V10I2 (Spring 2020) by Redstone Media Group

Innovative VOLUME 10 ISSUE 2

VETERINARY CARE

CARING FOR THE CANINE LIVER

A DETAILED LOOK AT HOW PROPER DIET, ANTIOXIDANTS AND SUPPLEMENTS SUPPORT AND PROTECT LIVER FUNCTION IN DOGS. — P. 10

THE DOG AGING PROJECT Read about a unique study that aims to determine the biological, lifestyle, and environmental factors influencing healthy canine aging. — P. 16

ADDING MINDFULNESS TO YOUR PRACTICE

Teach your staff these steps to becoming healthier, more engaged and present within the clinic setting. — P. 42

SPRING 2020

www.IVCJournal.com

ALLERGIES AND THE HYPERSENSITIVE IMMUNE SYSTEM

CASE REPORTS — FOCUS ON INTEGRATIVE MEDICINE

HELP CLIENTS UNDERSTAND PET FOOD LABELS

HEMP AND YOUR EQUINE PATIENTS

Allergen immunotherapy (AIT) gets to the root of patient allergies by retraining the immune system. — P. 36

Become a trusted resource for pet dietary advice by helping clients decipher ingredient labels. — P. 22

How an integrative approach led to successful outcomes in two veterinary patients with very different health problems. — P. 48

Making sense of the different types of hemp products available for horses. — P. 58

IVC Spring 2020

contents FEATURES

SUPPORTING LIVER FUNCTION AND DETOXIFICATION IN CANINE PATIENTS

THE DOG AGING PROJECT — 80,000 DOGS AND COUNTING

By Ihor Basko, DVM, CVA

An exploration of how to protect and care for the canine liver with proper diet, antioxidants and supplements that optimally support this important organ’s many functions.

By Katherine Tolbert, DVM, PhD, DACVIM and Audrey Ruple, DVM, MS, PhD, DACVPM, MRCVS

A longitudinal study that aims to determine the biological, lifestyle, and environmental factors that influence healthy aging in dogs.

NUTRITION NOOK

HELPING YOUR CLIENTS UNDERSTAND PET FOOD LABELS

By Jodie Gruenstern, DVM, CVA

Recapture your title as a trusted resource for pet dietary advice, and empower clients to realize the importance of understanding ingredient labels.

28 58 4

WESTERN HERBS FOR LIVER DYSFUNCTION IN ANIMAL PATIENTS

By Alexia Tsakiris-Vasilopoulos, BvetMed, GDipVWHM, CVA

Liver health is vital to patient health. Learn how a variety of Western herbs can be used to support liver function in animals.

RETRAINING THE HYPERSENSITIVE IMMUNE SYSTEM

By Jon Plant, DVM, DACVD

A comprehensive look at allergen immunotherapy (AIT) in dogs and cats, including regionally-specific immunotherapy (RSI).

INNOVATIVE PRACTICE

CASE REPORT 1

7 TIPS FOR CREATING A MINDFUL PRACTICE CULTURE

By Melissa Magnuson, DVM

Try teaching your staff these seven steps (inspired by our patients!) to becoming healthier, more engaged, and present.

AN INTEGRATIVE APPROACH TO VACCINE-INDUCED MENINGOENCEPHALITIS IN AN AUSTRALIAN SHEPHERD DOG

By Sara Humphrey, DVM Candidate 2020

How conventional veterinary medicine complemented with TCVM, nutritional support, and homeopathy brought this dog back to health.

CASE REPORT 2

USING AN INTEGRATIVE APPROACH TO TREAT FELINE BRACHIAL PLEXUS AVULSION By Cristina-Andreea Firulete, DVM, CVA

A multi-modal, integrative approach effectively restored limb function in a cat with a brachial plexus avulsion lesion.

DEMYSTIFYING HEMP AND CBD IN THE EQUINE By Joyce Harman, DVM, MRCVS

Clearing up the confusion surrounding the different types of hemp products available for horses.

IVC Spring 2020

advisory board 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 27 From the AVH 34 Industry innovations 41 From the AAVA 47 Profitable practice

— PhytoMAXX™ Plus by Animal Nutritional Products

57 From the NASC 61 From the VMAA 63 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.

64 From the VBMA 65 Marketplace 66 News bites

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.

IVC Spring 2020

SPRING 2020

EDITORIAL DEPARTMENT Editor-in-Chief: Dana Cox Managing Editor: Ann Brightman Associate Editor IVC: Laurin Cooke, DVM Senior Content Editor: Emily Watson Senior Graphic Designer: Dawn Cumby-Dallin Senior Graphic Designer: Alyssa Dow Web Design & Development: Lace Imson Social/Digital Media Specialist: Rebecca Bloom

COLUMNISTS & CONTRIBUTING WRITERS

Susan Albright, DVM, VP of VMAA Ihor Basko, DVM, CVA Chris Bessent, DVM Todd Cooney, DVM, CVH Cristina-Andreea Firulete, DVM, CVA Jodie Gruenstern, DVM, CVA Joyce Harman, DVM, MRCVS Sara Humphrey, DVM Candidate 2020 Cynthia Lankenau, DVM Melissa Magnuson, DVM Luiz Henrique Lima de Mattos, CRMV, CKTIE Jon Plant, DVM, DACVD Audrey Ruple, DVM, MS, PhD, DACVPM, MRCVS Katherine Tolbert, DVM, PhD, DACVIM Alexia Tsakiris-Vasilopoulos, BvetMed, GDipVWHM, CVA

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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 copyrightÂ© 2020. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: March 2020.

improving the lives of animals... one reader at a time.

IVC Spring 2020

contributors 1

1. IHOR BASKO, DVM, CVA

6. MELISSA MAGNUSON, DVM

cardiology, general and orthopedic surgery. He studied herbology in California, established a house call practice in San Francisco, and worked in a human acupuncture clinic. Dr. Basko was certified in acupuncture through the IVAS in1982. Today, he has a holistic practice on Kauai, Hawaii, offering dietary therapy, acupuncture, massage, laser therapy, TCM herbs and more. His current interests are the study of Hawaii’s medicinal plants, the biochemistry and biophysics of medicinal plants and mushrooms. P 10

wholly-owned AAHA accredited hospitals across southern New Hampshire. In 2019, Canobie Lake Veterinary Hospital was selected as a finalist for AAHA Hospital of the Year, an honor bestowed upon only three other hospitals in North America. Dr. Magnuson recently authored her first bestselling book, Animality — How Pets and People Connect, available on Amazon. P 42

Dr. Ihor Basko graduated from Michigan State University in 1971. His special interests were

2. CRISTINA-ANDREEA FIRULETE, DVM, CVA

Dr. Cristina Firulete graduated from Cluj-Napoca, Romania in 2017 and now practices in a holistic clinic in northern England. As a student, she worked in practices that offered alternative options such as homeopathy and acupuncture. Since qualifying as a veterinary surgeon, she has realized how important it is to treat every patient with a holistic view. Dr. Firulate received her CVA certification in December 2019. She also earned her certification from the Chi Institute and plans to continue her education in TCVM. Her conventional medical interests include emergencies, anaesthesia, and feline medicine, but her main goal is to recognize chronic pain and improve quality of life for her patients. P 53 3. JODIE GRUENSTERN, DVM, CVA

Dr. Jodie Gruenstern graduated from UW-Madison in 1987. She is a certified veterinary acupuncturist and food therapist by the Chi Institute; is former VP of the Veterinary Medical Aromatherapy Association (VMAA); and a member of the AHVMA and AzVMA. She authored Live with Your Pet in Mind, and founded Dr. Jodie’s Natural Pets, Integrating People for Animal Wellness (iPAW) and Dr. Jodie’s Integrative Consulting, PLLC. She was former owner of the Animal Doctor Holistic Veterinary Complex. Visit DrJodiesNaturalPets.com or email docjodie@DrJodiesNaturalPets.com. P 22 4. JOYCE HARMAN, DVM, MRCVS

Dr. Joyce Harman graduated in 1984 from Virginia Maryland Regional College of Veterinary Medicine. She is certified in veterinary acupuncture and chiropractic and has completed advanced training in homeopathy and herbal medicine. Her practice in Virginia uses holistic medicine to treat horses. Her publications include The Horse’s Pain-Free Back and Saddle-Fit Book — the most complete source of information about English saddles. P 58 5. SARA HUMPHREY, DVM Candidate 2020

Sara Humphrey is currently a fourth year veterinary student at Auburn University College of

Veterinary Medicine. During her time here, she has been Vice President of the Integrative Medicine Club. She will be completing a one-year rotating internship at BluePearl in Nashville, Tennessee following graduation. Sara’s current interests include ophthalmology, oncology, and internal medicine. She is currently attending The Chi Institute to obtain her acupuncture certification. Sara is planning to incorporate integrative medicine into any of these specialty fields to provide a wider range of therapeutic options to her patients. P 48

Dr. Melissa Magnuson has been practicing veterinary medicine full-time since 1999 at her three

7. JON PLANT, DVM, DACVD

Dr. Jon Plant is a 1988 graduate of Oregon State University, College of Veterinary Medicine. After 15 years of dermatology referral practice in Southern California, he taught at OSU, served as a dermatology consultant for Banfield Pet Hospitals and Dechra, founded SkinVet® Clinic in Oregon, and developed RESPIT allergen immunotherapy. Dr. Plant has served as the Chairman of the ACVD Examination Committee, and President of the Portland Veterinary Medical Association. P 36 8. AUDREY RUPLE, DVM, MS, PhD, DACVPM, MRCVS

Dr. Audrey Ruple is the Assistant Professor of One Health Epidemiology in the Department of Public Health at Purdue University. She is a licensed clinical veterinarian and a Diplomate of the American College of Veterinary Preventive Medicine. She obtained her DVM, MS and PhD degrees from Colorado State University and is a Member of the Royal College of Veterinary Surgeons. P 16 9. KATHERINE TOLBERT, DVM, PhD, DACVIM

Dr. Katherine Tolbert is a Clinical Associate Professor of Medicine, Small Animal Clinical Science at the Texas A&M University College of Veterinary Medicine. Her clinical research program focuses on small animal gastroenterology with a specific interest in investigating the efficacy of gastroprotectants and the rationale for their use in treating acid-related disorders, organ failure, neoplasia, and inflammatory diseases in dogs and cats. To this end, Katie has experience in clinical research and trials in companion animals. Her basic science research program is dedicated to characterizing pathogenic mechanisms and exploring novel therapies for GI infections in dogs and cats. P 16 10. ALEXIA TSAKIRIS-VASILOPOULOS, BvetMed, GDipVWHM, CVA

Dr. Alexia Tsakiris-Vasilopoulos received her BVetMed from the Royal Veterinary College, University of London, in 2005. She received her Certification in Veterinary Acupuncture from the Chi Institute in 2009; her certificate in Veterinary Herbal Medicine in 2015 from the College of Integrative Veterinary Therapies; qualified with a Graduate Diploma of Veterinary Western Herbal Medicine (CIVT) in 2017; and attended the Health Pioneers Institute in 2017. Dr Tsakiris completed David Winston’s Herbal Studies course in 2016. In 2016, she established an exclusively holistic small animal practice. P 28

IVC Spring 2020

editorial

NEVER DOUBT YOUR ABILITY TO

inspire

Years ago, when my twin daughters were pre-teens, they participated in a fashion show sponsored by one of the large fancy department stores in Denver. As each model walked the runway, the emcee shared their future aspirations. What struck me at the conclusion of the show was how many of those kids aspired to be veterinarians. They (most likely) did not yet know about the reality of student loan debt, the arduous academic road that lay ahead, the future sleepless nights of worry and concern for patients, the compassion fatigue and work-life imbalances. What they did know about was the essence, the image, the “feel” of our work. Veterinary professionals bridge the animal world with our human one. They support, in myriad ways, the exquisite, sacred and vital bond between people and the creatures with whom we share our Earth. And that, indeed, is an awesome role. This issue of IVC Journal offers a variety of enriching reads, all of which illustrate the many ways veterinarians contribute to honoring this sacred bond with animals. In an article by Dr. Katherine Tolbert and Dr. Audrey Ruple, you’ll learn about the innovative and ambitious research scope of the Dog Aging Project, the first longitudinal study of its kind in canines. This collaborative research will illuminate the best ways to proactively support longevity and vitality in our patients. That sounds like a goal those future veterinarians from the runway would be excited about!

IVC Spring 2020

We have two fascinating case studies to share this issue, both of which illustrate the benefits of integrative modalities in patient care, and both of which are written by younger members of our profession. I hope you will find it as inspiring as I do to see how members of the generation entering our profession today are already enriching their conventional training with expertise in different fields of medicine, adding as many tools to their practice toolkits as possible. You will also find inspiration for creating a mindful practice culture; empowering your clients to knowledgeably read food labels; and helping atopic patients by using an innovative regionally-specific approach to allergen immunotherapy. Addressing liver dysfunction with Western herbs, and supporting optimal hepatic function through diet, gentle detoxification, and TCVM are explored in two more highly informative articles. And for equine practitioners wondering about the use of phytocannabinoids in horses, we welcome the always insightful knowledge of Dr. Joyce Harman. Enjoy the content in this issue, and know that the good work you do every day continues to inspire the next generation.

Laurin Cooke, DVM Associate Editor, drlaurin@ivcjournal.com

IVC Spring 2020

PEER-REVIEWED

SUPPORTING LIVER FUNCTION AND DETOXIFICATION IN CANINE PATIENTS BY IHOR BASKO, DVM, CVA

An exploration of how to protect and care for the canine liver with proper diet, antioxidants and supplements that optimally support this important organ’s many functions.

Liver disease can be a slow and insidious process. Dogs that are overweight, suffer from diabetes, or have reoccurring episodes of pancreatitis are most susceptible. Inappropriate diets (high fat, high carbohydrate, rancid or moldy ingredients) and inadequate antioxidant function by the liver are the usual causes behind the onset of fatty liver disease and cirrhosis.

LIVER-DAMAGING FACTORS ARE EVERYWHERE

What are the Causes of Liver Dysfunction? Processed high-fat / low-fiber diet + Genetics + High carbohydrate diet / GM + Excess exposure and use of: + Antibiotics + Anti-seizure medications + Anti-inflammatory drugs + Opiates + Pesticides (food, water, home) + Veterinary flea and tick products

The liver is an important organ for survival. It processes and detoxifies digested food molecules into the energy and nutrients needed to feed and sustain the body. It protects the body against the onslaught of harmful pollutants in drinking water, food and air. These compounds and chemicals cause oxidative stress and DNA damage to liver cells, resulting in poor function, fibrosis, cirrhosis and possibly cancer. Unfortunately, our current world abounds in toxins and other factors that can damage the liver.

• Many liver-damaging environmental toxins commonly appear in our food, air and water. And with many pet food companies using contaminated ingredients from China and

IVC Spring 2020

Leads to Other Problems + Pancreatitis + Metabolic Syndrome + Fatty Liver Disease + Liver Cancer + Obesity + Diabetes + Muscle-wasting + Seizures

Dr. Basko * All Creatures Great & Small

other countries, a great deal of dog food is contaminated by aflatoxins, heavy metals, fluoride, pesticides, and other environmental toxins. Many of these ingredients have been “condemned for human use”, including meat from rendering plants that is not fit for consumption.1 •V eterinarians are also prescribing more monthly flea and tick preventive chemicals than ever before (in part

due to the rising incidence of Lyme and other tick-borne diseases), as well as concurrently prescribing heartworm medications, NSAIDS, phenobarbital, steroids and antibiotics. All these need to be detoxified by the liver. â&#x20AC;˘ With the increased popularity of certain breeds comes the increased incidence of associated genetic problems, a few of which affect the liver. Bedlington Terriers, Doberman Pinschers and Labrador Retrievers are susceptible to copper storage disease, while toy breeds such as Maltese, Yorkshire Terriers and Cavalier King Charles Spaniels are often born with liver shunt anomalies; Scottish Terriers can be susceptible to both diseases.2 â&#x20AC;˘ As human habitation continues to encroach on wildlife, whether in the city or countryside, unimmunized and at-risk dogs may become infected with hepatitis due to leptospirosis, or CAV-1 virus from exposure to coyotes, raccoons and other wildlife (bears, mink, ferrets, skunks, foxes). Adenovirus (CAV-1) consists of medium-sized double-stranded DNA molecules, which cause hepatocellular degeneration and necrosis, resulting in chronic liver disease in adult animals and a high fatality rate in puppies.3

THE LIVER HAS MANY FUNCTIONS The liver is one of the largest internal organs in the body and has over 500 functions. One of the most important is to process ingredients from the diet into nutritive factors that support regeneration in the body. The liver creates vitamins, antioxidants, enzymes, glucosamine, carnitine and hormones, and generates and stores energy in the form of glycogen, while assisting in the distribution of nutrients to the appropriate organs and tissues. The liver is also important in the detoxification and subsequent removal of toxic substances from the body. In the process, liver cells may die and tissues may become fibrotic or necrotic. A well-functioning liver will help patients with renal problems maintain lower blood ammonia levels. Additionally, the liver functions in transporting immune complexes from serum into bile which, when secreted into the GI system, protects against pathogenic bacteria, viruses, and parasites. In Traditional Chinese Veterinary Medicine (TCVM) terms, the Liver stores the Blood and manages and regulates the Qi (Energy) flow in the body. The Liver assists digestion and improves the Quality of the Blood.4 Continued on page 12. IVC Spring 2020

What Does the Liver Do? + Creates vitamins, antioxidants, enzymes, glucosamine, carnitine, and hormones. + Generates and stores energy in the form of glycogen. + Assists in the distribution of nutrients to the appropriate organs and tissues. + Detoxifies toxins and metabolic wastes. + Regulates blood sugar. + Creates bile to break down fat.

Continued from page 11.

SUPPLEMENTS: THE LIVER NEEDS PROTECTION AND SUPPORT FOR REGENERATION A good liver supplement should do the following:

q Provide

hepato-protection from toxins, which cause DNA damage. These toxins include metabolic waste, oxidation, and environmental toxins, as well as veterinary drugs, pesticides, and chemicals in the food and water.

Dr. Basko * All Creatures Great & Small

w I mprove

What is Liver Dysfunction? + Oxidative stress is in excess. + Cell death increases.

function (transform and utilize food, dietary substances, and energy), including interactions with the pancreas, gall bladder, and intestines. The liver should break down carbohydrates and fat into energy, and create and recycle antioxidants.

