V11I4 (Fall 2021) by Redstone Media Group

IVC Fall 2021

FALL 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 Junior Graphic Designer: Ethan Vorstenbosch Web Design & Development: Lace Imson Digital Media Specialist: Carlos Reyes

COLUMNISTS & CONTRIBUTING WRITERS

Susan Albright, DVM Todd Cooney, DVM, CVH Katherine Dahlhausen, PhD W. Jean Dodds, DVM Robin Downing, DVM, MS, DAAPM, DACVSMR, CVPP, CCRP Roger Dumoulin-White Sara Fox Chapman, MS, DVM, VetMFHom, CertIAVH Holly H. Ganz, PhD Laurie Jones, BA, RVT Chris Kilham, Medicine Hunter Cynthia Lankenau, DVM Julie Anne Lee, DCH, RCHom Sungwon Lim, PhD Julie Liu, DVM Jared Mitchell, DVM, CVMA Nell Ostermeier, DVM, CVA, FAAVA Lucas Pantaleon, DVM, MS, DACVIM, MBA Miraida Rivera-Viera, DVM Gary Tashjian

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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: September 2021. improving the lives of animals... one reader at a time.

IVC Fall 2021

contents FEATURES

8 THE NEONATAL GUT MICROBIOME By Holly H. Ganz, PhD And Katherine Dahlhausen, PhD

How to set up your canine and feline patients for a lifetime of health.

THE IMPORTANCE OF AIR DECONTAMINATION IN A VETERINARY HOSPITAL

By Gary Tashjian

By Sara Fox Chapman, MS, DVM, VetMFHom, CertiAVH How to use current research to help individualize your recommendations for canine sterilization.

NUTRITION NOOK

EDUCATING CLIENTS ABOUT DIETS FOR PUPPIES AND KITTENS By Miraida Rivera-Viera, DVM

Why offering a healthy diet very early in life — and helping your client make an informed choice — will set a solid foundation for an animal to thrive.

57 4

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USING ESSENTIAL OILS IN YOUNG ANIMALS

By Jared Mitchell, DVM, CVMA Many medications in everyday practice are designed for older animals. Alternative treatment options such as essential oils, when used properly, can be safe and effective for young animals.

AN EARLY, PROACTIVE APPROACH TO KEEPING CANINE JOINTS HEALTHY When identifying at-risk individuals for osteoarthritis, it’s important to consider ways to help protect their joints, and find formulations that best suit each patient’s needs.

By Sungwon Lim, PhD

CANINE STERILIZATION

By W. Jean Dodds, DVM

By Robin Downing, DVM, MS, DAAPM, DACVSMR, CVPP, CCRP

AI: THE NEWEST TOOL IN VETERINARY SCIENCE Artificial Intelligence is a valuable tool that can help veterinarians do their jobs with greater speed and precision.

VACCINE CONSIDERATIONS FOR PUPPIES AND KITTENS While vaccines are needed to protect against infectious disease, they are not innocuous. The timing and benefits/risks need to be carefully assessed.

By Julie Lie, DVM

HOW TO ATTRACT AND RETAIN OWNERS OF PEDIATRIC PETS Because of the strengthening human-animal bond, the best way to attract and keep new clients is to provide extraordinary service from the very first pediatric appointment.

BEYOND CUDDLES AND VACCINES: HOW TO CREATE A FEAR FREE™ EXPERIENCE FOR PUPPIES & KITTENS By adopting Fear Free practices and educating clients, we can make a huge impact on our patients’ emotional and physical health.

INNOVATIVE PRACTICE By Laurie Jones, BA, RVT

Strategies that improve the safety of indoor air is vital for infection prevention in veterinary hospitals.

NUTRITIONAL SUPPORT HELPS CANINE PATIENTS MAINTAIN HEALTHY WEIGHT

By Julie Anne Lee, DCH, RCHOM The science behind speciesspecific probiotics.

By Lucas Pantaleon, DVM, MS, DACVIM, MBA

THE EVOLUTION OF GUT HEALTH — PART 2

CLASS 3B VERSUS CLASS 4 LASER SYSTEMS By Roger Dumoulin-White

advisoryboard 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.

COLUMNS & DEPARTMENTS

7 Editorial 24 From the NASC 29 From the VMAA 42 Industry innovations 43 From the AVH 44 Profitable Practice — AminAvast 49 From the VBMA

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.

55 From the IVAS 56 Profitable Practice — NutriSource 66 News bites

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

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

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1. W. JEAN DODDS, DVM

Dr. Jean Dodds received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she established Hemopet, the first non-profit national blood bank program for animals. Dr. Dodds has been a member of many committees on hematology, animal models of human disease and veterinary medicine. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1994. P. 57

2. ROBIN DOWNING, DVM, MS, DAAPM, DACVSMR, CVPP, CCRP

Dr. Robin Downing is Hospital Director of The Downing Center for Animal Pain Management and Windsor Veterinary Clinic. She is a Diplomate of the American College of Veterinary Sports Medicine and Rehabilitation; a Certified Veterinary Pain Practitioner; and she was the third veterinarian in the world to earn the Diplomate credential in the American Academy of Pain Management. She was a founder of the International Veterinary Academy of Pain Management, and served as that organization’s second president. Dr. Downing is a clinical bioethicist and is currently completing a Doctorate in Clinical Bioethics at Loyola University of Chicago. P. 38

