Innovative VOLUME 10 ISSUE 1
VETERINARY CARE
4 INTEGR ATIVE APPROACHES TO PAIN YOUR PRACTICE CAN BENEFIT FROM TECHNOLOGICAL ADVANCES IN PAIN MANAGEMENT, FROM LOW-LEVEL LIGHT THERAPY TO HYPERBARIC OXYGEN THERAPY. – P. 10
www.IVCJournal.com
WINTER ISSUE 2019/2020
FEEDING INDOOR CATS FOR OPTIMAL HEALTH
UNDERSTANDING EQUINE METABOLIC SYNDROME
A CLOSER LOOK AT THE“OTHER”CANNABINOID
HOW MBRT CAN CHANGE BEHAVIOR FOR THE BETTER
An investigation into physiology explains why the diets of indoor cats need to model those of their wilder relatives. – P. 17
We know CBD has a variety of medical and veterinary indications…but does THC have a part to play? – P. 36
5 WAYS TO REVITALIZE YOUR PRACTICE
Stuck in a rut? Here are five simple ideas that will help rejuvenate yourself and your practice. – P. 26
Research sponsored by the Morris Animal Foundation is helping to unravel the complexities of EMS. – P. 52
Positive shifts in behavior may arise from Microbiome Restorative Therapy (MBRT) in companion animals. – P. 22
TCVM FOR GERIATRIC ANIMALS
Traditional Chinese Veterinary Medicine offers an effective two-pronged approach to treating older patients. – P. 60
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contents FEATURES
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4 INTEGRATIVE APPROACHES TO PAIN USING VETERINARY TECHNOLOGY
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NUTRITION NOOK
By Jessica Dreyfuss, DVM, CVA, CCRT, CVFT
From low-level light therapy to hyperbaric oxygen therapy, technological advances in pain management for animal patients are a boon to veterinary practice.
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FEEDING THE INDOOR CAT FOR HEALTH AND LONGEVITY
By Chris Bessent, DVM, MSOM, Dipl. OM, L.Ac.
Feline physiology explains why the diets of indoor cats need to model those of their wilder relatives.
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BEHAVIORAL CHANGES RESULTING FROM MICROBIOME RESTORATION
By Margo R. Roman, DVM
The potential of Microbiome Restorative Therapy (MBRT) to positively affect behavior in companion animals.
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5 IDEAS TO REVITALIZE YOUR PRACTICE
By Cheryl A. Cross, DVM, DACVP
Stuck in a rut? Here are five simple ideas that will help revitalize you and your practice.
INNOVATIVE PRACTICE TM
FEAR FREE APPROACH TO PAIN MANAGEMENT IN COMPANION ANIMALS
By Anne C. Hermans, DVM, CVH (AVH)
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TESTING THE CANINE HEALTHY SOIL HYPOTHESIS
By Steve Brown, Natasha Lilly, DVM, CVA, and James Pendergast
Is healthy soil the secret ingredient to better health for dogs? This article tells you how to participate in the groundbreaking research being done by the Canine Healthy Soil Project.
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CASE STUDY
By Barb Fox, DVM
Integrating essential oils into the treatment plan for a cat with severe oral trauma.
EQUINE METABOLIC SYNDROME
By Kelly Diehl, DVM, MS, Dipl. ACVIM
Research sponsored by Morris Animal Foundation is helping unravel the complexities of EMS.
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ACUPUNCTURE AND ANALGESIA IN VETERINARY MEDICINE
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THE TCVM APPROACH TO GERIATRIC ANIMAL CARE
By Neal J. Sivula, DVM, PhD, FAAVA, MDiv
An exploration of how this ancient modality treats pain in animal patients.
By Michelle Tilghman, DVM, CVA, CCRP
When treating older animals, the first goal is to diagnose and alleviate pain, and the second is to restore quality of life. Here’s how TCVM can help accomplish both aims.
Developed by a veterinarian, this initiative approaches the management of painful patients in a way that leads to improved outcomes and a rewarding therapeutic experience.
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THE“OTHER”CANNABINOID... DOES THC HAVE A ROLE IN VETERINARY MEDICINE?
By Karen Gellman, DVM, PhD
In the last issue, we looked at veterinary indications for CBD. We now explore questions surrounding THC, the “other” cannabinoid.
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advisory board
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Dr. Richard Palmquist, DVM GDipVCHM(CIVT) CVCHM (IVAS), graduated from Colorado State University in 1983. He is chief of integrative health services at Centinela Animal Hospital in Inglewood, California, former president and research chair of the AHVMA, and an international speaker in integrative veterinary medicine. Dr. Palmquist is a consultant for the Veterinary Information Network (VIN) and a past president of the AHVM Foundation. He has published two books, one for conventional veterinarians and a second for clients discussing how integrative thinking works. 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. She is co-owner of The Healing Oasis Veterinary Hospital, offering massage, rehabilitation, chiropractic and Chinese and Western Herbology. Michelle completed the Chinese Herbal Medicine program from the China Beijing International Acupuncture Training Center, and is certified in Chinese Medicine by the Wisconsin Institute of Chinese Herbology.
COLUMNS & DEPARTMENTS
8 Editorial 16 From the NASC 33 From the VMAA 34 Innovation awards 40 Profitable practice
— Digatherm
46 Industry innovations 51 From the AATCVM 59 From the AVH 64 From the VBMA 65 Marketplace 66 News bites
Dr. Joyce Harman, DVM, MRCVS, graduated in 1984 from Virginia Maryland Regional College of Veterinary Medicine. Her practice is 100% holistic, using acupuncture, chiropractic, herbal medicine and homeopathy to treat horses to enhance performance and those with a variety of chronic conditions, with an emphasis on Lyme Disease. Her publications include the Pain Free Back and Saddle Fit Books, and numerous articles in lay and professional magazines. She maintains an informative website: www.harmanyequine.com. Dr. Steve Marsden, DVM, ND, MSOM, Lac. Dipl.CH, CVA, AHG lectures for IVAS, the AHVMA, the AVMA, and numerous other organizations. He is co-founder of the College of Integrative Veterinary Therapies and is a director emeritus of the National University of Natural Medicine in Portland OR. He authored the Manual of Natural Veterinary Medicine (Mosby); and Essential Guide to Chinese Herbal Formulas (CIVT). Dr. Marsden is extensively trained in alternative medicine, including Chinese herbology, acupuncture and naturopathic medicine. He has holistic veterinary and naturopathic medical practices in Edmonton, Alberta. In 2010, Dr. Marsden was named Teacher of the Year by the AHVMA; and Small Animal Veterinarian of the year by the CVMA in 2009. Dr. Jean Dodds, DVM, received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she moved to Southern California to establish Hemopet, the first non-profit national blood bank program for animals. Dr. Dodds has been 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. Barbara Fougere, DVM, CVAA graduated in 1986, and was named the American Holistic Veterinary Medical Association Educator for 2011. Dr. Fougere is the principal 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.
Dr. Christina Chambreau, DVM, CVH, graduated from the University of Georgia Veterinary College in 1980. She is a founder of the Academy of Veterinary Homeopathy, was on the faculty of the National Center for Homeopathy Summer School and has been the holistic modality adjunct faculty liaison for the Maryland Veterinary Technician Program and is the former Associate Editor of IVC Journal. Dr. Chambreau teaches classes in homeopathy for animals, lectures on many topics, speaks on Radio and TV, and is the author of the Healthy Animal’s Journal among other titles. She is now on the faculty of the Holistic Actions Academy, which empowers members to keep their animals healthy with weekly live webinars.
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WINTER 2019/2020
EDITORIAL DEPARTMENT Editor-in-Chief: Dana Cox Managing Editor: Ann Brightman Associate Editor IVC: Laurin Cooke, DVM Associate Editor: Emily Watson Senior Graphic Designer: Dawn Cumby-Dallin Senior Graphic Designer: Alyssa Dow Social/Digital Media Manager: Elisabeth Dunphy Web Design & Development: Lace Imson
COLUMNISTS & CONTRIBUTING WRITERS Chris Bessent, DVM, MSOM, Dipl. OM, L.Ac. Bill Bookout Steve Brown Carmen M.H. Colitz, DVM, PhD, DACVO Todd Cooney, DVM, CVH Cheryl A. Cross, DVM, DACVP Kelly Diehl, DVM, MS, Dipl. ACVIM Jessica Dreyfuss, DVM, CVA, CCRT, CVFT Barb Fox, DVM Karen Gellman, DVM, PhD Jodie Gruenstern, DVM, CVA, VP of VMAA Anne C. Hermans, DVM, CVH (AVH) Cynthia Lankenau, DVM Natasha Lilly, DVM, CVA Terri McCalla, DVM, MS, DACVO James Pendergast Margo R. Roman, DVM Judith E Saik, DVM, DACVP, CVA, CVCH, CVFT Neal J. Sivula, DVM, PhD, FAAVA, MDiv Michelle Tilghman, DVM, CVA, CCRP
ADMINISTRATION & SALES Publisher: Redstone Media Group President/C.E.O.: Tim Hockley Accounting: Susan Smith Circulation & Office Manager: Libby Sinden
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IVC Journal (ISSN 2291-9600) is published four times a year by Redstone Media Group Inc. Publications Mail Agreement #40884047. Entire contents copyright© 2019. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: November 2019. improving the lives of animals... one reader at a time.
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contributors 1
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1. CHRIS BESSENT, DVM, MSOM, Dipl. OM, L.Ac.
Dr. Chris Bessent has over 30 years of experience in veterinary medicine, and has certificates in veterinary acupuncture, veterinary chiropractic, and veterinary Chinese herbology. She also received her degree in veterinary nutrition and founded The Simple Food Project, formulating freeze-dried raw food diets for cats and dogs using nothing but whole foods. Currently, Dr. Bessent divides her time between The Simple Food Project and Herbsmith, a manufacturer of premium, quality supplements for pets. Both are owned and operated out of her facilities in southeastern Wisconsin (simplefoodproject.com, herbsmithinc.com).
2. CHERYL A. CROSS, DVM, DACVP
Dr. Cheryl Cross is a veteran of both academic and private practice integrative veterinary medicine. Her small animal specialty practice incorporates acupuncture, LASER therapy, medical massage and myofascial work, Chinese and Western botanical medicine, and physical rehabilitation. In 2011, she co-founded the Integrative Medicine Service at the University of Tennessee College of Veterinary Medicine and provided student education and clinical service until 2015. Her specialty practice in Knoxville, TN aims to provide down-toearth and evidence-informed care that honors the roots of traditional medicine.
3. KELLY DIEHL, DVM, MS, Dipl. ACVIM
Dr. Kelly Diehl received her DVM from the University of Tennessee and started her career in an emergency clinic in New Jersey. She completed an internship at the Animal Medical Center in New York City, after which she moved west, completing a residency in small animal medicine at Colorado State University. Dr. Diehl joined the staff of the Veterinary Referral Center of Colorado as the co-owner of the internal medicine section. After 14 years, she left private practice to pursue a career in medical communication and joined the Morris Animal Foundation team in 2013. Dr. Diehl is a board-certified small animal internal medicine specialist and a Certified Veterinary Journalist.
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8. NATASHA LILLY, DVM, CVA
Dr. Natasha Lilly graduated from UC Davis with honors and a focus on equine medicine, and has certifications in acupuncture (IVAS, 2010) and Chinese Herbal Medicine (Chi Institute, 2012). She has also worked and studied under Dr Barbara Royal at the Royal Animal Treatment Center, and under the continued mentorship of Dr. Jaymie Noland of Cal Poly, San Luis Obispo, where she applies her passion for holistic approaches in her California practice. In addition, Dr. Lilly continues to lecture and co-operates a working ranch. She explores solutions for big world problems that can be appreciated best through the eyes of nature. This has led her to begin working alongside top leaders and researchers in regenerative agriculture through the Center for Regenerative Agriculture at Chico State University. Dr. Lilly is a co-founder of the Canine Healthy Soil Project.
9. MARGO R. ROMAN, DVM
Dr. Margo Roman graduated from the Veterinary College at Tuskegee Institute of Alabama, and was on the faculty of Tufts University, teaching anatomy, physiology and acupuncture. She was the consulting veterinarian in an IACUC for Creature Biomolecule in Hopkinton, Massachusetts, studying osteogenic proteins. Dr. Roman’s integrative practice, Main Street Animal Services of Hopkinton (M.A.S.H.), offers chiropractic, physical therapy, massage, Reiki, acupuncture, herbs, conventional medicine and more.
10. NEAL J. SIVULA, DVM, PhD, FAAVA, MDiv
Dr. Neal Sivula received his DVM from the Ohio State University. He completed an Internship, Clinical Residency and PhD from the University of Minnesota. He is certified in acupuncture from the International Veterinary Acupuncture Society and also holds an advanced acupuncture certification from the American Academy of Veterinary Acupuncture. He is a principle teacher for the CIVT Advanced Certification in Neuro-acupunture.
4. JESSICA DREYFUSS, DVM, CVA, CCRT, CVFT
11. MICHELLE TILGHMAN, DVM, CVA, CCRP
5. BARB FOX, DVM
12. STEVE BROWN
Dr. Jessica Dreyfuss (JessPetVet.com) graduated with honors from Duke University and received her veterinary degree with honors from North Carolina State University. She then completed a Specialty Rotating Internship. Dr. Jessie is a Certified Veterinary Acupuncturist, a Certified Canine Rehabilitation Therapist and a Certified Veterinary Food Therapist. She is a teaching assistant instructor at the prestigious Chi Institute at the University of Florida Veterinary School, and the owner and Medical Director of Healing Paws Center (HealingPawsFL.com). Dr. Barb Fox is a member of the Veterinary Medical Aromatherapy Association and the American Holistic Veterinary Medical Association. She has been in veterinary practice for over 25 years and has devoted the past 12 years to holistic veterinary medicine. Dr. Fox also is a speaker for various holistic medicine conferences and is a contributing author to several holistic publications.
6. KAREN GELLMAN, DVM, PhD
Dr. Karen Gellman is a graduate of Cornell College of Veterinary Medicine, and has a doctorate in animal locomotion biomechanics. She has advanced training and certification in veterinary acupuncture and veterinary chiropractic, and has practiced these and other modalities since 1995. She has been a speaker for IVAS, IVCA, AVDF, IAED and the Danish Veterinary Chiropractic Association. Dr. Gellman is the educational director and teacher in the Postural Rehabilitation training course for veterinarians, and teaches biomedical research programs for high school students at Cornell. She is Research Director of Maximum Horsepower Research, and principle investigator of a current study on equine posture funded by the AHVMA.
7. ANNE C. HERMANS, DVM, CVH (AVH)
Dr. Anne C. Hermans graduated from the Cornell University College of Veterinary Medicine in 1990. She has practiced in many types of small animal practice on both the West and East coasts. In 2000, she was certified by the Academy of Veterinary Homeopathy and opened a holistic consulting practice. In 2014, she launched Norwalk Community College’s Veterinary Technology program, which was AVMA-CVTEA accredited in 2016.
Dr. Michelle Tilghman is a leading authority and much-sought practitioner of complementary veterinary medicine, which harnesses both the fundamental strengths of Western medicine and the proven practices of Eastern medicine. A graduate of the University of Georgia College of Veterinary Medicine, she has been in practice since 1982. She is the owner and chief practitioner of Loving Touch Animal Center in Stone Mountain, Georgia, which focuses on integrative medicine, blending Eastern and Western medicine as well as physical therapy for complete patient care. Steven Brown is a nutritional researcher, founder and formulator of the first AAFCO-compliant commercially-available raw food diet in the US. He is also the author of two better-selling canine nutrition books, and a frequent lecturer/speaker at veterinary and dog health-related conferences. Steve is a well-respected voice in the field of pet nutrition. He is passionate about helping pets by teaching veterinarians, industry professionals and pet parents about how to formulate and feed ancestral-style, fresh meat-based diets that meet US and European nutrient standards. Steve is a co-founder of the Canine Healthy Soil Project.
13. JAMES PENDERGAST
James Pendergast has worked for over 13 years for one of the largest raw pet food companies in the US as the Product Formulator and Veterinary Director. He brings with him unparalleled and professional pet food formulation experience, research and proven results. With the tutelage of Steve Brown, his approach pushes the boundaries when it comes to optimal age-specific pet nutrition, and he has collaborated with two leading holistic veterinarians to formulate some of the most groundbreaking prescription raw pet food recipes available today. An active consultant, both domestic and international, James shares Steve’s passion for helping pet food companies and industry professionals formulate diets that meet US and European standards. James is a co-founder of the Canine Healthy Soil Project.
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editorial
HAVING ANSWERS WHEN PAIN COMES TO CALL I recently attended a weekend veterinary conference in my hometown, one I look forward to every year for its range of timely and useful topics. I love this conference because there is always something for everyone in our diverse profession, with speakers presenting on diagnostic, surgical, dental, integrative and internal medicine, along with business management-related topics. I was thrilled to see that not only were there over 18 hours of lectures devoted to identifying, assessing and treating pain with integrative medicine and rehabilitation, but that these lectures were packed and attendees sought even more information from the speakers long after the official talks were over. Clearly, there is high demand for innovative ways to address pain in our patients. We have all experienced pain ourselves, whether acute or chronic, physical or emotional. Regardless of its source, pain can be unrelenting in its call to be heard and addressed. Trying to eat without really wanting to; trying to sleep without being able to truly rest; trying to interact with family without being able to really enjoy their company; trying to move through the day despite the pain‌regardless of species, pain is a barrier to engaging fully in life. One of the saddest parts of being a veterinarian is realizing when we have nothing left to offer a patient in pain. One of the most joyful is when we do. This issue explores many of the tools veterinarians might consider adding to their repertoire to alleviate pain. Our contributing authors cover a lot of ground. Dr. Neal Sivula presents the current scientific understanding of how acupuncture achieves analgesia. Alongside the many
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modern uses of this ancient modality are technological innovations, including laser therapy, PEMF, regenerative medicine and hyperbaric oxygen therapy, all covered by Dr. Jessica Dreyfuss. Meanwhile, Dr. Michelle Tilghman shines a light on the deep rewards of geriatric medicine and TCVM approaches to supporting our older patients. A discussion about “the other cannabinoid� is expertly navigated by Dr. Karen Gellman in her piece on THC; and a remarkable essential oil case study is presented by Dr. Barb Fox, showcasing the power and usefulness of essential oils for severe oral trauma. Modern veterinarians also have tools to assess and treat emotional pain created by fear, anxiety and stress. Dr. Anne Hermans explores the importance of the Fear FreeTM initiative when evaluating painful animals. Feeding indoor cats in a way that supports their physiology will go a long way towards maintaining a healthy pain-free body, and Dr. Chris Bessent explores this topic in her piece. We also invite you to consider the behavioral implications of Microbiome Restorative Therapy with Dr. Margo Roman,and encourage you to join the research team of the Canine Healthy Soil Hypothesis by enrolling your patients in this groundbreaking project. This is an exciting and rewarding time to be a veterinarian! With much gratitude for your noble work,
Laurin Cooke, DVM Associate Editor, drlaurin@ivcjournal.com
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PEER-REVIEWED
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INTEGRATIVE APPROACHES TO PAIN USING today’s veterinary technology BY JESSICA DREYFUSS, DVM, CVA, CCRT, CVFT
FROM LOW-LEVEL LIGHT THERAPY TO HYPERBARIC OXYGEN THERAPY, TECHNOLOGICAL ADVANCES IN PAIN MANAGEMENT FOR ANIMAL PATIENTS ARE A BOON TO VETERINARY PRACTICE.
Today’s veterinary technology offers unique opportunities for enhancing pain management protocols, and forming comprehensive multimodal approaches to pain. Clients are increasingly concerned about the immediate and long-term effects of pharmaceutical medications — these concerns, sometimes founded (or unfounded) by “Dr. Google” have led to an increased pursuit of therapies traditionally labeled as complementary or alternative. As a modern veterinarian, you can improve patient care plans and client trust by becoming familiar with and using these tools. In this article, we will provide a brief overview of several of the most commonly used integrative pain management tools in veterinary medicine today.
1. LOW-LEVEL LIGHT (LLT) THERAPY/ LASER THERAPY/ PHOTOBIOMODULATION The word “laser” stands for “light amplification by stimulated emission of radiation”. Therapeutic laser therapy has been established for decades in the human field. Veterinarians should be cognizant of the difference between a veterinary
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therapeutic laser and a light emitting diode (LED), which can easily be purchased online at a relatively low cost. LEDs utilize a broader range of wavelengths; therapeutic laser therapy typically utilizes wavelengths in the 600 nm to 1,070 nm range, which allows for deeper tissue penetration.1 Veterinary therapeutic laser therapy units (typically Class 3-4 lasers) can vary in a number of ways, including wavelength, power density, pulse structure and even polarization.1 Additional parameters can include options or exact settings for exotic animals versus small animals versus large animals. This modality is unique in that veterinary technicians can easily perform the therapy by utilizing preset therapeutic settings — these settings may include such labels as “intervertebral disc disease”, “wound” or “chronic inflammation”. The average time for a complete laser therapy session will depend on the number of points utilized, as well as the strength of the laser to deliver “x” number of joules per time unit — the average time can range from about four to 15 minutes total.
