewed these requirements and incorporated applicable standards into the requirements for NASC members as appropriate to the animal industry. Although not specifically related to evidence-based medicine, other accomplishments of NASC include:
3 4 5 6 7 8 9 10
Labeling claims guidance consistent with regulatory approaches Scientific Advisory Committee review of ingredients
NASC independent quality audit program
Registration of products and facilities with FDACVM Random testing of finished products
Verification of adverse event report entry
“ Animal Feed Safety System (AFSS) – The Food and Drug Administration announced in August 2003 its intention to make its animal feed safety program more risk-based and comprehensive. When completed, the modernized Animal Feed Safety System (AFSS) will incorporate riskbased, preventive control measures for ensuring the safety of animal feed. FDA, with State assistance, has developed an AFSS framework document that identifies the current major processes, guidance, regulations and policy documents that address feed safety and the documents that should be developed to make the Agency’s feed safety program comprehensive and risk-based. Public meetings were held in September 2003, April 2005, September 2006 and May 2007 to share draft plans and documents,
Continuing Education programs for the animal supplement industry Cooperative, transparent programs with federal and state regulatory agencies
Summary In the United States, consumers spend approximately $1.4 billion annually on supplements for dogs, cats and horses. These products offer two things to veterinary practitioners. First and foremost, they provide the ability to coordinate care and make proper recommendations to the client, which integrative veterinary care
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may include complementary natural products. Whether or not the veterinarian recommends supplements, demand indicates that pet owners are purchasing these types of products for their animals. Secondly, animal supplements are a source of revenue for the veterinary clinic as part of a comprehensive care program. Everyone would like more “evidence” in the form of clinical studies to verify the safety and efficacy of currently available animal supplements. There are some very valid reasons why the ability and willingness of the industry to sponsor clinical research is challenging. These reasons primarily involve the limited ability to recover the substantial investment required to conduct randomized double-blind, placebo-controlled studies that satisfy the rigors of the scientific community. Furthermore, companies are limited in the claims they are allowed to make under current federal and state laws for any clinical studies yielding positive results. The majority of stakeholders, especially veterinarians, would be well served to at least fairly consider how these products compare to current drugs and medical devices which are utilized every day in practice. This is not to say the animal supplement industry is perfect and certainly some fair scrutiny is very reasonable. Don’t be afraid to call supplement companies and ask some tough questions about their quality programs, adverse event reporting systems and registrations with the various regulatory agencies. However, to simply dismiss the potential value and benefit of animal supplements because of the lack of evidence-based data is not to ask the right questions,
especially when the same criteria is not applied to literally hundreds of other products utilized every day in veterinary medicine. Good science is always fair and open-minded. If it wasn’t, where would the veterinary profession be today?
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 Safety of Dietary Supplements for Horses, Dogs, and Cats; Animal Nutrition Series, National Research Council of The National Academies, 2009. Pet Product News, August 2007; From Rebels to Role Models, Eve Adamson. Animal Feed Safety System, www.fda.gov/AnimalVeterinary/SafetyHealth/AnimalFeedSafetySystemAFSS/default.htm. cGMPs for Human Dietary Supplements, www.fda.gov/Food/DietarySupplements/ GuidanceComplianceRegulatoryInformation/RegulationsLaws/ucm079496.htm. Nutrition Business Journal, Volume XIV, No. 8, August 2009: 2009 U.S. Animal Nutrition Industry Overview.
Exhibit 1 NASC Ingredient Risk Report for Products Containing Glucosamine No. of NASC Registered Products with this ingredient: 909 Years ingredient on the market: 20 Ingredient name: Glucosamine – all forms Report data generated on: 10/1/2010
Adverse Events (AEs) Reported 1,100
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Report Rate Serious AEs (RR)/Million Reported Administrations
RR Serious AEs/ Million
0.54/million
0.00
integrative veterinary care
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Administrations of Products Containing Glucosamine 2,037,355,875
Veterinary Resource Guide ASSISTIVE DEVICES HandicappedPet.com Amherst, NH USA Phone: (603) 577-8858 Website: www.handicappedpets.com Best Friend Mobility Myrtle Beach, SC USA Phone: (503) 575-9407 Email: sylvan@sylvancompany.com Website: www.bestfriendmobility.org
ASSOCIATIONS American Holistic Veterinary Medical Association - AHVMA Abingdon, MD USA Phone: (410) 569-0795 Email: office@ahvma.org Website: www.ahvma.org 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
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
EQUINE NATUROPATH Cassie Schuster, ND, MH Waller, TX USA Phone: (713) 502-0765 Email: cassie.schuster@yahoo.com Website: www.wellranch.com
FLOWER ESSENCE THERAPY Head to Tail Health Soquel, CA USA Toll Free: (831) 359-6001 Phone: (831) 713-5307 Email: fullbloom09@gmail.com Website: www.headtotailhealth.com
LASER THERAPY
Theralase Veterinary Botanical Medicine Association - VBMA Toronto, ON Canada Acworth, GA USA Phone: (416) 447-8455 Email: office@vbma.org Email: info@theralase.com Website: www.vbma.org Website: www.Theralase.com Association of Veterinary Acupunturists of NATURAL PRODUCT Canada - AVAC MANUFACTURERS & DISTRIBUTORS Beaconsfield, QC Canada Phone: (514) 697-0295 Animal Necessity Email: office@avac.ca New York, NY USA Website: www.avac.ca Phone: (800) 721-1310 American Veterinary Chiropractic Association Email: sales@animal-necessity.com Website: www.animalnecessity.com - AVCA Bluejacket, OK USA Nelsons Phone: (918) 784-2231 North Andover, MA USA Email: avcainfo@junct.com Toll Free: (978) 988-0233 Website: www.animalchiropractic.org Phone: (978) 988-3833 Email: info@nelsons.net International Veterinary Acupuncture Society Website: www.nelsons.net - IVAS Lebalab Inc. Fort Collins, CO USA Sarnia, ON Canada Phone: (970) 266-0666 Phone: (519) 542-4236 Email: office@ivas.org Email: tellus@lebalab.com Website: www.ivas.org Website: www.lebalab.com American Academy of Veterinary Acupuncture SCHOOLS & WELLNESS - AAVA Glastonbury, CT USA EDUCATION Phone: (860) 632-9911 Email: aava@cttel.net Integrated Touch Therapy, Inc Website: www.aava.org Offering Small, Alliance of Veterinarians for the Environment Hands-On Intensive - AVE Classes in Animal Massage and Bodywork Nashville, TN USA Phone: (615) 353-0272 1-800-251-0007 wshaw1@bright.net www.integratedtouchtherapy.com Website: www.aveweb.org
College of Integrative Veterinary Therapies Evidence Based Natural Medicine www.civtedu.org office@civtedu.org + 303 800 5460 Sydney Office +61 2 80062025 Animal Spirit Network Pekin, IL USA Phone: (815) 531-2850 Email: carol@animalspiritnetwork.com Website: www.animalspiritnetwork.com PetMassage Ltd. Toledo, OH USA Phone: (419) 475-3539 Email: info@petmassage.com Website: www.petmassage.com
SUPPLEMENTS Herbsmith Inc. Hartland, WI USA Phone: (262) 367-1372 Email: mail@herbsmithinc.com Website: www.herbsmithinc.com MVP Laboratories Omaha, NE USA Phone: (402) 331-5106 Email: mvplabs@mvplabs.com Website: www.mvplabs.com SmartPak Plymouth, MA USA Phone: (774) 773-1125 Email: customercare@smartpak.com Website: www.smartpak.com The Hones Kitchen San Diego, CA USA Phone: (858) 483-5995 Email: info@thehonestkitchen.com Website: www.thehonestkitchen.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
THERMAL IMAGING ThermoScanIR Toronto, ON Canada Phone: (416) 258-5888 Email: info@ThermoScanIR.com Website: www.ThermoScanIR.com
WANTED All types of different modalities YOUR LISTING HERE integrative veterinary care
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nutrition nook Supportive Supplements
& fun foods
by Barbara E. Royal, DVM
There are a multitude of supplements out there, and they can be very helpful to your patients’ diets. But there are also some foods that can naturally assist in resolving certain issues, and others that are just plain fun. Let me touch on a few of my favorites:
for animals with a lot of heat in their skin or with loose stools. So be sure to monitor the response to see if it’s right for the animal. It is best to choose fish oils as the source. Good for many inflammatory conditions, arthritis and skin problems.