3. SARA FOX CHAPMAN, MS, DVM, VETMFHOM, CERTIAVH

Dr. Sara Fox Chapman graduated from Ohio State University in 1985. She studied homeopathy while living in Britain from 1998 to 2001, and later studied acupuncture and herbal medicine. Dr. Fox Chapman currently practices as the holistic vet within a small animal practice in Maryland. She represents the AVH with the International Association for Veterinary Homeopathy and the Homeopathy Advocacy Working Group, and is the Treasurer for the British Association of Homeopathic Veterinary Surgeons. P. 30

4. JULIE LIU, DVM

Dr. Julie Liu is a Fear Free veterinarian and freelance writer based in Austin, TX. In addition to being an Elite Fear Free Certified Professional and Cat Friendly Veterinarian, she’s a travel enthusiast and senior pet parent. More information about Dr. Liu and her work can be found at www.drjulieliu.com and LinkedIn. P. 20

5. JARED MITCHELL, DVM, CVMA

Dr. Jared Mitchell graduated from Mississippi State University's College of Veterinary Medicine in 2004. In 2010, he opened his practice, Mitchell Animal Clinic, in Mobile, Alabama. Wanting more for his patients, he began incorporating holistic modalities into his practice. Dr. Mitchell is completing certification to become a Certified Veterinary Medical Aromatherapist through the Veterinary Medical Aromatherapy Association. He also plans to achieve certifications in herbal medicine, acupuncture, veterinary chiropractic and other holistic modalities. P. 45

6. LUCAS PANTALEON, DVM, MS, DACVIM, MBA

Dr Lucas Pantaleon is a Board Certified Internal Medicine Veterinarian with a special interest and expertise in infection prevention. He has worked with Ogena Solutions as a veterinarian technical advisor for nine years. Dr Pantaleon enjoys researching, advising, teaching, speaking and writing about infection prevention and One Health for varied sectors within the veterinary industry. P. 14

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7. MIRAIDA RIVERA-VIERA, DVM

Dr. Miraida Rivera-Viera owns PetLives Consulting LLC in Atlanta, GA, which offers veterinary relief services and holistic consults at home. She received her Doctorate in Veterinary Medicine from St. George’s University in Grenada, WI, with clinical training at Cornell University. Following graduation, Dr. Rivera-Viera interned in small animal medicine and surgery followed by work at an integrative practice, which solidified her focus as an integrative veterinarian. She has studied veterinary acupuncture at the Chi Institute in Florida. P. 62

8. KATHERINE DAHLHAUSEN, PHD

Dr. Katherine Dahlhausen is a science writer for AnimalBiome. She was mentored by Holly Ganz during the beginning of her PhD at the University of California Davis and helped with the very beginning of the KittyBiome project. Katherine has worked on a wide variety of microbiome-related projects to date, including ones about koalas, buildings, pollinators, and coral reefs. P. 8

9. HOLLY H. GANZ, PHD

Dr. Holly Ganz is Chief Science Officer and co-founder of AnimalBiome. As a successful citizen scientist, she has translated her academic research into solutions for pets: firstly by assessing thousands of microbiomes to reveal common imbalances, and secondly by providing better approaches to maintain and restore gut health including screened Fecal Microbiota Transplantation material via oral capsules. P. 8

10. SUNGWON LIM, PHD

Dr. Sungwon Lim is the CEO and Co-Founder of ImpriMed, Inc., which uses artificial intelligence on live cancer cell analytics to predict how a patient will respond to cancer therapy drugs. He received his PhD degree in Bioengineering from Stanford University and a master’s degree in Translational Medicine from the UC Berkeley–UCSF Joint Bioengineering Program. Sungwon is a bioengineer and entrepreneur with 20 years experience in academia and biotech companies, with a focus on the development of novel cancer therapies. He is a strong advocate of functional precision medicine – personalizing a cancer treatment regimen based on each patient’s cancer cells’ functional responses to anti-cancer drugs, beyond cancer genetics. P. 26

LAURIE JONES, BA, RVT

Laurie Jones has worked for many decades as a RVT. Prior to entering the veterinary field, she earned a Bachelor of Arts in Spanish with a minor in Communications, serving as beat reporter, copy editor, and performing arts critic during her days at university. Laurie enjoys combining her experience in veterinary medicine with her passion for writing to educate and inspire readers. P. 52

editorial

s u c o F on young animals

Many months ago, when we started planning the content for the Fall issue of IVC Journal, my life was full of geriatric animals…my own and my patients’. But as articles started to arrive in my inbox, my home suddenly was full of kittens — five babies plus their young mother, Mama Grace. The mother had chosen a vacant condo near our home to deliver her babies. My twin girls, home from college for the summer, spent every evening at the condo playing with the kittens, trying to socialize them and gaining their trust. Fortuitously, Mama Grace moved her family to our front porch the day before the condo’s landscaping service arrived with noisy machines to trim all the trees and bushes the kittens had been playing in. I am still in awe at how she knew to move her family the day before, and how she actually accomplished it. How do you move five tiny kittens through a small forest to a porch and get everyone to cooperate? Having raised three children myself, I fully appreciate Mama Grace’s wisdom and instinct.

strengthen the bond between clients and their new animals, and how to bond those clients to your practice. Discover ways to build strong foundations of health by addressing the pediatric microbiome, with discussions about nutrition and vaccines, and by using Fear Free approaches to veterinary visits. Learn about new methods for treating pediatric patients safely with essential oils; explore alternatives to traditional times and procedures for sterilization; and look at ways to proactively protect the musculoskeletal integrity of growing bodies. And as your practice also grows and matures, consider how artificial intelligence can be an ally to your diagnostic capabilities, and why hospital air quality in our pandemic era is so essential. Mama Grace and her family have brought to my home an enormous amount of joy, energy — and awe at the wisdom of animals. Life continues, always. Fall blessings to everyone, for hope and renewal.

