V11I1 (Winter 2020-21) by Redstone Media Group

IVC Winter 2020/2021

WINTER 2020/2021

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: Cole McCall

COLUMNISTS & CONTRIBUTING WRITERS

Jennifer Adolphe, PhD Ellen Barber David Bieber, DVM Bill Bookout Nancy Brandt DVM, CVC, CVA, CVMA Michele Broadhurst, DC, CVC, CCSP, CCRP, FIAMA, MTech chiro Tom Cameron, DVM Todd Cooney, DVM, CVH Sarah Dodd, BVSc, MSc, PhD Candidate, ECVCN resident Floris Dröes, DVM (Hon), MRCVS, PGCert VMS Holly Ganz, PhD Van Harding, LAC, NCCAOM Megan Kelly, DVM Dawn Kingsbury, DVM, PhD, Dip. ACVIM (SAIM) Angie Krause, DVM, CVA, CCRT Cynthia Lankenau, DVM Julie Mayer, DVM, CVA CVC, CCRP Sandra Priest, DVM Margo Roman, DVM, CVA, COT, CPT Marlene Siegel, DVM, CNHP, ALT Henry K. Yoo, DVM, MSc, MBA

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IVC Journal (ISSN 2291-9600) is published four times a year by Redstone Media Group Inc. Publications Mail Agreement #40884047. Entire contents copyright© 2021. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: January 2021.

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

IVC Winter 2020/2021

contents FEATURES

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DIAGNOSING CANINE GASTROINTESTINAL AND PANCREATIC DISEASES

By Floris Dröes, DVM (Hon), MRCVS, PGCert VMS A discussion of some of the tests that are currently available (or will be in the near future) for diagnosing gastrointestinal and pancreatic diseases in dogs.

44 45

BOND-CENTERED APPROACH TO ANXIETY IN PETS, USING NONPHARMACEUTICAL METHODS

By Dr. Julie Mayer, DVM, CVA, CVC, CCRP Essential oils, Bach flower remedies, and CBD, used alone or in combination, can be very effective for chronically anxious pets and their owners.

COMBATING CANCER BY SUPPORTING GUT HEALTH AND THE IMMUNE SYSTEM By Canine Biologics

EMOTIONS: A POWERFUL TOOL FOR UNDERSTANDING HEALTH AND DISEASE By Marlene Siegel, DVM, CNHP, ALT

Human emotions impact both health and disease. They also impact companion animals. Can emotions in our animal patients provide clues for healing in pets and their owners?

49 50 51

A NON-INVASIVE DIAGNOSTIC PROCESS FOR FELINE GI LYMPHOMA By Henry K. Yoo, DVM, MSc, MBA

OZONE THERAPY: EFFICIENT AND COST-EFFECTIVE TREATMENT FOR INFECTIONS IN ANIMAL PATIENTS

By Dr. Margo Roman, DVM, CVA, COT, CPT Integrating ozone into treatment plans for animals with viral, bacterial, and fungal infections.

TESTOSTERONE REPLACEMENT THERAPY — HELPING NEUTERED AND SPAYED DOGS GET BACK ON THEIR FEET By David Bieber, DVM

PET NUTRITION IN FLUX: WHY WHOLE FOODS STILL MAKE THE MOST SENSE By Tom Cameron, DVM

RECOGNIZING AND TREATING MYOFASCIAL PAIN IN DOGS

By Dr. Michele Broadhurst, DC, CVC, CCSP, CCRP, FIAMA, MTech chiro Skeletal muscle and fascia play roles in pain and dysfunction. Addressing both structural and functional changes can improve outcomes in canine patients.

58 62

PLANT-BASED DIETS FOR DOGS

By Jennifer Adolphe, PhD, and Sarah Dodd, BVSc, MSc, PhD Candidate, ECVCN resident

INNOVATIVE PRACTICE

HOW TO ENSURE FELINE PATIENTS STAY HEALTHY AS THEY AGE By Angie Krause, DVM, CVA, CCRT

Maintaining the health of your feline patients when they reach their golden years involves engaging owners in their cats’ care before they become seniors.

SUCCESSFUL SELF-REGULATION: HOW NASC ELEVATES QUALITY STANDARDS IN DOG AND CAT SUPPLEMENTS By Bill Bookout

THE BENEFITS OF CHELATED AMINO ACID MINERALS (CAAM) FOR ANIMAL HEALING AND WELLNESS By Van Harding, LAc, NCCAOM

RETHINKING THE ROLE OF METRONIDAZOLE IN VETERINARY MEDICINE

By Dawn Kingsbury, DVM, PhD, Dip. ACVIM (SAIM), Ellen Barber, and Holly Ganz, PhD The appropriate and inappropriate uses of metronidazole, current research that contradicts our older assumptions, and how to determine if this drug is an ideal choice.

NUTRITION NOOK

AN INTERESTING CASE OF INAPPROPRIATE SUPPLEMENTATION IN A PUPPY By Sandra Priest, DVM

Almost nothing is written about the effects of inappropriate supplementation. This article presents a suspected case in a German Shepherd puppy.

INNOVATIVE BUSINESS

SIX WAYS VETERINARIANS CAN PUT THEIR WEBSITES TO WORK By Megan Kelly, DVM

Your website is the central hub of your veterinary practice’s marketing efforts. Use these tips to create a website that works hard for your practice.

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.

36 COLUMNS & DEPARTMENTS

6 Editorial 17 From the AAVA 21 Profitable practice

— Theralase®

17 From the AVH 34 Industry innovations 43 From the VMAA 56 From the AVH 61 From the NASC

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.

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.

65 From the VBMA 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 Winter 2020/2021

editorial

KEEP TURNING THE PAGES If you’re a bookworm, you know some chapters are hard to stomach. They’re the ones that hurt your heart or shock you with disbelief... the plot twists you didn't see coming. I remember the exact moment I learned the fate of Professor Dumbledore of Harry Potter fame. We were living in Colorado at the time, and I was driving my kids home after a long daytrip, crossing a remote mountain pass at midnight. We had been listening to the entire Harry Potter series in the car that year, but that night, the kids had long since fallen asleep, and my car was the only one on the road, surrounded by solitude, an inky dark sky, and mountains of endless deep snow. This part of the drive always unnerved me anyway, and hearing the end of Dumbleldore’s story multiplied my eerie loneliness. The only way to get home was to keep going. One careful mile at a time. That experience reminds me of how 2020 played out. Too many unforeseen moments, too much solitude, a strange feeling of unease. But we have all kept going, navigating the best we can when we can’t clearly see the road ahead. What has helped me the most this past year is simplicity. Listening to the birds, walking forest trails, being with my kids, helping clients care for their animals. There is something joyful, hopeful, grounding, and eternal about animals, trees, and children — even now-grown ones. And to that list, I would add education. When things feel shaky, picking up a book, a journal, taking a course, or watching a webinar all feel good. There is a sense of

IVC Winter 2020/2021

optimism in learning something new that gives us feelings of hope and empowerment. I hope you find hope and optimism — as well as inspiration — in this issue of IVC Journal. We have packed it with an assortment of great reads, from putting your website to work and reaching your feline pet parents, to recognizing emotional stress in your patients and rethinking how we use metronidazole. You will also find an in-depth look at diagnostic tools available for canine gastrointestinal disease, and an extensive exploration of myofascial pain in dogs. Learn ways to use ozone therapy to treat infections, and how to help clients choose supplements wisely without overdoing it. In related news, IVC’s Virtual Expo on the moon in November was a resounding success! You can watch the entire library of innovative talks from IVCVX speakers until February 6, 2021 — visit https://ivcvx.vet. May the New Year bring fresh chapters that light the way forward with themes of healing, compassion, understanding, and peace.

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

contributors 1

1. FLORIS DRÖES, DVM (HON), MRCVS, PGCERT VMS

Dr. Floris Dröes attained his DVM from Utrecht University (Netherlands). Afterwards he worked in private practice and at the emergency service of Utrecht University’s companion animal hospital. In 2017 he finished a rotating internship at Dick White Referrals (UK), while attaining a post-graduate certificate in small animal medicine and surgery from the University of Nottingham (UK). Recently, Dr. Dröes joined the Gastrointestinal Laboratory (Texas A&M University) to pursue a combined PhD/ residency program in small animal medicine. P 10

2. MEGAN KELLY, DVM

Dr. Megan Kelly owns and runs onlinepethealth.com, an international continuing education site for veterinary rehabilitation therapists. Every day she pushes the boundaries on what is considered the norm for professional education, creating, innovating and providing online solutions and outstanding customer experiences through webinars and online conferences for vets and veterinary rehabilitation therapists. P 62

3. DAWN KINGSBURY, DVM, PHD, DIP. ACVIM (SAIM)

Dr. Dawn Kingsbury has practiced general and specialty companion animal medicine around the world. She met Holly Ganz while studying for her PhD. Being chief veterinary officer at AnimalBiome aligns with Dr. Kingsburty’s interests — host-microbe interactions, precision medicine, and One Health — while allowing her to promote microbiome analysis as a non-invasive, clinically actionable tool and to cultivate evolving microbiome restoration strategies. P 51

Reiki Master. In her practice, Four Winds Holistic Animal Services, Dr Priest offers chiropractic care and energy medicine for small animals. P 58

7. MARGO ROMAN, DVM, CVA, COT, CPT

Dr. Margo Roman graduated from the Veterinary College at Tuskegee Institute of Alabama, and was on the faculty of Tufts University, teaching anatomy, physiology and acupuncture. She was the consulting veterinarian in an IACUC for Creature Biomolecule in Hopkinton, Massachusetts, studying osteogenic proteins. Dr. Roman’s integrative practice, Main Street Animal Services of Hopkinton (M.A.S.H.), offers chiropractic, physical therapy, massage, Reiki, acupuncture, herbs, conventional medicine and more. P 29

8. MARLENE SIEGEL, DVM, CNHP, ALT

Dr. Marlene Siegel graduated from the University of Florida College of Veterinary Medicine in 1985. After a few years of relief work and emergency care, she opened her own small animal and exotic practice (Pasco Veterinary Medical Center) in 1987, where she continues to practice full time. Dr. Siegel is an innovator in integrative medicine, offering a wide array of alternative therapies and detoxification services. She is an avid speaker on many topics, and has been featured in several documentaries, TV shows, and webinars, and contributes to several magazines regarding integrative veterinary care. P 23

9. MICHELE BROADHURST, DC, CVC, CCSP, CCRP, FIAMA, MTECH CHIRO

4. ANGIE KRAUSE, DVM, CVA, CCRT

Dr. Angie Krause graduated from Texas A&M University, College of Veterinary Medicine in 2007. A conventionally-trained veterinarian, she incorporates many holistic modalities into her canine and feline practice. She has a love for Traditional Chinese Medicine and Physical Medicine, using acupuncture and herbal formulas. She also offers laser therapy, myofascial release, physical therapy, nutrition, pharmaceuticals and surgery. Her goal is to use the body’s innate ability to heal to improve the health and longevity of dogs and cats, and to empower pet owners to become medical advocates for their animals. Dr. Angie has a house call practice in Boulder County called Boulder Holistic Vet (BoulderHolisticVet.com). P 45

Dr. Michele Broadhurst graduated from Chiropractic College (DIT) in 2003 with a Master’s degree in chiropractic and certification in myofascial dry needling. She is a 2006 Options for Animals alumni, is certified with the International Veterinary Chiropractic Association (IVCA), and is an internationally certified chiropractic sports physician, chiropractic acupuncturist, and certified canine rehabilitation practitioner through the University of Tennessee. Until 2018, she had a busy practice specializing in stud, racehorses and canines in South Africa and now resides in Colorado. Dr Broadhurst lectures internationally and is the author of A Clinician’s Guide to Dry Needling for Myofascial Pain, A Clinician’s Guide to Myofascial Pain in the Canine Patient and A Clinician’s Guide to Myofascial Pain in the Equine Patient. P 37

5. JULIE MAYER, DVM, CVA, CVC, CCRP

10. HOLLY GANZ, PHD

Dr. Julie Mayer has been practicing veterinary medicine for over 20 years. She has dedicated most of her career to holistic medicine and rehabilitation, and is certified in acupuncture, chiropractic, and rehabilitation, and is a Reiki practitioner. Dr. Mayer has owned successful holistic and rehabilitation centers in Illinois and currently owns a holistic practice in Arizona. She is an avid teacher and speaks about holistic medicine and rehabilitation to both the general public and veterinary colleagues. P 18

Dr. Holly Ganz is Chief Science Officer and co-founder of AnimalBiome. As a successful citizen scientist, she has translated her academic research into solutions for pets: firstly by assessing thousands of microbiomes to reveal common imbalances, and secondly by providing better approaches to maintain and restore gut health including screened Fecal Microbiota Transplantation material via oral capsules. P 51

6. SANDRA PRIEST, DVM

11. ELLEN BARBER

Dr. Sandra Priest graduated from the University of Tennessee College of Veterinary Medicine, then pursued training in animal chiropractic, becoming the first Tennessee veterinarian to be certified by the American Veterinary Chiropractic Association. Dr Priest also completed Richard Pitcairn’s Professional Course in Veterinary Homeopathy. She has studied various energy medicine modalities and became a

IVC Winter 2020/2021

Ellen Barber is a writer and editor with more than 20 years of experience serving corporations, publishers, and organizations in the fields of business, investment, investment management, and education. Grounded in the humanities, she has also spent time in the worlds of grant administration and medical research. She regularly contributes to AnimalBiome’s pet health blog posts. P 51

TOOK US TO THE MOON AND BACK! Mission accomplished... and what an incredible journey! Participants at the Innovative Veterinary Care Virtual Expo earned RACE-approved CE Credits, chatted with lecturers, received discounts on products and services, and competed for prizes at the “live” event. The reviews from attendees have been overwhelmingly positive and we want to thank everyone — our sponsors, exhibitors, speakers and participants for joining us for this galactic event.

VETERINARIANS SAY IVCVX WAS OUT OF THIS WORLD Our post-event feedback has been overwhelmingly positive! Survey respondents gave IVCVX a 9 out of 10 average overall rating, with 92% of vets saying that they would be “Very Likely” to recommend IVCVX to a friend or colleague. With this feedback in hand, as well as other lessons learned from the inaugural conference, the IVCVX team will continue to innovate and make IVCVX 2021 bigger and better. Our first IVCVX offered 48 AAVSB RACE-approved lectures from leading-edge veterinarians, on topics ranging from oncology and CBD, to laser therapy, and integrative solutions, and everything in between. IVCVX 2020 was also host to dozens of top industry exhibitors who showcased their trailblazing new products and offered deep show discounts.

THANK YOU TO OUR IVCVX 2020 SPONSORS The IVCVX team would like to thank our sponsors for their generous support. Their contributions were key in bringing together some of the industry’s top veterinary minds, helping us in our mission to advance innovative animal care, and making the first IVCVX a resounding success. GOLD SPONSORS

SILVER SPONSORS

THANK YOU TO OUR IVCVX 2020 SPEAKERS We are so grateful to our IVCVX speakers! Without their immense passion, commitment, and dedication to sharing innovative animal care knowledge, IVCVX would not have been possible. Thank you all!

MISSED THE LIVE EVENT? You still have until February 6, 2021 to register for your Extended Access or CE Credit Package, allowing you to watch lectures and earn AAVSB RACE-Approved CE Credits. Don’t wait! Time is running out!

BRONZE SPONSORS

PEER-REVIEWED

BY FLORIS DRÃ&#x2013;ES, DVM (HON), MRCVS, PGCERT VMS

DIAGNOSING CANINE GASTROINTESTINAL AND PANCREATIC DISEASES

A discussion of some of the tests that are currently available (or will be in the near future) for diagnosing gastrointestinal and pancreatic diseases in dogs. 10

IVC Winter 2020/2021

Diagnosing gastrointestinal and pancreatic diseases in the dog can pose a challenge as signs and symptoms are often nonspecific. Clinical signs range from lethargy, decreased appetite, and a slightly altered stance or walk (due to abdominal discomfort), to anorexia, vomiting, and diarrhea, or worse, hematochezia. Disruption of the microbiome’s gut-brain axis can alter behavior, including cognition and memory. A thorough history can help more closely define the origin(s) and potential localization of the problem, while laboratory tests provide additional verification of a clinical suspicion. This article will discuss different described tests that are currently available (or will be in the near future) to veterinary practitioners for diagnosing different gastrointestinal and pancreatic diseases. This list is not inclusive, since many more tests have been described in the literature, including screening with blood, cheek swabs, and tests for urine, feces, and saliva to identify potential food reactants. Most of these tests are poorly predictive of causation.

LABORATORY TESTS Any laboratory test depends on its inherent qualities and ability to discriminate between healthy and diseased animals. For many of these tests, biological variation is an inherent characteristic of the biological substance measured. Depending on its diagnostic characteristics (e.g. sensitivity and specificity), the test can be good for screening (high sensitivity, therefore a low false negative result rate), or for confirming diagnosis (high specificity, low false positive result rate). Case selection can improve the diagnostic accuracy and value of the results from laboratory tests.

PANCREATIC DISEASES Pancreatic lipase assays Acute pancreatitis in dogs usually presents with more overt signs, while chronic pancreatitis often involves subtle recurring signs.1 In acute pancreatitis, a physical exam might reveal generalized weakness (79% of cases), dehydration (46%), abdominal pain or discomfort (45% to 58%), and sometimes even icterus, pyrexia or hypothermia, bleeding diathesis, or abdominal effusion.2,3 Certain breeds have been described to be at higher risk of developing pancreatitis (see Table 1 at right). Diagnosing pancreatitis still remains challenging. The gold standard for diagnosis is histopathology; however, this is invasive, costly, and not without certain risks. Current laboratory tests to diagnose this disease are neither 100% sensitive nor specific. Historically, elevated serum amylase and lipase values were thought to suggest pancreatitis. Both

markers were not sensitive or specific, since extra-pancreatic sources (stomach and duodenum) have been described. More recently, lipase activity has been assessed by assays using other substrates: 1,2 diglyceride (1,2 DiG) and 1,2-o-dilaurylracglycero-3-glutaric acid-6’-methylresorufin ester (DGGR). 1,2 DiG has a reported sensitivity of 73% and specificity of 73%. Based on differing cut-off values for DGGR lipase, different sensitivity and specificity values have been reported (See Table 2 on page 13). Both these assays don’t solely measure pancreatic lipase. Lipases of other origins are measured as well, which could influence results. Others assays that assess the more specific canine pancreatic lipases are Spec cPL and SNAP cPL.4,5 Spec cPL results range from < 200 μg/L (considered normal range) to > 400 μg/L (considered highly suggestive of pancreatitis), while values from 200 to 400 μg/L are equivocal. Retesting equivocal results at a later stage, or using other diagnostic markers or modalities, is recommended. Using the > 200 μg/L cut-off in diagnosing acute pancreatitis, a multicenter study reported sensitivity of 90% and specificity of 72%, while using the > 400 μg/L cut-off provided a sensitivity of 75% and specificity of 78%.6 Overall, a positive Spec cPL has a good positive predictive value in cases suspected of acute

Table 1

Breeds at higher risk of developing pancreatitis: 2,3,43-45

• Miniature Schnauzer* • Yorkshire Terrier* • Poodles • Dachshunds • Sled dogs (Samoyed and Alaskan Malamute) • Cocker Spaniels • Fox Terriers • English Cocker Spaniel • Cavalier King Charles Spaniel • Boxer • Border Collie * indicates the breeds at higher risk of developing pancreatitis in the US. IVC Winter 2020/2021

pancreatitis, while providing a good negative predictive value when prevalence is low. Spec cPL is offered by specific reference laboratories. Shipment to and processing by a laboratory requires time (usually two or three days) before results are returned. SNAP cPL is a semi-quantitative method of measuring cPL that decreases turnaround time by providing a subjective result. Spot color intensity is determined by an observer in comparison to a reference spot. Results can be lighter than (corresponding to a cPL value < 200 μg/L); equal to (200-400 μg/L); or darker than (> 400 μg/L) the reference spot. After a more intense or equal-intense result, follow-up with a quantitative canine pancreatic lipase is recommended. SNAP cPL has a high reported sensitivity (93%) and specificity (74%).6 Abdominal ultrasonography Abdominal ultrasonography (AUS) can help diagnose pancreatitis and exclude other intestinal causes. AUS is dependent on equipment and operator characteristics. Originally, a sensitivity of 68% for diagnosing pancreatitis was described,2 with a sensitivity of 56% for chronic pancreatitis,2 while a more recent study showed an increased sensitivity of 89%.7 Signs on AUS suggestive of pancreatitis include an

enlarged, irregular, hypo-echoic pancreas, hyperechoic peripancreatic fat, and abdominal effusion.2,7,8 Trypsin-like immunoreactivity Trypsin-like immunoreactivity (TLI) was originally developed to diagnose exocrine pancreatic insufficiency (EPI) in dogs.9 In fasted dogs, serum TLI < 2.5 µg/L is considered diagnostic for EPI, while values ≤ 3.5 µg/L could indicate subclinical EPI, and are recommended to be retested after one month.9 Elevated fasted serum TLI has been described in experimentally induced pancreatic insults. However due to its short halflife, TLI is not used routinely. Serum TLI values > 50 µg/L are shown to be associated with pancreatitis or severe renal insufficiency.9,10 Reported sensitivity of TLI for the diagnosis of pancreatitis ranges from 33% to 47%, with a reported specificity of 65%.3,11,12 Other markers of canine pancreatitis • Pancreatic elastase-1 is produced by pancreatic acinar cells, and secreted into the bloodstream during pancreatitis. Serum canine pancreatic elastase-1 (cPE-1) seems to be significantly elevated with pancreatitis, and might be more

Figure 1: Basic recommended diagnostic work-up for a dog with suspected chronic enteropathy

Dog with chronic gastrointestinal signs (>3wks; intermittent for longer period) Thorough history & physical exam

Laboratory test including: -CBC -Biochemistry profile - Electrolytes Assess possibility of Addison's disease

Fecal examination for: - Worms - Giardia

Abdominal ultrasound assessing: GI tract, liver, pancreas, adrenals, kidneys

Dietary trial with novel protein for 6 weeks

Assess fecal microbial diversity (dysbiosis index)

Basal cortisol ACTH stimulation test

Endoscopy with intestinal biopsies

Antibioticresponsive enteropathy

Addison's disease

Immunosuppresive enteropathy

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Table 2: Sensitivity and specificity of different cut-off values for canine DGGR lipase assays described in literature

DGGR lipase cut-off value + (interpretation)

Sensitivity

Specificity

â&#x2030;¤ 140 U/L (not consistent with pancreatitis) 140-216 U/L (equivocal) > 216 U/L (consistent with pancreatitis)40

73.9-83.3%

76.9-83.8%

> 120 U/L

(consistent with pancreatitis)41

93.3%

53.3%

> 180 U/L

(consistent with pancreatitis)41

73.3%

66.6%

23-245 U/L (reference range) > 245 U/L (consistent with pancreatitis)42

0% (acute cases)

100% (acute cases)

23-245 U/L (reference range) > 245 U/L (consistent with pancreatitis)42

57% (chronic cases)

100% (chronic cases)

useful at diagnosing acute rather than chronic cases.13 Further studies of this marker are needed before it can be routinely used in practice. â&#x20AC;˘ Trypsinogen activation peptide (TAP), a product of trypsinogen cleavage, is released into the circulation and excreted by the kidney in acute pancreatitis. Plasma and urine TAP are elevated in acute pancreatitis.14 Availability of both cPE-1 and TAP in clinical practice may depend upon location.

GASTROINTESTINAL DISEASES Most acute gastrointestinal diseases (like diarrhea) resolve with supportive treatment: a highly digestible diet, increased fluid intake either enterally or parenterally in case of severe or ongoing fluid losses, and anti-nausea medications. Chronic gastrointestinal diseases (> 3 weeks of clinical signs, or recurring intermittent signs) could indicate a chronic enteropathy (CE). As canine CE often has a slower onset of clinical signs, diagnosis and definitive treatment usually require more time. A flow diagram for the suggested diagnostic work-up of canine CE is presented in Figure 1 on page 12. Continued on page 14.

IVC Winter 2020/2021

Continued from page 13. Different markers and methods described in the literature can help clinicians assess canine CE.

or folate concentrations therefore require evaluation of serum TLI to exclude EPI.