+ Cell regeneration decreases.

egenerate eR

+ Liver cannot function, causing metabolic waste and environmental toxin build up.

ssist in detoxification of toxic metabolic by-products, rA

+ Increased fat and toxins can cause necrosis.

new hepatocytes, reverse fibrosis, and improve intra-hepatic blood flow.

toxins and heavy metals.

+ Excess fat and carbohydrates cause bile to be secreted into the intestines.

t S upport related organs by decreasing toxins and oxidative

The process of metabolizing fat into useful nutrients, and creation of glycogen from carbohydrates to nourish the muscles and brain, is impaired.

y Protect against pathogens, viruses and bacteria, and parasites.

+ Muscles do not obtain enough glycogen and become weaker. Walking is impaired.

+ Liver converts high blood sugar to FAT, which contributes to obesity. + Liver is inefficient in converting cholesterol to make new cells and hormone production decreases. + Creation of antioxidants and vitamins is impaired. Dr. Basko * All Creatures Great & Small

What are the Symptoms of Liver Dysfunction? + Chronic geriatric liver problems + Behavioral problems and aggression + Intermittent vomiting + Vomit with yellow bile + Picky appetite + Lethargic + Allergies + Weight loss or gain + Twitching or seizures + Weak, slippery pulse + Bounding pulse with excess + Dry Eye Syndrome Dr. Basko * All Creatures Great & Small

IVC Spring 2020

stress on the heart, kidney, pancreas, and intestines.

u S upport

Deficiencies (TCM) such as Liver Yin, Liver Blood, and Spleen Qi.

i Mollify Stagnant Liver Qi (TCM) if present. BEFORE DETOXIFICATION Before fasting and a “heavy” detoxification program (dredging the Liver), one needs to observe and determine which Deficiencies must be mollified with Tonification (food, herbs, acupuncture). A very deficient patient might not react well to detoxification alone. There are specific TCM formulas from which to choose, based on the patient’s specific needs and situation. It’s also important to know what we are trying to accomplish. Are we detoxifying an environmental toxin in an acute situation? Or mollifying a chronic buildup of fat, toxic metabolic waste by-products, heavy metals or pesticides? Because of the liver’s complexity, in this author’s opinion, supporting its many functions with herbs, food and supplements is necessary during a detoxification process.

Summary of Therapeutic Properties of Various Ingredients Found in Liver Products Ingredients

HepatoProtection

Regenerate

Detoxify

Organ Support

Antiinflammation

Digestion

Immune System

Milk Thistle

Dandelion Astragalus Schizandra

Glutathione Alpha-Lipoic Acid NAC

Vitamins C &E

B-Complex Vitamins Choline

S.O.D. Wheat Grass

Enzymes & Probiotics

X X

Dr. Basko * All Creatures Great & Small

THE DETOXIFICATION PROCESS IN THE LIVER OCCURS IN TWO PHASES It is important to understand the two phases of detoxification and the specific kinds of toxins we intend to remove from the body. The liver transforms fat-soluble toxins into water-soluble form so they can be released through the kidneys (for elimination in the urine), skin (in dogs and horses), sweat glands, and into the bile (for elimination through the colon). How does the liver do this? Phase 1 of detoxification is very complex and includes oxidationreduction and hydrolysis reactions. The process is catalyzed by enzymes classified as P-450, which reside in the liver cells. Generally, these enzymes are triggered by exogenous toxins, releasing a mechanism that safeguards and protects. After the fat toxins are converted to water-soluble compounds and processed in Phase 2, they are eliminated from the body in the form of feces, urine or sweat.

Certain herbs, vitamins and antioxidants have proven to play an important role in supporting both liver function and detoxification. Understanding which supplements support Phase1 and Phase 2 will enhance your therapeutic results.

WHAT ABOUT FASTING? Generally, dogs that are not feeling well will fast themselves, although this can be upsetting for the client. Not eating for a day or more may be a good thing as long as the dog is hydrated with fluids and minerals such as coconut water. In patients that are geriatric, obese (with fatty liver disease), have Stagnant Liver Qi, or are suffering from GI distress, a one-day fast should be beneficial perhaps every ten days. Administering coconut water with a probiotic to the patient four to six times on that day might quell the GI upsets, and improve the dogâ&#x20AC;&#x2122;s appetite. Continued on page 14. IVC Spring 2020

Liver Supplements TCM Liver Yin Support: + Sour Foods + Apple cider vinegar + Lycium

Detoxification Phase I and II

Liver Stagnation Support:

Foods:

+ Bupleurum

+ Liver, eggs, choline

+ Uncaria

+ Cauliflower

+ Dan Shen

+ Dark leafy greens

+ Curcuma

+ Bok choy

+ Chemicals

+ Beet greens

+ Heavy Metals

Omega-3

+ Rehmannia

+ Endotoxins

+ Drugs

+ Metabolic Wastes

Detoxification Transitional Stage

+ Pollutants

+ Asparagus

+ Ligusticum

Phase 2

+ Exotoxins

+ Brussels sprouts

B-Complex Vitamins

+ Paeonia

and

Phase 1

+ Medicinal Mushrooms

Fat Soluble Toxins

+ Pathogens + Microbes

Water Soluble Toxins

Dr. Basko * All Creatures Great & Small

Detoxification Support

Detoxification Phase II

and

Phase 1 Fat Soluble Toxins

Phase 2 Water Soluble Toxins

+ Milk Thistle

+ Glutathione

+ Vitamin C

+ Vitamins C & E

+ Enzymes

+ S.O.D.

+ Probiotics

+ Dandelion

+ B-Vitamins

+ Vitamin A / Carotenoids

+ Milk Thistle

+ Turmeric

+ MSM, Sulfur, NAC

+M edicinal Mushrooms

+ Quercetin

+ Vitamin D3

+ Phospholipids

+ NAC

+ Citrus Bioflavonoids

+ Cruciferous vegetables: + Broccoli + Cabbage + Asparagus + Brussels sprouts

+ Amino acids: + Taurine + L-carnitine + L-glutamine + Cystine + Methionine + Choline

Water Soluble Toxins Elimination Gall Bladder

Kidneys

Skin

Bile

Urine

Sweat

Colon Bacteria

Dr. Basko * All Creatures Great & Small

Ears / Paws

Dr. Basko * All Creatures Great & Small

Continued from page 13.

Perhaps for more fragile patients, a bone and shiitake mushroom broth can be administered during the fast for one to three days, providing both nutrition and detoxification. Once the animal’s appetite returns to some degree, herbs and supplements to support more detoxification and liver function can be slowly added into the program. I personally like to start with medicinal mushrooms, making a “tonic” with reishi, shiitake and Cordyceps mixed in a B-complex liver syrup. After seven to ten days, I add a product with NAC (N-acetyl cysteine), vitamins C and E, dandelion, milk thistle, turmeric and SOD (superoxide dismutase), along with a probiotic blend that works in the colon (Bifidobacterium

IVC Spring 2020

strains, Bacillus subtilis, Bacillus coagulans) for gradual support and detoxification.

NOTE:

For a longer fast up to three days, a “green drink” might be more useful for providing hydration and antioxidants, as well as minerals.

I t is vital for clients to understand that fasting should be undertaken only under the careful guidance of a knowledgeable veterinarian.

DIETARY CONSIDERATIONS Preventing liver disease is the best intervention. Learning how to prepare the appropriate food at home with human grade meats, fish, eggs and vegetables is the foundation of health, as well as avoiding toxins in the environment. Diets for liver-compromised patients should be low in saturated fats and refined carbohydrates to prevent further oxidative stress to the liver, pancreas and gallbladder.5. Dogs with liver disease should eat diets high in methionine, cysteine, taurine, selenium, Omega-3 and zinc.

A good liver diet should consist of: •C hicken and turkey meat (vitamin B6, selenium and phosphorus) •E ggs (methionine, B vitamins, vitamin D, selenium and iron, as well as high biological value protein) • Oats (cysteine, selenium, vitamin B1 and manganese.) •Y ogurt (methionine, calcium, phosphorus, iodine, zinc, potassium and vitamins B2 and B12) •B roccoli (methionine, vitamin C, biotin, B2, B6, folic acid, manganese, potassium and antioxidants)

This does not mean the dog should eat all the foods listed every day. One must rotate the proteins and vegetables to create a diverse and balanced diet. Though a wide range of factors can cause poor liver function and lead to potentially life-threatening damage and disease, an integrative approach that includes detoxification, supplementation, dietary changes and preventive measures can help protect your canine patients.

Fox, Michael, WB, Vet Med, PhD, DSc, MRCVS. Not Fit for a Dog: The Truth About Manufactured Dog and Cat Food, Quill Driver Books Fresno, CA 2009.

organ Rhea, V., Bright Ronald M., Swartout Margaret S. Handbook of Small Animal Practice, 4th Ed, M Elsevier Science, USA, 2003.

Stone D, Lieber, A. Current Opinion in Molecular Therapeutics, 2006, 8:423-431.

•B eef, lamb and pork liver (taurine, high biological value protein)

B einfield Harriet, LAc, Korngold, Efrem, LAc, OMD. Between Heaven and Earth: A Guide to Chinese Medicine, Ballantine Books, 1991.

B asko, Ihor, DVM. Fresh Food and Ancient Wisdom: Preparing Healthy and Balanced Meals for Your Dogs, Mill City Press. Minneapolis 2010 Chapter 12 pg 205-23.

• Ocean fish, salmon (taurine, Omega-3)

RECIPES FOR LIVER DETOXIFICATION Fresh Green "Smoothies" to Detox Your Dog Raw Egg & Salad 1 raw egg 1/ 2 cup spinach 1/ 2 cup kale 1/ 4 cup Moringa leaves or 1/ 2 cup celery 2 teaspoons parmesan 1 teaspoon nutritional yeast 1/ 2 teaspoon spirulina 1 cup water

Dose: 1–4 oz, each meal

Traditio

Traditional Asian Medicine Foods Beneficial to Liver

• • • • • • • • • • • •

Liver (preferably pork or lamb) Eggs Squid, eel, shrimp Aduki (azuki) beans Natto Omega-3 fish oil Celery Eggplant • Medicinal mushrooms Bitter melon • Shiitake Daikon • Maitake Beet leaf • Himematsutake Dandelion • Cordyceps

Dr. Basko * All Creatures Great & Small

Shiitake "Detox" Broth

Crock-Pot Turkey & Barley

Ingredients

Directions

Shiitake mushrooms, 5 dried Pork or beef bone, 1 cup Daikon, 1/4 cup Carrot, 1/4 cup Celery, 1/4 cup Sea salt, 1 teaspoon Turmeric powder, 1/2 teaspoon

• Wash mushrooms and soak in 1 cup cold water overnight • Put bone, vegetables, salt, and turmeric in a soup pot with 4 cups of water. Bring to a boil, then simmer covered for 1 hour. • Add shiitake mushrooms and soaking water, simmer another hour, then remove from heat. Add liquid to food, or give to drink when not eating well. DOSE: 15 ml (3 teaspoons) per 10 lbs of body weight, 3 times daily.

Dr. Basko * All Creatures Great & Small

Ingredients

Directions

Turkey white meat, 4 cups Pearl barley (organic), 1/2 cup Broccoli, 1 cup Kabocha pumpkin, 1 cup Celery, 1 cup Sea salt, 1/2 teaspoon Dill, fresh, 2 teaspoons, (1/2 teaspoon if dried) Turmeric powder, 1 teaspoon Water or bone soup, 6–8 cups

• Chop the meat and vegetables into small, bite-size pieces depending upon your dog's jaw size. • Put everything into the crock pot and cook until done, about 2–4 hours. • Feed 1/2 cup per 6–10 lbs of body weight.

Dr. Basko * All Creatures Great & Small

IVC Spring 2020

Dog Aging Project The

80,000 dogs and counting

BY KATHERINE TOLBERT, DVM, PhD, DACVIM AND AUDREY RUPLE, DVM, MS, PhD, DACVPM, MRCVS

A longitudinal study that aims to determine the biological, lifestyle, and environmental factors that influence healthy aging in dogs, the Dog Aging Project is expected to spearhead advances in veterinary clinical practice.

“Should I change my dog’s food?” “What about probiotics?” “What can I give my dog for her coat?” As veterinary professionals, we are often asked for advice about diet, supplements, exercise regimes, and other factors that influence overall health. Veterinary medicine is quite robust when it comes to diagnosing and treating illness, but when it comes to proactive maintenance of ideal health, there is a distinct lack of evidence-based research upon which to base our recommendations. The research currently underway at the Dog Aging Project intends to close that gap. The Dog Aging Project is an innovative initiative that brings together a community of dogs, dog owners, veterinarians, researchers and volunteers to carry out the most ambitious study of dog health in the world. Funded by a U19 grant from the National Institute on Aging, a part of the National Institutes of Health, the Dog Aging Project is a longitudinal

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study modeled after ongoing human longitudinal studies such as the Framingham Heart Study and the Baltimore Longitudinal Study of Aging. The Dog Aging Project has three primary research aims: define aging, explain aging, and intervene in aging.

WHY STUDY AGING? In a clinical setting, veterinary professionals often treat patients with chronic disease and multiple comorbidities. While there are tools to diagnose and treat many of these conditions, prevention would be the gold standard and is a key focus of integrative approaches to veterinary medicine. In humans, the single greatest risk factor for the development of many of these diseases, including the major causes of mortality in developed nations, is aging.1 This is likely true for dogs as well. The Dog Aging Project is focused on understanding how biology, lifestyle and environment interact to influence healthy aging,

with the goal of intervening to increase healthspan — the period of life spent free of disease. Ultimately, healthy aging requires the maintenance of independent physical function, cognitive ability, mental health, and general well-being.2

WHY STUDY DOGS? Geroscience has made huge advances in the last few decades, but most of these studies have been conducted in laboratory settings with short-lived model organisms such as yeast, fruit flies, nematodes and mice. Several studies of health and aging have been conducted in companion dogs by researchers in our group and elsewhere,3,4,5,6 but only the Golden Retriever Lifetime Study (GRLS) combined a largescale longitudinal study with clinical and genetic data for each dog.7 The Dog Aging Project is working closely with, and expanding on, the breed-specific work by GRLS. By enrolling tens of thousands of both purebred and mixed breed dogs, the dataset we are building will encompass the full range of canine genetic and phenotypic diversity, including variation in size, shape, behavior, life expectancy, and age-related disease.8 Not only does this research have the potential to directly advance canine health; it also has the potential to inform human medical research as well.

A NOVEL VETERINARY RESEARCH FRAMEWORK The Dog Aging Project is a citizen science endeavor, which depends on the active participation of dog owners who both nominate their dogs for the project and collect data on their dogs throughout their lifetimes. All dogs are welcome — young and old, purebred and mixed breed, intact and sterilized, healthy dogs and those with chronic illnesses. Currently, dog owners from all around the US, and from a range of socioeconomic and cultural backgrounds, have nominated their dogs for the project. Our participants are invited to establish a secure personal portal at the Dog Aging Project and complete the Health and Life Experience Survey, an extensive questionnaire that collects detailed information about each dog’s lifestyle, home environment, and health history. Using a sophisticated cohort design, subsets of dog owners will be invited to participate in other activities as detailed below. The massive dataset generated by the Dog Aging Project will be made available to researchers around the world in a privacy-protected, open data model in order to maximize the project’s impact on the advancement of dog health. This complex project is supported by a highly interdisciplinary team from research institutions around the world who IVC Spring 2020

INTERVENING TO INCREASE HEALTHSPAN IN DOGS Rapamycin, also called sirolimus, is a specific inhibitor of the mTOR complex 1. This drug is FDA approved as a cancer chemotherapeutic and for preventing organ rejection in human transplant patients. However, at low doses, rapamycin has been shown to ameliorate multiple age-related issues, including cognitive, immune system and cardiac functional decline, and to extend lifespan in laboratory mice.13,14 Initial pilot studies conducted by our group demonstrated that there were no significant negative side effects from low-dose rapamycin use, nor any changes in hematology and clinical chemistry in companion dogs.15 In response to these promising early results, the Dog Aging Project is conducting the first large-scale, randomized, double blind, placebo-controlled clinical trial of rapamycin in 500 healthy, middle-aged companion dogs. Current Dog Aging Project participants will be invited to join this voluntary study based on specific selection criteria, including proximity to one of our participating veterinary teaching hospitals. These dogs, who will continue to live and play at home with their owners, will be closely monitored twice a year through physical exams, extensive clinical pathology, and echocardiograms. We are most interested in the effects of rapamycin on cardiac function and survival rate; additionally, we will be looking for effects on activity levels, cognition, and overall health. The entire study is being overseen by an independent Animal Welfare Advisory Board and a bioethicist to ensure we are meeting the highest possible ethical and safety standards for the dogs. If successful, this clinical trial will provide quantitative measures of effective intervention to increase both lifespan and healthspan, and could positively affect the lives of millions of companion dogs.

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have partnered with veterinary teaching hospitals across the US. This collaboration will enable the Dog Aging Project to meet its three primary research aims.

DEFINING AGING IN DOGS In humans, standardized clinical metrics quantify aging; for example, the Grip Test or Chair Stand. These are largely absent in veterinary medicine. Both dog owners and their veterinary health team members know that some dogs seem to age more healthfully than others. Some 12-yearold dogs play like puppies, while others experience the phenomenon of â&#x20AC;&#x153;frailty,â&#x20AC;? displaying reduced energy, declining cognition, and limited mobility. Unlike human medicine, there are no clearly defined metrics to determine how well or how poorly a dog is aging. In order to define aging in dogs, the Dog Aging Project is developing a rigorous, reproducible and practical Canine Fragility Score, which will be based on familiar tools and measurements (body weight, body condition score, activity monitor collars), existing scoring systems (Canine Cognitive Dysfunction Rating Score,9 Health-Related Quality of Life Instrument10) and novel metrics (gait speed and stair climb). Given the extreme variation in size, activity level, temperament, environment, and disease susceptibilities among dogs, the key to defining aging will involve measuring the change in an individual's metrics over time, hence the value of a long-term study like the Dog Aging Project. In addition, researchers in our group are documenting and describing the multimorbidity states of companion dogs.11,12 We will use this data to predict the likelihood that an aging dog with one diagnosis will develop a second within a given timespan. These data will be used to develop a Canine Multimorbidity Index to be used in the clinical management of aging dogs. Both this index and the Canine Fragility Score will be made available to clinicians to be used as a benchmark of canine health and to indicate the most valuable targets for intervention.