She and her babies are now indoors and happily snuggled on every comfy piece of furniture. My own girls are back at school, and I am absorbing all the topics presented in this issue of IVC Journal. Within these pages, you will find insightful articles on veterinary care for puppies and kittens. Find out how to

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

IVC Fall 2021

THE NEONATAL GUT

MICROBIOME: how to set up your young canine and feline patients for a lifetime of health

HD USEN, P

A E DAHLH ATHERIN K D N A , PHD H. GANZ BY HOLLY

Every surface of our world is covered in microbes. While we can’t see them, bacteria, viruses, fungi, and other microorganisms are inextricably linked to nearly every aspect of the health and well-being of all living things. Thanks to new scientific advances, we now know more about microbes than ever before. This is especially important for veterinary medicine, because research on the microbiome has introduced a whole new framework for diagnosing and treating the root causes of numerous common health conditions in pets. The majority of a dog or cat’s microbes are found throughout the intestinal tract; this community is collectively called the gut microbiome. Many researchers, doctors, and veterinarians think of and treat the gut microbiome as a metabolically active organ. This article touches on the importance of the microbiome in the overall health of pets, how it develops

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in young animals, and the methods veterinarians can use to support the microbiome health of patients from the very beginning of life.

THE IMPORTANCE OF THE GUT MICROBIOME You’ve likely heard about the gut microbiome; the term refers to the non-host genetic material of bacteria, viruses, fungi, and protozoa (or protists) found in the intestinal tract of an animal. The microbial community that makes up the gut microbiome is an ever-changing ecosystem, with the most profound changes occurring in the first year of a pet’s life. The microbiome development during this first year is significantly correlated to a pet’s overall health, which we will cover in more detail in the next section. However, it is

important to emphasize that the microbiome health of puppies and kittens can dictate health outcomes throughout their entire adult lives. If the gut microbiome becomes imbalanced or lacks the microbial diversity typically acquired in the first year of life, it can lead to adverse clinical signs and conditions later in life. This connection between the microbiome and long-term wellness arises because the gut microbiome and immune system are intricately linked; it’s estimated that approximately 80% of immune regulation occurs in the gut.

IMBALANCED MICROBIOMES IN ADULTHOOD As with most health conditions in pets, it’s important to catch microbiome imbalances early because they can be harder to resolve as time goes on. These issues can easily become a selfperpetuating cycle of imbalance that becomes increasingly harder to resolve. Numerous microbiome-associated conditions are found in cats and dogs, such as atopic dermatitis,1 obesity,2 inflammatory bowel disease (IBD),3,4 diabetes,5,6 and even mood disorders.7,8 How does the gut microbiome develop in puppies and kittens? The best way to support the lifelong microbiome health of cats and dogs is to understand how they develop their gut

microbiomes in the first place. The first exposure to microbes a puppy or kitten experiences is during birth, but major gut microbiome changes also occur during the nursing process, and during the transition to a diet beyond the mother’s milk.

Birth Both puppies and kittens are enclosed in amniotic sacs within their mother’s uterus. In dogs, these sacs are usually broken during birth. When a litter of puppies is delivered naturally, microbes that line the birth canal are the first to colonize the gut microbiomes of the puppies. If delivered by Caesarean section, the mother’s skin microbiota are the first to colonize the puppies’ gut microbiomes. Kittens are typically born in their amniotic sac, which is removed by their mother, who will then stimulate them to breathe by washing them with her tongue. The mother’s microbes are transferred to her kittens during this process, thus introducing them to her microbiome. Studies have shown that delivery mode significantly affects gut microbiome colonization,9 with infants delivered by Caesarean section having more adverse health outcomes later in life.10 These findings suggest that exposure to vaginal microflora

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HOW TO HELP YOUR PATIENTS ACHIEVE A HEALTHY MICROBIOME Provide your clients with tools and knowledge for building and supporting a healthy microbiome in their pets. While there is no magical formula for the perfect gut microbiome for a cat or dog, many factors promote a healthy gut. Have conversations with your clients about how to give their pets a nutritionally diverse and balanced diet, which is directly linked with digestive health. There are many ways to supplement a pet’s diet, such as adding prebiotics to stimulate the growth of beneficial gut bacteria.24 Hygiene practices are another important discussion to have with your clients. For example, remind clients that bathing their dogs too frequently can disrupt the skin microbiome, which can lead to atopic dermatitis.25 Additionally, discuss good dental hygiene practices to prevent periodontal disease, a condition that affects 80% of dogs by age three according to AVMA estimates.26,27