Total protein and albumin Serum total protein and albumin are measured routinely in many canine patients, especially in gastrointestinal cases. Dogs with severe CE show protein loss through the gut mucosa. Decreased serum albumin has been described as a negative prognostic indicator in dogs with CE.15,16

Other intestinal serum markers • Alpha1-proteinase inhibitor (α1-PI), also known as alpha1antitrypsin, is a major serine proteinase inhibitor produced by the liver. α1-PI has a similar molecular weight to albumin, and is lost at the same rate with gastrointestinal protein loss. In contrast to albumin, α1-PI can be quantified in feces as it is resistant to proteolysis. Fecal α1-PI is therefore helpful as a marker for gastrointestinal protein loss.17 Variations of α1-PI on a day-to-day basis are large, requiring evaluation of fecal samples on three consecutive days, which can be a disincentive for clients. α1-PI values ≥ 19 µg/g for a three-day mean sample are considered abnormally elevated, confirming histological lesions seen in canine protein-losing enteropathy (a form of CE), because these can be increased earlier than the presence of clinical signs, hypoalbuminemia, or both.18

Cobalamin and folate Cobalamin (vitamin B12) and folate (vitamin B9) are absorbed in the small intestine (ileum and duodenum, and proximal jejunum, respectively), and have been described as markers for CE. Hypocobalaminemia is thought to reflect distal small intestinal malabsorption, small intestinal dysbiosis, or a combination. Low serum cobalamin is considered a negative prognostic indicator in dogs with CE.16 Hypocobalaminemia can also be observed in EPI. Low serum folate can be due to chronic malabsorption in 14% of dogs with CE. However, it can be falsely elevated (to normal or above-normal levels) due to small intestinal dysbiosis or low cobalamin, and is therefore best assessed when serum cobalamin levels are normal. Abnormal serum cobalamin and/

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• Methylmalonic acid (MMA) is a metabolite shown to decrease with low intracellular cobalamin.19 MMA can be determined in serum or urine, and appears to be useful in combination with serum cobalamin at assessing cobalamin levels in dogs.20 This assay is technically challenging and costly, and therefore currently not routinely used in canine

CE. In the future, these challenges might decrease, making it more available for routine testing. • Calprotectin, S100A8/A9 complex, is a molecule that accumulates at sites of inflammation, and is released by activated macrophages and neutrophils.21 Serum calprotectin is not specific for diseases of the gastrointestinal tract; however, fecal calprotectin can be used as a surrogate marker for disease severity in canine chronic inflammatory enteropathy (CIE). It also seems to have ability in predicting treatment response in canine CIE.21 • Calgranulin, S100A12, is a molecule closely related to calprotectin, which appears a useful biomarker of gastrointestinal inflammation in dogs. Fecal calgranulin levels are correlated with the severity of endoscopic lesions and clinical signs, though not with histopathologic changes.21 Associations have been described between disease outcome in canine CIE and increased fecal calgranulin levels.22,23 Both calprotectin and calgranulin are currently not widely available, making routine use limited. In the future, availability might improve. • Other novel markers such as perinuclear antineutrophil cytoplasmic antibodies (pANCAs), receptor for advanced glycation end-products (RAGE), or polymorphonuclear leukocytes (APMNA), antibodies against gliadins (AGA), microbial outer membrane porin C (ACA), E Coli outer membrane porin (antiOmpC), flagellins (AFA), or combined panels have been described, but require further studies before they are practical and can be routinely advised in clinical practice.23-27 Canine dysbiosis index In both human and veterinary medicine, alterations of the gut microbiome have been described in relation to diverse (both acute and chronic) gastrointestinal diseases. Changes in the microbiome have been considered both cause and consequence. Historically, bacterial culture was used to identify the presence of bacteria in the gastrointestinal tract; however, resolution to identify anaerobic bacteria was low.28,29 Less than 20% of intestinal bacteria are cultivable with standard laboratory techniques.29 Recent developments have shown that molecular methods are far better at assessing and identifying these changes.28,29 A canine fecal dysbiosis index has been developed that shows an altered state of the gut bacterial microbiome.30 This dysbiosis index (DI) is acquired by a quantitative PCR (qPCR) panel consisting of eight bacterial “groups”: total bacteria, Faecalibacterium, Turicibacter, Escherichia coli, Streptococcus, Blautia, Fusobacterium, and Clostridium hiranonis. Each of their reported values is compiled into a single numerical value that measures closeness to the norm (l2) of the test sample to the mean prototype of each class. The DI is classified as a negative value (< 0, indicating normobiosis); a positive value, which can indicate an equivocal result (0-2); or dysbiosis (> 2). In equivocal results, follow-up assessment several weeks later is recommended. A dysbiosis index value > 2 with decreased abundance of C. hiranonis, one of the bacterial groups assessed, is common in dogs with diverse gastrointestinal diseases like EPI and CE.29,30 The higher the DI, the more deviation from normobiosis is present in the sample. DI has been described as having a sensitivity of 74% and specificity of 95% to distinguish healthy and CE dogs.30 Studies evaluating if dysbiosis patterns can distinguish between various forms of CE (food responsive CE, antibiotic IVC Winter 2020/2021

Key points • Diagnosing gastrointestinal diseases can pose a challenge for clinicians. • Multiple assays for diagnosing canine pancreatitis are available. Each of these tests has different characteristics, requiring careful consideration • Hypocobalaminemia can be observed in exocrine pancreas insufficiency. • Fecal α1-PI might be a helpful marker for gastrointestinal protein loss. • The canine dysbiosis index can help assess intestinal dysbiosis in canine chronic enteropathies. • Different medications (such as proton pump inhibitors and broad-spectrum antibiotics) have been described to change the gut microbiome even after stopping administration. • Clinical severity indices (CIBDAI and CCECAI) can help clinicians track disease activity and treatment progress in canine chronic enteropathies.

response CE, and inflammatory bowel disease) are required. Optimal assessment would encompass intestinal and systemic inflammation, immune function, and tissue damage by multiple methods such as histopathology in these studies. Different medications have been described in relation to changes in the gut microbiome. Proton pump inhibitors (like omeprazole) can lead to an increase in DI, which decreases back towards normal 14 days after cessation of the therapy. Administration of broad-spectrum antibiotics (like metronidazole, amoxicillin clavulanic acid, and tylosin) also induce microbiota shifts, increasing the DI, that resemble changes of dysbiosis observed in CE.31-34 Normalization of the DI takes several weeks after the end of administration.31-34 Studies evaluating how to address this intestinal dysbiosis (for example by fecal microbial transplant) are needed. Clinical severity indices In human medicine, the scoring of clinical disease severity is common practice to help assess severity and track treatment progression. In veterinary medicine, a scoring index for disease activity in canine inflammatory bowel disease, CIBDAI, was developed and validated to help manage clinical patients.35,36 This scoring index takes into account disease activity of six prominent gastrointestinal signs — attitude and activity, appetite, vomiting, stool consistency, stool frequency, and weight loss.35 Each sign is scored with a value of 0-3. A total cumulative CIBDAI score is created and disease is classified as insignificant (0-3), mild (4-5), moderate (6-8), or severe (≥ 9).35 Long term follow-up regarding CIBDAI scores are not known. Another clinical scoring index, CCECAI (Canine Chronic Enteropathy Clinical Activity Index), takes into account the CIBDAI factors, as well as serum albumin concentrations, presence of ascites, peripheral edema, and pruritus.37 Both these indices can help clinicians track disease and treatment progress. Histopathology The gold standard for quantifying intestinal inflammation in dogs remains a combination of endoscopic evaluation of the intestinal mucosa and histologic examination. Significant interobserver variability in the histopathologic assessment of intestinal biopsies has been described among pathologists even with use of the WSAVA standardization criteria.38,39 A novel shortened histologic scoring scheme has been proposed that showed statistically significant high correlation (r < 0.5) for some parts of the scoring protocol with clinical severity scoring indices.39 None of the novel histological scoring scheme factors showed strong correlations (r > 0.7) with clinical scoring severity indices.39 Future studies evaluating the best methods to assess histopathologic lesions and correlate these to clinical disease are warranted.

Watson P. “Chronic pancreatitis in dogs”. Top Companion Anim Med. 2012;27(3):133-139. doi: 10.1053/j. tcam.2012.04.006 [doi].

Hess RS, Saunders HM, Van Winkle TJ, Shofer FS, Washabau RJ. “Clinical, clinicopathologic, radiographic, and ultrasonographic abnormalities in dogs with fatal acute pancreatitis: 70 cases (1986-1995)”. J Am Vet Med Assoc. 1998;213(5):665-670.

Cridge H, Sullivant AM, Wills RW, Lee AM. “Association between abdominal ultrasound findings, the specific canine pancreatic lipase assay, clinical severity indices, and clinical diagnosis in dogs with pancreatitis”. J Vet Intern Med. 2020;34(2):636-643. doi: 10.1111/jvim.15693 [doi].

Hecht S, Henry G. “Sonographic evaluation of the normal and abnormal pancreas”. Clin Tech Small Anim Pract. 2007;22(3):115-121. doi: S1096-2867(07)00043-6 [pii].

Xenoulis PG. “Diagnosis of pancreatitis in dogs and cats”. J Small Anim Pract. 2015;56(1):13-26. doi: 10.1111/ jsap.12274 [doi].

Steiner JM, Teague SR, Williams DA. “Development and analytic validation of an enzyme-linked immunosorbent assay for the measurement of canine pancreatic lipase immunoreactivity in serum”. Can J Vet Res. 2003;67(3):175-182.

Steiner JM, Williams DA. “Development and validation of a radioimmunoassay for the measurement of canine pancreatic lipase immunoreactivity in serum of dogs”. Am J Vet Res. 2003;64(10):1237-1241.

McCord K, Morley PS, Armstrong J, et al. “A multi-institutional study evaluating the diagnostic utility of the spec cPL and SNAP(R) cPL in clinical acute pancreatitis in 84 dogs”. J Vet Intern Med. 2012;26(4):888-896. doi: 10.1111/j.1939-1676.2012.00951.x [doi].

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Williams DA, Batt RM. “Sensitivity and specificity of radioimmunoassay of serum trypsin-like immunoreactivity for the diagnosis of canine exocrine pancreatic insufficiency”. J Am Vet Med Assoc. 1988;192(2):195-201. Williams DA. “Introduction: Exocrine pancreatic insufficiency and pancreatitis”. Top Companion Anim Med. 2012;27(3):95. doi: 10.1053/j.tcam.2012.05.003 [doi].

Steiner JM. “Diagnosis of pancreatitis”. Vet Clin North Am Small Anim Pract. 2003;33(5):1181-1195. Steiner JM, Newman S, Xenoulis P, et al. “Sensitivity of serum markers for pancreatitis in dogs with macroscopic evidence of pancreatitis”. Vet Ther. 2008;9(4):263-273.

Mansfield CS, Watson PD, Jones BR. “Specificity and sensitivity of serum canine pancreatic elastase-1 concentration in the diagnosis of pancreatitis”. J Vet Diagn Invest. 2011;23(4):691-697. doi: 10.1177/1040638711407875 [doi].

Mansfield CS, Jones BR. “Plasma and urinary trypsinogen activation peptide in healthy dogs, dogs with pancreatitis and dogs with other systemic diseases”. Aust Vet J. 2000;78(6):416-422.

Jergens AE. “Clinical assessment of disease activity for canine inflammatory bowel disease”. J Am Anim Hosp Assoc. 2004;40(6):437-445.

Allenspach K, Wieland B, Gröne A, Gaschen F. “Chronic enteropathies in dogs: Evaluation of risk factors for negative outcome”. J Vet Intern Med. 2007;21(4):700-708. doi: 10.1892/0891-6640(2007)21[700:ceideo]2 .0.co;2 [doi].

Murphy KF, German AJ, Ruaux CG, Steiner JM, Williams DA, Hall EJ. “Fecal alpha1-proteinase inhibitor concentration in dogs with chronic gastrointestinal disease”. Vet Clin Pathol. 2003;32(2):67-72.

Heilmann RM, Parnell NK, Grützner N, et al. “Serum and fecal canine α1-proteinase inhibitor concentrations reflect the severity of intestinal crypt abscesses and/or lacteal dilation in dogs.” Vet J. 2016;207:131-139. doi: S1090-0233(15)00453-0 [pii].

Berghoff N, Suchodolski JS, Steiner JM. “Association between serum cobalamin and methylmalonic acid concentrations in dogs”. Vet J. 2012;191(3):306-311. doi: 10.1016/j.tvjl.2011.03.005 [doi].

Berghoff N, Hill S, Parnell NK, Mansell J, Suchodolski JS, Steiner JM. “Fecal and urinary N-methylhistamine concentrations in dogs with chronic gastrointestinal disease”. Vet J. 2014;201(3):289-294. doi: 10.1016/j. tvjl.2014.05.016 [doi].

Heilmann RM, Berghoff N, Mansell J, et al. “Association of fecal calprotectin concentrations with disease severity, response to treatment, and other biomarkers in dogs with chronic inflammatory enteropathies”. J Vet Intern Med. 2018;32(2):679-692. doi: 10.1111/jvim.15065 [doi].

Heilmann RM, Grellet A, Allenspach K, et al. “Association between fecal S100A12 concentration and histologic, endoscopic, and clinical disease severity in dogs with idiopathic inflammatory bowel disease”. Vet Immunol Immunopathol. 2014;158(3-4):156-166. doi: 10.1016/j.vetimm.2014.01.006 [doi].

Heilmann RM, Otoni CC, Jergens AE, Grützner N, Suchodolski JS, Steiner JM. “Systemic levels of the antiinflammatory decoy receptor soluble RAGE (receptor for advanced glycation end products) are decreased in dogs with inflammatory bowel disease”. Vet Immunol Immunopathol. 2014;161(3-4):184-192. doi: S01652427(14)00176-7 [pii].

Cabrera-García AI, Suchodolski JS, Steiner JM, Heilmann RM. “Association between serum soluble receptor for advanced glycation end-products (RAGE) deficiency and severity of clinicopathologic evidence of canine chronic inflammatory enteropathy”. J Vet Diagn Invest. 2020;32(5):664-674. doi: 10.1177/1040638720943584 [doi].

Heilmann RM, Otoni CC, Jergens AE, Grutzner N, Suchodolski JS, Steiner JM. “Systemic levels of the antiinflammatory decoy receptor soluble RAGE (receptor for advanced glycation end products) are decreased in dogs with inflammatory bowel disease”. Vet Immunol Immunopathol. 2014;161(3-4):184-192. doi: 10.1016/j.vetimm.2014.08.003 [doi].

From the AAVA The American Academy of Veterinary Acupuncture (AAVA) is committed to improving animal healthcare 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.

Due to COVID-19, all in-person meetings for 2020 became virtual or were rescheduled. The AAVA and IVAS (International Veterinary Acupuncture Society) are planning a Joint Congress in Alexandria, VA, from September 17 to 20, 2021, at the Westin Alexandria Old Town Hotel.

Estruch JJ, Barken D, Bennett N, et al. “Evaluation of novel serological markers and autoantibodies in dogs with inflammatory bowel disease”. J Vet Intern Med. 2020;34(3):1177-1186. doi: 10.1111/jvim.15761 [doi].

Allenspach K, Luckschander N, Styner M, et al. “Evaluation of assays for perinuclear antineutrophilic cytoplasmic antibodies and antibodies to saccharomyces cerevisiae in dogs with inflammatory bowel disease”. Am J Vet Res. 2004;65(9):1279-1283. doi: 10.2460/ajvr.2004.65.1279 [doi].

Honneffer JB, Minamoto Y, Suchodolski JS. “Microbiota alterations in acute and chronic gastrointestinal inflammation of cats and dogs”. World J Gastroenterol. 2014;20(44):16489-16497. doi: 10.3748/wjg.v20. i44.16489 [doi].

Suchodolski JS. “Diagnosis and interpretation of intestinal dysbiosis in dogs and cats”. Vet J. 2016;215:30-37. doi: S1090-0233(16)30033-8 [pii].

AlShawaqfeh MK, Wajid B, Minamoto Y, et al. “A dysbiosis index to assess microbial changes in fecal samples of dogs with chronic inflammatory enteropathy”. FEMS Microbiol Ecol. 2017;93(11):10.1093/femsec/fix136. doi: 10.1093/femsec/fix136 [doi].

Pilla R, Gaschen FP, Barr JW, et al. “Effects of metronidazole on the fecal microbiome and metabolome in healthy dogs”. J Vet Intern Med. 2020. doi: 10.1111/jvim.15871 [doi].

Manchester AC, Webb CB, Blake AB, et al. “Long-term impact of tylosin on fecal microbiota and fecal bile acids of healthy dogs”. J Vet Intern Med. 2019;33(6):2605-2617. doi: 10.1111/jvim.15635 [doi].

Chaitman J, Ziese AL, Pilla R, et al. “Fecal microbial and metabolic profiles in dogs with acute diarrhea receiving either fecal microbiota transplantation or oral metronidazole”. Front Vet Sci. 2020;7:192. doi: 10.3389/ fvets.2020.00192 [doi].

Werner M, Suchodolski JS, Straubinger RK, et al. “Effect of amoxicillin-clavulanic acid on clinical scores, intestinal microbiome, and amoxicillin-resistant escherichia coli in dogs with uncomplicated acute diarrhea”. J Vet Intern Med. 2020;34(3):1166-1176. doi: 10.1111/jvim.15775 [doi].

Jergens AE, Schreiner CA, Frank DE, et al. “A scoring index for disease activity in canine inflammatory bowel disease”. J Vet Intern Med. 2003;17(3):291-297.

The AAVA and IVAS are also planning to provide regional CE meetings for both small and large animal practitioners. In West Virginia, a small animal regional seminar featuring Dr. Constance DiNatalie will focus on food therapy for the acupuncture patient. A joint equine regional seminar is also being planned for late spring/early summer in Aiken, South Carolina, featuring Dr. Maurice Casey. AAVA’s new Online CE options for its members provide complimentary live and on-demand webinars. Non-members will be required to pay $150 but will be awarded a free one-year membership, giving them access to all member benefits. AAVA plans to add new webinars at least twice a year. These webinars began in November 2019 and new ones have been added every quarter. All webinars are IVAS and RACE approved for two CE hours.

Visit aava.org to learn more.

Jergens AE. “Clinical assessment of disease activity for canine inflammatory bowel disease”. J Am Anim Hosp Assoc. 2004;40(6):437-445. doi: 40/6/437 [pii].

Day MJ, Bilzer T, Mansell J, et al. “Histopathological standards for the diagnosis of gastrointestinal inflammation in endoscopic biopsy samples from the dog and cat: A report from the world small animal veterinary association gastrointestinal standardization group”. J Comp Pathol. 2008;138 Suppl 1:S1-43. doi: 10.1016/j.jcpa.2008.01.001 [doi].

Allenspach KA, Mochel JP, Du Y, et al. “Correlating gastrointestinal histopathologic changes to clinical disease activity in dogs with idiopathic inflammatory bowel disease”. Vet Pathol. 2019;56(3):435-443. doi: 10.1177/0300985818813090 [doi].

See additional references at IVCJournal.com

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A BOND-CENTERED APPROACH TO

CHRONIC ANXIETY

IN PETS, USING NON-PHARMACEUTICAL METHODS

Essential oils, Bach flower remedies, and CBD, used alone or in combination, can be very effective for chronically anxious pets and their owners. BY DR. JULIE MAYER, DVM, CVA, CVC, CCRP

Dogs and cats rely on their human caregivers. They trust us as their leaders and guides, and are very intuitive creatures. Often, however, the resulting human-animal bond is geared toward meeting our own needs, both physical and psychological.1 We also need to consider the human-animal bond from the dog or cat’s perspective, and realize it may even be damaging to pets in some ways, since they tend to live their lives in isolation from others of their kind, and identify instead with humans. Since pets communicate through observation, they are very likely to respond to even our subtlest mood changes, and mirror our mental and emotional states, positive and negative, a phenomenon referred to as “sympathetic resonance”.1 This means that when we are upset, angry, sad, or otherwise emotional, our pets are likely to become concerned, frightened or anxious. Chronically, this may cause health problems such as inappetence, gastrointestinal issues, aggression, depression, fear, destructive behaviors, inappropriate elimination, and much more. This is a two-way street, of course. The reverse is also true when our pets have behavioral issues of their own, and our well-being can be affected both emotionally and physically. Commonly-prescribed medications for behavioral modification can lead to unwanted side effects, both behavioral and physical, and sometimes caregivers end up surrendering their pets altogether.

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We have found that there are many safe, natural ways to help manage these situations. We can use these methods separately or in conjunction to get the desired behavior, and it is often helpful for both owner and pet to be treated. In fact, it is useful to approach the problem with the mindset of supporting and treating the human-animal bond. The top three methods we use for chronically anxious pets and their owners are essential oils, Bach flower remedies, and CBD. We work with the owner and the pet to find an effective combination of these therapies, and have seen much success with this approach.

ESSENTIAL OILS Essential oils are compounds that are extracted from plants. The oils capture the plant’s scent and flavor, or essence. Essential oils are obtained through the process of distillation, or mechanical methods such as cold pressing. Once the aromatic chemicals have been extracted, they are highly concentrated and powerful. This means a little goes a long way. Often, they are combined with a carrier oil to create a product that is ready for topical use. However, essential oils are most used in the practice of aromatherapy in which they are inhaled, often via a diffuser. In my practice, we have essential oil diffusers in every room. This is beneficial to pets, owners, and our staff. We all benefit from breathing them in.

Most people have heard that using essential oils with pets is dangerous and toxic, and this can be true, but not in the way most people think. The oils are very concentrated and need to be treated as such. Also, poor quality oils often contain additives that are harmful and can cause life-threatening reactions. Working with a professional trained in essential oil use ensures that the products and application methods are safe. Here is a list of some popular essential oils we use, and the health claims associated with them: • Anise (Pimpinella anisum): Calming • Bergamot (Citrus bergamia): Reduces depression and anxiety • Chamomile, Roman (Chamaemelum nobile): Improves mood, aids in relaxation, and reduces anxiety • Frankincense (Boswellia carterii): Boosts other oils and reduces depression • Geranium (Pelargonium graveolens): Helps release negative memories and eases nervous tensions • Lavender (Lavandula angustifolia): Stress-relieving, calming • Lemon (Citrus limon): Reduces anxiety • Melissa (Melissa officinalis): Reduces depression, grief, and anxiety and improves cognitive function • Rose (Rosa damascene): Reduces anxiety, aids in releasing traumatic memories, aids in conflict between other animals • Sandalwood (Santalum album): Grounding, increases acceptance, reduces stress guilt and aggressive behavior • Tangerine (Citrus tangerina): Reduces sleeplessness, anxiety, and depression • Ylang-Ylang (Cananga odorata): Reduces anxiety and depression, balances male and female energies.2 While there are many ways to use these oils, we have found that selecting a combination of three, adding a few drops of each to the diffuser, and running it throughout the day (or at night by the bed) is very effective. The list above is not complete, and many other oils can aid with stress relief in both pets and owners. Finding a combination the owner enjoys and that is effective for the pet is a sure win!

BACH FLOWER ESSENCES Many of the same plants are used in Bach flower remedies as in essential oils, but the former are taken from the plants using a different method. The flowers soak in spring water in the sun for a designated period of time; the flowers are then removed from the water, and the water is combined with an IVC Winter 2020/2021

alcohol for preservation, creating a Bach flower essence.3 There are 38 different essences that can be used in any combination, and it is virtually impossible to overdose. They can be used in conjunction with any other treatment modalities without interference.4 Here is a list of some popular Bach flower essences we use, and the health claims associated with them: • Aspen: for animals that “spook” easily; also used for animals that sense storms • Centaury: for animals that are timid and need confidence • Elm: for easily overwhelmed or high-strung animals • Gentian: for setbacks or depression • Holly: to balance negative emotions such as anger or jealousy • Honeysuckle: helps with homesickness • Impatiens: for those that are very nervous and easily agitated • Larch: for those that lack self confidence • Mimulus: for those that are fearful due to abuse • Mustard: to aid in deep depression • Pine: for the animal that assumes its owner’s guilt • Red Chestnut: for the animal that worries about its owner or other animals; also used for animals that sense storms • Rock Rose: used for any general form of panic or terror; helps with fear •S cleranthus: helps promote equilibrium and balances mood swings • Wild Oat: for those that are depressed or bored • Wild Rose: helps with those that are in confined spaces • Willow: helps with resentment, which may be a response to abuse or neglect.3 An easy-to-use combination Bach flower remedy called Rescue Remedy is very effective. We use the children’s (alcohol-free) version with dogs, and put it directly into their food or drinking water as needed for many different stressful situations. Quite often, our clients give their pets Rescue Remedy prior to coming into the office to help ease the stresses the animals have about veterinarians or car rides.