Treatment indications This modality can be utilized for several purposes, including but not limited to:1 • Wound healing — including chronic or acute skin conditions or post-operative incision sites • Decreasing pain and inflammation • Spinal cord or neurological injury2 • Post-dental cleanings and procedures • Preventative maintenance against sports-related injuries for agility dogs. Evidence for pain reduction has been demonstrated in several studies, including one in which laser-treated post-operative tibial plateau leveling osteotomy (TPLO) patients demonstrated greater healing and significantly improved peak vertical force analysis versus their untreated counterparts.3 Significant gait improvements were noted in another study that compared laser treated post-operative TPLO patients versus untreated.4 Human literature has also noted a reduction in the pain associated with knee osteoarthritis following treatment with high-intensity laser therapy. 5 How it works LLT functions in several ways, including: • Increasing adenosine triphosphate (ATP) production1 • Altering reactive oxygen species1 • Modulating level of cytokines1 • Stimulating the immune system1 • Stimulating neurogenesis1 More information The North American Association for Photobiomodulation Therapy (NAALT) offers you the opportunity to remain up to date on the latest research and more. Examples of companies that offer a variety of laser therapies are Companion, Cutting Edge and Respond.
2. REGENERATIVE MEDICINE/ STEM CELL THERAPY
Photo courtesy of Jessica Dreyfuss
Regenerative medicine involves the harvesting and utilization of the body’s cells in order to treat diseases. Results have been controversial. This author will examine one main subset of regenerative veterinary medicine — stem cell therapy. Other therapies in this arena may include “platelet rich plasma” (PRP) or platelet injections, or “plasma rich in growth factors” (PRGF) injections. Continued on page 12.
In order to protect the patient’s retina and ocular health, laser goggles (coined “Doggles”) are placed on the head during treatment.
Continued from page 11. Advanced veterinary training and an intimate knowledge of anatomy is necessary for the utilization of this technology. This procedure should be performed by veterinary professionals. Treatment indications In small animal medicine, stem cell therapy is typically utilized for orthopedic conditions, such as osteoarthritis or cartilage degradation in long bone joints. In a 2018 study examining over 200 stem cell-treated canine patients, 90% of dogs demonstrated marked improvement in mobility, and daily activity.6 However, it is interesting to note that the use of regenerative medicine has not been limited to degenerative orthopedic conditions. A recent 2019 study analyzing the use of mesenchymal stem cells to treat keratoconjunctivitis sicca (KCS) demonstrated a significant decrease in expression levels of such inflammatory markers as CD4, IL-6, IL-1 and more.7 How it works Mesenchymal stem cells (MSC) can be utilized for cartilage regeneration in animals.8,9 These cells are specifically selected due to their ability to take on the specific “morphophysiological aspects” of the cells around them, or overall plasticity.10 Cartilage regeneration is thought to be produced via:8 • Recruitment of endogenous cells • Differentiation into chondrocytes • Secretion of trophic factors for chondroprotection and immunosuppression.
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Interestingly, the harvesting of mesenchymal stem cells can be performed at a myriad of locations in the small animal, including but not limited to the umbilical cord, muscle, fat pads, synovial fluid, adipose tissue and bone marrow.8 Following selection and harvesting of the cells, they are typically transplanted intra-articularly.9 Within the equine world, stem cell therapy studies have demonstrated improvements following injections into tendons and ligaments.11,12 More information The North American Veterinary Regenerative Medicine Association (navrma.org) offers readers the latest research and developments of this tool.
3. PULSED ELECTROMAGNETIC FIELD (PEMF) THERAPY This is a form of electrotherapy that utilizes electromagnetic waveforms to treat tissues.13 PEMF therapy can differ in a number of ways — including but not limited to the strength of magnetic fields (measured in units of gauss), pulse width and pulse frequency, as well as targeted or non-targeted devices.13 Targeted PEMF therapy devices can be sold directly to veterinary clients. This can empower them with the ability to treat their pets from home. Treatment indication PEMF can be utilized for conditions such as edema, bone healing, wound healing, acute and chronic pain, as well as osteoarthritis and general inflammatory conditions.13 Continued on page 14.
Photos courtesy of Jessica Dreyfuss
From left to right: Baxter enjoys laser therapy during his acupuncture session for herniated disc treatment; Roxy receives laser therapy as part of a conservative management protocol for her partial cranial cruciate ligament rupture; Recently diagnosed with thoracolumbar disc herniation, Snuggle is given Assisi Loop treatment during his laser therapy.
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Continued from page 12.
VET TECHS AND EVEN CLIENTS CAN USE SOME OF THESE TECHNOLOGIES Some of the tools discussed in this article can easily be utilized by veterinary technicians as well as veterinarians, allowing for increased revenue per patient without the expenditure of doctor time. Certain modalities can even be sold to clients by veterinarians to allow pet owners to contribute to their animals’ pain management protocols from home, thereby deepening the humananimal bond.
Interestingly, this is one modality that has been approved by the FDA to treat conditions like post-operative pain as well as non-union fractures.13 In human medicine, this modality can be covered under Medicare and Medicaid. Research demonstrating effective pain control with this therapy abounds in today’s literature. One study demonstrated superior pain control in osteoarthritic dogs using a non-targeted PEMF device, as compared to treatment with Firocoxib (a nonsteroidal anti-inflammatory).14 Given this result, it is not surprising that PEMF devices have been advertised as “non-pharmaceutical anti-inflammatory devices” or “NPAIDs”.13 Significant pain control with PEMF therapy has also been established in human literature; daily targeted PEMF treatment of human subjects following breast surgery resulted in significant pain reduction and reduced use of pharmaceutical pain medications.15 How it works Targeted PEMF influences the nitric oxide (NO) molecules within the body, leading to reduced levels in inflammation. Other researched methods of action include the increased presence of heat shock proteins, affected cell membrane adenosine receptor expression, and more.13 More information This author would advise veterinarians to be diligent in utilizing PEMF devices that demonstrate research-based evidence in the veterinary field, since a plethora of PEMF and PEMF-like devices can be found online. More information on this category of products can be found at Respond Systems (respondsystems.com) as well as Assisi Animal Health (assisianimalhealth.com).
4. HYPERBARIC OXYGEN THERAPY (HBOT) Hyperbaric oxygen therapy involves breathing 100% oxygen under the presence of increased atmospheric pressure.16 Literature on this modality can be found in both human and veterinary journals. Unlike the previously mentioned modalities, HBOT requires significant financial investment and safety precautions in order to avoid explosions, given the high concentrations of oxygen required.17
Photos courtesy of Jessica Dreyfuss
Treatment indications HBOT is typically practiced as an adjunctive therapy. Conditions that can be addressed with this therapy include but are not limited to:16 • Wound healing16 • Carbon monoxide poisoning16 • Severe inflammation cases — such as sepsis, snake envenomation, ischemia, encephalitis and more18 Above: Penny receives cerebral treatment with Assisi Loop for her cerebellar abiotrophy condition; Turner (right) loves his bi-weekly treatments with Assisi Loop for cervical disc herniation.
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How it works Hyperbaric oxygen therapy targets molecular mediators of inflammation, including cytokines, nitric oxide (NO) and growth factors.16 This leads to decreased
edema and stimulation of angiogenesis, as well as recruitment of macrophages and more.16 These mechanisms of action can be especially groundbreaking in any clinical arena of decreased or lowered oxygenation within the body. For example, one study demonstrated that HBOT improved neurological outcomes following cardiac arrest and resuscitation.19 More information Additional research articles and information can be found at the Veterinary Hyperbaric Medicine Society website (vhbot.org).
CONCLUSION Modern veterinary technology offers a range of opportunities for multimodal pain management plans. Both human and veterinary literature has provided research-based evidence for the technologies discussed in this article. However, more research is necessary to elevate and understand the strength and reach of these therapies.
Chung, H, et al. "The Nuts and Bolts of Low-level Laser (Light) Therapy." Ann Biomed Eng. Vol. 40. (2)2012.
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Draper, WE, et al. "Low-level laser therapy reduces time to ambulation in dogs after hemilaminectomy: a preliminary study." Journal of Small Animal Practice. Vol. 53. 2012.
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Rogatko, CP, et al.“Preoperative low level laser therapy in dogs undergoing tibial plateau levelling osteotomy: a blinded, prospective, randomized clinical trial.” Vet Comp Orthop Traumatol, 30 (1): 46-53.
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Renwick, SM, et al. “Influence of class IV laser therapy on the outcomes of tibial plateau leveling osteotomy in dogs.” 47 (4): 5050 – 515. Vet Surg. 2018.
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Wyszynska, J, et al. “Efficacy of high intensity laser therapy in treating knee osteoarthritis: a first systematic review.” Photomedicine and Laser Surgery, Vol 36 (7). 2018.
5
Shah, K, et al. “Outcome of allogeneic adult stem cell therapy in dogs suffering from osteoarthritis and other joint defects.” Stem Cells International Volume. 2018.
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Sgrignoli, MR, et al. “Reduction in the inflammatory markers CD4, IL1, IL-6, and TNFalpha in dogs with keratoconjunctivitis sicca treated topically with mesenchymal stem cells.” Vol 31 (39), 101-525. 2019.
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Sasaki A, et al. “Mesenchymal stem cells for cartilage regeneration in dogs.” World Journal of Stem Cells, 26 11 (5): 254-269. 2019
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Kriston-Pal, E, et al. “Characterization and therapeutic application of canine adipose mesenchymal stem cells to treat elbow osteoarthritis.” Canadian Journal of Veterinary Research. 81 (1): 73-78. 2017.
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Markoski, MM. “Advances in the Use of Stem Cells in Veterinary Medicine: From Basic Research to Clinical Practice.” Scientifica. 2016.
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Godwin, EE, et al. “Implantation of bone marrow-derived mesenchymal stem cells demonstrates improved outcome in horses with overstrain injury of the superficial digital flexor tendon.” Equine Vet J. 44(1):25-32. 2012.
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Beerts, C. et al. “Tenogenically induced allogeneic peripheral blood mesenchymal stem cells in allogeneic platelet-rich plasma: 2-year follow-up after tendon or ligament treatment in horses.” Front Vet Sci. (4) 158. 2017.
SPOTLIGHT ON
OZONE THERAPY Do you use ozone therapy in your practice? O3Vets provides veterinarians with one of the most powerful tools you’ll ever put in your toolbox — one you probably don’t know much about yet, but which you’ll find indispensible. “Ozone therapy is probably the best thing I have added to my practice in my entire career,” says Dr. Judith Shoemaker, a respected veterinarian who has been practicing for over 40 years. Veterinarian Dr. Margo Roman agrees: “I don’t know how to practice medicine without it,” she stated in San Diego earlier this year. The truth is, nobody should practice veterinary medicine without ozone therapy. Here’s why. We have been programmed to need oxygen. Every minute of every day, our bodies — and those of our patients — are utilizing oxygen in an unknown number of ways to create energy and keep us alive. So when a patient comes into your clinic, you don’t have to guess whether or not he’s utilizing oxygen to carry out all the complex biological functions that keep him alive. In fact, we can safely assume that regardless of the diagnosis, increasing oxygen utilization at a cellular level will almost certainly result in a better prognosis, and possibly, a complete cure. This is how ozone therapy works.
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Gaynor, JS, et al. “Veterinary applications of pulsed electromagnetic field therapy.” Research in Veterinary Science. Vol 119 1-8. 2018.
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Pinna, S, et al. “The effects of pulsed electromagnetic field in the treatment of osteoarthritis in dogs: clinical study.” Pakistan Veterinary Journal, Vol 33 (1): 96-100. 2012.
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Rawe, A, et al.“Control of postoperative pain with a wearable continuously operating pulsed radiofrequency energy device: a preliminary study.” Aesthetic Plastic Surgery, 36: 458-463. 2012.
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Al-Waili, NS et al. “Effects of hyperbaric oxygen on inflammatory response to wound and trauma: possible mechanism of action.” The Scientific World Journal 6, 435-441. 2006.
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Hochman, L, et al. "Veterinary hyperbaric oxygen therapy: a critical appraisal." Plumbs therapeutic Brief. 2017.
By adding ozone therapy to your practice, you’ll boost the success rate of your clinic by adding a treatment that is: • Extremely safe • Easy for a technician to administer • Applicable for almost every patient • Has an incredible ROI.
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Braswell, C, et al. “Hyperbaric oxygen therapy.” Compendium: continuing education for Veterinarians. 2012.
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Rosenthal, R, et al. Hyperbaric oxygen reduces neuronal death and improves neurological outcome after canine cardiac arrest. Stroke, Vol 34 (5): 1311-1316. 2003.
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100% guaranteed — if ozone therapy doesn’t become one of your favorite treatments, we’ll refund your money and treat you to dinner! https://aw.honesto3.com/pets IVC Winter 2019/2020
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From the NASC CBD pet supplements — know the law and prioritize quality BY BILL BOOKOUT
Cannabidiol (CBD) is the hottest topic in pet health, and many animal parents are eager to understand its potential to help their dogs and cats. Chances are, you’re asked about CBD at least a few times a month — and this is good, because you want your clients asking you for information rather than consulting “Dr. Google”. But be sure to consider your risk for exposure when recommending or prescribing animal health supplements containing CBD. If you are a veterinarian who views CBD as a beneficial option for your clients, you should feel comfortable talking with your clients about it. Just ensure you know your state’s laws around whether this must be a discussion only, or whether you can recommend and dispense CBD products. Federally, CBD derived from hemp with less than 0.3% tetrahydrocannabinol (THC) was declassified as a Schedule I controlled substance under the 2018 Farm Bill. Unfortunately, many state laws vary,
as do the positions of the AVMA and state veterinary medical boards. Congress has publicly stated it encourages enforcement discretion for CBD animal products pending definitive guidance from FDA and its Center for Veterinary Medicine. Even if you practice in a state that allows veterinarians to recommend CBD, have a protocol in place for documenting that you’ve discussed and/or dispensed a CBD product. Good recordkeeping is essential and informed consent should also be documented. When considering CBD products to recommend, remember that product labels only tell part of the story. Scrutinize company marketing materials, including their websites. If they are making direct or implied claims suggesting the product will treat, prevent, mitigate or cure any disease in any of their materials, including product names, they are breaking the law and misleading consumers.
Don’t be afraid to pick up the phone and call the company to request studies that back up their product claims, and lab test results that confirm the product’s THC content is less than 0.3%. Also ask for proof that the CBD content meets label claims, and that the products are tested for microbial contaminants, heavy metals and pesticides. The NASC Quality Seal is an excellent way to identify a product from a responsible supplier. To earn permission to display the Quality Seal on their products, a supplier must pass a comprehensive facility audit every two years, maintain ongoing compliance with rigorous NASC quality requirements, and pass random independent product testing to ensure products meet label claim.
Bill Bookout is president and founder of the National Animal Supplement Council. He has more than 30 years’ experience in the animal health industry and holds a bachelor’s degree in physical sciences from the University of Wyoming, and a master’s degree from the Pepperdine University Presidents and Key Executives MBA program.
For more information The FDA held a public hearing in May 2019 and opened a public docket (FDA-2019-N-1482) to obtain scientific data and information about the safety, manufacturing, product quality, marketing, labeling and sale of products containing cannabis and cannabis-derived compounds. Visit ivcjournal.com/nasc-cbd to read written comments by Dr. Janet D. Donlin on behalf of the AVMA, as well as NASC’s written comments, which were accompanied by an Ingredient Risk Report from the NASC Adverse Event Reporting System (NAERS®). 16
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nutrition nook
FEEDING THE INDOOR CAT FOR HEALTH AND LONGEVITY BY CHRIS BESSENT, DVM, MSOM, Dipl. OM, L.Ac.
FELINE PHYSIOLOGY EXPLAINS WHY THE DIETS OF INDOOR CATS NEED TO MODEL THOSE OF THEIR WILDER RELATIVES.
As obligate carnivores, cats require animal protein. Domestic and wild felines have minimal ability to convert plant material into nutrients, relying instead on animal tissue in their diets to provide taurine and other essential amino acids, arachidonic acid, and preformed vitamin A. Feeding the indoor cat for optimal health necessitates a food that comes as close to the wild or feral feline diet as possible — ones that’s high in moisture and animal proteins, and low in carbohydrates. Recent research from UC Davis School of Veterinary Medicine supports these requirements. An examination of wild or feral cat diets showed a combination of rodent and small bird carcasses. The dietary analysis revealed 67% water content, 62% crude protein, 11% crude fat, 14.8% ash and 2% carbohydrate (nitrogen-free extract), with an average prey energy content of 3,929 kcal/kg DM. Interestingly, the diets of these wild cats exceeded the recommended allowances for fat, crude protein and essential amino acids set forth in the
National Research Council’s (NRC) 2006 publication, Nutrient Requirements of Dogs and Cats.1,2
WATER, DEHYDRATION AND CYSTITIS Cats are less sensitive to the sensation of dehydration than dogs are, and have a very weak thirst drive; therefore, they have a tendency to consume smaller volumes of water. However, the wild cat’s normal eating behavior may also play a role in water consumption. These felines tend to hunt and consume from six to ten small rodents and birds throughout the course of a day, nourishing their bodies periodically with small amounts of moisture from their prey. Cats are capable of producing very concentrated urine to conserve water. However, concentrated urine can be linked to inflammation of the bladder wall and a concentration of minerals leading to cystitis, crystal formation and subsequent urinary stone formation. Continued on page 18. IVC Winter 2019/2020
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Continued from page 17.
“CARBAHOLIC” INTERVENTION
Carbaholic cats are accustomed to crunchy kibble textures and animal digest palatants, so the key is to change the feline patient’s diet gradually. Instruct clients to start slowly, adding small quantities of real, fresh meat and ground organs to his kibble. Gradually, decrease the carbohydrateladen kibble and add more fresh meats. As the cat’s metabolism starts to correct, blood sugar decreases and becomes normalized, insulin receptors become more sensitive and in turn provide the tissue with the energy it needs. The cat will slowly become less ravenous, happier and healthier. Once he feels better, he’ll also become more active, which will normalize his body weight.
THREE CRUCIAL DIETARY REQUIREMENTS FOR CATS, FERAL OR DOMESTIC q High in moisture w High in animal proteins e L ow in carbohydrates 18
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When cats are dehydrated, it takes longer for them to restore their water balance by drinking alone, further evidence that supports their physiological need for dietary sources of moisture. If we want to nourish the indoor cat adequately, we need to give him foods high in moisture.
DIETARY PROTEIN AND AMINO ACID NEEDS Cats have a higher dietary protein requirement, and a particular need for dietary sources of amino acids. Required taurine comes from the tissues of the prey they consume. In the wild cat diet study, for instance, the combination of rodents and small birds had a taurine concentration of 0.92 +/- 0.33 g/16 g N, which is above the NRC recommendation.1,2 Taurine is an essential amino acid; cats cannot produce it from dietary sources of cysteine and methionine. Necessary for heart, eye and immune function, it is highly concentrated in meats and organs, particularly the heart, as well as seafood. There is little to no taurine in plant material, milk or eggs, so it must be obtained from meat proteins.
Taurine
Cats are also vulnerable to a deficiency of arginine, an essential amino acid. The combination of rodents and small birds in the wild cat diet study had an arginine concentration of 5.63 +/- 0.46 g/16 g N, also above the NRC recommendation.1,2 Even one meal without arginine leads to severe hyperammonemia. Catabolism of the high quantities of meat protein in carnivore diets leads to a large production of nitrogen, which needs to be converted and excreted as urea via the urea cycle. Arginine is necessary for this urea cycle conversion to occur. Without arginine, free urea and ammonia rapidly
Arginine
build up in the blood, leading to severe tremors, weakness, vomiting, ataxia and eventually coma and death. Fortunately, most to all meat-based diets have adequate levels of arginine.
UNIQUE VITAMIN AND MINERAL NEEDS Cats are unable to convert the amino acid tryptophan to the B vitamin, niacin; as such they require more dietary niacin than other animals. They are also unable to convert beta-carotene, found particularly in orange-colored fruits or vegetables, into the active form of vitamin A, retinol. The enzyme necessary to convert beta-carotene into retinol is underactive in the feline. Additionally, cats have a limited ability to convert 7-dehydrocholesterol in the skin to vitamin D, also necessitating a dietary animal source of this vitamin.
UNIQUE GLUCOSE BALANCE AND CARBOHYDRATE METABOLISM There are two ways to get glucose into a kitty’s body: one is via a dietary source of carbohydrates or sugars, and the other is through a conversion process called gluconeogenesis. The latter occurs when the amino acids from dietary proteins are converted into glucose. There is little ability to conserve amino acids in the body, so they
need to be used throughout the day, either as a component of protein synthesis or converted to glucose. Healthy cats tend to have consistent blood glucose concentrations, as carnivores maintain a constant state of gluconeogenesis throughout the day, with a slight increase in blood glucose levels immediately after eating.
