V11I3 (Summer 2021) by Redstone Media Group

Innovative VETERINARY CARE

VOLUME 11 ISSUE 3

MENTAL HEALTH FIRST AID FOR VETERINARY TEAMS

A PSYCHOLOGICALLY HEALTHY WORKPLACE IS ESSENTIAL TO GOOD MENTAL HEALTH. LEARN HOW A STAFF MEMBER OR MANAGER TRAINED IN MENTAL HEALTH FIRST AID CAN BENEFIT YOUR VETERINARY TEAM. — P. 28

GO DEEPER TO HEAL SKIN PROBLEMS

ADDING LASER THERAPY TO FIRST AID PROTOCOLS

HOW PEMF CAN BENEFIT YOUR PRACTICE

MEDICAL-GRADE HONEY FOR WOUND HEALING

The “kill and suppress” paradigm doesn’t offer a cure – treatments must support skin repair and regeneration. — P. 8

SUMMER 2021

www.IVCJournal.com

Utilized to treat arthritis, inflammation, pain, wounds, and more, PEMF has strong clinical evidence to supports its use in veterinary medicine. — P. 18

IMPROVE CPR OUTCOMES IN YOUR PATIENTS

The implementation of RECOVER guidelines into CPR protocols may increase survival rates in veterinary patients. — P. 24

Learn why photobiomodulation should be an essential part of veterinary first aid treatment plans. — P. 40

Honey has a wide spectrum of antimicrobial and immunomodulatory effects on the wound healing process. — P. 46

ESTABLISH A REALISTIC WORK-LIFE BALANCE

An achievable approach to work-life balance involves changing the way we practice veterinary medicine. — P. 60

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SUMMER 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 Digital Media Specialist: Cole McCall

COLUMNISTS & CONTRIBUTING WRITERS

Ihor Basko, DVM, CVA Bill Bookout Nancy Brandt, DVM, CVC, CVA, CVMA Deirdre Chiaramonte, DVM, ACVIM, CCRT, CERP, CVA Todd Cooney, DVM, CVH Coral Doherty, RVT, CPHSA Holly Ganz, PHD Karen Gellman, DVM, PhD Nicole Greiner, DVM, CVA Karen Hecht, PhD Doug Knueven, DVM, CVA, CVC, CVCH Cynthia Lankenau, DVM Elisha Lehrhoff, MS Toxicology Sam Meisler, DVM Lisa A. Miller, DVM, CCRT Armi Pigott, DVM, DACVECC Margo Roman, DVM, CVA, COT, CPT Jelena Spasic Emily Stein, PhD Gary Tashjian

ADMINISTRATION & SALES Publisher: Redstone Media Group President/C.E.O.: Tim Hockley Accounting: Donna Bailey Circulation & Office Manager: Libby Sinden

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IVCJournal.com 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: June 2021. improving the lives of animals... one reader at a time.

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contents FEATURES

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NUTRITION NOOK

HEALING SKIN PROBLEMS IN PETS BY DIVING DEEPER By Ihor Basko, DVM, CVA

Skin problems are difficult to cure using the conventional paradigm of “kill and suppress.” Treatments should support repair and regeneration, and restore normal skin function.

UNDERSTANDING PEMF AND ITS BENEFITS IN VETERINARY MEDICINE

By Deirdre Chiaramonte, DVM, ACVIM, CCRT, CERP, CVA PEMF is used to treat arthritis, inflammation, pain, wounds, and more. Strong clinical evidence supports its use, but different device parameters and claims cause confusion.

46 53 54

CPR: IT’ S NOT FUTILE!

By Armi Pigott, DVM, DACVECC The implementation of RECOVER guidelines into CPR protocols is showing promise as a way to improve outcome for veterinary patients.

HEMP CANNABIS USE IN PETS IS HERE TO STAY By Karen Gellman, DVM, PhD

MENTAL HEALTH FIRST AID FOR VETERINARY TEAMS By Coral Doherty, RVT, CPHSA

A psychologically healthy workplace is essential to good mental health. Learn how a staff member or manager trained in Mental Health First Aid can benefit your veterinary team.

SUPPORT CANINE HEALTH AND AGING WITH ASTAXANTHIN By Karen Hecht, PhD

DIETARY-DRIVEN DENTAL DISEASE MECHANISMS

58 59 60 64

MEDICAL-GRADE HONEY IN VETERINARY MEDICINE By Nicole Greiner, DVM, CVA

Honey’s wide spectrum of antimicrobial and immunomodulatory effects on the wound healing process exceed many currently available dressings.

HYPOCHLOROUS ACID SOLUTIONS FOR WOUND CARE IN ANIMAL PATIENTS By Jelena Spasic

MEDICAL OZONE FOR WOUNDS

By Margo Roman, DVM, CVA, COT, CPT Instead of reaching for antibiotics when treating wounds, consider medical ozone. It can treat a variety of wounds and should be a part of every veterinarian’s first aid toolkit.

COMPARING DOG FOOD TYPES By Gary Tashjian

THE HEALING POWER AND POTENTIAL OF TERPENES

By Elisha Lehrhoff, MS Toxicology

RETHINKING MODERN VETERINARY CARE By Sam Meisler, DVM

An achievable approach to work-life balance involves changing the way we practice veterinary medicine.

NUTRITIONAL SUPPORT FOR IMMUNITY IN ANIMAL PATIENTS

By Doug Knueven, DVM, CVA, CVC, CVCH

By Emily Stein, PhD

LASER THERAPY AND VETERINARY FIRST AID

By Lisa A. Miller, DVM, CCRT Why photobiomodulation needs to be an essential part of your veterinary treatment plans.

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.

28 COLUMNS & DEPARTMENTS

7 Editorial 23 From the AVH 36 Industry innovations 38 From the VBMA 44 From the NASC 45 Profitable Practice — Dermoscent 51 From the VMAA 52 Business profile — NOW Pets 66 News bites

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.

Dr. Barbara Fougere, DVM, CVAA graduated in 1986, and was named the American Holistic Veterinary Medical Association Educator for 2011. Dr. Fougere is the principal and one of the founders of the College of Integrative Veterinary Therapies. She has continued studying over the last 26 years, and has three Bachelor degrees, two Masters degrees, three post Graduate Diplomas, several Certifications and numerous other courses under her belt.

Dr. Christina Chambreau, DVM, CVH, graduated from the University of Georgia Veterinary College in 1980. She is a founder of the Academy of Veterinary Homeopathy, was on the faculty of the National Center for Homeopathy Summer School and has been the holistic modality adjunct faculty liaison for the Maryland Veterinary Technician Program and is the former Associate Editor of IVC Journal. Dr. Chambreau teaches classes in homeopathy for animals, lectures on many topics, speaks on Radio and TV, and is the author of the Healthy Animal’s Journal among other titles. She is now on the faculty of the Holistic Actions Academy, which empowers members to keep their animals healthy with weekly live webinars.

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contributors

1. IHOR BASKO, DVM, CVA

Dr. Ihor Basko graduated from Michigan State University in 1971. His special interests were cardiology, general and orthopedic surgery. He studied herbology in California, established a house call practice in San Francisco, and worked in a human acupuncture clinic. Dr. Basko was certified in acupuncture through the IVAS in 1982. Today, he has a holistic practice on Kauai, Hawaii, offering dietary therapy, acupuncture, massage, laser therapy, TCM herbs and more. His current interests are the study of Hawaii’s medicinal plants, the biochemistry and biophysics of medicinal plants and mushrooms. P. 8

2. DEIRDRE CHIARAMONTE, DVM, ACVIM, CCRT, CERP, CVA

Dr. Deirdre Chiaramonte received her DVM from Tufts University School of Veterinary Medicine. She is a Diplomat of the American College of Veterinary Internal Medicine and was the Director of the Tina Santi Flaherty Rehab and Fitness Unit of the Animal Medical Center in New York City. Dr. Chiaramonte is certified in canine and equine rehabilitation and acupuncture. Her current interests are in the field of rehab, obesity, and geriatrics. Dr. Chiaramonte is currently President of the Veterinary Medical Association of NYC and is the Director of Clinical Education at Assisi Animal Health. P. 18

3. NICOLE GREINER, DVM, CVA

Dr. Nicole Greiner graduated from Oklahoma State University with a DVM in 2014. She has been a Certified Veterinary Acupuncturist through Chi University since 2018. She currently practices as a clinical veterinarian at the Pet Alliance of Greater Orlando in Orlando, FL. She also enjoys learning alternative medicine and making house calls for acupuncture treatments for companion animals. P. 46

4. SAM MEISLER, DVM

Dr. Sam Meisler is the founder and CEO of PetWellClinic, an innovative walk-in veterinary franchise system offering general primary care and vaccinations for pets. He grew up in East Africa where he was immersed in both wildlife and domestic animals. Based in Knoxville, TN, Dr. Meisler owns and operates two full-service animal hospitals and four PetWellClinics. His wife, Julie, keeps him grounded and focused on what is important. He has two wonderful adult children and his own “menagerie” of pets. P. 60

IVC Summer 2021

5. LISA A. MILLER, DVM, CCRT

Dr. Lisa Miller is Vice President of Clinical Veterinary Medicine for Companion Animal Health, and a graduate of the University of Tennessee, College of Veterinary Medicine. She is certified in canine rehabilitation therapy, and practiced rehabilitation, sports medicine, and acupuncture before returning to general practice, and later, joining the animal health industry. Dr. Miller has been working with laser therapy/ photobiomodulation (PBM) since 2006, has lectured and written extensively on rehabilitation and laser therapy-related topics, and authored a chapter in Laser Therapy in Veterinary Medicine. She coordinates all veterinary and advanced PBM research involving Companion Animal Health technologies, and is a consultant and reviewer for PBM research worldwide. She is a member of the AVMA, the American Association of Rehabilitation Veterinarians, and the American Society of Laser Medicine & Surgery. P. 40

6. ARMI PIGOTT, DVM, DACVECC

Dr Armi Pigott is a board certified Criticalist. He practices full-time clinical medicine and trains interns and emergency and critical care residents in Milwaukee, WI. He is a RECOVER Certified Rescuer and RECOVER Certified CPR Instructor. His areas of professional interest are shock, resuscitation, trauma, and extracorporeal therapy. In his spare time, Dr. Pigott enjoys brewing beer and camping with his wife and four dogs. P. 24

7. MARGO R. 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. 54

8. CORAL DOHERTY, RVT, CPHSA

Coral Doherty is a Registered Veterinary Technologist and a Certified Psychological Health and Safety Advisor. She is certified in Mental Health First Aid and recently received her certificate in Quality Management from the University of Manitoba. She has worked in the veterinary industry for more than two decades, first as a RVT in small and mixed animal practices as well at the Assiniboia Downs Racetrack; then as a sales lead for veterinary food, medical supplies, and equipment, and as a practice management consultant. Currently, Coral is the Resource Development Director and Psychological Health and Safety Advisor at Better Mental Health for the Future. P. 28

editorial

Welcome summer! I hope this issue of IVC Journal finds you well and happy and optimistic for the bright months ahead.

what we have available and support that inherent wisdom towards healing.

I am always humbled by nature’s inherent wisdom. If you’ve had the opportunity to watch this year’s Oscar winner for best documentary, My Octopus Teacher, perhaps you were as amazed as I was that after losing an arm to a shark, the octopus regrows her arm, fully functional with muscles, nerves, and suckers. She is able to regenerate what she lost.

In this issue of IVC Journal, we explore a variety of tools for wound care, expanding your available options to help your patients, from ozone and PEMF to honey and therapeutic laser. We also take a deep dive into healing the skin, from both inside and out.

On a spring visit to see my parents in South Carolina’s Lowcountry, a gusty windstorm blew a baby squirrel out of his nest and into the path of an assortment of cats and dogs, as well as other wild critters. My mother’s Pomeranian found him, eyes still closed and with a severed hind limb. Not thinking he was likely to survive, especially without knowing which of the outdoor critters was responsible for the severed leg, we nevertheless treated him with what we had on hand, which was my therapy laser, an Assisi Loop, and some homeopathic medicines. His leg healed beautifully, and he seems undaunted by his earlier trauma. He will be released into his natural habitat soon, albeit without his daily favorite treat of fresh avocado! Wounds are a part of life, and nature for certain has established extraordinary mechanisms in all lifeforms to heal them. As veterinarians, sometimes we have to use

Additionally, the concept of first aid doesn’t just apply to physical wounds. While emotional wounds aren’t as readily visible, they can be as deep and jagged and traumatic as any other. Our profession continues to learn about ways to support the mental and emotional wounds of its members; read about how having a Mental Health First Aider on staff supports a mentally healthy practice. And finally, enjoy learning about a new concept for a balanced practice, one that supports wellness for both the human doctors and the animal patients. Cheers to all of you for a hopeful time ahead,

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

IVC Summer 2021

nutrition nook BY IHOR BASKO, DVM, CVA

Healing skin problems in pets by

diving deeper

Skin problems in animals are generally very difficult to cure using the conventional paradigm of “kill and suppress.” Treatments, including nutrition and supplements, that support repair and regeneration, and restore normal skin function, are a better approach.

IVC Summer 2021

The most frustrating skin problems integrative veterinarians see are chronic issues that have been treated by the conventional medicine paradigm of “attack and kill” (antibiotics) and suppressing the hyperactive immune system (steroids, antihistamines, chemotherapy). Unfortunately, these therapies offer no cure. Most medically-conscious pet owners, even without “being holistic” themselves, understand the likely outcome: no cure, side effects from drugs, and a lot of expense. These pet owners search the internet for advice or a holisticallyminded veterinarian for a second or even third opinion. After multitudes of conventional treatments that lead to no cure, where does one begin? Usually, after an onslaught of antibiotics, antifungal medications, steroids and antihistamines, the patient with skin problems is left to heal on their own. By this time, however, the skin has been sterilized, with a dead or dying microbiome in both the skin and digestive tract. Skin cells are unhealthy overall, and healing mechanisms and the immune system have been suppressed, making the patient more vulnerable to re-infection.

HEAL FROM WITHIN Most of the focus in conventional veterinary treatment plans is on only the surface of the skin. Topical antibiotic ointments and steroid creams as well as immuno-suppressive drugs and injections are often prescribed to help suppress symptoms (inflammation, itchiness, and infection). To facilitate skin healing, however, it is important to consider nutrients obtained from the diet, as well as supplements, to support the individual needs of the patient. Occasionally, veterinarians will recommend a “skin supplement” containing Omega-3 fatty acids and ground flax seeds. Integrative veterinarians might add evening primrose oil or hemp oil to decrease inflammation in the body and promote healing, and may also recommend vitamin, antioxidant, nutraceutical, and mineral supplements.

and give it a name (that does not explain the causative factors) such as atopic dermatitis. However, there are similarities among all the various acute and chronic skin problem patients: • Most were raised eating puppy or kitten chow and have eaten commercial pet food and treats most of their lives. • T hey do not get bathed enough with the proper shampoos. • T hey are over-treated with harsh shampoos, antifungal drugs, antibiotics, and suppressive drugs. • T hey take very few to no beneficial supplements to support skin regeneration and repair.

TREAT THE WHOLE ANIMAL To create a successful treatment plan, it is important to consider the ailing pet’s overall condition: age, current medical problems, diet, supplements, current drugs, climate (temperature and humidity), geographical location (tropical vs. desert; mountainous vs. prairie; Northern hemisphere vs. Southern). Most pets with skin problems have some underlying deficiency that has not been resolved: low thyroid hormones, lack of antioxidant-rich foods, impaired liver function, impaired digestion, nutritional deficits, and agerelated problems (kidney and cardiac weakness) due to oxidative stress. The most common supplemental deficiency is a lack of the appropriate number of antioxidants. Continued on page 10.

Veterinarians trained in TCVM (Traditional Chinese Veterinary Medicine) will add Chinese formulas to improve blood flow and energy circulation; improve detoxification and elimination of toxic by-products from metabolism, oxidative stress, and dead and damaged cells; and reduce inflammation.

DON’T TREAT THE DISEASE… TREAT THE PATIENT Each skin problem is different, as is each patient. The tendency is to group similar symptoms into a category IVC Summer 2021

Stratum corneum Stratum lucidum Stratum granulosum

Epidermis

Stratum malphigii (spinosum) Stratum germinativum (basale) Dermis

and attaches them to the dermis. The last three layers of the epidermis (stratum granulosum, stratum spinosum, and stratum basale) contain blood vessels, the lymphatic immune system, sensory nerves, and hormonal receptors.

The five layers of the epidermis form the “support team” of the body (Wei Qi) Muscle that expels “pernicious influences” (TCM) including toxins, pathogenic microbes, metabolic wastes, dead cells, allergens, and blood and skin parasites, and brings nourishment to the skin. Subcutaneous tisse

Figure 1: Layers of the skin and underlying tissues Continued from page 9.

A REVIEW OF THE SKIN The skin is composed of five cell layers (see Figure 1). Most skin therapies are focused only on this layer — i.e. the epidermis. • The first layer, the stratum corneum, is made up of dead epithelial cells (think of scales) that protect the more sensitive inner layers from trauma, infection and inflammation. Among the cells of this layer live the beneficial bacteria, viruses, yeasts and fungi, as well as oils and acids (ecology of the skin) that make up the skin microbiome and form a barrier of protection against infection and trauma.

Topical medicinal herbal teas, shampoos, and lotions can best be utilized to treat and affect the first three layers of the epidermis. Oral medicinal herbs and functional supplements and foods will affect the health of all layers of both the epidermis and the underlying dermis. The dermis has very important functions that include providing strength and nourishment to the epidermis and restoring the skin to normal function. The dermis also contains hair follicles, sweat glands, sebaceous glands, nerve endings, and blood vessels.

• Just underneath is the second layer, the stratum lucidum, which contains many immune system cells that function to remove foreign irritants, allergens, pathogenic microbes, metabolic wastes, and other toxins from the body at the surface level.

WHAT’S THE TREATMENT PLAN?

• The third layer of the epidermis, the stratum granulosum, provides “waterproofing” and moves keratinocytes from the stratum spinosum (fourth layer) into the upper layers of the skin to produce keratin, which is waterproofing and protective.

Problems arise with the use of strong chemical and antimicrobial shampoos, dips, ointments and salves, all of which are usually indicated to quell inflammation and kill pathogenic bacteria.

• The last layer, the stratum basale, creates and reproduces keratinocytes and transports these cells to the stratum spinosum. This layer supports the other epidermal layers

IVC Summer 2021

Before a plan for “healing the skin” can be created, we have to consider what treatments have been used that might have caused a delay in healing (inflammation, infection, immune suppression) and possible nutritional deficiencies.

Although it is important to quell inflammation and control infections, veterinary topical ointments will too often suppress healing and cause an imbalance to the protective microbiome, increasing susceptibility to re-infection. Continued on page 12.

Continued from page 10.

WHERE TO BEGIN Correct deficiencies Many skin problems develop due to an underlying deficiency (weakness) that goes unnoticed. These deficiencies can include:

1 2 3 4

Nutritional (minerals, vitamins, essential fatty acids, collagen) Depletion of vital energy due to oxidative stress (inflammation, cell death, metabolic toxins, DNA damage, organ dysfunction) Deficient detoxification system (lack of antioxidants, liver, spleen, kidney and/or digestive dysfunction) Immune system imbalance (hyperimmune responses, susceptibility to infection)

Skin-healing oral supplements The following plants and nutraceuticals have been researched for oral supplementation to protect against DNA damage from solar radiation, chemicals, mutations, infections and skin cancers as well as for improving healing. •A nthocyanidins (eggplant) • Proanthocyanidins (grape seed extract) •R esveratrol (Java plum, Japanese knotweed (Polygonum cuspidatum), grape skin, cranberry) • Nicotinamide/vitamin B3 • Vitamin E (alpha-tocopherol) and vitamin C • Green tea • Milk thistle • Quercetin (flavonoids) •A pigenin (calendula, parsley, chamomile, euphrasia, echinacea) • Turmeric •C arotenoids: lycopene, lutein, β-carotene, astaxanthin, zeaxanthin, vitamin A • Selenium, zinc • Melatonin, coenzyme Q10, alpha-lipoic acid • Oil: alpha-linolenic, linoleic (avocado, evening primrose, borage, sea buckthorn), Omega-3 and Omega-6 •C ollagen, NGF (nerve growth factor incorporating collagen, glucosamine, hyaluronic acid)

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5 6 7

Hormone system issues (hypothyroid, deficiencies of pregnenolone, DHEA, and cortisol) Deficiency of body fluids (Yin Deficiency); i.e. chronic state of dehydration (blood, cellular fluid, enzymes, collagen) Digestive problems, which cause issues with the absorption of nutrients essential for the skin as well as the body.

Optimal food and supplements A healthy diet rich in antioxidants, carotenoids, zinc, selenium, Omega-3 and Omega-6 fatty acids, and B-complex vitamins, as well as high biological-value proteins is necessary for healthy skin. Whatever nutrients are missing in the diet should then be supplemented. Whether your current treatment plan involves pharmaceuticals or herbs, concurrent administration of focused nutrition for the skin and antioxidants is essential. Zinc-containing foods are probably the best way to administer this mineral to pets: • Beef, lamb, pork, chicken • Chickpeas, green beans • Flax seeds • Pumpkin, squash seeds • Nutritional yeast • Mushrooms Vitamin A is important for skin healing. Most pets are deficient because they do not eat enough foods containing vitamin A and carotenoids. Sources of various forms of this vitamin include: • Cod liver oil • Fish: sardines, mackerel, anchovies, black cod, halibut • Liver • Wakame seaweed • Dandelion leaves, beet greens, carrots, collard greens, kale, broccoli, tomatoes, blue-green algae, spirulina — for beta, alpha, zeaxanthin, lutein, cryptoxanthin • Squash, pumpkin • A lgae, seaweed, shrimp, salmon, red sea bream — for astaxanthin (BioAstin) Nicotinamide (vitamin B3 niacin) protects against sun radiation and skin mutations and decreases inflammation in the skin and nails.1 Nicotinamide-rich foods include:

• Fish (tuna, salmon) • Poultry (chicken and turkey breast) • Pork, beef, liver • Eggs • Avocados • Mushrooms • Legumes (peas) • Nutritional yeast • Cereal grains (organic brown rice, wheat berries) Vitamin C can be supplemented (doses necessary for skin healing range from 250 mg to 1,000 mg bid) but it is also available in certain foods such as raw bell pepper, tomato, papaya, dandelion greens, snow peas, and kale. Essential fatty acids quell inflammation and speed up healing. Omega-3 GLA is found in evening primrose oil and borage oil. Collagen will speed up the healing of wounds and skin and can be supplemented with hyaluronic acid, bone broth, glucosamine, noni, and gotu kola, as well as amino acids (proline, glutamate, arginine, and ornithine.) Antioxidants are important for decreasing DNA damage to the skin, reducing inflammation, and supporting

regeneration of new healthy skin cells. Antioxidants are commonly deficient in geriatric pets and those eating commercial pet foods. Antioxidant vitamins, flavonoids, essential oils, nitrogen-containing compounds (indoles, alkaloids, amines and amino acids), monoterpenes, and phenolic acids play the main role in preventing the oxidative stress that produces DNA damage to skin cells, increased inflammation, and the generation of more toxic free radicals (reactive oxygen species ROS) which are the main cause of numerous negative skin changes. Continued on page 14.