EXPLAINING AGING IN DOGS This research aim will be accomplished by discovering the genetic and environmental factors that influence aging and by identifying intermediate molecular traits through which their influence unfolds. Ten thousand dogs will be selected from among all Dog Aging Project participants to receive a saliva swab kit. This kit will be utilized to capture genomic information about these dogs. Our team will integrate health measures and behavioral traits with genome sequence data and carry out comprehensive genomewide association studies. In addition, 1,500 participants from whom we have collected genomic information will partner with their primary care veterinarians to provide blood and fecal samples. The team at the Dog Aging Project will use a systems biology approach to quantify the metabolome (total number of metabolites), the microbiome (gut microfauna), and the epigenome (chemical compounds and proteins that regulate

The largest study of its kind, the Dog Aging Project will follow tens of thousands of companion dogs for ten years in order to identify previously unknown biological and environmental factors critical to improving healthy lifespan.

transcription) in this subset of dogs. Our team will use the data to identify molecular biological predictors of disease and longevity, and develop an epigenetic clock that predicts biological age in dogs.

80,000 DOGS AND COUNTING Response to the official launch of the Dog Aging Project in November 2019 has been astounding. As of January 2020, over 80,000 dog owners have nominated their dogs for this research. Data collection has already begun. This comprehensive multimodal approach will allow us to determine the biological, lifestyle, and environmental factors that influence healthy aging in dogs, which we are confident will lead to advances in veterinary clinical practice and pave the way for advances in human geroscience as well. For more information, visit dogagingproject.org. Kaeberlein M, et al. “Healthy aging: The ultimate preventative medicine”. Science 2015; 350(6265):1191-1193.

Rowe JW, Kahn RL. “Successful Aging 2.0: Conceptual Expansions for the 21st Century”. J Gerontol B Psychol Sci Soc Sci. 2015; 70(4):593-596.

Fleming JM, et al. “Mortality in North American dogs from 1984 to 2004: an investigation into age-, size-, and breed-related causes of death.” J Vet Intern Med. 2011; 25(2):187-198.

Hoffman J, et al. “The companion dog as a model for human aging and mortality.” Aging Cell. 2018.

Bonnett BN, et al. “Age patterns of disease and death in insured Swedish dogs, cats and horses”. J Comp Pathol. 2010; 142 Suppl 1:S33-38.

Hoffman JM, et al. “Reproductive capability is associated with lifespan and cause of death in companion dogs”. PLoS One. 2013; 8(4):e61082.

Guy MK, et al. “The Golden Retriever Lifetime Study: establishing an observational cohort study with translational relevance for human health”. Philos Trans Royal Soc London Series B, Biol Sci. 2015; 370(1673).

Fleming JM, et al. “Mortality in North American dogs from 1984 to 2004: an investigation into age-, size-, and breed-related causes of death”. J Vet Intern Med. 2011;25(2):187-198.

Salvin HE, et al. “The canine cognitive dysfunction rating scale (CCDR): A data-driven and ecologically relevant assessment tool”. Vet J. 2011; 188(3):331-336.

Reid J, et al.“Development, validation and reliability of a web-based questionnaire to measure health-related quality of life in dogs”. J Small Anim Pract. 2013; 54(5):227-233.

Hoffman J, et al. “The companion dog as a model for human aging and mortality”. Aging Cell. 2018.

Jin K, et al. “Multiple morbidities in companion dogs: a novel model for investigating age-related disease”. Pathobiol Aging & Age Related Dis. 2016; 6.

Halloran J, et al. “Chronic inhibition of mammalian target of rapamycin by rapamycin modulates cognitive and non-cognitive components of behavior throughout lifespan in mice”. Neuroscience. 2012; 223:102-113.

Miller RA, et al. “Rapamycin-mediated lifespan increase in mice is dose and sex dependent and metabolically distinct from dietary restriction”. Aging Cell. 2014;13(3):468-477.

Urfer SR, et al. “A randomized controlled trial to establish effects of short-term rapamycin treatment in 24 middle-aged companion dogs”. Geroscience. 2017; 39(2):117-127.

IVC Spring 2020

nutrition nook

HELPING YOUR CLIENTS UNDERSTAND PET FOOD LABELS BY JODIE GRUENSTERN, DVM, CVA

Veterinarians are no longer the trusted resource for pet dietary advice. This article will help you recapture your title and empower clients to realize the importance of understanding ingredient labels.

Many of today’s pet parents strive to be well-educated about pet foods. They trust their veterinarians to tell them what food to give their animals, only to leave the clinic, bag in hand, dismayed at why the veterinarian would recommend a food with such horrific-sounding ingredients. Others have come to believe they can decide for themselves what foods to give their pets; some are incredibly knowledgeable while some think the choice is as simple as checking the label for high protein or low fat. Few realize how complex, misleading, and deceptive pet food packaging can be, and that it often lacks both simplicity and transparency. Support your clients’ goals by using your education and resources to help them choose wisely and better understand pet food labels, and to turn to you for dietary advice.

IVC Spring 2020

EVERYONE GOOGLES The information Google provides depends, of course, on the specific question asked. An internet search of “top pet foods” recommended by veterinarians lists Hill’s Science Diet, Royal Canin, and Purina Pro Plan. By changing the search parameters to the “top healthiest pet foods”, Ollie's Healthy Turkey Fare, Pet Plate Chompin' Chicken, and Fromm Gold head the list. Why such a discrepancy in opinion?

PLAYING DETECTIVE TO DECODE THE TRUTH Many veterinarians rely on the manufacturers of prescription diets, and believe that the minimums and maximums of

Remind your clients that it’s not just what their dogs or cats eat, but rather what they absorb, that’s most crucial to good health.

protein, fat, fiber and moisture are all they need to know to recommend a quality food. The analysis panel can be very misleading, and while macronutrients are listed, carbohydrates are not included and must be calculated. Yet, when we read the ingredient lists of most dry kibble, it is obvious that starches are always included. Nutritionists know the devil is in the details, but one must play detective to decipher the truth.

DIGESTIBILITY, QUALITY AND SAFETY The three crucial parameters of digestibility, quality and safety cannot be easily determined by reading pet food bags. Remind your clients that it’s not just what their dogs or cats eat, but rather what they absorb, that’s most crucial to good health. This point was recently driven home to us by the ongoing investigations into spikes of canine dilated cardiomyopathy cases. Many of the diets that were tested were found to contain taurine, methionine and cysteine levels consistent with AAFCO recommendations, yet many dogs consuming those same diets lacked adequate taurine in their blood.1 A large number of clients understand that digestibility is important and that high protein content is not enough. (Leather meal, animal hide, is very high in protein, but completely indigestible.) The higher the moisture content, the lower the protein content will appear, but this protein may be of much higher quality than in a food whose analysis panel states a higher protein percentage. The guaranteed analysis protein percent is actually an archaic measure of nitrogen, a relic from the livestock feed industry, and not a measure of quality meat protein at all. Nitrogen can also come from plants. It can even come from toxic melamine; we have learned that unscrupulous manufacturers can artificially elevate “protein” levels in their foods to mislead consumers, and that pets can die from this hidden ingredient.

WHAT IS AAFCO AND WHAT DOES IT MEAN TO CLIENTS? AAFCO is the Association of American Feed Control Officials, an industry organization. Consumers have been trained to believe that a pet food is complete and balanced for all life stages if the bag states: “This food meets or exceeds AAFCO nutrient profiles and is suitable for all life stages.” Indeed, “exceeding” is not necessarily okay and “meeting” may still be inadequate. AAFCO admits: “It is impossible that any list of concentrations can invariably ensure that all nutrient requirements are fulfilled in all diet formulas without additional considerations.”2 Despite this admission of inadequate guidelines, they are currently all we have to rely on when we analyze a package of pet food. Pet parents view the AAFCO designation as the meeting of a nutritional standard. So it is important, at minimum, to understand the AAFCO terminology.

INGREDIENT ORDER AND DEFINITIONS — DECIPHERING THE FACTS Always look at the back of the bag or the side of the box for the full ingredient profile, listed in order of weight. Don’t rely on a cursory list of ingredients on the front of the bag next to the splashy photographs of fresh meat, fruits and vegetables. • Ideally, we want to see a specific meat, such as pork or beef, listed first. If it is, this means it has been weighed with the water still in it. This makes it heavier and brings it to the top of the list. It refers to clean flesh from slaughtered animals. However, the water is removed during processing, meaning there is less weight of actual meat-derived protein in the end product. Continued on page 24. IVC Spring 2020

Sadly, American corn is contaminated with mold and aflatoxins, which are potentially carcinogenic. Most corn is GMO unless stated otherwise, which means it won’t die when the fields are sprayed with glyphosate herbicide to kill the weeds. But the corn does incorporate the glyphosate into its cells. The cattle eat the corn, and the glyphosate becomes incorporated into the food web. Humans, livestock and pets ingest the contaminated corn and/or the contaminated meat.6 • After the starches on a label, a fat is listed along with how it is preserved (i.e. with mixed tocopherols, a source of vitamin E and/or rosemary extract). Avoid animal fat preserved with BHA, BHT or ethoxyquin. These artificial preservatives have been shown to be carcinogenic in rats;7 in fact, ethoxyquin is banned in Europe, Australia and New Zealand.8

Continued fromn page 23. • By-products are non-rendered and come from slaughtered animals. They include organs, fat and entrails, but no hair, horns, teeth or hooves. By-products can be healthy, but we don’t know the quality based on a label listing. Carnivores do need to ingest organs for good health.3 • A meat “meal” means the tissue has been rendered. This process converts waste animal tissue (not human grade meat) into stable usable materials like yellow grease, choice white grease, bleachable fancy tallow, and a protein meal such as meat and bone meal or poultry by-product meal.3 It contains no hair, hoof, hide or extraneous materials. By definition, while up to 9% of the crude protein in the product may be pepsin indigestible, the product would be more protein-dense than its clean flesh counterpart weighed with water included. • If a meat product is followed by more than one grain or starch, there may be more grain or starch than meat by weight, even though the meat is listed first. A common marketing trick is to list a grain, for example corn, broken down into corn gluten, corn starch, corn middlings, etc. This puts the corn versions below the meat source — unless you add them all together. This is called ingredient splitting.4 Corn is used to fatten livestock. Why? Corn is starchy. Starch is a carbohydrate or sugar. The body stores excess carbohydrate in the form of triglycerides, which are fat. In other words, fat is the storage form of excess carbs. Carbs make you gain weight, not fat! Corn is not a natural food for a carnivore diet.5

IVC Spring 2020

• Avoid added sugars such as corn syrup, molasses, beet sugar and maple syrup. These are not useful nutrients. They entice a pet to eat the food and to become addicted to it. Why? So your client keeps purchasing it! Just because a pet likes it, does not mean it is good for him. • Salt should not be too high on the list, but this is often the case with canned foods. Salt is also addictive. It is very difficult to get a cat off an addictive canned diet; it often takes a 21-day program. Taste buds will adjust, however, so tell your clients to be patient. • If vitamins and minerals are added, look for those that are chelated, which improves absorption (listed as a chelate or a proteinate). However, do be aware that this chelation is not “natural” and often occurs by combining a mineral with soy proteinate, which is most assuredly GMO.9 Remember that GMO seeds result in crops laden with pesticides, allowing a mechanism for these chemicals to be incorporated into

our patients’ (and our own) gut microflora.10 The best pet foods contain enough whole food sources of vitamins and minerals that synthetic versions need not be added. • Avoid canned foods that contain carrageenan as a “natural” thickener. This ingredient has been used in studies to intentionally stimulate inflammatory bowel disease.11 And we wonder why so many cats vomit? • JAVMA published a report showing an association between canned diets and hyperthyroidism in felines.12 We now know that can liners may contain BPA, a known endocrine disruptor.13 If a food contains dye (i.e. red dye 40), put it back on the shelf! Some grocery store foods, many treats, and dental chews still contain dye. Artificial colorings can be carcinogenic.14 Better ingredients can be utilized. For example, many pet parents know that blue-green algae can provide great antioxidant properties, while giving a beautiful green color to dental chews! • Small amounts of the best, healthiest, and most expensive ingredients are usually last on the list! These look like real foods. You may see blueberries, cranberries, broccoli, dried kelp, hemp seed and others. Some foods, like chicory root extract, are prebiotics that promote gut flora health. Prebiotics feed probiotics, the good bacteria in the gut. You may also see prebiotics listed on the label as inulin, which can come from chicory root.15 Added probiotics may not be as viable as those you add to the food yourself when serving it, but I applaud company attempts to include them, although paying more for them may be a waste of money. Probiotics will have names like Lactobacillus acidophilus and Bifidobacteria.

ALLERGENS AND CONTAMINANTS Chicken is overused as a protein in the pet food industry, and is the most stressed livestock source of protein. Beef is often considered a common allergen, especially for cats.16 Wheat and soy have long been regarded by many veterinarians as common allergens.17 Today, most soy is of genetically modified origin, which is now being linked to cancer due to its connection to glyphosate.18 Based on my observations, gluten-free rice may be a better choice for many pets than other grains. However, the processing and high starch content are still not ideal. There have also been concerns about the presence of arsenic in rice.19 Some GI signs initially improve or even resolve, only to recur with repetitive use. Millet is a more easily digested grain, but is also a source of starch.20 Continued on page 26. IVC Spring 2020

Why clients find many non-veterinary diets to be the “healthiest” •T hey have been educated to look for meat as the first ingredient. •T hey have been educated to look for high protein on the guaranteed analysis. • They know to avoid artificial preservatives. •T he savviest clients wish to avoid synthetic vitamins and minerals, and believe that whole food sources are best. •M any attempt to reduce starchy diets and processed foods for themselves and their pets. •P roactive clients want foods that include pro and prebiotics, superfoods, and herbals. •T oday’s pet parents don’t trust big corporate companies, and seek to purchase from small local manufacturers or even home-prepare their pets’ food.

Continued fromn page 25.

GRAIN-FREE MARKETING TRICK Don’t be fooled by “grain-free” diets. It doesn’t mean they’re starch-free. The grain is commonly replaced by starchy potato, tapioca or legumes such as chickpeas. To make kibble, there must be a starch source, and processed carbohydrates create inflammation.21 Starch is “dampening” according to TCVM philosophy. “Grain-free” diets may or may not be higher in protein. While clients have been misled to believe these diets contain more meat protein, this is not necessarily true. Meat is a complete source of protein and absorbable amino acids that are critical to good health.

IVC Spring 2020

Many pets suffering from allergic dermatitis or inflammatory bowel disease do improve on unique protein and unique carbohydrate diets, while others don’t. Improvement is often short-lived, simply due to a change in nutrients. But don’t make the mistake of shifting a pet who has improved on a grain-free diet back to a grain diet; rather, shift toward a fresh, species-appropriate, balanced raw diet.

CANCER AND OBESITY One out of two pets is now dying of cancer. Some seemingly innocuous ingredients may be detrimental, and foods that contain corn, soy, and excessive sugar sources may be partially to blame for the cancer and obesity epidemic.18 Dry kibble and canned foods are processed at high temperatures. Cooked starch produces carcinogenic acrylamides22 and cooked meats produce mutagenic heterocyclic amines.23 Sugar (glucose) fuels cancer cells.24 Dr. Thomas Seyfried’s metabolic management of chronic disease research, as well as research by Ketopet Sanctuary, have become the subject of discussion among many pet cancer Facebook groups. Just a few more reasons why our educated pet parents are avoiding processed foods and flocking to fresh, species-appropriate raw diets.

CONCLUDING THOUGHTS There is a great deal of confusion around pet food label terminology. In the end, my opinion is that it doesn’t matter, because it all pertains to processed food, which is woefully inadequate. But I also realize that society demands kibble and canned foods be available for dogs and cats, so there will always be some who need to feed these diets. It is disappointing that manufacturers have been known to lie on their labels. Some have claimed to use human grade ingredients, yet pentobarbital from euthanized animals was discovered in their foods.25 Information is powerful. If you empower your clients to be intelligent pet food consumers,

they will bond with you. They will appreciate your holistic recommendations of a species-appropriate diet with whole food vitamin supplementation, glandulars, medicinal Western and Chinese herbals, or even natural essential oils for wellness and therapy. Today’s consumers are purchasing more and more natural options for themselves and their pets, and are questioning old-fashioned conventional recommendations for pet care. Savvy pet parents are seeking veterinarians who know what is trending. They want to believe that their veterinarians are knowledgeable and have their pets’ best interests in mind at all times. Make sure your own advice is in sync with current progressive natural diet expertise. Educated pet parents make better food choices for their pets, and will also respect, trust and appreciate your other integrative suggestions if you are on the same page with them and their move toward quality natural nutrition.

fda.gov/animal-veterinary/news-events/fda-investigation-potential-link-between-certain-diets-and-caninedilated-cardiomyopathy

fda.gov/animal-veterinary/animal-health-literacy/pet-food-labels-general#Ingredient

aafco.org/Consumers/What-is-in-Pet-Food

dogfoodadvisor.com/dog-food-industry-exposed/ingredient-splitting/

scielo.br/scielo.php?script=sci_arttext&pid=S0103-84782016001202189

integrativesystems.org/systems-biology-of-gmos/

livescience.com/36424-food-additive-bha-butylated-hydroxyanisole.html

google.com/amp/s/observer.com/2015/05/the-grossest-substances-still-used-in-paneras-food/amp/

natureslogic.blogspot.com/2013/04/what-about-gmos-and-protein.html

academia.edu/7443850/Glyphosates Suppression_of_Cytochrome_P450_Enzymes_and_Amino_Acid_ Biosynthesis_by_the_Gut_Microbiome_Pathways_to_Modern_Diseases

ncbi.nlm.nih.gov/pmc/articles/PMC1242073/

avmajournals.avma.org/doi/abs/10.2460/javma.2004.224.879

From the AVH

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.