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CBD We regularly use CBD in our practice for both pain and psychological problems, with very good results. CBD is not psychoactive and will not alter an animal’s cognitive function or get him “high”. Many studies have been done showing the effectiveness of CBD when used for stress, anger management, and anxiety relief. Believe it or not, cannabis was used and accepted in veterinary medicine from the 1800s to the early 1900s.5 You can locate CBD just about anywhere these days, so we advise doing your research and sticking to products recommended or made by veterinarians. We carry a line of chewable CBD products that we use in cats and dogs, which both owners and pets seem to enjoy. We start small and increase to effect, following a biphasic U-shaped dosing curve. Drowsiness is the only known side effect of too much CBD, although loose stool can result from too many of the treats. Essential oils, Bach flower essences, and CBD products offer safe support options for stress and anxiety affecting the bond between pet parents and their beloved companions. Before reaching for pharmaceuticals, consider trying some of these options, alone or in combination. When used correctly, they are incredibly effective and carry much less risk, if any, than many pharmaceuticals. Graham H, Vlamis G. Bach Flower Remedies for Animals. Findhorn Press, 1999.

1 2

Shelton, M. ADR II The Animal Desk Reference Second Edition Essential Oils for Animals. 2018. Moore, A. Introduction to the Bach flower remedies. Proceedings Annual Conference of the AHVMA. 2006;331-336.

Blake, SR. Introduction to Bach flowers and easy application formulas. Proceedings Annual Conference of the AHVMA. 2004;6-7.

Silver, RJ. Veterinary CBD: What does the evidence say? A review of the studies. DVM 360 webinar Oct 2020.

PROFITABLE PRACTICE

INCORPORATE COOL LASER THERAPY INTO YOUR CLINIC

Theralase® Cool Laser Therapy (“CLT”) benefits animal patients, increases revenue and is a great value-added service for veterinarians and equine specialists. theralase.com/animal-use

ABOUT THIS SERVICE Theralase’s ® patented CLT medical laser systems use dual superpulsed wavelengths that penetrate up to 5” into tissue to help accelerate healing, reduce inflammation, and eliminate pain at even the deepest sites. For the past 27 years, at its head office in Toronto, Canada, Theralase has been manufacturing, selling, and servicing Cool Laser Therapy systems throughout the world. This innovative technology can provide an easy and effective way to help animals in need.

WHY PRACTICE OWNERS LOVE IT

INCOME POTENTIAL: sing the range of CLT systems that Theralase builds, U users can generate up to four times the ROI within the first year. COST: Theralase CLT systems can be purchased or leased for as low as $110 a month. TRAINING REQUIREMENTS: Training and certification are included and provided upon arrival of the system. Ongoing clinical and educational inquiries are handled through the Theralase online Members Only area and an in-house team of clinical practitioners. TIME TO IMPLEMENT: Theralase CLT systems are built for worldwide use, so clinics are able to start treating within the first day of receiving their system. Whether it’s used for first-line treatments or quality of life management, patients will receive healing at the speed of light.

Theralase’s CLT systems use Bluetooth and touchscreen technology to provide fast and effective relief to animals in a safe and natural manner. Using a noninvasive and non-thermal approach, Theralase CLT systems can greatly improve quality of life for patients while simultaneously providing a new stream of income for clinics. Veterinarians and veterinary technicians alike can easily and safely administer the therapy with just a few touches of a screen by using pre-set protocols or customizations easily created and stored in the software. Any condition associated with pain, inflammation, and tissue healing can benefit from Theralase Cool Laser Therapy. It is commonly used for the following issues: •A rthritic joints, spinal stenosis, hip dysplasia • Soft tissue injuries (strains/sprains) • Post-surgical pain and tissue healing • S kin problems (i.e. wounds, lick granulomas)

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COMBATING CANCER BY

SUPPORTING GUT HEALTH AND THE IMMUNE SYSTEM Immunity and gut health play a large role in the progression and treatment of chronic diseases. Using this knowledge can help give your canine cancer patients a better outcome. Canine cancers and treatments often have negative effects on immune, digestive, integumentary and other physiologic systems. Common impacts from the disease and its treatment include lethargy, digestive upset, weight loss, lameness, rapid heart rate/breathing, unusual discharge, pain and swelling. But if canine physiologies are supported through nutrition systems aimed at preserving their healthy function, the opposite can also be true. The health of these systems can play a critical role in how well the patient maintains a high quality of life throughout the disease’s progression and how well the side effects of treatment are tolerated.

THE LINK BETWEEN IMMUNITY, THE GUT AND CANCER Depending on the state of the patient’s microbiome, the right gut bacteria can produce several defenses that will help preserve the host’s healthy homeostasis. Through positive interaction between the animal’s microbiota and its immune system, a beneficial body response aimed at disease-causing organisms and neoplastic disease processes can be encouraged. In other words — the healthier the gut, the healthier the immune system and ultimately, the healthier the animal.

THE IMPORTANCE OF NUTRITIONAL SUPPORT A purpose-built and well integrated nutrition system that includes the right vitamins, minerals, amino acids, mushroom and plant extracts, and effective levels of Omega-3s (specifically DHA) can reduce inflammation and degradation of the gastrointestinal system lining, and guard against liver toxicity. These conditions often accompany cancer, and sometimes also manifest as the side effects of treatment. Gut health can be enhanced with diets that are rich in protein and naturally-occurring antioxidants, especially when their levels are carefully balanced to not interfere

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with the efficacy of oxidative treatments such as chemo and radio therapy.

THE CASE FOR LOW-CARB DIETS Studies have demonstrated the importance of limiting carbohydrates when building a nutrition plan for cancer patients: • Studies have linked carbohydrate-rich diets to colorectal cancer in humans.1 • Carbohydrate-restricted (along with high-fat) diets produce cancer cell starvation and apoptosis. At the same time, these diets increase the levels of ketone bodies available for energy production in normal cells, but not in cancer cells.2 • Mice fed a ketogenic diet experienced increased innate tumor-reactive and adaptive immune responses, including increased cytokine production and cytolysis via tumorreactive CD8+ T cells.3 There is much to consider when formulating a diet for patients battling chronic disease. Determining optimal amounts and proportions of nutrients and specific compounds to support gut and immune health, reduce inflammation, provide greater leverage for cancer treatments and guard against their damaging side effects can be critical in helping to assure the best outcome.

Belcheva A, Martin A. Gut microbiota and colon cancer: the carbohydrate link. Mol Cell Oncol. 2014;2(1):e969630. Published 2014 Nov 11. doi:10.4161/23723548.2014.969630

V ergati M, Krasniqi E, Monte GD, et al. Ketogenic Diet and Other Dietary Intervention Strategies in the Treatment of Cancer. Curr Med Chem. 2017;24(12):1170‐1185. doi:10.2174/0929867324666170116122915

Lussier DM, Woolf EC, Johnson JL, Brooks KS, Blattman JN, Scheck AC. Enhanced immunity in a mouse model of malignant glioma is mediated by a therapeutic ketogenic diet. BMC Cancer. 2016;16:310. Published 2016 May 13. doi:10.1186/s12885-016-2337-7

Canine Biologics (caninebiologics.com) is the only company dedicated exclusively to developing nutritional systems for canines with cancer. With its recently released, cancer-focused Integrated Nutrition System, it helps take the guesswork out of this challenging process facing both veterinarians and pet parents.

EMOTIONS: BY MARLENE SIEGEL, DVM, CNHP, ALT

A POWERFUL TOOL FOR UNDERSTANDING HEALTH AND DISEASE Research reveals that human emotions are powerful energies that impact both health and disease. Our emotions also impact those around us, including our companion animals. Can emotions in our animal patients provide clues to aid in healing for both pets and their owners?

Emotions are energy, and they exist on a spectrum, from the low-vibrating emotions such as shame, anger, and hatred to the higher-vibrating emotions of love, joy, and gratitude. These emotional energies play a vital role in our “human” experience. We are multidimensional energetic beings here to have an energetic experience. Emotions are the key to solving many of our dilemmas in life. Recognition of the emotions associated with an experience provides an opportunity to detach, shift or maintain the attachment, whichever is for the highest and best good of all involved. Our animal companions are often able to help us “see” and experience the emotions we need to heal on the energetic level. Much of what we know regarding the role emotions play in disease has been extrapolated from human research. Researchers in human medicine believe that there are trapped emotions associated with all disease. There is an ongoing debate in the scientific community regarding whether or not animals have “emotions”. I believe they most certainly do! In fact, the “trapped emotions” that pets have, associated with their specific health challenges, seem to always have a significant relationship to the pet’s “soul” parent, that owner who is attached to the pet for deep metaphysical meaning.

EMOTIONS AND THE BODY: THE MINDBODY-SPIRIT CONNECTION The Five Elements theory in Chinese Medicine states that each of the five elements has a corresponding emotion, as well as a corresponding organ. The Fire element corresponds to joy; the Earth with worry; Metal with sadness; Water with fear, and Wood with anger. Chakra theory has its roots in the ancient Vedic traditions of India. Imbalances in humans and animals have emotional implications (see sidebar on p. 26). Chakras are concentrations of energetic activity in specific locations in the body. They act as portals of entry, connecting the outer world, our auras and the internal environment of the body so every cell receives energetic communication. They also store “information,” much like a library, of past and present memories, experiences and belief systems. Ancient yogic texts talk about the five energy bodies. Starting with the Spiritual body, energy flows down to the Mental body, then the Emotional body, through the Etheric body, ultimately manifesting in the Physical body. Spiritual Body: The highest “body”. Source, where intuition lives, the connection to higher consciousness, where life as we know it starts and where all returns in the non-physical. IVC Winter 2020/2021

Mental Body: All the “thoughts”. This is also connected to all thoughts in the universe. The mental body is what we tap into when using Applied Kinesiology or muscle testing. Emotional Body: Everything is energy, even emotions! Energy (and emotions) were meant to flow through us. Trapped emotions occur when this energy which is vibrating at various intensities gets “stuck” somewhere in the body. Imagine they are like balls of energy that vary in size, depending on how much intensity of emotion is attached to them. This “trapped emotion” continues to vibrate and disrupt the energy of the region/organ it becomes stuck in. The spectrum of emotions, from the low-vibrating emotions (shame being the lowest) to the high-vibrating emotions (gratitude being the highest) serve as a “GPS” and help us navigate life by recognizing “flow” and “resistance”. Flow is that state where everything falls into place seamlessly and effortlessly, being more than serendipitous. Resistance is felt when everything seems to go wrong, nothing works out the way it was planned. Emotions also allow us to see the contrast (what we do not like or want) and choose how to experience the situation (as a victim, angry and bitter, or from compassion and love). It is interesting to note that in my experience, pets often reflect or mirror the emotions their pet parents need to address. I always acknowledge the pet and “release” them from the emotional attachment.

ENTRAINMENT: WE ENTRAIN OUR PETS AND THEY ENTRAIN US Entrainment is a physics principle that demonstrates that when energies come into proximity, they influence each other. Common examples of entrainment include: • Girls living in a dorm together often have synchronized menstrual cycles. • Tuning forks that are used to tune musical instruments. • Attending a motivational talk and leaving inspired. • Becoming drained after an encounter with an “energy vampire”, the person (or client) who sucks you dry and leaves you exhausted after your experience with them. Once the energy vampire client is acknowledged and you recognize what emotion they elicit, feel free to shift the energy and release the attachment to them! Remember, on an energetic level, you attracted them for a reason! Identify the purpose, shift the energy, and see the attraction disappear. This awareness gives us clues to the specific challenges our patients face. If the owner is anxious and fearful, their pet may exhibit kidney/urinary disorders. If the owner has anger issues, the pet may be dealing with liver disease. This insight can help us see that it is often not a coincidence that a pet has a particular health challenge when viewed through the lens of its relationship with its owner.

By recognizing the “emotions” that surface, we can “see” the programs we are hard wired to. Once we acknowledge the program we are running, we have the opportunity to delete and reprogram. This is referred to as neuroplasticity. Neuroplasticity is the change in neural pathways and synapses that occurs due to certain factors, like behavior, environment, or neural processes. During such changes, the brain engages in synaptic pruning, deleting the neural connections that are no longer necessary or useful, and strengthening the necessary ones.

EMOTIONAL ENERGY

A thought from the mental body combined with an emotion from the emotional body creates a “belief system”. A belief therefore is a thought we keep repeating.

Healing only occurs when in a parasympathetic state As societies have become more complex, the stress of life has increased. Jobs, family pressures, presidential elections, financial duress, and a global pandemic have created a level of stress that most people have never before experienced. I believe that nature and our animal companions are playing a pivotal role in helping to decrease the “stress” for those of us who allow it. Nature and animals are absorbing some of the stress and offering unconditional love to help us through these very tense times.

Beliefs are acquired by observing the behaviors of our caregivers when we are young, what we were taught in school or even what we hear in the media. We consequently affect our pets’ behavior through our perceived beliefs on training and lifestyle. Etheric Body: The place where all the energy comes together before manifesting into the physical body. Physical Body: The vehicle we use to experience “life”.

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The autonomic nervous system The first step in therapy is to get into a parasympathetic state. The autonomic nervous system has two branches, the sympathetic nervous system (short term survival mechanism that uses cortisol to enable the individual to fight or flee danger) and the parasympathetic nervous system (rest, digest, detoxify, and reproduce). When one is turned on, the other is turned off.

Trapped emotions It is generally agreed upon that emotions play a role in the expression of human disease, and that all disease has trapped

emotions associated with it. Trapped emotions can originate not only from the present lifetime; they can be inherited or of ancestral origin, or even develop within the womb. There are several documentaries that explain how emotions are linked to disease in people. I recommend E-motions (Gaia), Heal (Netflix), and What the bleep down the rabbit hole (YouTube). We are currently using what we know about emotions in humans and extrapolating that to the pets through our human lens. Though we have no way of knowing if this is truly accurate, I have experienced “healing” of the pet when these “trapped emotions” are resolved for the pet. Coincidence or truly related, cannot be proven. To evaluate trapped emotions in our companion animals, explore these options: • Qest4™ is a bioenergetic scan that is used for people and animals to evaluate energetic imbalances. There is a built-in program to evaluate emotions in people as well. With some intuitive skill, this information can be useful for the pet. The machine then can produce “imprints” which carry the energetic balancing frequencies for the patient’s condition. • The Emotion Code™ is the work of Dr Bradley Nelson. This technique requires proficiency in Applied Kinesiology or muscle testing. Using a series of charts, the “root emotion” associated with the problem is identified and then released. • Applied Kinesiology or muscle testing. There are many variations of this, from using a surrogate and testing muscle strength (positive indicator) or muscle weakness (indicating an energetic blockage or energetic problem) to using a pendulum to receive “yes and no” answers. I prefer “sway testing” (using your own body as a pendulum) to receive “yes and no” answers. Diet and toxins Always evaluate the patient’s diet and exposure to environmental toxicity. Feed a species appropriate, raw, grass fed or free range diet along with supplementation of the essential vitamins, minerals and parent essential fatty acids. Eliminate as many toxins as possible from the environment and test for nutritional deficiencies and excesses. Mold toxins and heavy metals such as mercury, lead, antimony and cobalt may have an insidious and significant effect on the pet’s health and behavior. Environment Some inappropriate pet behavior may be the result of environmental stresses and living conditions, inhibiting the animal from its natural behavior as we attempt to conform the animal to living indoors or under other non-natural settings.

TOOLS AND TECHNIQUES FOR ENTERING A PARASYMPATHETIC STATE Any of the following techniques, performed by humans, can impact the pet’s emotions either directly, through entrainment, or indirectly via intention. Techniques 1-4 help stimulate the parasympathetic nervous system. The first three tools are free and are available wherever you are!

q Breath! There are many breath exercises; they all work to stimulate the parasympathetic nervous system, activating the rest, repair, digest, and detoxify physiology of the body. The animals will entrain to the owner’s state of being.

Sitting and walking in nature, petting our animals, and being “present” all help to reduce our stress, and consequently our pet’s stress.

Practice daily gratitude. The more we stay in a higher emotional vibration, the more we impact those around us to also achieve positive emotional vibrations, making life so much better!

r Wholetones™.

This unique blend of music with frequency is profoundly effective in reducing anxiety and stress in animals and people. Live blood studies I performed on animals and people demonstrated rouleaux resolving within minutes of playing Wholetones, even in animals under anesthesia! I have seen aggressive animals become calm and tolerate handling without needing muzzles or sedatives. I have also been successful using Wholetones for thunderstorm anxiety and separation anxiety. Wholetones for Pets™: https://wholetones.com/music-for-pets?a_aid=341343&a_ bid=dc2a20c1 Wholetones 2sleep™: For anyone that has challenges going to sleep and staying asleep! https://wholetones.com/music-for-sleep?a_aid=341343&a_ bid=11110007

SUPPLEMENTS FOR MOOD MODIFICATION

q CBD. There is a plethora of information on the benefits of CBD on the endocannabinoid system.

w Herbs can be used to bring balance or harmony in the Heart Fire through the Kidneys (the Water element controls the Heart shen). Herbs are known to tonify (strengthen) the Kidneys and calm the Heart energy. Examples include rehmannia, asparagus root, ginseng, chamomile, peppermint, St. John’s wort, passion Continued on page 27. IVC Winter 2020/2021

ANIMALS, LIKE PEOPLE, HAVE SEVEN PRIMARY CHAKRAS ROOT CHAKRA: located between the genitals and the perineum. When balanced, beings feel safe, grounded and supported. Humans with imbalances may experience eating disorders or greedy, insecure behavior. Animals with imbalances may have low energy, food aggression, or be territorial. SACRAL CHAKRA: Located in the lower pelvis. When balanced, individuals feel creative, passionate, outgoing, and willing to take risks. Humans with imbalances may experience reproductive disorders, kidney/bladder dysfunction, fear, rigid thinking, or hip/pelvis/ lower back pain. Animals with imbalances may be lethargic, aloof or clingy, and have separation anxiety. They may also have poor personal boundaries. SOLAR PLEXUS CHAKRA: Located at the solar plexus just below the diaphragm. It plays a role in digestion and endocrine balance. It affects the stomach, liver, gallbladder, pancreas, and adrenals. When balanced, the individual is confident, has self-respect, and is in control. Humans with imbalances may experience chronic fatigue, digestion and liver dysfunction, stomach issues, low self-esteem, and fear of rejection/criticism. Animals with imbalances may lack confidence or be overly competitive, aggressive or dominant. HEART CHAKRA: Located in the thorax. When balanced, individuals feel joy, love, compassion, and trust. Humans with imbalances may have heart disease, lymphatic issues, shoulder problems, jealousy, anger, neediness, or separation anxiety. Animals with imbalances may be needy, clingy, and demanding or they may be disconnected, withdrawn and aloof.

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THROAT CHAKRA: Located in the throat area, it is home to creativity and the ability to speak the truth. When in balance, there is a free flow of honesty and truthfulness expressed in words. The person may also be a good listener! Humans with imbalances may see neck/ shoulder pain, throat or facial problems, lack of willpower and the inability to self-express appropriately. Animals may be overly vocal, not listen well, have a poor attention span, and be stubborn. Or, they may be timid, shy and introverted. BROW OR 3RD EYE CHAKRA: Located just above the eyes and between the brows. This chakra is all about self-awareness, spiritual vision, clarity and truth. When balanced, there is a sense of purpose and direction in life. The individual has a good memory, excellent problem solving skills, and a keen awareness of their place in society. Imbalances in humans appear as visual and auditory problems, headaches, dwelling in negative thought, learning disorders and hormone dysfunction. Animals with imbalances are poor learners, confused, can’t focus, and may be overly reliant on others for directions. CROWN CHAKRA: Located at the top of the head. It is associated with the pineal gland which is connected to spiritual awakening and expanded consciousness. This is where enlightenment, inspiration and higher consciousness reside for humans and animals. When balanced, one lives “in the present” and trusts their inner knowing. Imbalances for humans may be depression, an inability to learn, fear of alienation, a sensitivity to light and sound, and a disconnection with self-knowledge. Animals may be overly sensitive to environmental stimuli, anxious, worried and unable to relax.

Continued from page 25. flower and valerian root. All have ingredients known to calm the body and center the mind.

Flower Essences were first prepared in England in the 1930s by Dr. Edward Bach. Bach recognized the soul-spiritual dimensions of healing. Each of the 38 remedies in the Bach Flower system is associated with a basic human emotion. Using plant material, water and heat, the “vibrational energy” of the flower is transferred to the water. The person (or pet) can be muscle tested to see which remedies are needed to balance the energetic disturbances. Remedies can be taken orally or applied topically. Excellent reference books are also available to guide practitioners on flower essence selection for animals.

ADDITIONAL TOOLS FOR RELAXING AND REPROGRAMMING EMOTIONS

q Magnesphere™ is a Pulsed Electromagnetic device that is FDA approved for enhancing feelings of rest and relaxation. Studies using heart rate variability in people conclusively showed improvement when using the Magnesphere. Copper coils produce a low frequency signal, synchronous with the frequency of normal tissues, to restore normal vibration. Many readers will be familiar with another PEMF device, the Assisi Loop, which uses higher frequencies that work by interrupting the pain signal. Theta brain waves, measured at 4-7 Hz, are the brain frequencies of barely conscious states, just before sleeping and just after awakening. Theta is the intriguing border between the conscious and the subconscious worlds. When in a theta state, the mind is capable of deep and profound learning, healing and growth. The Magnesphere has frequencies that help attain a theta brain wave. The theta brain wave is the brain wave of hypnosis. Putting a patient in a theta brain wave state allows the practitioner to clear “trapped emotions” faster and more effectively. This emotional clearing technique also requires proficiency in muscle testing to identify the trapped emotions. This is particularly important for cancer patients who are holding onto unresolved resentments.

w Emotional Freedom Technique (EFT), also called “tapping”. The person “taps” on specific meridian acupuncture points while identifying the emotional stressors. The “tapping” activates the amygdala, part of the limbic system that plays a key role in the processing of emotions. The amygdala helps store memories of events and emotions so that an individual may be able to recognize similar events in the future. Tapping also stimulates the hippocampus (another part of the limbic system) to lower stress and reprogram negative beliefs. People can “tap” as a surrogate for their pets too.

Aromatherapy uses essential oils. As smells enter the olfactory system, signals are sent to the limbic system (comprising the amygdala, hypothalamus and hippocampus) which is known as the feeling center of the brain, responsible for emotion, behavior, motivation, memory and learning. Essential oils cause the brain to release neurotransmitters, such as serotonin, endorphins, and noradrenaline, depending on whether the oils were selected for their calming, euphoric, or stimulating effects. Essential oils have strong medicinal effects and must be used properly. Consult an aromatherapist knowledgeable in essential oil use for animals.

r TTouch® (also known as Tellington TTouch) is a body work method using circular movement to reduce fear and pain, enhance cellular function and communication, and support the healing potential of the body. When structural discomfort is reduced, there is reduction in anxiety and improvement in emotional balance.

t Fear Free® is a fee based training certification founded by veterinarian Dr. Marty Becker with contributions from experts in behavior medicine and handling. Their mission is to prevent and alleviate fear, anxiety, and stress in pets by inspiring and educating the people who care for them.

y Anti-anxiety clothing. The concept is to swaddle the pet and reinforce a sense of security.

u Core Distortion is a structural and energetic therapy that realigns the skull and spine, allowing the body to rebalance, improving energy flow and structure. This new modality is grounded in cranial sacral therapy, adding another dimension to the structural energetic therapy. Training on this technique will be available for veterinarians in the near future.