MICROBIOME RESTORATION Sometimes, puppies and kittens need a bit of help shifting their gut microbiomes to a healthy state. Microbiome testing provides detailed insight into the balance and diversity of the gut microbiome because it can catch bacterial imbalances early, identify missing beneficial bacteria, and highlight existing pathogenic bacteria. Microbiome testing results can help you make informed decisions about your patients’ care. For example, it can identify a diet-induced dysbiosis that can be easily resolved with a simple nutrient adjustment. Should you identify or suspect an imbalance in a patient, microbiome restoration therapies are a safe and effective method for improving microbiome health. Fecal Microbiota Transplants (FMTs) are one option; a FMT is a procedure that transfers the stool from a healthy donor into the digestive tract of a recipient.28-31 It introduces a complete and balanced ecosystem of microorganisms and metabolites that creates direct competition against dysbiotic bacteria for niche habitats and nutrients. While FMTs can be administered several ways, oral capsules are typically the least invasive and most affordable option.

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is important for the development of the gastrointestinal tract and immune system. This is especially important when considering breeds, such as bulldogs and terriers, who are typically born by Caesarean section. Interventions to introduce newborns to vaginal microbes may be beneficial for those delivered this way. While not yet a standard practice, an absorbent material can be inserted into the birth canal of a laboring mother, and then swabbed over the skin and mouth of newborns delivered via Caesarean section to imitate the microbial exposure of a natural birth.

Nursing The next major colonization of a puppy or kitten’s gut microbiome comes from nursing. A mother’s colostrum and breast milk contain not only beneficial microbes,11 but also important nutrients,12 maternally derived antibodies,13 and metabolites that facilitate healthy gut microbiome inoculation and colonization. Because the microbes in breast milk are so important for microbiome development, neonates receiving colostrum from a different species miss out on bacteria specific to the functions of their gut microbiome. Numerous studies highlight the association between nonbreast milk-fed human infants and adverse long term health outcomes. But why is this? Researchers at the University of Luxembourg found in one study that human infants who were fed formula had a delayed diversification of their gut microbiome compared to breast-fed fed infants during the nursing stage of microbiome development.14 Other studies point to the importance of nutrients and metabolites in breast milk that are crucial for healthy immune system development, and that formula-fed infants miss out on.15 Puppies and kittens that cannot be fed breast milk, such as orphans, may need extra microbiome support as they develop and age. We’ll discuss several ways to promote the balance and diversity of cat and dog gut microbiomes later on.

Weaning The transition from milk or formula to solid food triggers the next major shift in gut microbiome composition in infants. At this stage, the gut microbiome transitions to an adult-like composition, which researchers suggest is strongly driven by nutritional factors. Not all post-weaning diets have the same effect on the neonatal gut microbiome; one study found that kittens fed a canned post-weaning diet had more advanced microbiome functions compared to those fed a kibble based post-weaning diet.16

The speed17 and age18 at which weaning occurs significantly impact the microbial diversity of the gut microbiome and immune system development. While breeds, species, and individuals all require different weaning times for their optimal microbiome development, it's generally recommended to aim for weaning at 12 weeks in dogs and eight weeks in cats for the best gut microbial diversity outcomes.

WHAT CAN CAUSE AN IMBALANCE IN THE GUT MICROBIOME? The initial gut microbiome colonization stages during birth, nursing, and weaning are critical for building a diverse community of microbes, but it is also important to understand factors that can perturb this community. Here we discuss situations that are common to puppies and kittens.

Infections Viruses (e.g. parvo), parasites (e.g. giardia), and bacterial infections (e.g. E. coli) are known to impact the gut microbial community in cats and dogs. Often these infections trigger a host inflammatory immune response, which creates an environment favorable to pathogenic microbes. Beneficial microbes can be lost during these inflammatory states, leading to a loss of microbial diversity and balance in the gut microbiome.

Antimicrobials While infections can affect the diversity and balance of a microbiome, so can the treatments for them. In particular, antibiotics can wipe out beneficial microbes and lower bacterial diversity in the gut microbiome. In some cases, it can take years for a gut microbial community to recover from antibiotic therapy. When it is necessary to prescribe antibiotics in order to treat an infection, they should be used thoughtfully, especially in nursing mothers and young puppies and kittens, and by following the guidelines for antimicrobial stewardship.19,20 During and after a course of antibiotics, there are many ways to support a patient’s gut microbiome.

Diet and environmental factors The lifestyles of young cats and dogs have important ramifications for gut microbiome health. A nutritionally

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balanced and diverse diet promotes an equally balanced and diverse microbial community, but it is pertinent to look for clinical signs of food allergies or sensitivities, such as diarrhea, vomiting, and pruritus. Food allergies can trigger inflammation, which negatively impacts the diversity of the microbiome, resulting in chronic enteropathy.21 Similarly, environmental allergens can also trigger an inflammatory response. Early-life exposure to microbially-rich surroundings is important for pets to develop a strong immune system and a healthy gut.22 For example, outdoor microbes are diverse and several species of beneficial bacteria can be found in soil. Encouraging quiet, safe places for puppies and kittens to rest and play further protects them from having a stress response to their surroundings.23

Craig JM. Atopic dermatitis and the intestinal microbiota in humans and dogs. Vet Med Sci. 2016;2: 95–105.