A LIVER CLEANSE? Toxins affect us and our animals on many levels, so the idea of “detoxing and cleansing” is very popular these days. The liver is the main organ associated with this function, although the entire body working in harmony helps maintain internal order. A Google search for “liver detox” yields 67 million results; adding the word “homeopathy” lowers that number to 963,000! The truth is, a healthy balanced organism has a powerful detox/cleansing mechanism available to it at all times. Liver malfunction relates to many chronic health problems, and liver support/treatment often helps speed recovery. Homeopathic treatment of liver disease involves dealing with symptom totality and removing obstacles to cure. Liver disease itself may be one obstacle to cure and is often treated with liver-specific homeopathic remedies at lower potencies (3x to 6c) along with the appropriate constitutional remedy. A few examples of liver-specific remedies include:

med.stanford.edu/news/all-news/2016/06/link-between-canned-food-exposure-to-hormone-disruptingchemical.html

• Berberis vulgaris

• Myrica (bayberry)

healthline.com/health/food-nutrition/is-red-dye-40-toxic#2

• Carduus marianus (milk thistle)

• Phosphorus

prebiotic.ca/chicory_root.html

npr.org/sections/health-shots/2011/08/10/139386917/organic-poultry-farms-have-fewer-drug-resistantbacteria-study-finds

veterinarymedicine.dvm360.com/diagnosing-food-allergies-dogs-and-cats-bring-your-case-trial

naturalsociety.com/study-gmo-soy-accumulates-cancer-causing-formaldehyde/

glutenfreedietitian.com/gluten-free-diet-arsenic-and-rice/

thekitchn.com/good-grains-what-is-millet-67713

todaysdietitian.com/newarchives/110211p36.shtml

ncbi.nlm.nih.gov/pmc/articles/PMC6163171/

ncbi.nlm.nih.gov/pmc/articles/PMC2769029/

bc.edu/sites/libraries/facpub/seyfried-cancer/book.pdf

fda.gov/animal-veterinary/news-events/fda-alerts-pet-owners-about-potential-pentobarbitalcontamination-canned-dog-food-manufactured-jm

• Chelidonium majus (best known for liver support)

• Rumex crispus (yellow dock) • Taraxicum (dandelion)

There are many other helpful supplements for liver support/detox. An obvious preventive measure is to avoid toxic chemicals, harmful drugs, and overvaccination, as these all create heavy burdens for an already busy liver. For further help, contact a homeopathic veterinarian at the AVH.org. Submitted by Todd Cooney DVM, CVH IVC Spring 2020

PEER-REVIEWED

s b r e h n r e t s e W FOR LIVER DYSFUNCTION IN ANIMAL PATIENTS BY ALEXIA TSAKIRIS-VASILOPOULOS, BvetMed, GDipVWHM, CVA

Liver health is vital to patient health. Learn how a variety of Western herbs can be used to support liver function in animals.

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As holistic veterinary practitioners, we formulate treatment plans to support the body’s innate ability to heal itself. At the same time, we address the underlying cause of disease and provide symptomatic relief in our animal patients. The liver is the most important organ of metabolism in the body; supporting liver health supports the body’s ability to heal. This article illustrates how Western herbs support the many different functions of the liver.

A BRIEF REVIEW The liver plays a role in detoxifying molecules, including all the environmental toxins the body is exposed to. Considering there are somewhere between 25,000 and 84,000 chemicals in commerce in the United States, the liver has a heavy workload.1 Many metabolites are lipid soluble; they must be converted into water-soluble substances by the liver’s detoxification pathways in order to optimize removal. The liver processes these metabolites in two main ways:

Phase I involves cytochrome p450 enzymes (CYP450) and improves water solubility. The Phase I CYP450 superfamily of enzymes is the first defense to biotransform xenobiotics, steroid hormones, and pharmaceuticals. 2 These initial reactions have the potential to create oxidative damage within cell systems because of the resulting formation of reactive electrophilic species.2 The large CYP2 family of enzymes is involved in the metabolism of drugs, xenobiotics, hormones, and other endogenous compounds.2

Phase II uses conjugation enzymes, Nrf2 signaling, and metallothionein for further biotransformation. 2

The collective activity of these enzymes results in an increase in the hydrophilicity of the metabolite, theoretically leading to enhanced excretion in the bile and/ or urine. 2 Many foods as well as herbs appear to act as both inducers and inhibitors of CYP1 enzymes, an effect which may be dose dependent or altered by the isolation of bioactive compounds derived from food. 2 For example, turmeric has been shown in vivo to induce and inhibit CYP1 enzymes. 2

WHAT HAPPENS IN LIVER DISEASE? Chronic hepatitis is associated with mixed inflammatory infiltrates and characterized by hepatocellular apoptosis or necrosis, inflammatory infiltrates, regeneration, and fibrosis.3 Mild portal inflammation is seen as a common, nonspecific, reactive change (some internists recommend the pathologist confirms that there is moderate to severe inflammation and necrosis).3 The presence of fibrosis, found through a hepatic biopsy, denotes a more serious consequence.3 Liver cirrhosis is the final phase of all progressive and chronic liver diseases.4 The physiopathology of cirrhosis is

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Herbs to

support

liver health HEPATIC ANTIINFLAMMATORIES Andrographis paniculata, Curcuma longa, Silybum marianum, Glycyrrhiza glabra, Taraxacum officinale

ANTIFIBROTICS Astragalus membranaceus, Centella asiatica, Salvia miltiorrhiza, Urtica dioica

IMMUNE MODULATORS Astragalus membranaceus, Echinacea angustifolia, Ganoderma lucidum, Hydrastis canadensis, Andrographis paniculata, Curcuma longa

HEPATIC ANTIVIRALS Andrographis paniculata, Hypericum perforatum

CIRCULATORY AGENTS Ginkgo biloba, Centella asiatica, Urtica dioica

ADAPTOGENS Astragalus membranaceus, Centella asiatica, Ganoderma lucidum, Rhodiola rosea

ALTERATIVES Arctium lappa, Berberis vulgaris, Centella asiatica, Rumex crispus, Urtica dioica, Trifolium pratense, Taraxacum officinale

INTESTINAL MUCOSAL PROTECTANTS Curcuma longa, Centella asiatica, Ocimum sanctum

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determined by multiple factors of varying importance, including oxidative stress, systemic inflammation, and organ dysfunction.4 One of the key elements involved in cirrhosis physiopathology is systemic inflammation, recently described as one of the components in the cirrhosis-associated immune dysfunction syndrome.4 Local injury and inflammation and fibrosis in the liver create architectural disorganization which impairs bacterial clearance.4 With decreased liver function there is decreased synthesis of innate immune system proteins and pattern recognition receptors that, together, reduce the bactericidal capacity of the cells of the innate immune system.4 As cirrhosis progresses, the gut is affected, in particular the gut-associated lymphoid tissue (GALT), which is the first immunological barrier of defense against antigens and pathogens entering the organism from the intestine. As a consequence of leaky gut, an elevated enteric bacterial load, and changes in intestinal microbiota populations towards pathogenic species, GALT is under the constant pressure of pathological bacterial translocation (BT) and bacterial products translocation.4 Finally, at a systemic level, immune cell function is compromised.4 Based on this very brief review of hepatitis, several classes of herbs should be considered for use (see sidebar at left) depending upon the needs of the patient. A description of several follows. • Taraxacum officinale, commonly known as dandelion, has antioxidant properties found to be protective against hepatotoxicity induced by acetaminophen in mice. 5,16 Hepatotoxicity induced by acetaminophen is related to reactive oxygen species (ROS) formation and excessive oxidative stress; dandelion root and leaf were found to contain natural antioxidant compounds that diminish the drug-induced hepatic dysfunction. 5,6 Dandelion root was found to prevent the increase of serum aspartate and alanine aminotransferases.7 Other studies have shown that dandelion root, as well as dandelion leaf tea (water extract), reduced liver damage serum markers (ALT, AST, GGT, ALP and LDH) thus indicating the plant extract’s effects in restoring the normal functional ability of the hepatocytes.7,8 • Centella asiatica (gotu kola) contains asiatic acid, which has been shown in studies to be hepatoprotective, anti-inflammatory, antitumor and neuroprotective. It is also an antioxidant, aids in wound healing,

improves microcirculation, and heals inflamed intestinal tissue.9 Additionally, gotu kola inhibited liver fibrosis and largely improved liver function in a dose-dependent manner in rats.9 Liver fibrosis represents the final common pathway of virtually all chronic liver diseases. It is characterized by the excessive accumulation of extracellular matrix (ECM) and activated hepatic stellate cells (HSC) that are undergoing myofibroblast transition identified by de novo a-SMA expression.9 Although significant progress has been made in our understanding of hepatic fibrosis, treatment for liver fibrosis remains ineffective.9 Gotu kola shows potential as a useful herbal option for treatment. â&#x20AC;˘ Andrographis paniculata (green chiretta) is traditionally used for the treatment of the common cold, diarrhea, fever due to infectious causes, jaundice, and cardiovascular health. A health tonic for the liver, it addresses several issues encountered in liver disease due to its antiviral, hepatic anti-inflammatory, antibacterial, antioxidant, hepatoprotective, and immunomodulatory properties.10,11 As an immunostimulant, it enhances phagocytic activity.10 As an antiinflammatory, Andrographis has been found to inhibit COX-2 expression. Energetically, it is a Cold and Dry plant so is best used to clear the body of Heat and to dispel toxins. â&#x20AC;˘ Urtica dioica, better known as stinging nettle, encompasses many actions that are beneficial for liver disease. The leaf is traditionally used for anemia as it supports red blood cell production and capillary and venous integrity. Improving circulation supports blood flow to the healthy areas of the liver and is vital for the patient's health. The seeds also have antioxidant and hepatoprotective action.12 From an energetic perspective, nettle is generally Cool to Neutral and slightly Dry.13 It is nutritive, supplies minerals, and has the benefit of being a potassium-sparing diuretic, which can be helpful in cases of advanced liver disease with ascites. Nettle assists other organs, including the kidneys, as a tonic, and it enhances the elimination of uric acid and other metabolic wastes.10 Since leaky gut syndrome and dysbiosis often eventually accompany liver disease, the biofilm inhibition abilities of nettle are also beneficial. Many canine patients will readily drink a tea made with nettle leaf. Continued on page 32.

From far left: Taraxacum officinale, Centella asiatica, Andrographis paniculata, Urtica dioica.

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Continued from page 31. Right: Ocimum sanctum Below: Curcuma longa

• Ocimum sanctum, also known as holy basil or tulsi, is a sweet and spicy herb that will help calm a patient with liver disease through its adaptogenic actions. As an adaptogen, it helps with cloudy thinking (which plagues humans with liver disease as well as veterinary patients), in addition to enhancing resistance to the emotional and physiological stresses that accompany chronic disease. It is a nootropic, immunomodulator, anti-inflammatory, and antioxidant. It provides gastro as well as hepatoprotective effects, beneficial for those patients who have diarrhea and other signs of leaky gut with liver disease.14 • Curcuma longa (turmeric) inhibits hepatic inflammation and upregulates phase II enzymes.15 Beyond its hepatic effects, turmeric stimulates and improves digestion, decreases biofilm production, improves intestinal permeability function, and decreases intestinal inflammation.16,17 Holistic veterinarians address the whole patient and not just the disease. Liver disease in our animal patients is often idiopathic, so it is important to use herbs that are not only hepatoprotective but also exhibit anti-inflammatory and antimicrobial effects, inhibit fibrosis, improve circulation, and protect the gut. A nice generic formulation for liver disease in a patient may include 20% holy basil, 20% gotu kola, 15% Andrographis, 15% dandelion root, 10% turmeric, 10% nettle leaf, 5% licorice and 5% ginger. Herbs are a fantastic choice for veterinarians to use in patients with liver disease, as conventional medicine offers limited treatment options.

“Roundtable on Environmental Health Sciences, Research, and Medicine; Board on Population Health and Public Health Practice; Institute of Medicine. Identifying and Reducing Environmental Health Risks of Chemicals in Our Society: Workshop Summary”. Washington (DC): National Academies Press (US); 2014 Oct 2. 2, The Challenge: Chemicals in Today's Society. Available from: ncbi.nlm.nih.gov/books/NBK268889/.

Hodges, Romilly E, and Deanna M Minich. “Modulation of Metabolic Detoxification Pathways Using Foods and Food-Derived Components: A Scientific Review with Clinical Application.” Journal of nutrition and metabolism vol. 2015 (2015): 760689. doi:10.1155/2015/760689.

Twedt, David. “Chronic Hepatitis -- Latest Update in the Dog”. Atlantic Coast Veterinary Conference 2017, vin.com/members/cms/project/defaultadv1.aspx?id=8207613&pid=19448&meta=vin&.

Dirchwolf M, Ruf AE. “Role of systemic inflammation in cirrhosis: From pathogenesis to prognosis”. World J Hepatol. 2015;7(16):1974–1981. doi:10.4254/wjh.v7.i16.1974.

Dirleise Colle, Leticia Priscilla Arantes, Priscila Gubert, Sônia Cristina Almeida da Luz, Margareth Linde Athayde, João Batista Teixeira Rocha, and Félix Alexandre Antunes Soares. “Antioxidant Properties of Taraxacum officinale Leaf Extract Are Involved in the Protective Effect Against Hepatotoxicity Induced by Acetaminophen in Mice”. Journal of Medicinal Food 2012 15:6, 549-556.

Nazari A, Fanaei H, Dehpour AR, Hassanzadeh G, Jafari M, Salehi M, Mohammadi M. “Chemical composition and hepatoprotective activity of ethanolic root extract of Taraxacum Syriacum Boiss against acetaminophen intoxication in rats”. Bratisl Lek Listy. 2015;116(1):41-6.

Mahesh A, Jeyachandran R, Cindrella L, Thangadurai D, Veerapur VP, Muralidhara Rao D. “Hepatocurative potential of sesquiterpene lactones of Taraxacum officinale on carbon tetrachloride induced liver toxicity in mice”. Acta Biol Hung. 2010 Jun;61(2):175-90.

Abdulrahman L. Al-Malki , Mohamed Kamel Abo-Golayel1, Gamal Abo-Elnaga and Hassan Al-Beshri. “Hepatoprotective effect of dandelion (Taraxacum officinale) against induced chronic liver cirrhosis”. Journal of Medicinal Plants Research 2013; 7(20): 1494-1505.

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Li-xia Tang, et al. “Asiatic Acid Inhibits Liver Fibrosis by Blocking TGF-beta/Smad Signaling In Vivo and In Vitro”. PLoS One. 2012;7(2):e31350. doi: 10.1371/journal.pone.0031350.

David Winston. Herbal Studies Course 2014-2016. Notes.

Md. Sanower Hossain, Zannat Urbi, Abubakar Sule, K.M. Hafizur Rahman. “Andrographis paniculata (Burm.f.) Wall. Ex Nees: A Review of Ethnobotany, Phytochemistry, and Pharmacology”. 2014. Article ID 274905, 28 pages http://dx.doi.org/10.1155/2014/274905. Yener Z, Celik I, Ilhan F, Bal R. “Effects of Urtica dioica L. seed on lipid peroxidation, antioxidants and liver pathology in aflatoxin induced tissue injury in rats”. 2009. Food Chem Toxicol. 47(2):418-24. CIVT Veterinary Western Herbal Medicine, Graduate Diploma Class. 2015 Topic Notes. Kamyab, A.A., Eshraghian, A. “Anti-Inflammatory, Gastrointestinal and Hepatoprotective Effects of Ocimum sanctum Linn: An Ancient Remedy With New Application”, Inflamm Allergy Drug Targets, 2013 De;12(6):378-84.

Reuland DJ, Khademi S, Castle CJ, Irwin DC, McCord JM, Miller BF, Hamilton KL. “Upregulation of phase II enzymes through phytochemical activation of Nrf2 protects cardiomyocytes against oxidant stress”. Free Radic Biol Med. 2013 Mar; 56:102-11. Doi: 10.1016/j.freeradbiomed. 2012.11.016. Epub 2012 Nov 30.

Ghosh SS, He H, Wang J, Korzun W, Yannie PJ, Ghosh S. “Intestine-specific expression of human chimeric intestinal alkaline phosphatase attenuates Western diet-induced barrier dysfunction and glucose intolerance”. Physiol Rep. 2018 Jul;6(14):e13790. doi: 10.14814/phy2.13790.

Ghosh SS, Bie J, Wang J, Ghosh S. “Oral supplementation with non-absorbable antibiotics or curcumin attenuates western diet-induced atherosclerosis and glucose intolerance in LDLR/ mice — role of intestinal permeability and macrophage activation”. PLoS One 9: e108577, 2014. doi:10.1371/journal.pone.0108577.

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MILLENNIAL PET OWNERS WILLING TO SPEND MORE FOR QUALITY VETERINARY CARE

Millennials are now the largest demographic among US pet owners, with 35% owning one or more pets, compared to 32% of baby boomers. They are also more likely than previous generations to view their pets as valuable, irreplaceable members of the family. Seeing themselves more as pet parents than pet owners, millennials are willing to invest time in researching and gathering as much information as possible to pinpoint the veterinary practice or service that will provide the best quality of care for their animals. If patient-client interactions don’t go well, or clients feels the staff at the veterinary practice they’re patronizing is harried, stressed, or lacking confidence, millennial pet parents have no qualms about moving from vet to vet until they find the right fit. They’re also willing to spend more to ensure quality service and care for their furry family members. Spending on animal care increased 6.1% in 2018 for a total of $18.11 billion, and the APPA predicts a 4.8% increase in 2019 numbers. Veterinary practices and clinics that don’t attempt to keep up with changes in pet owner attitudes towards animal care won’t feel the positive impact of this increased spending, and could find their client lists dwindling.

CREDENTIALING AND TRAINING FOR VETERINARY TECHNICIANS ARE VITAL TO THRIVING PRACTICES With access to more animal care information than ever on the internet, clients now have even higher standards and more widely available options to treat their pets’ illnesses. It’s tempting to focus solely on introducing innovative cuttingedge medicine and techniques to your practice to draw new clients to your door. But it’s essential to pair innovation and solutions with a number of trained, knowledgeable and caring veterinary technicians and assistants in order to inspire trust and confidence in clients who think of their pets as family. Besides increasing the number of clients your clinic can help on a regular basis, encouraging skilled employees to pursue further training can assure a consistent standard of care for patients, reduced staff turnover, and incentives for new employees to perform their best, allowing veterinarians to focus on treatment, research and more. With Penn Foster’s online veterinary training, you can help your employees prepare for success while building client trust and growing your practice. Contact them today to learn more about Penn Foster’s accredited online veterinary programs (pennfoster.edu/programs-and-degrees/ veterinary-studies/veterinary-technician-associate-degree).