WHAT HAPPENS IF A CAT IS SUBJECTED TO HIGH DIETARY CARBOHYDRATES? Remember, the combination of rodents and small birds in the study mentioned above had a carbohydrate concentration of only 2%.1 Kibble is notoriously high in carbohydrates because it is necessary to form and hold the kibble together during the extrusion process. Commercially available dry kibble diets for cats have up to 60% carbohydrates (mean 41%). The carbohydrate is broken down into glucose via pancreatic enzymes. The glucose is then absorbed and transported via the portal vein to the liver. Within the liver, the glucose is phosphorylated into the active metabolizable glucose-6-phosphate. The phosphorylation process requires two enzymes: glucokinase, which becomes active in high blood glucose levels, and hexokinase, which becomes active in low blood glucose levels. Cats have minimal activity rates of glucokinase and high activity rates of hexokinase. Glucokinase in the cat also cannot be upregulated or increased during times of high blood glucose. Compared to dogs and humans, cats have a reduced capacity to metabolize large amounts of glucose, resulting in higher blood glucose concentrations after a carbohydrate load. Cats also have an extended postprandial period of eight to 15 hours compared to two to three hours for humans and three to six hours for dogs. Feline physiology favors glucose formation via gluconeogenesis, not glucose spikes produced by dietary carbohydrates.
WHEN CATS EAT HIGH-CARBOHYDRATE DRY KIBBLE DIETS The cat’s liver does not have the enzymes to convert high blood glucose into the active metabolic form of glucose (glucose-6-phosphate). Consequently, after a cat eats kibble, his blood glucose remains high — much higher than an omnivore’s blood sugar, and for a longer period of time. Carnivores cannot rapidly respond to these spikes in blood sugars and are subject to longstanding hyperglycemia. Obesity from high glucose levels has reached epidemic levels in our cats, a reflection of the trend in people. Chronic high blood glucose associated with obesity leads to a cascade of physiologic events. High blood glucose signals the release IVC Winter 2019/2020
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Kremen NA, Calvert CC, Larsen JA, Baldwin RA, Hahn TP, Fascetti AJ. “Body composition and amino acid concentrations of select birds and mammals consumed by cats in northern and central California”. J Anim Sci. 2013;91(3):1270–1276.
1
of insulin from the pancreas. With time, the pancreas will eventually lose the “blood glucose battle”, which leads to an insensitivity of insulin receptors in the tissue. The buildup of hyper-produced and released insulin leads to hyperinsulinemia, which leads to abnormal fat deposition, obesity and constant unrelenting hunger. The vicious cycle continues, as the addiction to carbohydrates grows. The obese “carbaholic” cat is created by a chronic species-inappropriate diet consisting of high dietary carbohydrates.
National Research Council. Nutrient Requirements of Dogs and Cats — Animal Nutrition Series. Washington, DC: The National Academies Press, 2006.
2
References American Diabetes Association. “Diagnosis and classification of diabetes mellitus”. Diabetes Care. 2014;37(Suppl 1): S81–S90. Appleton DJ, Rand JS, Sunvold GD. “Insulin sensitivity decreases with obesity, and lean cats with low insulin sensitivity are at greatest risk of glucose intolerance with weight gain”. J Feline Med Surg. 2001;3(4):211–228. Bradshaw JWS. “The evolutionary basis for the feeding behavior of domestic dogs (canis familiaris) and cats (felis catus)”. J Nutr 136:1927S-1931S, 2006. Case LP, Daristotle L, Hayek MG, Raasch MF, Canine and Feline Nutrition Third Edition, Mosby, 2011.
As any pet parent of an obese “carbaholic” kitty knows, it is difficult to convert these cats to a species-appropriate, high-meat protein, low-carbohydrate diet. They refuse to eat. The pancreas is in overdrive producing insulin, and the tissue that is insulinresistant is screaming for energy. So the cat is hungry, doesn’t feel well, and frankly, is unwilling to buckle to any dietary change. To keep our indoor cats happy and healthy their entire lives, we must honor their physiology. Their nutritional needs are unique and their welfare requires a commonsense approach. Recommending a high-moisture, high-meat protein diet low in carbohydrates for your feline patients is imperative to their lifelong health.
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Crenshaw KL, Peterson ME. “Pretreatment clinical and laboratory evaluation of cats with diabetes mellitus: 104 cases (1992–1994)”. J Am Vet Med Assoc. 1996;209(5):943–949. Elliott KF, Rand J, Fleeman LM, et al. “A diet lower in digestible carbohydrate results in lower postprandial glucose concentrations compared with a traditional canine diabetes diet and an adult maintenance diet in healthy dogs”. Res Vet Sci. 2012;93(1):288–295. Goossens MM, Nelson RW, Feldman EC, Griffey SM. “Response to insulin treatment and survival in 104 cats with diabetes mellitus (1985–1995)”. J Vet Intern Med. 1998;12(1):1–6. Gottlieb S, Rand J. “Managing feline diabetes: current perspectives”. Vet Med (Auckl) 2018; 9: 33-42. Hewson-Hughes AK, Gilham MS, Upton S, Colyer A, Butterwick R, Miller AT. “Post-prandial glucose and insulin profiles following glucose-loaded meal in cats and dogs”. Br J Nutr. 2011;106(Suppl 1): S101–S104. Morris JG, Rogers QR. “Ammonia intoxication in the near adult cat as a result of a dietary deficiency of arginine”. Science 199(4327):431-432, 1978. Yu S, Rogers QR, Morris JG. “Absence of salt (NaCl) preference of appetite in sodium-replete or depleted kittens”. Appetite 29: 1-10, 1997. Zini E, Hafner M, Kook P, Lutz TA, Ohlerth S, Reusch CE. “Longitudinal evaluation of serum pancreatic enzymes and ultrasonographic findings in diabetic cats without clinically relevant pancreatitis at diagnosis”. J Vet Intern Med. 2015;29(2):589–596.
PRODUCT PROFILE
Hope Science uses cetylated oils to give the veterinary community something to smile about In dogs and cats, red bleeding gums can be telling signs of gingivitis, chronic gingivostomatitis or a form of periodontal disease. inflammation of the gingiva, submucosal tissues, and oral mucus membranes in addition to periodontitis can be extremely painful. In the past, the most common treatment for this condition was partial and at times a full mouth extraction of the pet’s teeth. However, in an ever-changing veterinary market, more practitioners are reaching for preventative solutions to help patients suffering from dental issues. One such solution is DentaPet — a cetylated oil product that stands out as a game-changer in the field of animal oral health. DentaPet is an oral capsule that’s been shown in both human and pet-based clinical trials to restore gingival tissue. According to Dr. Kim Vanderlinden, CEO and founder, what makes this product so unique is its active oil ingredients. DentaPet is comprised of cetylated oils derived by distilling beef tallow (fat). Cetylated oils are not the same as Omega-3 or fish oils and therefore are not a source of these essential fatty acids. Clinically, however, cetylated oils have demonstrated strong anti-inflammatory-like properties.
DEVELOPMENT AND RESEARCH Originally, cetylated oils were used with great success in an orthopedic product called Active Again. Used both topically as a pain cream and orally for joint health, cetylated oils were shown by clinical trials to be more effective for pain management than glucosamine and CBD. Dr. Vanderlinden was curious whether these oils could help treat other conditions. “I knew that, theoretically, the anti-inflammatorylike properties of these oils should provide similar results in conditions impacted by redness and inflammation,” he explains. When used to improve the gingival health of cats, for example, periodontal case reports far exceeded expectations. A university feline study found a major difference in cats before and after using DentaPet. Cats with a history of poor gum
3.375
Results — mm Periodontal Pocket depth
2.25
health received a cleaning every six months, during which the periodontal pocket depths (see Chart 1) and amount of bleeding (see Chart 2) were measured and recorded. After a 30-day trial using DentaPet — before a cleaning — the same measurements were recorded. Researchers found a dramatic reduction of bleeding and periodontal pocket depths compared to an olive oil placebo. DentaPet is medically sealed in capsules to ensure the product is sterile and hygienic. The capsule can be opened and the palatable paste applied to the animal’s outer gums, lips or paws to be licked off.
JOIN THE STUDY!
To join Hope Science in investigating how DentaPet can help cats with stomatitis, call 1-866-Natural (628-8725).
THE FUTURE OF HOPE SCIENCE AND DENTAPET Backed by outstanding clinical trials in North America, along with positive customer feedback, DentaPet is a major advancement for animal periodontal health. In fact, Dr. Vanderlinden guarantees the product’s success: “DentaPet helps so consistently that it is 100% guaranteed — see an improvement in your patient’s oral health or get a full refund.” After hearing from many veterinarians that DentaPet has been successful in treating feline stomatitis, Dr. Vanderlinden and the Hope Science team are interested in further defining and quantifying these benefits through a feline stomatitis trial. Any veterinarians interested in taking part in the research for this difficult condition are encouraged to participate by contacting 1-866-Natural (628-8725).
(Left) Chart 1 — Comparison of feline pocket depths between the DentaPet and olive oil placebo groups.
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Results — Impact of treatment BOP — % Bleeding on Probing
90
60 1.125
0.
Cetylated Start
Cetylated 6 weeks
Olive Oil Start
Olive Oil 6 weeks
(Right) Chart 2 — Comparison of the amount of bleeding during probing between the DentaPet and olive oil placebo groups.
30
0
Cetylated Start
Cetylated 6 weeks
Olive Oil Start
Olive Oil 6 weeks
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Behavioral Changes Resulting from Microbiome Restoration: AN INTEGRATIVE VETERINARIAN’S PERSPECTIVE BY MARGO R. ROMAN, DVM
THE POTENTIAL OF MICROBIOME RESTORATIVE THERAPY (MBRT) TO POSITIVELY AFFECT BEHAVIOR IN COMPANION ANIMALS. Evidence supporting the critical role of a well-functioning microbiome in the health of veterinary patients continues to grow. Research indicates that significant components of the immune response originate in the gut,1-6 supporting the claim that disease conditions may arise from damage to the gut’s microbiome.7-13 Exposure to antibiotics and other medications, as well as environmental toxins and poor diets can alter the microbiome, weakening the immune system and setting the stage for gastrointestinal illness (GI) and allergies.14-18 The widespread use of hand sanitizers, bleaches, antimicrobials and chemicals such as pesticides, herbicides and preservatives, could contribute to the depleted numbers of microbes being found in human infants and pets.19-24 There is now growing evidence that such damage may be ameliorated by fecal transplantation, and this therapy, while still in its infancy, is increasingly being utilized in both human and animal medicine.25-34 Microbiome Restorative Therapy (MBRT) is a term this author coined in 2012 (as opposed to the customary term Fecal Microbiota Transplantation or FMT) to better describe what this therapy actually does — restore the microbiome.
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MICROBIOME INOCULATION AND RATIONALE FOR MBRT
Mammalian transit through the birth canal at parturition results in microbial inoculation. This “vaginal gulp” occurs as the fetus emerges, bathed in vaginal fluid containing lactobacillus and other microbes. Recent research suggests that even prior to birth, fetuses ingest amniotic fluid, the individual’s first “meal” of microbes. 35 Further microbial exposure takes place as the newborn nurses and later explores its environment. In the wild, baby animals crawl around in a dirt den while the mother regurgitates the food she has eaten to feed them or offers recently killed prey. This initial inoculation of the microbiome is the beginning of the individual’s immune system. Individuals not receiving these microbiome inoculations as well as other healthy, normally-occurring environmental bacteria may lose immune strength due to deficient exposure.1-7 In humans, full-term C-section babies who do not get their initial inoculation from the birth canal benefit from an oral transfusion of their mother’s microbiome. 36
In the case of animals, coprophagia may be a natural way for them to try to replenish their microbiomes. Giving them a healthy, balanced microbiome by transplantation can reset the gut flora and stop the coprophagia and eating of other undesirable things. 37,38 Animals in the wild often eat particular plants and other substances that provide certain nutrients as well as diverse bacteria, an additional way to balance the microbiome.
CAVEATS ABOUT
BEHAVIORAL EFFECTS OF MBRT
Ideal donors should be generational holistically-raised and be naturally reared and organically fed as much as possible. They should be thin in their body weight and have positive happy dispositions. Donors should be free of chronic medical conditions and be screened for parasites such as hookworms, roundworms, whipworms and tapeworms. Consider a PCR test for Giardia, C. difficile, C. perfringens, E. coli and Salmonella. A fecal analysis from animalbiome.com (with a 16s DNA sequencing) can show possibilities of a variety of microbiome species. Additionally, ensure that fecal donors have not been exposed to environmental or dietary gut microbe-killing chemicals or herbicides.14,17,18
This author and her clinical colleagues have observed through years of working with MBRT that this therapy is beneficial not only for its physical healing qualities, but also for its effects on behavior, adding to the possible positive outcomes of fecal transplants in companion animals. We have witnessed in our veterinary clinic, or through client feedback, distinct behavioral and even personality changes in MBRT recipients. While we do not know why these behavioral changes occur, we posit that microbiome restoration appears to be at least partially responsible for this effect. We have observed an added dimension of mental health and behavioral improvements within just a few hours or days of this novel treatment, and appreciate this as a significantly different consequence from the typical positive outcomes of other holistic treatments. A better understanding of the role the gut plays in emotional and psychological well-being is timely and necessary, and can inform the possibility of incorporating fecal transplants into behavioral therapeutic approaches for animals as well as humans.
A “ONE HEALTH” APPROACH The “One Health” concept is a relevant paradigm from which to approach this issue. Published scientific and subjective accounts describe how some organ transplant recipients seem to suddenly take on emotions and characteristics unlike their own, but very similar to those of their donors.39-44 This effect has been documented in heart, lung, kidney, liver and other organ and body part transplant patients (although the most dramatic and long-lasting effects seem to occur with heart transplants) 45,46 This intriguing side effect of organ transplants raises interesting questions regarding the nature and mechanisms of some kind of cellular memory that would generate such changes. Likewise, when we hear compelling subjective accounts of similar personality changes after fecal transplants in humans, this raises questions regarding the possible emotional and behavioral effects of MBRT in our animal
DONORS
Enough is now known about predictable clinical treatment outcomes of MBRT to emphasize the vital importance of having pre-screened, healthy, happy, uncontaminated and varied fecal donors.
It is nice to have knowledge of the donors’ success rates. At mashvet.com, our donors have been used successfully for over 7,000 MBRT cases, and have been used by many other veterinary clinics in the US.
WHEN TO
REPEAT MBRT In some transplant cases, we have seen animals completely changed and healed after only one treatment. Others require repetition; one of our patients needed 19 transplants. The criterion for reinoculation is a recurrence of symptoms. However, some owners of formerly very ill animals elect to give their pets MBRT orally on a weekly, bi-weekly or monthly basis for optimal maintenance. The addition of nutraceuticals can also help the microbes thrive, while exposure to certain chemicals could cause transplant disruption. Which foods and chemicals can help or hurt the effects of MBRT is another area of research to be explored and developed. IVC Winter 2019/2020
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QUESTIONS FOR
FUTURE RESEARCH
1
Is there memory within cells, stem cells, and possibly even microbial DNA, projecting not only the functioning of those particular organs or microbes, but also the personality traits of the organ or fecal donor?
2
What are the mechanisms that make this communication or projection possible? Could part of the explanation be a holographic framework within cellular or microbial DNA?
3
As each organ has its own unique microbiome in addition to its host cells, could each of these microbiome populations have inputs that affect responses in the whole organism in emotional or other ways?
4
How does the hormonal level of an animal affect the expression and activity of the microbiome? Do hormones affect the ability of microbes to communicate with the body, brain and each other?
5 6
Do excess hormones in donor fecal matter directly affect the behavior of the recipient?50
How much does the placebo effect influence outcomes in evaluating MBRT behavioral changes in the veterinary clinical setting?
patients. It is this author’s opinion that providing information on behavioral effects in humans as a result of fecal and organ transplantation is an important segue to any discussion of analogous responses in other mammals who cannot explain in words what they are experiencing.
MBRT CASE STUDIES The following are brief observational accounts of behavior and personality changes in some of our patients, as well as a report from a client who experienced MBRT through her own medical team. Please note that in addition to MBRT treatments, each animal was provided with an overall integrative therapy approach that included several other holistic treatments. These combined treatment modalities appear to provide significant healing synergistic effects, so are deemed crucial in our treatment protocols. But it was only after receiving MBRT in particular that animals showed a marked change in their behaviors, usually occurring within hours to one or two days.
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1. An 11-year-old spayed calico cat, thin and fragile on physical examination, suffered from constant diarrhea for over 18 months, producing ten to 20 stools per day, following years of intermittent diarrhea treated with metronidazole. She frequently hid in the basement of her home, and was fearful of the family’s dog. Previous evaluations included extensive ultrasounds, blood work and fecal examinations. Less than two days after MBRT, her stools were normal, and she could be found sitting confidently on the couch and playing with the dog. To have such a complete change in both her stool consistency and behavior after years of illness — and in less than 48 hours following therapy — is very unusual, even in an animal treated with standard holistic care for inflammatory bowel disease. This cat continues to do well, has gained weight, and has had no further episodes of diarrhea. 2. An 18-month-old black Labrador had been raised and trained as an assistance animal. Unfortunately, as a puppy and even after extensive training that he otherwise responded favorably to, he was coprophagic and exhibited some anxiety. His behavior as an assistance animal was excellent, but eating his stool as soon as it dropped to the ground was unacceptable to the organization, so they sold the dog to a caring family. For over six months, his new family still could not break his habit of eating stools, and his anxiety remained. After a single MBRT treatment, his coprophagia ceased and his anxiety was no longer an issue. 3. A seven-year-old neutered Maine coon cat presented with a mangy coat from years of atopic dermatitis, previously treated with multiple courses of antibiotics, cyclosporine, antihistamines and steroids. Following MBRT from a oneyear-old Siamese male donor who had just been neutered, he not only started healing from his dermatitis but showed a much happier demeanor than before treatment. After subsequent MBRT treatments from the same donor, he started showing sexual behaviors not seen before. This case raises questions about the effects of fecal transplants from hormonally-charged donors. 4. A 35-year-old woman, a client of this author, suffered from an autoimmune disease with gut complications, and received three fecal transplants, each from a different donor, over a period of several weeks. The only identifying factors she knew about the donors were their ages and genders: an 11-year-old girl, a 25-year-old woman, and a healthy young man. With the young girl, she reported a dramatic change, feeling healthy, balanced and blissful. With the young
woman, while she was physically improved, she felt no emotional changes. With the third, she reported sweating copiously with the strong body odor of a man, which she intensely disliked. She was also up all night feeling much stress, anxiety and upset. Upon inquiring, she learned that that the male donor was a bodybuilder who had just broken up with his girlfriend and was quite upset. Was the transplant responsible for these intense physical and emotional effects?
MORE QUESTIONS THAN ANSWERS At this stage in medical science, study of the microbiome creates more questions than answers. There are more than 100 trillion microbes in a healthy human being — microbes which originated about 3,000 million years ago. A large percentage of microbes are in the gut; however there are microbes in every organ system. Medical science does not currently understand the full significance of each of the microbiomes throughout the body. Is it the organ that runs the system, or the microbiome within the organ that directs the individual’s health? What we do know from direct observation is that in the majority of our fecal transplant cases, the animals are livelier and happier and exhibit more vitality following MBRT. Researchers continue to appreciate the value of the microbiome and how it can influence neurotransmitters, serotonin growth factors, and many other aspects of cellular communication and survival.41 Research illuminating the connection between the gut and brain is finding that precursors to many enzymes and neurotransmitters are within the microbiome. 35,47-49 How this brain/gut association is connected to actual behavioral outcomes following MBRT is an area for much-needed research. Through further observation as well as scientific research, we will uncover a better understanding of this primordial creation that is basic to all life. For information on using MBRT in your practice, see IVC Journal (Fall 2014) or visit ivcjournal.com/mbrt-immune-system/.
Acknowledgements: Many thanks to Carvel Tiekert, DVM, Odette Suter, DVM, PJ Broadfoot, DVM, and Deborah Moore, PhD for their critiques and comments on an earlier version of this paper. Thanks also to my clients and their beloved pets for seeing the possible benefits of these procedures, and much appreciation to my own dogs and cat for their microbiome donations to others. References available at ivcjournal.com Used with permission from Integrative Veterinary Care Journal IVCJournal.com 866-764-1212
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5 IDEAS TO
REVITALIZE YOUR PRACTICE BY CHERYL A. CROSS, DVM, DACVP
Stuck in a rut? Here are five simple ideas that will help revitalize you and your practice.
Integrative veterinarians are a diverse bunch. We see multiple species and offer modalities that range from ancient to cutting edge. We are not immune, however, to feeling stuck in a “practice rut” at certain points. Do you feel as if you are no longer learning or being challenged? Have patient outcomes plateaued? Do you feel like you’re operating on autopilot? You’re certainly not alone; here are a few things to keep in mind as you work toward giving your practice the revitalization it needs to thrive.