Probiotics
Unsweetened canned pumpkin is a
should be used regularly in many animals, and always during a food change or while using antibiotics. Lactobacillus sporogenes is often a good form of this. They can be purchased over the counter, but do a label check to be sure of the quality and proper bacteria. Dairy free versions are useful for sensitive animals.
Omega 3 fatty acids (fish oils) can be useful and usually can help hair coats, skin and musculoskeletal issues. They can occasionally provide too much oily heat
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integrative veterinary care
terrific stool regulator; good for constipation and also for diarrhea. We use this often during food changes to regulate stool. Use about one tablespoon one to two times per day for a 30-pound dog in food or as a treat. You can also mix pumpkin with meat baby food or yogurt and put into ice cube trays or Kongs and freeze to use as treats.
Green tripeis a useful source of protein for kidney disease, as it is odiferous, and very tempting, even to
those slightly nauseated by their uremia, and it is low in phosphorus, is metabolized well and shown to be of use to help the GI tract in kidney cases. Owners tend to prefer to buy it frozen because the canned smells awful.
Metamucil
is also for both loose stools or constipation. Many foods neglect to include proper fiber and adding some Metamucil daily can help (about a teaspoon per meal for a 50-pound dog) – I find some raw foods need added fiber content.
White rice can be used for diarrhea. Do not use Minute Rice. Cook the white rice with extra water and overcook it a bit till it’s gloopy. It has better absorption when it is overcooked and really sticky wet. Brown rice is not as good an absorbent for diarrhea/loose stools. As we are not using the rice for nutrition, but for its absorbent quality, it’s better to use the white rice here.
Rice cakes and green beans
diet change, or antibiotic use. Also as a fun treat (can also be mixed with meat baby foods or pumpkin and frozen in ice cube trays or put into Kongs and frozen). The yogurt you choose must have plenty of active cultures – i.e. Stoneyfield Farms, Greek Yogurt, Brown Cow, Kefir.
Dr. Barbara E. Royal graduated from the University of Illinois, College of Veterinary Medicine in 1995. She is certified in Veterinary Acupuncture (IVAS), and has completed training in Advanced Western & Chinese Herbal Medicine and Nutrition at Tufts University, and Animal Physical Therapy and Healing Techniques at the University of Tennessee. Her small animal practice, The Royal Treatment Veterinary Center in Chicago, provides an integrative approach to veterinary care and physical rehabilitation. Her new book, The Royal Treatment, How to Use What Nature Intended to Keep your Pets Wildly Healthy, will be published in the spring of 2012. Dr. Royal is the go-to veterinarian for Oprah Winfrey.
(plain, no salt) as low cal fun treats.
Fun foods and giving pills • Stage II meat baby foods (make sure there’s no onion powder in them) – chicken, beef, lamb and other flavors. Sometimes hard to find, I often see it at Treasure Island. (Gerber, Beechnut, Organic brands are also available.)
Excerpted with permission from “4,000 pet foods and counting – how to help owners choose, and why vet training in nutrition is lacking”, 2011 Proceedings, Annual Conference of the American Holistic Veterinary Medical Association.
• Use as a vehicle to give pills, powders, liquids that are unpalatable. • Use with warm water over foods as gravy. • Use directly or added to foods to improve taste of foods. • Use as a treat on plain rice cakes, or in ice cube trays or Kong toys, then freeze. • Liverwurst makes a good pill vehicle – use just enough to cover the pill completely. • Pats of butter or cream cheese, other cheeses and tripe are also a way to give pills, powders or other medicines. • Low sodium chicken or beef broth or just warm water added to food increases palatability. • Good quality plain yogurt, if the pet doesn’t have a dairy sensitivity. A good vehicle for pills and can be useful as a probiotic supplement during diarrhea episodes, any
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Chinese herbs for liver disease
by Steve Marsden, DVM, ND, MSOM, Lac. Dipl. CH, CVA
everal Chinese herbal formulas are routinely and markedly effective for managing small animal liver disease. This article focuses on Chinese herbal treatments for cholestatic, inflammatory, neoplastic and vascular disorders of the liver. The formulas discussed here are manufactured by the Natural Path Herb Company, but formulas with the same names from other companies, with the exception of Minor Bupleurum, will likely perform in a similar way. You can see them in action in an online presentation at civtedu.org.
Administration by enema Injectable forms of herbal medicine are not yet available, but high quantities of the appropriate formula can be delivered to an acutely ill patient via retention enema. A patient’s response is rapid and dramatic, with liver enzyme elevations subsiding and the patient stabilizing within a couple of days. Compounds in the formulas are absorbed across the large intestine mucosa into the portal circulation and from there move rapidly to the liver, bypassing any gastro paresis.