IVC Spring 2020

industry innovations Backed by sound science

The pet care market is flooded with CBD products, but it’s vital to choose only those that are backed by solid research. This year, Canopy Animal Health is launching the most scientifically sound companion animal cannabidiol (CBD) products available. “We have been focused on conducting research that will allow us to develop science-based canine and feline CBD products,” says veterinarian Dr. Robert Menardi, director of veterinary educational and technical services. The company has 22 studies either completed or underway. For example, Stephanie McGrath, DVM, MS, a veterinary neurologist at Colorado State University and leading researcher in the pet cannabinoid field, is conducting four preliminary studies with support from Canopy Animal Health. The studies are exploring the potential use of CBD to mitigate the symptoms of epilepsy in dogs, and investigating whether CBD might be safely used in cats. Canopy Animal Health will initially offer non-prescription CBD products, but is also developing a line of prescription products. CanopyAnimalHealth.com

The ultimate grooming tool

If some of your patients are looking a little scruffy, you might want to talk to their owners about this innovative multi-purpose grooming tool. The StripHair Gentle Groomer for Pets allows the user to remove loose hair, dirt and dander while massaging the animal’s muscles and keeping grooming-induced stress at bay. Because it’s soft and extra flexible, it’s ideal for grooming the face and legs. It can also be used to warm up an animal before exercise, or calm him down in moments of anxiety. StripHair.com

New product for urinary incontinence

Urethral sphincter mechanism incompetence (USMI) is a common cause of urinary incontinence in adult female dogs. Pegasus Laboratories, Inc. (d.b.a. PRN Pharmacal) recently launched its latest product in the urinary health market — once-a-day PROIN ER™ (phenylpropanolamine hydrochloride extended-release tablets). “Veterinarians are always concerned about pet parent compliance and have asked us about a once-a-day-product for years,” states Vice President and General Manager, Donna Logan. “FDA-approved as a treatment for USMI, PROIN ER features a unique, patented, extended-release technology.” PROIN ER is available in four mg sizes for dogs from 10 lbs to 125 lbs. PRNPharmacal.com 34

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Clinically proven hip and joint supplement

Looking for a superior joint supplement for your patients? At the VMX in January, the UK’s market-leading canine joint supplement brand, YuMOVE by Lintbells, launched YuMOVE ADVANCE 360 to the US. Grounded in science, this formulation takes a multi-modal approach to the management of canine mobility issues. Its triple action formula supports joint structure, promotes mobility, and assists the body’s natural anti-inflammatory process. It improves a dog’s mobility in just six weeks, and has been clinically proven by two independent studies (Royal Veterinary College London, 2015 and Massey University New Zealand, 2019). YuMoveAdvance360.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™ launched 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. FurBabyTracker.com

Pill administration made easy!

One in every four cat owners leaves the veterinary clinic with a pill prescription, and one out of every three admits their cat spits out the pills, according to a study commissioned by Royal Canin. The company’s Feline PILL ASSIST™ makes it a lot easier to administer medication to finicky feline patients. This palatable product has a soft texture that can easily be molded around any pill shape, enabling successful pill administration in over 90% of cases. Also features a moderate calorie content along with vitamins and probiotics. RoyalCanin.com

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PEER-REVIEWED

Retraining the hypersensitive immune system with regionally-specific immunotherapy BY JON PLANT, DVM, DACVD

A COMPREHENSIVE LOOK AT ALLERGEN IMMUNOTHERAPY (AIT) IN DOGS AND CATS, INCLUDING REGIONALLY-SPECIFIC IMMUNOTHERAPY (RSI).

Pruritus and otitis externa are two of the most common presenting complaints in small animal practice. Both are most often secondary to allergic dermatitis. When caring for a patient with allergic dermatitis, your complementary goals should be to control the pruritus, and manage the underlying allergic triggers. This article reviews the uses of allergen immunotherapy (AIT) in dogs and cats.

integrative medicine are accustomed to discussing limited-ingredient, raw and home-prepared diets to address underlying food hypersensitivity.

ESTABLISHING A DIAGNOSIS OF ATOPIC DERMATITIS

Addressing the underlying causes of atopic dermatitis (AD) is more complex. Depending on your comfort level with chronic immunomodulating therapeutics, you may offer Apoquel, Cytopoint, Atopica, or prednisone as long-term treatment options for AD. But are you missing an opportunity to target the underlying causes of the problem?

Most cases of allergic dermatitis in dogs and cats are triggered by fleas (flea allergy dermatitis), ingested proteins (food hypersensitivity), or environmental allergens (atopic dermatitis). The steps to making a diagnosis of atopic dermatitis should be familiar:1

Allergen immunotherapy (AIT) is described as the only treatment for AD that can result in partial or complete remission by addressing the underlying cause.2 Most studies evaluating the effectiveness of AIT in dogs with AD have

1. Take a thorough dermatological history 2. R ule out flea allergy dermatitis with appropriate flea control

3. R ule out food hypersensitivity with a limited ingredient diet trial

4. R ule out other pruritic dermatoses as indicated (e.g. skin scrapings for mites)

5. R ely on clinical features to establish a clinical diagnosis (see sidebar at top right).

TREATING THE CAUSE OF ATOPIC DERMATITIS Recommending routine flea control is automatic for most of us, especially when the dorsal lumbar area is affected or fleas are evident. Veterinarians practicing

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Interdigital erythema and inflammation in a three-year-old pitbull with atopic dermatitis.

been retrospective, but they report a success rate of 60% to 70%. 3 Because testing and treatment protocols for AIT in dogs and cats are not standardized, there is still a great deal of uncertainty regarding optimal allergen dosing, mixture, and administration. For instance, while some studies suggest that including fewer allergens is desirable, others have concluded that including 11 to 20 allergens is most effective.4 Regionally-specific immunotherapy (RSI) extracts are formulated with reference to the geographic distribution and prevalence of important aeroallergens, rather than an individual dog or cat’s allergy test results. The commercially-available regionally-specific immunotherapy product, RESPIT®, is standardized for nine geographic regions of the United States, and is available for either subcutaneous injection or oromucosal administration. The injectable formulations each contain 20 allergens; the oromucosal formulations contain 22. (See sidebar on page 38 for an example of one regional RESPIT® formula.) The common triggers of AD in pets are pollens, dust mites, and mold spores. Within these groups, certain allergens are more significant than others depending on their prevalence, allergenicity, and degree of crossreactivity between individual pollens. Veterinary dermatologists consider this information when deciding which allergens to include in allergy tests or in therapeutic extracts. 5

RETRAINING THE IMMUNE SYSTEM The objective of AIT is to retrain the pet’s immune system to tolerate natural exposure to the offending allergens. The mechanisms by which tolerance is achieved remain unclear in dogs and cats, but may include altering the responses of antigen presenting cells, regulatory T cells, and B cells, and influencing the expression of cytokines, especially IL-10.6 While there are no known contraindications to AIT in dogs and cats, it is most often recommended for patients that have clinical signs for six months or more throughout the year.

SELECTING ALLERGENS FOR IMMUNOTHERAPY The starting point for AIT is making a clinical diagnosis of AD, based on the pet’s history, clinical signs, and by ruling out differential diagnoses. Traditionally, a pet’s allergen sensitivity is then determined by the primary care veterinarian with serum IgE testing, or a veterinary dermatologist with intradermal testing (IDT). This forms the basis for formulating an individual pet’s therapeutic allergenic extract.1 More recently, several companies have begun marketing hair and/or saliva sensitivity testing (often directly to pet owners).

THE SIGNIFICANCE OF ALLERGY TEST RELIABILITY What do we know about the reliability of serum allergy testing, IDT, and hair/saliva sensitivity testing? It is clear that each method produces false positive and false negative readings for individual allergens and that they generally don’t agree well with each other.1 The agreement between four serum allergy testing laboratories on replicate samples was found to be poor. 7 Some of the hair/saliva tests have even been shown to report positive sensitivities to saline, water, and nylon “hair” from stuffed animals.8.9 And, although IDT is sometimes referred to as the gold standard in canine allergy testing, it is itself imperfect, relying on subjective interpretation and having unproven test-retest repeatability.10 Continued on page 38.

Diagnose canine atopic dermatitis based on these clinical features • Age at onset <3 years • Mostly indoors • Corticosteroid-responsive pruritus • Chronic or recurrent yeast infections • Affected front feet • Affected ear pinnae • Non-affected ear margins • Non-affected dorso-lumbar area This validated checklist is 85% sensitive and 79% specific when dogs meet at least five of these eight criteria. Adapted from: Favrot C, et al. “A prospective study on the clinical features of chronic canine atopic dermatitis and its diagnosis”. Veterinary Dermatology, 2010; 21: 23-31.

Effectiveness of regionally-specific immunotherapy for the management of canine atopic dermatitis11 A retrospective study was performed to evaluate the effectiveness of regionallyspecific immunotherapy (RESPIT®) in dogs at a veterinary dermatology referral clinic. 103/286 dogs met the inclusion criteria and an overall assessment (excellent, good, fair or poor) was assigned based on changes in pruritus severity, lesion severity, and the reduction in concurrent medications during a 270-day follow-up period. The overall response to RESPIT® was excellent in 19%, good in 38%, fair in 25%, and poor in 18% of the dogs. Adverse reactions were reported in 2.4% of the dogs. RESPIT® was considered safe and effective for the treatment of atopic dermatitis in dogs.

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Allergen ingredients in the California mixture of RESPIT® Oromucosal Spray GRASSES

Bermuda — Cynodon dactylon Johnson — Sorghum halepense Timothy — Phleum pratense

WEEDS

Dock — Rumex spp. Groundsel — Baccharis spp. Lamb’s quarters — Chenopodium album Plantain, English — Plantago lanceolata Ragweed, western — Ambrosia psilostachya Sagebrush — Artemisia tridentata Wingscale — Atriplex canescens

TREES

Alder — Alnus spp. Box elder — Acer negundo Cypress, Arizona — Cupressus arizonica Eucalyptus — Eucalyptus spp. Mulberry — Morus spp. Oak — Quercus spp. Olive — Olea europaea Willow — Salix spp.

MITES

House dust mite — D. farinae House dust mite — D. pteronyssinus

MOLDS

Alternaria alternata Cladosporium herbarum

that immunotherapy with imperfectly matched allergens is also effective. A total of 57% of dogs receiving RSI had a good to excellent response in a retrospective study.11 Similar results were reported in a double-blinded study comparing a stock mixture of allergens to IDT-based AIT.12 Placebocontrolled studies of both IDT-based AIT and RSI are needed. In a model of asthmatic cats, allergens given for AIT did not need to match the sensitizing allergens in order to provide a clinical benefit.13 In humans sensitive to both birch and grass pollens, sublingual AIT with either pollen individually produces clinical improvement and lower nasal eosinophil counts during both distinct pollen seasons.14 The mechanism of action of RSI may be both allergenspecific and non-specific. Phylogenetically related allergens often cross-react on IDT in atopic dogs.15 There are about 30 major groups of cross-reactive botanical proteins. Although imperfectly matching a dog’s sensitivities, RSI may include some allergen-specific epitopes as well as panallergens (e.g. profilins, polcalcins, and non-specific lipid transfer proteins) common to distinct allergen groups. These panallergens are widely distributed in nature with highly conserved amino acid sequence regions, structures, and functions.16

OROMUCOSAL OR INJECTABLE RSI? Continued from page 37. The reported differences between allergy tests are not insignificant and introduce substantial variability to allergen formulation. If you are selecting five allergens from a list of 50, there are 2,118,760 possible combinations. For ten allergens, the number of possible combinations is over ten billion. And for an extract that contains 15 of 50 possible allergens, the number balloons to a quadrillion combinations, exceeding the number of stars in the Milky Way galaxy! If your rationale for performing an allergy test is to perfectly match a pet’s prescription to his actual sensitivity, your chances of doing so based on an imperfect test are extremely low. The practical effects of this were brought to light in the previously referenced study comparing treatment recommendations of four serum allergy testing laboratories;7 85% of all the individual allergens recommended for nine dogs’ prescriptions were recommended by only one of the four laboratories. All four laboratories agreed on just 1/261 (0.4%) of the AIT ingredient recommendations.

IMMUNOTHERAPY WITH IMPERFECTLY MATCHED ALLERGENS While perfectly matching a therapeutic allergen extract to a pet’s sensitivity is a noble aspiration of allergy test-based immunotherapy, there is evidence in dogs, cats, and humans

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Once you make the diagnosis of AD and prescribe RSI, you have the choice of injectable or oromucosal spray formulations (see table below). For the commerciallyavailable product, each of the nine regional U.S. formulations includes 18 pollen and two dust mite allergens. The oromucosal versions also contain two common mold spores, Alternaria and Cladosporium. The two routes of administration stimulate somewhat different aspects of the immune system, but are of similar efficacy. Anecdotal reports suggest that oral immunotherapy may control signs of AD more quickly than subcutaneous immunotherapy.17 However, no rigorous studies in dogs or cats comparing the two have been published. A possible advantage of subcutaneous AIT administration is that the Table: Comparison of Injectable and Oromucosal RESPIT® Route

Subcutaneous Injection

Oromucosal Spray as DoseMetered Pump in the Cheek

Frequency

Weekly

Daily

Incremental Updosing

Yes

Pollens

Dust Mites

Mold Spores

Preservative

Phenol

Glycerin

frequency of injections can be reduced once a response is achieved, whereas ongoing daily administration is recommended when using the oromucosal route.

CONCOMITANT THERAPY Scratching, biting, and excessive grooming are what usually prompt your client to seek care for their dog or cat with atopic dermatitis, and you’ll want to control the pruritus while retraining the immune system with AIT. I’ll routinely prescribe Apoquel or Cytopoint for several months while beginning AIT. You may also choose to continue integrative medicine options during this time.

AVOIDANCE THERAPY Ideally, we would love to accurately identify aeroallergen triggers of atopic dermatitis and keep our patients away from them. However, there is only limited evidence that avoidance therapy is effective for managing AD in dogs or cats. 2 In an uncontrolled study undertaking house dust mite control measures in the homes of dogs with mite sensitivity, clinical improvement was noted.18 Given the uncertainty surrounding allergy testing and the impracticality of avoiding pollen allergens, avoidance therapy is an ancillary measure, at best. For dogs, regular bathing may help by removing in-contact allergens.

ADVERSE REACTIONS Adverse reactions to AIT, including RSI, are uncommon and most often present as an increase in pruritus and, less commonly, urticaria. These are usually manageable with dose reductions and/or pre-medicating with an antihistamine. Anaphylactic shock due to AIT is rare in dogs and cats. When pet owners are administering AIT at home, it is good practice to have them observe the pet for 60 minutes after subcutaneous AIT administration. The oromucosal route of administration is associated with fewer adverse reactions and is preferred by this author for dogs with a history of urticaria.

medications). 6,11 The variable response rate may relate to the choice of allergens, route of administration, or the fact that AD has a complex pathogenesis that is somewhat different from patient to patient in different stages of the disease. Pets that have responded during the first year are often treated for at least two more years. The dosing frequency of subcutaneous AIT is often reduced over time to every two to four weeks, but oromucosal AIT is usually maintained at once daily, as much as possible. After several years, I may discontinue AIT on a trial basis. However, AIT has traditionally been regarded by most authors as a lifelong therapy for dogs and cats.

Disclosure statement: The author of this publication developed RESPIT ® and has a financial interest in RESPIT, LLC. For more information, visit vetrespit.com.

Hensel P, Santoro D, Favrot C, Hill P, Griffin C. “Canine atopic dermatitis: detailed guidelines for diagnosis and allergen identification”. BMC Vet Res. 2015;11:196.

Olivry T, Sousa CA. “The ACVD task force on canine atopic dermatitis (XIX): general principles of therapy”. Vet Immunol Immunopathol. 2001;81(3-4):311-6.

DeBoer DJ. “The future of immunotherapy for canine atopic dermatitis: a review”. Vet Dermatol 2017;28: 25–e6.

Griffin CE, Hillier A.“The ACVD task force on canine atopic dermatitis (XXIV): allergen-specific immunotherapy”. Vet Immuno and Immunopath 2001 81:363-383.

Hillier A, DeBoer DJ. “The ACVD task force on canine atopic dermatitis (XVII): intradermal testing”. Vet Immunol Immunopathol. 2001;81(3-4):289-304.

Loewenstein C, Mueller RS. “A review of allergen-specific immunotherapy in human and veterinary medicine”. Vet Dermatol. 2009;20(2):84-98.

Plant JD, Neradelik MB, Polissar NL, Fadok VA, Scott BA. “Agreement between allergen-specific IgE assays and ensuing immunotherapy recommendations from four commercial laboratories in the USA”. Vet Dermatol. 2014;25(1):15-e6.

Bernstein JA, Tater K, Bicalho RC, Rishniw M. “Hair and saliva analysis fails to accurately identify atopic dogs or differentiate real and fake samples”. Vet Dermatol. 2019;30:105-e28.

Coyner K, Schick A. “Hair and saliva test fails to identify allergies in dogs”. J Small Anim Pract. 2019;60(2):121-5.

Ferrer-Canals G, Plant JD, Beale KM, Fadok V. “Reliability of intradermal allergy tests in dogs with atopic dermatitis”. NAVDF 2009 Abstracts. Vet Dermatol. 2009;20(3):228.

Plant JD, Neradilek MB. “Effectiveness of regionally-specific immunotherapy for the management of canine atopic dermatitis”. BMC Vet Res. 2017;13(1):4.

OUTCOME Improvement in patients receiving AIT is measured by a reduction in pruritus and less frequent and severe clinical signs, including secondary pyoderma, Malassezia dermatitis, and otitis externa. The regular use of a pruritus visual analog scale (vetrespit.com/resources/PVAS.pdf ) and a skin lesion scoring index (atopiscore.com) is helpful in monitoring improvement.

Garfield R, Editor. “Injection immunotherapy in the treatment of canine atopic dermatitis: comparison of 3 protocols”. Annual Meeting of the American Academy of Veterinary Dermatology and American College of Veterinary Dermatology; 1992; Montreal, Canada.

Reinero C, Lee-Fowler T, Chang C-H, Cohn L, DeClue A. “Beneficial cross-protection of allergen-specific immunotherapy on airway eosinophilia using unrelated or a partial repertoire of allergen(s) implicated in experimental feline asthma”. Vet J. 2012;192(3):412-6.

Marogna M, Spadolini I, Massolo A, Zanon P, Berra D, Chiodini E, et al. “Effects of sublingual immunotherapy for multiple or single allergens in polysensitized patients”. Ann Allergy Asthma Immunol. 2007;98(3):274-80.