Antioxidants A deficiency of antioxidants can lead to significant free radical damage over time, causing: • Inflammation • Degenerative diseases • Weakened immune system This results in skin problems, cancer, premature aging, nephritis, cardiovascular problems, arthritis, spinal myelopathy, etc.

IVC Summer 2021

Shampoo recipe Dr Bronner's Liquid Castile Soap (base) (Lavender, Hemp or Baby)

12 oz

Aloe vera juice

2 oz

Green tea 2 oz Java plum tea

2 oz

Olive oil 2 tsp

Continued from page 13.

Improve the health of the digestive system A healthy GI system is necessary for skin problems to clear up and heal.2 Pets treated with antibiotics, those with food sensitivities and/or allergies, or pets eating commercial processed foods need to take a probiotic.

THE IMPORTANCE OF BATHING Bathing is important for cleansing, detoxifying, and to repair, regenerate, and facilitate healing. Bathing every three to four days will improve skin and hair quality as well as control fleas and ticks.

There are many different types and bacterial strains of probiotics, so it is necessary to try another brand when results are not optimal. Use live strains whenever possible, such as Theralac (human brand) and/or Protegrity GI by Vet Classics.

The protective layer of the skin contains water-soluble compounds as well as lipids. The shampoo should not destroy these layers. Therefore, it is important to keep the pH of the shampoo between 6.5 to 7.5. A dog’s skin normally has a pH of 7.5.

The dysbiosis or imbalance of the digestive system microbiome and other dietary factors can have a negative influence on the skin’s microbiota, and upon keratinocyte regulation and homeostasis as well as skin barrier function. 3

To heal the skin, we must also quell inflammation and control the infection. In allergic pets, the immune system has become “hyper-sensitized” to allergens and responds with strong reactions (inflammation, itchiness, swelling). Mast cells, Th1 and Th2 cells, are primarily responsible for the inflammation and irritation because they have become hyper-stimulated to attack foreign compounds and allergens that pose a threat to the body by secreting histamines and acids. Quercetin, Omega-3, evening primrose oil (GLA), vitamins D, A, and C, vitamin B complex, turmeric, milk thistle, green tea, proanthocyanidins, and Chinese herbal formulas help control the reactions of the hyper-vigilant immune system.4

Topical antioxidants Topical supplementation of antioxidants has been shown to affect the antioxidant network in the skin.1 Some common plants and substances with antioxidant, antiinflammatory, regenerative, protective, and moisturizing functions, when used topically, include: • Squalene2 • Olive oil, vitamin E oil from sesame seeds, hazelnut, wheat germ sunflower, and pumpkin seed oil • Resveratrol

Toxins from pathogenic bacteria and fungi can cause inflammation, cell death, and swelling of the skin areas. It’s best if the infections can be controlled topically and without antibiotics, whenever possible.

• L actoferrin3 • Roots: turmeric root, golden thread (coptis), goldenseal • Leaves: neem, noni, gotu kola, Java plum •G reen tea, plantain, holy basil, chamomile, calendula, comfrey • Lunaria biennis seed oil • Tamanu oil (Calophyllum inophyllum)

IVC Summer 2021

Besides oral supplements, shampoos, lotions and salves can be of great benefit. Oil extracts of beneficial plants are good for dry skin as well as for longer duration of effects. Teas and lotions (water, glycerin soluble) can benefit wound healing, rashes and infections. The pet owner can make a tea

IVC Summer 2021

Topical treatments and their goals

Cleanse and detoxify

dead cells, metabolic wastes, toxins from the environment, dead skin, parasites, pathogenic yeasts and bacteria. • Golden thread • Echinacea • Chamomile • Turmeric • Goldenrod • Gotu kola • Neem • Noni • Peppermint • Rosemary • Eucalyptus • Baking soda and lemon juice

Quell inflammation (if present)

•A loe vera gel • Comfrey leaves • Golden thread (Coptis sinensis) • Green tea • Plantain • Witch hazel • L actoferrin • Chamomile • Yarrow • Calendula • Hemp oil

Nourish and restore skin microbiome

•A pple cider vinegar rinse • Coconut, jojoba, and olive oil • Vitamin E oil • Comfrey (allantoin) • Marshmallow • Green tea • Collagen (bone broth/ hyaluronic acid/Noni) • Calendula/marigold

Repair DNA damage

• Green tea • Holy basil tea • Aloe vera gel • Vitamin E oil • Noni leaf • Krameria triandra • Squalene • Olive oil • Comfrey (allantoin) • Quercetin • Resveratrol • Japanese knotweed • Turmeric

There may be more medicinal plants in each of these categories. Research continues to point out the importance of these plants in the treatment of dermatological problems.

Repair, restore and regenerate TOPICALLY ADMINISTERED Aloe vera Comfrey leaf tea Rose flower Vegetable glycerin Green tea (decaf) Chamomile tea Calendula Witch hazel Hemp seed oil Olive oil Coconut oil Vitamin E oil

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Sample Formula Aloe vera juice Witch hazel Green tea Rose glycerin Rosemary oil (preservative)

using some of the ingredients listed in the sidebar at left, and either add it to their current shampoo, or make a topical skin lotion, depending on the goals and focus of the treatment. Rose glycerin can easily be made at home by collecting red rose flowers and steeping them in vegetable glycerin for about two weeks. The solution will turn a cranberry color. The rose flowers contain many antioxidants for the skin, and are antimicrobial.

IN CONCLUSION Skin problems in general are very difficult to cure using the conventional paradigm of “kill and suppress.” What is missing in the conventional approach are treatments that support repair and regeneration and restore normal skin functions. Deciding on a treatment plan after a patient has been treated with drugs and antibiotics by other veterinarians can initially be confusing to an integrative veterinarian. However, careful study of the patient’s history, along with a thorough examination, lab testing, identifying and supplementing deficiencies, as well as restoring the microbiome of the gut and skin will generate a treatment plan that produces more positive results, and possibly a cure.

Nicotinamide. Memorial Sloan Kettering Cancer Center (mskcc.org)

Korać RR, Khambholja KM. Potential of herbs in skin protection from ultraviolet radiation. Pharmacogn Rev. 2011;5(10):164-173. 2

3 Huang ZR, Lin YK, Fang JY. Biological and pharmacological activities of squalene and related compounds: potential uses in cosmetic dermatology. Molecules. 2009;14(1):540-554.

6 2 2 1 5

oz oz oz oz drops

4 Griffiths CE, Cumberbatch M, Tucker SC, et al. Exogenous topical lactoferrin inhibits allergen-induced Langerhans cell migration and cutaneous inflammation in humans. Br J Dermatol. 2001; 144(4):715-725. 5 Katherine L. Brown MD Tania J. Phillips MD, FRCPC Nutrition and wound healing. Clinics in Dermatology Volume 28, Issue 4, July–August 2010;432-439. 6 Fleck, Erin, Madigan, NMD., L.E., L.E.I. The Microbiome: Gateway to the Skin’s Ecosystem. Skin Inc. November 2020. 7 Schmitt, Walter, H., DC, DIBAK, DABCN. The Immune System and Its Effect on the Brain and HPA Axis. August 23, 2014.

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UNDERSTANDING

Pulsed Electromagnetic Field Therapy (PEMF) AND ITS BENEFITS IN VETERINARY MEDICINE

BY DEIRDRE CHIARAMONTE, DVM, ACVIM, CCRT, CERP, CVA

PEMF therapy is used in both human and veterinary medicine to treat arthritis, inflammation, pain, edema, fractures, and acute and chronic wounds. Even though strong clinical evidence supports its use, different device parameters and claims have caused confusion. Pulsed electromagnetic field (PEMF) therapy is a noninvasive electrotherapy that uses an electromagnetic waveform delivered by antenna. PEMF devices have been approved by the US Food and Drug Administration (FDA) to treat non-union fractures, and cleared to treat soft tissue post-operative pain and edema.1 PEMF therapy devices have been in use for more than a century.1 During the 1930s, a vacuum tube-based diathermy machine used to deliver heat deep into tissue was modified by changing the duty cycle to not produce heat. This new non-thermal device was discovered to have therapeutic effects in pain reduction and wound healing. In the 1970s, orthopedic researchers and clinicians began to surgically implant electrodes into bone to treat non-healing fractures.2,3 Shortly thereafter, non-invasive antennas were used to pulse electromagnetic fields across non-healing fractures in dogs and humans.4 This gave rise to low-powered PEMF devices called bone growth stimulators (BGS), later approved by the FDA.5 During the 20th century, more and more research and clinical evidence led to a greater understanding of how PEMF works.6,7

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DIFFERENTIATING PEMF DEVICES Several parameters determine the mechanism of action, efficacy, and safety of each device, including the electromagnetic waveforms they emit, the size and geometry of the antenna, and the difference in treatment applications. These combined variabilities necessitate the need for validation of each individual PEMF type device. Different PEMF devices have different magnetic fields that can vary from less than one gauss to several thousand gauss. A gauss is a measure of magnetic induction, also known as magnetic flux density. As defined by today’s International Systems of Units, a tesla corresponds to 10,000 gauss. • Devices generating biological effects from magnetic fields are usually categorized as low frequency, with less than 1,000 Hz carrier frequency. • H igh frequency devices with greater than 1,000 Hz carrier frequency usually produce biological effects stemming from electric fields.

Additionally: •T argeted PEMF (tPEMF) devices have waveforms specifically produced to deliver energy to tissue and modulate biologically signaled cascades. • Non-targeted PEMF devices employ waveforms that are not designed to enhance specific biological effects, and are less efficient. Increased calcium ion (Ca2+) signaling has been recognized as an important factor supporting the clinical effects of tPEMF as well as other PEMF technologies and predecessors.8,9 PEMF exposure releases intracellular calcium, which in turn enhances binding of Ca 2+ to calmodulin (CaM).

TARGETED PEMF MECHANISM OF ACTION Targeted PEMF induces downstream production of nitric oxide (NO). Dr. Louis Ignarro and colleagues described the role of NO in biology as a gaseous signaling molecule, particularly about its cardiological effects.10 In 1998, they were awarded the Nobel Prize in Physiology or Medicine for their research.10,11,12 NO is an important homeostasis signaling molecule as it can function as a vasodilator and also influence the nervous and immune systems.13,14 Targeted PEMF enhances NO production

which clinically reduces pain, edema, and inflammation by reducing programmed cell death, promoting blood vessel dilation, and enhancing circulation.1,9,15,16,17,18,19,20 Calcium binds with CaM when increased concentrations of Ca 2+ are present in the cytoplasm. Rapid bursts of NO are produced when Ca 2+ to CaM binding activates constitutive nitric oxide synthase (cNOS). NO binds to soluble guanylyl cyclase and increases production of cyclic guanosine monophosphate (cGMP). Anti-inflammatory responses, enhanced blood flow, and production of growth factors are activated following enhanced NO and cGMP — all required for tissue repair and healing. After tissue injury, surgical or traumatic, a complex inflammatory cascade occurs to avoid infection, enhance tissue remodeling, and start tissue healing. Concurrently, an anti-inflammatory cascade is initiated, decreasing inflammation, increasing cGMP, and releasing growth factors to bolster vascularization, tissue regeneration, and remodeling. Heat shock proteins (HSP) are inducible proteins that are expressed under stressful conditions but are considered cytoprotective and prevent apoptosis. 21 A specific group of HSPs — HSP70, important in protein folding — are induced by tPEMF therapy, also imperative for tissue healing.22,23,24 Continued on page 20.

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From top to bottom: Assisi Loops, 10cm and 20cm; Retorno de Maria before Assisi Loop treatment; Retorno de Maria after Assisi Loop treatment; Fred receiving therapeutic Assisi Loop treatment for elbow osteoarthritis.

Case studies A colt named Retorno de Maria was kicked in the leg, resulting in a wound that was not discovered until 48 hours later. Because it was considered contaminated, the skin was not sutured; instead, the wound was washed thoroughly, covered in antiseptic, and wrapped. The Assisi Loop was used for 25 minutes twice a day for five days. No other treatments were used and the leg was wrapped only for the first two days. In just those two days, the inflammation and edema had decreased significantly. Dr. Aurelio Chaux, a retired thoracic surgeon at Cedar Sinai Hospital in Los Angeles, who was treating the horse, left on a trip and was told the colt had not received any other treatments or medications since the time she left. “To my surprise, the wound had healed completely and the remaining scar is small, there is no residual pain, and movement in the leg is normal. One month later, there is no swelling or lameness.” Fred, a 17-year-old male neutered terrier mix with osteoarthritis in his limbs and spine, exhibited lameness that was most pronounced in his left elbow. He was acting depressed and less interactive. His pain and inflammation medications were not keeping him comfortable. At the direction of veterinarian Dr. Lisa Lancaster, he started Assisi Loop treatments three times per day for two weeks, then two times per day for a week, then once a day. He was started on Tramadol and glucosamine at the same time, but the Loop was his main mode of treatment. By week two, Fred was more interactive, and willing to move. He still had lameness but his comfort level had improved. “It seemed to make a pretty big difference for him,” says his owner, Kris. “He was hobbling around the house all the time before that. What I notice now is that he’s pretty lame on his first couple steps when he gets up, but if you didn’t know he had such significant [arthritis] in his elbow, you’d probably have a hard time telling… The reason I believe the Loop works is that I’d taken him up to my other place in Grand Junction, and forgot to bring it with me. I noticed a pretty significant decline over a couple of days of not using it, versus getting back here and using it again.”

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Continued from page 19.

RESEARCH SUPPORTING PEMF AND TPEMF EFFICACY • Both acute and chronic inflammation often add to pain and edema. Several studies support the effectiveness of PEMF and tPEMF to combat pain, edema, and inflammation. » One post-surgical breast surgery study that used a continuous PEMF device for seven days reported significantly lower visual analog pain (VAS) scores and ingestion of fewer narcotic pain pills.25 » Targeted PEMF has been used in four doubleblind, randomized, placebo-controlled research studies in humans undergoing breast augmentation, breast reduction, bilateral mastectomy and reconstruction, and mastectomy with transverse rectus abdominus reconstruction.19,20,26 Targeted PEMF treatment, compared to placebo treatment, significantly reduced pain by 50%, edema by over 40%, interleukin-1 beta by 40%, and narcotic pain ingestion by 50% post-operatively.20 • Research has also documented that PEMF enhances vascular function and wound repair. » One study in rats demonstrated that PEMF treatment accelerated new blood vessel growth five-fold in an arterial flap transfer.27 » I n a subsequent study in rats, arterial blood supply to a tissue flap was cut off and PEMF was applied. The sham cohort had virtually complete flap failure while PEMF-treated animals exhibited significant vascularization and virtually complete flap survival.28 PEMF is effective in wound healing due to enhanced vascularization and tissue perfusion. • PEMF devices that are FDA-cleared are safe, effective treatments for chronic wounds, and several studies demonstrate that treatment accelerated the healing of chronic pressure wounds such as diabetic leg and foot ulcers as well as pressure sores.29,30,31,32 Continued on page 22.

ADVERTORIAL

The “frenemy”, Escherichia coli, may be contributing to your patients’ chronic diarrhea cases BY HOLLY GANZ, PHD

Veterinarians are trained to consider Escherichia coli to be normal inhabitants of the gut lumen. However, there is growing evidence that E. coli should be considered a pathobiont (or a “frenemy”). While low levels of E. coli (median of 0.5% in cats and 1% in dogs) are in fact normal in the fecal microbiomes of these species, overgrowths are problematic and contribute to dysbiosis (imbalance) in the gut microbiome, as well as chronic diarrhea. Antibioticinduced dysbiosis increases oxygen availability at the colonic epithelium. As a result, obligate anaerobes decrease and facultative anaerobes bloom, contributing to an overgrowth of E. coli. Elevated levels of Escherichia can indicate, escalate, and/or perpetuate an inflamed epithelium.

as increasing the amount of protein in the diet to promote the growth of important groups like Fusobacterium.

An analysis of a large database of fecal microbiome samples from cat (n=943) and dog (n=2,968) patients collected by AnimalBiome was presented at the American College of Veterinary Internal Medicine (ACVIM) 2020 Forum, and showed that 15% of cats and 30% of dogs with chronic GI conditions had elevated levels of Escherichia. These patients were more likely to have diarrhea and recent antibiotic exposure compared to those with normal levels of Escherichia, and were more likely to be older and to have lower body condition scores. Consistent with prior antibiotic exposure, the fecal microbiomes of cats and dogs with high levels of Escherichia were dysbiotic and depleted in key bacterial members of the core fecal microbiome found in healthy cats and dogs.

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 healthy community of cat- or dog-specific bacteria. The Gut Restore Supplement, a fecal transplant in an oral entericcoated capsule, provides a convenient method for rebuilding microbial diversity in the gut microbiome. Follow-up testing of the gut microbiome after MBRT provides a concrete measure of whether the microbiome is in a more balanced state or if more work may need to be done.

Testing your patient’s fecal microbiome composition provides useful information about the bacterial groups present, beneficial groups that may be missing, and the abundance of pathobionts like Escherichia, to help you assess how to best support your patient’s health. Dietary shifts can be made to address imbalances in core bacterial groups, such

Escherichia overgrowths can be targeted by products like Gut Maintenance Plus, a powerful blend of prebiotics and probiotics specifically designed to stop diarrhea flare-ups caused by Escherichia. Active ingredients include Saccharomyces boulardii (S. boulardii), a yeast probiotic clinically proven to combat diarrhea (>250 peer reviewed publications); PreForPro, a prebiotic bacteriophage cocktail targeting particularly bad strains of Escherichia; and prebiotic mannan-oligosaccharides (MOS) to feed beneficial gut bacteria and improve intestinal health.

Having a diverse and balanced assemblage of gut bacteria helps keep frenemies like Escherichia in check.

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 IVC Summer 2021

» I n 2018, a randomized, double-blind, placebocontrolled study was conducted on dogs with acute, severe intervertebral disc extrusion and paraplegia being treated with spinal decompression surgery. Dogs receiving targeted PEMF therapy exhibited significant reductions in surgical incision pain, lower concentrations of inflammatory spinal fluid markers, and improved proprioceptive function compared to sham controls. 34

Effect of PEMF on cutaneous full thickness wound in a rat model. The results showed the mean tensile strength of the treated wounds was 59% stronger than that for the sham group, meaning wound healing was significantly accelerated.

» T he Assisi Loop ® also underwent a second randomized, double-blind, sham-controlled study evaluating its effects on dogs with acute intervertebral disc extrusion and paraplegia treated with spinal decompression surgery. Dogs receiving tPEMF therapy had significantly improved visual analogue scores (VAS) on wound healing and wound evaluation (WES) scoring. Interestingly, sham-treated patients had higher numbers of owner-administered pain medication compared to tPEMF-treated dogs. 35

Continued from page 20. In a randomized, clinical trial involving paraplegic veterans with sacral ulcers, one 30-minute daily treatment with PEMF every weekday for one month resulted in 64% wound closure, versus a 7% increase in wound size in the sham-treated veterans.30,33 • Recently, a targeted PEMF device called The Assisi Loop® has been used in veterinary patients to assess efficacy of post-operative pain reduction and wound healing. Strauch, B., Herman, C., Dabb. R., Ignarro, L. J., Pilla, A. A., 2009. Evidence-based use of pulsed electromagnetic field therapy in clinical plastic surgery. Aesthet Surg J 29, 135-143.

l-Mandeel, M., Watson, T, 2008. Pulsed and Continuous short-wave therapy, 12th Ed. Elsevier, New York.

Paterson, D.C., Carter, R.F., Maxwell, G.M., Hillier, T.M., Ludbrook, J., Savage, J.P., 1977. Electrical bonegrowth stimulation in an experimental model of delayed union. Lancet 1, 1278-1281. 3

Bassett, C.A., Pilla, A.A., Pawluk, R.J., 1977. A non-operative salvage of surgically resistant pseudarthroses and non-unions by pulsing electric fields. A preliminary report. Clin Orthop Relat Res, 128-143.

5 Bassett, C.A., Mitchell, S.N., Gaston, S.R., 1982 Pulsing electromagnetic field treatment in ununited fractures and failed arthrodesis. JAMA 247, 623-628. 6

Pilla, A.A., 2006. Biological and medical aspects of electromagnetic fields. CRC Press, Boca Raton, FL.

Pilla, A.A., 2013. Nonthermal electromagnetic fields: from first messenger to therapeutic applications. Electromagn Biol Med 32, 123-136.