PRACTICE DOES NOT ALWAYS MAKE PERFECT It’s a common assumption that the longer one is in practice, the more proficient one becomes. However, some studies actually
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reveal the opposite:1 time in practice is inversely proportional to outcome. Why this paradox? If we dig a little deeper, some usable information emerges that can help us give our clinics — and our minds — a boost.
1. IT’S REALLY HARD TO STAY CURRENT The importance of being up to date with scientific and technological advancements and their use is critical. Interestingly, hospitalists with higher caseloads had better outcomes irrespective of their time in practice.2 Researchers explain that this is less about patient numbers and more about maintaining ongoing experience of recognizing and treating acute illnesses using current best practices. For my practice, I
do a literature review every month on my primary focus areas, including herb-drug interactions and contraindications. As feeling isolated is also a risk factor for practice stagnation and dissatisfaction, consider joining an online forum or network, take CEs that you enjoy, or subscribe to email lists that send current research. All are potential ways to lighten the load of doing everything yourself, and to interact with colleagues in a supportive manner. Create an online file of articles you find helpful and invite others to view and contribute.
2. CROSS TRAIN WITH NEW MODALITIES AND TEACHERS Training3 with diverse teachers is an important part of my own practice. I have learned amazingly helpful skills from training courses for non-veterinary practitioners. It complements my own education and provides me with new tools I can utilize with my patients. We all tend to have our favorite teachers and styles, and approaches used by those trained elsewhere can lend a fresh perspective. If you’d like to work more with supplements or herbs, look into suppliers that drop ship or have patient fulfillment services if stocking inventory is limited by space or budget.
3. IMPROVED PATIENT OUTCOMES ARE DIRECTLY RELATED TO TIME IN PRACTICE WITH SPECIALTIES REQUIRING MANUAL DEXTERITY4 Acupuncturists, for example, not only have significantly improved tactile and fine motor skills over time due to increases in key brain areas, but they also have better emotion regulation.5 The longer the time in practice, the better the abilities. I’m right-handed, but have to acupuncture left-handed at times for patient comfort. I’ve found the more I practice switching hands, the easier it is. Look for work activities or hobbies to continue cultivating these gifts.
5. HEAL THYSELF We are often the last group to utilize for ourselves what we champion in our practices. If visiting a care provider isn’t feasible at this time, studies show sitting quietly for 15 minutes a day can be transformative6 for lowering stress, reducing anxiety and improving memory. Take lameness exams outside or simply take five minutes to walk a dog. Alarmingly, veterinarians are at significantly higher risk of suicide than the general population due to complex occupational stressors, depression, and burnout. The nonprofit organization Not One More Vet (nomv.org) provides multiple avenues of assistance including an online support group, and the AVMA has a list of mental well-being resources for veterinarians (avma.org/ ProfessionalDevelopment/PeerAndWellness/Pages/get-help.aspx). It’s imperative that we continue to prioritize our health and support one another. In fact, it’s a matter of life or death. Be well, friends. ncbi.nlm.nih.gov/pubmed/15710959
1
hbr.org/2017/05/do-doctors-get-worse-as-they-get-older
2
ivcjournal.com/education-clients/
3
journals.lww.com/academicmedicine/Fulltext/2004/10001/Deliberate_Practice_and_the_Acquisition_ and.22.aspx/
4
ncbi.nlm.nih.gov/pmc/articles/PMC3686711/
5
ncbi.nlm.nih.gov/pmc/articles/PMC3004979/
6
avma.org/ProfessionalDevelopment/PeerAndWellness/Pages/get-help.aspx
7
4. IT MAY BE YOUR PATIENT POPULATION More seasoned or specialist care providers often see more complex cases with an overall poorer prognosis. When I first began my practice, a typical client was one unfamiliar with the modalities I used but unwilling to euthanize their critically ill companion: “You are my last hope and if you can’t help, I have to euthanize the dog that saved my daughter’s life.” No pressure, right? There is no quick solution here — but looking at what types of patients comprise your practice load and evaluating if you still find them rewarding is a start. What might your ideal practice demographic look like?
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innovative practice
FEAR FREE APPROACH
™
TO PAIN MANAGEMENT IN COMPANION ANIMALS BY ANNE C. HERMANS, DVM, CVH (AVH)
Developed by a veterinarian, this initiative approaches the management of painful patients in a way that leads to improved outcomes and a rewarding therapeutic experience. Fear, pain, anxiety and stress may coexist in animal patients, challenging even the most experienced diagnostician and care provider. A painful animal may be fearful of examination, which could lead to a masking of symptoms due to elevated adrenaline or cortisol. The animal may also be overreactive in anticipation of painful handling, or may exhibit fear-based aggression. The body language signals of the fearful and painful animal are similar, and they can be difficult to differentiate. Approaching the case management of the painful (or potentially painful) patient in a way that minimizes
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confounding emotional and behavioral triggers leads to improved outcomes and a rewarding therapeutic experience.
WHAT IS THE FEAR FREE™ APPROACH? The Fear Free™ initiative was created by Dr. Marty Becker to benefit animals, their people and all veterinary professionals by reducing patient fear, anxiety and stress (FAS). Fear Free implements a range of specific behavioral and handling techniques, incorporates environmental modifications at home and in the clinic, and employs multi-modal alternative and conventional pharmaceuticals as indicated. In a Fear Free practice, every patient has an emotional record and owners are counseled about how to make the trip to the veterinarian a calmer event. Once in the clinic, thoughtful traffic flow and scheduling reduce the situational escalation of stress, and the environment is managed so every sensory experience is as low-stress as possible. Frequent food rewards and distraction with toys and other pleasant experiences build successful interactions. Communication, gentle handling, frequent patient assessment and adaptable therapeutic plans involve the entire veterinary team. Implementing Fear Free in your practice may be as simple or extensive as resources allow. The training builds naturally on the foundation of compassionate care, articulating specifically integrated steps and procedures. Fear Free certification is available to veterinarians, the veterinary support team, students and facilities. Commitment to the mindset and the holistic approach is a key step, and many improvements may be made even with existing equipment and infrastructure. The versatility and flexibility of the approach are showcased in the context of pain management by two Fear Free Continued on page 30.
FAS Scale Stop
High FAS
• Little to no interest in treats, toys, and/or attention
Level 5 | Severe signs of FAS with aggression such as growling, lunging, barking, hissing, snarling, and/or snapping. Intolerant of procedures.
• Fight, freeze, or flight response • Sedation + pharmaceutical/ nutraceutical PVP
Level 4 | Severe signs of FAS without aggression, such as immobility, fidgeting, escape behavior, dilated pupils, excessive panting (dog), increased respiratory rate, trembling, tense closed mouth, ears back, tail tucked or thrashing (cat). May or may not be accepting of any types of reinforcers. Not interested in interacting with team members and may be showing active avoidance (moving away).
Caution
Moderate FAS
• Moderate interest/ disinterest in treats, toys, and/ or attention
Level 3 | Displays more than 2 moderate signs of FAS occurring more than 4 times in a minute. May refuse reinforcements for brief moments. Might take treats roughly at times. May also be hesitant to interact with team members but not actively avoiding team members.
• Fidgeting, difficulty settling • Pharmaceutical/ nutraceutical PVP
Level 2 | Displays 1 to 2 moderate signs of FAS, such as ears slightly back or to the side, tail down, furrowed brow, slow movements or overly attention seeking, and/or panting with a tighter mouth (dog), occurring 4 or less times in a minute. Readily accepts reinforcement (treats, toys, and attention). Still soliciting social interactions with team members.
Go
Low FAS
• Readily accepts treats, toys and/ or attention
Level 1 | Displays 1 or 2 mild signs of FAS, such as lip licking, avoids eye contact, turns head away without moving away, lifts paw, or partially dilated pupils, and/or panting but commissures of lips are relaxed, occurring less than 4 times in a minute. Interested in reinforcers (treats, play, attention) and chooses to interact with the team members.
• Relaxed or mild signs of FAS • Nutraceutical PVP
Level 0 | No signs of FAS. Pet displays relaxed body language and solicits social interactions with team members.
FAS SCALE: Fear Free reference for patient assessment.
©2017 Fear Free. Written by Kenneth Martin, DVM, DACVB and Debbie Martin, LVT, VTS (Behavior)
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Continued from page 28.
FEAR FREE FACTORS TECHNIQUES PRIOR TO VISIT • Short rides in the car if unaccustomed • Short visits to veterinary clinic without exam • Food rewards for excursions, training and handling • Pheromone sprays (Adaptil® Dogs, Feliway® Cats) • Prescription and/or OTC anti-anxiety medications • Acclimatization to safe, comfortable, and familiar carrier • Secure carrying and transportation techniques • Discussion of procedures and expectations
certified practices (Aspetuck Animal Hospital and The Cat Clinic); a Fear Free designed educational space (Norwalk Community College Veterinary Technology Program Live Animal Lab); and the author’s holistic consulting practice. Right: NCC’s Live Animal Lab with rolling Tristar privacy screens, Snyder quiet-latch cages, walk-on scale (with mannequin) and FAS posters.
Left: In the Live Animal Lab with veterinary technology students, Opal is enjoying peanut butter, a favorite treat.
IN FULL-SERVICE HOSPITALS THE CLINICAL SPACE •M inimization of inter and intraspecies contact (visual, auditory, olfactory) • Neutral non-white color palette for building and uniforms • Walking surfaces with good traction • Warm, soft, non-slip exam surfaces • Lift tables and scales, ramps and steps • C ages with hiding places and quiet latches • Minimal contact with stainless steel and bright lights • Soothing species-appropriate music in wards and exam rooms • Extensive use of species-appropriate pheromones (sprays, diffusers) • Non-harsh cleaners and chemicals to minimize olfactory burnout
EXAMINATION TECHNIQUES • Starts with history and communication • Prioritizes medical “needs” over medical “wants” •C onsiderate Approach and Touch Gradient • Frequent reassessment of FAS • Revision of plan if needed, based on FAS • Food rewards at all stages of the clinic experience • Toys and distraction techniques if successful • Recording and updating emotional record • Communicating with client during the examination • Utilization of drugs if needed for safety and comfort
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Aspetuck Animal Hospital (aspetuckanimalhospital.com) has been AAHA certified since 2011, and Fear Free certified since 2016. Dr. Michael Gorra, a 1997 graduate of the Cornell College of Veterinary Medicine, recently spoke about how Fear Free and Low-Stress Handling ® have changed his practice, staff, patient care and approach to the painful patient. “It’s made a big difference in our flow and how we do things, and how we look at challenges,” he says. “Even if we don’t get to the point where [our patients] are happy, wagging their tails with their ears up — at least we can do things safely and not make things worse…. What I have found is that my lay staff dive right into it…. They really feel empowered that they’re truly making a difference.” The hospital implemented multi-modal proactive pain management even before its Fear Free training. Nonsteroidal anti-inflammatories, gabapentin, tramadol and trazadone are frequently prescribed in combination. Sometimes medications are given prior to a procedure that is expected to be painful, in order to decrease sensitization and windup. Multi-modal therapy including anxiolytics has decreased the practice’s need to prescribe opiates for painful patients. In addition to conventional pain management, Dr. Trish Grinnell, a 1997 graduate of the Cornell College of Veterinary Medicine, is certified in Veterinary Acupuncture and incorporates this modality: “I do acupuncture as general pain management. I had a friend who would do acupoints on all emergency patients to help calm them, but most of my acupuncture patients are pretty fear-free in the first place. Or if they start out nervous, they relax over time.”
Dr. Gorra adds how Fear Free Touch Gradient and Considerate Approach techniques have improved his ability to identify when an animal might be in nonprocedure-based pain. “[They have] allowed me to evaluate what is really going on with the animal,” he says. “If the dog is freaked out, I’m not going to get an accurate reading on where the back pain, joint pain, abdominal pain is. Is the heart rate elevated due to a medical issue, because they hurt, or because they’re hyped up? We de-escalate when we can, and that begins at home with the owner.” For example, owners are encouraged to bring their animals to the hospital hungry so they will be enthusiastic about food rewards. Owners may wait in the car with their pets rather than the waiting room if the animal’s FAS score is 3 or above, and enter through a back entrance directly into an exam room to avoid other animals.
IN THE FELINE-ONLY PRACTICE Using the Fear Free approach, feline-only practices have the opportunity to manage the medical, surgical and behavioral needs of feline patients without interspecies stress. Although cats are obligate carnivores and consummate hunters, they are an emotionally and metabolically sensitive prey species with a highly developed flight instinct and ability to mask pain. Owners are frequently unaware that their cats may be in pain or stressed, and may believe that stress-induced behaviors like trembling, vocalizations or open-mouth breathing are normal. Good client education, preparation at home, considerate transportation, minimization of antagonistic environmental cues (auditory, olfactory and visual), providing stratified hiding spaces, and accurate reading of behavioral cues may all help contribute to a calm and productive feline examination experience. The Cat Clinic of Danbury (danburycatclinic.com) has been Fear Free certified since 2017. Dr. Barbara Fanning, a 2006 graduate of the University of Tennessee College of Veterinary Medicine and The Cat Clinic’s owner, estimates that the Fear Free approach has improved the clinic’s ability to help 90% or more of its patients, including cats that could barely be handled before. An understanding of how quickly cats can turn fear and stress into undesirable behavior means there are no “bad cats” at the clinic. Before their visit, a Calm Kitty Kit that includes gabapentin, Zylkene® and a Feliway wipe is dispensed for most cats. In many cases, owners report an improvement in their cat on Zylkene alone, and are able to continue these benefits since hydrolyzed milk proteins are safe for long-term use. Continued on page 32.
Left: Veterinary Assistant Cailie has prepared cages for inpatients, including a privacy towel sprayed with Feliway. Right: Dr. Gorra with a homemade hiding space for caged cats. Felines also often feel secure in low-sided exam baskets.
Above: Soft colors, shelves and terraces, vertical stratification, and hiding areas. Right: NCC’s Live Animal Lab Cat Zone, for felines only, complete with raised Snyder quiet-latch cages, Feliway diffuser, towel warmer and plug-in aquarium.
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Continued from page 31. Dr. Fanning and her veterinary team work closely with cat owners to determine the least stressful handling situation for their felines. Many cats are “afraid of everything…if we don’t know there’s pain, and we touch something that hurts, are they painful or are they acting out because they’re terrified?” She describes her examination of a cat whose chief complaint was lameness and whose hind leg was trembling. Dr. Fanning, her helper and the owner worked together gently and easily with the cat, maintaining continuous gentle touch, proceeding slowly and cautiously, supporting his body in a secure position, trying to find step-by-step what didn’t hurt and saving the painful leg for last. Although the presentation was acute, which meant the patient hadn’t been given the benefit of the Calm Kitty Kit, he was examined in a warmlylit room with a Feliway-sprayed towel on the exam table and iCalmCat music playing. “Applying Fear Free methods really makes a huge difference,” says Dr. Fanning. “Instead of fighting and man-handling them, we keep that wind-up from happening. They can tolerate things a lot longer and not be so afraid.” If the patient described above became too painful to work with comfortably, or too frightened, he would have been sedated with an injectable sedative like butorphanol or Dexdomitor ®. Without the wind-up to a terrified state, lower doses of sedatives and anesthetics can be used. Dr. Fanning and Dr. Gorra’s teams embrace the Fear Free approach, keeping vets and staff safe, implementing all aspects of compassionate patient care, and educating clients about the approach. Veterinary support staff may be primarily involved with many potentially stressful therapeutic interactions: restraint, sample collection, diagnostic procedures, medication, treatments and therapeutic grooming. When veterinary assistants and technicians know how to read when an animal Left: Their holistic consulting practice exams concluded, Maddie and Zoe eagerly await more treats. Below: Dr. Gorra in Fear Free exam room, ready with treats and a soft non-slip exam surface.
is fearful, stressed or anxious; when they appreciate the many ways in which painful animals can act; and when they have acquired a body of relevant techniques and communication skills, they are empowered and integral members of an effective veterinary team.
IN THE VETERINARY TECHNOLOGY CURRICULUM Educating knowledgeable and compassionate caregivers is the mission of Norwalk Community College’s AVMA-CVTEA accredited Veterinary Technology program, for which this author is the Program Coordinator. The Program has incorporated Fear Free into its curriculum and clinical instructional space, the Live Animal Lab. Both the Program Coordinator and its Clinical Coordinator, Valerie Ramos CVT, LVT, MBA, are Fear Free certified, as are a number of other program instructors. Many of the Program’s veterinary technology students take advantage of the Fear Free complimentary student training. The veterinary technician’s multi-faceted role is a well-supported area of Fear Free education. The Program’s Community partners welcome its Fear Free approach and its Fear Free oriented students. For example, one of NCC’s clinical partners, the Pet Animal Welfare Society (PAWS) located in Norwalk, uses Fear Free techniques. When PAWS brings kittens to the Live Animal Lab for Intake examinations, the students complete a standard Feline Medical Record and an Emotional Record, under supervision. The Intake form was developed in collaboration with PAWS’ head technician, Matthew Berg, and records information such as specific behaviors on Intake, behavior during handling and procedures, food preferences, what worked and what didn’t, and FAS scores before, during and after handling and procedures. PAWS is delighted to have behavioral information to assist in homing their new kittens successfully. The students gain valuable experience in a holistic approach to patient care, and accept the responsibility of building positive patient experiences early on.
IN A HOLISTIC CONSULTING PRACTICE Fear Free techniques extend naturally to a variety of clinical and practice settings. The author’s holistic practice serves patients whose owners are seeking therapeutic alternatives, or whose primary care veterinarians have referred them for integrative care. Many patients have had previous traumatic clinical experiences and managing their FAS is essential to therapeutic success. The author’s practice footprint is a single-room consulting office in a quiet location, designed to be as non-threatening as possible; patients generally regard an office call as a social visit. There is
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abundant natural light, soft cushions and mats, and no harsh odors or metal surfaces. Examinations are conducted to the extent that is safe and comfortable for the owner and the animal, as there are no cage facilities or support staff. Appointments begin with the client interview, which allows the patient to acclimate to the surroundings without forced contact, and allows observation of patient behavior including curiosity, mobility, interactivity and potential guarding of painful areas. Fear Free techniques align with the patient-centered practice philosophy and have increased the scope and range of examination and diagnostics that are possible with minimal assistance.
IN SUMMARY Veterinary medicine is a caring profession for people who love animals; if we can help them without hurting or scaring them, everybody benefits. With the understanding that even non-painful routine procedures may be perceived as threatening and/or stressful, veterinary care may be delivered in a way that does not erode trust and confidence. Animals suffering acute or chronic pain, which may be exacerbated by the fear of pain or unrelated fear and anxiety, can be diagnosed and treated in a respectful, compassionate way that leads to better experiences and outcomes. REFERENCES Chapel D. (2016). “How Your Hospital Design Can Be Fear Free”. Paper presented at the North American Veterinary Conference, Practice Management, 375-376. Dalla Costa E, Bracci D, Dai F, Lebelt D, Minero M (2017). “Do different emotional states affect the Horse Grimace Scale Score? A pilot study”. Journal of Equine Veterinary Science, 54, 114-117. Fanning B. Personal communication. May 14, 2019. Fear Free, LLC. FearFreePets.com. Retrieved May 31, 2019. Gorra M. Personal communication. May 28, 2019. Grandin T, Deesing M. (May 2002). “Distress in animals: is it fear, pain or physical stress”. Manhattan Beach (CA): American Board of Veterinary Practitioners Symposium. Grinnell P. Electronic communication. June 1, 2019. Griffenhagen G, Jamie Kadrlik CVT, Petty M, MAV C, CVPP, D, Sheilah Robertson, BVMS, DECVAA WS. “2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats”. aaha.org/public_documents/ professional/guidelines/2015_aaha_aafp_pain_management_guidelines_for_dogs_and_cats.pdf. Accessed April 1, 2019. Harvey H. (2016). “The Big Goal of Reducing Fear-Pain-Stress in our Clinical Care”. Paper presented at the North American Veterinary Conference, Small Animal — Pain Management, 936-939. Hermans A. (2018). “Fear Free™ and Norwalk Community College’s Live Animal Lab”. The NAVTA Journal, August/September, 15-19. “How Do I Know When it’s Time? Assessing Quality of Life for Your Companion Animal and Making End-of-Life Decisions”. The Ohio State University Veterinary Medical Center. vet.osu.edu/vmc/sites/ default/files/import/assets/pdf/hospital/companionAnimals/HonoringtheBond/HowDoIKnowWhen. pdf. Accessed May 31, 2019. Lopez-Luna J, Al-Jubouri Q, Al-Nuaimy W, Sneddon LU. (2017) “Impact of stress, fear and anxiety on the nociceptive responses of larval zebrafish”. PLoS ONE 12(8): e0181010. doi.org/10.1371/journal.pone.0181010. Sandkuehler J, Lee J. (2013). “How to erase memory traces of pain and fear”. Trends in neurosciences, 36(6), 343-352. Stilwell N. (2019) “A practical approach to evaluating pain in cats”. DVM360 Magazine. veterinarynews. dvm360.com/practical-approach-evaluating-pain-cats.