Buckley L, Schmidt V, McEwan N, Nuttall T. “Cross-reaction and co-sensitization among related and unrelated allergens in canine intradermal tests”. Vet Dermatol. 2013;24(4):422-e92.

Hauser M, Roulias A, Ferreira F, Egger M. “Panallergens and their impact on the allergic patient”. Allergy Asthma Clin Immunol. 2010;6(1):1.

Many dogs or cats will show improvement in the first three to six months, but a one-year trial is often recommended. Most studies evaluating AIT report that about 20% of dogs have an excellent response, and 40% have a good response (a greater than 50% reduction in signs and concomitant

DeBoer DJ, Morris M. “7th World Congress of Veterinary Dermatology Abstracts, Multicentre open trial demonstrates efficacy of sublingual immunotherapy in canine atopic dermatitis”. Vet Dermatol. 2012;23(s1):64.

Swinnen C, Vroom M. “The clinical effect of environmental control of house dust mites in 60 house dust mitesensitive dogs”. Vet Dermatol. 2004;15(1):31-6.

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TAPE

— A VALUABLE ITEM IN THE VETERINARY TOOLBOX BY LUIZ HENRIQUE LIMA DE MATTOS, CRMV, CKTIE

As a qualified veterinarian, I work primarily with horses in my practice. Among the many valuable items in my veterinary toolbox is tape. I often get questions and requests for assistance with other animals besides horses, so I have used the elastic taping skills from my training with large animals to develop some principles for dogs. Whether working with humans, horses or small mammals, the general concepts for using tape remain similar. We utilize tape in many ways — for cases of chronic or acute pain; postural control and biomechanics; circulatory and lymphatic conditions; injuries and protection of tendons, ligaments and joints; conditions of fascia and scarring; and for seeking muscular homeostasis. Elastic taping shows both immediate and long-term effects, either solving the issue up front or increasing patient compliance for further care (we know that patient compliance is always going to be an issue). In general, taping is an adjunct therapy that may be used in conjunction with other techniques such as cryotherapy, hydrotherapy, chiropractic, acupuncture, electrotherapy and

Figure 1

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Figure 2

micro-physiotherapy (Figure 1). The tape may be applied over the animal’s coat if it is not too heavy (Figure 2). For some lymphatic and pain control applications, it might be advisable to shave the treatment area, although this is less of an issue with newer canine-specific tape. In any case, it is important to use the correct tension (stretch) and application methodology, and the hair should be very clean. Taping works through the endogenous analgesic system (Figure 3). We look for a variety of results: we may modulate pain by bandaging through the skin and adjacent tissues; we may apply compressive and decompressive forces to control the pain message; and we may improve communication of the sensory-motor cortex, thus inhibiting the recognition of pain. For the circulatory/lymphatic system, the tape acts on the skin Figure 3 via its elastic effect (Figure 4). This can promote movement between tissues, assist in selfregulation of interstitial fluid, normalize temperature and provide objective control of pain, edema and bruising. One simple muscular technique, as an example, would be facilitation of the gluteus area.

Figure 4

From the AAVA Figure 5

Figure 6

The American Academy of Veterinary Acupuncture (AAVA) is committed to improving animal health care through the advancement of veterinary acupuncture. The AAVA’s seat within the American Veterinary Medical Association’s (AVMA) House of Delegates (HOD) gives us multiple opportunities to represent veterinary acupuncture. The AAVA strives to bring veterinary acupuncture practitioners together to promote acupuncture to veterinarians and the public.

UPCOMING EVENTS

Figure 7

Figure 8

Figure 9 This taping might address both gait and pain issues as part of a program of care. First, measure a length of tape in the area shown (Figure 5). Begin the application by anchoring the unstretched end of the tape strip on the upper pelvis (Figure 6). Apply with moderate stretch, no more than 35% (Figure 7). Finish on the femoropatellar joint with no stretch at the very end (Figure 8). This application is designed to encourage movement in the affected area (Figure 9). If your patient assessment indicates that it is better to discourage movement in that muscle group, here is an alternative: you can modify the above application by reversing the tape direction; anchor at the joint and draw the tape upwards. Education in proper taping techniques will enable many happy outcomes for canine patients. With the advent of new canine tape, we foresee even greater results! Luiz Henrique Lima de Mattos specializes in physiotherapy. He has studied at Universidade Metropolitana de Santos, Universidade Estadual Paulista (UNESP) and The Royal Veterinary College (London), researching the effects of Kinesio Taping in equine physiotherapy. Luiz works with small and large animals in private practice and as a program coordinator at IBVET Instituto Brasileiro de Veterinária. He has been active in Kinesio Taping research and education since 2013 in Brazil, the US and the UK.

Join us for our 15th Annual AAVA Meeting, scheduled for April 17 to 19 at the Peabody Hotel in Memphis, Tennessee. This iconic Memphis hotel is on the National Registry of Historic places. A limited number of animal-friendly rooms are available on the fifth floor — so book early and bring Fido, if you wish! Registration is now open at aava.org. AAVA and IVAS are once again joining forces in 2020 to provide regional CE meetings for both small and large animal practitioners. A small animal regional seminar, featuring Dr. Constance DiNatale and focusing on food therapy for the acupuncture patient, will run April 25 and 26 in West Virginia. An equine regional seminar is also planned for May 30 and 31, featuring Dr. Maurice Casey and taking place in Aiken, South Carolina. Visit aava.org for more information.

ONLINE WEBINARS AAVA is proud to announce our new online CE options for AAVA members. We are now providing live and on-demand webinars to our members. Non-members will be required to pay $150, but will be awarded a one-year free membership, giving them access to all member benefits. These new webinars began in November of 2019 with Dr. Michelle Tilghman presenting “Interventions for Chronic Back Pain”. In February, Dr. Dolores Puertas presented “Introduction to the Balance Method for Equine”. Recorded webinars are also available on demand at aava.org and are IVAS and RACE approved for two CE hours. New webinars will be added soon.

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innovative practice

7 tips

for creating a

mindful practice culture (inspired by our patients!) BY MELISSA MAGNUSON, DVM

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Pets and people are connected. I don’t think we realize how much we affect our animals by our presence, personality, and daily routines. Or wait…maybe it’s the other way around. Do we realize how much our animals can affect and teach us? Some of the greatest lessons I have learned have come from my pets. Whether it’s to slow down, be present, drink more water, or play more, these lessons came from animal teachers. Pausing to breathe, notice, and pay attention to the present moment is perhaps the hardest thing to do. Accepting that everything happens for a reason, in the way it’s supposed to happen, is hard to accept. This is taking life in stride, which I think our pets do well. Let’s try to learn from them. I like to teach my staff the following seven steps to becoming healthier, more engaged, and present.

EARN TO BREATHE. I don’t mean just your standard day-toL day breathing; learn how to completely fill your lungs, and then completely exhale. It is the most restorative free health benefit you can achieve. Close your eyes. Sit and breathe in slowly through your nose and try to completely fill your lungs. Count to ten; this helps. Hold your breath for three, then slowly release it through your lips, counting to ten again. Just one deep breathing cycle will bring you relaxation and clarity. Doing this exercise multiple times can reduce your heart rate, blood pressure and cortisol levels. This is something you can do anytime, anywhere, and at no cost. It works wonders with relieving in-the-moment stress. Once you have mastered breathing, try meditation. I love Headspace; it’s a great meditating app for anyone who wants to learn. Continued on page 44.

HOW TO

DEEP BREATHE: q Sit and close your eyes w Breathe in slowly through your nose for the count of 10

e Hold your breath for the count of 3

r Slowly release through your lips for the count of 10

Continued from page 43.

I am healthy & strong

FIND A MANTRA. A mantra is a positive phrase or personal affirmation. It can be something simple like “I’m beautiful” or “I’m healthy”. Write it down and repeat it twice daily in the mirror. What you think about, you bring about. Get an index card and write down your mantra…mine sits on my mirror in the bathroom, so I remember to do it every day.

DRINK WATER. Your body is made up of 60% water, and it’s vital to so many processes. It flushes wastes, rebuilds cells, transports proteins, protects the brain, cushions joints, and helps you maintain your body temperature. Drinking water is so important to feeling good.

ISTEN MORE THAN YOU TALK. The art of listening can be L mastered, but it takes a patient and thoughtful person. Be present when someone else is talking. Focus on his or her words and meaning. Ask questions but don’t interrupt. Stay curious and out of judgment. Don’t offer solutions unless you are asked. Don’t be a one-upper; when you are listening, it’s not about you. Listening skills will open your world to so much information. The more you listen, the more extraordinary coincidences you will notice.

EXERCISE. It can be anything. Maybe you need a guided class or gym membership. Maybe try an online program like OMFIT or GAIA. Or just start walking every day. Walking outdoors gives you the double benefits of exercise and enjoying nature. Aim for one hour of some type of activity per day. Going up and down your stairs at home may count for 20 minutes. Get creative with movement; take a dance class, ride your bike to work, or try yoga.

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DETOX YOUR BODY. Choose foods that are less processed, and contain less sugar and fewer additives. Try adding fresh fruit and veggies to every meal. Maybe you can adopt one plant-based meal per day. Notice how good you feel after you eat. Paying attention to your body, being present, and noticing how the food makes you feel helps you make wiser choices. Keep a food/feeling diary. Write down what you eat, then how you feel. You will quickly start making wiser choices. If you hate fruits and veggies, try smoothies; blend them all up for a great meal packed with vitamins, minerals and fiber. Continued on page 46.

A personal story One day, I was running late, rushing to leave home and get to my hospital because I was interviewing a veterinarian. As I was about to hurry out, I discovered that one of my dogs had peed all over the floor right in front of the door I was about to exit. I quickly grabbed a towel to soak up the urine, and a spray bottle of Nature’s Miracle to clean the floor. I looked around at my four dogs, wondering who was responsible, as it wasn’t typical for them to urinate in the house. Then I realized how late I really was, after I’d stopped to clean everything up. I laughed and thought to myself: “It’s the way the universe wants it to happen.”

I jumped in my car and left. Down the road from my house is a very sharp curve that leads to the main road. As I approached the curve, I saw that two cars had collided and were off the road. I pulled over and checked to see if everyone was okay. They were fine, and had called 911. I continued on my journey, contemplating the possibility that perhaps my dogs knew I needed to slow down…and how slowing down that particular morning quite possibly saved me from an icy patch and an accident. Needless to say, I was very grateful to my dog for urinating on the floor!

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Continued from page 45. FOCUS ON OTHERS. Veterinary medicine is a service industry. Every day we are given the privilege of making someone’s life better. We are very powerful, but with power comes great responsibility. Noticing what you can do to make a difference for someone else, and then doing it, will ultimately fulfill you. Simply taking a cat carrier out to the car for an elderly client, or finding some toys for the mom with two rambunctious toddlers, can profoundly alter the client’s experience — and yours. Try focusing on serving others in meaningful ways. It will feel great, I promise. One of my employees waited outside an exam room door while a client said her final goodbyes to her deceased cat. This client lives by herself, and my staff member didn’t want her to walk to her car alone, since every other time she always walked with her cat. I thought this was such a beautiful gesture.

IMPLEMENTING THE STEPS How do you make these steps a part of everyday life in a busy veterinary hospital? At our practices, I have added a mindfulness component to every session of hospital rounds. Practice owners — if you are not doing this, please start. Close every Wednesday (or pick the day you want) for two hours and do hospital rounds. Focus on your hospital and staff and how you can create a better practice culture for everyone. It has been three years now since I implemented mindfulness into our hospital rounds. We start each session by meditating. For about two months, our staff thought this was crazy, and then something beautiful happened. They started asking to meditate longer. We use our Headspace app to guide us. They often ask for ten- to 20-minute meditations and it has changed our staff. They now participate in hospital rounds in a different way. They listen more, and are proactive and thoughtful with their conversations. Along with meditating, we also talk about wellness tips, like those listed above. At one of our rounds, we invited a yoga therapist who took us through some poses to relax us and help us through our day. I have witnessed one of our doctors

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going through these yoga poses before she enters certain appointments. I asked how it has helped her, and she replied that it allows her to better handle difficult clients. By picking a topic and incorporating it into each round session, you will empower your staff. The day after we invited a local nutritionist to talk about healthy eating, several staff members started bringing in healthy treats and cutting out sugary coffee. You can accomplish a lot by focusing on one positive change; introduce it, and see how it helps. I believe you will be pleasantly surprised. When you implement the seven steps presented in this article, the universe will start to show you positive energy in many ways. Pay attention. Thoughtful breathing will bring you great clarity. Your mantra will build your soul. Drinking water will replenish your vital systems and make you feel good and less tired. Listening will teach you how many connections you can make within the universe — and how many meaningful coincidences occur. Exercise moves the body to clear the mind. Healthy food gives your body the opportunity to process more efficiently, and fuels it with energy. Finally, focusing on others will fill you up with kindness and love.

Profitable Practice PHYTOMAXX™ PLUS BY ANIMAL NUTRITIONAL PRODUCTS anpvet.com/phytomaxx | 800-224-6805

INCOME POTENTIAL: Veterinarians who started using PhytoMAXX™ for pain management and separation anxiety are now using it for more complex issues. Clients want to buy hemp extract from the veterinarian, and not an unknown company, so the income potential increases further.

TRAINING REQUIREMENTS: When using CBD, understanding the potential available to you is of the utmost importance to you and your staff. It’s also important to understand the laws surrounding cannabis use in your area. Doctors and techs should be educated on absorption rates and proper dosing of CBD. When you purchase PhytoMAXX™, an educational brochure for future and existing clients is supplied.

TIME TO IMPLEMENT: PhytoMAXX™ can be implemented in your clinic immediately after purchase. Clients can begin using the product at home as soon as proper instructions have been provided to them. As experts in hemp extract, Animal Nutritional Products is able to offer any information required by you or your client.

SOME POTENTIAL USES: Veterinarians and pet parents have successfully used PhytoMAXX™ for a wide range of health concerns, including pain, separation anxiety, skin issues, sterile cystitis, lack of appetite and IBD. Compared to tramadol, galliprant and fluoxetine, this product has been reported by pet parents to have a longer half-life (three to four hours more). While this result has not been clinically studied, it has been tested in clinics and through observation.

WHAT PhytoMAXX™ Plus is a full spectrum hemp extract available in a liquid or chewable formula that addresses the CB1, CB2 and TRPV1 receptors. These receptors are prevalent in the body and brain of the endocannabinoid system in all animals. The formulation is designed to repair this system, which controls the CNS, immune and GI systems. This hemp extract can eliminate or reduce the need for NSAIDs and fluoxetine consumption, and can be used as part of a multimodal regime for many everyday health issues in animals.

WHY The attention given to CBD by the internet and media is overwhelming — there is a lot of “canna-confusion” out there, and clients are struggling to find safe, effective and fairly-priced products. Veterinarians are capitalizing on the CBD boom; the key is to purchase from a reputable company that knows the laws and regulations. PhytoMAXX™ is a veterinary exclusive product, so your clients won’t find it on the internet.

WHO Clients are much more educated about alternative medicine these days, but they still need guidance when it comes to CBD. They are seeking alternative ways to alleviate issues other medications sometimes can’t help with, and offering a safe and effective hemp extract like PhytoMAXX™ offers them peace of mind with third party lab testing.

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CASE

CASE REPORTS 48

1 AN INTEGRATIVE APPROACH TO

VACCINE-INDUCED MENINGOENCEPHALITIS IN AN AUSTRALIAN SHEPHERD DOG

BY SARA HUMPHREY, DVM CANDIDATE 2020

As part of my training at Auburn University College of Veterinary Medicine, I was tasked with completing an externship to address a problem commonly faced in veterinary medicine — the lack of therapeutic options for patients with chronic disease, immunosuppression, and/ or comorbidities. Due to these barriers, veterinarians recommending treatment modalities need to incorporate integrative medicine into their practices to offer alternative therapies for these patients. When selecting a veterinary practice to complete my externship, I noticed that PAZ Veterinary, in Austin, Texas, utilizes acupuncture, herbal therapy, food therapy, and cold laser treatments. These This case report demonstrates the efficacy of an integrated approach that complements conventional veterinary medicine with TCVM, nutritional support, and homeopathy.

INTRODUCTION A three-year-old castrated male Australian Shepherd was diagnosed with suspected vaccine-induced meningoencephalitis, causing sudden onset and progressive hind limb weakness and ataxia, as well as anorexia and lethargy. The dog responded well to a combination of conventional therapy (Western medicine), Traditional Chinese Veterinary Medicine (TCVM), body support supplements, and homeopathy. The addition of integrative therapies to the original conventional treatment plan allowed for the corticosteroid dose to be tapered, and improved the overall quality of life for the dog.

PRESENTATION The patient presented to a specialty hospital for hind limb ataxia, lethargy, and decreased appetite. He was drinking normally, with no history of coughing, sneezing, diarrhea or vomiting. He was on monthly heartworm and flea and tick control and

alternative therapies can improve the quality of life and possibly extend the lifespan of many patients. Additionally, there may be serious side effects associated with the administration of opioids, NSAIDs and steroids, which can be avoided through the application of integrative medicine in everyday practice. During my two weeks at PAZ, I selected a case in which a patient was immunosuppressed or suffered from chronic disease, and utilized integrative medicine therapeutic options to enhance the animal’s quality of life, treat the disease(s), and/or extend his lifespan. had just received his annual vaccinations, along with his first leptospirosis vaccine, a few days prior to presentation. On physical examination, back pain was elicited, with potential etiologies including disc disease, infectious disease, immune-mediated disease, or cancerous processes.

DIAGNOSTIC WORKUP The patient was evaluated with the following tests: complete blood count, serum biochemistry, cerebrospinal tap, and a 4Dx Neospora, Cryptococcus, and neuro PCR panel. Imaging included lateral lumbar radiographs and an MRI of the cervical and thoracic spinal cord. All tests were within normal limits except for a slight elevation in the patient’s liver enzymes.

INITIAL TREATMENT AND RESPONSE The patient was initially treated for two weeks with prednisone at 0.5 mg/kg by mouth twice daily. At a recheck examination performed two weeks later, the dog’s owner reported he had

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remained ataxic and required a sling for assistance for about one week after initial treatment; however, upon presentation, the patient’s appetite was increased and the ataxia had resolved. Due to his positive response to steroids, steroid-responsive meningitis was the top differential. The prednisone dose was increased to 1 mg/kg by mouth twice daily.