Brighton, C.T., Wang, W., Seldes, R., Zhang, G., Pollack, S.R., 2001 Signal transduction in electrically stimulated bone cells. J Bone Joint Surg Am 83-A, 1514-1523. 8

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PEMF has demonstrated biological and clinical effects for a variety of conditions. Advancement of the field has shown PEMF’s usefulness in treating pain, inflammation, bone healing, and acute and chronic wounds. It is non-invasive and safe and can be used as a stand-alone or adjunctive treatment modality to treat veterinary patients with a variety of conditions. 36 Pilla, A.A., Fitzsimmons, R., Muesham, D., Wu, J., Rhode, C., Casper, D., 2011. Electromagnetic fields as first messenger in biological signaling: Application to calmodulin-dependent signaling in tissue repair. Biochem Biophys Act 1810, 1236-1245.

Ignarro, L.J., 1990. Biosynthesis and metabolism of endothelium-derived nitric oxide. Annu Rev Pharmacol Toxicol 30, 535-560.

Ignarro, L.J., Lippton, H., Edwards, J.C., Baricos, W.H., Hyman, A.L., Kadowitx, P.J., Gruetter, C.A., 1981. Mechanisms of vascular smooth muscle relaxation by organic nitrates, nitrites, nitroprusside and nitric oxide: evidence for involvement of S-nitrosothiols as active intermediates. J Pharmacol Exp Ther 218, 739-749.

Ignarro, L.J., Buga, G.M., Wood, K.S., Byrnes, R.E., Chaudhuri, G., 1987. Endothelium derived relaxing factor produced and released from artery and vein is nitric oxide. Proc Natl Acad Sci USA 84, 9265-9269.

Bogdan, C., 2001. Nitric oxide and the immune response. Nat Immunol 2, 907-916.

Calabrese, V., Mancuso, C., Calvani, M., Rizzarelli, E., Butterfield, D.A., Stella, A.M., 2007. Nitric oxide in the central nervous system: neuroprotection versus neurotoxicity. Nat Rev Neurosci 8, 766-775. 14

15 Bragin, C.T., Statom, G.L., Hagberg, S., Nemoto, E.M., 2014. Increases in microvascular perfusion and tissue oxygenation via pulsed electromagnetic fields in the healthy rat brain. J Neurosurg, 109.

Pilla, A.A., 2012. Electromagnetic fields instantaneously modulate nitric oxide signaling in challenged biological systems. Biochem Biophys Res Commun 426, 330-333.

17 Pena-Phillippedes, J.C., Yang, Y., Bragina, O., Hagberg, S., Nemoto, E., Roitbak, T., 2014. Effect of pulsed electromagnetic field on infarct size and inflammation after cerebral ischemia in mice. Translational Stroke Res 5, 491-500.

Rasouli, J., Le khraj, R., White, N.M., Flamm, E.S., Pilla, A.A., Strauch, B., Casper, D., 2012. Attenuation of interleukin-1beta by pulsed electromagnetic fields after traumatic brain injury. Neuroscience Letters 519, 4-8. 18

Rohde, C., Chiang, A., Adipoju, O., Casper, D., Pilla, A.A., 2010. Effects of pulsed electromagnetic fields on interleukin-1 beta and postoperative pain: a double-blind, placebo-controlled, pilot study in breast reduction patients. Plast Reconstr Surg 125, 1620-1629.

Rohde, C.H., Taylor, E.M., Alonso, A., Ascherman, J.A., Hardy, K.L., Pilla, A.A., 2015. Pulsed Electromagnetic Fields Reduce Postoperative Interleukin-1beta, Pain, and Inflammation: A Double-Blind, Placebo-Controlled Study in TRAM Flap Breast Reconstruction Patients. Plast Reconstr Surg 135, 808e-817e.

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.

21 Robertson, J.A., Thomas, A.W., Bureau, Y., Prato, F.S., 2007. The influence of extremely low frequency magnetic fields on cytoprotection and repair. Bioelectromagnetics 28, 16-30.

DiCarlo, A.L., Farrell, J.M., Litovitz, T.A., 1999. Myocardial protection conferred by electromagnetic fields. Circulation 99, 813-816.

23 Rodriguez de la Fuente, A.O., Alcocer-Gonzalez, J.M., Antonio Heredia-Rojas, J., Balderas- Candanosa, I., Rodriguez-Flores, L.E., Rodriguez-Padilla, C., TamezGuerra, R.S., 2009. Effect of 60 Hz electromagnetic fields on the activity of hsp70 promoter: an in vitro study. Cell Biol Int 33, 419-423.

Rodriguez-De la Fuente, A.O., Alcocer-Gonzalez, J.M., Heredia-Rojas, J.A., Rodriguez-Padilla, C., Rodriguez-Flores, L.E., Santoyo-Stephano, M.A., Castaneda-Garza, E., Tamez-Guerra, R.S., 2012. Effect of 60 Hz electromagnetic fields on the activity of hsp70 promoter: an in vivo study. Cell Biol Int Rep (2010) 19, e00014.

TREATING AN ACUTE CASE OF HEAT STROKE IN A DOG On a hot, humid, July day in Indiana, a dog was brought in with typical symptoms of severe heat stroke — rectal temperature of 106°F, rapid panting, uncontrollable twitching and jerking, rigid body posture, inability to move much, a glassy stare, and poor response to voice. This is a true crisis situation, as you know, and we went into high gear, preparing to insert an IV catheter, give injections, and cool down this dog.

25 Rawe, I.M., Lowenstein, A., Barcelo, C.R., Genecov, D.G., 2012. Control of postoperative pain with a wearable continuously operating pulsed radiofrequency energy device: a preliminary study. Aesthetic Plast Surg 36, 458-463. 26 Heden, P., Pilla, A.A., 2008. Effects of pulsed electromagnetic fields on postoperative pain: a double-blind randomized pilot study in breast augmentation patients. Aesthetic Plast Surg 32, 660-666.

Roland, D., Ferder, M., Kothuru, R., Faierman, T., Strauch, B., 2000. Effects of pulsed magnetic energy on a microsurgically transferred vessel. Plast Reconstr Surg 105, 1371-1374.

28 Strauch, B., Patel, M.K., Navarro, J.A., Berdichevsky, M., Yu, H.L., Pilla, A.A., 2007. Pulsed magnetic fields accelerate cutaneous wound healing in rats. Plast Reconstr Surg 120, 425-430. 29 Weber, R.V., Navarro, A., Wu, J.K., Yu, H.L., Strauch, B., 2004. Pulsed magnetic fields applied to a transferred arterial loop support the rat groin composite flap. Plast Reconstr Surg 114, 1185-1189.

Kloth, L., Berman, J., Sutton, C., Jeutter, D., Pilla, A., Epner, M., 1999. Effect of pulsed radio frequency stimulation on wound healing: a double-blind pilot clinical study, Electricity and magnetism in biology and medicine. Springer, pp. 875-878.

Mayrovitz, H.N., Larsen, P.B., 1995. A preliminary study to evaluate the effect of pulsed radio frequency field treatment on lower extremity peri-ulcer skin microcirculation of diabetic patients. Wounds 7, 90-93.

Then I remembered something: I’d just finished the first session of a veterinary homeopathy course, and we had talked about heatstroke. Two remedies came to mind — homeopathic Aconitum and Belladonna. Belladonna tends to have enlarged pupils, which this pup didn’t, so I quickly grabbed a dose of Aconitum and popped it into her mouth.

AN “AH-HA” MOMENT About 30 seconds later, as we continued to prepare other measures, my tech said, “Hey look, she’s acting better!” And she was — relaxing her posture, making better eye contact, even beginning to wag her tail, and breathing more normally. It had only been a minute or so since the remedy, but we took her temperature again, and it was already down to 103.5°F. I gave her another dose, and didn’t do anything else. Five minutes later, her temp dropped below 102°F, and she seemed completely normal. We were all shocked, and I walked her up to the front, where her owners were still filling out consent forms. They were also shocked, because just a few minutes before they were given a pretty guarded prognosis — and now they were taking their dog home as if nothing had happened.

This was the first homeopathic cure I’d ever seen, and it was rapid. The reason this dog responded so quickly is that she received a remedy capable of causing a similar state to the one she was experiencing.

Stiller, M.J., Pak, G.H., Shupack, J.L., Thaler, S., Kenny, C., Jondreau, L., 1992. A portable pulsed electromagnetic field (PEMF) device to enhance healing of recalcitrant venous ulcers: a double-blind, placebo-controlled clinical trial. Br J Dermatol 127, 147-154.

USING THE RIGHT REMEDY IS KEY

Salzberg, C.A., Cooper-Vastola, S.A., Perez, F., Viehbeck, M.G., Byrne, D.W., 1995. The effects of non-thermal pulsed electromagnetic energy on wound healing of pressure ulcers in spinal cord-injured patients: a randomized, double-blind study. Ostomy Wound Manage 41, 42-44, 46, 48. 33

Zidan, N., Fenn, J., Griffith, E., Early, P.J., Mariani, C.L., Munana, K.R., Guevar, J., Olby, N., 2018. The effect of electromagnetic fields on postoperative pain and locomotor recovery in dogs with acute, severe thoracolumbar intervertebral disc extrusion: a randomized placebo-controlled, prospective clinical trial. J Neurotrauma. 34

Alvarez, L.X., McCue, J., Lam, N.K., Askin, G., Fox, P.R., 2018. Effect of Targeted Pulsed Electromagnetic Field Therapy on Canine Postoperative Hemilaminectomy: A Double- Blind, Randomized, Placebo-Controlled Clinical Trial. JAAHA Mar/Apr 2019, 83-91.

36 Gaynor, J.S., Hagberg, S, Gurfein, B.T., 2018. Veterinary Applications of Pulsed Electromagnetic Field Therapy. Research in Veterinary Science May 2018.

Potency selection is not as critical as the right remedy; use the potency you have and repeat as needed. Re-dose when the remedy action starts to decrease, which might be in five, ten, 30 or 60 minutes. The symptom picture might also change to require a different remedy, so be prepared to change remedies as the patient changes.

Submitted by Todd Cooney, DVM, CVH

Aconite (Aconitum napellus; monkshood) Symptoms with great fears, stresses (heat), chills, or sudden drastic changes in weather. Dramatic display of symptoms after these. Great anxiety, “deer in the headlights” look. Sudden onset of high temperature with thirst, colic, convulsions, pneumonia.

BY ARMI PIGOTT, DVM, DACVECC

It’s NOT futile! The implementation of RECOVER guidelines into CPR protocols is showing promise as a way to improve outcomes for veterinary patients.

It’s every veterinary professional’s worst fear. A healthy animal goes into a routine and supposedly low-risk procedure… and arrests. What happens in the next seconds to minutes will likely determine the patient’s outcome. How will the team respond? With a purposeful, coordinated transition to high quality, evidence-based CPR? With discombobulated flailing and yelling? Something in between? How does a team move from fumbling attempts at resuscitation to purposeful, coordinated CPR? What is the best way to perform CPR, and who should lead the resuscitation efforts? And how can veterinary professionals access high quality, hands-on training? These are the questions being addressed and answered by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) Initiative.

WHAT IS RECOVER AND WHAT ARE THE GUIDELINES? The RECOVER initiative was created in 2010 by veterinary emergency and critical care specialists with the purpose of organizing and disseminating the first true evidence-based veterinary cardiopulmonary resuscitation (CPR) guidelines. It is a collaborative effort by members of the American College of Veterinary Emergency and Critical Care (ACVECC) and the Veterinary Emergency and Critical Care Society (VECCS). The RECOVER Initiative has three goals:

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#1 #2 #3

Develop and update evidence-based, consensus veterinary CPR guidelines through extensive review of primary CPR literature. Provide standardized CPR training to veterinary professionals and pet owners, offering CPR certification through the ACVECC and endorsed by the VECCS. Inform and support scientific research to improve the approach to CPR in animals.1

The RECOVER guidelines2-8 were published in 2012, and are the first published consensus recommendations for CPR in veterinary medicine. It was a massive undertaking that involved over 100 veterinary professionals from ACVECC and VECCS, working with advice from the International Liaison Committee on Resuscitation (ILCOR), the group responsible for performing the extensive literature surveys upon which evidence-based human CPR guidelines are developed.1 The guidelines are freely available online in a special issue of the Journal of Veterinary Emergency and Critical Care, Volume 22, Issue s1 at https://onlinelibrary.wiley.com/toc/14764431/22/s1.2-8 They include when and how to initiate CPR; how to perform chest compressions; drug dose and timing recommendations; and monitoring devices and techniques that have a beneficial role

during the resuscitation process and those that do not. The guidelines also include visual aids to guide caregivers through the steps of CPR, drug administration, post-resuscitation care, and team dynamics. Once the guidelines were written, a consistent, standardized training program could be developed. In human medicine, establishing ILCOR and developing evidence-based clinical guidelines allowed consistent training for human healthcare professionals and the lay public, which has led directly to improved patient outcomes.9,10 Shortly after completion of its guidelines, RECOVER established a standardized training and certification program on this model for veterinary professionals, and recently released a course for the lay public. Studies evaluating veterinary professionals’ knowledge of the CPR guidelines and outcomes before and after they were published are sparse; but those that have been published suggest that knowledge of these guidelines is spreading through the veterinary professional community, and outcomes may be improving.11-14 Research into many areas of resuscitation is ongoing in many hospitals and institutions, and includes a large, multinational CPR database maintained by the RECOVER Initiative, similar to human databases, where registered hospitals enter data from every CPR event performed within them.

IT’S NOT FUTILE — CPR OUTCOMES Owners and veterinary professionals alike often ask questions such as “is it worth it”, “how well does it work”, or “can you really get them back?” It is worth it, it can work, and you can get some of them back. As in human medicine, the number of survivors is low, but that doesn’t make it futile. We know the outcomes between people and animals differ, and making direct comparisons is difficult for several reasons. There are decades’ worth of data and thousands of publications evaluating human outcomes, but very limited data in veterinary medicine to date. Most of the available veterinary data comes from university and specialty referral hospitals caring for the sickest of patients that often have a poor prognosis due to their underlying disease. In addition, the epidemiology of underlying pathology leading to arrest is different between humans and animals. Acknowledging these

limitations, some comparisons are still worth discussing. Overall, approximately 45% of humans and 35% to 55% of dogs and cats will achieve return of spontaneous circulation (ROSC).11,12,15,16 Many of these patients will subsequently die in the hospital or (in veterinary medicine) be euthanized due to perceived poor prognosis or lack of financial ability to pursue treatment.16 In humans, there is a significant difference between patients that arrest outside the hospital (OHCA) versus in the hospital (IHCA). Survival to discharge for humans that arrest in the hospital is 17% to 34%, while OHCA sees only about 10% survival.15 Survival to discharge in dogs and cats is 6% to 19%,11,12,16 with less variation between in-hospital and out-of-hospital arrests, but also with significantly less data from which to make this determination.15 Of particular note, dogs and cats that arrest due to anesthesia- or sedation-related complications are much more likely to survive. A study by Hofmeister et al conducted prior to publication of the RECOVER guidelines found that 47% of dogs and 42% of cats that arrested in association with an anesthetic event (time from induction to extubation) survived to discharge.11 Hoehne et al found similar results, noting that cats and dogs that arrested in association with anesthesia or sedation were 14.8 times more likely to survive and be discharged than those with other causes of arrest.16 This statistic, and the finding in

CPR outcomes using RECOVER guidelines Overall return of spontaneous circulation

35%-55%

Survival to discharge

6%-19%

Anesthesia or sedation — associated arrest

14.8x more likely to survive

Single-hospital outcome improvement: Pre-RECOVER-based CPR

17% ROSC, 0% survival to discharge

Post-RECOVER-based CPR

43% ROSC, 5% survival to discharge

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Putting the guidelines into practice: training for veterinary professionals The RECOVER initiative offers evidence-based training and certification for veterinarians, veterinary technicians and nurses, and non-licensed veterinary staff members. Similar to CPR in humans, the RECOVER guidelines break CPR up into two parts: basic life support, which is performing chest compressions and breathing for the patient, and advanced life support, which involves using drugs and monitoring devices to improve the chances of achieving ROSC and monitor the effectiveness of ongoing CPR efforts. There are multiple levels of certification. The first level is the online certificate course. This course, which can be found on the RECOVER Initiative website (https://recoverinitiative.org), teaches the basics for performing high quality CPR. It qualifies for 8.5 hours of RACE-approved CE, and focuses on rapid recognition and response to cardiopulmonary arrest; proper delivery of chest compressions; breathing for the patient; monitoring and assessing the effectiveness of CPR while it is ongoing; timing cycles of

CPR; treatments to deliver during CPR; and effective team dynamics and communication. This course is the foundation for performing high quality CPR, and for taking the RECOVER Rescuer Certification course, which is an in-person CPR simulation course also open to all veterinary team members. Participants work in teams to perform CPR in a variety of scenarios designed to improve hands-on CPR and communication skills learned in the certificate course. These are small-group courses with instructors providing direct feedback on compression technique, overall delivery of the CPR algorithm, as well as communication and team dynamics. These courses are held at major veterinary conferences worldwide, as well as at some local veterinary conferences, and occasionally local workshops. Upcoming courses as well as a list of instructors certified to teach the course can be found on the RECOVER website.

both humans and animals that a shorter period of time from arrest to initiation of CPR is a significant factor in survival,15,16 suggests it is imperative for veterinary professionals of all levels of qualification to be prepared to perform high quality CPR in any setting —particularly those who work with sedated or anesthetized animals. Data in human medicine shows that development of evidencebased standardized training programs does have a positive impact on performance and patient outcomes.10 A single veterinary publication that evaluates performance in a hospital before and after implementation of the RECOVER guidelines shows significant outcome improvements in this hospital’s performance.17 This study evaluated outcome in 141 dogs — 68 resuscitated prior to implementing RECOVER guidelines and 73 after implementing RECOVER guidelinebased CPR. The study reports no difference between the groups with regards to baseline patient characteristics. These results are impressive: prior to performing guideline-based resuscitation, the group had 17% ROSC with 0% survival to discharge. Following implementation of RECOVER guidelinebased CPR, they achieved 43% ROSC and 5% survival to discharge. This study is also notable because it is one of the few veterinary CPR studies not performed in a tertiary veterinary hospital, indicating that positive outcomes can be achieved in the non-tertiary, non-24-hour environment. References available at IVCJournal.com

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Hemp cannabis use in pets

IS HERE TO STAY What have we learned about veterinary cannabis use over the last two-and-ahalf years, since hemp CBD became legal in the US?

1 2 3

The two most common reasons people seek CBD for their pets are to treat anxiety and provide pain relief. Most hemp CBD products are safe for pets.1,2 While oral administration of CBD products for dogs (on food or in a treat) is widespread, elevated ALP has been documented in multiple studies dosing orally at 2 mg/kg. 3,4

OFFER VET-TO-VET CBD PRODUCTS What added value can veterinarians offer clients in the crowded direct-toconsumer cannabis marketplace? A handful of hemp product lines have been formulated by veterinarians, not “CBD bubble” marketeers. It’s time that veterinarians became proactive in dispensing cannabinoid supplements. Who better than a trusted vet when it comes to advising about indications, helping to find the optimal dosing regimen, understanding the difference in administration methods, and monitoring pets for adverse effects? Your practice can exert quality control over hemp CBD by offering vet-to-vet products that are high quality, high potency, and easy to dose.

As a veterinarian, what added value can you offer your clients when it comes to CBD products? BY KAREN GELLMAN, DVM, PHD

WHAT ELSE YOU SHOULD KNOW ABOUT CBD • Did you know that by dosing CBD transmucosally (directly in the mouth), dogs can achieve better systemic absorption and minimize risks of elevated ALP? Transmucosal administration allows micro-dosing of hemp CBD products — using 0.25-0.5 mg/kg instead of 2 mg/kg that some recommend for dosing on food. By administering hemp CBD products directly into the systemic circulation, we can avoid stressing the liver P450 cytochrome system. 5 High potency oil products are best for this method of administration. • When dosing directly into the mouth, palatability matters! Hemp plants can have wildly different terpene profiles based on genetics, cultivation, and weather conditions. Terpenes are the source of hemp’s odor and flavor. Also, different carrier oils have different flavors and shelf stability. Be sure to taste-test a potential product, find out whether the company’s hemp source is consistent batch to batch, and choose neutral shelf-stable carrier oils. • Some hemp products differentiate themselves by the incorporation of minor cannabinoids. For example, what do you know about cannabigerol (CBG)? This is the “mother molecule” of all cannabinoids — the base compound from which the rest are made. Early clinical trials indicate that CBG outperforms other cannabinoids for appetite

stimulation — an important factor for cancer patients and pets with a fragile GI tract. Promising trials are also being done on CBG’s effects on neurodegenerative diseases and immune-mediated skin and gut syndromes. Wouldn’t it be great to have safe, effective treatment options for degenerative myelopathy and IBD? As more states legalize marijuana use, pressure is building on the DEA to remove it from the Schedule 1 drug list. It’s time to take charge of your clients’ willingness to use CBD for their pets, and learn how hemp cannabinoids can help patients with anxiety, pain, and end-of-life care.

1 McGrath, Bartner et al. A report of adverse effects associated with the administration of cannabidiol in healthy dogs. JAHVMA. 2018;52:34-38.

Gamble LJ, Boesch JM, et al. Pharmacokinetics, safety, and clinical efficacy of cannabidiol treatment in osteoarthritic dogs. Front in Vet Sci. 2018; 5:165.

Bartner, McGrath et al. Pharmacokinetics of cannabidiol administered by three delivery methods at two different dosages to healthy dogs. Can J Vet Res. 2018; 82:178-183.

Deabold KA, Schwark WS, Wolf L, Wakshlag JJ. Single-dose pharmacokinetics and preliminary safety assessment with use of CBD rich hemp nutraceutical in healthy dogs and cats. Animals. 2019; 9(10):832. https://doi.org/10.3390/ani9100832.

Zendulka O, Dovrtelova G, Noskova K, et al. Cannabinoids and Cytochrome P450 interactions. Curr Drug Metab. 2016;17(3):206–226.