From the VMAA
The Veterinary Medical Aromatherapy ® Association (VMAA) is an organization of veterinarians and veterinary technicians dedicated to the responsible use of aromatherapy in animal practices. Their mission is to promote standards of excellence in animal aromatherapy, to provide outreach and education to veterinarians and auxiliary animal practices, and to promote continual improvements in Veterinary Medical Aromatherapy®. The VMAA is elevating the veterinary profession through innovation, education, and advocacy of integrative medicine. Essential oils combine perfectly with massage or warm water soaks for pain management. The oils enhance the effectiveness of each modality and can be very safe if chosen and utilized properly. Massage and warm water therapy increase circulation and decrease inflammation to promote healing and comfort. A popular blend of essential oils commonly used with either approach contains clove, helichrysum, Kitten enjoying a paw soak. wintergreen, peppermint and copaiba. You can place several drops of this combination in your palms to massage the spine, hips or stifles, or mix with a healthy emulsifier and soak a sore paw in warm water. • Clove has a numbing effect. Parents have applied it to the sore gums of teething babies probably as far back as Biblical times! Today, many holistic veterinarians combine clove with coconut oil and apply it to sensitive gingiva in dogs and cats. It is a “hot” oil and should be used cautiously in our susceptible felines. Similarly, it can temper the throbbing of sore joints and muscles. • Helichrysum has long been revered for its natural support of the neurologic and cardiovascular systems. It is often used to assist with the body’s repair of bruised tissues. It is an expensive oil and therefore often found diluted or in combinations. • Wintergreen contains natural salicylate, which we recognize as salicylic acid, the anti-inflammatory component in aspirin. While this could be another concern for felines, a diluted blend has been used safely and effectively with cats. Just as aspirin’s safety in felines is dose-related, this is often the case with essential oils as well. • Peppermint is often used by humans for headaches, so keep this in mind for your veterinary staff. It is also said to improve focus! Peppermint enhances the penetration of other oils and quiets tingling nerves. It is often found in shampoos used for itchy scalps. • Copaiba is a sap from a tree in the Amazon, where the indigenous people use it as a steroid. A major natural chemical constituent called beta-caryophyllene is notably anti-inflammatory. This earthy oil is a great addition to this popular blend!
Submitted by Jodie Gruenstern, DVM, CVA, VP of VMAA IVC Winter 2019/2020
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2019
Innovative Veterinary Care Journal
EDITOR’S CHOICE INNOVATION AWARDS Innovative Veterinary Care Journal is proud to celebrate the companies that push to make a difference in animal care. This year’s winners have gone above and beyond to make veterinary practice easier on the patients and better for the vets. Leaders like this take risks to present something new to a wider audience, serving to propel animal care forward through passion, research and innovation.
Nutrition
Clinic Equipment
Raised Right Pets are a true human-grade pet food company. Their products are developed with veterinarians and pet food formulation experts to create complete and balanced whole foods that are specific to each pet’s stage of life.
Respond Systems are manufacturers of stateof-the-art laser therapy and PEMF equipment — providing faster and better healing methods for painful conditions.
Runners up: Now Pets, Evolution Diet Pet Food Corp
Honorable Mention: International Win
Honorable Mention: Ketogenic Pet food
Gyms for Dogs helps you create the best outdoor play areas for your canine patients to enjoy. Use services like Colorplay to customize your equipment to match your practice, and Duradog to help it last.
Education
National Animal Supplement Council is a non-profit industry group dedicated to protecting and enhancing the health of companion animals and horses. Their continued work of advocacy, standardization, and education is vital to supporting growth in this vital industry. Runners up: College of Integrative Veterinary Therapies (CIVT), International Veterinary Acupuncture Society (IVAS) Honorable Mentions: Vluggen Institute for Equine Osteopathy and Education, Veterinary Botanical Medicine Association
Opthalmics
Animal Necessity combines current research with pharmaceutical-grade nutraceuticals, and continues to provide effective supplements for many pet issues. Runners up: Natural Opthalmics, PRN Pharmacal
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IVC Winter 2019/2020
Runners up: Digatherm, SurgiTel
Services For Your Practice
Runner up: Elias
Diagnostics
igitherm offers the D only veterinary-specific software, the highest resolution possible, and an accuracy of +/- 1°C for your thermal imaging needs.
Pain Management
Litecure (Companion Animal Health) provides a partnership in bringing laser therapy to your practice. Laser therapy is effective in targeting specific tissues and decreases inflammation, pain and increases healing. Runners up: RX Vitamins, Medicinal Cannabis Dispensary
Pet Product Innovation
leepypod S creates carriers that can be used as safe car seats or napping spots for your pets at home or on the go. Meeting the highest standards of safety, they ensure that pets are protected in ALL their travels.
Research/Animal Welfare
orris Animal M Foundation participates in research that improves the lives of all animals, companion, farm, and wild, all over the world. Their studies have led to significant breakthroughs in diagnostics, treatments, and preventions to benefit animals worldwide.
Equipment Supply
Golden Needle Acupuncture Supply are quality suppliers of acupuncture equipment, clinical supplies, and patient fulfillment services for veterinary professionals.
Ortho Equipment
My Pet's Brace provides custom leg braces and prosthetics made individually for helping heal leg injuries. Their braces are proven, effective solutions for ACL or CCL injuries and are a successful alternative when surgery isn’t an option.
Complementary Medicine Parsemus Foundation has pioneered the research and development of nonsurgical hormone-preserving sterilization technology for dogs and cats. Their advocacy and education of this method is improving pets' lives and helping veterinary practices provide alternative sterilization methods for their patients. Runner up: Main Street Animal Services of Hopkinton (MASH)
Congratulations
IVC
TO ALL THE BELOW COMPANIES!
JOURNAL INNOVATION AWARD
IVCJournal.com
20 1 9 Supplements: Immune Support
Standard Process utilizes a complete wellness approach, and has been providing whole-food based supplements since 1929. Their Immune support products are a testament to their commitment to excellence. Runners up: Animal Biome, Glacier Peak Honorable Mentions: Glacier Peak, RX Vitamins, Sustenance Herbs
Supplements: Joint Support
Animal Biome are leaders in Gut Health Products. Their testing and treatment kits are a complete pathway to optimal digestive health for dogs and cats.
Honorable Mention: Dane Creek Corp.
Supplements: Skin/Coat
Healer's Petcare has a wide range of formulas that support healthy R WE skin and coats for dogs AR, and cats. Infused with Omega-3 fatty acids, their tea-tree oil based healing products were some of the first of their kind to treat pet skin conditions using natural formulas. SE
Honorable Mentions: Dane Creek Corp., Dechra
Runner up: Animal Necessity
BOW
Runners up: Sustenance Herbs, PRN Pharmacal
Supplements: Cancer Therapy/Support
Torigen Pharma offers an autologous prescription product for dogs and cats that uses the animal’s own tumor cells to create a personalized immunotherapy. It comes with a simple protocol, and can be used alone or with traditional cancer treatments.
BY
Hope Science Vet has developed their line of Joint Support products backed up with solid science and a commitment to increasing the quality of life for animals affected by mobility issues.
Supplements: Behavioral Support
AnimalEO products were developed by an internationally recognized Holistic Veterinarian using medical grade essential oils for the complete and natural care of all animals. Their behavioral support supplements can be an important part of bringing calm and happiness to animal companions.
LLC
Runners up: Animal Necessity, Dane Creek Corp.
STAY TUNED FOR THE ANNOUNCEMENT OF OUR 2020 NOMINEES FOR THE IVC EDITOR’S CHOICE AWARDS, COMING SOON!
Runners up: Horizon Life Science, Elias
Supplements: Gut Health
Runner up: RX Vitamins
Supplements: Allergies
Now Pets Pet Allergy formulation contains natural botanicals that can help animals to maintain normal histamine levels. Runner up: Standard Process
Supplements: Pain Management
RX Vitamins for Pets is an innovative nutraceutical company providing nutritional formulations designed to enhance patient outcomes. Runner up: Glacier Peak
Do you know a company that should be nominated for one of our awards? Send us your pick and that company could be chosen! Email us your nomination and the reason why you chose them at:
info@ivcjournal.com
IVC Winter 2019/2020
35
THE “OTHER”
CANNABINOID... DOES THC HAVE A ROLE IN VETERINARY MEDICINE? BY KAREN GELLMAN, DVM, PhD
In the last issue, we looked at veterinary indications for CBD and the complex regulatory picture affecting its use. We now explore questions surrounding THC, the “other” cannabinoid.
While CBD products for both humans and animals have already taken over your local farmer’s market, coffee shop and feed store, the “other” cannabinoid, THC (trans-Δ9-tetrahydrocannabinol), is another can of worms altogether. Many federal, state and local cannabis regulations conflict with each other and are in flux, so if you are confused, join the club! Here are the big questions most vets are wondering about:
q Does THC have useful indications in veterinary medicine? w Is it safe for pets? e Is it legal for veterinarians to recommend or dispense THC-containing products? This article will help provide answers to these questions.
1. IS THC A USEFUL MEDICINE FOR PETS? There is considerable overlap in the effects of THC and CBD, the principle compounds found in the Cannabis sativa plant (see chart on page 39). THC-rich compounds can be an important clinical adjunct to treating severe pain and neurologic disorders,2-4 in the treatment of cancer,5-10 and in complex gastrointestinal imbalances.11-13 Because of the decades-old prohibition of cannabis research, we are only just learning the many roles of the endocannabinoid system (ECS), which includes CB1 and CB2 receptors as well as their endocannabinoid ligands and the ligands’ synthesizing/degrading enzymes. Broadly speaking, the ECS is the mechanism through which the nervous system
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and immune system (inflammatory reactions) communicate and balance each other. It is probable that many chronic neurologic syndromes, such as multiple sclerosis, refractory epilepsy, brain tumors, Parkinson’s disease, Alzheimer’s disease, traumatic brain injury/chronic traumatic encephalopathy,2 amyotrophic lateral sclerosis (ALS) and its canine analogue, degenerative myelopathy,3 have their origins in ECS dysfunction. THC is a partial agonist of both CB1 and CB2 receptors in the CNS, and is a phyto-mimetic for the neurotransmitter AEA (anandamide, also known as N-arachidonoylethanolamine). While the psychoactive properties of THC are legendary, its analgesic properties are in large part mediated outside the endocannabinoid system: THC is a positive allosteric modulator of mu and delta opioid receptors, so it enhances the endogenous enkephalin response and potentiates any exogenous opioid medications.4 Because of this phenomenon, compassionate “medical marijuana” use has long been approved for severe chronic pain conditions. In human medicine, THC has been used to alleviate the side effects of oncology treatments in addition to pain management, and as an anti-emetic and appetite stimulant to address cancer cachexia. However, growing research indicates that phytocannabinoids, both CBD and THC, also have direct anti-tumor effects. The National Cancer Institute website (cancer.gov/about-cancer/treatment/cam/hp/cannabis-pdq) states as follows: “Cannabinoids may cause antitumor effects by various mechanisms, including induction of cell death, inhibition of cell growth, and inhibition of tumor angiogenesis invasion and metastasis.5-8 Two reviews summarize the molecular mechanisms of action of cannabinoids as antitumor agents.9,10 Cannabinoids appear to kill tumor cells but do not affect their non-transformed counterparts and may even protect them from cell death.” Some of the more exciting recent research trends concern the role of the ECS in the gastrointestinal tract,11-13 leading to applications for phytocannabinoids in managing chronic disorders like inflammatory bowel disease. Cannabinoid receptors are fundamentally involved in all aspects of intestinal physiology, such as motility, secretion, and epithelial barrier function. The ECS has a strong impact on the pathophysiology of the gastrointestinal tract, and is believed to maintain homeostasis in the gut by controlling hypercontractility and promoting regeneration after injury. Continued on page 38. IVC Winter 2019/2020
37
Continued from page 37.
Helping clients while ensuring the safety of your license It is very likely that all the regulatory and educational issues will be resolved in the next five to ten years. Meanwhile, the most desperate clients are turning to “Dr. Google” in the hopes of saving the lives of their beloved pets, at any cost. What can you do to ensure the safety of your DEA license while serving your clients’ need for knowledge and access? An answer that Dr. Rob Silver, a leading veterinary cannabis educator, came up with was to write a consumer book on cannabinoid use for pets — a reference guide for those people whose veterinarians are prohibited from advising them directly. His book is available for download or purchase at potforpets.info.
2. IS THC SAFE? THC is not toxic to dogs — researchers were unable to establish an LD50 with doses higher than 3,000 mg/kg.14 THC exhibits a surprising lack of respiratory depression for a substance with such profound psychoactive properties. However, the effects of accidental high dose THC ingestion in canines can be alarming and include ataxia, obtundation, urinary incontinence, hyperesthesia and tremors.15 These incidents most commonly happen when dogs steal and ingest their humans’ recreational high dose THC edibles, whether commercial or homemade, such as baked goods made with THC “butter”. “Static ataxia” has long been recognized as a characteristic of canine THC ingestion, and is due to the unusually high concentration of CB1 receptors in the canine cerebellum.16 Despite many medical reports on canine cannabis toxicosis, fatalities are very rare and arise from indirect causes. Veterinarians in states with early adoption of legal cannabis have found that with careful habituation, dogs can access the medical benefits of THC. It is usually recommended to build tolerance slowly over the course of several weeks, after which the psychoactive effects are no longer present. At professional CE events given by cannabinoid experts, dosage has been suggested as equal parts THC:CBD, ranging from 1 mg/kg to 5 mg/ kg, or even products with a higher THC to CBD ratio. At this point, the evidence is primarily anecdotal. This veterinarian’s anecdotal experience includes a cat with an advanced facial tumor that completely resolved within six weeks of the owner feeding him homemade “bud butter” from a recipe found online. Cats do not seem to share the canine sensitivity to THC’s psychoactive effects.
3. IS IT LEGAL FOR YOU TO PRESCRIBE OR EVEN DISCUSS CANNABIS FOR PETS? In my previous article, I wrote: “If you don’t like the cannabis regulations in your state, wait ten minutes,” thereby
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reflecting the rapidly changing regulatory picture (IVC Journal Fall 2019). This is an oversimplification, of course. The regulatory picture is confusing because it is conflicting at every level. We have the US federal government, whose Farm Bill of 2018 declared (industrial) hemp to be treated as any other agricultural product (USDA regulation); but down the street at the FDA, they claim that CBD is a drug, citing the recent approval of Epidiolex to treat pediatric refractory epilepsy. The FDA, on paper, still considers all cannabis products to be Schedule 1 drugs under the Controlled Substance Act. Meanwhile, the state governments of AK, CA, CO, ME, MA, MI, NV, OR and WA have made all forms of cannabis legal for both medical and recreational use. Other states’ regulations range from medical and decriminalized, to medical only, decriminalized only, and fully illegal. But this is just the beginning — once a state (or a nation, such as Canada) legalizes cannabis, there are endless decisions required on how to regulate cannabis products for safety, accountability, taxation and distribution. This has resulted in some awkward transitional situations for veterinary use in the US. For instance, in California, any adult can buy hemp CBD products at any grocery story, and THC products at both medical and recreational dispensaries; but veterinarians are forbidden to talk about either cannabis product with their clients. So Californian pet guardians who think (rightly or wrongly) that cannabis can help their animals have full access to the substance, but zero access to professional veterinary medical guidance. Legislation to address this problem has been held up in the state capital by lobbying from a manufacturer of OTC pet cannabinoids who wants to sell in recreational dispensaries, while vets advise that veterinary therapeutic cannabinoids should be restricted to medical dispensaries, like their human equivalents. The bill calls for vets to be able to “discuss” cannabinoid use, but has yet to define what that term means.
Therapeutic effects
THC
CBD1
Psychoactive
Yes
No
Pain modulation
Yes
Yes
Anti-seizure
Maybe
Yes
Anti-tumor
Yes
Yes
Helps with nausea/appetite
Yes
Maybe
Anti-anxiety
No
Yes
Anti-inflammatory
Yes
Yes
Big monied interests have moved aggressively into the cannabis industry world wide, so this confusion and struggle is universal. On the recreational side, Big Tobacco and Big Alcohol argue that they are best prepared to comply with a complex regulatory structure. On the medical side, the FDA is playing both sides of the coin: while keeping cannabis as a Schedule 1 drug, they reserve the right to regulate it as a pharmaceutical, which is in the interests of the large pharmaceutical corporations who are heavily invested in cannabis drug development and tightly linked to the FDA. Dr. Gary Richter, a nationally recognized veterinary cannabis expert and educator, comments: “For years, herbalists and health care practitioners have been making the case that cannabis is powerful and effective medicine. When we lobby to have the medical benefits of cannabis recognized, we have to accept some degree of FDA regulation. We can't have it both ways.”17 However, unlike most drugs, hemp or marijuana can be grown in one’s backyard and easily converted to medicinal form — so how closely can any agency truly regulate its use?
There is a sense of profound frustration among veterinarians who have studied the potential medical benefits of CBD and THC for their most vulnerable patients. Most vets do not join the profession to become paper-pushers or business magnates. We put up with the educational investment and hard (often thankless) work because we are dedicated to the well-being of animals and the power of the human-animal bond. Phytocannabinoid therapies offer enormous potential to ameliorate the pain and ravages of serious chronic disease in animals. How can we justify not using them when we have taken an oath to help prevent avoidable suffering? Many veterinarians are carefully walking this line, risking their licenses and livelihoods to do so. It’s about time that veterinary medical professionals, researchers and regulators — both state and federal — put their heads together and figure out how to quickly and safely navigate this profound cultural transition to therapeutic cannabis use. Editor’s Note: IVC Journal is closely following advancements in this rapidly-changing industry, and will continue to update readers on the latest research and applications regarding cannabinoid use in animal patients.
Silver R. Veterinary Medical Cannabis: Part One. NYS Veterinary Conference, Cornell University, October 2018.
1
Russo EB (2018). “Cannabis Therapeutics and the Future of Neurology”. Front Integr Neurosci. 12: 51.
2
Fernández-Trapero M, Espejo-Porras F, Rodríguez-Cueto C, Coates JR, Pérez-Díaz C, de Lago E, Fernández-Ruiz J (2017). “Upregulation of CB2 receptors in reactive astrocytes in canine degenerative myelopathy, a disease model of amyotrophic lateral sclerosis”. Dis Model Mech. 10 (5):551-558.
3
Kathmann M, Flau K, Redmer A, Tränkle C, Schlicker E (February 2006). "Cannabidiol is an allosteric modulator at mu- and delta-opioid receptors". Naunyn-Schmiedeberg's Archives of Pharmacology. 372 (5): 354–61.
4
Guzmán M (2003). “Cannabinoids: potential anticancer agents”. Nat Rev Cancer. 3 (10): 745-55.
5
Blázquez C, Casanova ML, Planas A, et al (2003). “Inhibition of tumor angiogenesis by cannabinoids”. FASEB J 17 (3): 529-31.
6
Vaccani A, Massi P, Colombo A, et al (2005). “Cannabidiol inhibits human glioma cell migration through a cannabinoid receptor-independent mechanism”. Br J Pharmacol 144 (8): 1032-6.
7
The most recent AVMA guidelines (d1n6ollu2qc3al.cloudfront. net/app/uploads/20190528140050/2019_AVMA_Cannabis-FAQ. pdf) rely heavily upon the FDA interpretation. However, state by state, veterinary medical boards will be influenced by local political forces, lobbyists, or even by the ages and personal experiences of their members. In my home state of New York (which has a strong agricultural hemp program), the official state veterinary board guidelines speak of our obligation to educate our clients on cannabis use (vets.nysvms.org/HigherLogic/System/ DownloadDocumentFile.ashx?DocumentFileKey=858a0da4-30ffbf3b-9d0f-147600137168). Yet, at the most recent New York State Veterinary Conference, I spoke to many colleagues who firmly believed they could lose their NY veterinary licenses if they did so. There is a serious disconnect between the consumer drive for pet cannabis products, their veterinarians’ ability to knowledgeably counsel them, and the ever-changing legal and regulatory landscape.
Ramer R, Bublitz K, Freimuth N, et al (2012). “Cannabidiol inhibits lung cancer cell invasion and metastasis via intercellular adhesion molecule-1”. FASEB J 26 (4): 1535-48.
8
Velasco G, Sánchez C, Guzmán M (2012). “Towards the use of cannabinoids as antitumour agents”. Nat Rev Cancer 12 (6): 436-44.
9
Cridge BJ, Rosengren RJ (2013). “Critical appraisal of the potential use of cannabinoids in cancer management”. Cancer Manag Res 5: 301-13.
10
Taschler U, Hasenoehrl C, Storr M, Schicho R (2016). “Cannabinoid Receptors in Regulating the GI Tract: Experimental Evidence and Therapeutic Relevance”. In: Greenwood-Van Meerveld B. (eds) Gastrointestinal Pharmacology. Handbook of Experimental Pharmacology, vol 239. Springer, Cham.