Method • 9 grams (4.5 teaspoon) in divided doses TID • Suspend each dose in a maximum of 10 to 15 ml of warm water • Instil into the transverse colon using a small rubber French feeding tube
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• Use only granular extracts or crushed tablets, never liquid extracts
1. Biliary tract inflammation High ALP and no elevated post-prandial bile acids. Cholestasis caused by steroid hepatopathy and biliary tract inflammation leads to secondary changes, including fibrosis and apoptosis of hepatocytes and cholangiocytes.
Herbal treatment Si Miao San (Four Marvels Powder) Cang Zhu
Atractylodes rhizome
Huai Niu Xi
Achryanthes root
Yi Yi Ren
Coix seed
Huang Bo
Phellodendron bark
How it works: • Anti-inflammatory and antioxidant • Anti-microbial (important in cholangiohepatitis) • Promotes bile synthesis and flow • Inhibits nitric oxide synthase to limit acute inflammation
Dose: • Dose of granular extract • 1g (1/2 tsp) BID for 10kg animals • 2g (1 tsp) BID for 20kg animals • 3g (1½ tsp) BID for 30kg animals and higher
• Can be mixed in food or given in gel caps
Management: • May be used along with Ursodiol • Additive or synergistic effect with other antibiotics • No long term safety concerns • Cease use if loose stools occur
2. Hepatocellular Adenocarcinoma Both ALT and ALP markedly elevated, greater than five or six times normal. Acute abdominal pain is common and often the first presenting sign. Often caused by chronic hepatitis, which leads to oxidative damage to liver DNA, potentially leading to tumor development.
Herbal treatment Ge Xia Zhu Yu Tang (Angelica and Corydalis)
3. Chronic Hepatitis Both ALT and ALP mildly to moderately elevated -- usually up to three or four times normal. By the time clinical signs appear, the animal already has a cirrhotic liver. Signs include loss of appetite, vomiting, weight loss, depression or lethargy, increased thirst and urination. Laboratory changes include elevated liver enzymes, and moderate to severe inflammation without evidence of tumor or infection. Chinese herbs inhibit fibrosis and cirrhosis development, extending lifespan usually for years. The formula discussed here is not as effective for copper toxicosis. Use instead Angelica and Corydalis discussed above, either alone or in tandem with chelation. Possible sequelae: hepatomegaly, jaundice, coagulation problems, ascites, weight loss, hepatic encephalopathy, hepatocellular adenocarcinoma.
Dang Gui
Chinese Angelica
Chuan Xiong
Ligusticum rhizome
Chi Shao Yao
Red Peony root
Zhi Ke
Bitter Orange peel
Gan Cao
Licourice root
Xiang Fu
Cyperus rhizome
Wu Yao
Lindera root
Chai Hu
Bupleurum
Mu Dan Pi
Peony Tree bark
Dang Gui
Angelica sinensis
Tao Ren
Persica seed
Bai Shao Yao
White Peony
Hong Hua
Safflower flower
Bo He
Mint
Yan Hu Suo
Corydalis rhizome
Bai Zhu
White Atractylodes
Fu Ling
Poria
Gan Cao
Licourice
How it works: • Actions contributed by several ingredients • Reduction of nitric oxide synthase, resulting in reduced hepatic blood flow • Inhibition of angiogenesis • Net effect is a reduction of acute inflammation and the deprivation of blood supply to rapidly growing tumors • Increases superoxide dismutase (SOD) levels, resulting in reduced free radical damage and lower ALT and AST levels • Inhibits fibrosis and collagen synthesis • Analgesic • Antiproliferation and apoptosis inducing effects, particularly for hepatocellular carcinoma
Dose: • Dose of granular extract • 1g (1/2 tsp) BID for 10kg animals • 2g (1 tsp) BID for 20kg animals • 3g (1½ tsp) BID for 30kg animals and higher • Can be mixed in food or given in gel caps
Herbal treatment Rambling Ease Powder (Xiao Yao San; Bupleurum and Dang Gui Powder)
How it works: • Reduces inflammation by safely increasing endothelial nitric oxide production • This limits chemotaxis of neutrophils into the tissue, while increasing blood flow • Increases superoxide dismutase (SOD) levels, resulting in reduced free radical damage and lower ALT and AST levels • Inhibits fibrosis and collagen synthesis • Net effect is a reduction of inflammation
Dose: • Oral use is generally sufficient • Dose of granular extract • 1g (1/2 tsp) BID for 10kg animals • 2g (1 tsp) BID for 20kg animals • 3g (1½ tsp) BID for 30kg animals and higher • Can be mixed in food or given in gel caps
Management: • If liver enzymes elevate significantly during use of this formula, then the patient has acute hepatic inflammation; use Ge Xia Zhu Yu Tang (Angelica and Corydalis) instead integrative veterinary care
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4. Microvascular Portosystemic Shunt Increased ALP with elevated post-prandial bile acids. Probably most cases in dogs are due to intravascular inflammation, leading to increased blood pressure within the vessels, and secondary portal hypertension. Other causes include portal vein thrombosis, diffuse hepatic fibrosis and cirrhosis. The goal of therapy is to resolve chronic intravascular inflammation. Associated findings: microcytosis, due to injury of erythrocytes in narrowed vasculature; mild non-regenerative anemia, which aggravates liver hypoxia and hypofunction; low BUN, creatinine, glucose, albumin and cholesterol, from reduced synthesis due to blood flow impairments; possible ALP, especially in young animals; serum bile acids not absorbed post-prandially due to shunting; liver often small in size, even in non-cirrhotic and idiopathic cases. Possible sequelae: ascites, potential hepatic encephalopathy, GI ulceration (splanchnic vasculopathy), ammonium biurate urolithiasis
Herbal treatment Rambling Ease Powder (Xiao Yao San; Bupleurum and Dang Gui Powder) Chai Hu
Bupleurum
Dang Gui
Angelica sinensis
Bai Shao Yao
White Peony
Bo He
Mint
Bai Zhu
White Atractylodes
Fu Ling
Poria
Gan Cao
Licourice
How it works: • Reduces inflammation by increasing endothelial nitric oxide production • This limits chemotaxis of neutrophils into the tissue, while increasing blood flow • Stimulates bone marrow to correct anemia and further improve blood flow • Increases superoxide dismutase (SOD) levels, resulting in reduced free radical damage and lower ALT and AST levels • Inhibits fibrosis and collagen synthesis • Net effect is a reduction of inflammation and improved liver perfusion
Management: • No herb/drug interactions anticipated
5. Autoimmune Disease and Septicemia Liver enzyme elevations plus azotemia is a hallmark of systemic disease amenable to this formula. Liver inflammation may be a source of immune complexes that promote glomerulonephritis; autoimmune tendencies can be enhanced in both tissues by immune system malfunction; deep-seated parasitic, bacterial and viral infections can promote inflammatory responses.