Dr. Karen Gellman is research director of Maximum Horsepower Research, which studies posture and locomotion in horses and dogs. She is a graduate of Cornell College of Veterinary Medicine, with a PhD from Cornell in animal locomotion biomechanics. Dr. Gellman has co-taught the Postural Rehabilitation professional training course for the past eight years and speaks to veterinarians, chiropractors, and physical therapists. She is trained in acupuncture, chiropractic, and other modalities and has an integrative veterinary practice in Ithaca, New York (equinesportsmed.com). IVC Summer 2021

Mental Health First Aid

A psychologically healthy workplace is essential to good mental health. Learn how a staff member or manager trained in Mental Health First Aid can benefit your veterinary team.

for

veterinary teams BY CORAL DOHERTY, RVT, CPHSA

During the latter half of the 20th century, society’s views of mental illness underwent a profound shift. People began to question the stereotypical and prejudiced beliefs that those living with mental illness were violent, helpless, or a risk to society. Now, decades later, we recognize that people with mental illnesses, given treatment and self-care, can contribute to society, lead fulfilling lives, and enjoy everything life has to offer — including satisfying careers. Society has recognized the need for more workplace planning that removes all discrimination and stereotypes. This includes analyzing the way work is managed to provide working environments that are appropriate, safe, inclusive, and incorporate everyone’s human rights. An inclusive workforce at a veterinary hospital or any other workplace recognizes the risks to both occupational

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physical and mental health. We can no longer afford to damage people’s mental health at work by excluding occupational psychological risk management.1 Having a staff member or manager trained in Mental Health First Aid work is an important beginning.

OCCUPATIONAL PSYCHOLOGICAL HEALTH To perform a job or task with empathy, compassion, and professionalism, we need occupational psychological health.2 Working in a veterinary workplace exposes the worker to emotional stressors that affect mental health and job satisfaction.3 In fact, mental health illness is four times more prevalent among veterinary team members, including practice owners, than among the general population.8 A discussion of common occupational psychological health risks appears in the sidebar on page 32.

Workplace mental health and COVID-19 COVID-19 has magnified workplace stress,16 and the need for employee mental health support beyond the status quo.22,23 Both workers and employers have been feeling the extra burden on their mental health.19 Additionally, the effects of working through a pandemic may not be fully apparent to veterinary professionals until sometime in the future. Predictions of mental health and well-being suggest that mental health services will be unable to keep up with the needs of North Americans.23,24

In 2013, the Canadian National Standard for Psychological Health and Safety was released. It was researched and coordinated by the Mental Health Commission of Canada, and written by the CSA (Canadian Standards Association), which publishes standards with an internationally accepted level of quality that implies they can be used anywhere in the world.4 The Canadian National Standard is designed to help employers and employees assess the psychological health and safety risks of their workplace, and apply the internationally written framework designed to protect and promote mental health and wellness at work.4 In the US, the AVMA has designed a website that assists veterinary practices in the formation and monitoring of a mental wellness program (Guiding Principles for State Veterinary Wellness Programs). 5

PSYCHOLOGICAL HEALTH AND SAFETY LIABILITY Just as with physical safety, employers are responsible for providing a psychologically healthy work environment where mental health is protected and promoted.1,4,26 Employers should notice when their staff members exhibit symptoms of psychological stress, such as being: • Inefficient, exhausted • Uncooperative • Cynical, negative, anxious, over-reactive • Gossiping, whispering • Low performing • Burned out, stressed

NORMALIZE ASKING FOR HELP All too often, the stigma8 of asking for help when mental health is in jeopardy means the situation becomes more impulsive and urgent. A staff member/manager trained in Mental Health First Aid (MHFA)25,26 can help reduce this stigma and normalize asking for help when workplace stress

becomes overwhelming and mental health starts hurting. This can be invaluable to employees and practice owners.

THE ROLES OF A MENTAL HEALTH FIRST AIDER IN VETERINARY WORKPLACES25,27

1 2 3 4 5 6 7

Support the psychological risk mitigation plan and the psychological health and safety risks of veterinary workplaces.4,5,26 Keep a person safe from harm where he/she may be a danger to herself/himself or others. Guide a person to appropriate help to prevent the mental health problem from becoming more serious. Support the recovery of good mental health. Give comfort to a person experiencing a mental health problem. Champion a return-to-work program.1,28 Reduce stigma associated with asking for help.

A person trained in MHFA (MHFAider) can offer a confidential discussion, provide a listening ear, and allow the time an employee or practice owner needs to talk about their mental health. A Mental Health First Aider provides help to a person developing a mental health problem or experiencing a mental health crisis, or a worsening of their mental health. When mental health pain becomes too intense, a MHFAider on staff is often already familiar with employee history and can recognize needed support. A MHFAider is trained to initiate open, non-judgmental dialogue for someone who feels they aren’t able to cope with the thoughts and feelings they are having. This is important because the person who needs help feels alone, isolated, and may even be confused about their overwhelming feelings and thoughts. A MHFAider is trained to quickly gain the trust that is needed to help someone in distress, get some help, and save a life. Continued on page 31. IVC Summer 2021

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Continued from page 29.

HOW TO BECOME TRAINED IN MENTAL HEALTH FIRST AID A two-day course (eight hours total) is available online at https://www.mhfa.ca/en/course-types in a group format. The course teaches you how to:

Recognize the symptoms of mental health problems. It does not teach diagnosis.

2 3

Identify situations that are emergencies or life-threatening.

Offer a listening ear and how to ask appropriate questions. Guide a person towards appropriate professional help, or determine if more serious action is required. It does not teach people to be therapists.

A MHFAider can provide early detection and determine how to help a person who is not feeling well, a huge benefit to the individual, their family, and community. A MHFAider can bring light to a stigma that needs to be erased. Having someone on staff who is trained in Mental Health First Aid is part of the paradigm shift that veterinary hospitals can implement to assist employees when they need help. These trained personnel can recognize signs of mental distress, offer practices as a preventative approach to a mental health crisis, 29 and promote mental well-being in the workplace. 1 Mentalhealthcommission.ca. The Aspiring Workforce: Employment and Income for People with Serious Mental Illness. Available at: https://www.mentalhealthcommission.ca/sites/default/files/ 2016-06/Workplace_MHCC_Aspiring_Workforce_Report_ENG_0.pdf. 2 Cohen SP. Compassion fatigue and the veterinary health team. In:Veterinary Clinics of North America: Small Animal Practice. January 2007; 37(1):123-134. 3 Chu L-C. The Influence of Compassion Fatigue on Job Performance and Organizational Citizenship Behaviours: the moderating effect of person-job fit. J Nurs Scholarsh. March 23, 2021.

Mentalhealthcommission.ca. The Canadian National Standard for Psychological Health and Safety. Available at: https://www.mentalhealthcommission.ca/English/what-we-do/workplace/national-standard.

5 avma.org. Guiding Principles for State Veterinary Wellness Programs Available at: https://www.avma.org/resources-tools/wellbeing/guiding-principles-state-veterinary-wellness-programs. 6 Bartram DJ, Baldwin DS. Veterinary surgeons and suicide: influences, opportunities and research directions. Veterinary Record. 2008;162: 36-40.

Whiting TL, Marion CR. Perpetration-induced traumatic stress — A risk for veterinarians involved in the destruction of healthy animals. Can Vet J. 2011;52(7):794-796.

8 Bartram DJ, Baldwin DS. Veterinary surgeons and suicide: a structured review of possible influences on increased risk [published correction appears in Vet Rec. 2010 Apr 10;166(15):451].Vet Rec. 2010;166(13):388-397. 9 Moore IC, Coe JB, Adams CL, Conlon PD, Sargeant JM. The role of veterinary team effectiveness in job satisfaction and burnout in companion animal veterinary clinics. J Am Vet Med Assoc. 2014;245(5):513-524. 10

ada.com. Signs of Burnout. Available at: https://ada.com/signs-of-burnout/.

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avma.org. Organizational Compassion Fatigue. Available at: https://www.avma.org/resources-tools/ wellbeing/organizational-symptoms-compassion-fatigue.

12 Epstein EG, Delgado S. Understanding and addressing moral distress. The Online Journal of Issues in Nursing. 2010;15(3). Manuscript 1.

21 ehstoday. Is it even possible to exclude emotions from safety leadership?Available at: https://www.ehstoday.com/safety-leadership/article/21161959/is-it-even-possible-to-exclude-emotionsfrom-safety-leadership.

13 adaa.org. Symptoms of PTSD. Available at: https://adaa.org/understanding-anxiety/ posttraumatic-stress-disorder-ptsd/symptoms.

Pearson CM, Andersson LM, Porath CL. Assessing and attaching workplace incivility. Org Dyn (2000) 29:123–37.

Wayne AS, Rozanski EA. Cataloguing the response by emergency veterinary hospitals during the COVID19 pandemic via weekly surveys. J Vet Emerg Crit Care (San Antonio). 2020;30(4):493-497.

Spitznagel MB, Ben-Porath YS, Rishniw M, Kogan LR, Carlson MD. Development and validation of a Burden Transfer Inventory for predicting veterinarian stress related to client behavior. J Am Vet Med Assoc. 2019;254(1):133-144.

15 Murcia M, Chastang JF, Niedhammer I. Psychosocial work factors, major depressive and generalised anxiety disorders: results from the French national SIP study. J Affect Disord. 2013;146(3):319-327.

24 cmha.ca. Mental Health Effect of COVID19 Predictions. Available at: https://cmha.ca/wp-content/ uploads/2020/06/EN_COVID-19-Policy-Brief.pdf.

Kabasakal E, Özpulat F, Akca A, Özcebe LH. Mental health status of health sector and community services employees during the COVID-19 pandemic [published online ahead of print, 2021 Mar 9]. Int Arch Occup Environ Health. 2021;1-14.

Moore I, Coe JB, Adams CL, Conlon P, Sargeant JM. Exploring the impact of toxic attitudes and a toxic environment on the veterinary healthcare team. Front Vet Sci. 2015;2:78.

Siegel KJ, Schembari BC. Compassion fatigue risk factors in suicide crisis hotline counselors. The 37th Annual Association for Death Education and Counseling Conference. April 2015. Available at: https://www.researchgate.net/publication/298215320_Compassion_fatigue_risk_factors_in_suicide_ crisis_hotline_counselors.

cdc.gov. CDC Employees: How to Cope. Available at: https://www.cdc.gov/coronavirus/2019-ncov/ community/mental-health-non-healthcare.html.

Mair, TS, Mountford DR, Radley R, Lockett E, Parkin TD. Mental wellbeing of equine veterinary surgeons, veterinary nurses and veterinary students during the COVID-19 pandemic. Equine Vet. Educ. 2021; 33 (1) 15-23.

Keil K. Mental health first aid. Can Vet J. 2019 Dec;60(12):1289-1290.

Hadlaczky G, Hökby S, Mkrtchian A, Carli V, Wasserman D. Mental Health First Aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: a meta-analysis. Int Rev Psychiatry. 2014;26(4):467-475.

Kroll H. Mental Health First Aid: addressing mental health as a public health priority. Perspect Public Health. 2015;135(1):12-14.

chrc-ccdp.gc.ca. A Guide for Managing the Return to Work -Human Rights Commission of Canada. Available at: https://www.chrc-ccdp.gc.ca/sites/default/files/gmrw_ggrt_en_2.pdf.

washingtonpost.com. Coronavirus is causing a historic rise in mental health problems. Available at: https://www.washingtonpost.com/health/2020/05/04/mental-health-coronavirus/.

Common occupational psychological risks in veterinary workplaces2,6,7 1. STRESS9

2. BURNOUT9,10

Stress is a common workplace risk that occurs when workloads or demands exceed your comfort zone. Although stress is common in the workplace, it doesn’t negate the need to have conversations with a Mental Health First Aider early on, before it begins to affect performance. A Mental Health First Aider will listen and ask questions that will help you cope or find assistance.

Burnout is a psychological syndrome that emerges as a prolonged response to chronic interpersonal stressors on the job. The three key dimensions of this response are overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment.

Emotional

Irritable, anxious, moody, feeling trapped, frustrated

Patterns

Eating more/less and sleeping more/less

Physical

Palpitations, increased blood pressure, sweating

Substances

Alcohol, tobacco, drug (prescription or illegal)

Performance

Decreased productivity, difficulty concentrating

Coworkers may notice

Change in behavior, bullying, harassment, anxiety, over-reactions, depression, taking more time off than usual, tardiness

Relationships

Strained, feeling alone, as if nobody understands

Thoughts

Racing, repetitive (going over things from work)

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Emotional

Low mood, lack of creativity, listless, anxious, distant, feeling numb, negative

Patterns

Sleeping less, loss of purpose, absenteeism

Physical

Headaches, muscle aches, hypertension

Substances

Alcohol, tobacco, drug (prescription or illegal)

Performance

Decreased productivity, difficulty concentrating, makes mistakes

Coworkers may notice

Low mood, cynicism, frustration, lack of creativity, quickness to anger, job turnover, negative attitude, disengagement, unproductivity

Relationships

Strained, negative

Thoughts

Negative, cynical, lacking accomplishment, self-critical

3. COMPASSION FATIGUE2 Compassion fatigue is defined as an never-ending exposure to suffering and pain that can cause personal emotional distress and a reduced ability to be empathetic and provide occupational cooperation to patients, owners, and coworkers. 2,11 Job satisfaction is difficult to achieve with compassion fatigue.3 It is considered a risk factor for mental illness, and a contributing risk factor for suicide.18 Organizational compassion fatigue is a chronic and cultural form of worker stress, also known as a toxic work environment.9.17 Organizational compassion fatigue affects morale, esprit des corps, and workplace engagement, amongst other toxic workplace factors.3,17

Emotional

Exhaustion, bottled up emotions, sadness, apathy

Patterns

Recurring nightmares or flashbacks, feeling powerless

Physical

Feeling tired, lack of self-care, aching

Substances

Alcohol, tobacco, drug (prescription or illegal), overeating, gambling

Performance

Decreased productivity, difficulty concentrating, makes mistakes

Coworkers may notice

Irritability, lack of pain recognition in patients, isolation, lack of care for owners’ feelings, voicing excessive complaints, frustration, emotionally distanced, uncooperative, doesn’t want to help, presenteeism, absenteeism

Relationships

Neglected

Thoughts

Apathy, low mood, indifferent

4. MORAL DISTRESS

Moral distress is characterized by three components: emotional exhaustion, depersonalization, and lack of personal accomplishment. Moral distress is the inability of an individual to act according to his or her core values and perceived obligations due to internal and external constraints.

The stress of working with the public and relieving the suffering of animals in distress comes at a cost to mental health.8,19,2,14 Organizational compassion fatigue11 can occur when employees are stressed and burned out, and team cohesiveness, occupational performance, satisfaction, and civility lag.9,17,20 Unfortunately, most workers cannot identify their emotions and biases because they never received any formal training in this area.21 This leaves employers wondering how they can help those who are not able to understand the problems they are facing.

5. PTSD — POST TRAUMATIC STRESS DISORDER7,13 Those with PTSD re-experience trauma through intrusive and distressing recollections of the event, flashbacks, and nightmares. They also experience emotional numbness and avoid places, people, and activities that are reminders of the trauma.

6. PITS — PERPETRATOR INDUCED TRAUMATIC STRESS7 This form of PTSD arises when a person creates and/or controls the trauma, such as having to euthanize/cull large numbers of healthy animals.

7. CAREGIVER BURDEN TRANSFER14

8. ANXIETY AND DEPRESSION

This involves the transfer of emotional stress and pain from a client to a veterinary team/veterinarian who is consulting with the pet owner and diagnosing and treating the animal. Often, the owner doesn’t realize they are doing this. This is a fairly new discovery of potential occupational psychological risk for the veterinary team.

These two mental health concerns also affect the general population and need to be considered as risk factors that contribute to a worker’s mental health status.8,15

9. SUICIDE8 When individuals feel they can no longer endure their high levels of mental pain and suffering, and/or they feel hopeless about finding a way out of their situation, suicide may seem the only option. IVC Summer 2021

SUPPORT CANINE HEALTH and AGING with

astaxanthin BY KAREN HECHT, PHD

As nature’s most powerful antioxidant, astaxanthin benefits canine endurance, aging, vision health and more.

Antioxidants are a beneficial part of the animal diet because they help neutralize potentially harmful free radicals. Free radicals are reactive molecules produced both as by-products of the body’s natural physiology, and as a result of interaction with the environment. Both endogenous and dietary antioxidants work together to control and balance the level of free radicals in the body. When this balance is tipped in favor of free radical accumulation, oxidative stress and damage can occur to healthy cells. Oxidative stress can happen anywhere in the body, including in muscles, eyes, skin, and brain.

OXIDATIVE STRESS IN BOTH AGING AND ACTIVE DOGS Managing oxidative stress with antioxidants in healthy aging dogs is an approach that has been studied and shown to have benefits for learning and cognition. Additionally, studies have shown that an antioxidant-rich diet helps combat levels of oxidation in both aging and exercising dogs. • Aging dogs tend to have the balance tipped toward oxidative stress. As a dog ages, his body’s own antioxidant

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function deteriorates, and free radicals begin to accumulate. Older dogs accumulate oxidized proteins and lipids, which can affect canine health in many ways. In one study, dogs with senile dementia had 400% more oxidized protein and 250% more oxidized lipids in their brains, compared to their agematched healthy counterparts. • Active and working dogs also experience significant oxidative stress. Aerobic exercise in both untrained and trained dogs can cause free radical accumulation. This is because muscles produce energy using mitochondria, which are the powerhouses of the cell. Mitochondria burn oxygen, carbs and fat to produce energy, but the energy production also produces free radical by-products. The more active the dog and the more energy consumed, the more free radicals are produced. This leads to damage of healthy muscle tissue, which can affect endurance, performance and recovery.

ASTAXANTHIN, A NATURAL ANTIOXIDANT Daily antioxidants are known to support canine health in a variety of

ways, including promoting a healthy immune response, supporting eye health in aging dogs, and contributing to a normal inflammatory response. There are many dietary antioxidants to choose from, and a varied diet containing many antioxidants is beneficial since they all work somewhat differently. Antioxidants like natural astaxanthin and vitamin E can boost a dog’s antioxidant capacity, helping to address reactive oxygen species (ROS) and control oxidative stress. Natural astaxanthin is a targeted mitochondrial ingredient whose antioxidant activity is reported to be higher than that of beta carotene, lutein and vitamin E. Natural astaxanthin has some features that make it unique among antioxidants:

The many ways natural astaxanthin supports canine health • EXERCISE: Astaxanthin’s ability to lower oxidative stress, reduce exerciseinduced inflammation, facilitate carbohydrate sparing, and promote lipid utilization in muscles during exercise makes it a powerful health supplement for canine muscle recovery and endurance. • AGING: Natural astaxanthin has been shown to inhibit lipid peroxidation in cell membranes, scavenge excess ROS, and improve overall mitochondrial function, making it an ideal supplement to keep canines active and well into their golden years.

• It is one of nature’s most powerful antioxidants, which means it is very good at quenching free radicals, in particular singlet oxygen. One study revealed that astaxanthin is 6,000 times stronger than vitamin C, 110 times stronger than vitamin E, and even three to five times stronger than its cousin carotenoids, lutein and beta carotene. • Astaxanthin is a fat-soluble antioxidant that can access cell membranes, unlike water-soluble antioxidants. This is important because cell membranes are made of lipids, which are especially sensitive to oxidation. Natural astaxanthin has a unique structure that can span the cell membrane from end to end for better membrane coverage and antioxidant protection. • It favors all membranes, but as much as 50% of all membranebound astaxanthin has been found in mitochondrial membranes, the energy-producing parts of the cell that also produce free radicals as

a by-product of their metabolic activity. This means that natural astaxanthin is poised at the site of free radical production to help neutralize these unstable molecules before they start a chain reaction that can damage healthy mitochondria and tissue. Natural astaxanthin is red in color and belongs to the family of antioxidants called carotenoids, which are most commonly found in fruits and vegetables. However, unlike carotenoids such as beta-carotene found in carrots, lycopene found in tomatoes, and lutein found in spinach, natural astaxanthin is found in redcolored seafoods like lobster, crab, shrimpand salmon. For dogs and people, the main dietary source of natural astaxanthin is wild salmon. However, salmon is a rare protein in commercial dog food, and a dog would have to consume four filets of wild king salmon daily to get a beneficial amount of astaxanthin. This is why supplementation with quality, natural astaxanthin is important.

• VISION: Astaxanthin possesses a remarkable ability to cross the bloodretinal barrier and reach the eye. It is clinically proven to support dynamic focus in humans, and combined with other ingredients, has been shown to help stabilize the refractive index in aging dogs. A formulation containing natural astaxanthin also alleviated dry eye symptoms in dogs, reduced ocular inflammation, and increased tear production. • COGNITION: Astaxanthin is known to cross the blood-brain barrier, and support nourishing blood flow. In numerous studies, astaxanthin blocked the activation of NF-kB, reduced markers of systemic inflammation and supported healthy neurons in animals. In addition, natural astaxanthin supports cognitive function, especially memory retention and spatial memory in humans.

Dr. Karen Hecht is the Scientific Affairs Manager at AstaReal Inc., producer and purveyor of the most studied brand of natural astaxanthin. She studied algal molecular biology as a postdoctoral associate at the Pacific Northwest National Laboratory. Dr. Hecht earned her PhD in Biological Sciences at the University of Pittsburgh, and a BSc in Biochemistry from the University of Toronto. Dr. Hecht has spoken at conferences, on radio shows, and podcasts on the subject of natural astaxanthin as an ingredient for animal and human health. IVC Summer 2021

industry innovations

Superior immune support Talk to your clients about the importance of healthy immunity in their pets. Standard Process Veterinary Formulas™ utilize human quality ingredients to provide targeted nutrition for pets beyond what their regular diets provide. These formulas include a number of products to support animal immune systems. VF Thymex® for Pets supports a healthy thymus gland — the master gland of the immune system — and is a good source of vitamin C. Canine & Feline Immune Support provides nutritional and biochemical support for healthy immune cells and tissues. standardprocess.com/Veterinary-Formulas

Dental bones that fight plaque Help your canine patients keep their teeth clean by recommending ProDen PlaqueOff® Dental Bones. These dog chews incorporate the company’s PlaqueOff System®, and when used as part of a daily oral care maintenance program, they clean plaque, tartar, and freshen breath through a natural abrasive action. Available in regular and mini sizes, and in five tasty flavors including Turkey & Cranberry, Chicken & Pumpkin, Bacon, Bison & Apple, and Vegetable Fusion. Grain-free, gluten-free, soyfree and made with natural ingredients in the USA. SwedencareUSA.com

IVC Summer 2021

Painless insulin injections for diabetic animals PKA SoftTouch Inc. has developed a revolutionary pain-free, pre-filled insulin injection device for diabetic cats and dogs. The innovative Micro-Needle will allow vets and pet parents to inject only 1.5 mm into the skin layers where there are no nerves — and therefore no pain. At the time of this writing, clinical trials are underway at the University of Guelph to determine the efficacy of this technology for the animal market, with the product becoming available in 2022. Visit pkasofttouch.com to learn more, or invest via their crowdfunding campaign at frontfundr.com/company/pka.