11
Hasenoehrl C, Taschler U, Storr M, Schicho R (2016).“The gastrointestinal tract – a central organ of cannabinoid signaling in health and disease”. Neurogastroenterol Motil Dec; 28(12): 1765–1780.
12
Uranga JA, Vera G, Abalo R (2018). “Cannabinoid pharmacology and therapy in gut disorders”. Biochem Pharmaco Nov;157:134-147.
13
Thompson GR, Rosenkrantz H, Schaeppi UH, Braude MC (1973). “Comparison of acute oral toxicity of cannabinoids in rats, dogs and monkeys”. Toxicology and Applied Pharmacology 25(3), 363-372.
14
Meola SD, Tearney CC, Haas SA, Hackett TB, Mazzaferro EM (2012). “Evaluation of trends in marijuana toxicosis in dogs living in a state with legalized medical marijuana: 125 dogs (2005-2010)”. J Vet Emerg Crit Care (San Antonio) Dec;22(6):690-6.
15
Freundt-Revilla J, Kegler K, Baumgärtner W, Tipold A (2017). “Spatial distribution of cannabinoid receptor type 1 (CB1) in normal canine central and peripheral nervous system”. PLoS One Jul 10;12(7):e0181064.
16
Richter G, DVM. Personal communication.
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IVC Winter 2019/2020
39
Profitable Practice DIGATHERM
INCOME POTENTIAL: Digatherm’s system generates a profit and a positive return on investment in the first month. Since it is a diagnostic screening tool with a one-time investment and can be used on almost every patient coming in the door, earning potential is unlimited.
TRAINING REQUIREMENTS: Initial onsite hands-on training with staff members familiarizes them with the Digatherm system, patient positioning, image capture, and interpretation of the images. Additional sessions of live, remote on-line training ensure quick implementation, good imaging technique, and accurate interpretation.
TIME TO IMPLEMENT: Initial onsite training of doctors and staff by Digatherm ensures immediate implementation.
SOME POTENTIAL USES: There are countless applications for this tool. For instance, it can be used to detect and localize injuries, illness, neurological or orthopedic conditions, and aging changes.
WHAT Digatherm’s first veterinary-specific thermal imaging system takes patient exams to a new level, while allowing you to improve practice profits. The company’s thermal camera, integrated with a tablet PC, allows you to capture, store and share images with a handheld digital device. With Digatherm, you can image your patients’ real-time physiology. The images give you new physiological information and important clues that create a road map for further diagnostics and treatment. You can share the images with clients on their devices, so they can see, understand, and become involved and compliant with their animals’ care.
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IVC Winter 2019/2020
WHY By investing in and integrating Digatherm’s thermal imaging system into your practice, you’ll improve your hospital’s quality of care. Incorporate it into your exam routine to capture several screening images for healthy patients; and take more comprehensive screening images for unwell or geriatric patients. Modest fees for a thermal image screen, or an across-the-board fee increase for your examinations, will produce revenue that is instantly profitable. Practices that fully integrate Digatherm’s thermal imaging system normally recover their investment in the first year.
WHO Digatherm excels in training you and your staff. Your local rep will do initial onsite training, to be followed by several online training sessions, thereby ensuring that you quickly integrate thermal imaging into your practice, capture good quality images, and interpret the images correctly. Digatherm makes thermal imaging work for you — and makes it profitable!
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IVC 10:1
DON'T MISS ANOTHER ISSUE!
TESTING THE CANINE
HEALTHY SOIL HYPOTHESIS BY STEVE BROWN, NATASHA LILLY, DVM, CVA, AND JAMES PENDERGAST
Is healthy soil the secret ingredient to better health for dogs? This article tells you how to participate in the groundbreaking research being done by the Canine Healthy Soil Project.
Many veterinarians have shared with us that they still see a lack of optimal health in their canine patients, even those on balanced, speciesappropriate, fresh food diets. We theorize that something is still missing: the ancestral microbes, their “old friends”, found in nutrient-rich soil and other ancestral environments. The Canine Healthy Soil Hypothesis states that exposure to healthy soil, especially as a young puppy, can help restore a dog’s ancestral microbial communities and therefore enhance his overall health. We define healthy soil as that which is quality tested, sustainable and produced through regenerative agricultural methods. Healthy soil may be nature’s ultimate probiotic for all dogs, from young puppies to older canines. The dog’s microbiota — the community of microscopic organisms on and in his body — likely influences a tendency toward health or disease, including, but not limited to, the following conditions: allergies, obesity, diabetes, dental disease and gingivitis, dermatitis, cancer, arthritis, and cognitive decline and disease.
Is this hypothesis accurate? We are a volunteer group of pet food professionals, veterinarians, regenerative agriculture specialists and microbiologists who want to know if the Canine
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IVC Winter 2019/2020
Healthy Soil Hypothesis is true. Steve Brown (see below for more info) is leading the program’s start-up. If the hypothesis is true, we can help take a major step toward understanding how to promote good health in dogs, and perhaps humans too, while raising awareness of the global benefits of healthy soil for all living beings. “The diseases most people die of have been attributed to unhealthy lifestyles. But evidence now suggests bacteria are to blame, heralding a revolution in medicine.”1
WHO The Canine Healthy Soil Hypothesis start-up team •S teve Brown is a renowned formulator of ancestral-type diets for dogs, as well as a researcher, author of two books on canine nutrition, developer of several best-selling leading edge canine dog foods and treats, and the developer of the Animal Diet Formulator™ program. •D r. Natasha Lilly, DVM, is co-founder of the Royal Animal Health University and an Adjunct Professor College of Agriculture, Cal Poly University, San Luis Obispo.
• James Pendergast is a commercial pet food formulation consultant, and the veterinary sales director for a leading fresh food diet company. • Technical advisors include: Dr. David C. Johnson, PhD, Soil Microbiologist/Molecular Biologist, New Mexico State, College of Engineering, Institute for Sustainable Agricultural Research r. Tim LaSalle, PhD, Co-Founder of CSU Chico, Center D for Regenerative Agriculture; Director of Outreach & Development; Adjunct Professor D r. Holly Ganz, PhD, microbial ecologist who studies how microbes and mammals interact; CEO and founder of AnimalBiome, a biotech company based in the San Francisco Bay Area.
Call for volunteers In order to test this hypothesis, we need volunteers to be part of our research and sign up their dogs for testing. The more dogs that participate, the more all of us can learn. Testing will begin in the spring of 2020. Everyone who participates will become part of the team, and if we prove the hypothesis, everyone is part of the revolution in our understanding of what makes dogs, and possibly also humans, healthy.
WHAT Defining healthy soil Healthy soil is highly biodiverse; one gram, ¼ teaspoon, may contain 10 billion microbes, and 2,000 to 50,0002 species per gram, though some studies estimate as many as 10,000,000.3 Healthy soil is clean, not treated with herbicides, pesticides or chemical fertilizers, and sustainable, preferably produced on polyculture farms through Regenerative Agriculture methods (csuchico.edu/regenerativeagriculture/ra101-section/ra101-definitions. shtml). Regenerative Agriculture is a holistic land management practice that produces healthy microbe-rich soil for healthy plants, animals, humans and the environment. The canine healthy soil team will provide healthy soil for the initial set of preparatory tests (see step two under “HOW”). We will also provide healthy soil for the veterinarian-guided tests (step three under “HOW”), but our goal is to get enough participants that we can examine other more local sources of healthy soils. Adult dogs will be inoculated with healthy soil as a topper to food, with an estimated dose of ½ gram per day for a 10 lb dog. For breeders, we will test several methods of inoculating very young puppies, including the application of healthy soil
to whelping areas so that litters will be born in soil, much like their ancestral relatives were.
WHY The science The canine ancestral environment was full of microbe-rich soil. Starting at birth, soil-based microbes colonized every canine environmental niche, externally and internally. Today, most puppies are born inside, in a radically different environment often full of harsh cleaning chemicals, antimicrobial soaps, and the accompanying indoor microbes that thrive in such environments. Many puppies may never play in soil until they get to their new homes, if then. They are not exposed to their ancestral microbes. Just as we find that most dogs are healthiest when they consume their ancestral diets, we think they are healthiest when they have their natural — ancestral — microbial populations. Dogs co-evolved with the trillions of microbes that are in and on their bodies. The dogs who possessed the greatest harmony between their genes and the microbes to which they were exposed were the fittest and most successful. From a Darwinian perspective, the canine genes selected for were those that fit best with the microbes in the dogs’ environment. Continued on page 44.
WHY HEALTHY SOIL AND NOT PROBIOTICS: THE CANINE HEALTHY SOIL HYPOTHESIS COROLLARY
Vitamin supplements are to whole foods as probiotic supplements are to healthy soil. HERE’S AN EXAMPLE: Vitamin: thiamine • Supplement: 100,000 ppm thiamine and no other nutrients • Natural foods: at most 25 ppm to 30 ppm thiamine and hundreds of other nutrients Microbes: • Probiotic supplements: 10 to 20 species, 10 to 50 billion microbes/g • Soil: 2,000 to 50,000+ species, 500,000 to 10 billion microbes/g
IVC Winter 2019/2020
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Participate in the program! Instructions for you and your clients.
1. Sign up now on our website at caninehealthysoil.com. 2. Testing for the marker microbes begins in February 2020. 3. You will be notified by email with details for ordering test kits for oral samples. 4. Both veterinarians and pet parents fill out the CHSP questionnaire (coming soon). 5. Collect oral samples for sending to the lab, either in the vet clinic or at home with instructions. 6. Results from each animal will be shared by our team through email updates.
For more information and to sign up, visit caninehealthysoil.com.
Continued from page 43. “Many microorganisms in the intestine seem to have developed in sync with their host animals over millions of years.” 4 “Given the ongoing extinction of our ancient commensal organisms, the future of a healthy human microbiome may include restoration of our ancestral microbial ecology.”5
The asthma-protective effect of polyculture farms and the Amish dust studies Amish dust studies and similar research using dust from organic polyculture farms show that exposure to highly biodiverse soil and dust reduce the symptoms of allergies. In the Amish dust studies, scientists bred a variety of mice that suffered from a chronic inflammatory disease akin to allergic asthma. The mice developed asthma symptoms when exposed to egg proteins. The team divided the mice into three groups: one group had egg proteins sprayed in their environment for inhalation every two or three days for a month; the second had egg proteins plus dust from organic monoculture farms; and the third group had egg proteins plus dust from Amish farms. The mice exposed to just egg protein suffered allergic responses as did the mice exposed to egg protein and organic monoculture farm dust. But the mice exposed to egg protein and Amish dust had almost no allergic responses.6 The allergy- and asthma-protective effects of dust from polyculture farms have been replicated with human infants7and piglets.8 Most studies on mammal microbiota are conducted with humans, mice, pigs and rats; just a few have been done with dogs. Studies suggest, though, that bacteria can reasonably
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IVC Winter 2019/2020
be expected to function similarly in the digestive tracts of different species. The results we find with dogs may eventually help humans. “The structural and functional similarity of the dog microbiome to the human one implies that, as human studies are predictive of results in dogs, dog studies may be predictive of results in humans. Thus, dog studies provide a double benefit: for dogs directly and for their potential to generalize to humans.”9
Early exposure is important: why we need to work with dog breeders “The composition of the gut microbiota in early life is emerging as a factor in helping achieve and maintain good health in the years to come.”10 “Our findings show that a key timing of exposure to the microbiota and microbiota metabolites may actually be very early in life.”11 Again, most puppies are born indoors now, in an attempt to create sterile environments. Microbes that can withstand harsh chemicals populate the puppies; these are not their ancestral microbes. It is possible that a small inexpensive change in the way breeders raise their puppies — adding small amounts of healthy soil to whelping areas — can have a significant long-term beneficial effect on the puppies’ lives. We need your help in testing this.
Why not just give probiotics? Probiotics do not address the high level of species diversity present in healthy soil. They also often over-represent a fewer number of species (see Canine Healthy Soil Hypothesis Corollary sidebar on page 43).
HOW The project’s four components STEP 1: Recruiting study participants Pet parents and veterinarians will sign up more than 2,000 dogs to complete oral cavity testing before and after exposure to healthy soil microbiota. At least ten breeders will sign up for testing genetically-similar litters with and without early exposure to healthy soil. STEP 2: Completing preparatory work We will recruit sufficient sponsorship to pay for the extensive preparatory work and for testing with breeders. The preparatory work includes quality testing and approval of the healthy soil, determining dosage and frequency of exposure, and identifying marker microbes. Once we know more about our marker
microbes, we can provide more information regarding the duration of the soil administration and timing of re-tests. STEP 3: Testing the oral cavities of participants Our testing will focus on exposure to the oral cavity for the following reasons: recent studies suggest that good health begins in the mouth; oral cavity examinations by veterinarians are routine; the eruption of puppy and adult teeth are ideal times for exposure and testing; the human oral microbiota has already been well-studied; and canine dental care can be expensive. “The worst culprits, which seem to play a role in the widest range of ailments, are the bacteria that cause gum disease. This is the most widespread disease of aging — in fact, “the most prevalent disease of mankind.”12 “Oral microbiome data suggest that a single-pathogen model cannot account for either caries or periodontitis: in these diseases, many constituents of the bacterial community are perturbed.”13 STEP 4: Doing data collection, analysis, and publishing Our goal is to finalize analyses and publish results two years after commencing the study.
WHEN We need veterinarians and dog parents to sign up now. Individual dog testing will begin in the spring of 2020 — see sidebar at top left for details. newscientist.com/article/mg24332420-900-have-we-found-the-true-cause-of-diabetes-stroke-andalzheimers/#ixzz5w2TNt2oN.
1
Raynaud A, Nunan N. “Spatial Ecology of Bacteria at the Microscale in Soil”. PLOS doi.org/10.1371/journal. pone.0087217. January 2014.
2
Roesch LFW, et al. “Pyrosequencing enumerates and contrasts soil microbial diversity”. The ISME Journal. 2007;1:283–290.
3
Youngblut ND, Reischer GH, Walters W, et al. “Host diet and evolutionary history explain different aspects of gut microbiome diversity among vertebrate clades”. Nature Communications. 2019; 10 (1) DOI: 10.1038/ s41467-019-10191-3.
4
The ancestral and industrialized gut microbiota and implications for human health”. Nature Reviews. June 2019.
5
Best described in Never Home Alone by Rob Dunn.
6
“The asthma-protective effect of farms appears to be associated with rich home dust microbiota; Farm-like indoor microbiota in non-farm homes protects children from asthma development”. Nature Medicine. 2019.
7
“Amish (Rural) vs. non-Amish (Urban) Infant Fecal Microbiotas Are Highly Diverse and Their Transplantation Lead to Differences in Mucosal Immune Maturation in a Humanized Germfree Piglet Model”. Frontiers in Immunology. July 2019.
8
“Similarity of the dog and human gut microbiomes in gene content and response to diet”. Microbiome. 2018;6:72. microbiomejournal.biomedcentral.com/articles/10.1186/s40168-018-0450-3.
9
Ishiguro, E, et al. Gut Microbiota, Interactive Effects on Nutrition and Health. Academic Press, 2018; p41.
10
Harusato A, Viennois E, Etienne-Mesmin L, et al. “Early-Life Microbiota Exposure Restricts Myeloid-Derived Suppressor Cell–Driven Colonic Tumorigenesis”. April, 2019;DOI: 10.1158/2326-6066.CIR-18-0444.
11
New Scientist. August 7, 2019; newscientist.com/article/mg24332420-900-have-we-found-the-truecause-of-diabetes-stroke-and-alzheimers/#ixzz5w2U72l28.
12
Ishiguro, E, et al. Gut Microbiota, Interactive Effects on Nutrition and Health. Academic Press, 2018; p57.
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industry innovations Laser technology that helps grow your practice
Laser therapy for veterinary medicine continues to make big strides. The Platinum 4 by Summus Medical Laser combines their highest-power (24W), multi-wavelength (650nm, 810nm, 915nm, 980nm) Class IV therapy laser with a transformative technology platform that delivers usage metrics and treatment data engineered to grow your practice. With the Performance Tracker, your staff can chart treatment conditions and even calculate revenue streams to justify your ROI. Pair that with the company’s best-in-class training, education, service and support, and you can see how these therapy lasers produce outstanding clinical and financial results. 866-595-7749 or summuslaser.com/veterinary-lasers
Ultrasound in the palm of your hand
Ultrasound imaging is vital for the diagnosis of many patient problems. Butterfly Network, the makers of the first handheld whole-body ultrasound system, is bringing ultrasound-on-a-chip technology to vets and animals with iQ Vet, a single probe, smartphone connected device. Currently, many vets rely on white label products originally designed and intended for human use, which can cost upwards of $50,000. The all-new iQ Vet features software with pre-set settings specifically designed for scanning animals — at just under $2,000. You’ll have access to a high-resolution device that will lead to earlier diagnosis, thereby improving medical care for all animals, large and small. butterflynetwork.com
Reducing pain in your equine patients
Want to help your equine patients feel their very best before and during every ride? Benefab® understands the important parallel between pain and behavior in horses. This was the driving force behind the development of their Rejuvenate SmartScrim, which has been clinically proven to reduce back soreness in moderate- to high-exercise horses. It features far-infrared therapy with medical-grade magnets that are placed over key acupuncture points for targeted therapy, addressing the back, shoulders and hind end. benefabproducts.com
CBD in tablet form
Joint support for allergic dogs
Prescribing supplements to dogs with food sensitivities or intolerances can be tricky. Phycox® HA HypoAllergenic Joint Supplements are specifically for dogs with both allergies and joint issues. They use hydrolyzed vegetable protein derived from soybeans and do not contain beef, chicken or wheat. They are also available in a Max formulation that contains the same hydrolyzed vegetable protein in addition to six more ingredients and three times the phycocyanin for maximum joint health support. 866-933-2472 or dechra-us.com
Giving CBD to dogs just got easier. Santeer ™ uses cutting-edge science and natural ingredients to formulate their LUV Chewable Pet Tablets. They allow your dog to absorb more CBD, since they’re five to ten times more soluble than soft gels and tinctures. The fast-acting tablets contain just four ingredients that come directly from GMP pharmaceutical supply companies. They are available in three variants for small, medium and large dogs. santeer.com
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Keeping an eye on ocular health
Your patients’ eye health is crucial to their quality of life. Animal Necessity’s patented Ocu-GLO™ is now available in powder capsules for large and extra large dogs. Formulated by veterinary ophthalmologists and backed by clinical research, Ocu-GLO™ PBXL provides 13 key antioxidants, including grapeseed extract, lutein and Omega-3 fatty acids, which work synergistically to protect the eye from oxidative stress. Also available as a gelcap or powdered blend for cats and small dogs. ocuglo.com
New communication platform for you and your clients
When clients drop their pets off at your clinic for treatment or surgery, they naturally feel anxious. To help, Fur Baby Tracker™ is launching a new clinic and pet owner communication platform at VMX 2020 in January. This real-time communication tool allows both clients and staff to have access to the real-time status of a patient’s progress through his treatment plan. It generates an average of six to 15 updates per 24-hour treatment tracked, delivered directly to the pet owner via both text message and app updates. It also provides significant benefits to the clinic, including real-time visibility of a patient’s status for the entire staff, improved workflow efficiency, and a new profit center. Fur Baby Tracker invites you to participate in their VMX 2020 and WVC 2020 market launch promotions. Pre-register and enter to win one of three prizes at each show: an iPad complete with one free month of Fur Baby Tracker, a marketing consulting bundle from Red Brick Partners to help build your business or a Massage Envy Gift Card.
Ozone therapy benefits patients
Ozone therapy is one of the most positive approaches to healing in our veterinary patients. Ozone brings oxygen into the tissues and displaces CO2, alleviating inflammation and infection. It’s a very effective treatment for acute and chronic viral diseases since it acts as a viricidal agent. Ozone used in conjunction with other modalities, such as ultraviolet blood irradiation therapy and microbiome restorative therapy (MBRT or fecal transplants), creates a powerful combination that further benefits the body’s ability to heal and stay healthy. mashvet.com
Changing the way cancer is treated
The goal of harnessing the immune system to help in the fight against cancer is becoming a reality. Torigen, a team of cancer researchers and veterinarians, offers personalized cancer immunotherapy for companion animals. It’s created from an individual animal’s surgically-resected tumor, and may work by stimulating an immune response against tumor-associated antigens. Contact Torigen to speak with one of the veterinary specialists on their team. torigen.com IVC Winter 2019/2020
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CASE STUDY INTEGRATING ESSENTIAL OILS INTO THE TREATMENT PLAN OF A CAT WITH SEVERE ORAL TRAUMA.
BY BARB FOX, DVM
A one-year-old DSH female cat was presented for severe injury to the mandibular bone, gingivae, and surrounding soft tissues. The trauma was caused by an embedded nylon collar; an elastic band holding two pieces of the collar together had slipped over the cat’s chin, entrapping the nylon behind her lower canine teeth. Substantial necrosis of the tissue covering the mandibular bone had occurred, exposing the bone for approximately 1” on both sides. Granulation tissue had already begun to form over the embedded collar, making surgical removal necessary.