Herbal treatment Xiao Chai Hu Tang (Minor Bupleurum Combination) Chai Hu
Bupleurum root
Ban Xia
Pinellia rhizome
Gan Cao
Licorice root
Sheng Jiang
Ginger rhizome
Da Zao
Jujube
Ren Shen
Ginseng root
Huang Qin
Scutellaria root
How it works: • Much of the effect contributed by Bupleurum, but adequate Ginseng levels seem necessary for proper effect • Reduces renal and glomerular inflammation • Hepatoprotective • Inhibit liver inflammation and fibrosis • Antioxidant • Enhances macrophage activity and pathogen clearance, but reduces T cell responses involved in hypersensitivity reactions • Inhibits nitric oxide synthase in particular organs, including liver and kidney • Reduces acute inflammation • Promotes resolution of inflammatory problems due to infectious agents, including liver abscesses
Dose: • Dose of granular extract • 1g (1/2 tsp) BID for 10kg animals • 2g (1 tsp) BID for 20kg animals • 3g (1 ½ tsp) BID for 30kg animals and higher • Can be mixed in food or given in gel caps
Management: • No herb drug interactions anticipated
Dose: • Oral use is generally sufficient, since most cases are not emergencies • Dose of granular extract • 1g (1/2 tsp) BID for 10kg animals • 2g (1 tsp) BID for 20kg animals • 3g (1½ tsp) BID for 30kg animals and higher • Can be mixed in food or given in gel caps
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integrative veterinary care
Dr. Steve Marsden is one of the chief educators of veterinarians worldwide in the use of complementary and alternative therapies. He regularly lectures for the International Veterinary Acupuncture Society, the American Holistic Veterinary Medical Association, and the American Veterinary Medical Association. He is co-founder of the College of Integrative Veterinary Therapies and a director of the National College of Natural Medicine. His textbook, Manual of Natural Veterinary Medicine, has been translated into multiple languages. When not teaching, Dr. Marsden divides his time between his veterinary and naturopathic medical practice in Edmonton, Alberta.
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The Honest Kitchen The Honest Kitchen’s gently dehydrated whole foods for dogs and cats are made without high heat or irradiation, to maintain the natural nutrition in the raw ingredients. The company’s foods are 100% human grade because they’re made in a human food facility, not in a pet food plant. When prepared with warm water according to directions, the foods provide a nourishing, high-moisture diet. Grain-free options available. Ingredients include free-range chicken, wild caught fish, some organic ingredients and NO genetically engineered ingredients. Used by holistic veterinarians for their own pets. To try a box for free, vets can email
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h profile Dr. Susan Wynn DVM, CVA, CVCH, AHG
...I realized my training gave me the resources to help veterinarians interested in the field defend those interests and advance their practices. internship at Friendship Hospital for Animals in Washington, DC, where she was able to watch integrative veterinarian Dr. Monique Maniet at work. “What fascinated me most was the way dogs and cats experienced huge improvements in health just by changing diets,” she says. Dr. Wynn also became intensely interested in herbal medicine during her internship. “I view it as an extension of nutrition – bodies know how to interact with these natural molecules, whether they are purely nutritive or act like some plant compounds as ‘specialized nutrition for specialized cells’.”
Dr. Wynn has a special interest in educating other veterinarians about integrative medicine.
By Ann Brightman any integrative veterinarians start their careers in conventional medicine. Often, it’s by seeing firsthand how alternative therapies can complement traditional treatments that convince doctors to start incorporating holistic ideas into their practices. When veterinarian Dr. Susan Wynn graduated from the University of Georgia’s College of Veterinary Medicine, her approach was solely conventional. “I had no interest whatsoever in integrative medicine in my first year of practice,” she says. Dr. Wynn started out with an interest in being an equine surgeon. “I’ve always had horses and thought it would be fun,” she explains. “Then a stallion recovering from anesthesia kicked me in the leg, and I realized I could still have horses without the everyday risk, so I switched my focus back to small animals.” Dr. Wynn did an
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To this day, nutrition and herbal medicine are still of major interest to Dr. Wynn. “I completed a residency in veterinary nutrition in 2010 and am working on board certification. I’m also certified in Chinese and Western herbal medicine and in acupuncture.” She currently works with Georgia Veterinary Specialists in Sandy Springs, Georgia, and also has a passion for educating other veterinarians about the benefits of an integrative approach. “In the mid-90s, I was doing a post doctoral fellowship in viral immunology at the medical school of Emory University,” she explains. “My lab was the recipient of one of the first Office of Alternative Medicine center grant awards. We were also teaching an alternative medicine class to the second-year medical students. There was so much controversy attached to alternative medicine at the time, and so much happening in the field as the Office of Alternative Medicine changed names and became an official Center in the National Institutes of Health. The push back from skeptics was particularly strong, and I realized my training gave me the resources to
help veterinarians interested in the field defend those interests and advance their practices. At that time, there were plenty of integrative veterinarians educating the public, and I felt my chosen focus would fill an unmet need.” Dr. Wynn has co-authored four books on alternative medicine. These include Veterinary Herbal Medicine, the Manual of Natural Veterinary Medicine: Science and Tradition and Complementary and Alternative Veterinary Medicine: Principles and Practice. “I’m proud of my books, which I understand have served as resources for many integrative veterinarians trying to put what they’ve learned into a larger context” she says. “I’ve had the pleasure of working with leading co-authors and teachers, and from them I learned the value of idea cross-pollination. “Integrative medicine is still in early enough stages that it’s easy to think we’ve heard enough when we’ve heard from one teacher,” she adds. “I think it’s important to learn from as many as possible. After working with various authors and teachers, I realized it was important to keep the medical education frontier fresh, and to that end, I’ve worked on several conference committees for my professional organizations. This has given me a chance to reach out beyond the veterinary profession, incorporating the insights and experiences of medical doctors, food animal producers, and
many others who impact our profession.” Dr. Wynn is a past president of the American Holistic Veterinary Medical Association (AHVMA) and PresidentElect of the American Academy of Veterinary Acupuncture. “I founded the Veterinary Botanical Medicine Association, and a local organization called PALS that helps people with chronic illnesses keep their pets. I have also worked on the boards of the Georgia Veterinary Medical Association and the American Academy of Veterinary Nutrition. Some of my most fulfilling work has been on conference committees, where I could really make a difference in the information available to local veterinarians and on a national level.” Dr. Wynn is motivated in part by a strong desire to give back to the veterinary profession. “I believe in volunteerism. I hope that by volunteering, I can show other veterinarians by example how they can actually change the future by working in organized veterinary medicine.” Another strong motivation is her lifelong love of animals. “Apparently, I was talking about being a vet from the time I was four years old. I’ve been in practice for 24 years, working from a number of general and two specialty practices, and it’s still the animals that make it worthwhile.”