CONCLUSION I have extrapolated information learned from modalities on the human side and successfully adapted them to my animal patients, enabling the pets to release these “trapped emotions”, bringing healing to both the pet and the pet parent. Imagine having suitcases tied to your legs and “dragging” this baggage through life. Releasing these trapped emotions is like cutting the ties to the baggage. Most pet parents feel an emotional shift, becoming calmer and more peaceful as these trapped emotions are cleared. The universe, God, source energy, universal consciousness, whatever you choose to call it, that “energy” we are all connected to, is talking to us all the time, through our emotions and experiences. If we choose to listen more, life becomes a magical exploration with endless possibilities, limited only by our beliefs. IVC Winter 2020/2021

A NON-

INVASIVE

DIAGNOSTIC PROCESS FOR

BY HENRY K. YOO, DVM, MSC, MBA

FELINE GI LYMPHOMA

GI disorders are among the most common reasons cat parents visit the veterinarian. These patients are often empirically treated, either because clients cannot afford advanced and invasive diagnostics, and/or because the patient may not be a good candidate for anesthesia. Although a quality diagnosis may warrant a biopsy, the vast majority of feline patients with GI disorders do not get one.

MODES OF DIAGNOSIS • Ultrasound is highly effective in the differential diagnosis of patients with chronic enteropathies (CE). Evidence of gastric or intestinal wall thickening, intestinal lesions, and other pathognomonic findings are very helpful in differentiating normal cats from those with CE. Ultrasound can also aid in identifying patients suspected of having lymphosarcoma; however, ultrasonographic findings are not definitive and normal findings do not rule out a diagnosis of GI LSA. • Blood tests have recently become available to aid in the identification of feline CE. These tests include albumin, cobalamin, folate, total protein, lactate dehydrogenase, haptoglobin, and thymidine kinase type 1.1-5 • Cobalamin and folate testing are often performed on patients with CE. Cobalamin will often be low in acute pancreatitis, IBD, and LSA whereas folate will be low in IBD and LSA. In patients with small intestinal bacterial overgrowth (SIBO), folate is often elevated with low cobalamin.4 • Inflammation plays a central role in CE. Intestinal dysbiosis can lead to an inflammatory response and, if left uncorrected, to inflammatory bowel disease (IBD). The consensus is that chronic IBD may lead to abdominal LSA, which is most often seen in cats of advancing years. Measuring inflammation in cats can easily be performed using haptoglobin (HPT), a moderate, positive acute phase protein. HPT can be useful in differentiating normal patients versus those with CE. • Thymidine kinase, type 1 (TK1) is a DNA proliferation marker. TK1 makes the nucleotide thymine through the salvage pathway versus de novo synthesis, and is upregulated when there is a dysregulated cell cycle. Studies in humans, cats, and dogs have shown that TK1 is upregulated in LSA.5

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CONCLUSION Many of the aforementioned tests are individually and collectively processed at our laboratories, but when taken in combination, they provide escalating diagnostic value. A commercially available blood panel designed specifically for cats with CE includes TK1, HPT, cobalamin, and folate.6 These parameters are integrated statistically into an index called the Neoplasia Index® (NI). Additionally, levels of each parameter offer a unique signature to provide insight into disease classification (e.g., small cell, large cell, IBD). Patients with mediastinal LSA have also been found to have extremely high levels of TK1, making the blood panel useful for a wide range of lymphomas in cats. When clinical signs and other implications indicate chronic enteropathy, the use of blood testing and ultrasound is often sufficient to rule in a diagnosis of LSA. However, biopsy might still be highly diagnostic if the clinician has the means to proceed.

Paulin MV, Couronné L, Beguin J, et al. “Feline low-grade alimentary lymphoma: an emerging entity and a potential animal model for human disease”. BMC Veterinary Research 2018; 14(1):306. doi: 10.1186/s12917018-1635-5.

Awaysheh A, Wilcke J, Elvinger F, et al. “Evaluation of supervised machine-learning algorithms to distinguish between inflammatory bowel disease and alimentary lymphoma in cats”. Journal of Veterinary Diagnostic Investigation 2016; 28: 679–687.

Jugan MC, August JR. “Serum cobalamin concentrations and small intestinal ultrasound changes in 75 cats with clinical signs of gastrointestinal disease: a retrospective study”. J Feline Med Surg 2017; 19(1):48-56. doi: 10.1177/1098612X15598184. Epub 2016 Jul 11. PMID: 26239940.

Dossin O. “Laboratory tests for diagnosis of gastrointestinal and pancreatic diseases”. Top Companion Anim Med 2011; 26(2):86-97. doi: 10.1053/j.tcam.2011.02.005. PMID: 21596348; PMCID: PMC7104967.

Taylor SS, Dodkin S, Papasouliotis K, et al. “Serum thymidine kinase activity in clinically healthy and diseased cats: a potential biomarker for lymphoma”. Journal of Feline Medicine and Surgery 2013;15(2):142-147. doi:10.1177/1098612X12463928.

VDI Laboratory, Simi Valley, CA, www.vdilab.com.

Dr. Henry K. Yoo is Medical Director of Westchester Veterinary Center and Cat Clinic and an Adjunct Professor at Western University. He has worked as a researcher and faculty member in both veterinary and human medicine. His “5 Steps of Preventive Medicine” and “Value Chain in Veterinary Medicine” have been published in national veterinary journals and global periodicals. Dr. Yoo has served as the NAVLE Exam writer for the US and Canada. Presently, he is the President and Executive director of Infinity Medical Consulting & Co., which encompasses veterinary and human medicine.

Integrating ozone into treatment plans for animals with viral, bacterial, and fungal infections.

Photo courtesy of Dr. Margo Roman

PEER-REVIEWED

Ozone ne BY DR. MARGO ROMAN, DVM, CVA, COT, CPT

therapy: rapy:

an efficient and cost-effective treatment for infections in animal patients

As veterinarians in the 21st century, we need to be proactive, adaptable, and willing to pursue more efficient and costeffective solutions in medical care for animals. One particularly safe and effective method is medical ozone therapy. While it has been practiced for a century, ozone therapy has escaped the attention of many healthcare professionals. Medical ozone, generated from USP O2, with a resulting mixture of O2 and a tiny percentage of O3, is especially effective against microorganisms, and has been continuously observed as one of the most efficient and cost-effective options for reducing viral, bacterial, and fungal infections.1 This is especially important given the overuse of antibiotics and the growing and urgent demand for different antimicrobial options. In an August 2020 publication titled Antimicrobial Resistant Pathogens Affecting Animal Health in the U.S., the AVMA encourages good stewardship in relation to the overuse of antibiotic drugs.2 Ozone therapy is one way to practice this stewardship.

WHY OZONE? Medical ozone breaks down into various oxygen subspecies that adhere to viruses, bacteria, fungi, and other microbes, as

well as diseased and deficient tissues. Through oxidation and other chemical reactions, these disease-causing microorganisms and deficient cells are killed and eliminated from the body. The chemical reactions yield hydrogen peroxide, reactive oxygen species (ROS), and lipid oxidation products (LOPS). The United State Environmental Protection Agency (EPA) has recognized that “ozone is a very strong oxidant and virucide”3 One study states that “medical ozone is more bactericidal, fungicidal, and virucidal than any other natural substance”4 Additional studies proved that ozone infused into donated blood samples “can kill viruses 100% of the time.”5 Being a potent oxidant, ozone reacts immediately with a number of ions and biomolecules present in biological fluids, namely antioxidants, proteins, carbohydrates, and preferentially polyunsaturated fatty acids (PUFAS).1 Veterinary medical ozone has effectively treated infections from a wide range of microbes, including methicillin-resistant Staphylococcus aureus (MRSA) and other Streptococcus, Staphylococcus, Nocardia, and yeast species. It has been used to treat osteomyelitis, chronic skin and ear infections, moist dermatitis, bladder, kidney, and liver infections, ruptured pyometra with peritonitis, IVC Winter 2020/2021

OVERUSE OF ANTIBIOTICS & RESISTANCE DEVELOPMENT The Animal and Plant Health Inspection Service (APHIS) and the AVMA advocate for the restriction of antibiotic medication in the treatment of animals to reduce the risk of resistant strains in both animals and humans.6 The August 2020 Judicious Use of Antimicrobials on the AVMA website gives many reasons for this proactive stand on good stewardship.2 A recent study by the Mayo Clinic showed that children who had received antibiotics in the first two years of life had more allergies, celiac disease, autism, ADHD and asthma.7 A major contributor to developing immune resistance is the abundant use of antibiotics in animal diets. Antibiotics should be used judiciously in companion animals based on culture and sensitivity results, and if other effective therapies are unavailable or not indicated. Oxidative modalities such as medical ozone and hyperbaric oxygen, as well as Ultraviolet Blood Irradiation Therapy and Hemealumen (UVBI with photobiomodulation with red, green, amber, and blue light) are excellent options for fighting infections without the use of antibiotics. Oxidative modalities are even more effective when supported with complementary modalities such as herbal medicine, homeopathy, laser, Pulsed Electromagnetic Field therapy (PEMF), and acupuncture.

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meningitis, gut dysbiosis, parvo and other viral infections, and bacterial pneumonia. Dentists use ozonated water as a disinfectant because it effectively destroys bacterial biofilms.8 This is possible due to the oxidization of infected cells, stimulation of the mitochondria of healthy cells, and an increase in the production of NAD, ATP and NO within the Krebs cycle. This oxidative process speeds up the rate of recovery and helps reduce pain. Ozone therapy also stimulates the production of white blood cells to fight infection, and stimulates the membranes of red blood cells, a process that in turn increases the flexibility and distensibility of these cells. This chain of events increases the delivery of oxygen from the blood to the cells.9

CASE STUDIES • Feline coronavirus in a cattery A five-week-old Maine Coon kitten named Stella displayed symptoms of fatigue and lack of appetite shortly after being adopted in 2004. The client learned a week later that the cattery’s entire population of 30 cats developed an upper respiratory infection from feline coronavirus the day after Stella was adopted. All the cats were extremely ill, and eventually all had to be euthanized. Stella developed congestion in her eyes and sinuses along with inappetence. Her initial treatment included Nu-Cat liquid vitamins, Pet Tinic-B vitamins, First Defense Powder (an herbal mixture for upper respiratory infections), and one treatment of subcutaneous medical ozonated saline. This treatment helped some; however, the patient was still not recovering adequately a week later, as her upper respiratory issue was not resolving and she was still very congested. At this time, the patient was placed in her own carrier which was then inserted into a plastic bag. A tube was inserted into the carrier and ozone gas that had been bubbled through olive oil was carried through the tube into the sealed carrier. Bubbling ozone gas through olive oil generates ozonides and renders the ozone safe for inhalation therapy at low concentrations. These ozonides can be used to effectively treat viral, fungal, and bacterial lung infections. The cat was removed from her sealed carrier after 30 to 45 seconds. She struggled to breath due to the immense discharge from her mouth and nose. Her face was wiped clean. On her way home, the patient began to make gagging noises, but stopped as she expelled large amounts of mucus from her nose, mouth, eyes, and even ears. The client said, “I was pulling mucus out and it just kept coming; it was like ropey pieces.” After this, the kitten recovered within two days. Stella survived this severe infection and lived another 15½ years. • Parvovirus in a kennel In 2014, 20 dogs in a kennel, ranging in age from five weeks to adults, were diagnosed with parvovirus via a polymerase chain reaction test (PCR); even dogs who had received parvovirus vaccines were positive. A nine-month-old sled dog was taken to the emergency clinic and treated in intensive care for three days. The veterinarians at the clinic said there was nothing more they could do; the dog was losing consciousness, and they recommended euthanasia. The owner called this author’s hospital and wanted to try ozone therapy. The puppy was treated in the back of the owner’s car due to the severity of this contagious disease.

On presentation, the puppy was barely breathing. The mucus membranes were white, there was no anal tone, blood was pouring out of the anus, and the puppy was comatose with no expression of pain. We started ultraviolet light blood irradiation therapy (UVBI) of 2 mL of blood with 20 mL of ozonated saline, ½ mL of isotonic Biocean (a form of saline from the bottom of the ocean with full trace minerals), and warm water bottles placed near the puppy. We then gave subcutaneous ozonated saline, in two separate pockets, waited ten minutes, and then gave an injection of vitamins C and B complex in one pocket and vitamins A and D in the other. In addition to the other treatments, the dog’s rectum was insufflated with 40 cc ozone gas (55 ug/ ml) followed by an administration of 25 cc of Microbiome Restorative Therapy (MBRT) from Lili, our nine-year-old Standard Poodle fecal donor. The owner was instructed to give ozonated saline subcutaneously, oral fecal transplants of MBRT, the homeopathic medicine Veratrum album, and the parvo nosode to all the dogs in the kennel. As advised, the owner did not allow this very sick puppy near anyone else. She took the puppy up a back stairwell to the third floor, separated from the other dogs. Three hours after leaving the clinic, while making dinner, she looked behind her

and saw that the puppy was hungry, and had walked down the three flights of stairs to ask for food. The 18 remaining puppies and dogs that received the treatment of ozonated saline, oral MBRT, and homeopathics survived, all without any prescribed antibiotics. Only one dog that did not get the ozone and MBRT treatment died at the ER. The science behind medical ozone and ultraviolet light therapy shows it can reduce the viral and bacterial load, which allowed us to get the upper edge on these cases of parvovirus. Ozone gas was administered rectally and reduced the biofilm in the gut. The whole process circulated O3/O2 through the rectal vein to the caudal mesenteric vein to the liver, stimulating the mitochondria of the liver cells. Through MBRT, we were able to immediately transfer the healthy symbiotic microbiome of the canine fecal donor to this very ill dog. As observed in these cases, it can be postulated that bacteriophages in the gut (along with ozone therapy) may have been contributing factors in the dramatic four-hour turnaround of the ill sled dog puppy. These results suggest a suitable replacement for antibiotics. • Ruptured pyometra with severe peritonitis in a Lab An eight-year-old intact female Labrador Retriever, collapsed

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and moribund, was taken to surgery for a ruptured pyometra of 72 hours duration. Surgery revealed a pus-filled abdomen, a uterus dilated to 3" to 4" in diameter, and three areas of omental adhesions saturated with pus.

incision line. Four days post op her condition had improved so dramatically that all medications were discontinued, and she was given MBRT. No further medications were needed and she fully recovered.

The omentum and abdomen were lavaged with ozonated saline multiple times to bring both O3/O2 to tissues and remove the bacterial load. Ozonated saline was used to flush the vaginal canal. Homeopathic Phosphorus 200c was given during the surgery to help control bleeding. Post-operatively, multiple homeopathic treatments were used, including Arnica montana, Calendula officinalis, and Bellis perennis. In addition, acupuncture, and UVBI Hemealumen therapy were performed, and the patient was later offered ozonated water to drink.

• Lab with chemotherapy complications A two-year-old Labrador Retriever undergoing chemotherapy for lymphoma developed Nocardia infection within the proximal humerus. After three months of unsuccessful treatment with surgery, antibiotics, and antifungals, amputation was recommended.

She was discharged five hours later, sitting up and drinking water. Home care consisted of Rimadyl, Clavamox, and homeopathic Arnica 10M and Bellis perennis 200 C. Lactated Ringers Solution spiked with B-complex and vitamin C was also dispensed. The dog recovered astonishingly quickly. For the next two days, she received UVBI with Hemealumen, intraperitoneal ozone gas, ozonated saline, and some ozone gas injected at the

ADDITIONAL RESOURCES Altman N. The Oxygen Prescription: The Miracle of Oxidative Therapies. Healing Arts Press; 2007. Bocci V. “Ozone A New Medical Drug”. 2011. Retrieved from DOI: 10.1007/978-90-481-9234-2.

Ozonated saline was given subcutaneously over the area. The area was numbed, and then with guided ultrasound, ozone gas at 41 ug/ml was injected into the weakened bone where the osteomyelitis had been identified. Subsequent ozone injections along with UVBI with Hemealumen therapy were performed. Over a year later, the patient is still alive and did not require amputation of the leg. Ozone can also be implemented as a cancer treatment. Cancer is an anaerobic disease, and neoplastic cells do not thrive in a high oxygen environment. Weekly or monthly ozone treatments can be an important preventive step for individuals who have a predisposition to cancer.9 Incorporating ozone therapy into commonly-seen clinical conditions offers practitioners an effective, easy-to-implement option for managing infections in the veterinary setting. Continued research will illuminate further new applications.

Bocci V. “Does ozone therapy normalize the cellular redox balance? Implications for therapy of human immunodeficiency virus infection and several other diseases”. Med Hypotheses. 1996 Feb;46(2):150-4. doi: 10.1016/s0306-9877(96)90016-x. PMID: 8692040.

Menendez-Cepero S, Zamora Z, Hernandez F. “Importance of the Toxicological Tests in the Application and Safety of Ozone Therapy”, J Ozone Ther. 2018:2(3). Retrieved from DOI: 10.7203/jo3t.2.3.2018.10009.

“Antimicrobial-resistant pathogens affecting animal health in the U.S”. AVMA.org. https://www.avma.org/ sites/default/files/2020-10/AntimicrobialResistanceFullReport.pdf. August, 2020.

“Wastewater Technology Fact Sheet: Ozone Disinfection”. Epa.gov. https://19january2017snapshot.epa.gov/ sites/production/files/2015-06/documents/ozon.pdf. September, 1999.

Zaky S, Kamel SE, Hassan MS, Sallam NA, Shahata MA, Helal SR, Mahmoud H. “Preliminary results of ozone therapy as a possible treatment for patients with chronic hepatitis C”. J Altern Complement Med. 2011 Mar;17(3):259-63. doi: 10.1089/acm.2010.0016. PMID: 21417811.

Srisuknimit V J, “Fighting Fire with Fire: Killing bacteria with virus” Feb 1, 2018 Blog: Harvard Science In The News. Available here: http://sitn. hms.harvard.edu/flash/2018/bacteriophagesolution-antibiotics-problem Walker, M. “Covid-19 in the Ear: Have You Heard About the Risk for HCPs?” July 23, 2020. Retrieved from https://www.medpagetoday.com/ infectiousdisease/covid19/87720.

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Jani P, Patel G, Yadar P, Sant L, Jain H (2012). “Ozone therapy: the alternative medicine of the future”. Int J PharmBioSci;2(4):196-203.

“AAFP/AAHA basic guidelines of judicious therapeutic use of antimicrobials”. AVMA.org. https://www.avma. org/resources-tools/avma-policies/aafpaaha-basic-guidelines-judicious-therapeutic-use-antimicrobials.

Aversa Z, Atkinson EJ, Schafer, M et al. “Association of infant antibiotic exposure with childhood health outcomes”. mayoclinicoroceedings.org https://www.mayoclinicproceedings.org/article/S00256196(20)30785-0/fulltext#articleInformation. Nov 15, 2020.

Bialoszewski D, Pietruczuk-Padzik A, Kalicinska A, et al. “Activity of ozonated water and ozone against Staphylococcus aureus and Pseudomonas aeruginosa biofilms”. Med Sci Monit. 2011;17(11):BR339-BR344. doi:10.12659/msm.882044.

Shallenberger, F. AAOT lecture conference. “How Does Ozone Therapy Work”. Retrieved from a peer reviewed Powerpoint.

TESTOSTERONE REPLACEMENT THERAPY

— helping neutered and spayed dogs get back on their feet How Testosterone Replacement Therapy can benefit your neutered and spayed canine patients and offer a new revenue stream for your clinic. BY DAVID BIEBER, DVM

Dogs who have been spayed or neutered typically have very low levels of testosterone (< 0.1ng/ml) and may experience side effects as a result. If you notice that your patient has trouble getting up, has reduced muscle mass, or is knuckling the paws after being neutered or spayed, he/she may be experiencing side effects from reduced testosterone levels. Other side effects of reduced testosterone can include hip dysplasia, arthritis, intervertebral disc disease, or degenerative joint disease. These side effects can be reduced with Testosterone Replacement Therapy (TRT), which increases testosterone levels back to normal levels, restoring healthy muscle mass and bone density as well as increasing quality of life.

A LOOK AT THE BENEFITS The benefits of TRT are significant and free of side effects. I’ve conducted three clinical studies of TRT and found an increase in quality of life in over 140 canines, with a 95% success rate. In my most recent study of 38 spayed and neutered canines, conducted from 2011 to 2018, I found that the above mentioned medical conditions improved in 36 of the 38 dogs after TRT treatments. The two canines that did not show improvement had degenerative myelopathy. The findings also demonstrated that TRT was especially effective for improving mobility and energy. Currently, I’m working on expanding the benefits of TRT protocol to other clinical settings and to younger canines to help improve quality of life and increase longevity.

INTEGRATING TRT INTO YOUR PRACTICE From a practice perspective, TRT can provide your practice with an additional revenue stream yielding an average of $2,000 to $3,000 per patient annually. Veterinarians have faced increased competition from online retailers selling prescription pet foods,

medications, and nutraceuticals at reduced prices. However, TRT cannot be purchased online since it requires ongoing medical evaluation, and an IM injection of a DEA controlled substance. Therefore, in addition to improving quality of life for your patients, TRT can be a significant revenue stream for your practice. TRT can be used to assist in physical therapy for dogs who have been spayed or neutered. It should not be used on aggressive canines, any dog taking corticosteroids, or those with Cushing’s disease or neoplasia. I’ve been treating patients for over 12 years with Dogosterone, my own effective and innovative TRT treatment plan, which I’ve worked on over the years to simplify and improve. Certification in TRT, specifically Dogosterone, is necessary to properly diagnose, determine dosage, and to safely manage patient care while administering TRT. If you would like to get certified in Dogosterone Therapy, you can sign up for my online course curriculum and competency test, which is certified by AAVSB RACE, at dogosterone.com. Upon successful completion, you will have the knowledge to immediately implement TRT in your own practice. Completion of this course also includes marketing materials for your practice, listing you on our website as certified in Dogosterone Therapy, informational brochures for your clients, and two years of follow-up consultation to assist with any questions regarding TRT.

Dr. David Bieber attended Syracuse University, where, after just two years, he was accepted to and later graduated from the University of Pisa Veterinary School in Italy. In 1989, Dr. Bieber opened Sheridan West Animal Clinic, specializing in treating dogs, cats, reptiles and pocket pets. Since 2009, he has focused on rehabilitation for canines and felines, including platelet-rich-plasma therapy (PRP), stem cell therapy, Class IV Laser Therapy, pain management, and Dogosterone™ Therapy. IVC Winter 2020/2021

industry innovations

Healthy balance for healthy pets The endocannabinoid system (ECS) governs a number of critical functions in the body, including the neuronal, gastrointestinal, endocrine, immune, bone, and muscular systems. VF Hemp Oil from Standard Process helps support the ECS in dogs and cats. It comes in liquid form, which provides convenient, flexible dosing with a graduated dropper. It’s also gluten free, and contains nongenetically engineered hemp. standardprocess.com/Veterinary-Formulas

Premium pet food for your patients If you want to recommend a diet high in DHA, Omega fatty acids, and easily digestible proteins for your canine and feline patients, Healthy Shores premium pet food is the answer. Every can contains more than 85% humangrade wild North American fish and is AAFCO-compliant for a complete and balanced diet. The company offers four flavors — wild-caught Pacific Salmon, Albacore Tuna, Hake, and Herring. They use premium cut fish and the food is made in their human-grade seafood facility. healthyshores.com

National veterinary reference lab

The recent consolidation of veterinary reference labs has significantly reduced lab testing options and the healthy competition necessary to keep the quality of service high and prices low. Maranda Vet Labs (MVL) is a national veterinary reference laboratory that provides professional testing services for veterinary practices, animal shelters, and rescues. Founded and guided by veterinarians to ensure the highest ethical conduct, MVL clinical testing is performed by experienced laboratory technologists using equipment and techniques that meet or exceed reference lab standards. MVL is the better option to support your most common testing needs: member pricing, no contracts, and trusted results. MarandaVetLabs.com

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INNOVATION AWARD

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INNOVATIVE VETERINARY CARE JOURNAL

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Vegan pet foods that offer complete nutrition Feeding a dog or cat a flesh-based or vegan-vegetarian diet is problematic if the food isn’t providing all the nutrients required to stay healthy. Evolution Diet offers the only Complete-For-All-Life-Stage Plant Protein Pet Foods made in the US and Canada that meet or exceed Nutrition Research Council (NRC) and AAFCO Certification Standards for 100% nutritional completeness. Established in 1989, Evolution Diet has garnered several international awards over the years. No doubt a big part of this recognition is due to the high quality of the products —they are made from organic, non-GMO, and non-toxic, chemicalfree ingredients. petfoodshop.com

Homeopathic allergy eye drops Suppressing allergy symptoms with steroids, mast cell stabilizers, and antihistamines hinders the same processes the body uses to fight bacteria and viruses. Allergy Drops from Natural Ophthalmics are homeopathic, so the body reacts to them by desensitization. These eye drops stop allergy symptoms such as itching, burning, watering, edema, and general ocular sensitivity. They contain no preservatives and do not sting. Relief is accomplished with the first drop and there is no rebound effect when discontinued. NaturalEyeDrops.com

Mushroom-based immune support Maintaining healthy immunity in your patients is a key goal. I’m-Yunity® extract is a standardized ingredient polysaccharopeptide (PSP) that can only be isolated from the Coriolus versicolor mushroom. This extract supports immune health and helps stabilize white blood cell counts. It also enhances energy and appetite. Unlike other mushroom products, this is a pure herbal supplement. The vegetarian capsules can be used as an adjunct health supplement for animals with cancer and those on chemotherapy, as well as for the maintenance of good health. Tested to comply with heavy metal, pesticide, and microbial safety standards. buyimyunity.com

Nutrition system for dogs with cancer For your canine cancer patients, consider Canine Biologics’ Integrated Nutrition System. Formulated by veterinary oncologists, this unique threepart system combines 100% human grade food, salmon oil, and targeted supplements in a home-delivered nutrition solution that’s easy for pet parents to prepare. Whether used alone or in conjunction with veterinarianprescribed therapy plans, it supports the digestive, immune, integumentary, and other physiologic systems in dogs with cancer, and in animals that can benefit from additional nutritional support. Visit caninebiologics.com to learn more about their Veterinary Partner Program.