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To complicate the case further, deep-seated infection had set in. Copious purulent discharge was found throughout the necrotic tissue and where the collar had invaded the soft tissues of the oral cavity.
POOR PROGNOSIS The prognosis was very poor to grave, due to possible osteomyelitis, sepsis and loss of soft tissue of the chin due to compromised blood supply. However, the caretaker for the cat’s elderly owner insisted we try heroic measures because the cat “was all she had to live for”.
Referral to a specialty center was discussed, but the family did not have the funds for this. Complications and prognosis were discussed in detail with the elderly woman’s family and her caretaker, but they still wanted to proceed with conservative treatment.
ESSENTIAL OILS A KEY PART OF TREATMENT The cat was sedated and prepped for surgery. After carefully excising the collar from the gingival and sublingual tissues, the wounds were lavaged with a highly diluted cleanser containing essential oils of cinnamon, clove, rosemary, eucalyptus and lemon. Short-acting penicillin and cefovecin (Convenia) were injected subcutaneously to control infection. Subcutaneous fluids were given to rehydrate the cat. Next, cotton applicator sticks were saturated with essential oil Blend “A” (clove, lemon, cinnamon bark, eucalyptus and rosemary) and applied to the open wounds. Blend “B” (helichrysum, wintergreen, clove and peppermint) was placed on top of the oils in the first blend. Then, an ointment containing mink oil, beeswax, lanolin, wheat germ, carrot and rosehip oils was packed into the wounds to help seal in the essential oils. Buprenorphine was given SQ for pain control. Continued on page 50.
ESSENTIAL OILS USED FOR PAIN CONTROL
ESSENTIAL OILS USED FOR INFECTION CONTROL:
CARRIER OIL BLEND USED IN THIS CASE:
• Copaiba (Copaifera reticulata)
• Copaiba (Copaifera reticulata)
• Coconut oil
• Helichrysum (Helichrysum italicum)
• Clove (Syzygium aromaticum)
• Sweet almond oil
• Clove (Syzygium aromaticum)
• Cinnamon bark (Cinnamomum zeylanicum)
• Sesame oil
• Peppermint (Mentha piperita)
• Rosemary (Rosmarinus officinalis)
• Wheat germ oil
• Lavender (Lavandula angustifolia)
• Eucalyptus (Eucalyptus radiata)
• Grapeseed oil
• Lemon (Citrus limon)
• Sunflower oil IVC Winter 2019/2020
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Cat sedated and ready for excision of collar/ elastic band.
Lateral view of exposed mandibular bone and extensive swelling of chin.
Continued from page 49.
DRAMATIC RECOVERY • The next morning, the cat was ingesting a soft prescription diet for post-surgical patients without difficulty, even though she had not been able to eat or drink for days. • Three days of treatment with once-daily injections of penicillin and essential oils applied topically resulted in dramatic tissue regeneration and restoration of soft tissue.
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FROM THE
AATCVM Day 4: no more exposed mandibular bone; chin size has returned to normal.
Day 4: ventral view of healthy granulation tissue; no sign of infection.
The American Association of Traditional Chinese Veterinary Medicine (AATCVM) is a nonprofit organization founded in 2006 to support practitioners of Traditional Chinese Veterinary Medicine (TCVM) and promote high quality research in all aspects of TCVM, including acupuncture, Chinese herbal medicine, Tui-na and food therapy. The AATCVM promotes the practice of evidence-based TCVM by funding high quality studies of the basic science and mechanisms of action of treatments and randomized clinical trials of the efficacy of treatments.
A RECAP OF THE 21ST ANNUAL TCVM CONFERENCE The 21st Annual TCVM Conference took place in the picturesque and historic city of Shanghai, China from August 30 to September 2, 2019. It attracted about 400 attendees, the largest number since its inception in 1999. • On the fourth day, the cat was discharged without any take-home medications, since the caretaker and elderly owner could not treat her. • At her two-week checkup, the cat was doing remarkably well. There were no signs of infection or tissue sloughing, and she continued to heal completely. Therapeutic grade, pure essential oils can be successfully and safely used in cats, providing certain usage guidelines are followed. In this case, the oils were not diluted at the beginning, then dilution was performed at a ratio of one drop EO to three drops carrier oil. The severity of the wounds and resulting infection necessitated aggressive therapy. In the author’s opinion, tissue regeneration and infection control were greatly enhanced by the use of essential oils. Healthy new tissue covered the mandibular bone in just four days, and the grossly swollen chin tissue returned to normal in the same time frame.
The theme of the conference, hosted by the Chi Institute and co-sponsored by the World Association of Traditional Chinese Veterinary Medicine (WATCVM), centered around the clinical application of TCVM in dogs, cats, exotics, and horses. An exciting learning and networking opportunity, the conference featured lectures by renowned TCVM experts from around the world who shared their vast clinical experiences and research findings. In addition to hearing many insightful lectures, attendees were able to reunite with peers and instructors, participate in hands-on workshops, and explore some of the many breathtaking sights Shanghai has to offer.
JOIN US FOR THE 2020 CONFERENCE The 22nd Annual TCVM Conference will be hosted on the Chi Institute campus in beautiful Reddick, Florida from November 19 to 22, 2020. The main theme will be gastrointestinal and hepatobiliary diseases in dogs, cats and horses. As with past conferences, the event will serve as an excellent opportunity for veterinarians to learn from top TCVM experts, gain hands-on experience, and network with practitioners from around the globe. Submitted by Judith E Saik, DVM, DACVP, CVA, CVCH, CVFT IVC Winter 2019/2020
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Equine metabolic syndrome BY KELLY DIEHL, DVM, MS, Dipl. ACVIM
Research sponsored by Morris Animal Foundation is helping unravel the complexities of EMS.
The term “equine metabolic syndrome” was coined in 2002. It was used to describe a disease that shared many features with metabolic syndrome in people. In horses, the syndrome is characterized by obesity (either generalized or regional), insulin resistance and a predisposition to laminitis. The rise in EMS cases coincided with the transition of horses from working animals to companion animals with more sedentary lifestyles. But EMS is a complex disease that involves more than just lifestyle, and has both genetic and environmental components. This complexity has complicated EMS research, though new breakthroughs could provide key clues toward treating this disease.
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Morris Animal Foundation is a major sponsor of EMS research around the world, and our grantees are leaders in the field. We’re excited about some recent findings from our funded grants.
GENETICS PLAY A ROLE IN EMS A genetic explanation for this disease makes evolutionary sense and supports what we see clinically. It was beneficial for early equids to develop an efficient metabolism to survive in times of scarce resources. However, this same trend toward thriftiness can lead to obesity and insulin dysregulation. Researchers at the University of Minnesota published findings on a correlation between height in Welsh ponies
and their baseline insulin levels. They found that shorter ponies had higher baseline levels, which translates into a greater potential for EMS.1 Data on the predisposition of certain horse breeds for developing EMS provides further evidence for a significant genetic influence. The Minnesota team also published a study that estimated the heritability of certain EMS biochemical traits in Morgan and Welsh ponies, which ranged from moderate to high heritability. The findings have implications for future research on genetic risk factors for EMS. 2
EMS is a complex disease. Through strategic funding, Morris Animal Foundation hopes to generate a path to better diagnostics, treatments and, hopefully, new preventive strategies for this serious threat to horses. Learn more at morrisanimalfoundation.org.
Norton EM, Avila F, Schultz NE, Mickelson JR, Geor RJ, McCue ME. “Evaluation of an HMGA2 variant for pleiotropic effects on height and metabolic traits in ponies”. J Vet Intern Med. 2019;1–11. https://doi. org/10.1111/jvim.15403 1
Norton EM, Schultz NE, Rendahl AK, McFarlane D, Geor RJ, Mickelson JR, McCue ME. “Heritability of metabolic traits associated with equine metabolic syndrome in Welsh ponies and Morgan horses”. Equine Vet J. 2019;475-480. https://doi.org/10.1111/evj.13053 2
Durward-Akhurst SA, Schultz NE, Norton EM, Rendahl AK, Besselink H, Behnisch PA, Brouwer A, Geor RJ, Mickelson JR, McCue ME. “Associations between endocrine disrupting chemicals and equine metabolic syndrome phenotypes”. Chemosphere. 2019;652-661. https://doi.org/10.1016/j. chemosphere.2018.11.136 3
AND SO DOES THE ENVIRONMENT The University of Minnesota research team is also investigating environmental factors. Although it’s tempting to give genetics the major role in the development of EMS, some experts suggest that almost 50% of the phenotypic variability in EMS is due to environmental factors. The Minnesota team recently reported how endocrinedisrupting chemicals could play a role in clinical disease in horses. They reported that horses living close to federal Superfund sites, where endocrine-disrupting chemicals may be concentrated, were more likely to have a history of laminitis and biochemical abnormalities related to EMS. 3 Diet, exercise and season can also influence the EMS phenotype, but research has shown that these factors account for only a small part of this variation.
NEW RESEARCH FOCUS AREAS Morris Animal Foundation has several new studies in progress that are tackling EMS from different directions. Recently funded projects include:
+ How
the gut microbiome and metabolome influence insulin levels
+ A description of the microbiome in Shetland ponies who do and don’t develop EMS
+ T he
effect of phenylbutazone on insulin and glucose dynamics
+ T he roles of adiponectin and systemic inflammation on insulin dysregulation.
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MITOCHONDRIA:
and muscles require a lot of energy, they have particularly high densities of mitochondria. When mitochondria are not healthy, these tissues are often the first to show signs of poor function.
BY CARMEN M.H. COLITZ, DVM, PhD, DACVO AND TERRI MCCALLA, DVM, MS, DACVO
Mitochondrial dysfunction can have primary (genetic) or secondary (e.g. age-related, infectious) causes. Aging tissues undergo oxidative stress because their mitochondria often fail to produce sufficient ATP. Since eyes are continually bombarded with oxidative stressors (UV light and oxygen), and mitochondria both generate and can be damaged by oxidative stress, it makes sense that chronic exposure to oxidative stress causes instability and cumulative damage of mitochondrial DNA.
THE ENERGY OF LIFE
Mitochondria are fascinating and critically important “powerhouse” organelles inside cells. They use oxygen to make energy in the form of ATP. Mitochondria are unique in that their ancestors are bacteria that were ingested into cells to form a beneficial host/bacteria relationship (termed endosymbiosis) over 1.45 billion years ago. Thus, each of our cells has two different sets of DNA — one in the host cell nucleus, and the second in mitochondria (MtDNA). However, only maternal MtDNA is inherited. During normal metabolism, mitochondria generate harmful reactive oxygen species (ROS) that must be neutralized and balanced by antioxidants to prevent cellular damage. In fact, mitochondria can inflict self-injury as they are the main intracellular generators of ROS as well as the main target of ROS attack. An imbalance of ROS and antioxidants can cause mitochondrial dysfunction, leading to inflammation and chronic illness. When antioxidant defenses are inadequate to neutralize ROS, cell damage and/or cell death results, initiating inflammation. Neutralization of ROS occurs by a variety of antioxidant systems, including the glutathione redox system, ascorbic acid, tocopherals, retinoids, catalase and superoxide dismutase. Mitochondrial disease is a group of disorders characterized by dysfunctional energy production (ATP) along the mitochondrial electron transport chain. Most disease processes have some degree of mitochondrial dysfunction. Mitochondrial damage can occur from either too little or too much energy production. Because cells of the eye, brain
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Glaucoma causes chronic hypoperfusion of the optic nerve. Because the optic nerve contains abundant mitochondria, this makes it vulnerable to damage from glaucoma. Cancer is also associated with mitochondrial dysfunction. Mitochondria play important roles in carcinogenesis by altering energy metabolism, resisting apoptosis, increasing ROS production, and altering mtDNA. Uveal melanoma is the most common primary intraocular tumor in dogs, cats and humans. Novel therapies for this cancer are directed at inhibiting tumor-specific mitochondrial function, and hold promise as a new way to treat ocular cancers. Supplements that reduce mitochondrial dysfunction help maintain healthy glutathione levels and include vitamins C and E (in the form of mixed tocopherals), alpha lipoic acid, coenzyme Q10, folate, vitamins B6 and B12, green tea extract, turmeric, Omega-3 fatty acids and zinc. Providing a variety of antioxidants to dogs and cats may better protect the powerhouse of their cells from constant attack and self-combustion by ROS. The foundation of health is protection and enhancement of the energy of life. Dr. Carmen Colitz is a board-certified veterinary ophthalmologist with a PhD in Comparative and Experimental Medicine. She has extensively researched antioxidants in eye health. Based out of Florida, her work has helped countless dogs, cats and aquatic mammals over the last 20 years. Dr. Terri McCalla has been a board-certified veterinary ophthalmologist for nearly 30 years, and has an MS in Comparative Pathology. Her special interests include both retinal disease and the effects of stress on ocular health in animals. Her private referral practice is located in Bellingham, WA. Carmen and Terri are founders of Animal Health Quest Solutions and formulators of Ocu-GLO, a vision supplement for dogs and cats comprised of 12 antioxidants.
ACUPUNCTURE AND ANALGESIA I N VETE R I NARY M E DICI N E BY NEAL J. SIVULA, DVM, PHD, FAAVA, MDIV
AN EXPLORATION OF HOW THIS ANCIENT MODALITY TREATS PAIN IN ANIMAL PATIENTS.
Acupuncture is defined as the stimulation of specific predetermined points near the surface of the human or animal body. This stimulation produces therapeutic effects by evoking homeostatic mechanisms within the nervous, endocrine, cardiovascular and other body systems, and in turn, promoting self-healing.1 The practice of acupuncture stimulates the endings of small nerves and other tissues around the points, leading to both local and systemic effects. This article explores how acupuncture achieves analgesia, which occurs on many levels,2 in veterinary patients.
MECHANISMS OF ACTION Current knowledge of the mechanisms of action in acupuncture pain control involves a number of areas, both local and global. • Pain perception may be altered locally. The response to a painful stimulus may be dampened, secondary muscle spasms and tissue drag can be reduced, and neurochemical alteration of inflammation can occur throughout the body.3 Electroacupuncture or EA (see sidebar on page 57) has been
shown to be superior to dry needling for pain reduction when Functional MRI (fMRI) is used to measure the brain’s response to a painful stimulus. Because of this, EA is more often used for pain relief in research studies than dry needling.3,4 • Pain relief at the level of the spinal cord has been explained using the Gate Control Theory.5 This theory is based on the stimulation of A-beta and A-delta fibers. These fibers compete with the pain transmission of the slower-firing C fibers at the level of the spinal cord. Acupuncture-stimulated A-beta and A-delta fibers fire onto the receptors of neurologic circuits at the local spinal cord level and block the reception from C fibers, thereby closing the “gate” to further pain transmission because these synapses are occupied. This is a proposed mechanism for the local inhibition of pain transmission and is fast-acting and of short-duration.5 • The effects of acupuncture occur at more than just the local spinal cord level. Impulses from both A-delta and C fibers synapse in the dorsal horn gray matter of the IVC Winter 2019/2020
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spinal cord interneurons, which leads to the release of inhibitory neurotransmitters that reduce pain transmission both up and down the spinal cord. Stimulation of A-delta fibers leads to activation of enkephalinergic interneurons that inhibit the pain response by blocking C fiber transmission. Acupuncture also decreases the release of neurotransmitters that increase the pain response at the level of the spinal cord.6 • Central pain sensitization in the brain from peripheral nerve damage or tissue injury can be an important source of chronic pain. Patients that experience central sensitization have been shown to have pain receptors with increased activity in the spinal cord. In mice and rats, acupuncture has been demonstrated to reduce the pain response in these receptors, showing that acupuncture can be effective for pain control even after central sensitization has occurred.7 • Acupuncture can have effects on tendons, ligaments, muscles and other connective tissues. Relief from painful muscle spasms can be achieved by inserting a needle directly into the muscle. Reducing primary muscle pain and spasm with acupuncture also serves to reduce nerve pain secondary to tissue drag from the spastic muscle. It is especially effective when the acupuncture point used is close to where the tendon attaches to a muscle.8
• Increases in sympathetic nervous system tone have been demonstrated in patients with chronic pain.9 Vasoconstriction is a by-product of this increased sympathetic tone, which leads to a variety of problems including hyperesthesia, allodynia, burning and aching. These issues are not related to inflammation and are resistant to treatment with anti-inflammatory medication.9 In horses, it has been demonstrated v ia thermography that EA increases blood flow to muscles with reduced blood circulation.10 Research in rats has shown that blood flow to the rear limb is increased when acupuncture is performed at the level of the nerve root next to the spine, instead of at a location further down the limb.10 • Patients experiencing pain often have secondary anxiety as well. Studies using fMRI have shown that acupuncture stimulates calming neurochemistry in painful as well as depressed patients.11 • Acupuncture in humans has been shown to be effective for the treatment of back pain when compared to sham treatment (stimulation of points on the body not known to be acupuncture points). The relief from pain was greater when patients received EA at the nerve root compared to dry needle acupuncture in the same locations.3 Continued on page 58.
In patients with muscle pain, needling trigger points (areas of pain and muscle spasm), as well as defined acupuncture points, has been shown to be superior to simply treating acupuncture points alone.8
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ELECTR
ACUPUNCTURE
— the most researched area of acupuncture
Electroacupuncture was developed in the 1930s in China. The low-intensity stimulation of acupuncture points through the manual use of acupuncture needles for surgical pain relief was effective, but EA was developed to ease staffing needs in the hospital. With the help of EA, more patients could be treated with less manpower. Early machines used 2 Hz to 15 Hz power because it mimicked the frequency of stimulation provided by manual acupuncture.3 The effects of EA on the brain have been studied using a variety of diagnostic tests, including functional magnetic resonance testing (fMRI) and positron emission tomography (PET) scans. When it comes to pain perception in the brain, it has been shown that the thalamus and other higher centers in the cortex are activated when a painful stimulus is applied. After acupuncture, these areas are not as stimulated. The mechanism of this decrease in pain transmission may be be caused either by modulation of the pain transmission at the level of the ascending tracts of the spinal cord, or by reduction of impulse transmission at the level of the dorsal horn gray matter of the spinal cord.3 In research regarding EA and pain relief, the areas that have been studied are the influence of EA on the dorsal horn gray matter of the spinal cord, the periaqueductal gray matter (PAG), the pons, medulla, limbic system, cerebral cortex and the autonomic system in general. It has been shown that the frequency of EA is important as it changes the areas of pain transmission affected.3 Centrally, high frequency EA also reduces histamine and dopamine release in the PAG region while increasing
norepinephrine release to reduce pain transmission. In descending pathways, EA has been demonstrated to help activate areas of the medulla oblongata which are involved in pain control via descending pathways using serotonin, epinephrine and norepinephrine.17 The voltage used must be enough to overcome the resistance of the tissue being treated, and the current must be enough to depolarize nerves. Using these parameters, the dose needed is about 20 mA. Lower voltages are used in EA than in TENS units because when doing EA, the resistance of the skin is bypassed by the needle.3 Stimulating a patient with a wide range of frequencies will provide for a broader range of neurotransmitter release. Dense-dispersed EA units alternate the frequency between low and high frequencies every few seconds. The alternation allows for nerve fibers to accommodate to stimulation, and allows for the optimum release of neurotransmitters.3 EA should be considered for patients in which dry needling is ineffective or the treatment effect cannot be maintained, and if the pain is chronic or acute and intense (e.g. postsurgical pain). The points selected for EA should be similar to those used for dry needling. The practitioner can also pair the needles close together within the same muscle for EA treatments.3 Contraindications for EA include caution when used in the neck (it may cause hypotension), and in patients known to have seizures (it could possibly induce seizures). It also should not be performed in broken skin because of the risk of infection.3
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Continued from page 56. • Acupuncture in humans for osteoarthritis of the stifle and hip was shown to be effective over three months of treatment, but the cost often exceeded routine medical treatment because of the need for multiple sessions. Acupuncture treatment has been shown to be superior to sham treatment for stifle arthritis.12 • Pain relief for cancer patients is an important part of therapy. Traditionally, opioids have been used for the relief of cancer pain. The side effects of opioids in humans include depressed respiratory function, decreased appetite, constipation and addiction. The use of EA for nerve pain secondary to experimentally-induced tumors in mice was shown to be beneficial at reducing this cancer-related pain.13 There have been a few quality studies assessing the effectiveness of acupuncture for pain relief in animals. It has been shown to be effective in the treatment of lameness, back pain, thoracolumbar pain and hoof pain in horses.14,15
THE ACUPUNCTURE POINT PRESCRIPTION Acupuncture point selection is important for achieving a positive treatment outcome. Selecting points that stimulate both A-delta and A-beta receptors in the dorsal horn of the spinal segment of the painful area will maximally compete with the C fiber pain, thus inhibiting it.16 The needle should be inserted as close as possible to the source of pain — “Put the needle where it hurts.” From a neurological perspective, formulating an acupuncture point prescription is based on a physical and neurologic examination of the patient. Points are chosen close to the primary area of discomfort and to the spine, in order to more efficiently affect the transmission of pain at the level of the spinal cord, as well
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From the AVH as distal to the primary area of concern. These distal points often lie close to nerve bundles that can provide pain relief in a powerful manner.5 Acupuncture has a broad range of effects on the neurologic system which have been widely studied and documented. The specific effects of acupuncture on the neurologic system should be taken into account when deciding if it will benefit a particular patient, along with which points and method would best suit that patient.