Turnbaugh PJ, Ley RE, Mahowald MA, Magrini V, Mardis ER, Gordon JI. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature. 2006;444: 1027–1031.

Suchodolski JS, Markel ME, Garcia-Mazcorro JF, Unterer S, Heilmann RM, Dowd SE, et al. The fecal microbiome in dogs with acute diarrhea and idiopathic inflammatory bowel disease. PLoS One. 2012;7: e51907.

Minamoto Y, Otoni CC, Steelman SM, Büyükleblebici O, Steiner JM, Jergens AE, et al. Alteration of the fecal microbiota and serum metabolite profiles in dogs with idiopathic inflammatory bowel disease. Gut Microbes. 2015;6: 33–47.

Kieler IN, Osto M, Hugentobler L, Puetz L, Gilbert MTP, Hansen T, et al. Diabetic cats have decreased gut microbial diversity and a lack of butyrate producing bacteria. Sci Rep. 2019;9: 4822.

Jergens AE, Guard BC, Redfern A, Rossi G, Mochel JP, Pilla R, et al. Microbiota-Related Changes in Unconjugated Fecal Bile Acids Are Associated With Naturally Occurring, Insulin-Dependent Diabetes Mellitus in Dogs. Front Vet Sci. 2019;6: 199.

KEY TAKEAWAYS The gut microbiome of puppies and kittens undergoes the most change during the first year of life. From the moment of birth, microbes from the mother rapidly colonize her newborns, with the delivery method having a significant effect on the colonization process. Nursing and weaning methods drive the subsequent developmental stages of the gut microbiome, and have longlasting effects on the newborn’s overall health into adulthood. An imbalance in the microbiome is linked to numerous health conditions; infections and antimicrobials can also trigger an imbalance in the gut microbial community. Luckily, several evidence-based options are available to veterinarians and pet parents alike for maintaining and restoring a healthy microbiome in cats and dogs (see sidebars). Visit animalbiome.com to learn more about integrating a microbiome focus into your veterinary practice.

Li Y, Guo Y, Wen Z, Jiang X, Ma X, Han X. Weaning Stress Perturbs Gut Microbiome and Its Metabolic Profile in Piglets. Sci Rep. 2018;8: 18068.

Massacci FR, Berri M, Lemonnier G, Guettier E, Blanc F, Jardet D, et al. Late weaning is associated with increased microbial diversity and Faecalibacterium prausnitzii abundance in the fecal microbiota of piglets. Anim Microbiome. 2020;2: 2.

Ganz H. Rethinking the role of metronidazole in veterinary medicine - IVC Journal. 25 Feb 2021 [cited 4 Aug 2021]. Available: https://ivcjournal.com/metronidazole-veterinary-medicine/.

Lloyd DH, Page SW. Antimicrobial Stewardship in Veterinary Medicine. Microbiol Spectr. 2018;6. doi:10.1128/ microbiolspec.ARBA-0023-2017

Ganz H. A new framework for chronic GI disease in dogs and cats - IVC Journal. 31 Mar 2021 [cited 4 Aug 2021]. Available: https://ivcjournal.com/chronic-enteropathy-chronic-gi-disease-dogs-cats/.

Tasnim N, Abulizi N, Pither J, Hart MM, Gibson DL. Linking the Gut Microbial Ecosystem with the Environment: Does Gut Health Depend on Where We Live? Front Microbiol. 2017;8: 1935.

Foster JA, McVey Neufeld K-A. Gut-brain axis: how the microbiome influences anxiety and depression. Trends Neurosci. 2013;36: 305–312.

Zheng P, Zeng B, Zhou C, Liu M, Fang Z, Xu X, et al. Gut microbiome remodeling induces depressive-like behaviors through a pathway mediated by the host’s metabolism. Mol Psychiatry. 2016;21: 786–796.

Dominguez-Bello MG, Costello EK, Contreras M, Magris M, Hidalgo G, Fierer N, et al. Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proc Natl Acad Sci U S A. 2010;107: 11971–11975.

Neu J, Rushing J. Cesarean versus vaginal delivery: long-term infant outcomes and the hygiene hypothesis. Clin Perinatol. 2011;38: 321–331.

Foster JA, Rinaman L, Cryan JF. Stress & the gut-brain axis: Regulation by the microbiome. Neurobiol Stress. 2017;7: 124–136. Everard A, Lazarevic V, Gaïa N, Johansson M, Ståhlman M, Backhed F, et al. Microbiome of prebiotic-treated mice reveals novel targets involved in host response during obesity. ISME J. 2014;8: 2116–2130.

The Effect of Water Hardness on Surfactant Deposition after Washing and Subsequent Skin Irritation in Atopic Dermatitis Patients and Healthy Control Subjects. J Invest Dermatol. 2018;138: 68–77. Bajaj JS, Matin P, White MB, Fagan A, Deeb JG, Acharya C, et al. Periodontal therapy favorably modulates the oral-gut-hepatic axis in cirrhosis. Am J Physiol Gastrointest Liver Physiol. 2018;315: G824–G837.

Niemiec BA. Periodontal disease. Top Companion Anim Med. 2008;23: 72–80.

Toscano M, De Grandi R, Peroni DG, Grossi E, Facchin V, Comberiati P, et al. Impact of delivery mode on the colostrum microbiota composition. BMC Microbiol. 2017;17: 205.