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industry innovations Grain free wellness If you have patients allergic to grains, you want to recommend a diet free of these ingredients. Love™ is The Honest Kitchen’s new grain-free whole-food recipe for all breeds, sizes and life stages. It’s made with human grade beef, sweet potatoes, potatoes, organic flaxseed, organic coconut, parsley, dandelion greens, papaya, cranberries, pumpkin, honey, rosemary, vitamins and minerals. The Honest Kitchen’s products are made without high heat, pressure or irradiation, to maintain the natural nutrition in the raw ingredients. The foods are gently dehydrated and simply require the addition of warm water. This creates a high-moisture meal that helps keep animals well hydrated. thehonestkitchen.com
Mulling over massage? Incorporating massage into your practice can help increase your revenue and enhance your relationships with your canine patients and their owners. It can be used for wellness maintenance and as an effective complement to your rehabilitation procedures. PetMassage™ Training and Research Institute is a pioneer in canine massage training. Founded in 1998, when the institute’s first two PetMassage™ for Dogs videos were introduced (endorsed by veterinarian Dr. Michael W. Fox), it continues as a leader in the field of animal massage and bodywork. Workshop offerings include both “dry” PetMassage™ for dogs and WaterWork, which is conducted in a heated pool. Foundation level workshops are convenient four-day extended weekends; the WaterWork workshop is five days. petmassage.com
Supplement source Nutritional supplements are being used by more veterinarians as a way to help maintain patient health. i Love Dogs was founded in 2007 by businessman Eric Chan and Bill Lai, who has a background in human pharmaceuticals and nutraceuticals. “Our main product line is i Love Dogs vitamins and supplements,” says Martha Smith, General Manager. “They’re veterinarian formulated for canine physiology, and are fortified with decaffeinated green tea and reishi mushroom, which provide antioxidant and immune system support to dogs.” The supplements are being dispensed in veterinary clinics in both the US and Canada. “Our Reishi with Green Tea supplement is very popular with oncology centers. Veterinarians are also using our Glucosamine and Chondroitin with Green Tea and Reishi supplement for orthopedic issues, and the Multivitamin with Green Tea and Reishi for nutritional deficiencies and digestive balance.” The company has several information-related websites, including ilovedogs.com, which includes an Ask a Vet column where readers can write in and ask consulting veterinarians dog health
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questions. Meanwhile findavet.us can help increase visibility for vet clinics. “Member clinics get detailed profiles, including photos and vet bios, as well as the opportunity to contribute content as a guest expert blogger.” Two veterinarians work with i Love Dogs. Dr. Michelle Hoag practices at Plaza del Amo Animal Hospital in Torrance, California, and answers the Ask a Vet column. “Dr. Patrick Mahaney, who practices at Veterinary Cancer Group in Culver City, California, also answers Ask a Vet questions and frequently contributes his veterinary perspective on dog-related issues as a guest blogger.”
Professional oral care
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Mobility aid Wheelchairs for dogs are a godsend in cases where mobility is severely limited, whether through illness, injury or post surgery. The Walkin’ Wheels dog wheelchair is a fully adjustable canine cart that easily changes size in height, length and width to accommodate different sizes of dog as well as various levels of mobility, from partial to complete rear leg paralysis. Designed to be stocked and sold by veterinarians, the wheelchair is ideal for long term as well as canine rehabilitative use. Simply take one measurement of the dog’s height, select the appropriate size wheel (which is based on this one measurement) and snap adjust the frame accordingly. handicappedpets.com
Super gravy Clear Conscience Pet is the Winner of the 2011 Editor’s Choice Award from Pet Product News International. All products are made from humanely, sustainably and naturally raised livestock sources from family farms, free of added growth hormones, antibiotics, steroids, GMOs, grains and glutens. One of the company’s products, SuperGravy®, is a holistic instant dry gravy mix for animals. “I have had success getting cancer patients to eat, as well as an elderly dog with chronic pancreatitis who was refusing all food, and an elderly cat with debilitating intestinal issues who was refusing his special diet,” says Dr. Stacy Robertson, DVM. “Adding a small amount of SuperGravy got them to eat again.” Free freight and no minimums are offered to all veterinarians in the continental US. clearconsciencepet.com or supergravy.com
Healthy vision relies on many factors, and nutraceuticals can be included among them. One example of a scientifically-formulated vision supplement for dogs is Ocu-GLO Rx™, distributed by Animal Necessity, LLC. The supplement was formulated by Dr. Carmen Colitz, a board-certified veterinary ophthalmologist with a PhD in molecular biology, along with Dr. Terri McCalla, also a board certified veterinary ophthalmologist, and Debby Smith, a compounding pharmacist and chemist. Ocu-Glo Rx™ is a blend of 12 antioxidants including grape seed extract, lutein and omega-3 fatty acids. These ingredients may slow the progression of numerous eye diseases while also supporting the immune system and providing anti-aging support. Dr. Colitz has done extensive research on how antioxidants affect health. This formulation is especially helpful for dogs at risk of blindness from age-related retinal degeneration, cataracts, uveitis, glaucoma and dry eye. Animal Necessity, LLC was founded in 2006 by industry professionals and combines more than 30 years of clinical experience from Dr. Norma Pestano and cutting-edge research from leading veterinarians. The company delivers a line of quality nutraceuticals for animals, with a range of products including vision support, calming aids, digestive aids, hip and joint support, liver support, skin and coat care and multivitamins. The products are guaranteed certified under FDA Good Manufacturing Practices (GMP) regulations. Animal Necessity’s nutraceuticals are designed to act as a complement to surgery and medication as well as providing natural alternatives when standard methods are not an option. animalnecessity.com or ocuglo.com integrative veterinary care
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Green cleaning
by Ann Brightman
Young Living, meanwhile, makes a universitytested product called Thieves that Dr. Roman and her staff find beneficial too. It’s a combination of clove, lemon, cinnamon, eucalyptus and rosemary essential oils. “When washing my hands between appointments, I use lavender with Thieves.
Dr. Margo Roman uses an earth friendly disinfectant to wipe up an exam table.
reen cleaners are wonderful, both for our health and the planet’s, but ingredients like baking soda just don’t cut it in a hospital setting, where you need to ensure that bacteria, viruses and other pathogens are dealt with promptly and thoroughly. Question is, are there any environmentallyfriendly chemical-free cleaning and disinfecting products and techniques that meet the sanitation needs of a veterinary clinic? The answer is yes, according to many integrative veterinarians.