Kaptchuk TJ. “Acupuncture: theory, efficacy, and practice”. Ann Intern Med. 2002; 136:374-383.
1
Bowsher D. “Mechanisms of acupuncture”. In: Filshie J, White A, eds. Medical Acupuncture: A Western Scientific Approach. Edinburgh: Churchill Livingstone; 1998: 69-92.
2
Ulett GA, Han S, Han JS. “Electroacupuncture: mechanisms and clinical application”. Biol Psychiatry. 1998; 44: 129-138.
3
Napadow V. “Effects of electroacupuncture versus manual acupuncture on the human brain as measured by fMRI”. Human Brain Mapp. 2005; 23(3): 193-205.
4
White A, Cummings M, Filshie J. An Introduction to Western Medical Acupuncture. Edinburgh: Churchill Livingstone Elsevier; 2008.
5
Carlsson C. “Acupuncture mechanisms for clinically relevant long-term effects — reconsideration and a hypothesis”. Acupunct Med. 2002; 20: 82-99.
6
Hsiang-Chun L. “Acupuncture analgesia-mediated alleviation of central sensitization”. Evid Based Complement Alternat Med. 2019; Mar 7: 6173412.
7
Melzack R. “Myofascial trigger points: relation to acupuncture and mechanisms of pain”. Arch Phys Med Rehabil. 1981; 62: 114-117.
8
Cho ZH, Hwang SC, Wong EK, et al. “Neural substrates, experimental evidences and functional hypothesis of acupuncture mechanisms”. Acta Neurol Scand. 2006; 113: 370-377.
9
von Schweintz DG. “Thermographic evidence for the effectiveness of acupuncture in equine neuromuscular disease”. Acu in Med. 1998; 16 (1): 14-17.
10
Yang CH, Lee BH, Sohn SH. “A possible mechanism underlying the effectiveness of acupuncture in the treatment of drug addiction”. Evid Based Complement Alternat Med. 2008; 5: 257-266.
11
Bowsher D. “Mechanisms of acupuncture”. In: Filshie J, White A, eds. Medical Acupuncture: A Western Scientific Approach. Edinburgh: Churchill Livingstone; 1998; 69-92.
The Academy of Veterinary Homeopathy is comprised of veterinarians who share a common desire to restore true health to their patients through the use of homeopathic treatment. Members of the Academy are dedicated to understanding and preserving the principles of Classical Homeopathy.
ARNICA — A KEY REMEDY FOR PAIN (AND MORE)!
Arnica is the most familiar homeopathic remedy worldwide. According to Dr. M.L. Tyler in Homeopathic Drug Pictures, it should be in every home, and everyone should know its uses. Just browsing the key phrases from Dr. Hahnemann’s initial provings of Arnica gives great insight (and remember, what a drug can cause, it can cure): • felt as if bruised all over • pain…as after a violent fall • pain in the heart…as if it had got a shock • chest painful during breathing/tightness in chest • bloody expectoration • fear of being touched Also be aware of these lesser known keynotes: • stupor • retinal hemorrhage • epistaxis • putrid smell from mouth • offensive flatus • f requent attempts to urinate • sprains/strains
• concussions; cerebral hemorrhage • “putrid” fevers; septicemia • post extraction dental pain • t umors following injury
12
Lee HJ. “Substance P and Beta endorphin mediate electroacupuncture induced analgesia in a mouse cancer pain model”. Acupunct Electrother Res. 2009; 34: 27-40.
13
Klide AM. “Acupuncture for treatment of chronic back pain in the horse”. Acupunct Electrother Res. 1984; 9: 57-70.
14
Xie H. “Evaluation of electroacupuncture treatment of horses with signs of chronic thoracolumbar pain”. JAVMA. 2005; 227: 281-286.
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Choi EM, Jiang F, Longhurst JC. “Point specificity in acupuncture”. Chin Med. 2012; 7:4.
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Fukazawa Y, Maeda T, Kishiokia S. “The pharmacological mechanisms of electroacupuncture”. Curr Opin Investig Drugs. 2009; 10: 62-69.
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In all these situations, Arnica proves to be the remedy for trauma par excellence. Trauma, in all its various forms and effects, recent or older, is addressed by Arnica as by no other single drug. It is the main pain medicine used in my busy practice, from post-op to post-injury indications, and it can often be alternated with other homeopathic remedies to bring greater relief. Submitted by Todd Cooney DVM, CVH IVC Winter 2019/2020
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PEER-REVIEWED BY MICHELLE TILGHMAN, DVM, CVA, CCRP
The Traditional Chinese Veterinary Medicine approach to geriatric animal care
When treating older animals, the first goal in veterinary medicine is to diagnose and alleviate pain, and the second is to restore quality of life. Here’s how TCVM can help accomplish both aims.
As a veterinarian, I find that treating geriatric patients is among my most challenging and rewarding missions. Restoring joy and mobility to a grateful animal, along with the recognition that he is now pain-free, is the underlying motivation behind my life’s work. Moreover, the animals’ owners are so thankful to have additional quality time with their babies that they are likely to remain our clients forever. I know these patients come to my clinic in order to finish their lives in a loving, supportive environment. Just as there are midwives who aid with the transition into life, I feel like a midwife to death, the one who gently guides animals toward their final portals in life. For these reasons, I have embarked on a journey to love and care for geriatric souls, using a TCVM approach.
THE TEMPERATURE QUESTIONS As with youthful patients, we begin our work with the basic Yin and Yang questions and establish where the geriatric
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patient is. Ask the following temperature questions: • Is the animal heat- or cold-seeking? • In what weather conditions does he feel best? • Does he pant at night or is he under the covers? • Check the tongue for color and hydration. Red or pale? Dry or wet? • Has there been any change in behavior? • Has he exhibited aggression toward housemates and/or humans? • Does he seem to be in pain?
FIRST, TREAT THE PAIN Always treat pain first. Pain is a stasis — a stagnation of the flow of Qi, blood flow or joint motion. Many geriatrics are in pain due to a decrease in fluids (Yin) and not enough motion (Yang). These areas of stasis become stagnant, “stuck”, and
they hurt. Pain can be caused by an area of Damp Cold stasis, or an area of Hot Dry stasis where too much Heat has depleted the Blood. Initiating movement in the area of stasis is a simple way to start the process of healing pain.
treatment modalities, including conventional medicine, acupuncture, physical rehabilitation, chiropractic treatment, prolotherapy, nutrition, homeopathy and herbals to develop a tailor-made plan to meet the individual patient’s needs.
Consider the tongue and pulse when diagnosing stasis. The pulse often has an irregular, choppy, thin quality to it when an animal is in pain. The tongue may show redness and Heat. Establish the location, nature and extent of the pain through close observation of movement and behavior.
Conventional approaches include the use of NSAIDS, opioids and Adequan. A multimodal approach will combine the different modes and sites of action of the various agents in order to increase pain relief while reducing dosages and possible side effects. Owner education is an important aspect of the multimodal approach. Teaching owners how to recognize pain and educating them on topics such as weight control, exercise, and environmental management (e.g., flooring, bedding, etc.) is a critical part of effective treatment.
In geriatrics, behavior changes can be signs of pain or a loss of sensory organ function. Aggression toward a playful younger animal in the house can be the older one saying, “That hurts! Leave me alone!” Changes in urination or defecation habits may also be caused by pain. For example, I recently worked with an older poodle that had been rescued from desperate circumstances as a young animal. She had recently begun urinating in the house and on the deck. Her owners had enrolled her in an obedience class in an attempt to stifle this behavior; however, radiographic images revealed an old poorly-healed pelvic fracture her owners had been unaware of. The cold weather, coupled with the slippery stairs leading to the yard, made it difficult for the dog to urinate anywhere else. Letting her out through a different door — one without stairs — remedied the behavior in short order.
Acupuncture The TCVM approach to geriatrics should always include the use of acupuncture. Electroacupuncture is one of the most effective methods of moving areas of stasis and quickly increasing the pain threshold. More-than-adequate research documents the efficacy of acupuncture as a method of pain relief. Acupuncture analgesia is seen more intensely along the meridian of the point being stimulated. Consideration should be given to the points used, and if they should be local or along muscle channels.
Treatment modalities for pain The modern veterinarian has a variety of treatment approaches at hand to combat pain in geriatric patients. Once the diagnosis has been made, practitioners may select from multiple
There is also evidence that acupuncture may assist in recovery from spinal cord injuries, which are common in geriatric IVC Winter 2019/2020
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BI AND WEI SYNDROMES q Bi syndrome refers to the
obstruction of Qi and Blood in the meridians, due to the invasion of Wind, Cold, Dampness, repetitive motion, and external pathogenic factors. This syndrome can manifest as soreness, pain, numbness, a heavy sensation, swelling of joints and limbs, and limited movement.
patients. Dogs with spinal cord injuries who received a combination of conventional veterinary treatment and electroacupuncture had better recovery in urinary control, conscious proprioception and ambulation when compared with those who received conventional treatment alone.1 The main meridians that are effective from a TCVM perspective are the Yang meridians, which are responsible for gross motor muscle movements. The ability to get off the floor, squat to potty, and walk up stairs involve the following meridians:
w Wei syndrome is characterized by muscle weakness, atrophy, and a generalized wasting of the body. Geriatric patients can have a combination of Bi and Wei syndromes. When addressing these, the first goal is to eliminate the pathogenic factor(s) from the body. Keep the Yin/Yang balance in mind. Regulate the Qi and Blood while removing the obstructions from the channels and the collaterals. Finally, pay attention to the Wei Qi — strengthen the body’s resistance.
• Bladder meridian — controls the major superficial back muscles • Stomach meridian — the psoas and quadriceps • Gall Bladder meridian — the lateral muscles of the body, including the gluteal muscles The most effective points are the major points in the muscles from the proximal to the distal meridian: • BL11 • BL23 • BL28 • BL40 • BL54 • BL60
• GB29 • GB30 • GB34 • ST36 • KD3
SECOND, ESTABLISH A TCVM DIAGNOSIS Constitutional elements The constitutional element of the animal should be taken into consideration when making a TCVM diagnosis. A patient’s element can be a clue to the TCVM diagnosis. Water — Kidney Is the animal fearful? Does he have a history of inappropriate urination or urinary incontinence?
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Wood — Liver and related behaviors Does he have a short fuse? Terriers in particular have a temper and are often Wood animals. Fire — Heart Older Fire animals were previously very active and energetic, but have lost that essential nature. Metal — Lung Is the animal aloof? Has he developed respiratory symptoms, particularly as he has aged? Earth — Spleen Has the animal’s digestion been affected as he has aged? Are his stools dry and hard or too wet? The TCVM diagnosis is always valuable. There seem to be two schools of thought on the core cause of deficiency in traditional Chinese medicine — one that focuses on the Kidney and the other the Spleen. The Spleen school sees the Spleen as the center of deficiency because it is responsible for the transportation and transformation of Gu Qi (food); this is an important consideration when evaluating the diet of a geriatric animal. In aging humans, the digestion of protein is reduced due to a decrease in hydrochloric acid. I find this to be true in aging animals as well. Simple strategies such as changing the animal’s diet to something more easily digested (from dry to wet), and feeding smaller more frequent meals can be beneficial. Also, cooking and serving the food warm can help feed the Spleen, thereby increasing Postnatal Kidney Qi and replenishing Kidney Jing.
Patterns of deficiency Most of our geriatric patients will have deficiency patterns. First, the Qi is deficient, then the Blood becomes deficient and stagnant. The body fluids, not being nourished by the Blood, will dry up and condense to phlegm. The Jing, not having nourishment, will then become deficient. Most geriatric patients have some degree of deficiency, and zeroing in on the correct one can restore their vitality. Below are the different patterns of Kidney and Spleen deficiencies. Those that are starred are the most common: • Kidney Yang Deficiency* • Kidney Yin Deficiency* • Kidney Qi Not Holding Firm* • Kidney Failing to Receive Qi • Kidney Jing Deficiency* • Kidney Yang Deficiency Water Overflowing
• Kidney Yin Deficiency Empty Heat Blazing* • Kidney and Liver Yin Deficiency* • Kidney and Heart Yin Deficiency* • Kidney and Lung Yin Deficiency* • Kidney and Spleen Yang Deficiency*
When determining the deficiency pattern of patients, remember that the Spleen is responsible for the Qi in the body, and for the transportation and transformation of food (without food, there would be no Qi). The Liver is like a tree, moving the Qi upward and outward through the body. When the Spleen is damaged, the Qi will be decreased due to impaired digestion. When Qi decreases, the Blood is affected and becomes deficient. The Spleen is very sensitive to Cold and Damp; it prefers Dry and Warm. Spleen deficiency patterns are therefore as follows: Qi Deficiency, Yang Deficiency, Damp Cold, and Damp Heat. In veterinary medicine, older patients are some of the most challenging to treat. Begin by checking the tongue, feeling the pulse, and differentiating between Yin and Yang patients. When proceeding with treatment, use the points that work for you and try some of the empirical Wei points. Proceed with a TCVM diagnosis, as this is always helpful when treating patients with multiple modalities. Remember, your first goal as a practitioner is to diagnose and alleviate pain. Your second goal is to restore the geriatric animal’s quality of life, using every modality available to you.
Xie H, Wedemeyer L.”The validity of acupuncture in veterinary medicine”. AJTCVM 2012;7:35-43.
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References Beijing College of TCM. Essentials of Chinese Acupuncture. Beijing, China: Foreign Language Press, 1980. Dung HC. Anatomical Acupuncture. San Antonio, TX: Antarctic Press, 1997. Fratkin JP. Chinese Herbal Patent Medicines. Boulder, CO: Shya Publications, 2001. Han, Hyun-Jung. “Clinical effect of additional electroacupuncture on thoracolumbar intervertebral disc herniation in 80 paraplegic dogs”. AJCM 2010;38:1015-1025. Hayashi AM, Matera JM, Fonseca Pinto, AC. “Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disk disease in dogs”. JAVMA 2007;231:913-8. Johnson JA. Chinese Medical QiGong Therapy. Pacific Grove, CA: The International Institute of Medical Qigong, 2005. Kendall D. Dao of Chinese Medicine. New York, NY: Oxford University Press Inc, 2002. Maciocia G. The Foundations of Chinese Medicine. London, England: Churchill Livingstone, 1989. Maciocia G. The Foundations of Chinese Medicine. 2nd ed. Churchill Livingston, 2011. Schaeffer R. IVAS Teaching Manual, Sess. 4, pp. 612-614, 2010. Schoen A. Veterinary Acupuncture. St. Louis, MO: Mosby, Inc., 2001. Xie H, Preast V. Traditional Chinese Veterinary Medicine. Reddick, FL: Jing Tang, 2002.
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From the VBMA
The Veterinary Botanical Medicine Association is a group of veterinarians and herbalists dedicated to developing responsible herbal practice by encouraging research and education, strengthening industry relations, keeping herbal tradition alive as a valid information source, and increasing professional acceptance of herbal medicine for animals. Submitted by Cynthia Lankenau, DVM
DID YOU GUESS LAST ISSUE’S HERB? The beautiful polypore mushroom was seen on our first walk at Aigas Field Centre in Beauly, Scotland. The Latin name is Fomes fomentarius and it’s also known as horse hoof fungus or tinder fungus. It’s the mushroom species that was found on the 5,300-year-old corpse of Ötzi the Iceman, and was used as tinder. From the underside, it truly looks like a horse hoof. It is not very edible but is amazing to look at and a very important polypore if survival skills are needed; it can be used to incubate coals from a fire, carried through the day, and used to light the next campfire.
PAST ACTIVITIES The VBMA has been very busy with webinars, the International Herbal Symposium, and our amazing Scottish eco-tour at Aigas Field Centre. We enjoyed a member-led herb walk at Two Rivers Park in Nashville, Tennessee, the day before the AHVMA Conference. Dr. Joyce Harman discussed Perilla mint (Perilla frutescens), a plant that treats phlegm conditions and is used to disperse Wind-Cold, bloating, and stomach and lung problems. She also identified evening primrose (Oenothera spp) from a small bracket of leaves. David Winston uses the leaf, root bark or flower for gastrointestinal-based and hepatic depression, inflammatory bowel disease and irritable bowel syndrome, and for irritative coughs and gastrointestinal irritation. Dr. Cindy Lankenau talked about staghorn sumac (Rhus typhina). The berries are indicated for oral issues, and can be used as a cooling summer tea. Goldenrod (Solidago virgaurea) is used as a Kidney Jing tonic, strengthening the lower back and helping in the treatment of allergies based on weak kidney function. The diuretic effects of lance-leaf plantain (Plantago lanceolata) and the Blood clearing effects of red clover (Trifolium pretense), were discussed by Mike Walker.
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Canadian f leabane (Erigeron canadense) was also seen, and is one of the herbs that Greg Tilford discussed during his VBMA sponsored talk on “Wayside Weeds” at the AHVMA conference. It can be used as a styptic and is a very effective treatment for bleeding hemorrhoids. The whole plant is antirheumatic, astringent, balsamic and diuretic, and is also an emmenagogue, tonic and vermifuge.
Canadian fleabane found on the pre-AHVMA Conference herb walk.
UPCOMING EVENTS The next VBMA webinar will be presented on December 12, 2019 by Dr. Kendra Pope, DVM, DACVIM (Oncology), CVA, CVCH, CVFT, CVTP. This is sure to be a very interesting talk. Remember that past webinars are available for purchase at vbma.org. We are also finalizing our 2020 conference, starting on October 25 in Eugene, Oregon with the Oregon Mushroom Festival, followed by a day of lectures on October 26 featuring Kevin Spelman, PhD and Subhuti Dharmananda, PhD. On October 27, the ACVBM will host Chanchal Cabrera. The week will conclude with a two-and-a-halfday eco-tour at a local hot springs. Stay tuned for more information about this incredible event!
GUESS THIS HERB!
Join the VBMA at vbma.org to find out. The answer will also be published in the next issue of IVC Journal.
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news bites WHAT MILLENNIALS WANT FROM THEIR VETS
OBESITY LINKED TO GENE MUTATION
Millennials might get a bad rap, but 75% have companion animals, and many make veterinary care a top priority. An independent survey released by Weave revealed what millennials want from their veterinary clinic experiences, what makes them move on from a clinic, and what helps them maintain loyalty. Here are some key findings :
You have probably seen more than your share of overweight canine patients. The Association for Pet Obesity Prevention estimates that 56% of dogs in the United States are overweight or obese — a huge problem for canine health.
as concerned about their animals’ health as their own.
15%
Only will always answer their phones even if they don't know who’s calling, but 81% would definitely answer if they saw it was their veterinarians.
81% want their vets
to automatically recognize them when they call; 72% say they have had to wait while their vets look up their accounts.
Millennials also like their veterinarians to be tech savvy. "They have grown up with technology, and expect that tech to enhance all experiences throughout their lives, including purchases like veterinary care for their animals," says Brandon Rodman, CEO at Weave. "They require tailored services…. You can't provide personalization without the right technology." getweave.com
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SCIENTISTS REVEAL NEW THEORY ON HOOF DISEASE Using innovative 3D Synchrotron imaging techniques, as well as histological sampling and stem cell biology, scientists at the University of Nottingham have discovered new information about the causes and potential treatment of hoof diseases in horses. The research team studied the hooves of 129 horses, acquiring the most detailed pictures ever produced of hoof structure, biology and physical dynamics. The results revealed a number of key findings: • A “dished hoof” (i.e. a dorsally curved hoof as observed in cases of chronic laminitis) is fundamentally caused by the fact that hooves are asymmetric (with a short heel and long toe). This in turn explains why donkeys are less prone to hoof deformities/ pathologies, since they tend to have long heels. • The dorsal curvature can be exacerbated by a low body condition score or/and rapidlygrowing hoof.
New high resolution imaging techniques allow scientists to dissect the hoof components and visualise them in 3D.
The research, led by Dr. Cyril Rauch, Associate Professor in Physical and Mathematical Veterinary Medicine & Science, will have huge implications for the prevention and management of chronic hoof pathologies and deformities. royalsocietypublishing.org/doi/10.1098/rsif.2019.0214
Photo courtesy of University of Nottingham
92% of millennials are
Researchers at Cambridge University recently identified a gene mutation linked to obesity in Labrador retrievers; the same team plans to use DNA samples from dogs enrolled in the Morris Animal Foundation Golden Retriever Lifetime Study to search for a similar locus in this breed. Identifying dogs at risk for obesity can help you and your clients strategize on effective weight management. morrisanimalfoundation.org/goldenretriever-lifetime-study
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