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Pet nutrition in flux:

WHY WHOLE FOODS STILL MAKE THE MOST SENSE A look at whole foods versus synthetic ingredients in pet foods and why the former offer superior benefits to your animal patients. BY TOM CAMERON, DVM The guaranteed analysis on a bag of pet food doesn’t tell the whole story. That is, it doesn’t tell which of the nutrients come from whole foods, and which are synthetic. But this clarification matters a great deal when it comes to supporting the health of your animal patients — and here’s why.

DEFINING “WHOLE FOODS” In the strictest sense, whole foods are: • In their original form as they occurred on the stalk, vine, tree, or ground • Grown in fertile soil and harvested without refinement • Contain a complex array of essential nutrients, enzymes, phytochemicals, and antioxidants to support health.

HOW PROCESSING IMPACTS NUTRIENTS Commercially manufactured kibble pet foods are processed at temperatures between 250° and 500° Fahrenheit. This processing varies from company to company, but all heat processing destroys or inactivates some food value. For instance, many vitamins and minerals are known to be destroyed or inactivated at 120° Fahrenheit and higher. Because whole foods exposed to heat lose nutrients, many holistic veterinarians recommend that some percentage of the diet be made up of uncooked fresh, unprocessed (and thus, whole) foods, to replace those nutrients. Many pet food brands are supplemented with synthetic vitamins and minerals after cooking. Those that are not must have an extremely high level of nutrition prior to processing so that appropriate nutritional value remains intact. In most cases, these are the brands you want to recommend.

BATTLE OF THE INGREDIENTS: WHOLE VS. SYNTHETIC Synthetic vitamins are structurally different from vitamins that occur in foods. Synthetic vitamins come in stereoisometric

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forms. While most naturally-occurring vitamins in foods have a structural rotation all to the right (most common) or to the left, synthetic vitamins come in combinations of many different rotations. Say for example that vitamin C from a carrot has a rotation like a right hand. This form of vitamin C fits perfectly into a right-handed receptor to be used by the body. Synthetic vitamins come in multiple rotations (say, both right and left hand shapes, some with no thumbs, some with only three fingers). This means that only a portion of synthetic vitamin C can be absorbed and used in the body. The rest must be disposed of like waste products, putting an added energy drain on the body. Several large-scale human studies have concluded that synthetic multivitamin use has had little or no effect on lowering the risk of various health conditions. Synthetic vitamins simply cannot work as effectively as vitamins from whole foods.

WEIGHING THE OPTIONS So what foods should you recommend to your clients? While some levels of nutritional integrity are preserved in the production of kibble, this is highly dependent on the initial quality of the food ingredients, and the extent of heat, pressure, and processing time these food ingredients are exposed to. Freeze dried foods are closer to fresh, but freeze drying also involves processing. For all the above reasons, the diet should ideally always contain at least 25% fresh, minimally processed foods. The more fresh food, the better pet health becomes — and that goes for the owners, too!

Dr. Tom Cameron earned his DVM from Michigan State University in 1982. A long-time proponent of canine and feline nutrition, he speaks nationally on the role of therapeutic nutrition in veterinary medicine. After 25 years of private practice, Dr. Cameron spent nine years as Director of Veterinary Education and Technical Support at Standard Process Inc. Other areas of interest include photonic therapy and cold laser treatments. He continues to teach veterinarians and pet owners how to use nutrition and targeted supplementation to optimize health. Dr. Cameron currently serves as a consulting veterinarian for Nature’s Logic, a 100% natural pet food with no synthetic vitamins or minerals.

PEER-REVIEWED

Recognizing and treating

myofascial pain in dogs

Skeletal muscle and fascia play roles in pain and dysfunction. This article explores why addressing both structural and functional changes can improve outcomes in canine patients.

BY DR. MICHELE BROADHURST, DC, CVC, CCSP, CCRP, FIAMA, MTECH CHIRO

Muscle and fascial pain in canine patients often occurs as a result of joint injury or dysfunction. If the joint is not functioning correctly, mechanical stress can be placed on the functional muscle unit of that joint (flexors, extensors, adductors, abductors, etc.) and the fascia associated with it. However, myofascial pain and dysfunction can also lead to joint dysfunction. Myofascial pain can follow nerve injury or dysfunction, and muscles innervated by an irritated or injured nerve can become painful.

SKELETAL MUSCLE AND FASCIA Skeletal muscle is one of the most adaptable tissues in the body. It makes up approximately 44% of live body weight in

mixed breed and purebred dogs. In greyhounds, muscle to live weight is approximately 57%.1 It is well recognized that the primary process by which change is created in skeletal muscle is the level of muscle activity in relation to normal muscle activity.2Â Every structural aspect of muscle can change given the proper stimulus.Â Muscle pain or myalgia is described as an aching, cramping pain that is difficult to localize and can refer to deep somatic tissues. Myalgia activates cortical structures and is inhibited by descending painmodulating pathways. The activation of nociceptors, also known as pain receptors, is very effective at inducing neuroplasticity in the dorsal horn neurons that occur in chronic pain.3 Continued on page 38. IVC Winter 2020/2021

Continued from page 37.

DRY NEEDLING OF MYOFASCIAL TRIGGER POINTS The reduction of a trigger point may be done by various methods: the preferred method (by this author) is by inserting a needle and releasing the trigger point. Alternative therapies include ischemic compression, injecting the trigger point, spray and stretch techniques, cold laser, extracorporeal shockwave therapy, and more. Deep dry needling of myofascial trigger points is associated with reduced local and referred pain, improved range of motion,15,16 and decreased MFTP irritability both locally17,18 and more remotely.19,20 Dry needling normalizes the chemical milieu and pH of skeletal muscle21-23 and restores local circulation.24 Superficial dry needling is thought to activate mechanoreceptors coupled to slow conducting unmyelinated C fiber afferents, and indirectly, stimulate the anterior cortex.25 Superficial dry needling may also be mediated through stimulation of A-delta fibers26 or via stretching of fibroblasts in connective tissue.27 This method is associated with reduced local and referred pain and improved range of motion.28,29 Dry needling, especially when used in combination with stimulation of the needle, can place fibroblasts in a high-tension matrix, at which point the fibroblast assumes a lamellar shape, and increases its collagen synthesis and cell proliferation.30,31 Dry needling has been shown to directly activate fibroblasts through mechanical manipulation of the needle,32,33 which in turn activates the release of cytokines and other proinflammatory mediators.34-37 It can play a substantial role in the process of mechano-transduction, which is described as the process by which the body converts mechanical loading into cellular responses.38-43 Fibroblast activation with a solid filament has been shown to result in pain neuromodulation.34

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Fascia has been defined as the connective tissue system that permeates the body, forming a continuous, whole-body, threedimensional matrix of structural support. It penetrates and surrounds all organs, muscles, bones, and nerve fibers. Every muscle fiber and every muscle belly are surrounded by fascia. This is extremely important because fascia transmits almost 40% of the force of a muscle contraction. Of equal or possibly even more importance, the fascia is a sensory organ that communicates with the CNS. Muscle spindle cells that help regulate muscle function are found in the fascia. If the fascia is too dense and unable to slide over and within muscle, then the spindle cells cannot provide normal feedback to the CNS. There will be abnormalities in muscle function, leading to eventual pain and dysfunction. Current research shows that the force generated from a muscle contraction is transmitted not along a tendon as previously thought, but rather by the connective tissue within the muscle and fascia, and both of these contain mechanoreceptors and proprioceptors. When a muscle is in use, the fascia that is connected to spindle cells stretches. The normal stretching of fascia communicates the force of the muscle contraction and the status of the muscle regarding its tone, movement, rate of change in muscle length, and position of the associated body part to the central nervous system (CNS). Fascia can be compared to a spider’s web that surrounds, separates, supports and protects the body down to the cellular level, while allowing the body to move freely. If you touch one portion of the web, the whole web moves, providing the spider with information that it then reacts to. Fascia is a whole-body communication system. If stimulated, it transmits a signal to every part of the body. Fascia evolves into tough, flexible supporting structures like ligaments and tendons and forms the bursae that reduce friction and allow free movement over joints. Fascia’s most essential job is to produce scar tissue after an injury and help stabilize the area while it’s being repaired. Another vital job is to keep the muscles separate so they’re able to slide past each other as they work in different directions. Fascia helps with delivery of fluids, nutrients, and oxygen as well as removal of toxins and waste. Electrical impulses flow through it, and it is thought that the energy or life force known as “Qi” in Traditional Chinese Medicine flows through it as well.

MYOFASCIAL TRIGGER POINTS Dr Janet Travell, the leading authority on myofascial pain in humans, defines a trigger point as a “hyperirritable locus within a taut band of skeletal muscle, located in the muscular tissue and or its associated fascia”.4 Myofascial trigger points (MFTPs) are located both in muscle and fascia, and are palpable and symptomatic in

their character. There is a resistance felt on palpation of the muscle, and the area is tender and painful. MFTPs are associated with dysfunctional motor endplates, endplate noise, and an increased release of acetylcholine. MFTPs activate muscle nociceptors and are peripheral sources of persistent nociceptive input, thus contributing to the development of peripheral and central sensitization. This results in changes in biomechanics, posture, and performance, and the development of many compensations that change the movement patterns of the dog.

Characteristics of myofascial trigger points MFTPs have three major characteristics: sensory, motor, and autonomic. The muscle pain or myalgia associated with MFTPs is described in humans as diffuse, deep, and difficult to localize with defined referred pain patterns. When the MFTP is manually stimulated, localized, and if the trigger point is active, referred pain is appreciated. Very often palpation of a MFTP in a dog can result in a â&#x20AC;&#x153;jump signâ&#x20AC;?, a pain response resulting in vocalization and/ or withdrawal as pressure is applied. Other sensory aspects include peripheral and central sensitization. Peripheral sensitization can be described as a reduction in threshold, and an increase in responsiveness of the peripheral ends of nociceptors. Central sensitization is best explained as a physicochemical change resulting in increased excitability of neurons within the CNS.5 Motor abnormalities of MFTPs include the development of a taut band within the muscle, a local twitch response (LTR) with stimulation, muscle weakness without atrophy, and loss of reciprocal inhibition.6 The taut band is a localized band of hardened muscle within the softer homogeneous muscle. Taut bands IVC Winter 2020/2021

Myofascial dry needling being performed with a pincer grip.

are identified as running parallel to muscle fibers and can be described as a localized contracture within the muscle without nerve-initiated activation of the motor endplate or neuromuscular junction.7

What is the difference between MFTPs and muscle spasm? Muscle injury alters the normal equilibrium between the release and breakdown of acetylcholine, and its removal by acetylcholinesterase from acetylcholine receptors in the postsynaptic membrane. Substances such as calcitonin gene related peptide (CGRP) and Substance P (SP), released during muscle injury, facilitate increased release of acetylcholine, inhibition of breakdown, and upregulation of acetylcholine receptors. A persistent muscle fiber contraction develops leading to the development of the taut band and subsequently to the formation of MFTPs. Trigger points can be described as segments of muscle fiber with intensely contracted sarcomeres and increased diameter.

It is postulated that there is a problem at the motor endplate resulting in excessive release of acetylcholine. This excess results in sarcomere shortening that has been observed histopathologically. Contraction knots or areas of concentrated focal sarcomere contraction have been described in animals and humans.8,9 Muscle spasm is the result of increased neuromuscular tone of the entire muscle due to a nerve-initiated contraction. A muscle spasm that is painful is referred to as a muscle cramp. The contracture associated with the taut band also results in reduction in range of motion. The MFTP is located within the taut band and is what distinguishes it from other painful areas within muscle.10 The local twitch response (LTR) is another motor component of MFTPs that separates them from other myofascial pathologies. A local twitch response is a unique involuntary spinal cord reflex resulting in a rapid contraction of the taut band following manual stimulation of the MFTP. Manual stimulation can be accomplished by direct palpation or introduction of a needle. The LTR in dogs can also serve as verification of a MFTP.

Clockwise from left: Fascia and the underlying muscle; Fascia; Off weighting and biomechanical compensations due to myofascial trigger points, 12 weeks post TPLO.

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Muscle Fiber

process.12 Additional motor or muscle dysfunction from MFTPs is brought about by disordered recruitment or altered muscle activation patterns in muscles that work together to produce a specific action.13,14

Normal Muscle Fiber Trigger points

Taut Muscle Bands

Muscle overuse or overload and direct trauma are the most common causes of MFTPs. Low-level muscle contractions, uneven intramuscular pressure distribution, direct trauma, unaccustomed eccentric contractions, eccentric contraction in unconditioned muscle, and maximal or submaximal concentric contractions can lead to muscle injury and subsequent development of MFTPs.

An illustration of a myofascial trigger point

Weakness is recognized in muscles that have MFTPs. This weakness occurs without atrophy and is not related to neuropathy or myopathy.11 Weakness is usually rapidly reversible immediately upon inactivation of the MFTP. This rapid reversal suggests that weakness is a result of inhibited muscle activation. Remember that MFTPs in one muscle can inhibit the function of contractile force in another, proving a central inhibition An illustration of the canine myofascial system.

Clinical applications Let’s look at this a little more clinically so you can understand the significance of myofascial pain in your clinic.

Myofascial trigger points found in the hamstring muscles.

• A dog presents with non-weight-bearing pelvic limb lameness and has adopted hopping actions in the contralateral pelvic limb, resulting in unusual eccentric contractions of the coxofemoral and stifle extensors in an attempt to limit flexion. ROM of the coxofemoral joint decreases, as does thoracolumbar vertebral mobility; this is because the lumbar paraspinal muscles become overloaded as they must now assist with ambulation and not solely spinal stabilization. The iliopsoas develops MFTPs and this results in a hyperkyphotic thoracolumbar posture. This may be an acute or chronic injury; the compensatory mechanisms we see are the same. • A dog presents with a CCL tear. The dog goes to surgery but refuses to use the leg and is showing abnormal biomechanics on a walk or trot, due to myofascial compensations. If we do not treat the compensations, the dog’s full recovery is in jeopardy as the abnormal biomechanics will remain. • In dogs with osteoarthritis, myofascial pain syndromes occur and MFTPs form because of sustained lowIVC Winter 2020/2021

DEFINING FASCIA — parallels between mainstream and Chinese medicine

In Traditional Chinese Medicine, the similarities between the Sanjiao and the Connective-Tissue Metasystem or fascia are very clear and are interchangeable. Ancient Chinese scholars believed that the Sanjiao or Triple Energizer was the largest Fu (Yang) organ in the body. They believed the Sanjiao was a literal organ located inside the body but outside the other Zang-fu (Yin-Yang) organs. Due to this configuration, the Sanjiao has no defined morphology, and was therefore known to be “formless” because it took on the shape of the surrounding organs. These two “formless” organ complexes (Sanjiao and Connective-Tissue Metasystem or fascia) can be seen to occupy the same space within the body. The Triple-Energizer Metasystem is a dedicated organ system in TCM. There is a direct correlation between fascia as defined by “modern medicine” and the Triple-Energizer meridian. Myers44 says that “fascia forms the biological container and connector for every organ” and that it is “much more than plastic wrap around the muscles” and other organs. Ting Chin45 stated, “The Triple Burner is a large bag supporting the organism from outside and holding it inside.” In Unschuld’s44 translation of the Nan-ching, Huang Wei-san said, “The Triple Burner is a fatty membrane covering the entire physical body from the inside.” Regarding the Connective-Tissue Metasystem, Myers and others have reported that since fascia is so variable, the actual architecture is difficult to define. Therefore, even though it exists, it does not have a true form. In Unschuld’s44 translation of the Nanching, Hsü Ta-ch’un says, “The text states that the Triple Burner has no form. The Sanjiao Triple-Energizer Meridian is essentially one and the same as the fascial metasystem.”

Evans HE, de Lahunta A: Miller’s Anatomy of the Dog, 4th Edition. Elsevier Saunders, 2013, St. Louis, Missouri.

Simons DG, Travell JG, Simons LS: Myofascial Pain and Dysfunction: The Trigger Point Manual. Volume 1. Upper Half of Body 1999; Lippincott Williams & Wilkins, Baltimore, Maryland.

Dommerholt J, Shah JP:“Myofascial Pain Syndrome”In: Ballantyne JC, Rathmell JP, Fishman SM, Editors: Bonica’s Pain Management, 4th Edition, Lippincott, Williams & Wilkins, 2010. Baltimore, Maryland. Chapter 35:450-471.

Travell, Janet and David Simons. Myofascial Pain and Dysfunction: The trigger point manual Vol1. Baltimore: Williams and Wilkins , 1983.

Simons DG, Stolov WC: “Microscopic Features of Transient Contraction of Palpable Bands in Canine Muscle”. Am J of Physical Med 1776; 55(2):65-88.

Mense S, Gerwin RD: Muscle Pain: Diagnosis and Treatment 2010; Springer-Verlag Berlin Heidelberg.

Gerwin RD, Shannon S, Hong CZ, et al: “Interrater reliability in myofascial trigger point examination”. Pain 1997; 69:65-73.

Mense S, Gerwin RD: Muscle Pain: Diagnosis and Treatment 2010; Springer-Verlag Berlin Heidelberg.

Gerwin RD, Dommerholt J, Shah JP: “An Expansion of Simon’s Integrated Hypothesis for Trigger Point Formation”. Current Pain and Headache Rep 2004; 8:468-475.

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This is an incredibly in-depth topic that requires much more discussion than one article can provide. The relationship between the structural and functional elements of the body, and how they interact and compensate for each other, is a fascinating topic. Without identifying functional as well as structural dysfunctions, and addressing them correctly, effectively, and concurrently, we will never be able to provide a fully integrated system of care that ensures the best possible outcome for our patients.

Gerwin RD: “Myofascial and Visceral Pain Syndromes: Visceral-Somatic Pain Representations”. J Musculoskel Pain 2002; 10(1/2):165-175.

IN CONCLUSION

Gerwin R: “A study of 96 subjects examined for both fibromyalgia and myofascial pain”. J Musculoskel Pain 1995; 3:121.

level contractions in a muscle or group of muscles. When a muscle needs to perform a low-level contraction, only a few muscle fibers are enlisted for that action. When these low-level contractions occur, the same few muscle fibers are always used, and even if they become exhausted, no other muscle fibers attempt to help out. This has been referred to as the “Cinderella hypothesis”. The rest of the muscle, just like Cinderella’s sisters, never help out: the same fibers are the first to activate, do all the work on their own, and are the last to retire. Again, compensations and physiological changes occur in the exhausted overused muscles that result in a decrease of activity in those recruited muscles. We see an increase in lameness, weakness, and disability that is attributed to age-related dysfunction but can be addressed on a functional level and corrected and improved if we know what to look for.

Lucas KR, Rich PA, Polus BI: “Muscle Activation patterns in the scapular positioning muscles during loaded scapular plane elevation: The effects of Latent Myofascial Trigger Points”. Clin Biomech 2010; 8:765-70. Simons DG: “Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction”. J Electromyogr Kinesiol 2004; 14:95-107.

Lucas KR, Rich PA, Polus BI. “Muscle activation patterns in the scapular positioning muscles during loaded scapular plane elevation: the effects of latent myofascial trigger points”. Clin Biomechanics. 2010;25(8):765-770. Lucas KR, Polus BI, Rich PS. “Latent myofascial trigger points: their effects on muscle activation and movement efficiency”. J Bodyw Mov Ther. 2004;8:160-166.

Kuan TS, Hsieh YL, Chen SM, Chen JT, Yen WC, Hong CZ. “The myofascial trigger point region: correlation between the degree of irritability and the prevalence of endplate noise”. Am J Phys Med Rehabil. 2007;86(3):183-189.

Chen JT, Chung KC, Hou CR, Kuan TS, Chen SM, Hong CZ. “Inhibitory effect of dry needling on the spontaneous electrical activity recorded from myofascial trigger spots of rabbit skeletal muscle”. Am J Phys.

Hsieh YL, Chou LW, Joe YS, Hong CZ. “Spinal cord mechanism involving the remote effects of dry needling on the irritability of myofascial trigger spots in rabbit skeletal muscle”. Arch Phys Med Rehabil. Jul 2011;92(7):1098-1105.

Tsai C-T, Hsieh L-F, Kuan T-S, Kao M-J, Chou L-W, Hong C-Z. “Remote effects of dry needling on the irritability of the myofascial trigger point in the upper trapezius muscle”. Am J Phys Med Rehabil. 2010;89(2):133-140.

Shah JP, Gilliams EA. “Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome”. J Bodyw Mov Ther. Oct 2008;12(4):371-384.

Shah J, Phillips T, Danoff JV, Gerber LH. “A novel microanalytical technique for assaying soft tissue demonstrates significant quantitative biomechanical differences in 3 clinically distinct groups: normal, latent and active”. Arch Phys Med Rehabil. 2003;84:A4.

Shah JP, Danoff JV, Desai MJ, et al. “Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial triggerpoints”. Arch Phys Med Rehabil. Jan 2008;89(1):16-23.

Simons DG. “Understanding effective treatments of myofascial trigger points”. J Bodyw Mov Ther. 2002;6(2):81-88.

Olausson H, Lamarre Y, Backlund H, et al. “Unmyelinated tactile afferents signal touch and project to insular cortex”. Nat Neurosci Sep 2002;5(9):900-904.

Baldry PE. Acupuncture, Trigger Points and Musculoskeletal Pain. Edinburgh: Churchill Livingstone; 2005.

Langevin HM, Bouffard NA, Badger GJ, Iatridis JC, Howe AK. “Dynamic fibroblast cytoskeletal response to subcutaneous tissue stretch ex vivo and in vivo”. Am J Physiol Cell Physiol. Mar 2005;288(3):C747-756.

Edwards J, Knowles N. “Superficial dry needling and active stretching in the treatment of myofascial pain--a randomised controlled trial”. Acupunct Med. 2003/9 2003;21(3 SU):80-86.

Simons DG, Mense S. “Understanding and measurement of muscle tone as related to clinical muscle pain”. Pain. 1998;75(1):1-17.

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 OIL THERAPY SUPPORTS AN ANXIOUS TERRIER

A three-year-old Jack Russell Terrier presented with chronic pancreatitis. He was underweight with nervousness and anxiety. His guardian exhibited a “Type A” personality. For initial therapy, only Lavender (Lavandula angustifolia) essential oil was recommended, since all other conventional medical approaches had already been used with no success. The guardian was asked to place one or two drops on her dog’s back and belly using a baby application technique. She was then asked to hold her hands by his nose until he walked away. I also asked her to inhale and envision the calm needed for her dog.