Foods that match ancestral diets Feed your canine and feline patients what they were born to eat. Darwin’s Natural Selections is formulated to suit ancestral diets. That means no fillers, dyes, artificial ingredients, hormones, or antibiotics. All the ingredients are fresh, raw, and human-grade. The meats in Natural Selections are free-range or cage-free, and the vegetables are organic. All recipes are single-protein, making them ideal for limited ingredient diets or elimination diets. darwinspet.com

New pheromone products for cats For cats with stress or behavioral issues, consider bSerene™, a new line of calming pheromone products. For both single- and multi-cat homes, bSerene helps with hiding, scratching, fighting, and urine marking. Includes a plug-in diffuser kit that comes with refills clinically proven to last 45 days, and a spray with catnip oil ideal for use in veterinary clinics. Developed by vets, these products are a trusted way to introduce longer-lasting, science-based stress relief to your feline patients. bSerenepet.com

Hydration supplement with electrolytes Animals need electrolytes for optimum hydration. They help the body produce energy and are also responsible for stimulating muscle contractors, including those that keep the heart beating. Electrolytes carry potassium, sodium, calcium, chloride, phosphate, and magnesium, which are just a few of the ingredients in Petralyte, a tasty electrolyte and nutrient enhanced hydration supplement for dogs. It helps dogs stay hydrated so they can stay healthier and more active, while at the same time take in nutrients faster and more efficiently. Veterinary-certified through extensive research and trial testing, Petralyte is easy to use and comes in three animal-favorite flavors: chicken, beef and turkey. petralyte.com

Help for allergic dermatitis As a veterinarian, you know that allergic dermatitis is a big problem for many animals. ATOP 7® spot-on is an innovative skin care product specifically designed to help soothe and repair the atopic skin of dogs and cats. Formulated with ingredients of natural origin, it’s easy to use thanks to its single-dose format and weekly application. Its efficacy has been demonstrated by studies conducted by veterinary dermatologists. The ATOP 7® range also includes a shampoo, mousse, a steroid-free soothing spray, and a moisturizing fluid cream. dermoscent.com/en

news bite HUGE GROWTH MAY LEAD TO MORE MENTAL HEALTH ISSUES The COVID pandemic is taking its toll on veterinary practitioners. While some industries saw mass layoffs and sales declines, veterinarians and vet techs have been inundated with new clients and patients. The demand, of course, is related to the vast numbers of dogs and cats newly acquired by people working remotely from home. In a recent article from Associated Press, veterinarians say they have extended hours, hired additional staff, added telehealth options, and refused to take any new patients, and they still can’t keep up. Approximately 12.6 million U.S. households added a new pet to their homes following the start of the pandemic in March 2020, according to a COVID-19 Pulse Study by the American Pet Products Association. In addition to the increase, people working from home were more vigilant in noticing health issues in their pets, which might typically have gone unnoticed in other years. Veterinary schools can’t produce enough new grads to meet the demand, and experts don’t expect this growth to slow any time soon. In fact, veterinary positions are projected to increase 16% by 2029, while vet tech positions will grow almost 20% in the coming five years. The mental health fallout may be severe in an industry that already struggles with compassion fatigue, anxiety and depression. Some larger clinics have hired compassion fatigue specialists to help practitioners cope. No matter what size your clinic, it will be wise to plan for a continuation of growth and demand for the foreseeable future. IVC Summer 2021

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? Angelica (Angelica archangelica) is a warm, slightly moist herb with a bitter and pungent energy. It acts as a diaphoretic and warming carminative. Its Western pharmacological description includes antibacterial, antiinflammatory, antispasmodic, antiviral, and hepatoprotective effects. It is a bitter tonic, a choleretic, a mild CNS stimulant, an expectorant, a nervine, and a prokinetic. Angelica is perhaps the best warming bitter in the Materia Medica. It enhances digestive function and is highly effective for treating dyspepsia or deficient Spleen symptoms of gas, bloating, belching and nausea. During the COVID-19 pandemic, it is also an herb to keep on hand if there are signs of edematous respiration. Angelica can exert its influence at the Tai Yin layer in the body, influencing the Lung and Spleen. It is a biennial plant and grows to a substantial height. Both the roots and seeds can be used medicinally. The roots are harvested at the end of the first year’s growth.

CASE REPORT Pepper is a five-year-old spayed mixed breed dog that came into the office with mild upper respiratory disease characterized by a dripping nasal discharge and sneezing, accompanied by GI symptoms of mucus in her stool, poor digestion and diminished appetite. Her diagnosis was a Spleen and Wei Qi deficiency with excessive Damp. Her King herb was Angelica archangelica added in Gui Zhi Tang. She recovered uneventfully within the week.

IVC Summer 2021

VBMA EVENTS • Registration is open for the International Herbal Symposium. This event will remain online for 18 months, and is an amazing symposium with lectures from around the world. Our veterinary track offers exciting topics, such as alpacas, diet, cannabis, grief treatment, and metabolic syndrome. Register online at www.internationalherbsymposium.com/registration. • On June 16, Huisheng Xie, BSvm, MS, PhD will present a webinar on equine protozoal myeloencephalitis. EPM is an important neurologic disease of horses. Its conventional diagnosis, treatment, and presentation have remained a big challenge to veterinary clinicians, parasitologists, and researchers since it was initially noticed in 1968. This presentation will provide an overview of these challenges and the unique role of the immune system in EPM. Traditional Chinese Veterinary Medicine (TCVM) theory views this disease pattern as a Zheng Qi Deficiency with Qi and Blood Stagnation. The treatment strategies and protocols of herbal medicine and acupuncture will be discussed in detail. Case studies on how to integrate TCVM and Western medicine for diagnosis, treatment, prognosis, and prevention will also be presented. Registration is open at www.vbma.org and past webinars are available for purchase as well. • The annual VBMA member meeting will take place virtually on June 10. Fall webinars are being scheduled now. Visit www.vbma.org and www.acvbm.org.

GUESS THIS HERB!

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

Dietary-driven

BY EMILY STEIN, PHD

carbohydrate and microbially-metabolized sugars, leading to inorganic acid, mineral acid, organic acid, and other proinflammatory waste product production. 5

inorganic and organic acids can favor the growth of acid-tolerant dental pathogens.8-10 The problem is that the host animals do not have such defense mechanisms.

Surprisingly, we also see non-omnivores with dental disease. Indeed, gingivitis, gum disease, and abscesses are also found in over 50% of middle-aged large cats, equines, and bovines, all with very divergent diets and gut anatomies.6

Persistent activation can manifest as periodontal disease, stomatitis, or abscess formation. More troubling, the consequences are not limited to the mouth. Inflammation and subgingival overgrowth of microbes can alter reproduction, shorten lifespan, and/or lead to downstream systemic conditions (cardiovascular, GI, liver, kidney, joint, etc). A depiction of staged disease processes is presented in the adapted image shown below.6

dental disease mechanisms Diet is currently considered in the context of nutrient absorption by an animal’s lower gut. The upper gut, home to the second most abundant microbial population in the mammalian body, is also fully capable of mechanical and enzymatic digestion and nutrient absorption. Due to the rapid transit time of food through the mouth, however, oral microbes must manufacture enzymes to process the food quickly and effectively. Then they must wait for broken-down nutrients to recirculate in saliva and crevicular fluid, as food is processed in the lower gut and absorbed into the host’s bloodstream.1 The billions of microbes attached to every single square millimeter of oral tissue, particularly on the tongue and subgingival spaces, are continuously bathed with waxing and waning levels of nutrients that they require for growth. However, this can be harmful to the animal host.

HIGH RATES OF GINGIVITIS AND GUM DISEASE Omnivores, such as humans, canines, and swine, are prone to gingivitis and gum disease at rates of 47% to 71%, 70%, and 50%, respectively. 2-4 It is no surprise that dental disease is so prevalent in these species, as the omnivore diet is rich in

CARBOHYDRATES ARE A KEY DRIVER OF DENTAL DISEASE Genetic, behavioral, and many others factors likely drive dental disease in animals. A very established driver is the ingestion of dietary carbohydrates. Although acceptable for the lower gut, they are not ideal for the oral cavity. Hidden carbohydrates exist as bulking agents found in kibble and many feeds; these carbohydrates are quickly realized and metabolized by oral microbes. Why call out carbohydrates? The inflammation-causing oral microbes can quickly utilize carbohydrates, convert them to stronger acids and organic acids, which lower the tissue pH and elicit an immune response; this can then weaken the barrier function of the animal’s mucosal epithelia.7 The most relevant repercussion is that

We have recently initiated preclinical work on equine oral microbial biofilms. Interestingly, we are finding correlations similar to trends observed in humans, canines and felines:

1. The older the animal, the more dysbiosis is observed. 2. The more feed given to the animal, instead of naturally foraged foods, the higher the oral pathogen count. 3. Both factors seem to strongly link to the presence or patient history of dental disease in that animal. References available at IVCJournal.com Emily Stein, PhD, founded Primal Health (TEEF for Life) in 2017 to focus on improving the dental health of both humans and animals by producing oral microbiome modulation products. She has spent 12 years developing Selective Microbial Metabolism Regulation Technology (SMMRT™) at Primal Therapies, Inc., which is focused on using metabolic influencers to re-engineer disease-causing bacterial biofilms into those that are health-promoting, to decrease inflammation and improve outcomes. Prior to that, Dr. Stein spent seven years as a research fellow at Stanford University in Rheumatology and Immunology focused on the neuro-endocrineimmune axis in autoimmune and chronic inflammatory diseases. She holds a PhD in Microbiology from the University of California at Berkeley where she studied inter- and intra-cellular signaling pathways involved in stress response and community development in bacteria; she received her B.S. in Microbiology and Immunology at the University of Iowa where she studied the interaction between M. tuberculosis and innate immune cells. IVC Summer 2021 39

Why photobiomodulation needs to be an essential part of your veterinary treatment plans.

Light as a restorative and protective therapy for the treatment of injury and disease in veterinary medicine has generated increasing interest over the last decade. This is due to numerous factors, especially the ability to apply this modality in a non-invasive way that has no detrimental side effects to the patient, or negative environmental impacts. Laser therapy, or photobiomodulation (PBM), has a beneficial effect on cells and tissues, contributing to a directed modulation of cell behaviors, enhancing the processes of tissue repair and cell proliferation while also reducing inflammation and pain. All these effects make PBM a versatile modality for many “first-aid” situations, such as treating traumatic wounds or burns, acute muscle injuries, and snake bite envenomation cases.

TRAUMATIC WOUNDS, BURNS, AND DECUBITAL ULCERS

BY LISA A. MILLER, DVM, CCRT

Laser therapy and veterinary first aid 40

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The benefits of laser therapy in wound healing are well described in the literature. In vivo and in vitro studies have shown that PBM accelerates the activity of fibroblasts, collagen synthesis, and neovascularization, decreases inflammatory cells, and increases the amount of elastic fibers in the wound healing process.1,2,3 PBM also offers a demonstrated benefit for use in thermal burns to encourage re-epithelialization and reduce scar tissue.4 It may also have potential benefits for infected wounds, where it may enhance macrophage function and modulate the immune response 5 as well as potentially having some direct effects on microorganisms.6 Straightforward acute wounds that have been cleaned may require only one to three treatment sessions, depending on wound size, before significant contraction and/ or complete healing is noted. Treatment should be administered in an off-contact manner so as not to contaminate the wound further, or contaminate the optical probe itself. The entire wound

Case report

that PBM attenuated the extent of edema, myofibrillar degeneration, and area of necrosis.13

A starting dose of 2-5 J/cm 2 is recommended, treating daily if possible and then reducing the frequency of treatment sessions as the lesion improves. 7 Chronic or infected wounds and thermal burns may require a more aggressive treatment schedule. Alongside other standard of care therapies and supportive care measures, especially for wounds such as decubital ulcers, higher fluences (energy densities) may be necessary in order to appreciate beneficial results. If no improvements are seen after three or four treatment sessions with the previously mentioned starting doses, an increase in the amount of total energy (in total joules) delivered at 25% to 50% per session is recommended until a significant response is seen.8 It is worth noting that PBM should be applied after the wound or burn has been cleaned (or debrided) and prior to the application of any dressings, ointments, or bandages.

MUSCLE INJURIES

Taking all of the above into account, PBM is crucial during several phases of rehabilitation from muscle injury. During the acute phase following injury, where the goal is to limit the effects of immobilization, reduce pain and inflammation, and promote healing of the injured tissue, PBM may be used daily if possible.14 Additionally, it may be used throughout later stages of rehabilitation where the goals shift to enhancing mobility, improving endurance and/or strength, re-establishing more normal neuromuscular control patterns, and ultimately to strengthening and conditioning injured areas even further. Time between treatment sessions is gradually increased as the patient improves, a common approach to resolving injuries and returning to full function. In the case of performance animals, long term maintenance therapy as a preventative measure prior to athletic events may also be considered.

PBM may be used preventatively to benefit athletic training by reducing delayed-onset muscle soreness and signs of muscle damage after intense exercise. This modality may also be used to treat muscle damage caused by strains or trauma. Numerous studies have demonstrated the usefulness of PBM in muscle recovery after injury.8,9,10 Studies that have examined markers for oxidative stress and inflammation in muscle tissue from euthanized animals, or in serum from other patients, have demonstrated that PBM accelerated or resolved the acute inflammatory response and reduced oxidative stress elicited by muscle trauma.11,12 Other research that looked at PBM effects on histopathological features after muscle injury showed

When treating in vivo, the depth of the target tissue is of utmost importance.15 Thus, for transcutaneously delivered light to be effective in injured muscle tissue, the light’s parameters and PBM application protocols must be such that — after accounting for the light’s energy losses in the haircoat and the intervening tissues of the skin, fat, etc. — a sufficient amount of light must reach and be absorbed by muscle cells in the injured area(s). A starting point for fluences that may be effective, depending on the size of the patient and the depth of tissue being treated, would be 6-10 J/cm 2 up to 20 J/cm 2 or higher in some cases.15,18,19 One way to maximize the amount of light penetrating to deep tissue for

Figure 1. Thermal burn 6 days after initial presentation to DVM, prior to debridement.

Figure 2. Thermal burn 12 days after initial presentation, after debridement.

Figure 3. Thermal burn 26 days after initial presentation.

Figure 4. Thermal burn 51 days after initial presentation.

Figure 5. Thermal burn 90 days after initial presentation.

IVC Summer 2021

Photos courtesy of Dr. Jeanette Pettit.

“bed” should be treated as well as a few inches of healthy-looking tissue margin around the wound.

Figures 1 to 5 depict the case of a dog that was trapped in a kennel during a house fire. The dog was treated with PBM starting six days after initial presentation to the ER for thermal burns, in addition to standard of care wound therapies; however, no skin grafts were performed.

musculoskeletal injuries is to treat with the optical probe in firm contact with the skin, minimizing the amount of light that may be lost due to reflection off the skin’s surface.17

SNAKE BITES Numerous small animal models have been researched with regards to PBM and inflammatory pain. One particular application of PBM and its benefits in treating inflammatory pain is related directly to snake bite envenomation. Bites from certain snakes can cause severe local tissue damage, systemic coagulopathy, and localized edema, intense pain, hemorrhage, and myonecrosis. Studies in mice have shown that PBM improved pain, reduced inflammatory infiltration, stimulated phagocytosis, and increased regeneration of muscle fibers and myoblast proliferation after injection of Bothrops moojeni venom.20,21 PBM has also been shown to promote vascular endothelial growth factor receptor 1 (VEGFR-1) expression and increase angiogenesis, 22 as well as improve skeletal muscle regeneration by accelerating recovery of the myofiber mass23 post-injection of venom into mouse skeletal muscle. A veterinary surgeon working from a large multispecialty 24-hour emergency and critical care hospital in Tucson, Arizona, that treats an average of 395 rattlesnake envenomation cases each year, recently authored a chapter in the veterinary textbook Laser Therapy in Veterinary Medicine: Photobiomodulation. 24 In this chapter, Dr. Barbara

Gores describes initiating laser therapy for snake bite envenomation patients after they have been stabilized with IV fluid therapy, analgesics, and in most cases, antivenin. Treatment with PBM usually begins six to eight hours after hospital admission and is administered once daily while the patient is hospitalized (usually two to four treatments in-clinic) followed by an additional two to four sessions after discharge at a fluence of approximately 8 J/cm 2; though as with other deep tissue doses, this varies depending on the size of the patient and the area/depth of the wound being treated. Dr. Gores goes on to describe that anecdotally, over the past decade since initiating PBM for these cases, there has been a significant decrease in clinical morbidity as well as the necessity to perform major surgical reconstruction of snake bite wounds at their facility. This is also consistent with the anecdotal success reported to this author by other colleagues utilizing PBM in similar cases throughout the country. In conclusion, since Mester’s original discovery in the 1960s (see sidebar below), a large amount of research has been done to elucidate the mechanisms behind PBM. Though further work focusing on a deeper understanding of molecular mechanisms, biological context, and optimal dosing parameters for various conditions is still underway, great progress has been made in PBM research. This modality has the potential to make a significant impact on the overall prognosis and outcome of many veterinary

PBM — its discovery and how it works The positive effects of photobiomodulation therapy (formerly low level laser therapy, or LLLT) were originally observed in a rodent model more than 60 years ago by Dr. Endre Mester, when he noted the effects this application of light had on hair growth and wound healing. PBM is a photochemical interaction that occurs between target cells and applied laser light. Mitochondria within cells contain chromophores that absorb photons from PBM. The primary chromophore of interest is the enzyme, cytochrome coxidase, located in the mitochondrial membrane and which impacts the activity of various molecules such as nitric oxide (NO), calcium ions, ATP, beneficial reactive oxygen species (ROS), and numerous other signaling molecules. These molecules work together by various pathways to normalize metabolism and regulate proteins that are affected by redox reactions and involved in cellular proliferation and

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differentiation. Together with cytokines and growth factors, they aid in tissue recovery and the reduction of oxidative stress and inflammation. In addition to the effects mediated primarily via the biologically active chromophore mentioned above, lightsensitive ion channels are also found within the cell membrane. These ion channels are gated by light and include "transient receptor potential" (TRP) channels2 that are activated by specific factors, such as heat or cold, noxious chemicals, mechanical forces, voltage, and others. When activated, TRP channels open, allowing ions such as sodium to flow into the cell. This results in an action potential, which is realized as a nerve impulse. Mounting evidence suggests that light-mediated activation of TRP is responsible for some of the mechanisms of action of PBM as well, particularly regarding histamine-dependent wound healing effects and antinociceptive effects. 2

patients being treated for acute traumatic conditions; however, this therapy may be commonly overlooked when evaluating these cases. Laser therapy is well tolerated in veterinary patients, and easy to perform by technical staff. Its use should be considered, especially in these types of cases, in order to maximize success, reduce pain, and hasten the return to full health.

1 Mester, E, et al. The effect of laser beams on the growth of hair in mice. Radiobiol. Radiother, 1968. 9(5), 621–626.

Freitas and Hamblin. Proposed Mechanisms of Photobiomodulation or Low-Level Light Therapy. IEEE J Sel Top Quantum Electron, 2016. 22(3).

3 Melo VA, et al. Effect of low level laser on sutured wound healing in rats. Acta Cir Bras. 2011. 26(2): 129-134.

Loreti, EH, et al. Use of Laser Therapy in the Healing Process: A Literature Review. Photomed Laser Surg, 2015. 33(2): 104-116.

Gal, P, et al. Histological assessment of the effect of laser irradiation on skin wound healing in rats. Photomed Laser Surg, 2006. 24(4): 480-488.

6 De Moraes, JM, et al. Anti-inflammatory effect of low intensity laser on the healing of third degree burn wounds in rats, 2013. 28(4): 1169-76.

Burger, E, et al. Low level laser therapy to the mouse femur enhances the fungicidal response of neutrophils against Paracoccidioides brasiliensis. PLoS Negl Trop Dis, 2015. 9(2).

8 Bradley, D. Wounds In: Laser Therapy in Veterinary Medicine: Photobiomodulation. Eds. Ronald J Riegel and John C Godbold. 2017. John Wiley & Sons, West Sussex, UK. 100-113.

Nussbaum, EL, et al. Effects of low level laser of 810nm upon in vitro growth of bacteria: relevance of irradiance and radiant exposure. J Clin Laser Med Surg, 2003. 21(5)283-290.

10 Ferraresi, C, et al. Effects of Light-emitting diode therapy on muscle hypertrophy, gene expression, performance, damage, and delayed-onset muscle soreness: Case control study with a pair of identical twins. Am J Phys Med Rehabil, 2016. 95(10): 746-757.

Sussai DA, et al. Low-level laser therapy attenuates creatine kinase levels and apoptosis during forced swimming in rats. Lasers Med Sci, 2010. 25:115–120.

12 Borsa PA, Larkin KA, True JM. Does phototherapy enhance skeletal muscle contractile function and postexercise recovery? A systematic review. J Athl Train, 2013. 48: 57–67.

De Marchi T, et al. Low-level laser therapy (LLLT) in human progressive-intensity running: effects on exercise performance, skeletal muscle status, and oxidative stress. Lasers Med Sci, 2012. 27:231–236.