Small animal hospital Dr. Margo Roman of Main Street Animal Services of Hopkinton (M.A.S.H.) in Hopkinton, Massachusetts uses a multi-pronged approach to combating pathogens while ensuring her patients and staff are not exposed to harmful toxins. Essential oils, some of which have antiviral and antibacterial properties, play a significant role in the clinic’s cleaning choices. “Products I use a lot include Mrs. Meyers,” she says. “They have four different essential oils – basil, geranium, lavender and lemon. They’re concentrated liquids that you use per gallon of water. I mix them in a spray bottle and use them for tables and floors.” Dr. Roman also uses products from Earth Friendly. “Sometimes I’ll add extra lavender oil, since it’s antiviral and antibacterial.”
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“I try and see animals with respiratory conditions such as kennel cough outside the clinic in the clients’ vehicles,” adds Dr. Roman. “But if they do come in, we have a diffuser that we use to clean the air and we’ll put Thieves in that. We also designed the clinic so that each room has access to outside air. I open the windows, close off the rest of the building, use that room to examine the animal and wipe everything down before opening up the room again. I might use a chemical disinfectant once every two years or so. There aren’t any laws for using strong chemicals unless you’re dealing with rabies.” M.A.S.H. also uses ozonated water to clean surfaces. “It’s antibacterial and antivirual,” Dr. Roman says. A Kangen machine is another option she recommends. “I don’t have one myself, but it will change the pH of water to make it more acidic and good for cleaning.” Dr. Roman says using green cleaners is not cost prohibitive, but it is a bit more labor intensive. “It takes a little more effort because you need to screen appointments more carefully to make sure the animal doesn’t have an infectious respiratory condition. If he does, we tell clients to leave the animal in the car.” The products themselves are easy to come by. “They’re accessible to everybody. We order them online so we don’t have to take time to go out and buy them.”
Equine practice “Cleaning up an equine facility comes with its own set of challenges, similar but different from a small animal veterinary clinic,” says Dr. Hannah Evergreen of Evergreen Holistic Veterinary Care – Equine (EHVC – Equine) in Snohomish,
Washington. “We have stalls and treatment areas that we need to disinfect after patients leave, as well as grooming supplies, blankets, halters, leg wraps and the like. There’s also manure management for parasite control.” Dr. Evergreen’s first line of defence is, quite simply, good oldfashioned water and scrubbing. “First and foremost, a little bit of ‘elbow grease’ goes a long way in keeping an equine facility clean and sterile,” she says. “Removing all organic materials (manure, bedding, dirt, etc.) that tend to come with horses is the first step. Cleansers — even toxic chemical ones — won’t work through organic material. Stalls, barn aisles and the treatment bay are thoroughly cleaned and then scrubbed with water to remove organic material.” Once this has been done, the areas are ready to be disinfected. What Dr. Evergreen uses for this purpose depends on the situation. “I take the risk of the pathogen into consideration when deciding what to use. For example, cleaning a stall after a horse with something highly contagious like strangles requires extensive disinfecting versus just cleaning.” EHVC – Equine has special quarantine stalls located at the far end of the barn. “These are disinfected with dilute chlorine bleach (one part bleach to four parts water).” Although bleach is not really a green cleaner, Dr. Evergreen says that non-chlorine bleach, while a good cleanser, is not a disinfectant. “And although bleach can cause skin and respiratory irritation if used incorrectly, it breaks down quickly after use and generally is not harmful to the environment at that point. “Our resident stalls are cleaned with water, or soap and water – I like the Dr. Bronner’s organic pure castile soap,” Dr. Evergreen adds. “Our office and storage room and treatment surfaces are cleaned with disinfectant sprays. We use Seventh Generation Multi-Surface Disinfecting Cleanser for most things. Other good products we use include Mrs. Meyer’s Cleanser (an alternative to Comet), Simple Green, Biokleen, Citra Solv, or homemade vinegar and water solutions. Tea tree oil, thymol (thyme oil) and vinegar kill bacteria and viruses and are great safe and natural ingredients to look for. “As for hand washing, research shows that the key ingredient to killing bacteria on your hands is vigorous washing for at least 20 seconds with warm water.” Dr. Evergreen avoids harsh soaps because they can cause the skin to crack and, over time, increase the harboring of bacteria on the hands. “Soap is necessary to remove organic debris, but the way you wash your hands is more important than using antibacterial or chemical soaps. I use Dr. Bronner’s soap and proper hand washing techniques unless I am dealing with a serious known
or suspected pathogen, or scrubbing for surgery.” Like Dr. Roman, Dr. Evergreen implements additional tactics to help with sanitation and reduce or eliminate the need for chemical cleansers. “Keeping pastures, paddocks and stalls picked free from manure twice a day helps us minimize the numbers of parasite and pathogens. We are also careful to minimize the spread of contamination by quarantining new horses and keeping sick horses in specific quarantine areas. We use separate wheelbarrows, muck rakes, halters and grooming equipment for quarantined horses. Our barn is big and open and has excellent natural ventilation. We coordinated stalls so horses that are potentially contagious are at the end of the barn and not sharing air space with the other horses. We also try to manage cases of strangles, rhino, influenza, etc., in the horse’s home environment, if possible, to decrease the risk of spreading these highly contagious diseases to other horses.” It takes a little extra effort and energy, but using non-toxic, environmentally-friendly cleaners is worth it, both for the well being of your patients, and you and your staff.
Green cleaners and disinfectants Biokleen, biokleenhome.com Citra Solv, citrasolv.com Dr. Bronner’s, drbronner.com Earth Friendly, ecos.com
Mrs. Meyers, mrsmeyers.com Seventh Generation, seventhgeneration.com Simple Green, simplegreen.com Young Living, youngliving.com
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TMJ–the master link A properly functioning temporo-mandibular joint is crucial to a horse’ s well being and performance.
by Heather K. Mack, VMD
orses rely heavily on the proper function of the temporo-mandibular joint (TMJ). The ability to move the jaw correctly – side to side, forward and back, up and down – affects not only their ability to masticate, which is the very first step in proper digestion, but also body balance and biomechanics. Yet proper TMJ function often gets overlooked by veterinarians. I practice and teach a dental paradigm based on the principle that the TMJ is the “master link” in equine biomechanics. In balanced equine dentistry, we work toward maintaining equilibrium or a balanced state of repose between two or more antagonistic forces that exactly counteract each other. In doing so, we adjust the angles and planes of the cheek teeth and incisors. This maximizes the surfaceto-surface contact between these biophysical planes and achieves optimal jaw biomechanics. Ultimately,
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we are looking to achieve three-point harmony between the incisors, molar tables and TMJ.