REVACCINATION AND RETURN OF SYMPTOMS Because the dog was doing well at home and was appearing to go into remission, his owner subsequently scheduled an appointment for him to receive his second leptospirosis booster. The patient relapsed within 48 hours following the vaccination, and returned to the specialty hospital with ataxia and hind limb weakness. No other recent changes were noted in his lifestyle at this time. Mycophenolate at 10 mg/kg by mouth twice daily was added to his medications.

INTEGRATIVE MEDICINE CONSULTATION — ASSESSMENT AND TREATMENT PLAN The patient then presented to the author for a second opinion and an integrative medicine consultation, at which time several alternative therapies were discussed. On the TCVM physical examination, the patient showed a Qi deficiency; his mouth was slightly wet and muscle atrophy was present bilaterally on his head. The dog’s ears were hot and his tongue was red and cracked, suggesting

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a Yin deficiency or Heat excess. His carpal and tarsal pads were dry (suggesting a blood deficiency or Heat excess), and his nose was dry and cracked (suggesting a fluid deficiency +/- excess or a Yin deficiency). The patient was determined to be a mixture of Metal and Earth constitutions. He was sociable and relaxed yet exhibited muscle weakness, which is a characteristic of the Earth element. He also had a good hair coat, and according to his guardians, he loved order and obeyed rules, all of which are attributes of the Metal element. • To treat the hind limb weakness and ataxia, weekly acupuncture sessions were recommended to help bring blood flow to the areas of weakness and stimulate the nerves to regain muscle strength. Acupuncture point selection was based on the TCVM pattern diagnosis of Kidney Qi deficiency, Yin deficiency, and excess Heat with Wind invasion. If improvement was noted, the acupuncture sessions would be continued once per month, until improvement could be seen in the patient’s overall muscle condition. The first acupuncture session was performed at this initial appointment. • Bupleurum and Kudzu, Chinese herbs useful for the treatment of meningitis, were chosen because they are known to support a healthy nervous system and spinal cord by addressing the Heat lodged in the joints, muscles, and nerves along the back. Continued on page 52.

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Continued from page 50. • Nutritional whole body support was provided by a mushroom based supplement to help improve the patient’s excess Heat and Yin deficiency imbalances, as well as support the overall Qi in the body. • Due to the elevation in liver enzymes, and to help support the metabolism of the pharmaceuticals, Rx Vitamins for Pets Hepato Support was prescribed at one to two capsules orally every 12 hours. • H omeopathic Thuja occidentalis was prescribed to detoxify the patient from vaccination administration. Thuja is an effective homeopathic to help resolve symptoms associated with vaccination, such as lethargy, muscle weakness, muscle pain, and gastrointestinal disturbances when present. Due to the strong correlation between the initial onset of clinical signs and the recent relapse after vaccine booster administration, subsequent titer testing for canine distemper virus, canine parvovirus type 2, canine adenovirus type 1, and rabies was strongly recommended for this patient, to avoid another possible relapse. Although law requires a rabies vaccination, exemptions may be granted in certain states. Lastly, if the patient is determined to be at low risk for exposure, the need for leptospirosis vaccination may be reconsidered in the future.

CASE PROGRESS One week after beginning integrative treatment, the dog exhibited increased energy and playfulness. The prednisone dose was reduced to 0.75 mg/kg by mouth twice daily. A recheck involving a complete blood count and chemistry panel were recommended in three weeks, along with a further reduction in the prednisone dose if the patient continued doing well. The second acupuncture session was scheduled in one week’s time; if the patient tolerated it well, electroacupuncture would be considered for future sessions. EA would allow for an adjustment of the frequency and intensity of the impulse being delivered through the needles.

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SUMMARY The patient had a sudden episode of acute onset hind limb ataxia and weakness, along with decreased appetite. The only major change in his lifestyle was the administration of vaccinations a few days prior to the presentation of clinical signs. After a range of diagnostic testing was performed and differentials were ruled out, including disc disease, infectious disease, and cancerous processes, the main differential remaining was meningoencephalitis of unknown origin (MUO). Prednisone was administered to suppress the immune system because an immune-mediated response was highly likely at this point. At the patient’s next recheck, he responded very well to the prednisone therapy and appeared to have gone into remission. At that time, steroid-responsive meningitis was the presumptive diagnosis. The patient was kept on prednisone to ensure complete recovery and avoid a relapse. Due to his recovery, a booster vaccination was given about one week later; the patient immediately relapsed about 48 hours after the vaccine and exhibited the previous clinical signs of hind limb ataxia and weakness. Although the pathogenesis of this patient’s clinical presentation is beyond the scope of this paper, this case demonstrates the need for awareness of vaccine-related disease as well as the benefits of integrating protocols from both conventional and complementary modalities during treatment.

References Ma A. Clinical Manual of Chinese Veterinary Herbal Medicine. Mainland Acupuncture publishing 2016. Xie H, Preast V. Traditional Chinese Veterinary Medicine: Fundamental Principles, 2nd Edition. Tianjin, China: Chi Institute Press 2013. Xie H, Preast V. Xie’s Veterinary Acupuncture. Ames Iowa. Blackwell Publishing, 2007.

Declaration of interest The author declares that there is no conflict of interest which could be perceived as prejudicing the impartiality of this paper. Funding The author did not receive any specific grant or funding from any organization in the public, commercial, or non-profit sectors.

CASE

USING AN INTEGRATIVE APPROACH TO TREAT

FELINE BRACHIAL PLEXUS AVULSION

BY CRISTINA-ANDREEA FIRULETE, DVM, CVA

his article illustrates how a multi-modal, integrative approach effectively restored limb function in a feline brachial plexus avulsion lesion. PRESENTATION Luca, an 18-month-old neutered male domestic short-haired cat, presented as an emergency after being involved in a road traffic accident. On physical examination, he was depressed, slightly responsive to stimuli, and had miosis of the left pupil, consistent with partial Horner’s syndrome. He exhibited complete absence of function and sensation in his left forelimb and had a dropped elbow with carpal flexion. Deep pain was absent. Panniculus reflex was absent on the affected limb, which was cold and flaccid with pale

pads. After stabilization, Luca was diagnosed with brachial plexus avulsion of the left forelimb. INTEGRATION OF TREATMENT MODALITIES Luca’s treatment plan consisted of an integrated approach, including the following: 1. Conventional pharmaceuticals and support •N SAID: Metacam — 0.2mg/kg injection, then 0.1mg/kg for four consecutive days • Opioid: Buprenorphine — 0.02mg/kg IM every eight hours until discharge • Intravenous fluid therapy: 4ml/kg/h until discharge Continued on page 54. IVC Spring 2020

Continued from page 53. 2. Homeopathic medicines •A conitum napellus 30c: Two doses on gums, twice on the day of admission, to help with recovery from shock and fear, and for its pain relief properties • Secale cornutum 30c: Three doses on gums, every 12 hours, for numbness, insensibility and coldness of limbs •A rnica montana 30c: Twice daily doses on gums for four days, for bruising and effects of paralysis and trauma •H ypericum perforatum 30c: Twice-daily doses on gums for eight weeks, for paralysis, neuralgia and paralytic pain, and spinal concussion 3. Acupuncture using a TCVM approach and Tui-Na (Chinese therapeutic massage) At the TCVM examination, Luca’s tongue was pale. The pulse was deep and weak with depressed Shen. It was initially difficult to establish his constitution due to the opioid influence, but it was later identified as Earth-Metal. Earth constitution animals are happy, lively and eager to please their owners. They love attention and cuddles but are quite laid back, without the excitability of Fire animals. Metal constitution personalities prefer routine and order. Luca was a laid back cat, and while he loved attention and cuddles, he showed a preference for the comfort and security of his basket. He tolerated his treatments well, but they were done in the same order each time, in his preferred location and position.

Above: Luca receiving dry needle and electroacupuncture treatments.

By applying TCVM theories of Yin/Yang, Eight Principles, Five Elements and Zang Fu physiology and pathology to make the TCVM diagnosis,* one main TCVM pattern is associated with trauma to the brachial plexus: Nerve Qi/Blood Stagnation with local Qi Deficiency (after trauma). Trauma induces Qi/Blood stagnation at the site of injury, causuing Qi deficiency of the local tissues, including nerves. The result is the acute onset of paresis or paralysis of the affected limb.

*The Yin-Yang theory is fundamental to Chinese medicine. Yin is closely related to anatomy (the organ itself) while Yang is closely related to the physiology (the organ’s function). In other words, a change in the organ’s shape (Yin) can affect the organ’s function (Yang) and vice versa. Yin-Yang is the basis for the Eight Principles diagnostic system, which is used to diagnose disease. The Eight Principles system associates Interior, Cold and Deficiency Patterns with Yin. Exterior, Heat and Excess Patterns are associated with Yang. The ancient Chinese divided the natural world into five elemental categories: Wood, Fire, Earth, Metal and Water. All organs correspond to an element and will be divided into Yin or Yang. Traditional Chinese medical practitioners use the properties of the Five Elements and the relationships between them to describe the relationships among the body’s internal organs, as well as the relationship between the body and the natural world.

Above: Luca successfully bearing weight on his affected forelimb.

IVC Spring 2020

The guiding treatment principles for Luca were to resolve Qi/Blood Stagnation, tonify local Qi deficiency, and promote peripheral nerve regeneration.

Electroacupuncture (EA) was selected over dry needles alone for its efficacy at resolving Qi/Blood stagnation and promoting nerve regeneration.

•T H14 — for shoulder and thoracic limb pain and lameness •S han-gen — classic point for appetite stimulation •D a-Feng-Men — calming point

Electroacupuncture points and indications:

Tui-na included gentle Moo-fa (massaging up and down the affected limb for three to five minutes twice daily), Ba-shen-fa stretching, and Ban-fa flexing and extending all joints, including the digits, to improve Qi/Blood flow to the peripheral nerves.

• Liu-feng (six needles) — for limb paresis and paralysis • LI4 — master point, Yuan-source point, and local point, for paralysis • Li15 — for shoulder pain and lameness, cervical pain, intervertebral disk disease • SI9 bilateral — for shoulder pain, thoracic limb lameness, paresis, paralysis, and generalized pain • Gb 21 bilateral — crossing point of the TH, GB, and Yang-Wei Channels, for shoulder pain, thoracic limb paresis and paralysis

Luca received these TCVM treatments for four consecutive days while hospitalized after the incident. The EA and dry needling were done once daily in the evening while Tui-na was performed twice daily.

Dry needle points and indications:

4. Photobiomodulation/laser therapy Photobiomodulation uses specific wavelengths of light (red and near-infrared) to stimulate the body's natural ability to heal. The effects of laser energy include improved healing time, pain reduction, increased circulation and decreased swelling.

• LI10 and St 36 — general Qi tonic • SI3 and Liv 3 — to relieve pain and stagnation of Qi • TH5 — Luo-connecting point of the TH Channel, conﬂuent point of Yang-Wei Channel, paresis or paralysis

During laser therapy, infrared laser light interacts with tissues at the cellular level, increasing metabolic activity within the cell. By improving the transport of nutrients across the cell membrane, the increased production of cellular energy (ATP) is

EA settings were continuous: discontinuous pattern 80:120 Hz, for 30 minutes.

IVC Spring 2020

BRACHIAL PLEXUS AVULSION — causes, signs and standard treatment

This condition results from a traumatic injury to the C6 to T2 nerve roots that innervate the thoracic limb. With severe extension or abduction of the limb, the nerve roots stretch or tear from their attachment to the spinal cord. Clinical signs vary with the extent of root involvement. Complete avulsion results in flaccid paralysis of the limb, anaesthesia distal to the elbow, ipsilateral Horner’s syndrome, and ipsilateral loss of the cutaneous trunci (panniculus) reflex. The injured animal bears little or no weight on the limb and drags the dorsal surface of the paw on the ground. Sensation to the ventral surface of the paw is spared if only the cranial nerve roots are affected. Avulsion of the caudal nerve roots causes loss of sensation on the caudal surface of the limb with variable loss on the cranial surface. Standard treatment is based on physiotherapy and pain relief medication but the prognosis is poor. Amputation of the limb may be necessary because of damage from dragging or self-mutilation. Recovery is possible in mild cases in which the roots are contused rather than avulsed.

electroacupuncture and laser therapy sessions were reduced to once per week. By Week Five, Luca started to place his paw in a normal position. He would no longer tolerate electroacupuncture, so only dry needles were used. He was walking slowly but limping, as he had moderate muscle atrophy. By eight weeks after the accident, Luca had recovered 100% of his limb function. To this author’s knowledge, one other similar case report has been published of a cat presenting with a brachial plexus injury. The patient underwent daily physiotherapy and indoor confinement, recovering full ambulatory capacity after six weeks.1 CASE REFLECTION There is an increasing demand for alternative and complementary therapies in both human and veterinary medicine. Working in a holistic clinic has given me the opportunity to integrate these modalities into case protocols, especially in situations where existing conventional treatment options offer a poor to very poor prognosis. In Luca’s case, homeopathic medicines were used alongside Chinese acupuncture for their own properties and to complement the TCVM approach. Homeopathic medicines can be very beneficial in emergency situations, as they are safe and gentle, supporting the natural ability of the body to restore itself in a short period of time. Acupuncture, especially electroacupuncture, is a very powerful tool, but can be used only when a TCVM diagnosis has been reached, and not in acute presentations when the patient is unstable. Incorporating both modalities into Luca’s treatment plan led to a successful outcome for this cat.

stimulated. The cascade of beneficial effects that follows includes increased cellular function and tissue repair. S antifort, KM. “Return of function in a feline thoracic limb after suspected traumatic brachial plexus injury with loss of nociception”.Veterinary Record Case Reports, August 29, 2016.

A Class IV laser treatment protocol for the affected elbow and shoulder was given each morning, at a dose of 540 Joules, just before the first Tui-na treatment, to help with muscle pain and encourage relaxation. OUTCOME After the first day of treatment, Luca began to regain sensitivity in his affected limb, with daily improvement thereafter. He was discharged on Day Four with full sensation in his carpal joint though it was still lacking in functional response. The owners were instructed how to massage the leg at home, and advised to continue with the homeopathic medicines as prescribed and the oral NSAID for one more week. The

IVC Spring 2020

References Clarke, John Henry. A Dictionary of Practical Materia Medica, B. Jain Publishers (P) Ltd, 2017. Curtis W. Dewey (Editor), Ronaldo C. da Costa (Editor). Practical guide to canine and feline neurology, 3rd Edition, Wiley Blackwell, 2015. Huisheng Xie Dr.; Cheryl Chrisman ACVIM-Neurology; Lisa Trevisanello Dr. Traditional Chinese Veterinary Medicine for Neurological Disease, Jing Tang Publishing, 2011. Huisheng Xie Dr.; Vanessa Preast Dr. Traditional Chinese Veterinary Medicine: Fundamental Principles, 2nd Edition, Chi Institute Press, 2013. Huisheng Xie Dr.; Vanessa Preast Dr. Xie’s Veterinary Acupuncture, Blackwell Publishing, January 2007. msdvetmanual.com/nervous-system/diseases-of-the-peripheral-nerves-and-neuromuscular-junction/ trauma-of-the-peripheral-nerve-and-neuromuscular-junction#:~:targetText=Brachial%20Plexus%20 Avulsion%3A,attachment%20to%20the%20spinal%20cord. vetstream.com/treat/felis/diseases/brachial-plexus-avulsion.

From the NASC Supplementation for dogs at various life stages BY CHRIS BESSENT, DVM

When speaking to your clients about supplementation, the conversation should focus on adding to a healthy diet — i.e., incorporating ingredients that aren’t being supported through diet. If a pet owner is using kibble, a number of supplements need to be added, regardless of the dog’s age.

q Joint

supplement with glucosamine, hyaluronic acid (HA) and chondroitin. In the wild, when a dog devours his prey, he’ll eat the joint capsules, joint fluid and cartilage caps of the bones, which provide him with the basic components for joint health. No kibble in existence has adequate levels of joint-supporting ingredients like chondroitin, HA and glucosamine, so this supplement is number one.

mega-3 wO

fatty acids. Most shelfstable dog foods lack the amounts needed to be optimally beneficial. Omega-3 fatty acids are expensive — think fish oil, krill and algae — and they also tend to become rancid. In fact, most of the polyunsaturated fat in a dog food’s guaranteed analysis comes

from Omega-6 fatty acids, which tend to be more pro-inflammatory. This makes it necessary to add clean, healthy and fresh Omega-3 sources to a pet’s diet.

e P robiotics.

The FDA has a zerotolerance policy for salmonella in shelf-stable foods. In the process of eliminating pathogens, however, manufacturers are also eliminating the healthy bacteria necessary for a good gut biome. The “kill-step”, which exposes kibble to high heat, is why we generally don’t see probiotics in “complete” pet diets. So it’s crucial to add a probiotic to the dog’s diet to flood the gut with beneficial bacteria.

THE AGING DOG As a dog gets older, we need to supplement his diet more, especially with antioxidants. Antioxidants can be produced in our own bodies, or come from what we consume in our diets. As we age, our endogenous antioxidant levels start to decrease; if we don’t increase our antioxidant levels, our bodies are susceptible to damage from

free radicals and oxidative stress. This can lead to premature aging, the progression of chronic diseases, and a hypersensitive immune system, which damages good cells as well as bad. So it’s vital we start increasing a dog’s antioxidant levels as he ages. A terrific amount of research has also been done on adding other beneficial supplements to support a dog’s aging organs; unfortunately, dogs can’t get these nutrients just from food. Included are CoQ10 for heart health, and valine, isoleucine and leucine for an aging brain. You want to increase the lipoic acid in the dog’s diet as well — lipoic acid is converted into glutathione, the body’s most important antioxidant. These supplements will support the aging dog in both mind and body. Dr. Chris Bessent, owner and operator of Herbsmith, practices holistic veterinary medicine in Wisconsin. Herbsmith manufactures premium quality supplements for dogs and cats. Utilizing proven scientific research and years of veterinary experience, the company provides innovative natural solutions for the health and wellness of animals so they can live their best lives longer. (herbsmithinc.com). Herbsmith is a proud member of the National Animal Supplement Council (NASC).

IVC Spring 2020

Demystifying

hemp and CBD in the equine

CLEARING UP THE CONFUSION SURROUNDING THE DIFFERENT TYPES OF HEMP PRODUCTS AVAILABLE FOR HORSES.