Silveira PCL, et al. Low-level laser therapy attenuates the acute inflammatory response induced by muscle traumatic injury. Free Radic Res, 2016. 50:503–513.

Renno et al. The effects of Low Level Laser Therapy on Injured Skeletal Muscle. Bras Archives Biol Tech, 2014. 57(1): 48-54.

Canapp, D. Laser Therapy for the Canine Athlete In: Laser Therapy in Veterinary Medicine: Photobiomodulation. Eds. Ronald J Riegel and John C Godbold. 2017. John Wiley & Sons, West Sussex, UK. 215-226.

Zein R, et al. Review of light parameters and photobiomodulation efficacy: dive into complexity. J Biomed Optics, 2018. 23(12).

Gaynor J. Energy modalities, therapeutic laser and pulsed electromagnetic field therapy. In: Handbook of Veterinary Pain Management, 3rd Ed. 2015. Mosby, St. Louis, MO. 357-362.

Miller L, et al. Retrospective Observational Study and Analysis of Two Different Photobiomodulation Therapy Protocols Combined with Rehabilitation Therapy as Therapeutic Interventions for Canine Degenerative Myelopathy. Photobiomodulation, Photomedicine, and Laser Surg, 2020. 38(4): 195-205.

Nadur-Andrande, N, et al. Effects of photobiomodulation on edema and hemorrhage induced by Bothrops moojeni venom. Lasers Med Sci, 2012. 27(1): 65-70.

21 Dourado, DM,et al. Effects of Ga-As laser irradiation on myonecrosis caused by Bothrops Moojeni snake venom. Lasers Surg Med, 2003. 33(5): 352-357. 22 Dourado, DM, et al. Low level laser therapy promotes vascular endothelial growth factor receptor 1 expression expression in endothelial and non-endothelial cells of mice gastrocnemius exposed to snake venom. Photochem Photobiol, 2011. 87(2): 418-426.

Silva, LM, et al. Photobiomodulation protects and promotes differentiation of C2C12 myoblast cells exposed to snake venom. PLoS One, 2012. 11(4).

24 Gores, B. Snake Bites In: Laser Therapy in Veterinary Medicine: Photobiomodulation. Eds. Ronald J Riegel and John C Godbold. 2017. John Wiley & Sons, West Sussex, UK. 128-131.

IVC Summer 2021

From the NASC NASC celebrates in the animal supplement industry BY BILL BOOKOUT

The National Animal Supplement Council (NASC) is proudly celebrating 20 years of successful advocacy and leadership actions that have helped sustain and elevate the animal supplement industry for the benefit of millions of dogs, cats, and horses. What began as a passionate grassroots effort with 18 dedicated founding member companies has grown into the leading voice for the industry. NASC represents nearly 275 manufacturers of animal health and nutritional supplements, plus more than 100 vetted supplier companies that provide NASC members with raw materials, contract manufacturing, laboratory testing, and other professional services.

HOW THE NASC STARTED The true origin of the NASC actually dates back to 1996, when the US Food and Drug Administration’s Center for Veterinary Medicine (FDA-CVM) declared that the Dietary Supplement Health and Education Act (DSHEA) — a 1994 statute of US federal legislation that recognizes human dietary supplements — doesn’t apply to animal supplements despite their similarity to human products. This placed similar products marketed for animals into limbo because they were considered “unapproved”. As time passed, orders to stop sales and pull supplement products marketed as animal feed from retail shelves

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increased exponentially, with no good solution in sight. As consumer demand for these products continued to increase, the future of the industry became increasingly uncertain, compelling industry participants to define a proactive approach to solving a problem that clearly was not going away. After numerous failed attempts by state and federal regulators to identify viable options, a group of industry leaders rallied to help lay the groundwork for what would become the NASC. After registering as a non-profit organization, NASC’s specific intent of “working cooperatively with the regulatory agencies and the American Association of Feed Control Officials (AAFCO) to define, develop and implement a system of self-regulation, incorporating input from the regulators and addressing the issue for the benefit of all stakeholders” became a reality. The industry adopted this plan for responsibly bringing animal supplements for dogs, cats, and horses to market. To this day, NASC is a model for selfregulation that has been a driving force in creating a favorable regulatory climate for animal supplements to be responsibly marketed, as well as a primary resource for the future growth and success of the animal supplement industry. Now, the NASC Quality Program and audit verification are widely recognized as “the Gold Standard” in the industry.

WHO DESERVES THE CREDIT? We have made enormous strides due to collaborative efforts by NASC members, regulators at the state level, and many individuals within FDA-CVM, along with support from associations including AAFCO, the American Pet Products Association (APPA), and the American Holistic Veterinary Medical Association (AHVMA), as well as retail partners, both large and small. And we cannot forget the millions of dog, cat, and horse owners who will always be part of our success story — these people and their animals give us our motivation! Simply stated, our collective success is measured by one thing: credibility through results. People often credit me for NASC’s success. While I am very humbled and appreciative of the praise, the credit really belongs to everyone who has been part of the NASC story for the past 20 years. It has been an honor and privilege to serve as founder and president of NASC, and together we have helped shape the foundation of a great industry that continues to make a difference in the lives of millions of animals around the world.

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.

PROFITABLE PRACTICE

HOW INTRODUCING NATURAL DERMO-CARE CAN MAKE FOR A HEALTHY BOTTOM LINE Dermoscent® offers unique natural skincare solutions for dogs, cats, and small mammals. dermoscent.com

WHY IT MAKES SENSE FOR YOUR PRACTICE Most practices see a substantial number of dermatological cases. Dermoscent’s comprehensive range of high quality dermo-care products meet a unique set of criteria: 1. Natural ingredients — to meet the high demand from pet parents. 2. Scientifically-proven efficacy — the effectiveness and tolerance of the products are proven with numerous studies conducted by renowned dermatologists worldwide, and published in peer-reviewed journals. 3. Improved compliance — the availability of different galenic forms (spot-ons, rinse-free foams, shampoos, etc.) promotes compliance by pet owners, a key success factor in the management of chronic ailments. In addition to medication during acute phases, skin barrier repair products help achieve a sparing effect, which is important, considering the side effects of longterm or inappropriate use of some chemical molecules. In the maintenance phase, Dermoscent products help reduce relapses for the well-being of your patients and satisfaction of pet parents.

PROFITABLE PRODUCTS Dermoscent has formulated a number of unique products to help manage the following ailments: Pruritic/allergic/atopic skin: the ATOP 7® range helps soothe and repair the sensitive skin of dogs and cats. Skin prone to microbial imbalances (pyoderma, Malassezia dermatitis): the PYO range helps purify and rebalances the skin flora of dogs and cats. Recurrent otitis externa: PYOclean® Oto is a purifying ear cleanser based on antimicrobial and antibiofilm natural ingredients designed for dogs, cats and small mammals. Kerato-seborrheic disorders (dandruff, bad odor, greasy skin and coat, excessive hair loss, sebaceous adenitis, ichthyosis, etc.): The Essential range hydrates and helps regulate skin and coat condition of dogs, cats and small mammals. Hyperkeratosis and non-infected calluses: Dermoscent BIO BALM® nourishes, protects and helps repair and soothe nose, pads and non-infected calluses of dogs. * Hills et al. Survey of the prevalence, diagnosis and treatment of dermatological conditions in small animals in general practice. Vet Record 2006

INCOME POTENTIAL:

20% of veterinary consultations are related to dermatology.* Recommending topical and natural solutions such as Dermoscent can tremendously increase clinic income. The suggested margin offered to clinics starts at 50%.

TRAINING REQUIREMENTS:

Dermoscent has developed an online training platform for veterinarians who wish to further specialize in the management of skin disorders and implement Dermoscent products into their therapeutic protocol: dermoscent-training.com.

TIME TO IMPLEMENT:

Dermoscent products are now available via all major wholesalers, which ensures that veterinary clinics can be supplied quickly and easily.

IVC Summer 2021

Sweet for care wounds: BY NICOLE GREINER, DVM, CVA

Honey has many beneficial effects that make it an ideal wound dressing. Its wide spectrum of antimicrobial activity and immunomodulatory effects on the wound healing process exceed many currently available dressings.

the use of MEDICALGRADE HONEY in veterinary medicine

Wound healing is a complex process. It involves inflammatory, debridement, repair, and maturation phases, which ultimately lead to a scar or restoration of the original tissue. Honey, the modified secretion of flower nectars and honeydews from the bees of the genus Apis, possesses numerous bioactive properties that make it a useful tool for wound care involving chronic and traumatic wounds, as well as burns.1 In fact, several randomized controlled studies have demonstrated statistically significant beneficial effects of honey on wounds in both animals and humans.2,3 With the discovery of antibiotics, the medical use of honey fell out of favor.2 However, honey has a 4,000-year-old record of historical usage for its medicinal properties.4 And with the rise of antibiotic resistance, the focus on honey for its antimicrobial and wound healing properties has been the spotlight of several recent studies, 5 and a 2016 article was published in JAMA Dermatology examining the role of honey in wound treatment.6 Its usefulness has been extensively examined and used in human medicine due to the prevalence of chronic wounds, but there are also several animal studies focusing on honey and wound care, and a variety of medical honey products are available for veterinarians.1,2,3,7,8,9

PROPERTIES: HOW DOES HONEY HELP? Honey is a complex mixture of over 200 components.10 Monosaccharides, primarily fructose, comprise nearly 80% (w/v), while its water content varies between 15% to 21% (w/v).10 Honey also contains proteins, vitamins, minerals, phenolic compounds, organic acids, and volatile compounds

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that all contribute to its bioactivity.10 The composition and thus the bioactivity of honey varies based on its geographical origin and floral source (Figure 1).11 Manuka honey, for example, is a monofloral honey originating in New Zealand from the flowers of Leptospermum scoparium trees. Manuka honey is recognized for its high levels of an antibiotic substance called methylglyoxal (MGO), or unique manuka factor (UMF).12 MGO is not necessarily unique to manuka honey, and other honey varieties such as kanuka and other European honeys, contain this chemical. 5,13 Licensed medical grade honey products tend to use manuka honey products and rate its antibiotic activity based on the concentration of UMF. Because honey contains particulate contaminants, such as pollens, and microorganisms from the honeybee gastrointestinal tract, most notably Clostridium botulinum spores, a medical-grade, filtered, gamma-irradiated product is recommended for wound treatment. Unlike pasteurization, gamma-irradiation preserves the bioactive compounds lost due to heat treatment.14 Honey exerts a multifaceted antimicrobial effect that has been shown to inhibit gram-positive and gram-negative bacteria, yeast, and fungi.15,16 It is an acidic substance with a pH of between 3.2 and 4.5, due to the presence of organic acids, that inhibits the growth of many microorganisms.15 The osmotic effect, due to the high osmolarity (Opposite) Figure 1: from honey’s high sugar content, Species of monofloral honeys dehydrates and inactivates and some of their identified bioactive components. bacteria.15 Honey has been shown Leptospermum scoparium to affect bacteria through is the manuka tree. Continued on page 48.

ARBUTUS UNEDO

ASPHODELUS MICROCARPUS

Methyl syringate

Homogentisic Acid

Methylglyoxal Kaempferol

p-Coumaric Acid

Leptosin

LEPTOSPERMUM SCOPARIUM

MENTHA PIPERITA

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CONTRAINDICATIONS FOR HONEY USAGE Honey products should not be used in patients with an allergy to bee venom or bee products. It should also not be used for wounds with active hemorrhage.

Continued from page 46. multiple mechanisms, such as changing their cell structure, decreasing membrane potential, disrupting the cell-cycle and metabolism, decreasing cellular growth, affecting efflux pump mechanisms, disrupting quorum sensing, and disrupting biofilms. 5 Studies have shown a bactericidal or bacteriostatic effect against many wound pathogens such as multidrug-resistant Staphylococcus aureus, methicillinresistant Staphylococcus pseudintermedius, Pseudomonas, Pasteurella multocida, Enterococcus, Proteus, and Escherichia coli.16,17 The minimum inhibitory concentrations of various honeys range anywhere from greater than 50% down to 0.25%.18 Honeys are classified into hydrogen peroxide (H 2O2) dependent or non-H 2O2 dependent antimicrobial pathways. H 2O2 is thought to be slowly generated in honey due to the deposition of glucose oxidase into the honey by the bee. Although phenolic compounds possess antimicrobial qualities, the phenolic concentrations found in H 2O2 dependent honey are too low to exert an antimicrobial effect. Instead, it is thought that the phenolic compounds and minerals found in honey synergize together and with H 2O2 produce an antimicrobial effect. 5 H 2O2 is present in honey at a concentration that is 900 times less than the conventional 3% H 2O2 antiseptic, yet it exhibits antimicrobial activity while simultaneously preventing tissue damage through various mechanisms.19 Non-H 2O2 dependent honeys utilize other antimicrobial mechanisms, such as the high concentrations of phenolic compounds found in Malaysian multifloral meliponini honey.20 The most studied of these non-H 2O2 dependent honeys is manuka honey, whose antimicrobial effect is due to high levels of MGO, a breakdown product of dihydroxyacetone contained in the nectar of the manuka tree flower.12 Although the mechanisms of action on bacteria have yet to be fully understood, MGO has shown to disrupt bacterial fimbriae, flagellum, and other

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bacterial cell structures. 5 Honey has also been reported to synergize its antimicrobial effects with the use of antibiotic administration. 5 There have been reports of antimicrobial resistance to manuka honey in biofilm-producing bacteria, but it appears that synergism with antibiotics negates these findings thus far. 5

HONEY AND WOUNDS Wounds are assessed and classified at presentation for their degree of contamination (clean, clean-contaminated, contaminated, or dirty).21 A treatment plan is then created that involves first, second, or third intention healing process. In clean wounds, first intention healing is always preferred; however cost, health status of the animal, failure of first intention healing, infection, and surgical limitations might limit the veterinarian to select the second intention method. This method leaves the wound open, covered by bandages, to allow for granulation, re-epithelization, and contraction.22 The phases of wound healing are summarized in Table 1. When applied to the wound as a part of the wound dressing honey forms a physical barrier and maintains a moist environment while preventing bandages from adhering to the wound bed; this has been shown to accelerate granulation and healing.22 Due to its high osmolarity, honey decreases wound edema and pulls exudates away from the wound bed.1 This effect activates autolytic debridement of the wound bed through osmotic action by drawing water out of the wound, and may also activate plasminogen, which breaks down wound fibrin.26 On the wound bed, honey also exerts several antiinflammatory and immune-modulating effects that result in reduced healing time, 27 scarring, 28 edema, 29 exudate, 30 and increased wound tensile strength. 31 Honey has been shown to neutralize reactive oxygen species during the inflammatory phase of healing, stimulate or inhibit macrophages and fibroblasts, and stimulate keratinocytes, depending on the chronicity of the wound. 32 Unlike common wound antiseptics such as chlorhexidine, 23 iodine, and silver-ion, honey is non-cytotoxic to the wound bed. 33 During the repair phase, honey has been shown to stimulate angiogenesis, formation of granulation tissue, and re-epithelialization. 32 Due to its high density of sugars, vitamins, and minerals, honey delivers nutrition to the healing tissues. Honey has been reported to help reduce pain due to its anti-inflammatory effects, but there are reports of pain upon application in some human patients with highly inflamed wounds. 34

Table 1: The phases of wound healing* ONSET AFTER INJURY

DURATION

EVENTS

INFLUENCE OF HONEY

Inflammatory

Immediate — 24 hours

1 to 5 days

• Hemostasis • Fibrin plug formation • +/- scab formation

• • • •

Debridement

6 to 12 hours

3 days

• Phagocytosis of debris, bacteria, necrotic tissue by neutrophils and macrophages • Release of ROS

• • • •

Repair

3 to 5 days

2 to 3 weeks or until all collagen deposited

• A ngiogenesis • Fibroplasia • Fibrin replaced by collagen produced by fibroblasts • Deposition of ECM • Granulation tissue formation • Mitosis of basal cells • Re-epithelization • Wound contraction by myofibrocytes

•A ctivates keratinocytes • Decreases time to re-epithelization • Increases scar tensile strength

Maturation

17 to 20 days

3 to 4 weeks up to 2+ years

• Reduction in capillaries • A poptosis of macrophages and fibroblasts • ECM modifications • Collagen maturation

• Reduces amount of scarring

educes ROS R Reduces edema Reduces wound exudate Attracts neutrophils, monocytes, and fibroblasts • Decreases wound pH • Possible pain reduction educes ROS R Keeps wound bed moistened Promotes autolytic debridement Activates plasminogen

*Adapted from Fossum,23 Ackerman,24 Hargis and Myers.25

LICENSED MEDICAL-GRADE HONEY (MGH) PRODUCTS

regions, and must be free from contaminants like pesticides, herbicides, heavy metals, and spores. 5

Multiple honey products for human and animal medicine are available for wound management. Thus far, there have been no reports of botulism through the topical application of raw honeys, but again, a gamma-irradiated medicalgrade honey product is recommended for wound treatment. 5 These honeys are strictly regulated, collected from organic

Manuka MGHs are classified based on their UMF content. The UMF rating correlates with the MGO concentration. For example, UMF-10 manuka honey contains an MGO rating of 263mg/kg. 35 A compound unique to manuka honey, leptosperin, has been recently discovered; it contributes to

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manuka honey bioactivity, and is now incorporated into the UMF rating. 35 A rating of no less than UMF-10 should be selected for wound treatment. 35 However, as pointed out in a 2020 study by Bucekova et al, 36 due to the unreliability of the UMF rating, medical-grade manuka honeys also utilize MGO concentration (e.g. Manuka Vet ®), percentage of pure honey (e.g. KRUUSE Manuka products), and non-peroxide activity (e.g. Integra MediHoney ®) to indicate the degree of antibacterial activity. Manuka honey products are available in natural, gel, paste, ointment, and cream forms that are directly applied to the wound bed for wounds with pockets, sinuses, tunneling, and undermining. In addition, medical-grade manuka impregnated bandages such as tulle (gauze), foams, hydrogel colloidal sheets, hydrogel sheets, and calcium alginate are available (Figure 2). The type of bandage should be selected based on the amount of exudate the wound is producing; e.g. for heavy exudative wounds, a calcium alginate bandage should be selected. Alternatively, the veterinarian can create MGH impregnated bandages by applying at least 30 cc of MGH to a 10 cm x 10 cm cotton gauze.7 Any pockets or sinuses should be filled with MGH honey.7 A three-layer bandage should then be applied over the wound.

BANDAGE CHANGE PROTOCOLS Honey will maintain its bioactive effects until it is diluted by wound exudates up to 45 to 60 times its volume. 34 According to a recommendation by Molan and Betts, 38 bandages might initially require changing up to three times daily until wound exudates subside. Ensure that the honey application extends beyond the margins of the wound bed. Afterwards, a bandage change may only be necessary every two to three days. If the bandages adhere to the wound, more frequent bandage changes are required. Molan and Betts also recommend that non-adherent bandages, such as those impregnated with paraffin, should be chosen to allow the honey to diffuse into the wound. 38 Conflicting information exists on the duration and type of MGH recommended in veterinary medicine. A 2011 study of wounds of the equine distal limb by Bischofberger et al8 recommended using manuka honey up to 12 days with daily bandage changes, followed by a thin topical application of manuka honey gel two to three times daily for up to 21 days. A 2018 review by Kennedy39 recommended using honey only during the inflammatory phase (no more than five days) and until a healthy granulation bed is seen, with bandages being left on for up to five days. A 2018 study in mice by Sawazaki et al also recommended only using MGH during the inflammatory phase of wound healing, due to the

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Figure 2: Application of a KRUUSE Manuka AD honey impregnated gauze to a dog’s limb, using sterile technique.37

low pH of honey delaying the re-epithelialization process of traumatic wounds, but this was thought to occur because of the application of a pure rather than diluted MGH.40 A technical review for Manuka Vet ® products recommends selecting a MGH with a concentration greater than 500 mg/ kg, following the protocol presented by Bischofberger et al for horses, or using the protocol outlined by Kennedy for dogs and other species.41

1 Lay-flurrie K. Honey in wound care: effects, clinical application and patient benefit. Br J Nurs. 2008;17(11):S30-S36. doi: 10.12968/bjon.2008.17.Sup5.29649. 2 Molan PC. The evidence supporting the use of honey as a wound dressing. Int J Low Extrem Wounds. 2006;5(1):40-54. doi: 10.1177/1534734605286014. 3 Molan, PC. The evidence and the rationale for the use of honey as wound dressing. Wound Practice and Research. Journal of the Australian Wound Management Association. 2011;19(4): 204-220. 4

Manjo G. The Healing Hand: Man and Wound in the Ancient World. Harvard University Press; 1975.

Combarros-Fuertes P, Fresno JM, Estevinho MM, Sousa-Pimenta M, Tornadijo ME, Estevinho LM. Honey: Another Alternative in the Fight against Antibiotic-Resistant Bacteria? Antibiotics. 2020; 9(11):774.

6 Rogalska T. Healing the Bees Knees — On Honey and Wound Healing. JAMA Dermatol. 2016 Mar;152(3):275. doi: 10.1001/jamadermatol.2015.3692.

Matthews KA, Binnington AG. Wound Management Using Honey. Compendium Cont Edu for Pract Vet. 2002; 24(1):53-60.

Bischofberger AS, Dart CM, Perkins NR, Kelly A, Jeffcott L, Dart AJ. The effect of short- and long-term treatment with manuka honey on second intention healing of contaminated and noncontaminated wounds on the distal aspect of the forelimbs in horses. Vet Surg. 2013;42(2):154-60. doi: 10.1111/j.1532-950X.2012.01083.x.

9 Mandel HH, Sutton GA, Abu E, Kelmer G. Intralesional application of medical grade honey improves healing of surgically treated lacerations in horses. Equine Vet J. 2020;(1):41.doi: 10.1111/evj.13111.

da Silva PM, Gauche C, Gonzaga LV, Costa AC, Fett R. Honey: Chemical composition, stability and authenticity. Food Chem. 2016 Apr 1;196:309-23. doi: 10.1016/j.foodchem.2015.09.051. Epub 2015 Sep 16. PMID: 26593496.