Hicks MR, Cao TV, Campbell DH, Standley PR. “Mechanical strain applied to human fibroblasts differentially regulates skeletal myoblast differentiation”. J Appl Physiol. Aug 2012;113(3):465-472.

Langevin HM, Bouffard NA, Fox JR, et al.“Fibroblast cytoskeletal remodeling contributes to connective tissue tension”. J Cell Physiol. May 2011;226(5):1166-1175.

Fu ZH, Wang JH, Sun JH, Chen XY, Xu JG. “Fu’s subcutaneous needling: possible clinical evidence of the subcutaneous connective tissue in acupuncture”. J Altern Complement Med. Jan-Feb 2007;13(1):47-51.

Fu ZH, Chen XY, Lu LJ, Lin J, Xu JG. “Immediate effect of Fu’s subcutaneous needling for low back pain”. Chin Med J. (Engl). Jun 5 2006;119(11):953-956.

Chiquet M, Renedo AS, Huber F, Fluck M. “How do fibroblasts translate mechanical signals into changes in extracellular matrix production?” Matrix Biol. Mar 2003;22(1):73-80.

L angevin HM, Storch KN, Snapp RR, et al. “Tissue stretch induces nuclear remodeling in connective tissue fibroblasts”, Hitochemistry and Microbiology, 2010 Apr;133(4):405-15. doi: 10.1007/s00418-010-0680-3.Epub 2010 Mar 18. Dommerholt J, Shah JP: “Myofascial Pain Syndrome” In: Ballantyne JC, Rathmell JP, Fishman SM, Editors: Bonica’s Pain Management, 4th Edition, Lippincott, Williams & Wilkins, 2010. Baltimore, Maryland. Chapter 35:450-471

Two weeks later, they returned — the dog had fully recovered. Ten years later, he has suffered no recurrence of the pancreatitis. Lavandula angustifolia is a nervine and sedative. In psychoemotional circles, it is known as a way to balance relationship energy. It is known that the energy of the guardian can affect the energy of the pet, and in TCVM, the emotions associated with the spleen, stomach, and pancreas are pensiveness and worry, for which Lavender is effective. At 13 years of age, this dog continues to be well. His guardian only occasionally uses the Lavender oil when “Mom gets a bit uptight”.

Svensson P, Minoshima S, Beydoun A, et al: “Cerebral processing of acute skin and muscle pain in humans”. J Neurophysiol 1997; 78(1):450-460.

Niddam DM, Chan RC, Lee SH, et al: “Central modulation of pain evoked from myofascial trigger point”. Clin J Pain 2007; 23(5): 440-448.

Hagglund M, Walden M, Bahr R, et al: “Methods of epidemiological study of injuries to professional football players: developing the UEFA model”. Br J Sports Med 2005; 39:340-346.

Mueller-Wohlfahrt HW, Haensel L, Mithoefer K, et al: “Terminology and classification of muscle injuries in sport: the Munich consensus statement”. Br J Sports Med 2013; 47(6):342-350.

Evans J, Levesque D, Shelton GD:“Canine inflammatory myopathies: a clinicopathologic review of 200 cases”. J Vet Intern Med 2004; 18(5):679-691.

Shelton GD: “Routine and specialized laboratory testing for the diagnosis of neuromuscular diseases in dogs and cats”. Vet Clin Path 2010; 39(3):278-295.

Dommerholt J, Huijbregts P: Myofascial Trigger Points – Pathophysiology and Evidence-Informed Diagnosis and Management, 2011; Jones and Bartlett Publishers,Sudbury, Massachusetts.

Myers, T., “Fascial Fitness: Training in the Neuromyofascial Web”, IDEA Fitness Journal, 8/4 (2011).

Unschuld, P. U., Nan Ching: The Classic of Difficult Issues (e-book edn, Los Angeles: University of California Press, 1986), 771. With commentaries by Chinese and Japanese authors from the third through the twentieth century.

Submitted by Nancy Brandt DVM, CVC, CVA, CVMA IVC Winter 2020/2021

Plant-based diets for dogs Trends in companion animal nutrition often mirror those in human nutrition. This reflects the desire of pet owners to feed diets that they consider healthy and beneficial to their pets. Some owners also want to feed their animals in a similar way to how they feed themselves. Diets composed of greater quantities of plant-based ingredients are becoming more popular due to concerns about the environmental, ethical, and health impacts of food. Our research team at the University of Guelph performed a survey of pet owner attitudes about plant-based diets. Almost half of respondents expressed interest in these diets but they had concerns about nutritional completeness, veterinarian disapproval and availability. As a result, we published a literature review to provide veterinarians with evidence-based guidance for clients who wish to feed plant-based diets to their adult dogs.1 Nutrients of concern are those found in high levels in animal tissues but not in plants: • Total amount of protein and protein quality must be considered, which depends on protein digestibility and amino acid composition and availability compared to species requirements. Dogs require 22 amino acids. They can make 12 of these from other precursors (the non-essential amino acids). The other ten are essential amino acids they must obtain through food. Because most plant proteins have an amino acid that is in short supply relative to requirements (i.e. limiting amino acid), complementary proteins are used to provide all amino acids in the required amounts. Oats and peas are complementary proteins. When provided together, in the same or even a different meal, they provide a balance of all essential amino acids. • Alpha-linolenic acid is the only essential Omega-3 polyunsaturated fatty acid required to maintain health in adult dogs. It is found in oilseeds such as canola and flax. OATS

PEAS

BY JENNIFER ADOLPHE, PHD, NUTRITION MANAGER AT PETCUREAN, AND SARAH DODD, BVSC, MSC, PHD CANDIDATE, ECVCN RESIDENT

The longer chain Omega-3 fatty acids, EPA and DHA, can be produced from alpha-linolenic acid. While this conversion is inefficient in dogs, it is adequate to meet nutritional needs. However, if it is desirable to fortify plant-based dog food with EPA and DHA due to the anti-inflammatory and cognitive benefits of these nutrients, some species of marine algae have recently been identified to be rich sources of these fatty acids. • Vitamin A is a fat-soluble vitamin found exclusively in animal tissues. Dogs can convert carotenoids (e.g. beta-carotene) found in vegetables to vitamin A. Vitamin A requirements of dogs fed plant-based diets can be met by including vegetables rich in beta-carotene, or through a preformed vitamin A supplement. • Vitamin B12 is a water-soluble vitamin not found in plant materials, but abundant in animal tissues. The animals themselves are not actually the source of B12. It is the microorganisms within their digestive tract that synthesize the vitamin, which is taken up by the animal and stored in their tissues. Supplements of vitamin B12 synthesized by microorganisms are readily available. • Dogs are unable to synthesize vitamin D in their skin as can many other mammals, so they require a dietary source. A limited number of ingredients, such as egg yolk, liver, and fatty fish, are natural sources of vitamin D. To meet the requirements using non-animal sources, supplements are available that contain vitamin D2 (ergocalciferol) from fungi, or vitamin D3 (cholecalciferol) from lichen. • Animal tissues are rich sources of calcium, phosphorus, potassium, and zinc. However, adequate quantities of these minerals can be readily met through supplementation of plantbased diets. Sustainable sources of protein are critical from a planetary health perspective. By considering the use of plant-based over animal-based proteins, we can help OATS PEAS mitigate the environmental impact of pet food.

Dodd SAS, Adolphe JL, Verbrugghe A. Plant-based diets for dogs. J. Am. Vet. Med. Assoc. 2018;253(11): 1425-1432.

Representation of essential amino acid profile of oats and peas. Complementary proteins provide a balance of all essential amino acids.

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innovative practice

Maintaining the health of your feline patients when they reach their golden years involves engaging owners in their cats’ care before they become seniors.

How to ensure feline patients stay healthy as they age BY ANGIE KRAUSE, DVM, CVA, CCRT

Cats are a growing yet overlooked sector of the pet population. For decades, veterinary medicine has treated cats like small dogs. Much cat behavior is misinterpreted and misunderstood by society and animal professionals alike. These factors, combined with a cat’s independent nature, have led to a lack of healthcare for felines worldwide. This article presents ways for veterinarians to engage clients in their cats’ healthcare — well before they become seniors. This improves quality of life, deepens the human-cat bond, and ensures healthier senior years for your feline patients.

STEP #1:

IMPLEMENT WAYS TO GET CATS IN THE CLINIC

We cannot advocate and care for our patients without seeing them on a regular basis. Most cat guardians are not aware that their cats need regular veterinary care. As a result, painful conditions such as tooth resorption, IBD, and arthritis go undiagnosed and untreated. Our job as veterinarians is to reach and educate as many cat parents as possible. One of the easiest and most efficient ways to do this is by reaching cat guardians IVC Winter 2020/2021

via text, email, and social media. The following are strategies to engage cat parents and increase the number of feline exams in your practice.

Use email and text engagement Most veterinary practices communicate with clients via text and email to send reminders. Email and text are fertile mediums for creating a consistently engaged relationship with your clients. Keeping in touch with clients with relevant content pertaining to their cats is a great way to educate and increase compliance. Weekly email or text messages can be a mix of fun and informative content. This allows clients to learn with digestible forms of information and gives them the opportunity to hit reply and engage with you.

Current clients with cats are the most important group on your email list to engage. If your client has only cats, be sure they receive cat-specific content. This will help them feel connected and engaged with you and your clinic. The second group to engage is clients who bring their dogs or other species to your practice, but have cats at home who are not yet established in the practice. Individual clients can be added to this group by asking if their other pets live with cats at home. The third group includes cat guardians who have not been seen in your clinic but live in the area. Running targeted ads on social media channels such as Facebook, Instagram, and Pinterest is a great way to grow your email list and increase the number of cat exams in your clinic. Hiring an ads expert is recommended to help create the most targeted ad possible.

Write blog posts

For example, many cat guardians donâ&#x20AC;&#x2122;t realize that vomiting at any frequency is abnormal for a cat and should not be ignored. This fact, delivered in email or text, may trigger a visit that allows you to perform diagnostics and recommend diet changes. The discussion about IBD can start years earlier and save many cats years of pain and suffering. When clients understand that their cat may have IBD, and they understand it is treatable, they are more likely to return for diagnostics or come in for regular examination.

Blog posts are a great way to maintain an accessible bank of information for your clients. Links to these posts can be sent out via email, text message, and even in exam notes to provide your clients with more information on everything from nail trims to tips on managing diabetic cats. These posts can also be shared on social media to reach current and prospective clients.

Producing weekly content may sound overwhelming for the busy practitioner. However, using email marketing tools such as MailChimp or ActiveCampaign can automate emails. These emails can be repeated yearly to save time. Blog posts and video content can be created by the entire veterinary team. As content is created, it can be stored in a bank and be updated and recycled as needed.

Blogs can be quick and easy to read and help prepare clients for veterinary visits. For example, when a feline patient turns ten, you may send out an article on the top three reasons the cat needs bloodwork. The client may also be interested in learning the top five ways cats show pain. This blog could be sent out annually after cats reach the age of 12.

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Your blogs can also help cat parents find credible information written by a veterinarian or veterinary professional. Writing and publishing these articles on Wordpress helps cat parents find your clinic when they use common search terms applicable to the article.

Create video content Video is a great way to educate and stay in touch with cat parents in and outside of your practice. Video links can be sent out via text message and email while producing great ranking on social media channels. Educational videos can help demonstrate common procedures performed at home and can also be entertaining. It’s helpful for cat parents to see videos that demonstrate how to medicate cats, trim nails, and administer subcutaneous fluids. Providing links to these educational videos can also decrease the time spent by veterinarians and staff in the exam room. High quality videos can be produced with a lavalier lapel microphone, a smartphone, and a tripod. Videos can easily be edited and uploaded to YouTube or Vimeo from a smartphone.

STEP #2:

MAKE THE KITTY’S EXPERIENCE POSITIVE After you have successfully scheduled your feline patient for an examination, it’s time to ensure that the experience is positive for both the cat and owner.

Prepare your client and patient A smooth veterinary visit starts at home. Send your client information on how to prepare in advance, when possible. A series of videos or blogs with tips on carrier selection and the process of acclimating the cat to the carrier can help reduce stress on the way to the clinic. Using synthetic pheromones, such as Feliway, can also reduce stress. For established patients, prescribing gabapentin to be given by mouth two hours prior to the visit can greatly reduce a feline patient’s stress, and increase compliance. This improved compliance may expand the diagnostics and treatments the patient is willing to tolerate.

Educate veterinary staff Handling and treating cats is an art. Skillful handling can increase compliance while keeping veterinary staff safe. Investing in staff training on how to gently restrain cats can yield great returns for both cats and veterinary practices, including a larger number of tolerated diagnostics and treatments. This author recommends training from Fear Free Pets and the American Association of Feline Practitioners. Both offer education and certifications for staff and hospitals.

Keep the cat and guardian together Letting the guardian stay present for physical exams, treatments, and sample collection can help keep them engaged, and build a

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relationship of trust. Using pre-visit medications such as gabapentin can make sample collection and treatments easier and safer for both the patient and staff. Gentle restraint in the presence of the guardian may further enhance client compliance due to increased comfort levels. Some clients may feel uncomfortable while some procedures may be inappropriate to perform in front of them. It’s important to communicate with your clients to understand their preferences.

STEP #3:

MAINTAIN COMMUNICATION AND CONTACT POINTS Once you have established a relationship with your client, and have a clinical picture of the feline patient, it’s important to set up ongoing communication. Below is an outline of common areas in feline disease and how to maintain communication and education with clients.

Dental disease This is an area where cats are often neglected. Many cats live with painful resorptive lesions their entire lives. Start talking about tooth resorption at every exam when cats are young. Show guardians how to look for these lesions and which teeth are commonly affected. Teach that these lesions are painful, and most cats will not stop eating nor express their extreme discomfort. For cats that have already been diagnosed and treated for tooth resorption, send reminders for free quarterly oral exams and yearly sedated exams with full mouth radiographs. Educating clients on the clinic’s anesthesia protocols may also increase compliance with regular dental procedures. Teaching clients how to examine their cats’ mouths can be more attainable than recommending that they brush their teeth daily. Empower them to look for canine tip fractures, tooth resorption, and gingivitis on a weekly basis. This information can be delivered in exam rooms and also as video or blog delivered by email, text, and through social media channels.

Kidney disease Most cats will experience some degree of kidney disease in their senior years. It’s important that clients know the symptoms associated with feline kidney disease and understand the importance of early detection. Diagnosing renal disease in its early stages may help slow its progression and allow the detection of related problems such as hypertension and pyelonephritis.

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This is a great opportunity to use the reminder systems in your veterinary software to trigger client communication. For example, when a patient has been diagnosed with IRIS Stage 1-2 renal disease, a reminder for blood pressure readings should be set for every six months. This would also be a good time to send an automated email sequence educating clients on different aspects of renal disease, such as diet, supplements, and subcutaneous fluids.

Chronic pain Many cats live with chronic pain from arthritis and other orthopedic and neurological diseases. Indoor cats are often expected to be sedentary, and cat parents don’t often notice when they become less mobile. Teach your clients to look for changes in mobility and how to assess pain while petting their cats. Discuss the possible treatment options such as chiropractic, acupuncture, laser therapy, massage, and pharmaceuticals. When clients know there are ways to help treat pain, they may be more motivated to look for signs of it.

Mental health issues As we begin to better understand feline behavior, we can appreciate that keeping cats indoors with other cats, as well as feeding them twice daily, can have serious impacts on their mental and emotional health. These effects can manifest in lower urinary tract disease, psychogenic alopecia, and inappropriate elimination. Our canine patients often have professional trainers advocating for their mental health. Cats rely on veterinarians to educate their guardians on ways to enrich their mental and emotional well-being. Mental health tips are great to disperse in emails and through social media. Giving your clients tips about the number and location of litter boxes, recommending food puzzles, and encouraging play before feeding to mimic the prey cycle can have positive impacts on feline mental health. Recommending catios or other ways to help kitties safely enjoy outside time can be life-changing for many cats. Cats depend on you as a veterinarian to engage guardians to help them receive the medical care they deserve. Felines have long been underserved, and they need us to advocate for them now more than ever. This author encourages you to utilize the strategies in this article to reach and educate more cat guardians.

Successful self-regulation: how NASC bridges a gap and elevates the standard for quality in dog and cat supplements BY BILL BOOKOUT

Millions of people give animal health and nutritional supplements to their dogs and cats. Sometimes it’s to address a specific concern, to proactively support good health, or provide targeted nutritional benefits. No matter the reason, supplements can be an important part of a dog or cat’s wellness regimen. Animal health and nutritional supplements are overseen and regulated by the U.S. Food and Drug Administration’s Center for Veterinary Medicine (FDA-CVM), and in many cases by individual state regulatory agencies as well. What consumers may not understand is that unlike pharmaceuticals, supplements for animals (and people) do not require FDA approval to be manufactured or sold. There is no law that requires supplements to be evaluated before their release, nor are label claims required to be proven accurate or truthful prior to marketing. It is only after a supplement is introduced for sale that this all changes. The FDA and state regulators then have legal authority to review the product, its label claims, and any reported adverse events. They can pull a product from shelves if a problem is discovered; the product is not properly labeled; or the company is acting irresponsibly. But even then, dog and cat supplements are typically not a high regulatory priority unless a major issue arises.

NASC members are responsible manufacturers and suppliers of animal health and nutritional supplements, and are committed to quality, vigilance, and embracing a philosophy of continuous improvement within their own companies and the industry at large. The NASC Quality Program provides strict guidelines for product quality assurance in written, consistent raw material sourcing and manufacturing standards, adverse event reporting, and labeling requirements that are within the guidelines provided by the regulatory agencies. To earn permission to display the NASC Quality Seal on its products and marketing materials, an NASC member company must pass a comprehensive facility audit every two years, maintain ongoing compliance with rigorous NASC quality standards, participate in annual continuing education facilitated by NASC, and pass random independent testing of their products to ensure they are meeting label claims. Consumers can have confidence in products with the NASC Quality Seal because they come from reputable suppliers that meet NASC’s demanding requirements.

Consumers often take it for granted that if a product is available for sale then it is being produced and supported by a responsible company. But sometimes this isn’t the case, and products of questionable quality may reach store shelves. So where does this leave you, and how can you trust products?

No single person or company can change an entire industry. But when a group of companies that represents over 80% of their industry share a vision for a system of transparency, collaboration, and the implementation of best practices, the result is successful self-regulation that bridges the gap between what the law requires and what consumers demand. This benefits the ultimate stakeholders — the millions of dogs and cats that are given supplements by those who want them to live their best lives.

This is where the National Animal Supplement Council (NASC) comes in. Made up of supplement manufacturers and suppliers who are competitors in everyday life, NASC member companies have banded together to collectively address issues and affect important change, which ultimately elevates the industry and results in better practices, procedures, and products.

Bill Bookout is president and founder of the National Animal Supplement Council. He has more than 30 years’ experience in the animal health industry and holds a bachelor’s degree in physical sciences from the University of Wyoming, and a master’s degree from the Pepperdine University Presidents and Key Executives MBA program. IVC Winter 2020/2021

The benefits of CAAM for ANIMAL HEALING AND WELLNESS A better understanding of chelated amino acid minerals (CAAM) and how they work in the body will help you promote health and prevent disease in your animal patients. BY VAN HARDING, LAC, NCCAOM

In the animal body, blood levels of minerals are constantly held to critical measures. When the levels change slightly, the animal may appear ill. The way to heal many diseases and maintain health is by managing levels of macro and micro (trace) minerals.

CHELATED AMINO ACID MINERALS (CAAM) Animals are designed to ingest chelated minerals that naturally exist in plants and animal tissue. They also have the ability through digestion to create chelated minerals, but at lower levels that do not meet their needs. The term chelation comes from the Greek word chele, which means claw; a chelator functions like a crab’s pincer that takes hold of food. A chelator is a molecule of a mineral that has been bonded together with organic matter, such as an amino acid (AA). Plants create CAAM through their roots; they absorb minerals from soil and then chelate amino acids, helping the plants to grow. In animals, during digestion, HCl in the stomach breaks down proteins into amino acids that then come in contact with a mineral. The +/- attraction causes the molecule to become chelated. Animals that eat other animals consume CAAM from the prey. The intestinal mucus allows minerals that weigh less than 1,500 daltons to easily be absorbed. All CAAM molecules are the correct size for the intestines. Also, when a mineral becomes chelated, it becomes magnetically neutral, and this prevents the CAAM from connecting to an organic salt and being discharged in feces.

Today, it is important to supplement the diet with CAAM. Depending upon geography, some soils do not contain certain minerals. As well, industrial farming has depleted minerals in soil, pet food manufacturing has reduced mineral contents by cooking, and animals with GI problems cannot absorb and assimilate minerals well. The lack of minerals in pet food gives rise to many diseases and behavior problems. Target Organ

Major & Micro Minerals

Spleen S, P, K, Se, Na Thyroid I, S, P, K, Se, Na Adrenals S, P, K, Se, Na Brain Fe, Mg, Mn, Zn, S, P, K, Se, Na Bones Ca, Fl, S, P, K, Se, Na Heart Zn, Mn, Fe, S, P, K, Se, Na Muscles Zn, Ca, Mg, S, P, K, Se, Na Blood Zn, Ca, Cu, Fe, Mo, S, P, K, Se, Na Liver Zn, Mn, Fe, S, P, K, Se, Na Lung Mn, S, P, K, Se, Na Pancreas Cr, Mn, Ni, S, P, K, Se, Na Kidney Zn, Mn, Fe, S, P, K, Se, Na Skin Si, S, P, K, Se, Na

Target Organ Spleen Thyroid Adrenals Brain Bones Heart Muscles Blood Liver Lung Pancreas Kidney Skin

Major Amino Acids

glutamic, leucine, lysine glutamic, leucine, proline glutamic, leucine, lysine arginine, phenylalanine, lysine glutamic, leucine, serine glutamic, leucine, lysine glutamic, lysine, isoleucine aspartic acid, leucine, lysine glutamic, leucine, lysine glutamic, leucine, threonine glutamic, leucine, lysine glutamic, leucine, lysine serine, glutamic, glycine

Research in human nutrition involving the testing of CAAM with radioactive isotopes has identified that CAAM are directed to where they are needed; they are “tagged” or “targeted” to organs and systems. The charts above show examples from research in nutritional and functional medicine in people. Animals will have their own unique needs according to species. When combined, minerals and amino acids create CAAM for a target organ to be healed or maintain health. The quality standard for buying CAAM comes from worldwide companies backed by patented technology and proven science. These companies also remove waste resulting from the chelating process, leaving the chelates pure. The pure chelated mineral is bioavailable and can target the appropriate organs or systems. Dynamite (animalandhumannutrition101.com) is a company that utilizes CAAM, allowing healing from the inside out.

In 2002 at the age of 40, Van Harding experienced a major health crisis and was given six to 12 months to live. He chose from his Bucket List to resume the study of his life's passion — horses. He was introduced to Complementary and Alternative Medicine (CAM) by several of the world’s top veterinarians and therapists. Those medicines combined with guidance from his mentors, his prior medical science knowledge (pre-med and pre-veterinary sciences), and his problem-solving skills led to creative solutions and eventually the restoration of his health. Van established a horse therapy practice and entered acupuncture college. He is now dedicated to bringing these powerful therapies and medicine practices to a wide range of conditions.

IVC Winter 2020/2021

Rethinking the role of

metronidazole in veterinary medicine This article discusses the appropriate and inappropriate uses of metronidazole, highlights current research that contradicts our older assumptions, and prompts some questioning to determine if this drug is an ideal choice.

BY DAWN KINGSBURY, DVM, PHD, DIP. ACVIM (SAIM),* ELLEN BARBER,° AND HOLLY GANZ, PHD*

When your patients have diarrhea, a course of metronidazole (Flagyl) might be the appropriate treatment. However, this antibiotic has become a knee-jerk response to cases of diarrhea based on good theory and historical practice, rather than scientific evidence. A growing body of evidence-based research suggests that metronidazole is much less effective for some gastrointestinal conditions than previously thought. In addition to potential adverse side effects, we now know that metronidazole can cause unhealthy long-term changes in a pet’s gut microbiome.1,2 Because metronidazole has activity against several diarrhetic agents, it has become the most frequently-used antibiotic for nonspecific diarrhea.3 But in some cases, it may be the wrong choice. Several studies have found that metronidazole doesn’t help inflammatory bowel disease (IBD)4 or acute diarrhea in dogs.5 So is metronidazole the right treatment for your patients? Or could we be doing more harm than good by prescribing it?