Le Huërou-Luron I, Blat S, Boudry G. Breast- v. formula-feeding: impacts on the digestive tract and immediate and long-term health effects. Nutr Res Rev. 2010;23: 23–36.

Ganz H. Microbiome Restorative Therapy in Companion Animals - IVC Journal. 21 Aug 2018 [cited 4 Aug 2021]. Available: https://ivcjournal.com/microbiome-restorative-therapy-companion-animals/. Roman, M. Proactive use of Microbiome Restorative Therapy (MBRT) in the veterinary clinic - IVC Journal. 29 Jan 2021 [cited 4 Aug 2021]. Available: https://ivcjournal.com/proactive-microbiome-restorative-therapymbrt-veterinary/.

Gopalakrishna KP, Hand TW. Influence of Maternal Milk on the Neonatal Intestinal Microbiome. Nutrients. 2020;12. doi:10.3390/nu12030823

Wampach L, Heintz-Buschart A, Hogan A, Muller EEL, Narayanasamy S, Laczny CC, et al. Colonization and Succession within the Human Gut Microbiome by Archaea, Bacteria, and Microeukaryotes during the First Year of Life. Front Microbiol. 2017;8: 738.

Schwartz S, Friedberg I, Ivanov IV, Davidson LA, Goldsby JS, Dahl DB, et al. A metagenomic study of dietdependent interaction between gut microbiota and host in infants reveals differences in immune response. Genome Biol. 2012;13: r32.

Young W, Moon CD, Thomas DG, Cave NJ, Bermingham EN. Pre- and post-weaning diet alters the faecal metagenome in the cat with differences in vitamin and carbohydrate metabolism gene abundances. Sci Rep. 2016;6: 34668.

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Niina A, Kibe R, Suzuki R, Yuchi Y, Teshima T, Matsumoto H, et al. Improvement in Clinical Symptoms and Fecal Microbiome After Fecal Microbiota Transplantation in a Dog with Inflammatory Bowel Disease. Vet Med (Auckl). 2019;10: 197–201. Berlanda M, Innocente G, Simionati B, Di Camillo B, Facchin S, Giron MC, Savarino E, Sebastiani F, Fiorio F, Patuzzi I. Faecal Microbiome Transplantation as a Solution to Chronic Enteropathies in Dogs: A Case Study of Beneficial Microbial Evolution. Animals. 2021;11: 1433.

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The importance of air decontamination

in a veterinary hospital As part of an infection prevention protocol, it's vital that veterinary hospitals implement

BY LUCAS PANTALEON, DVM, MS, DACVIM, MBA

strategies that improve the safety of indoor air.

Clean air is a basic requirement of life, and the quality of indoor air, where people and pets spend a large part of their lives, is an essential determinant of health and well-being.1 A debate is ongoing as to whether indoor air should be treated the same way as drinking water, from the decontamination point of view.2 In any given setting, one may choose not to drink the water or eat the food that is available, but generally one has little choice about breathing the same air as everyone else. This makes air an environmental equalizer, with the unique potential to evenly disperse whatever it may contain. Infectious agents entering indoor air can mix in rapidly with no perceptible color or smell.3 This highlights the importance of improving indoor air quality and reducing exposure to pollutants and pathogens.4 Indoor air quality has come to the forefront during the pandemic, which was caused by an airborne pathogen. People had to adapt to a “new normal.” For example, veterinary companion animal medicine shifted to curbside service in order to improve the safety of the clinical team while maintaining essential veterinary services. The goal of creating a healthy indoor environment is nebulous, because individuals respond variously to different exposures. There is also a lack of clear consensus on what constitutes a healthy indoor environment, and

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what measurable metric can be used to assess indoor air.5 Ideally, multiple strategies such as ventilation, filtration and decontamination will need to be combined in a layered approach with other routine infection prevention measures, with the end goal of making indoor spaces safer. Additionally, each building presents a unique challenge and opportunity to improve the health of its occupants.

AIRBORNE PATHOGENS Buildings have been associated with infectious disease outbreaks, such as COVID-19 and influenza, and the time that people or animals remain indoors in close contact is a main contributor to contagion.6 Sources of indoor microbes include aerosols from people and animals, pathogen aerosolization from biofilms, and re-suspension of dust.3,6,7 In human hospitals, pathogens such as Acinetobacter baumannii, noroviruses, and Clostridium difficile responsible for healthcare-associated infections can spread via aerosol.7,8 Furthermore, airborne pathogens can settle on surfaces, which in turn become secondary vehicles for transmission.8 Canine and feline viral respiratory disease, spread via aerosols, is a prevalent problem in shelters, boarding facilities, and veterinary hospitals.9 Indoor air is a complex media that contains particulate and gaseous components. It is a mixture of outdoor air

and recycled indoor air.5 Large respirable droplets (>5 μm) rapidly settle out of the air, whereas virus-laden small droplets (<5 μm), referred to as “droplet nuclei,” are suspended in the air for long periods and propagate depending on airflow.10 In poorly ventilated and crowded indoor spaces, infectious virus within the “droplet-nuclei” can infect susceptible hosts.10 Hospitals are dynamic environments where the composition of bio-aerosols is diverse and generated from multiple sources such as patients, staff, outdoor air, surfaces, drains and equipment. Also, season, temperature and humidity, the ventilation system, number of people and animals, the frequency of doors opening, and movement of people all influence the microbe concentration in the air.7 A major challenge in preventing and controlling the airborne spread of infection is the presence of multiple and mobile pathogen sources at a given location and time.3 Infected or colonized people or pets may contaminate air in their immediate vicinity, exposing susceptible hosts without the air having reached any available means of pathogen decontamination. Therefore, when there is very close contact between people and/or animals, it would be virtually impossible to prevent exposure to an airborne pathogen.2