Anatomy The TMJ is a complex array of bones, muscles, ligaments, fascia, nerves and cartilage. It is a synovial joint between the condyles of the mandible and the temporal bone. It is a very strong, tight encapsulated joint with an articular disc that allows for the gliding movement of the condyle. The horse’s TMJ is considerably more complex than a human’s because of three factors: 1. I t is connected to the ears and horses have movable ears with 20 or more muscles. 2. The hyoid bone articulates with the temporal bone. 3. H orses have teeth erupting continuously throughout their lives.
The function of the pterygoid muscles is to pull the mandible from side to side.
Bones
1
The temporal bone is the most cranial bone in the TMJ mechanism. It is part of the maxilla. It is also home to the auditory or Eustachian tube. This is where balance and equilibrium are recorded through the vestibulocochlear nerve. Tightness in the muscles or temporo-mandibular joint disorder (TMD) can adversely affect the horse’s balance and proprioception. Also, the trigeminal nerve rests on the inside of the temporal bone. One of the three branches of the trigeminal nerve is the motor nerve to the muscles of mastication.
2
The mandible at birth consists of left and right halves that have a cartilaginous joining at the center, much like the pubic bone of the pelvis. These two halves fuse together and become a complete jawbone when the horse is two to three months old. The mandible is considered one of the most important “pattern setters” in the body. A pattern setter is a body part or condition that sets up patterns of habitual compensatory movement in other parts of the body. The “right handedness” of a horse, for instance (see sidebar), can often be dissected back to TMJ dysfunction. I believe this is also why limited range of motion in the TMJ can cause limited or asymmetric pelvic movement.
the cranium, or sphenoid bone, and insert onto the medial aspect of the mandible. The function of the pterygoid muscles is to pull the mandible from side to side. Horses with TMD often exhibit great discomfort when palpating the medial pterygiod muscle trigger point. The horse by nature is a grazing animal, and will graze up to 16 hours a day if allowed. When the head is dropped down in the grazing position, the mandible comes down and forward in the joint capsule and the atlantoaxial joint opens. This relaxes the muscles and connective tissue around the TMJ, and the upper and lower molars achieve proper contact. Many performance horses are kept in stalls and fed from hay bags or elevated feeders. This does not promote healthy TMJs.
Symptoms of TMD These are many and varied and include low performance levels, imbalanced gaits or lameness, uneven tooth wear, head shaking, cribbing, teeth grinding, signs of headache, behaviors such as spookiness, ADD, ear sensitivity, head shyness and bitting difficulty, being a poor keeper, muscle wasting (especially on the top line), difficulty flexing the poll and engaging the hindquarters, and an unwillingness to change leads.
3
The hyoid apparatus is group of seven bones that cradles the larynx and pharynx, connects to the tongue and articulates with the temporal bone. Excessive tongue pulling, cribbing, throat surgery, and even chronic cough can create restriction in the hyoid apparatus, which can adversely affect the TMJ.
Muscles Though several muscles are responsible for jaw movement, I will review the three that are most influential and palpable. • The masseter muscle is the largest. It can be easily observed while a horse is chewing. It brings the upper and lower jaws together. • The temporalis muscle is the next major muscle and also easily observable. It works in conjunction with the masseter muscle. Its primary function is to close the mandible. • The pterygoid muscles attach from the central bone of integrative veterinary care
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The right-handed horse withers to allow the head to go forward and down, lift the lower cervicals and engage his hindquarters. Pain in the jaw will likely kill the desire for specific movements and sometimes for any movement at all. The most common causes of restricted A/P motion are: • Incisor abnormalities, especially overjet or overbite • ATRs (accentuated transverse ridges) • Hooks on lower 11s or upper 6s • Missing molars • Wave complexes
• Incisor wedge sending maxilla to right, mandible to left. • Atlas superior on left. • Horse camps on left front leg, has larger left foot, often more prominent shoulder muscles, often hollow behind left shoulder. • Pelvis is most often in reciprocal relation with the jaw, creating a right posterior ilium. In other words, the pelvis is rotated forward and upward on the right. • A full 75% of horses I see have a reciprocal pelvis to the incisor wedge; 25% mirror the wedge. Dr. Judith Shoemaker taught me almost two decades ago that horses have different levels of proproiceptive awareness. Some try hard to correct their imbalances, while others just adapt to leaning. • Ribcage expanded on left, contracted on right. Already bending to right and very difficult to bend left. • Tail often held to left.
How it affects riding Most riders use reins to communicate with their horses. They expect the horse to interpret their signals. If there is pain or imbalance in the TMJ, the signals are polluted. Any deviation from normal will alter the rider’s communication. If she asks the horse to move to the left by picking up the rein and adjusting her body, and it causes him pain, it is actually telling him not to go forward. The horse starts to break down millisecond by millisecond. First he will perceive a physical inability which soon turns into an emotional situation. He will not feel good because he cannot do what the rider is asking. The balance of the teeth determines the readiness of flexion which must be obtained and maintained to facilitate correct maneuvers. If a horse’s jaw is restricted in anterior-posterior (A/P) motion, he cannot drop his jaw into neutral, raise his
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By paying closer attention to the balance and function of the TMJ in your equine patients, you can help preserve their overall health and performance levels.