WHEN IS METRONIDAZOLE THE RIGHT CHOICE? Metronidazole is an extremely useful antibiotic and antiprotozoal agent that’s been around since the 1950s. In both human and veterinary medicine, it has cured life-threatening anaerobic infections. Being bactericidal, metronidazole has the potential to work faster and more efficiently than other antibiotics (e.g. clindamycin). • Metronidazole is effective against Bacteroides fragilis, a normal gut and mouth commensal that can be isolated from wound infections, abscesses, pyothorax, and cholangiohepatitis. Metronidazole has historically been used for suspected anaerobic osteomyelitis, especially involving the jaw and mouth.6 However, more recent reviews suggest suboptimal bone penetration.7 • Metronidazole works well against Clostridioides — a genus of bacteria that includes C. difficile, a well-known cause of antibiotic-associated diarrhea in humans and an implicated IVC Winter 2020/2021

cause in animals.8–10 With regards to acute, nonspecific, canine diarrhea cases given metronidazole, a one-to-two-day shorter recovery has been reported.11

dysbiosis. A new study published this year in the Journal of Veterinary Internal Medicine calls attention to metronidazole’s dramatic effects on the canine gut microbiome.1

• In pets, metronidazole has been used to treat Helicobacter gastritis. However, resistance is problematic.12–14 When polymicrobial sepsis is suspected, it’s a valuable and inexpensive addition to the arsenal to broaden anaerobic coverage. Whether used for Helicobacter or sepsis, metronidazole is combined with other medications, which can complicate interpretation of in vitro culture and sensitivities.

Healthy dogs were medicated with a 14-day course of metronidazole; more than 50% developed diarrhea during treatment. The gut microbiome composition changed significantly, and included decreases in important beneficial bacteria, such as Fusobacteria — one of the dominant phyla of bacteria in the gut microbiomes of dogs and cats — and reductions in overall richness (the number of different bacterial species present). Effects were not temporary: four weeks post metronidazole, microbiome changes had not fully resolved, compromising healthy gut function.

• Historically, metronidazole was effective against Giardia.15 However, resistance has developed, so again, combination therapy is often recommended for refractory infections.16

A NEW STUDY URGES CAUTION IN CHOOSING METRONIDAZOLE

The authors recommend that veterinarians adopt a more cautious approach when using metronidazole, particularly in dysbiotic patients.

Along with the pathogens, most antibiotics also alter the commensal populations needed for health. As a result, important gut microbiome populations can be decimated, leading to

QUESTIONS TO ASK WHEN CONSIDERING METRONIDAZOLE FOR A PATIENT

TEST YOUR PATIENT’S

MICROBIOME

COMPOSITION AFTER A COURSE OF ANTIBIOTICS After finishing a course of metronidazole or any other antibiotic, it’s important to find out what changes the medication might have made to your patient’s unique microbiome, especially dysbiosis. Testing your patient’s microbiome composition will give you valuable information about the bacterial populations present, along with any missing beneficial taxa, and help you assess how to best support your patient’s health.

While metronidazole is shown to be an appropriate choice for some conditions, in other cases, it may not be as effective as we have assumed. Consider whether metronidazole will be beneficial for your patient. Here are some questions to ask: 1. Does my patient need antibiotics? In many cases of canine diarrhea, the answer may be no. Though some health issues, such as life-threatening bacterial infections, do require antibiotics, other conditions may resolve with supportive care alone. For example, dogs with hemorrhagic gastroenteritis are often given antibiotics, but according to veterinary consensus guidelines, antibiotics are appropriate for this condition only when sepsis is present.17,18 Researchers have found that as long as sepsis is not involved, even hemorrhagic gastroenteritis responds just as well to supportive care as to antibiotics.19

For example, if your patient’s fecal sample shows a deficiency in the important Fusobacteria phylum (which metronidazole can reduce), increasing the amount of protein in the pet’s diet may help, since Fusobacteria flourish in protein-rich environments.1,45

In fact, several studies have shown that metronidazole can actually make diarrhea worse, not only by reducing populations of “good” anaerobic bacteria, but also by altering the intestinal mucus.20,21

If antibiotic therapy has resulted in missing beneficial bacteria that your patient needs for gut health, FMT material can be administered with a fresh feces enema in-clinic, or via freeze-dried feces made into oral capsules to replenish the missing microbial diversity.

2. What are the possible side effects of metronidazole? Most medications have potential adverse side effects. Metronidazole has a very bitter taste and often causes excessive salivation, drooling, gagging, or frothing at the mouth, especially in cats. In both cats and dogs, the drug may also cause nausea and hyporexia. Pets taking metronidazole may eat less than

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usual or refuse meals altogether. Vomiting and diarrhea are also relatively common. More serious, though less common, adverse effects include lethargy, weakness, hepatopathy, central nervous system signs such as nystagmus, head tilt, loss of balance and coordination, stumbling, knuckling, or even seizures. Teratogenicity has been recorded in rodents, though not humans.22 Rare idiosyncratic reactions in dogs have included pancytopenia.23 In cats, metronidazole has been found to cause reversible DNA damage to lymphocytes.24 Given long term and at a high dose in female mice, tumor-promoting effects are documented, and its carcinogenic potential has been questioned in people.25,26 3. Does my patient have any conditions that would make a bad reaction more likely? Metronidazole should not be used when a patient has had an adverse reaction to it in the past. While some medications have been shown to increase the metabolism of metronidazole (e.g. prednisone and phenobarbital), no medications have been shown to clearly decrease metabolism.27 Don’t use metronidazole if your patient might be pregnant.28 If your patient has liver disease, metronidazole should be used very cautiously and at a lowered dose. It should also be used cautiously in any animal with a compromised nervous system or suspected neoplasia. 4. Are there any supplements that can be combined with metronidazole to improve the outcome for my patient? • Certain probiotics may help support better outcomes and reduce side effects. In a study of shelter dogs with diarrhea, a combination of the probiotic Enterococcus faecium SF68 and metronidazole led to better overall results than metronidazole alone.29 • When silymarin (an anti-inflammatory flavonoid derived from milk thistle seed) was combined with metronidazole to treat Giardia in another study, dogs had better appetite, less intermittent vomiting, and less weight loss than when receiving metronidazole alone.30 • Adding the yeast Saccharomyces boulardii to a pet’s food may reduce the risk of antibiotic-associated diarrhea.31 S. boulardii is a probiotic that works by supporting beneficial gut bacteria and inhibiting the growth of pathogenic bacteria. 5. What are the alternatives to metronidazole? Are there alternatives to metronidazole for treating aspects of your patient’s gastrointestinal (GI) signs? Hippocrates is often credited with the maxim, “Let thy food be thy medicine and medicine be thy food.” Veterinarians have long used dietary modification in disease management. Given the plethora of amassing scientific evidence, diet is IVC Winter 2020/2021

A PERSPECTIVE ON ANTIBIOTIC USE IN VETERINARY MEDICINE Antimicrobial therapies, including antibiotics, have had a profound impact on both human and animal health. Prior to Alexander Fleming’s discovery in 1928 that penicillin inhibited the growth of bacteria, no treatments existed for infections such as pneumonia, gonorrhea, and rheumatic fever. Many surgical procedures and chemotherapies that are common today would not be possible without the availability of antimicrobial therapies.

ANTIMICROBIAL STEWARDSHIP

However, as Fleming himself warned, the overuse of antimicrobials can lead to the development of antimicrobial resistance, not only in the bacterial pathogens being targeted but also in other related microorganisms. The modern world continues to see valuable, lifesaving antibiotics lose their effectiveness as pathobionts become resistant to them. In order to prevent antibiotic resistance, doctors and veterinarians must use these medications judiciously — which includes identifying the actual cause of a given infection through diagnostics and making sure the antibiotic being prescribed has been proven effective against that cause. This approach, known as antimicrobial stewardship, can produce better patient outcomes, reduce resistance to antimicrobial drugs, and decrease the spread of deadly infections caused by multidrugresistant microorganisms.

MICROBIOME DISRUPTION

Another danger is the tendency of antimicrobials to disrupt the gut microbiome, causing dysbiosis. Furthermore, concerns grow regarding the use of antimicrobials in animals whose gut microbiomes are already imbalanced, such as pets with IBD or other chronic gastrointestinal disorders. Given these risks, it’s important to explore the viable alternatives to antibiotic usage. For example, both probiotics and fecal microbiota transplantation (FMT) have been investigated as alternative approaches to IBD and other causes of diarrhea in dogs.49,50 A 2020 study concluded that FMT works better than metronidazole in dogs with acute diarrhea because FMT helps restore gut health, whereas metronidazole “has a negative impact” on the microbiome.5

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cemented as the foundation of health. For example, diarrhea often equates with dysbiosis. Prebiotic fibers such as inulin and psyllium may help by feeding beneficial bacterial populations while also firming up the stool. As mentioned previously, probiotic blends can help resolve diarrhea and support gut function. Empirical evidence for the use of phytonutrients like carvacrol (extracted from oregano, thyme and several other plants) is accumulating.32–38 Other symptomatic treatments include anti-nausea medications, proton pump inhibitors (to reduce acid production), motility inhibitors (to reduce cramping and the sense of urgency), bile acid sequestrants (to control bile acid malabsorption in chronic diarrhea cases), and vitamin B12 (cobalamin, which is often deficient in chronic diarrhea cases).39–42 While some of these approaches may also cause changes to the gut microbiome, those changes will generally be less profound than the effects associated with metronidazole. Lastly, if your patient’s microbiome is significantly dysbiotic, the introduction of beneficial microbes via fecal microbiota transplantation (FMT) — i.e. Microbiome Restoration Therapy (MBRT) — can help by seeding the gut with a whole healthy community of dog- or cat-specific bacteria. Recent studies have found that FMT improves restoration of the gut microbiome from antibiotic exposure; one of these studies also found that probiotics may impair its recovery.43,44

INAPPROPRIATE USES OF METRONIDAZOLE Because past research has found metronidazole to be effective against certain causes of diarrhea in dogs, it has become many veterinarians’ go-to treatment for diarrhea in general. The problem is that there isn’t much scientific evidence that metronidazole actually helps some of the conditions it’s being used for. And yet, even without strong scientific evidence of its effectiveness, metronidazole has become the most commonly prescribed antimicrobial agent for acute diarrhea in dogs.3 Here are three common situations in which research has found metronidazole to be the wrong choice. • Giardia infection In the past, metronidazole was commonly used to treat infections caused by the protozoan parasites Giardia and Tritrichomonas, which are known to cause diarrhea in cats and dogs. Over time, however, both these organisms have developed metronidazole resistance, so this medication by itself is no longer a curative treatment for these protozoal infections.46

• Inflammatory bowel disease (IBD) Because metronidazole has a positive effect on Crohn’s disease in humans, it is often used for diarrhea in dogs with IBD and other chronic diseases of the intestines, usually in combination with the steroid prednisone.47 However, researchers established in 2010 that metronidazole doesn’t actually add any benefit in this scenario: prednisone plus metronidazole is no more effective for IBD than prednisone by itself.4 • Acute diarrhea Because of its historical effectiveness against such diarrheainducing agents as Giardia and C. diff, metronidazole has been increasingly used by veterinarians to manage diarrhea due to other causes. But there is little evidence that it actually helps acute, nonspecific diarrhea (diarrhea with an undetermined cause) — a category that represents the majority of diarrhea cases in both cats and dogs.

MINIMIZING METRONIDAZOLE’S BITTER TASTE If you prescribe metronidazole, consider putting the medication in an empty food-grade capsule (either gelatin or plant-based) or have a compounding pharmacy formulate a palatable liquid to minimize the drug’s bitter taste.

Pilla R, Gaschen FP, Barr JW, et al. Effects of metronidazole on the fecal microbiome and metabolome in healthy dogs. J Vet Intern Med. Published online August 28, 2020. doi:10.1111/jvim.15871

Igarashi H, Maeda S, Ohno K, Horigome A, Odamaki T, Tsujimoto H. Effect of oral administration of metronidazole or prednisolone on fecal microbiota in dogs. PLoS One. 2014;9(9):e107909.

Singleton DA, Noble PJM, Sánchez-Vizcaíno F, et al. Pharmaceutical Prescription in Canine Acute Diarrhoea: A Longitudinal Electronic Health Record Analysis of First Opinion Veterinary Practices. Front Vet Sci. 2019;6:218.

In the veterinary sphere, there is some evidence that metronidazole reduces the time it takes for acute diarrhea to resolve. However, a study in dogs found that this reduction amounted to only a couple of days. And as the authors pointed out, most cases of diarrhea in dogs resolve in a few days “regardless of treatment.”11

Another study that looked at treating acute diarrhea in dogs found no significant difference between metronidazole and a placebo. The authors concluded that the use of metronidazole for such cases “should be discouraged until evidence-based data demonstrate a difference in treatment outcome.”48

Jergens AE, Crandell J, Morrison JA, et al. Comparison of oral prednisone and prednisone combined with metronidazole for induction therapy of canine inflammatory bowel disease: a randomized-controlled trial. J Vet Intern Med. 2010;24(2):269-277. Chaitman J, Ziese A-L, Pilla R, et al. Fecal Microbial and Metabolic Profiles in Dogs With Acute Diarrhea Receiving Either Fecal Microbiota Transplantation or Oral Metronidazole. Front Vet Sci. 2020;7:192.

Spellberg B, Lipsky BA. Systemic antibiotic therapy for chronic osteomyelitis in adults. Clin Infect Dis. 2012;54(3):393-407.

Thabit AK, Fatani DF, Bamakhrama MS, Barnawi OA, Basudan LO, Alhejaili SF. Antibiotic penetration into bone and joints: An updated review. Int J Infect Dis. 2019;81:128-136.

Marks SL, Kather EJ. Antimicrobial susceptibilities of canine Clostridium difficile and Clostridium perfringens isolates to commonly utilized antimicrobial drugs. Vet Microbiol. 2003;94(1):39-45. Wetterwik K-J, Trowald-Wigh G, Fernström L-L, Krovacek K. Clostridium difficile in faeces from healthy dogs and dogs with diarrhea. Acta Vet Scand. 2013;55:23.

Chon J-W, Seo K-H, Bae D, Park J-H, Khan S, Sung K. Prevalence, toxin gene profile, antibiotic resistance, and molecular characterization of Clostridium perfringens from diarrheic and non-diarrheic dogs in Korea. J Vet Sci. 2018;19(3):368-374.

Langlois DK, Koenigshof AM, Mani R. Metronidazole treatment of acute diarrhea in dogs: A randomized double blinded placebo-controlled clinical trial. J Vet Intern Med. 2020;34(1):98-104.

SUMMARY RECOMMENDATIONS We encourage veterinarians to discuss these issues with their clients. Metronidazole and other antibiotics can be valuable tools in treating a sick pet, but it’s important to make sure the chosen drug’s effectiveness in a given situation is supported by scientific evidence. And if your patient already suffers from an imbalanced gut microbiome, due to chronic GI issues or other health problems, antibiotics should be used only if absolutely necessary. Additionally, testing your patient’s microbiome after a course of antibiotics (see sidebar on page 52) is recommended, especially if GI signs linger. Identifying and correcting any dysbiosis can make an enormous difference in your patient’s long-term health and happiness.

Baele M, Decostere A, Vandamme P, et al. Helicobacter baculiformis sp. nov., isolated from feline stomach mucosa. Int J Syst Evol Microbiol. 2008;58(Pt 2):357-364.

Veyrier FJ, Ecobichon C, Boneca IG. Draft Genome Sequence of Strain X47-2AL, a Feline Helicobacter pylori Isolate. Genome Announc. 2013;1(6). doi:10.1128/genomeA.01095-13

Kondadi PK, Pacini C, Revez J, Hänninen M-L, Rossi M. Contingency nature of Helicobacter bizzozeronii oxygen-insensitive NAD(P)H-nitroreductase (HBZC1_00960) and its role in metronidazole resistance. Vet Res. 2013;44:56.

Scorza AV, Lappin MR. Metronidazole for the treatment of feline giardiasis. J Feline Med Surg. 2004;6(3):157-160.

Argüello-García R, Leitsch D, Skinner-Adams T, Ortega-Pierres MG. Drug resistance in Giardia: Mechanisms and alternative treatments for Giardiasis. Adv Parasitol. 2020;107:201-282.

Lutz B, Lehner C, Schmitt K, et al. Antimicrobial prescriptions and adherence to prudent use guidelines for selected canine diseases in Switzerland in 2016. Vet Rec Open. 2020;7(1):e000370.

Weese JS, Giguère S, Guardabassi L, et al. ACVIM consensus statement on therapeutic antimicrobial use in animals and antimicrobial resistance. J Vet Intern Med. 2015;29(2):487-498.

Unterer S, Strohmeyer K, Kruse BD, Sauter-Louis C, Hartmann K. Treatment of aseptic dogs with hemorrhagic gastroenteritis with amoxicillin/clavulanic acid: a prospective blinded study. J Vet Intern Med. 2011;25(5):973-979.

Wells CL, Maddaus MA, Reynolds CM, Jechorek RP, Simmons RL. Role of anaerobic flora in the translocation of aerobic and facultatively anaerobic intestinal bacteria. Infect Immun. 1987;55(11):2689-2694.

*Affiliated with AnimalBiome °Affiliated with Condensed Light

Wlodarska M, Willing B, Keeney KM, et al. Antibiotic treatment alters the colonic mucus layer and predisposes the host to exacerbated Citrobacter rodentium-induced colitis. Infect Immun. 2011;79(4):1536-1545. References continued on page 56.

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References continued from page 55. Sheehy O, Santos F, Ferreira E, Berard A. The use of metronidazole during pregnancy: a review of evidence. Curr Drug Saf. 2015;10(2):170-179.

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.

Weiss DJ. Bone marrow necrosis in dogs: 34 cases (1996-2004). J Am Vet Med Assoc. 2005;227(2):263-267.

Sekis I, Ramstead K, Rishniw M, et al. Single-dose pharmacokinetics and genotoxicity of metronidazole in cats. J Feline Med Surg. 2009;11(2):60-68.

Bendesky A, Menéndez D, Ostrosky-Wegman P. Is metronidazole carcinogenic? Mutat Res. 2002;511(2):133-144.

Adil M, Iqbal W, Adnan F, et al. Association of Metronidazole with Cancer: A Potential Risk Factor or Inconsistent Deductions? Curr Drug Metab. 2018;19(11):902-909.

Eradiri O, Jamali F, Thomson AB. Interaction of metronidazole with phenobarbital, cimetidine, prednisone, and sulfasalazine in Crohn’s disease. Biopharm Drug Dispos. 1988;9(2):219-227.

Pichler L. Teratogenicity in dogs and cats-a review for practitioners and toxicologists. Wien Tierarztl Monatsschr. 2007;94(9/10):214.

Fenimore A, Martin L, Lappin MR. Evaluation of Metronidazole With and Without Enterococcus Faecium SF68 in Shelter Dogs With Diarrhea. Top Companion Anim Med. 2017;32(3):100-103.

NERVOUS DOGS, NERVOUS OWNERS? Nervous dog owners tend to have nervous dogs. One trainer has said: “The tension flows down the leash.” I like this, as it relates to the energetic nature of the problem. This truth has became obvious to me during my 30+ years of veterinary practice, and is finally being recognized in scientific literature. The conclusion seems to be that neurotic owners behave differently, and dogs read this emotion and react to it. The result is that long-term stress levels become synchronized in dogs and their owners. Although mental symptoms are tricky to gauge in animals, homeopathy offers some options for anxiety. The New World Veterinary Repertory lists 208 remedies under the rubric “MIND; anxiety”, and then breaks this down into subcategories. Here are a few highlights, covering some of the more common presentations in our animal friends, with the number of remedies in parentheses:

Chon S-K, Kim N-S. Evaluation of silymarin in the treatment on asymptomatic Giardia infections in dogs. Parasitol Res. 2005;97(6):445-451.

McFarland LV, Surawicz CM, Greenberg RN, et al. Prevention of beta-lactam-associated diarrhea by Saccharomyces boulardii compared with placebo. Am J Gastroenterol. 1995;90(3):439-448.

Mousavi S, Schmidt A-M, Escher U, et al. Carvacrol ameliorates acute campylobacteriosis in a clinical murine infection model. Gut Pathog. 2020;12:2.

Yuan W, Seng ZJ, Kohli GS, Yang L, Yuk H-G. Stress Resistance Development and Genome-Wide Transcriptional Response of Escherichia coli O157:H7 Adapted to Sublethal Thymol, Carvacrol, and transCinnamaldehyde. Appl Environ Microbiol. 2018;84(22). doi:10.1128/AEM.01616-18

Gaur S, Kuhlenschmidt TB, Kuhlenschmidt MS, Andrade JE. Effect of oregano essential oil and carvacrol on Cryptosporidium parvum infectivity in HCT-8 cells. Parasitol Int. 2018;67(2):170-175.

Giovagnoni G, Rossi B, Tugnoli B, et al. Thymol and Carvacrol Downregulate the Expression of Salmonella typhimurium Virulence Genes during an In Vitro Infection on Caco-2 Cells. Microorganisms. 2020;8(6). doi:10.3390/microorganisms8060862

Sánchez C, Aznar R, Sánchez G. The effect of carvacrol on enteric viruses. Int J Food Microbiol. 2015;192:72-76.

Katsoulos PD, Karatzia MA, Dovas CI, et al. Evaluation of the in-field efficacy of oregano essential oil administration on the control of neonatal diarrhea syndrome in calves. Res Vet Sci. 2017;115:478-483.

Mooyottu S, Flock G, Upadhyay A, Upadhyaya I, Maas K, Venkitanarayanan K. Protective Effect of Carvacrol against Gut Dysbiosis and Clostridium difficile Associated Disease in a Mouse Model. Front Microbiol. 2017;8:625.

Senderovich H, Ghassem Khani E. The Role of Bile Acid Sequestrant in Diarrhea Management: Too Good to Be True? Clin Gastroenterol Hepatol. 2018;02(03). doi:10.21767/2575-7733.1000048

Enright EF, Griffin BT, Gahan CGM, Joyce SA. Microbiome-mediated bile acid modification: Role in intestinal drug absorption and metabolism. Pharmacol Res. 2018;133:170-186.

• During thunderstorm (6); Phosphorus main remedy

• In a vehicle (2); Borax, Lachesis

• From noise (11); Aurum, Causticum, Pulsatilla, Silicea main remedies

Toresson L, Steiner JM, Olmedal G, Larsen M, Suchodolski JS, Spillmann T. Oral cobalamin supplementation in cats with hypocobalaminaemia: a retrospective study. J Feline Med Surg. 2017;19(12):1302-1306. Toresson L, Steiner JM, Spodsberg E, et al. Effects of oral versus parenteral cobalamin supplementation on methylmalonic acid and homocysteine concentrations in dogs with chronic enteropathies and low cobalamin concentrations. Vet J. 2019;243:8-14. Taur Y, Coyte K, Schluter J, et al. Reconstitution of the gut microbiota of antibiotic-treated patients by autologous fecal microbiota transplant. Sci Transl Med. 2018;10(460). doi:10.1126/scitranslmed.aap9489

• Restless, rapid walking (5); Arsenicum album, Tarentula main remedies

• Startled easily (4); Aloe, Apis, Lycopodium, Sulphur

• Restlessness (74); Arsenicum album, Kali-c, Tarentula main remedies Treating early signs of anxiety with homeopathy, while considering the symptom totality, offers a powerful option, and can hopefully spare an animal from the damaging effects of chronic stress/anxiety and a lifetime of pharmacological symptom manipulation that doesn’t stimulate deeper improvement or healing. Find a homeopathic vet at the AVH.org.

Suez J, Zmora N, Zilberman-Schapira G, et al. Post-Antibiotic Gut Mucosal Microbiome Reconstitution Is Impaired by Probiotics and Improved by Autologous FMT. Cell. 2018;174(6):1406-1423.e16. Martinez-Lopez LM, Pepper A, Pilla R, Woodward A, Suchodolski J, Mansfield C. Effect of Sequentially Fed High Protein, Hydrolysed Protein, and High Fibre Diets on The Faecal Microbiota of Healthy Dogs: A Cross-Over Study. Published online 2020. Upcroft P, Upcroft JA. Drug targets and mechanisms of resistance in the anaerobic protozoa. Clin Microbiol Rev. 2001;14(1):150-164.