INDOOR AIR MITIGATION STRATEGIES Controlling the concentration of indoor respiratory aerosols to reduce airborne transmission of infectious agents is paramount to keeping occupants safe.6 This can be achieved via source control measures such as face masks or distancing, and engineering controls such as ventilation, filtration (see sidebar on page 18), or air decontamination (photocatalytic oxidation) (see sidebar on page 17).6 Ventilation can reduce the concentration of pathogens in the air, decreasing the probability for them to be inhaled, contact mucus membranes, or fall out of the air to accumulate onto surfaces.11 Ventilation is a passive process by which air has to pass through an appropriate filter to capture particulate matter and microbes. Photocatalytic oxidation (PCO) has been shown to kill pathogens in air and on surfaces (see sidebar on page 17). It is an active process as different types of ions and reactive oxygen species (ROS) are released into the air where they bind to and eliminate pathogens and pollutants. Ultimately, the objective of air decontamination methods is not to kill all the microorganisms in a room (that would be sterilization), but to reduce air microbial content and surface

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contamination in order to lower disease transmissibility.2 It is likely that different air decontamination strategies will have complementary and additive effects to make indoor air safer for animals and people.

PCO AND AIRBORNE PATHOGENS The ROS produced by PCO have been shown to be an effective tool for inactivating different types of enveloped and non-enveloped viruses.4,12 The principal inactivation mechanisms involve damaging viral capsid proteins from the interaction with .OH and .O2-, followed by the fragmentation of the viral nucleic acid.12 The interaction between ROS and bacteria produces damage to the cell wall and cytoplasmic membrane, increasing cell permeability and death.4 Interaction with the intracellular coenzyme A inhibits the respiratory chain, further

contributing to microbial death.4 Hydroxyl radicals seem to exert the strongest bactericidal activity.12 Hydroxyl radicals are short-lived, particularly unstable, and react rapidly with most biological molecules.12 Hydroxyl radicals and hydrogen peroxide penetrate the cell wall, oxidize membrane fatty acids, induce lipid peroxidation, oxidize proteins, and damage DNA.12 Fungi are more resistant to PCO when compared to bacteria and viruses, likely due to the chitin in their cell walls.4 Advanced PCO devices have shown good efficacy against fungi in laboratory testing.

SAFETY OF INDOOR AIR When using an air decontamination device, the comfort and safety of humans and animals should not be compromised. Technologies used in air decontamination must be

Figure 1: The mechanism of action of PCO and the mineralization of microbes and pollutants.

This figure depicts the mechanism of action of PCO and the mineralization of microbes and pollutants. Adapted from “Modified TiO2 based photocatalysts for improved air and health quality” by V. Binas (J Materiomics, 2017).4

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Photocatalytic oxidation Photocatalysis is a natural chemical change enabled by photon activated catalysis.4,5 It has been used for water treatment, purification of drinking water, and air decontamination.12 Photocatalysis triggers the destruction of a wide range of microbes by generating highly reactive oxygen species, such as superoxide and hydroxyl radicals, that cause oxidative stress and microorganism death.4 Sunlight is the cheapest source of light, but it is difficult to use indoors and only available during the day.5 Ultraviolet (UV) fluorescent lamps are an efficient, long-lasting, and readily available light source for photocatalysis.5 Titanium dioxide (TiO2) is an effective photo-induced catalyst and is used to oxidize organic and inorganic compounds in air due to its strong oxidative ability and long-term stability. It is an abundant, inexpensive and non-toxic material. PCO initiated by UV light activation of TiO2 is a well-studied process.12 TiO2 acts as the catalyst and has the appropriate band gap energy to allow absorption of a UV photon to generate electron holes initiating the chemical change.5 The TiO2 low energy valence band is filled with electrons, while the high-energy conduction band is electron-free.

safe, so environments can remain occupied during the decontamination process.2 Indoor air decontamination devices should be able to continuously deal with the fluctuations in indoor air contamination to decrease the risk of airborne pathogens transmission.2 Second generation advanced PCO devices represent a proactive and safe air decontamination method that can be used as an additional layer for infection prevention. Volatile organic compounds (VOCs) are a group of gaseous pollutants that cause adverse health effects.15 Reducing the concentration of VOCs has been investigated for different indoor environments using oxidation-based processes as one effective mechanism for their removal.15 PCO has been shown to decompose VOCs, and upon complete oxidation they are converted to CO2 and H2O2.15 A downside of some first generation PCO devices is the production of intermediates like formaldehyde, acetaldehyde and acetic acid, as well as ozone.15 Breathing ozone is harmful, especially for children, the elderly, and people with respiratory problems. Ozone irritates the eyes, nose, and throat; can cause chest pain, coughing,