11 Molan PC. The Antibacterial Activity of Honey 2. Variation in the potency of the antibacterial activity. Bee World. 1992;70(2): 59-76. 12 Mavric E, Wittmann S, Barth G, Henle T. Identification and quantification of methylglyoxal as the dominant antibacterial constituent of Manuka (Leptospermum scoparium) honeys from New Zealand. Mol. Nutr. Food Res. 2008; 52(XX):483-489 doi: 10.1002/mnfr.200700282.

Holt S, Johnson K, Ryan J, Catchpole O, Zhang S, Mitchell KA. New Zealand Kanuka Honey Has High Levels of Methylglyoxal and Antimicrobial Activity. J Altern Complement Med. 2012;18(3):203-204. http:// doi.org.proxy.uchicago.edu/10.1089/acm.2011.0685

From the VMAA Molan PC, Allen KL. The effect of gamma-irradiation on the antibacterial activity of honey. J Pharm Pharmacol. 1996;48(11):1206-9. 14

15 Molan PC. The antibacterial activity of honey: 1. The nature of the antibacterial activity. Bee World. 1992;73(1), 5-28.

de Groot T, Janssen T, Faro D, Cremers NAJ, Chowdhary A, Meis JF. Antifungal Activity of a Medical-Grade Honey Formulation against Candida auris. Journal of Fungi. 2021;7(50):50. doi:10.3390/jof7010050.

Maruhashi E, Braz BS, Nunes T, Pomba C, Belas A, Duarte-Correia JH, Lourenço AM. Efficacy of medical grade honey in the management of canine otitis externa — a pilot study. Vet Dermatol. 2016;27(2):93-8e27. doi: 10.1111/vde.12291.

Molan PC. The antibacterial activity of honey: 2. Variation in the potency of the antibacterial activity. Bee World. 1992; 73(2), 59-76.

Brudzynski K, Abubaker K, St-Martin L, Castle A. Re-examining the role of hydrogen peroxide in bacteriostatic and bactericidal activities of honey. Front. Microbio. 2011;2(213):1-9. doi: 10.3389/fmicb.2011.00213.

Jibril FI, Hilmi ABM, Aliyu S. Effect of Non-hydrogen Peroxide on Antibacterial Activity of Malaysian Meliponini Honey against Staphylococcus aureus. J Pharm Bioallied Sci. 2020;12:S831-S835. doi:10.4103/jpbs.JPBS_280_19.

21 Devriendt N, de Rooster H. Initial Management of Traumatic Wounds. Vet Clin North Am Small Anim Pract. 2017; 47(6): 1123-1134. 22 Thompson E. Debridement Techniques and Non–Negative Pressure Wound Therapy Wound Management. Vet Clin North Am Small Anim Pract. 2017; 47(6): 1181-1202.

Fossum TW. Chapter 16: Surgery of the Integumentary System. 4th ed. In: Small Animal Surgery. Elsevier Mosby; 2013: 190-288.

Ackermann MR. Inflammation and Healing. In: Zachary JF ed. Pathologic Basis of Veterinary Disease. 4th ed. Mosby; 2007:153-191.

25 Hargis AM, Myers S. The Integument. In: Zachary JF ed. Pathologic Basis of Veterinary Disease. 4th ed. Mosby; 2007:1107-1125.

Mitchell T. Use of Manuka honey for autolytic debridement in necrotic and sloughy wounds. Journal of Community Nursing. 2018;32(4):38-43.

27 Bergman A, Yanai J, Weiss J, Bell D, David MP. Acceleration of Wound Healing by Topical Application of Honey. Am J Surg. 1989;145(3):374-376. doi: 10.1016/0002-9610(83)90204-0. 374-376.

The Veterinary Medical Aromatherapy® Association (VMAA) is an organization of veterinarians and veterinary technicians dedicated to the responsible use of aromatherapy in animal practices. Their mission is to promote standards of excellence in animal aromatherapy, to provide outreach and education to veterinarians and axillary animal practices, and to promote continual improvements in Veterinary Medical Aromatherapy®. The VMAA is elevating the veterinary profession through innovation, education, and advocacy of integrative medicine.

ESSENTIAL OILS FOR ANIMAL FIRST AID

Understanding the beneficial properties of essential oils reveals how they can be so helpful in veterinary emergencies. In fact, plants use the essential oils they produce for their own biological safety. Essential oils are known to be antimicrobial, anti-histaminergic, and anti-inflammatory. They can serve as neurotransmitters, tissue hormones, enzymes, and cofactors for biological processes. They promote tissue healing by supplying negative ions, ozone and oxygen. Essential oils can help manage pain and infections and promote tissue regeneration.

ESSENTIAL OILS FOR FIRST AID

Bleeding — Helichrysum italicum on location, undiluted. Unlike cauterization, this oil also protects against infections and promotes tissue healing. Very useful after dental procedures. Use caution around cautery, as essential oils are flammable.

28 Goharshenasan P, Amini S, Atria A, Abtahi H, Khorasani G. Topical Application of Honey on Surgical Wounds: A Randomized Clinical Trial. Forsch Komplementmed. 2016;23(1):12-5. doi: 10.1159/000441994.

Bruising and pain — Helichrysum italicum, Peppermint and Frankincense (Boswellia carterii) undiluted on location.

Febriyenti F, Lucida H, Almahdy A, Alfikriyah I, Hanif M. Wound-Healing Effect of Honey Gel and Film. J Pharm Bioallied Sci. 2019;11(2):176-180. doi: 10.4103/jpbs.JPBS_184_18.

Burns — Lavender (Lavandula angustifolia) on location every five minutes for 30 minutes, then twice a day until healed.

30 Iacopetti I, Perazzi A, Martinello T, Gemignani F, Patruno M. Hyaluronic acid, Manuka honey and Acemannan gel: Wound-specific applications for skin lesions. Res Vet Sci. 2020 Apr;129:8289. doi: 10.1016/j.rvsc.2020.01.009.

Smaropoulos E, Cremers NA. Medical grade honey for the treatment of paediatric abdominal wounds: a case series. J Wound Care. 2020 Feb 2;29(2):94-99. doi: 10.12968/jowc.2020.29.2.94.

32 Majtan J. Honey: An immunomodulator in wound healing. Wound Repair Regen. 2014; 22(2):18792. doi: 10.1111/wrr.12117 Fossum TW. Small Animal Surgery. 4th ed. Elsevier Mosby; 2013.

Deanne G. Manuka Honey: why this multi action antimicrobial is a valid alternative to silver. Wounds. 2020;16(4):72-77.

Molan PC. Clinical Usage of Honey as a Wound Dressing: An Update. J of Wound Care. 2004;13(9)353-356.

Allergic reactions — Lemon, Blue Tansy (Tanacetum annuum) and Frankincense, undiluted on location. Can use over carotid arteries if systemic reaction. Very useful topically at vaccine injection sites. Heat stroke — Peppermint diluted in ice water and misted over the whole body. Place undiluted on the feet and follow with a cold wet pack to drive in the oil.

UMF website Grading System Explained. Unique Manuka Factor: Honey Association. 2021. Accessed April 30, 2021. https://www.umf.org.nz/grading-system-explained/. 35

36 Bucekova M, Bugarova V, Godocikova J, Majtan J. Demanding New Honey Qualitative Standard Based on Antibacterial Activity. Foods. 2020;9(9):1263. doi: 10.3390/foods9091263.

KRUUSE Manuka AD 10x12.5 cm absorbent dressing, 10/pk, sterile. KRUUSE. Accessed April 30, 2021. https://kruuse.com/products/consumables/wound-care-and-bandaging/dressing/kruusemanuka-ad-10x12-5-cm-absorbent-dressing-10-pk-sterile.

38 Molan P, Betts J. Using honey dressings: the practical considerations. Nursing Times. 2001;96(49)36.

Kennedy CR. The role of Manuka honey in second intention healing of wounds of the equine distal limb. Veterinary Ireland Journal. 2018;8(11):669-674.

These are just some examples of how to use essential oils in an emergency, to support recovery. In first aid applications, the oils are rarely diluted. This is a time for strong action. Make sure you know your oils. Many products are diluted with fillers or are not Biologically Active® and could therefore cause damage rather than help. For example, while Lavender essential oil (Lavandula angustifolia) helps with burns, Lavandin is high in camphor, and can actually cause burns.

Sawazaki T, Nakajima Y, Urai T, Mukai K, Ohta M, Kato I, et al. Efficacy of Honeydew Honey and Blossom Honey on Full-thickness Wound Healing in Mice. Wounds. 2018;30(7):197–204.

41 Manuka Vet®. Manuka Vet® Skin & Wound Technical Review. Accessed May 5, 2020. https://www.manukavet.com/site_files/15793/upload_files/A4Booklet_p7.pdf?dl=1.

Oil quality, type of oil, and technique all matter in using essential oils responsibly.

Submitted by Nancy Brandt, DVM, CVC, CVA, CVMA IVC Summer 2021

BUSINESS PROFILE

How one family’s passion for health can help your clients and patients

LIVE HEALTHIER LIVES

For many veterinary clients, “healthy” isn’t a trend — it’s a way of life. Health-conscious people are seeking organic foods, regularly seeing naturopaths, and replacing chemical cleaners with essential oils. These lifestyle choices are also extending to their dogs and cats; however, it’s not always easy for them to find trustworthy pet products. Enter NOW®, a company that empowers people — and their dogs and cats — to lead healthier lives by offering high quality, affordable natural products. “Back in the 60s, the health food industry was in its infancy,” says Regina Flight, Category Manager for NOW® Pets. “During these formative years, entrepreneur Elwood Richard started a small chain of health food stores in the Chicago area, called Health House. With a degree in physical chemistry, along with research experience in enhancing physical performance through the use of healthy foods and nutritional supplements, Elwood was a firm believer in the benefits of natural products. He eventually started NOW in order to offer health foods at a competitive price in his stores.” NOW has come a long way since it was founded just over half a century ago. It’s not only a well-known name among health-conscious people, but it’s also helping dogs and cats to better health. “For years, veterinarians using several of our human supplements in their clinics and dispensaries requested that we create a pet-specific line of supplements, specifically formulated for companion animals,” says Regina. “Those conversations planted the seed for NOW Pets.” The NOW Pets line includes supplements for joint health, immunity, allergies and GI support. The company also offers Omega-3 softgels, urinary support chewable tablets, a relaxant, and a unique L-lysine powder for cats. Thanks to the

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input of Dr. Barbara Royal, who has helped NOW bring 12 pet products to market, the company’s formulations address common health conditions faced by thousands of animal parents across North America. “Because Dr. Royal uses these products in both her clinics, she sees firsthand how well they work for her clients,” says Regina. To ensure the quality of their pet products, NOW sources their ingredients from suppliers they know and trust. “We’ve developed strong long-standing relationships with the best ingredient and raw material suppliers, and we leverage these relations to ensure our pet products are formulated with natural botanicals and quality ingredients,” says Regina. Their entire pet line is made from many of the same quality ingredients as their supplements for people, and every bottle carries the National Animal Supplement Council seal — a testament to the company’s high standards. Still owned by the Richard family, NOW celebrated their 50th anniversary a few years ago — a significant milestone that had them reflecting on their past and looking to the future. Whatever the next 50 years holds for this trailblazing company, they plan to remain committed to their founding principle — empowering healthy lives for all. “As a pet parent, I trust the quality and integrity of our products and feel very confident giving them to my aging dog,” says Regina. “Every day, I see firsthand how they help her.” That’s certainly cause for celebration!

BY JELENA SPASIC

Hypochlorous acid solutions for wound care in animal patients

Using the appropriate wound treatment in your animal patients can mean the difference between a quick recovery and prolonged healing marred with complications. Hypochlorous acid solutions are a recent and highly effective approach to wound care. There are dozens of different wound cleansers on the market that can help with reducing biofilm and cleansing wounds in order to facilitate optimal healing. Relatively new to the wound market are hypochlorous acid solutions.

HYPOCHLOROUS SOLUTIONS — HOW THEY’RE MADE AND WHAT THEY CAN DO Electrolyzed water is an all-natural, no-rinse, non-toxic, nonirritating, and environmentally-safe antimicrobial solution composed of three simple ingredients. When salt water is electrolyzed, it produces an anolyte solution that consists of >99.3% water, chloride salt, and hypochlorous acid (HOCl).

reaction oxidizes at the positively charged anode. The reaction releases chlorine in the process, which becomes hypochlorous acid. Since the sea salt concentration is above the physiological value of 0.9%, a hyperosmolar, and consequently decongestant, effect occurs in the wound tissue, with effective biofilm reduction. This decreases wound pain and improves local blood flow. Thanks to the ionized sea water, a deep effect is achieved, as the H 2O clusters in ionized water are smaller and thus penetrate deeper into the tissue.

SEA SALT ITSELF HAS A GERM-REDUCING PROPERTY

HOCl is a naturally-occurring chemical produced by neutrophils to fight bacteria and inflammation after an infection or trauma. It has the unique power to eradicate dangerous organisms while not causing harm to cells. HOCl is one of the only agents that is non-toxic to the delicate cells that heal wounds, while being lethal to almost all known dangerous bacteria and viruses that threaten health. Although it may sting slightly when applied to an open wound, a hypochlorous acid solution is otherwise safe to use on open wounds and mucous membranes, including the mouth and eyes, as the acid is non-cytotoxic and rigorously tested for safety. It has anti-odor properties and can be frequently used before and after wound debridement. Hypochlorous acid also exists in the form of a hydrogel, which makes it ideal as a wound filler.

In chemistry, the hydrogen ion concentration is characterized by the pH value. Acids have a high concentration of H+ ions and have an oxidizing effect. Basic substances, on the other hand, have a high proportion of OH ions and have a reducing effect. Basic substances are therefore antioxidants — that is, they counteract and neutralize oxidation and free radicals. It is also known that enzymes, signal molecules, neurotransmitters and growth factors, all important for the individual wound healing phases, can optimally develop their effect in the basic environment (especially in the epithelialization phase). The quality of salt used in HOCl solutions is important; it should be rich in minerals, containing all 84 essential trace elements that are also present in the human body. It acts as a natural preservative in the solution.

The chemistry behind making hypochlorous acid is well known: an electrolytic process breaks down a saltwater solution (H 2O + NaCl) into essential elements before the

Jelena Spasic harnesses her background in large healthcare systems, as well as in international humanitarian medical organization Doctors Without Borders, to commercialize and bring to market exciting new NexoPet products for animal health and well-being. IVC Summer 2021

Medical

ozone FOR WOUN DS: a new drug of choice in veterinary practice

BY MARGO ROMAN, DVM, CVA, COT, CPT

Instead of immediately reaching for antibiotics when treating wounds in your animal patients, consider medical ozone. It can be used to effectively treat a variety of wounds and should be a part of every veterinarian’s first aid toolkit.

All wounds and skin infections can benefit from medical ozone. It can be used for many commonly encountered conditions in general veterinary practice, including lacerations, pyodermas, abscesses, bite wounds, deep abrasions, rashes, gangrenous lesions, allergic reactions, insect and tick bites, severe contusions with contamination, and hotspots.

OZONE AND THE DIRTY WOUND Whenever a wound needs to be cleaned of biofilm, dirt and debris, and disinfected, healing oxygen can be added to the tissue through the use of medical ozone. It kills on contact microbes, yeast, mycoplasmas, viruses, bacteriophages, and other organisms that can make up a biofilm on skin and other tissues. This process then floods the area with oxygen, which encourages healthy tissue to regenerate and thrive.

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We have no pharmaceutical drug in our current medical arsenal with that range of efficacy. Due to the development of resistant strains of microbes, antibiotics are ineffective for treating some infections. Culture and sensitivity testing can only inform us of a minimal number of pathogens present in a wound; even if the antibiotic we are prescribing helps remove those microbes, there may be others that were not identified through testing. Additionally, antibiotic therapy can lead to dysbiosis throughout the body. We can no longer justify prescribing antibiotics automatically, when another treatment — i.e. medical ozone — is available that does not contribute to resistance and avoids the dysbiosis associated with antibiotic therapy.

Using medical ozone revives wounded or crushed tissue and enhances vascularization. Darkly bruised areas regain a pink healthy color after medical ozone therapy.

HOW DO WE GIVE OZONE TO WOUNDS? The fundamentals of ozone and its application techniques are very adaptable to all veterinary practices. Medical ozone can be delivered easily in a suspension of ozonated saline. Normal saline is run through bubbling ozone and oxygen for 30 minutes, at a minimum level of 55 µg per milliliter. Levels up to 75 µg/mL can be used when done with distilled water or saline. The ozonated saline needs to be used within a 45-minute period to get the highest level of suspended ozone. It can be used as a wound flush to wash away the biofilm, kill the bacteria and microbes in the lesion, and help restore more oxygen within the tissue. Debris and traumatized cells are rinsed off as well. For disinfection, higher concentrations of 37-60 µg/ ml can be used. To stimulate tissue healing, lower concentrations of 15-25 µg/ml are beneficial. For example, one can bag a limb by filling a used saline bag with ozonated saline and placing a tube into it that continues to bubble throughout the fluid bag. This way the ozone keeps refreshing, and the bubbling action helps flush and clean the wound. Rinsing wounds with ozonated saline potentiates the flushing and reduces or may eliminate the need for antibiotics. Further, enhancing the microbiome with gut support and even Microbiome Restorative Therapy (MBRT) adds healthy microbes that will support a stronger microbiome that can then help fight infections. Continued on page 57.

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CASE STUDIES

Bliss, a one-year-old female Siamese cat, developed severe moist dermatitis following her rabies vaccination, when she suffered intense itching on her head and neck. She was given UVBI Ultraviolet Blood Therapy with ozone. Some of the ozonated blood was injected under the skin around the lesions. Within three days, the wounds had dried out and healed. No antibiotic or steroid medications were used.

A young Pit Bull Terrier presented for bite wounds resulting from a dog fight. These wounds are generally heavily contaminated. Ozonated saline was used to cleanse the wound; compresses soaked with ozonated saline were used as well. In cases such as this, medical ozone can also be given subcutaneously or rectally. Clients can be sent home with ozonated saline in glass bottles to flush drains. This dog’s wounds healed without antibiotic medications. Homeopathics were given orally.

A dog suffered from infected pododermatitis. Infected paws can be treated by bagging the feet with ozone gas. Ozone can be run through an olive oil bubbler and then through a splitter to treat multiple feet or areas simultaneously. In this case, the owner was doing this several times a week. The dog also received subcutaneous ozonated saline for systemic support. Adding UVBI would be helpful too. Note: bagging treatment can be administered by filling a bag with ozone gas, without bubbling through olive oil. However, the gas is irritating to the lungs. This type of treatment should only be performed in a well-ventilated room; and when it is time to remove the bag, try to retain the gas inside as the limb is slid out, sealing in O3O2 gas. Then take the bag outside to air out safely.

A five-year-old Labrador Retriever presented for moist dermatitis and hot spot following a tick bite. Ozonated saline was administered under the skin of the lesion; additional ozone was given subcutaneously over the shoulders. This dog’s wounds healed with only ozone and homeopathic medicines. Note: due to the settling of subcutaneous fluid, give a minimal amount on the head and a larger volume over the shoulders and back to avoid retention of fluid in vulnerable areas under the neck.

1. Bliss receiving ozonated blood around her lesion; 2. Ozone treatment for bite wounds resulting from a dog fight; 3. Treating infected feet with ozone gas; 4. Ozone treatment of moist dermatitis from a tick bite.

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Scrabble, a six-year-old Wheaten Terrier, received a small, deep cut in the crease of his right elbow when playing outside with another dog. He was put on antibiotics, but the leg continued to swell; surgery was performed with drain placement, and culture of the wound isolated MRSA. The right forelimb continued to swell, and multiple incisions were made over the entire limb to open up areas from the carpus to the shoulder. Specialists recommended amputation after multiple surgeries, as the infection continued to spread dorsally and the dog was weakening. Upon presentation to this author’s hospital, ozonated saline was flushed through the mattress-type incisions, and more ozone was given subcutaneously. Vitamin B-complex and vitamin C were given in pockets of the subcutaneous ozonated saline over the ribs, and rectal ozone was administered as well. Along with hyperbaric oxygen, ozone therapy reduced the pain and infection. The treatments continued for three days, the leg healed, and subsequent cultures for MRSA were negative.

Continued from page 55. Additionally, this author utilizes homeopathic medicines such as Arnica montana, Ledum palustre and Calendula officinalis orally for gentle support to speed recovery. Ozonated oils like olive, sunflower, hemp, coconut, jojoba, with or without essential oils, are now available to heal infected skin. Ozonated suppositories can be given rectally, vaginally, or even ingested. Ozonated olive oil capsules are easy to ingest.

TREATING MRSA WOUNDS A 2018 study found that medical ozone demonstrated a high efficacy/low cost option for killing MRSA skin infections. The researchers demonstrated that ozonated water (1 mg/l) can sterilize all S. aureus and MRSA in one minute.1

Ozone owes its biocidal effectiveness to its ability to oxidize organic material in bacterial membranes, which weakens the cell wall and leads to cell rupture, causing immediate death of the bacteria cell. It also destroys viruses, yeast, bacteriophages, mycoplasmas, fungal and other infectious species. Try not to immediately reach for antibiotics when other therapies like medical ozone can be used to effectively treat wounds in your patients.

Song M, Zeng Q, Xiang Y, et al. The antibacterial effect of topical ozone on the treatment of MRSA skin infection. Mol Med Rep. 2018;17(2):2449-2455. doi:10.3892/mmr.2017.8148.

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DOG FOOD TYPES BY GARY TASHJIAN

If your clients have ever asked you to compare dog foods for them, you know what a challenge (and headache) this can be. The nutritional info can baffle even the most nutritionsavvy dog owner, and it can be difficult to simplify this information in a way clients can understand. When comparing two pet foods, it’s important to compare the “dry matter” nutritional values rather than the “as fed” nutritional values. This is particularly important if the foods are very different in consistency, such as a raw food and a kibble. The nutritional information typically listed on any pet food is the “Guaranteed Analysis.” This is the “as fed” nutritional information, which includes crude fiber, crude fat, and crude protein as well as the moisture content of the meals. The word “crude”, in this case, refers to the method of nutritional testing rather than the quality of the ingredients.