Dr. Heather Mack graduated from the University of Pennsylvania School of Veterinary Medicine in 1991. In the early 1990s, she received certification from both the
International Veterinary Acupuncture Society (IVAS) and the American Veterinary Chiropractic Association (AVCA). She began her studies of Traditional Chinese Medicine and acupuncture in 1985 while attending Columbia College. She runs an Equine Sports Medicine practice and has been breeding, raising, training, observing herd dynamics and healing horses at her Mystic Canyon Ranch in Idaho for over 14 years. balancedequinewellness.com
References Gronberg, Pauli. (2002) ABC Of The Horse, A Handbook of Equine Anatomy, Biomechanics, and Conditioning. www.pg-team.fi. May, Kevin J., DVM. (2008) Interrelationships Between Equine Acupuncture, Chiropractic And Dentistry. Procc. of 34th IVAS 2008 international congress, Keystone, CO, USA. Rooney, James R. Clinical Neurology of the Horse. KNA Press Inc. 1971 June, First Edition. Upledger, John E., DO, FAAP. Craniosacral Therapy II, Beyond The Dura. Eastland Press Inc. 1987 Willoughby, Sharon L., DVM, DC. (1992) Sacropelvic Module
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events 57th Annual AAEP Convention November 18-22, 2011 San Antonio, TX Shift into the future of equine health care. Stay in-step with the best practices in your profession. Commit to growing alongside your colleagues during the AAEP’s 57th Annual Convention in San Antonio, Texas. This year’s educational program presents opportunities to learn: • New versatile skills for ambulatory scenarios, including needle-free injections and field anesthesia • How to apply breakthrough epidemiological research to your daily practice • Implications for the use of stem cell therapies and other biologic drugs to treat orthopedic problems • How to utilize imaging like the experts to improve diagnostic accuracy • How to utilize the latest reproductive techniques to optimize outcomes • Applying service excellence to your veterinary practice and its impact on your client’s satisfaction and your business success. For more information: (859) 233-0147 aaepoffice@aaep.org www.aaep.org/convention.htm
Comprehensive Clinical Cardiology December 3-4, 2011 Toronto, Ontario, Canada Join Sonya Gordon, DVM, DVSc, DACVIM (Cardiology) and Michael O’Grady, DVM, MS, DACVIM (Cardiology) for a two-day (12 hours of CE credit) in-depth training in canine and feline cardiology. The program will utilize an interactive approach to provide an up-to-date, practical and clinically relevant review of heart disease in the dog and cat. The goal is to enhance clinical knowledge while augmenting participant abilities to identify the subtleties of diagnosis, prognosis and management strategy in clinical cardiology cases. Emphasis will be to facilitate the incorporation of these tools into clinical practice using a practical case-based approach. For more information: Anne Behnan (800) 375-7994 ext. 224 abehnan@lifelearn.com www.lifelearn.com
Timely Topics in Internal Medicine December 4, 2011 Course Director: Linda Ross, DVM, DACVIM The 13th annual Timely Topics in Internal Medicine conference is scheduled for December 4, 2011 in the Agnes Varis Campus Center (Building O on the campus map) at Tufts University. Linda Ross, DVM, DACVIM and associate professor in the Department of Clinical Sciences at the Cummings School of Veterinary Medicine, will be the course director. This conference is 6 hours of Continuing Education credit. The registration fee is $199. Registration includes lectures, laboratory and course notes on a CD (printed notes are available for an additional charge of $10.) Both online registration form and a PDF registration form are available. For more information: (508) 839-5302 http://vet.tufts.edu/
Practical Veterinary Seminars December 4, 2011 The Best Western Plaza Hotel – Honolulu, HA Surgery of the Anus, Ear and Stomach will be covered. These presentations will include conditions encountered; with the anal area of dogs. Perianal fistulas & anal sac disease; with the ear and surgical corrections including TICA and with the Stomach including GDV surgery. All will be covered in a practical descriptive manner, A “must hear” for all SA practitioners. Also new products will be discussed. For more information: Dr. M. Joseph Bojrab (702) 219-2507 drbojrab@aol.com www.drbojrab.com
Can I Really Communicate with my Animal? Wednesday, December 14, 7-8 p.m. ET & Thursday, January 5, 7-8 p.m. ET International Tele-seminar with Sue Becker Join Sue Becker for this one-hour FREE telephone seminar and discover what animal communication is all about. Is it really possible for you? What is involved? What can you learn from them? Can anyone connect telepathically with their animal buddy, or is it a special gift? What about wild, non-domesticated species? Get answers to these and many other questions in this fascinating
class. Bring your own questions as well! Sue Becker, BFRAP, BFRP, CTTP is an internationally known animal communicator and consultant, instructor and writer. She has worked with thousands of animals of many different species and holds recognized practitionerships in Bach Flower Remedies both for animals and humans, Tellington TTouch Method, Reconnective Healing, and has extensive training in many other physical and energy modalities. For more information: 519-896-2600 suebecker@cyg.net www.suebecker.net
2012 AVMA Veterinary Leadership Conference January 6-8, 2012 InterContinental Hotel – Chicago, IL The VLC offers a robust three days of networking and workshop opportunities designed with you in mind. Tracks for current and emerging leaders, as well as state and allied representatives, are offered. This conference is also open to all veterinary professionals interested in learning more about leadership, team building and how the AVMA works with you and for you. New this year, receive continuing education credit for attending select sessions. Registration Fee: $295/person Deadline: December 16, 2011 For more information: (800) 248-2862 www.avma.org/about_avma/governance/vlc/ default.asp
NAVC Conference 2012 January 14-18 2012 Orlando, Florida The NAVC Conference 2012 offers more than 1,300 hours of enriching CE opportunities, so whether you are a veterinarian, veterinary technician, practice manager or other staff, you will return home with new and practical knowledge designed just for YOU. For more information: (800) 817.9928 www.navc.com/navc-conference
P o s t y o u r e ve n t o n l in e at: IVCJournal.com 46
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integrative veterinary care
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THE THENA NA TTURAL URALORAL ORALCARE CARE REMEDY REMEDYTHAT THAT VETERINARIANS VETERINARIANSCOUNT COUNTON. ON.
VetzLife VetzLife Oral Oral Care Care are are the the products products more more and and more more Veterinarians Veterinarians trust trust toto remove remove plaque plaque and and control control tartar tartar inin companion companion animals. animals. With With VetzLife VetzLife Veterinarians are able toto prescribe aa professional strength solution that Veterinarians are able prescribe professional strength solution that naturally softens and eliminates tartar, freshens bad breath and has even naturally softens and eliminates tartar, freshens bad breath and has even proven toto reverse oral disease. It’sIt’s the perfect alternative toto dental scaling proven reverse oral disease. the perfect alternative dental scaling - especially when companion animals can’t tolerate anesthesia, and forfor - especially when companion animals can’t tolerate anesthesia, and preventing plaque preventing plaque and tartar build after dental treatments. And best and tartar build upup after dental treatments. And best ofof all, 100% natural, 100% safe, 100% guaranteed and easy use. all, it’sit’s 100% natural, 100% safe, 100% guaranteed and easy toto use.
Sold Sold inin over over 6,000 6,000 clinics clinics
Proven. Proven. Professional. Professional. Profitable. Profitable. Oral Oral Care. Care. See See you you at:at: NAVC NAVC Conference, Conference, Orlando, Orlando, FL FLJanuary January 14-18 14-18
Please Please contact contact your your favorite favorite VetzLife VetzLife distributor distributor salesperson: salesperson: MWI MWI Veterinary Veterinary Supply, Supply, Penn Penn Veterinary Veterinary Supply, Supply, Midwest Midwest Veterinary Veterinary Supply, Supply, H&H H&H Wholesale, Wholesale, FirstFirst Veterinary Veterinary Supply, Supply, VetsVets International, International, Hawaii Hawaii Mega-Cor Mega-Cor
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integrative veterinary care
Proudly Proudly made made in the in the U.S.A. U.S.A. www.vetzlife.com www.vetzlife.com 888-453-4682 888-453-4682