BY JOYCE HARMAN, DVM, MRCVS

Hemp is all the buzz these days, and for good reason. It’s a plant with literally thousands of uses. Hemp is used for clothing, fuel, paper, and everything in between. It is a weed and capable of growing in many different conditions with little additional fertilizer or other inputs. Hemp is nutritious and can have medicinal properties. This article will help clear up the confusion about the different types of hemp products available to horses.

Important note! Many horses compete under national or international rules against doping in sports. Currently, as of this writing, CBD use is illegal in sports under FEI or USEF rules. Make sure your equine clients are aware of this.

IVC Spring 2020

DEFINITIONS First, a few definitions to clear up the confusion between the different uses and types of hemp: • Hemp is known by the Latin names Cannabis sativa or Cannabis indica. There isn’t a clear botanical differentiation between the two species, despite some claims otherwise. Hemp is a cannabis plant that contains no detectable level of THC (tetrahydrocannabinol), the ingredient that can make the animal “high”. • Marijuana is the same basic plant but does contain THC and can make the animal “high”. • Cannabinoids are the medicinal compounds shown to be medically useful for many conditions. These

are found only in the leaves and buds of the plant. The acronym “CBD” is commonly used for medicinal preparations, but in reality, there are over 100 different cannabinoids in a hemp plant. Active compounds called terpenes work synergistically with CBDs. • Endocannabinoid system is the receptor system for cannabinoids found in all mammals and in most body systems. • Omega-3 and 6 fatty acids are found only in the seeds of the plant. Omega-3 is an essential fatty acid that cannot be made in the body, so needs to be ingested. • Industrial hemp is generally grown for its fiber (stems) and seeds. The plants are grown close to each other to promote tall, stemmy, fibrous plants

with lots of seeds. Industrial hemp contains very little, if any, CBD. • Medicinal hemp is grown to enhance leaf and bud growth, with high levels of CBD and no Omega-3 or 6 fatty acids. • Bio-accumulator is a term used for plants — of which hemp is one — that take up the contaminants and toxins in the soil in which they grow. So when feeding hemp in any form, it’s important to use organically-grown hemp.

HEMP CBD Hemp buds and flowers with a high content of cannabinoids (CBDs) are among the most interesting new herbal medicines to come on the market. The medicinal properties of CBDs in animals, especially horses, are just beginning to be explored. Several years of clinical observations and data indicate that horses are very responsive to CBD, in ways that are similar to other species, including humans.

CANNABINOIDS Cannabinoids are compounds that come from either endogenous sources (endocannabinoids) or herbal sources (phytocannabinoids). Medicinal hemp contains over 100 different phytocannabinoids in varying concentrations. Some of the cannabinoids present in smaller amounts include cannabigerol (CBG), cannabichromene (CBC), cannabidivarin (CBDV), and tetrahydrocannabivarin (THCV). Hemp contains many other compounds important to the body’s regulatory pathways, such as terpenes and flavonoids. Plants like hops, flax and Echinacea share some of these compounds.

THE ENDOCANNABINOID SYSTEM The endocannabinoid system in vertebrate animals is thought to have been in existence for over 500 million years. All mammals have receptors in

most of their internal organs for the cannabinoids found in hemp. These are important in the regulation of many body functions. Endocannabinoids are compounds released internally in the nervous system to bind to receptors and transmit information. There are two main types of receptors that occur in different tissues, CB1 and CB2.

The CB1s are primarily in the central nervous system with some in the external organs, while the CB2s are mostly in the immune system, in B cells and natural killer cells, with some in the spleen and tonsils. The complex interactions between the cannabinoids, the immune system, and the inflammatory pathways create a vast array of biochemical functions affected by those cannabinoids. Continued on page 60. IVC Spring 2020

Hemp seeds

Hemp seeds are the most nutritious part of the plant used as food. They contain about 20% protein, 6% carbohydrates, and about 73% healthy fats. They also have significant amounts of calcium, magnesium, manganese, phosphorus, potassium, zinc, and vitamins A and E. Most diets contain an excess of Omega-6 (inflammatory), but hemp contains a healthy balance of Omega-6 to Omega-3 linoleic acid (an anti-inflammatory compound). Feeding hemp oil is a great way to give horses these benefits (be sure to keep it refrigerated in warm weather). Hemp oil from seeds also contains the Omega-6 fatty acid, gamma-linolenic acid (GLA), a compound not frequently found in food. It offers excellent antiinflammatory properties, cancerfighting immune support, and support for insulin resistance (IR). Hemp protein is highly bioavailable, although it is not a complete protein for replacing all other sources. One ounce of seed contains 9.2 g of protein. Hemp seeds and the protein that comes from their processing are now available; they are a fabulous way to give horses protein without feeding them geneticallymodified corn and soybean. The hemp leaf is an excellent source of fiber, magnesium, calcium and phosphorus. It also contains antioxidant polyphenols to help protect cells from free radical damage, as well as more beneficial chemical compounds such as flavonoids. Separating the nutritional properties of hemp from its medicinal ones can be complex, since many nutritional compounds are good for horses because they enhance health.

60 60

IVC Spring 2020 IVC Spring 2020

Very little endocannabinoid research has been done on domestic animals, horses included. Because the endocannabinoid system is present in all mammals, phytocannabinoids have the potential to affect the health of any internal organ with endocannabinoid receptors. For example, the gut, liver and brain all contain receptors for CBDs.

FEEDING CANNABINOIDS TO HORSES Hemp can be fed as a supplement in a variety of ways. The most common form available is an oil extract. It can become quite costly for horses but works great for small animals. Hemp can be fed to horses in the more economical form of powdered biomass or pellets (which may contain a filler). The amount to feed ranges from about 25 mg to 50 mg twice a day. Sensitive horses need a much lower amount, and it’s always a good idea to use less to begin with. Products contain variable amounts of CBDs and often do not have full analyses, so actual doses may vary greatly from product to product. The hemp industry is not yet regulated, so there are many companies with questionable quality control. All products fed to animals should have a Certificate of Analysis (COA) available on the company website.

CLINICAL EFFECTS IN EQUINES Taking the lead from the small animal and human studies, CBD products have shown positive effects for a number of equine conditions. • Issues that center around pain are common in horses. Cannabinoids

have action in both acute and chronic pain by modulating pain signals in the central and peripheral nervous systems and acting similarly to an anti-inflammatory. • Laminitis is very painful and can be helped with cannabinoids. CBDs can have a positive effect on the metabolic pathways often compromised in insulinresistant horses. • Musculoskeletal pain in the form of various arthritis conditions is responsive to CBDs, with many horses back to performance and remaining sound. This is true for old horses as well as young performance horses. • Cannabinoids cross into the brain and can be helpful for horses that have experienced trauma, mental and physical. Human research has shown success with post traumatic stress disorder (PTSD). Similar symptoms are common in horses and in many cases the response to CBD has been dramatic. However, it is not the cure for every horse with mental issues. • Cannabinoids have potential benefits for most body parts, reduci ng i n f la m mat ion a nd behaving as an antiox idant. Inflammation is now considered one of the leading causes behind many chronic diseases, from skin disease to arthritis. • The immune system is another area where CBDs are helpful. They have a direct effect on many of the complex immune pathways in the gut (where a large portion of the immune system resides). They also directly affect the cells of the immune system.

• Lyme disease is a serious chronic problem in horses around the country, and especially on the east coast. Lyme suppresses the immune system, causes pain and inflammation, affects temperament, and causes many more and varied symptoms. Cannabinoids are beneficial as a major part of treating Lyme disease in this author’s practice. • The eye is another area where CBDs have an affinity, with some human data to back up their use. Horses with uveitis and chronic ulcers respond well to CBDs as a part of their treatment.

CONCLUSION Hippocrates once stated: “Let food be thy medicine and medicine be thy food.” In the case of hemp, it’s very true! Hemp in all its forms is a worthwhile addition to a horse’s diet.

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 axillary 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 AND THE LIVER Essential oils have a unique physiological relationship with the liver. Due to their lipophilic nature, specific metabolic pathways of the liver come into play in order for the excretion of essential oils to occur. Humans, horses and dogs have similar hepatic Phase 1 and Phase 2 detoxification pathways. Cats, however, have been shown to lack various cytochrome P450 enzymes, thus making their Phase 1 function of transforming fat-soluble metabolites to a water-soluble form two to 20 times slower than in dogs. A study published in 2017 offers a different explanation for how cats may be able to handle exposure to essential oils, particularly those with a phenol content. In dogs and humans, glucuronidation is the primary Phase 2 reaction that renders a substance water-soluble for elimination via bile, stool and urine; however, this study showed that glucosidation accounted for most of the phenol elimination in cats.* Laboratory values have been studied in four resident cats at a veterinary clinic that diffuses quality essential oils daily, and cleans with a plant-based essential oil-infused product. The cats range in age from ten to 16 years. Bloodwork performed prior to their dental cleanings, and for senior panels, was reviewed from 2013 to 2019. All revealed normal ALP, ALT, TBili, BUN and Cr values. One cat, being treated for hyperthyroidism since 2015, continues to show normal liver and kidney parameters. Contact a VMAA member for guidance on how to implement safe and effective usage of essential oils for your animal patients — visit vmaa.vet. *Slovak JE, Mealey K, Court MH. “Comparative metabolism of mycophenolic acid by glucuronic acid and glucose conjugation in human, dog, and cat liver microsomes”. J Vet Pharmacol Ther. 2017; 40(2):123-129. Submitted by Susan Albright, DVM, VP of VMAA IVC Spring 2020

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DON'T MISS ANOTHER ISSUE!

news bites STUDYING THE EFFECTS OF GLYPHOSATE IN DOGS AND CATS

In the spring of 2019, the Environmental Protection Agency (EPA) declared that glyphosate — commonly known as RoundUp™ — is not a carcinogen or endocrine disruptor. They did, however, find that it poses potential risks to mammals, birds and plants. Due to the lack of concrete information about this herbicide, and its effect on dogs and cats, researchers at the Health Research Institute Laboratories (HRI) are conducting a more comprehensive study. They’re measuring levels of glyphosate in pet urine and working to determine if there is an acceptable daily level of this chemical for companion animals. Here are some results so far: • Cats average 8 ppb (parts per billion), 16 times more than what’s found in human urine. • Dogs average 15.8 ppb — 32 times the human average. • Dogs that eat raw food have virtually no detectable glyphosate. • Those that eat canned food have more. • Those that eat dry kibble have higher levels. • Surprisingly, those that eat grain-free kibble have the highest levels. It’s believed ingredients such as oats, pea protein, chick peas and lentils may be a cause. • Testing reveals that crops like oats and legumes deliver the highest glyphosate levels to human consumers. Visit hrilabs.org/animalstudy/ to learn more.

Photo courtesy of Morris Animal Foundation

INNOVATIVE SCREENING METHOD FOR FELINE HEART DISEASE

A new two-minute screening technique could help save cats from dying prematurely of heart disease. Morris Animal Foundation-funded researchers at the Cummings School of Veterinary Medicine at Tufts University have developed a focused cardiac ultrasound (FCU) protocol to increase detection of cardiac issues in cats that aren’t outwardly showing signs of disease. The team published their study in the Journal of Veterinary Internal Medicine. “Heart disease is one of the biggest killers of cats. It’s very common but often undiagnosed, as many cats don’t reveal symptoms,” said Dr. Elizabeth Rozanski, veterinary researcher, clinician and associate professor at Cummings School. “FCU is something that small animal practitioners can add to their yearly physical exams as cats gets older to catch heart disease earlier.”

Full echocardiograms can detect heart problems, but can be costly, require special training, and are usually reserved for when a cat is already showing distress — often too late to make a difference. Dr. Rozanski proposes that an FCU, an abbreviated echocardiogram using equipment already available in a practice, could screen and determine if a cat needs more in-depth evaluation.

RESEARCH ON EQUINE METABOLIC SYNDROME

A research team at the University of Minnesota College of Veterinary Medicine has investigated genetic mutations in Morgan horses and Welsh ponies, two breeds that are at higher risk for equine metabolic syndrome (EMS). The scientists found that EMS is polygenetic, which means horses with an EMS diagnosis often have mutations on more than one gene. They also discovered that both breed-specific mutations are associated with EMS, and mutations are shared between the two breeds. The researchers concluded that a single genetic test will not reveal whether or not a horse is genetically predisposed to EMS. Rather, they suggest further research be done into developing a more intricate panel test to meet the complexity of the disease's genetic nature. mdpi.com/2073-4425/10/11/893

morrisanimalfoundation.org IVC Spring 2020

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 MEDICINAL HERB? The leaves, flowers, tops and roots of mullein (Verbascum thapsus) are all used medicinally, each with different indications. Mullein leaf releases salty mucilage and is used as an emollient to bring water into hardened, closed places; it draws water into dried-out tissues. This activity causes a release of secretions from the tissues. Mullein is indicated when tissues are dry or when water is caught in isolated pockets. It is particularly useful for dry, irritable, tickly coughs, and old coughs. Mullein opens the lungs and sinuses, reduces coughing and tightness, lubricates the mucosa, relaxes the larynx, and causes a more open feeling in the head and brain. It loosens mucus and moves it out of the body. Mullein is valuable for all lung problems because it nourishes as well as strengthens. The plant’s basal rosette leaves and root improve lubrication of the connective tissues in joints, improving cartilage health. Mullein releases synovial fluid into the bursa and disperses internal fluids into the surrounding tissues, lubricating the joints, muscles, bones and ligaments. It is a remedy for complex fractures, spinal dryness, inflexibility, pain, and nerve pain along pinched or irritated nerve tracts.

but remained disabled with poor lateral stability. Molly had a very dry tongue, with signs of Yin deficiency. It was felt she was unable to heal due to a deficiency of fluids nourishing her spine. A combination of mullein and nettle root was added to her herbal formulas. Within two weeks, Molly had improved significantly, regaining an almost normal gait.

PAST ACTIVITIES AND UPCOMING EVENTS The VBMA continues with a strong webinar series, including a recent presentation by Dr. Kendra Pope on “Oncology and Herbal Medicine”. Recordings of this and other webinars, along with announcements for future webinars, are available at vbma.org. This year’s joint conference with the ACVBM takes place in Eugene, Oregon. Book accommodations at Graduate Eugene Hotel for $139 per night (graduatehotels.com/eugene/ ). •O ctober 26: VBMA will host lectures featuring Kevin Spelman RH (AHG) and Subhuti Dharmananda PhD, director of the Institute for Traditional Medicine (ITM). • October 27: ACVBM will host lectures by Chanchal Cabrera MSc, FNIMH, RH (AHG), Medical Herbalist. • October 28-30: VBMA Domestic Ecotour at Belknap Hot Springs, Lodge and Gardens, McKenzie Bridge, OR. For registration information, visit acvbm.org.

Mullein root also has an influence on the nerves and mind. It is a great pain killer and helps induce sleep. It has a calming effect on all inflamed and irritated nerves, especially facial nerves. The crushed fresh flowers have been used to remove warts and have a specific effect on ear problems. Mullein tea has been used for dropsy, sinusitis, and swollen joints. The hot tea helps when applied to mumps and tumors, and for sore throats and tonsillitis.

GUESS THIS HERB!

CASE REPORT Molly is an 11-year-old spayed Lhasa Apso. At four years of age, she suffered a severe disc protrusion that required surgery, after which she remained paralyzed with no deep pain in the hind legs. After a month of acupuncture, with Chinese herbs specific for spinal disc issues, she was walking

IVC Spring 2020

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IVC Spring 2020

news bites PFAS FOUND IN DOG AND CAT FECES

Perfluoroalkyl and polyfluoroalkyl substances (PFAS) are used in a wide range of consumer products, from pizza boxes to carpets to non-stick cookware. These chemicals are consequently ubiquitous in the environment; in fact, researchers have discovered that cats and dogs excrete PFAS in their feces at levels that suggest exposure above minimum risk levels. Reported in Environmental Science & Technology Letters, the research was carried out by Kurunthachalam Kannan and his colleagues, who measured 15 different PFAS in 78 samples of cat and dog feces. Using high-performance liquid chromatography and tandem mass spectrometry, the researchers detected 13 different PFAS in the samples. The most abundant compounds in both cats and dogs were longer-chain perfluorocarboxylic acids. The team found that for three specific compounds (perfluorooctanoic acid, PFOA; perfluorononanoic acid, PFNA; and perfluorooctanesulfonic acid, PFOS), as well as for total PFAS, estimated exposure levels were above the minimal risk levels set by the U.S. Agency for Toxic Substances and Disease Registry. acs.org/content/acs/en/pressroom/newsreleases/2020/february/fecalexcretion-of-pfas-by-pets.html

UPDATED FELINE RETROVIRUS GUIDELINES

The American Association of Feline Practitioners (AAFP) has released updated “Feline Retrovirus Testing and Management Guidelines” to the veterinary community. Published in the Journal of Feline Medicine and Surgery, the guidelines provide the most current information about feline retrovirus infections to veterinary practitioners. “The 2020 guidelines contain new information about feline leukemia and feline immunodeficiency virus infections,” says Retrovirus Guidelines Co-Chair, Susan Little, DVM, DABVP (Feline). “They were written by an international panel of experts that included not only retrovirus researchers, but veterinarians working in private practice and in shelters.” “These guidelines address rapidly-evolving knowledge about how testing results, clinical expression, and prognosis for FeLV may change over time relative to the cat’s current immune responses…; how quantitative testing may be used to better inform clinical decisionmaking; and an emerging trend in which screening for FeLV and FIV is increasingly shifting from animal shelters…to veterinary practices,” adds Julie Levy, DVM, PhD, DACVIM, DABVP (Shelter Medicine). catvets.com/retroviruses

IVC Spring 2020

NEW BILL WOULD LET SICK PETS SKIP RABIES VACCINATION

Certain health problems can render pets more likely to suffer adverse reactions to vaccinations. On January 28, lawmakers in the state of Delaware passed a bill that would enable sick, disabled or infirm dogs, cat and ferrets to be exempted from rabies vaccines if their vets determine the shots would be harmful to their health.

House Bill 214, which was filed last summer by Rep. Ron Gray, R-Selbyville, states that veterinarians must certify any such exemptions in writing. Exemptions would remain valid for one year only, after which the pet’s condition would need to be re-evaluated. As of this writing, the bill has yet to be signed into law by Delaware Governor, John Carney. delawareonline.com/story/news/politics/2020/01/28/delawarecould-soon-let-some-dogs-cats-and-ferrets-skip-rabiesshots/4595886002/

IVC Spring 2020