HOW MOISTURE CONTENT AFFECTS COMPARISONS The moisture content simply refers to how much water is in a food. The value varies widely among kibble, fresh cooked, raw, and canned foods. While moisture content is an important component of the meal, it can cause the nutritional values of different types of food to appear misleading. To compare foods on a “dry matter” basis rather than an “as fed” basis, you need to exclude the moisture portion of the food. Consider this scenario: a fresh dog food has 72% moisture content. This means the other components of the meal comprise the remaining 28%. The “as fed” percentage of protein is listed as 13%. This means that the dry matter protein content of the food is 13/28, or 46%. Comparing the “dry matter” values of a

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kibble and fresh food meal provides a very different picture to comparing their “as fed” values. Because fresh or raw meals, as well as most canned foods, have a much higher moisture content than kibble, the protein and fat content can appear misleadingly low if the two foods are compared using the “as fed” nutritional values rather than the dry matter values. Comparing the dry matter values of different food types should help give the most accurate picture of how any two foods differ nutritionally. This allows you to help your clients more easily make informed decisions regarding their pets’ health and diets.

WHAT TO LOOK FOR IN A DOG FOOD BRAND If you are recommending that a client switch up their dog’s diet, here are some factors to consider: •C onvenience: Is the food accessible to the client? Is it easily found in a store or online? •F reshness: When was the food made? This is different from the expiration date. While the latter is important, it doesn’t tell you when the food was actually manufactured. Over time, nutrients in pet food can degrade, so it’s important to recommend a product that’s kept fresh. •A ffordability: Is the food realistically within your client’s budget? Is it a product they’ll be able to stick with?

Gary Tashjian is the owner and founder of Darwin’s Natural Pet Products. Gary spotted the opportunity to help more pets live longer lives with healthier diets and founded Darwin’s Natural Pet Products in 2004, the first raw pet food company in the Pacific Northwest. Over the past 17 years, Darwin’s has served more than 80 million nutritious meals to dogs and cats, helping tens of thousands of pets live healthier lives.

ADVERTORIAL

The healing power and potential of

TERPENES BY ELISHA LEHRHOFF, MS TOXICOLOGY

Terpenes are responsible for the robust aromatic smell and flavor of the cannabis plant. Hundreds of terpenes are present in each strain.1 They are found in the trichrome of the flower and increase in concentration as the plant continues to grow.1 The terpene market continues to widen as more herbal supplement manufacturers are interested in adding terpenes to their products for the added health benefits.1 By 2024, the terpene market is predicted to expand into a 20-billion-dollar market.1

EACH TERPENE HAS ITS OWN HEALING BENEFITS “Terpenoids are pharmacologically versatile: they are lipophilic, interact with cell membranes, neuronal and muscle ion channels, neurotransmitter receptors, G-protein coupled (odorant) receptors, second messenger systems and enzymes”2 Terpenes are evaluated by the FDA on an individual basis.2 The most common types seen in cannabis, such as D-limonene, β-myrcene, α-pinene, D-linalool, and β-caryophyllene, are all generally recognized as a safe food additive by the Food & Drug Administration. 2 Each terpene is unique and has its own set of health benefits along with an individual smell and flavor.1 + D-limonene has a strong lemon smell and is currently being studied as a possible cancer treatment, due to previous studies demonstrating how it may cause cell death in breast cancer.2 + B-caryophyllene is considered the most bioavailable terpene in cannabis. It contains anti-inflammatory properties and has a pepper scent that can be utilized to ward off insects.1 + β-myrcene is another bioavailable terpene that has a hopslike flavor and is well known for its anti-inflammatory and analgesic properties.2 + α-pinene is a bicyclic monoterpene that smells like pine, is most prominent in nature, has anti-inflammatory properties, and can be utilized as a bronchodilator. 2 + D-linalool is a terpene alcohol with a soothing lavender smell that can be utilized as a local anesthetic on the skin. If ingested, it has been proven to contain anticonvulsant properties.2

ENHANCEMENT AND SYNERGY “Terpenes can enhance the effect of cannabinoids and synergize the feeling of relaxation, stress relief, energy boost, and maintaining focus along with their underlying pharmaceutical functions.”1 The terpene profile of each hemp strain is based on the genetic makeup of the strain and is individualized to each plant.2 Cultivar specificity ensures each plant will contain the same terpene profile in every product. Terpenes combined with phytocannabinoids, flavonoids, cannabinoids, and tetrahydrocannabinol have the ability to produce the entourage effect through synergizing all these combined ingredients.2 “Four basic mechanisms of synergy have been proposed: (i) multi-target effects; (ii) pharmacokinetic effects such as improved solubility or bioavailability; (iii) agent interactions affecting bacterial resistance; and (iv) modulation of adverse events.”2 The synergistic entourage effect has a much greater effect on the body than if any of those ingredients were taken independently.2 HempMy PetTM utilizes our own genetic line of Cherry AbacusTM hemp, bred and produced at our local farm in Colorado. Our full-spectrum hemp extract combines the phytocannabinoids CBD (cannabidiol), CBG (cannabigerol), and CBC (cannabichromene), with terpenes, flavonoids, tocopherols, and under 0.3% THC to create a cultivar specific product full of bioactive, human-grade, vegan ingredients that are beneficial for animals. We are incredibly proud to be cultivar specific, so we can ensure every customer receives the same product every time they purchase from us. Each batch is third party analyzed and tested to ensure purity, potency and safety for every pet. Sommano SR, Chittasupho C, Ruksiriwanich W, Jantrawut P. The Cannabis Terpenes. Molecules. 2020; 25(24):5792. https://doi.org/10.3390/molecules25245792

Russo EB. Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br J Pharmacol. 2011;163(7):1344-1364. doi:10.1111/j.1476-5381.2011.01238.x.

Elisha Lehrhoff, is originally from Los Angeles, CA. She graduated from Colorado State University in 2015 with a BA in Animal Science and a minor in Business Administration. Throughout her undergraduate career, she fell in love with research and working with animals. She completed her Master of Science in Toxicology in 2017 and hopes to return to school in the fall of 2021 to pursue her PhD in Public Health. She is currently working for HempMy PetTM as Head of Research, Toxicologist. Elisha thrives in a scientific writing environment and is specifically interested in holistic preventative health and the endocannabinoid system. IVC Summer 2021

modern veterinary care

BY SAM MEISLER, DVM

An achievable approach to work-life balance involves changing the way we practice veterinary medicine.

In order to attract new talent, the practice of veterinary medicine must change the method and manner in which it is being delivered. A new generation of veterinarians is currently entering the workforce, and their need for a healthy, happy life must be accounted for. We must work together within the veterinary profession to create an environment that will develop and nurture new employees, both now and in the future.

CURRENT PRESSURES ON VETERINARIANS Change can be good, but it is sometimes met with resistance. We naturally resist change because it tends to bring with it a feeling of uncertainty and loss of control. During my first year as a veterinarian, my typical workday was filled with exciting “firsts” and challenges. There was happiness when a case was successful, but also tears when things went awry; however, this was a mix I needed to experience firsthand. I loved the scope of work that made up my day. I would be delivering a calf in the morning, and repairing a dog’s humerus in the afternoon. It was exciting. The only negatives were emergency calls and long hours. During my first six months as a vet, I was on call 24/7 for emergency duty, then transitioned to 60 hours per week.

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Unfortunately, the idea of shared emergency calls with other practices, or of an emergency hospital, was not a welcome topic of conversation with my employer. Neither was shortening the workweek. “You just haven’t paid your dues yet,” was a sentence frequently heard by my generation of veterinarians.

A WHOLE NEW WORLD The current generation of veterinarians experiences immense pressures. For example, clients want us to say that their pets are perfectly healthy (often with very little diagnostic information at our disposal). They want us to see their pets on-demand and at all hours of the night. They want us to give them a diagnosis whether they allow us to perform diagnostics or not. And above all, many pet owners want their vets to be the sole doctors for everything, and many times refuse referral to specialists who would offer more dedicated treatments. As vets and as a human beings, we understand that clients want nothing less than world-class service done right the first time, and delivered at reasonable cost. On top of this, veterinarians and those with their own practices have another wall to scale: the internet. Having

one’s personal and professional life placed under a public microscope is another stressor for vets and vet clinic employees. Social media can be both explicit and subtle in its interactions with us. To become a veterinarian, a student must succeed in the world of academia and higher education. He or she has to be a high achiever. However, once a student becomes a veterinarian, the grading system becomes a matter of a five-star review versus a one-star hit job. Additionally, when one posts updates on Facebook or Instagram, they tend to be positive or funny. We post the way we want to be perceived, not necessarily the way we really are. This prompts a distorted view of how we fit in among our peers. As we try to reconcile how we feel personally, versus how all our peers appear on social media, we can become more isolated. On social media, it seems as though our peers are doing great while we feel like we can’t keep up. The chasm between what we think we need to be — perfect — versus how we are — imperfect — only widens. As such, we are expected to not only excel overall as veterinarians, but also in the many sub-disciplines as well. We are expected to be the best at dentistry, radiology,

soft-tissue surgery, orthopedic surgery, preventive care, wellness care, internal medicine, and behavior — just to name a few. This part of the veterinary culture that requires us to be a “jack-of-all-trades” veterinarian can be very demanding. Another stressor is experiencing failure every day, when it was non-existent during our education. In addition, the increase in educational costs have given rise to enormous student loan debts. And finally, the idea of a healthy worklife balance has been introduced with no clear way to achieve it. According to the American Veterinary Medical Association’s 2019 survey of veterinary graduates, over 10% have accumulated over $300,000 worth of debt; this is a big increase from 2013 and earlier when less than 1% of graduates had that much debt (www.avma.org/blog/mixed-news-student-debt). In the years after graduating, veterinarians who have indexed their loan repayment to income have actually had their debt load increase due to interest accumulation. Many are seeing their debt-to-income ratios become too high to qualify for a home mortgage. Continued on page 62.

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(Clockwise from top left) A PetWellClinic facility; PetWellClinics focus on client education, preventative medicine, and compassionate primary care; Dr. Katie Comerford, DVM.

Finding balance

What does work-life balance even mean? On the surface, it seems to imply achieving a balance between the needs of work with the needs of your personal life, and not letting one completely overwhelm the other. Many people define it in terms of actual units of time. If one spends a certain amount of time at work and a certain amount of time on family and home life, then you can achieve work-life balance and happiness. Unfortunately, there are too many veterinarians who work a 40-hour week and are still not in a healthy mental state. And many veterinarians view work as something to get through so they can really enjoy their time off later. They are willing to work a few hard long shifts so they can then recover, rest and get back into work again. For these veterinarians, the recovery time needed is often too much of a sacrifice. For me, work-life balance is achieved not necessarily through balancing time, but rather by minimizing the negative impacts and maximizing the positive effects of one on the other. By doing this, one can seamlessly go from one to the other. It involves having both a healthy personal life and a healthy work life. A healthy personal life can mean different things to different people and is something each of us needs to work on individually. A healthy work life must involve enjoying work in a meaningful and productive way so it doesn’t bleed into one’s personal life in a harmful manner.

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Photos courtesy of PetWellClinic

The term “work-life balance” has been thrust upon the profession as something readily achievable. Defining and achieving it, however, will elude our grasp if we do not change the parameters by which we practice veterinary medicine.

Continued from page 61. Today, the typical veterinarian is tasked with orchestrating multiple cases at once, trying to be proficient in multiple disciplines, working very long shifts, not getting home at a regular time, worrying about student loan debt, and not being able to leave work problems at work.

THE MODERN APPROACH FOR VET WELLNESS First, the shift length must be shortened. Long shifts serve those who like to get their work time over with, or those who just love working so much they do not have time for a personal life. Humans operate on a diurnal rhythm, not a weekly one. We must look at work in terms of how much time it takes per day, not per week. Eight hours should be the maximum shift length veterinarians work on any given day. Our work is both intellectually and emotionally taxing. Working more than eight hours in one day does not leave time for recovery, nor allow for enough meaningful personal time during that day. Veterinarians should also be allowed to pick a few interesting disciplines and give up the rest. They should be encouraged to

excel at dermatology and preventive care, or at surgery and dentistry; simply put, be expected to know some disciplines, but not all. Clients demand excellence. Not meeting that demand is stressful. Finally, teaching our veterinarians how to deal with the emotional pressure that clients unknowingly inflict on them is vital. Today’s veterinarian needs to learn how to work with clients to help their pets, rather than take over all the decision-making and emotional pressure that comes with it. Most of the time, a veterinarian knows very little about a pet’s condition. So learning how to be honest with a client goes a long way to reducing feelings of guilt when things go wrong. Interestingly, when I founded the PetWellClinic, it was with the health of the veterinary employees in mind. Our shifts are kept to eight hours. This way, our vets can predict with greater certainty when they can leave. We specialize in animal conditions that do not require hospitalization, radiology or surgery, and make expert referrals for other needs. The disciplines we do not offer in-house tend to be the most stressful. Our veterinarians see a great variety of diseases and conditions, and as primary care providers we take pride in advising clients where to go next if needed. Our veterinarians are not required to multi-task and run multiple cases at the same time. They work on one case at a time, allowing their full focus to rest on the pet in front of them. They love starting up a case and the satisfaction that comes with it, and then not having to deal with protracted diagnostics and treatment. Above all, their personal sense of balance only reaffirms their passion as veterinarians. IVC Summer 2021

NUTRITIONAL SUPPORT FOR IM M U N ITY IN ANIMAL PATIENTS

Foods that may be beneficial for optimal immune system and gut microbiome health in animals.

BY DOUG KNUEVEN, DVM, CVA, CVC, CVCH

The immune system is the protective mechanism animals rely on in the face of external threats experienced every day in their immediate environments. While the animal is outside on walks, interacting with other animals, and or even interacting with humans at home, the immune system works hard around the clock to keep healthy, functioning immune cells circulating constantly in the body, primed and ready in the event of a pathogenic invasion. Providing the immune system with the energy it needs is vital for maintaining this 24/7 protection; nutrition powers the immune response just as it does for all other systems of the body.

INNATE AND ADAPTIVE IMMUNE RESPONSES The immune system is characterized by two different stages:

1 2

The innate immune response is a fast-acting, nonspecific response that focuses on targeting the location of the infection with pro-inflammatory immune cells that identify and destroy pathogens.

When the innate immune response isn’t enough to clear an infection, the adaptive immune response comes into play. This system is pathogen-specific, made up of T cells, B cells, and antibodies; it is through the adaptive immune response that the immune system is able to remember pathogens.

THE GI TRACT PLAYS AN IMPORTANT ROLE The gastrointestinal (GI) tract is considered the largest organ of the immune system, both facilitating digestion and housing the gut microbiome. The healthy microbes that live in the gut microbiome pay their rent by supporting the health of their host: boosting nutrient absorption, fighting pathogenic microbes in the gut, and strengthening the immune response. Thus, by taking care of the gut microbiota, the host can optimize its own immune capabilities.

THESE FOODS MAY HELP OPTIMIZE IMMUNE HEALTH Paying close attention to an animal’s diet is important for the regular nutritional support that the microbiome and immune system need. A few foods in general may be particularly beneficial for optimal immune health:

References available at IVCJournal.com

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• Buckwheat is a source of rutin, a phytonutrient with antioxidant power, and a source of prebiotic fiber. Buckwheat is a pseudograin, which means it is naturally gluten-free. It has been shown to increase circulating levels of important detoxification molecules supporting liver function.1 • Spanish black radish is a cruciferous vegetable — the same family that includes kale and Brussels sprouts. Spanish black radish is rich with glucosinolates, phytonutrients that are associated with liver, gallbladder, and general digestive support. 2 This vegetable also promotes liver detoxification through efficient elimination and by stimulating bile function. 3,4 • Beetroot is rich with nitrates, which convert to nitric oxide in the body for promoting vascular function and immunity. Phenolics from beets support antioxidation, and betalains are linked with healthy inflammation. 5 Another phytonutrient, betaine, promotes detoxification and immune function in the face of stress.6 • Brussels sprouts, like Spanish black radish, contain glucosinolates as well as phenolic compounds and carotenoids.7 These phytonutrients are known for regulating the immune system. Additionally, the sulfur in Brussels sprouts is linked to liver detoxification.8 • Chlorophyll extract is visible as the green pigment found in plants, and is highly valuable for its antioxidant and anti-inflammatory activity. Research has linked chlorophyll to wound repair, red blood cell activity, healthy hemoglobin levels, and gut microbiome modulation.9-11 Proper immune system care relies on proper nutrition. The intricate relationship between the GI tract, the microbiome, and the immune response is important for whole-body health; and feeding this relationship with the right nutrients is the best way to maintain this health. Dr. Doug Knueven received his veterinary degree from Ohio State University in 1987 and has been practicing veterinary medicine in the Pittsburgh area ever since. He is the owner and medical director of Beaver Animal Clinic in Beaver, PA. Certified in veterinary acupuncture, veterinary Chinese herbal medicine, and veterinary chiropractic, he also has advanced training in natural nutrition, Chinese food therapy, massage therapy, and homeopathy. An active longtime member of the AVHMA, he has been practicing alternative veterinary medicine since 1995.

ADVERTORIAL

There are no bad cats: using pheromones to communicate calm Pheromones are natural chemical signals that animals of the same species use to communicate and interact with one another. Cats and dogs of all shapes and sizes produce a wide range of pheromones, and each sends a different signal that influences behaviors.

a safe and drug-free calming option to give their cats a more comfortable environment.” Notably, the bSerene diffuser is clinically proven* to result in a calmer kitty after just seven days of use, and each refill lasts up to 45 days, giving cat owners a full month to observe results.

Cats use the feline facial pheromone (FFP) to mark their surroundings as safe and to bond with other cats. They do this by rubbing their faces against walls, furniture and even your legs! This pheromone conveys a comforting message that helps cats feel secure in their environment, so they can relax even in times of chaos. Cats that scratch, hide, or urinate outside the litterbox aren’t bad kitties — they’re simply anxious. This type of behavior often stems from feeling nervous or fearful, and is their way of communicating that they’re upset.

Synthetic pheromones have long been utilized, recommended, and studied by veterinarians. They are effective because animals of all ages respond similarly to pheromones, resulting in a chemical reaction in the brain. Synthetic pheromone products, such as bSerene diffuser and spray, mark areas for your cat to perceive as safe. They communicate to the cat that there’s no need to be on guard, and that it is safe to relax, almost like putting up Post-it ® notes as reminders throughout the house. Pheromones are species-specific and feline pheromones will not affect or influence other animal species or humans in the house.

To help calm anxious kitties, Scientia Pet™, a new brand of science-backed animal wellness products, offers a collection called bSerene™ which specifically mimics the feline facial pheromone. “During development, we discovered that cat owners were aware that their cats were exhibiting stressed-induced behaviors, but were less aware of the benefits of pheromone calming solutions,” says Chuck Latham, Founder of H&C Animal Health, which owns Scientia Pet. “In fact, 67% of cat owners have never purchased pheromones and were uncertain as to their benefits and effectiveness,” adds Latham. “It became essential for us to create an innovative and efficacious line of pheromonebased products, and to also educate cat owners that this is

Stressful situations in which pheromones can help include a new animal or baby in the house, holidays, guests visiting the home, separation anxiety, or extreme weather. Pheromones are also useful for short-term lifestyle or environmental stressors such as car rides, vet visits, loud noises, grooming, or boarding. It’s important to know that a cat isn’t being “bad” when his behavior is off; these issues arise from humans impacting the cat’s environment. Calming pheromones are an effective solution.

bSerenePet.com

*data on file

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news bites PET SPENDING EXCEEDS $100 BILLION OVER THE PAST YEAR During the pandemic, American animal parents have spent more money than ever on their dogs, cats and other pets, exceeding over $100 billion in sales for the first time in industry history. The amount of money Americans are spending on pet supplies, food, treats, vet care, and products has increased significantly since the start of 2020, and is showing no signs of slowing down, according to the American Pet Products Association (APPA).

AWARD FOR LANDMARK STUDY ON SENIOR CATS This past March, the Morris Animal Foundation awarded its Mark L. Morris Jr. Investigator Award to Dr. Carlo Siracusa, Associate Professor of Clinical Behavior Medicine at the University of Pennsylvania’s School of Veterinary Medicine, for a groundbreaking study on how chronic inflammation affects cognition, behavior and the overall health of senior cats. The award, which funds up to $200,000 annually for three years, is designed to support impactful companion animal research for which there is a pressing need. Recent surveys of cat owners indicate approximately 28% of cats aged 11 to 14 years develop signs of behavioral issues and cognitive decline, with prevalence increasing to over 50% in cats 15 or older. “There is an increasing body of evidence that shows the immune system and inflammatory response have an influence on behavior, but we don’t yet have enough data on cats,” said Dr. Siracusa. “We want to investigate how physical health influences mental health and vice versa.” Dr. Siracusa, along with his colleagues and a team at Italy’s University of Milan, will study 100 clientowned cats aged seven years or older. Researchers will first perform a routine veterinary exam on each cat to look for signs of chronic inflammation. Qualified veterinary behaviorists then will assess the cats’ behavior, their living environments and their cognitive abilities using validated questionnaires and behavioral tests. morrisanimalfoundation.org.

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“This past year presented a host of challenges that resulted in consumers… turning to their pets for comfort and companionship,” says APPA President and CEO, Steve King. “Interestingly, the product trends we are seeing… mirror those of consumers — a desire for a healthier lifestyle, increased focus on fitness, turning to supplements for improved well-being, and technology playing a larger role in everyday life.” Other trends from this year’s APPA report: •$ 31.4 billion was spent on veterinary care and products, a 7.2% increase. •$ 22.1 billion was spent on supplies, live animals, and OTC meds, a 15.1% increase. •$ 42 billion was spent on pet food and treats, a 9.7% increase. For more information about APPA’s State of the Industry Report, visit americanpetproducts.org/ press_industrytrends.asp.

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