Sprockett D, Fischer N, Boneh RS, et al. Treatment-Specific Composition of the Gut Microbiota Is Associated With Disease Remission in a Pediatric Crohn’s Disease Cohort. Inflammatory Bowel Diseases. 2019;25(12):1927-1938. doi:10.1093/ibd/izz130

Shmalberg J, Montalbano C, Morelli G, Buckley GJ. A Randomized Double Blinded Placebo-Controlled Clinical Trial of a Probiotic or Metronidazole for Acute Canine Diarrhea. Front Vet Sci. 2019;6:163.

Rossi G, Pengo G, Caldin M, et al. Comparison of microbiological, histological, and immunomodulatory parameters in response to treatment with either combination therapy with prednisone and metronidazole or probiotic VSL#3 strains in dogs with idiopathic inflammatory bowel disease. PLoS One. 2014;9(4):e94699.

Niina A, Kibe R, Suzuki R, et al. Improvement in Clinical Symptoms and Fecal Microbiome After Fecal Microbiota Transplantation in a Dog with Inflammatory Bowel Disease. Vet Med (Auckl). 2019;10:197-201.

Submitted by Todd Cooney, DVM, CVH

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RAPIDLY RESOLVES

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FAST-ACTING RELIEF FOR DIARRHEA If the cause of diarrhea is not infectious, the most common culprit is an abrupt change in diet, such as a new brand or flavor of food, new or rich treats, garbage or “road kill”. For intermittent diarrhea, DoggyStat is an effective, easy to use, all-natural and rapidlyacting antidiarrheal food supplement that helps dogs quickly return to normal intestinal function and maintain a healthy gut environment. A single serving of DoggyStat typically resolves loose or liquid stools within 12 to 24 hours. The powder can be mixed with wet or dry food, or water. DoggyStat delivers a unique combination of ingredients directly to the inside of the gastrointestinal tract, exactly where it is needed during periods of diarrhea. Micronutrients,

WHAT ARE CFPS?

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doggystat.com Special wholesale ordering: wholesale.doggystat.com IVC Winter 2020/2021

nutrition nook

PEER-REVIEWED

An interesting case of

inappropriate supplementation BY SANDRA PRIEST, DVM

in a puppy

A few well-chosen supplements can help a dog or other animal live longer and feel better, but almost nothing is written about the effects of inappropriate supplementation. This article presents a suspected case of the latter in a German Shepherd puppy.

To understand the effects of inappropriate supplementation, consider the meaning of “health”. Health is a dynamic balance of the components that make up an animal. When an animal is balanced, there are no symptoms. When balance is disturbed, malfunctions occur, leading to symptoms. If symptoms represent imbalances, then the primary goal of treatment should be to restore balance, allowing symptoms to either resolve on their own or respond to treatment. Symptoms are a reflection of disorder; they are not the primary issue. This article highlights the case of a German Shepherd puppy suspected of suffering from excessive and inappropriate supplementation.

SUPPLEMENTS CAN CREATE BALANCE OR IMBALANCE, DEPENDING ON HOW THEY’RE USED Supplements are a way to restore balance by filling deficiencies in metabolic processes. As long as the supplement is chosen appropriately and given in the amount needed, the body can benefit. However, inappropriate and/or excessive supplementation can actually cause imbalances in metabolic functioning. For example, giving a supplement to correct liver function may be unbalancing if the liver abnormality is actually caused by a problem elsewhere in the body. In serious cases of over-supplementation, the number of supplements is so large that it is impossible to determine how they are interacting with each other and with other natural treatments, such as homeopathy and herbs. Evaluating the actions of a homeopathic remedy can be particularly

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difficult when concurrent multiple supplements and/or herbs are modifying the body’s ability to respond to the remedy. Each year, I see several cases of illness directly caused by inappropriate use of supplements and other natural treatments. Helping the client understand what is happening, and stopping unneeded or conflicting treatments, are many times the only actions necessary. It may take several weeks for the patient’s body to regain its balance. Once that occurs, an assessment can be made of what, if any, supplements are needed, and they can be reintroduced at appropriate doses.

CASE REPORT — INAPPROPRIATE SUPPLEMENTATION IN A GERMAN SHEPHERD PUP The most extreme case of inappropriate supplementation I have seen involved a five-month-old German Shepherd puppy. The client had declined the antibiotics and steroids prescribed by another veterinarian, and there was no mention of diagnostic testing in the records. At the first office visit, the puppy was covered in red oozing sores with alopecia, and was hot and sweaty to the touch. Her demeanor was appropriate, and her physical exam was otherwise normal. She was eating an appropriate natural diet. Based solely on physical exam, likely causes of her symptoms included primary dermatitis and secondary dermatitis from skin parasites or allergies. Puppy shots (distemper-hepatitisparvo-parainfluenza) had been given at six weeks and ten weeks. The client reported she had not observed any changes after the vaccinations. The history indicated a normal lifestyle. There were other dogs in the household, none of whom displayed similar symptoms.

Multiple supplements and topical treatments were used The history did, however, indicate the use of copious numbers and types of supplements and topical natural treatments; this

was confirmed by the shopping bag full of products the client brought to the appointment. It contained immune-boosting combinations, oral and topical coconut oil, apple cider vinegar, vitamins, wild oregano oil, antioxidants, fish oil, and various natural shampoos. An inventory of the bag indicated the client had used six shampoos, ten different sprays, and seven ointments topically. Some of the sprays and ointments had been used concurrently. The puppy was given ten supplements with breakfast; three more were given with dinner. The client declined further workup due to financial constraints, so no testing was performed. Thinking about this case from a balance perspective, it appeared to me that the large numbers of supplements and topical treatments could have resulted in physiological imbalances that then led to the symptoms the puppy was exhibiting. The sheer number of oral and topical treatments made it impossible to know how they were interacting and which, if any, were having beneficial effects. In addition, many of these products were for the human market, so in several cases the doses being given the puppy were incorrect. Some of the combination products contained a number of the same ingredients, potentially resulting in an overdose situation for the puppy.

Starting from scratch The client obviously loved her puppy, and was extremely anxious and concerned about her symptoms. I discussed with her the likelihood that the mix of products she was using may be responsible for the symptoms. She was extremely reluctant to stop everything but eventually agreed to do so. Based on the puppy’s symptom picture, I prescribed the homeopathic medicine Sulfur 30C. I crushed one pellet and divided the powder into quarters. The client was instructed to give one packet of powder in a small amount of food once a week on the same day of the week. A very low dose of vitamin E was also prescribed. The dose selected was unlikely to interfere with the homeopathic prescription and was an attempt to

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GUIDELINES FOR TALKING TO CLIENTS ABOUT SUPPLEMENTS • Identify the client’s reasons for wanting to supplement. Is there a perceived problem, or is it a response to media/online stories about supplements in general or about the health benefits of a particular supplement? • Communicate clearly that inappropriate and/or excessive supplementation can actually cause illness in an animal by creating imbalances. • Advise clients to look for adverse responses to supplements, just as they would for any medication. These responses can vary from vomiting, diarrhea, and itching to more subtle signs such as lethargy. Keeping a journal of an animal’s responses can help pinpoint supplement actions. • Encourage clients to have their animal’s symptoms addressed by the veterinary team prior to supplementation. • Schedule annual re-evaluations of supplement regimens, and every time a health issue occurs. • Educate clients on how to identify reputable supplement companies through your clinic’s social media platforms, online and in-house literature, and at each visit. • Ask clients to list and compare all the ingredients of all the supplements their animals are taking to help identify potential overdoses.

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boost client compliance, as she was still convinced that her puppy needed multiple products to get better. Two weeks later, the puppy’s sores were drying up and her hair was growing in; four weeks after the initial visit, her coat was glossy and her skin normal. Even though she was markedly better, her owner became somewhat agitated and reiterated her concern that the puppy would not live without all those supplements; she remained convinced that without more supplements her puppy would sicken and die. A fish oil product and probiotic were agreed upon as being safe, but I reminded her that the puppy was now healthy and did not need more supplements to remain so.

Back for another visit Six months later, the puppy returned with similar symptoms after a flea problem that began two months earlier. The client came with another bag of products, including several oral combinations of herbs and supplements designed to make the dog unattractive to fleas, as well as an assortment of shampoos and sprays. The puppy had red oozing sores on the caudal half of her trunk, and several fleas were noted. Many of the products might have been appropriate if they were being used alone or in conjunction with one or two others. Several of the oral products contained overlapping ingredients. The combined level of these ingredients may have been too much for this puppy. I believe that all the supplements and products had again created an underlying health imbalance that needed to be corrected before symptoms could resolve. I prescribed vitamin C and grapefruit seed extract to help reduce inflammation and infection and improve the puppy’s comfort level, in addition to appropriate flea control, using one topical spray, a yard spray, and a premises treatment. The unneeded items from the bag of products were put in Ziploc bags marked “do not use”. One month later, the puppy’s coat and skin were normal. There was no evidence of fleas. The client was happy with the recovery but was still adamant that more supplements were needed to keep the puppy healthy, despite having seen her return to normal without them. Even though she had twice made the puppy sick with over-supplementation, the client remained firm in her conviction that the puppy would not live unless more products were used.

Client behavior a significant factor The interesting aspect of this case was the client’s behavior. She appeared almost pathologically afraid that her puppy would get sick. Despite repeated discussions and demonstrated evidence that the puppy did not need all those products to be healthy, she appeared psychologically unable to stop overloading her puppy with supplements. While the presentation may have resembled Munchausen by proxy, I do not believe this client’s behavior was motivated by attention-seeking. Something in the past had triggered this irrational fear and now the old pattern was playing out with this particular dog. If time constraints had permitted, it would have been interesting to ask the client if she felt this way about her other dogs, or if she could talk about when she first began to believe that her puppy needed so much help to stay healthy.

From the NASC

Sizing up supplements to expand your offerings and boost your bottom line BY BILL BOOKOUT

The clearest path to good health, whether for person or pet, requires a balanced approach that includes quality nutrition, an active lifestyle, a nurturing environment, and access to regular healthcare that includes education and preventative care. Incorporating the use of quality supplements into your practice may be one way to meet the needs of clients who feel they could be doing more to support the long-term health of their pets, while also helping to generate revenue for the clinic as part of a comprehensive care program. Market research shows that pet owners are purchasing supplements for their dogs, cats, and horses to the tune of nearly $3 billion annually. Regardless of whether or not a veterinarian is recommending them, the demand for these products is strong, and growing every year. Offering supplements through your practice enables you to coordinate care and make proper recommendations to your clients, which may include complementar y natural products in conjunction with mainstream treatments and modalities.

Veterinarians wary of selling supplements through their practice would be well served to at least consider how these products compare to current drugs and medical devices. The fact is, there will be times when clients reject traditional treatment recommendations for reasons such as prohibitive cost, potential impact on the pet’s overall health, or agerelated risks. Practicing evidence-based medicine but remaining open-minded toward integrative approaches on a caseby-case basis may help you better serve your clients’ needs by helping them understand there is more than one path to better health for their pets. Of course, everyone would like more “evidence” in the form of clinical studies to verify the safety and efficacy of currently available animal health and nutritional supplements. There are some valid reasons why there are challenges around the industry’s ability and willingness to sponsor clinical research. These reasons primarily involve the limited ability to recover the substantial investment required to conduct randomized, double-blind, placebocontrolled studies that satisfy the rigors

of the scientific community. In addition, companies are limited in the claims they are allowed to make under current federal and state laws for any clinical studies yielding positive results. It is short-sighted to simply dismiss the potential value and benefit of animal supplements because of the lack of evidence-based data, particularly when the same criteria are not applied to literally hundreds of other products utilized every day in veterinary medicine that are not approved for animal use. Good science is always fair and openminded. Educate yourself on products of interest and make your determination through fact-finding. Don’t be afraid to call supplement companies and ask some tough questions about their quality programs, adverse event reporting systems, and registrations with the various regulatory agencies. By performing due diligence, you will find products you feel good about selling, your clients will have another reason to trust you to care for their pets, and you will have access to new a revenue stream that will help keep your practice healthy and thriving. IVC Winter 2020/2021

innovative business

BY MEGAN KELLY, DVM

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Your website is the central hub of your veterinary practice’s marketing efforts. All roads generally lead back to it. Use these tips to create a website that works hard for your practice.

It goes without saying that your veterinary practice needs a website. As Bill Gates says, “If your business is not on the internet, then your business will be out of business.” If someone is looking for a veterinarian, they might do a Google search, or stumble on a social media post and click a link to your website to find out more. It doesn’t matter if you are paying for the traffic via social media or if you are getting it organically — most of your potential clients eventually land on your website. For this reason, you need to make sure your website is optimized to convert potential clients into actual clients, by giving it a competitive edge. Observing the following six key pointers will help you accomplish this.

1. DECIDE ON THE GOAL OF YOUR WEBSITE Before you even consider building a website, decide on your goal. What do you want your web visitors to do? Do you want them to book an online appointment? Do you want them to contact you via the contact form? Do you want them to phone you? Once this is clear, then you can structure your website, building navigation around this goal.

2. CREATE AN EFFECTIVE ANCHOR FOR YOUR WEBSITE Every website needs a striking anchor. The anchor is the first thing that catches a visitor’s eye when they look at your website. It should instantly tell them what you’re all about and how you can help them. On most of the veterinary websites I look at, the anchor is either the practice logo or a stock image — perhaps of dogs running on a beach or field. They are usually beautiful pictures, but they do not tell me what the practice does or what makes it different from the practice down the road. A good anchor will convey your unique selling proposition (USP).

• Do you have particular expertise in a niche aspect of veterinary care? • Do you have a multi-disciplinary team — perhaps a veterinary rehabilitation therapist on site a few days a week? All these are excellent unique selling propositions. You need to decide what your USP is and use it to your advantage. An effective anchor with your USP tells people right away whether they should leave, scroll, or take action. Your anchor and USP need to include text, not just a logo or picture. A short, well-worded sentence that tells visitors how you can help them or what you can do for them is ideal. For example: • “We help pet owners by guiding them to make the right choices for their pets’ health, so that all pets live healthier, happier and longer lives.” • “We’re open seven days a week and see to all your veterinary needs at a reasonable cost. Your pet’s health is our priority!” • “Your friendly, family vet for all your pets’ health needs. We now offer hydrotherapy for certain chronic conditions and fast post-operative recovery.”

4. HAVE A CLEAR CALL TO ACTION (CTA) Your Call to Action (CTA) is a button that asks your visitors to do something. It could be “Make an appointment now” or “Find out how we can help your pet”. These are just examples, but the idea is that the visitor is invited to do something that will connect them with you.

Your USP is what distinguishes you from your competitors and should be easy to pick up at a glance. For example

Keep in mind that when a potential client comes to your website, they are interested in one thing — what you can do for them. Can you solve their problem? Once they know you can, they want to know what to do next. If people don’t find what they’re looking for, or if it is not clear what action you want them to take, they’ll leave.

• Do you offer home visits? • Are you open seven days a week? • Perhaps you see all animals, large and small?

You should have one Call to Action to eliminate confusion and it should be on every page. If someone scrolls to the end of the page, your Call to Action should be right there, so that they are

3. WHAT IS YOUR UNIQUE SELLING PROPOSITION (USP)?

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WHAT DO PEOPLE DO WHEN THEY VISIT YOUR WEBSITE? The percentage of visitors who navigate away from a website after viewing one page is called the bounce rate. The average bounce rate is about 58%. This means that more than half your visitors will look at your website and leave without taking any action. When you are spending money on advertising, and time on social media getting traffic to your site, you do not want to be losing over half the people who are visiting it. So why would people leave your website? And how can you get them to stay? Web visitors have three options when they arrive at a website:

q Leave — People leave because they feel you are not the right fit for them; or you are the right fit but the timing isn’t right; or possibly because your website was not clear and they simply couldn’t work out if you were the right fit or not. w Scroll — Visitors scroll to find

more information. They are not 100% sure if you are the right fit for them or not, so they scroll to seek the information that will either confirm or deny that fact. They might scroll and then leave, but of course your hope is that they will scroll and take action.

e Take action — People take

action when it is clear you are the right fit and there is no confusion as to what you want them to do.

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in no doubt as to what to do. If they scroll to the end of the page and there is no Call to Action, they will not know what to do and will leave. When someone goes ahead and completes the website’s Call to Action, we call this a conversion. Your website is not just there to give you a presence. It has a job to do — to convert browsers to customers! Your website should be achieving conversions every day.

5. KEEP CONTENT SIMPLE AND MINIMAL Avoid too much content on one page – visitors can get information overload. Sifting through tons of content is tiring and if there is too much information, visitors will leave. You don’t want to overwhelm them. Keep it simple, clean, and to the point. Use a maximum of two fonts. Most veterinary websites are designed like an online brochure, with loads of difficultto-read text. Try to add bullet points and adopt the “less is more” approach.

6. MAKE IT MOBILE FRIENDLY With the majority of people accessing sites from their phones, we need to design our websites to be mobile responsive. This means all pages have to be optimized to be viewed on a cellphone. You will need to get your web designer or developer to do this. A website that looks good on a laptop and is not optimized for cell phones will miss out on more than half its potential traffic.

THE VALUE OF A GREAT WEBSITE One cannot underestimate the value of a great website. Ideally, it is an extension of your team, conveying the culture and personality of your practice. It may take time to get the wording and images just right to convey who you are and turn browsers into customers. A great idea is to send your first draft to a few people for their responses. They will be able to point out aspects you’ve missed, and tell you how clearly your anchor, USP, and Call to Action are functioning. Lastly, keep your website up to date! There is nothing more frustrating than a site where numbers no longer function or that doesn’t reflect the current realities of your team and services.

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? Reishi, Ganoderma lucidum, Ling Zhi, is a warming bitter mushroom that tonifies Qi, calms the Shen, and is a powerful immune amphoteric. It also has adaptogenic, antiinflammatory, antioxidant, antiviral, cardiotonic, hepatoprotective, hypocholesterolemic, and nephroprotective actions. Ling Zhi can be used for hyper-immune activity and is helpful for allergic conditions, as it stabilizes mast cells and reduces histamine response. Reishi is very useful for autoimmune conditions such as lupus, rheumatoid arthritis, thrombocytopenia, and ankylosing spondylitis. It also helps restore depleted immune function in cancer and chronic diseases, such as persistent Lyme disease. Animal studies have shown this herb can treat skin cancer and inflammatory skin conditions. It can lower blood sugar and LDL cholesterol levels, reduce obesity by modulating the gut microbiota, and prevent liver fibrosis. CASE REPORT Floyd, a 15-year-old male mixed breed dog, has suffered from seasonal allergies for ten years, though these have been well controlled. When he turned 14, he developed several cutaneous mast cell tumors. Due to his age, his owners have treated him with only botanical medicines, of which Reishi is one of the leading herbs. Although he still has some episodes of pruritus, he is doing well, and the tumors have not increased in size.

Holistic Strategies and the Cytotoxic Herbs.” The lecture provided an overview of the development and progression of cancer. Chanchal provided guidance on: increasing mitochondrial energy transfer; normalizing gene expression and repair; disrupting cancer cell metabolism; normalizing growth factors, signal transduction, and signal transcription; promoting hepatic and other metabolic detoxification pathways; supporting bone marrow and immune activity; reducing local inflammation; normalizing angiogenesis; strengthening blood vessel walls; inhibiting collagenases, proteases, and hypercoagulation; and inducing apoptosis. Her Materia Medica of cytotoxic herbs included pawpaw (Asimina triloba); sweet wormwood (Artemisia annua); Xi Shu, translated as “Happy Tree” (Camptotheca acuminate); greater celandine (Chelidonium majus); chaparral (Larrea divaricata); American pokeweed (Phytolacca decandra); Eastern arborvitae (Thuja occidentalis); and mayapple (Podophyllum). Chanchal supplemented this lecture with talks on osteoarthritis. • Kevin Spelman, RH (AHG) presented a talk on therapeutic mushrooms, a lecture on renal herbs, and a timely discussion on herbs indicated for COVID-19. • Subhuti Dharmananda, PhD spoke on the topic of formulation with an in-depth discussion from the Shan Hun Lang onwards. UPCOMING EVENTS The VBMA is currently developing its webinar schedule for 2021. They will also be participating in the 2021 International Herb Symposium. Visit vbma.org for more information.

GUESS THIS HERB!

VIRTUAL CONFERENCE ACVBM/VBMA held a virtual joint conference on October 24 and 25, 2020. Lectures were presented in real time, with opportunities for all participants to interact with each other, the speakers, and vendors. All lectures will remain online for on-demand listening until the end of January 2021. Here are a few highlights: • Medical herbalist Chanchal Cabrera’s feature presentation was entitled “A Materia Medica for Managing Cancer:

Join the VBMA at vbma.org to find out. The answer will also be published in the next issue of IVC Journal.

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news bites SOLVING THE MYSTERY OF CANINE DISTEMPER IN WILD TIGERS Canine distemper virus (CDV) causes serious disease in dogs – but it also infects other carnivores, including threatened species like the Amur tiger, which numbers fewer than 550 individuals in the Russian Far East and neighbouring China. It is often assumed that domestic dogs are the primary source of CDV, but in a study published in the Proceedings of the National Academy of Sciences, the Cornell Wildlife Health Center’s Dr. Martin Gilbert and colleagues found that other local wildlife was the primary source of CDV transmission to tigers. The research was led by Cornell University, the Wildlife Conservation Society, and the University of Glasgow. Using samples from domestic dogs, tigers, and other wild carnivores, they compared viral genetic sequence data and used antibodies to assess patterns of exposure in each population. “The taiga forest where the tigers live supports a rich diversity of 17 wild carnivore species,” says study co-author Dr. Nadezhda Sulikhan with the Federal Scientific Center of the East Asia Terrestrial Biodiversity of Russian Academy of Sciences. “Our findings suggest that more abundant small-bodied species like martens, badgers, and raccoon dogs are the most important contributors to the CDV reservoir.” To determine whether currently available CDV vaccines could protect wild tigers, the researchers showed in the laboratory that serum from tigers vaccinated in captivity was able to neutralize the strain of CDV detected in Russia. vet.cornell.edu/about-us/news

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STUDY EXPLORES RISK FACTORS OF COLIC A retrospective study published in the Canadian Veterinary Journal determined that a horse’s ability to survive colic may depend largely on which intestine the condition originates in. Among horses with colic that originated in the large intestine, 74% survived, compared to only 36% of horses with disease in the small intestine. The study, conducted at the Veterinary Hospital in Charlottetown, PEI, looked at medical records from 575 horses from 2000 to 2015. The most common diagnosis among the horses was impaction colic (18% of cases), followed by twisting and abnormal location of the large colon. Less than one-quarter of cases had no clear diagnosis. This latter group of horses were much more likely to survive their bout of colic (83%). Other findings: • Horses with severe clinical signs of colic were less likely to survive. •O lder horses and those displaying colic for more than 12 hours were less likely to survive. • Eighteen horses with stomach ulcers presented with signs of colic. researchgate.net/publication/339934011_Clinical_findings_diagnoses_ and_outcomes_of_horses_presented_for_colic_to_a_referral_hospital_ in_Atlantic_Canada_2000-2015

DO DOGS PROCESS FACES THE SAME WAY HUMANS DO? Researchers in the Department of Ethology at Eötvös Loránd University, Hungary, set out to answer this question using a functional magnetic resonance imaging (fMRI) experiment. For the study, 20 dogs and 30 humans viewed short movies of canine and human faces and, for comparison, the backs of their heads. The researchers identified brain areas in both dogs and humans that differentially responded to the videos depending on whether or not they showed an individual from their own species. The study found no brain areas in dogs that encode whether the viewed image is a face or the back of a head — whereas in humans, this is a crucial distinction. While the human brain is better at distinguishing faces from nonfaces, the dog brain is more focused on discriminating dogs from humans. The findings were published in The Journal of Neuroscience. To watch a video abstract about the research, visit youtu.be/VO3YxGQ3P5M.

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