The difference in energy between the two bands (band gap) equals the amount of energy necessary to excite an electron from the valence band to the conduction band.12 In other words, UV light irradiation leads to the promotion of electrons (e-) from the valence band to the conduction band, leaving positive holes (h+) behind.12 The positive holes (h+) induce the oxidation process and the electrons (e-) condition the reduction process.12 The electron holes (h+) react with water molecules or hydroxyl radicals (.OH). Electrons (e-) react with molecular oxygen (O2), forming superoxide anion radicals (.O2-).12 The biocidal effect is attributed to the generation of ROS, with hydroxyl radical (HO.) followed by superoxide radical (O2-), hydro-peroxyl radical (HO2-) and hydrogen peroxide (H2O2) being the primary species responsible for microbial destruction.4,12 Additionally ROS oxidize the dead microbial cells and organic matter to CO2 and H2O.4,12,13 (see Figure 1 on page 16). The exact photochemical reaction involved in microorganism inactivation is not yet fully understood, due to the lack of suitable probe technics.13 It appears that indirect oxidation via .OH radicals is a key mechanism.13

shortness of breath, and throat irritation; and may trigger asthma attacks in those with asthma. Long-term exposure to ozone could cause chronic breathing impairments and compromise the respiratory defense mechanisms.16 Concerns have been raised that some air decontamination devices emit ozone at unhealthy rates.16 The Occupational Health and Safety Administration states that ozone levels for indoor spaces should be less than 0.1 ppm.17 The California Air Cleaner Regulation certifies air cleaners (CARB approval) for which the ozone emission is no greater than 0.05 ppm.18 Underwriters Laboratories (UL) created the validation for zero ozone air cleaning devices (UL 2998). Zero ozone emission products that qualify must demonstrate that they emit less than the maximum ozone concentration limit of 0.005 ppm, which is below quantifiable levels for ozone testing. When purchasing air decontamination devices, it is key to assure that they meet safety standards.

CONCLUSION In the last year-and-a-half, veterinarians shifted to a curbside system to provide a vital service while keeping their teams IVC Fall 2021

Ventilation and filtration To reduce far-field (within a room but beyond 6’) airborne transmission of SARS-CoV-2 and other viruses in small-volume indoor spaces, it is recommended that four to six air exchanges occur per hour.6 This could be achieved via a combination of the following: outdoor air ventilation, recirculated air that passes through a filter with a minimum efficiency rating value of 13 (MERV-13), or the passage of air through a highefficiency particulate air (HEPA) filter.6 The guidelines for four to six air exchanges per hour are consistent with rates for human hospital settings, where the higher air exchange rates are an important component of the infection prevention protocol.6 For other buildings, including veterinary hospitals, the target recommendations are much lower, representing an opportunity to improve air decontamination strategies.

safe. As the pandemic recedes, veterinary hospitals are again allowing pet owners inside the buildings. Therefore, implementing strategies to improve the safety of indoor air as part of the infection prevention protocol is vital. As more air decontamination devices become available, it is important to evaluate their safety and performance. Due to the complexities of indoor air environments, the assessment of microbial survival and evaluation of decontamination methods requires specialized equipment, technical skills, and test protocols.8 Today, specialized laboratories work with sealed aerosol chambers in order to evaluate air decontamination devices in a laboratory setting using microorganism surrogates. When purchasing PCO devices, it is key to ensure that laboratory testing for efficacy and safety has been completed. Technologies and strategies aimed at improving indoor air quality must provide a safe, healthy, productive, and comfortable environment and reduce energy consumption.13

Adamkiewicz G. WHO guidelines for indoor air quality: selected pollutants. In https://www.euro.who. int/__data/assets/pdf_file/0009/128169/e94535.pdf: World Health Organization 2010:1-484. 2 Sattar SA. Workshop on “The Role of Indoor Air as a Vehicle for Human Pathogens: A Panel Discussion”. Am Journal of Infect Control. 2016;44:S147-149. 3 Sattar SA. Indoor air as a vehicle for human pathogens: Introduction, objectives, and expectation of outcome. Am Journal of Infect Control. 2016;44:S95-S101. 4 Binas V. Modified TiO2 based photocatalysts for improved air and health quality. J Materiomics. 2017;3:3-16. 5 Hay SO, Obee T, Luo Z, et al. The viability of photocatalysis for air purification. Molecules. 2015;20:13191356. 6 Allen JG, Ibrahim AM. Indoor air changes and potential implications for SARS-CoV-2 transmission. JAMA. 2021;325:2112-2113. 7 Skowron K. Efficacy of radiant catalytic ionization in reduction of Enterococcus spp., Clostridioides difficile and Staphylococcus aureus in indoor air. Atmosphere. 2020;764:1-12. 1

Increasing air exchange rates has trade-offs. The costs of moving more air as well as cooling or heating it are higher. Improving ventilation and filtration accounts for people and animals that are distanced 6’ from each other, and does not have a significant influence on close contact transmission.6 The high air exchange rates are effective under typical or low occupancy capacity situations. In crowded buildings, ventilation would have to be scaled up even further.6

Sattar SA, Kibbee RJ, Zargar B, et al. Decontamination of indoor air to reduce the risk of airborne infections: studies on survival and inactivation of airborne pathogens using an aerobiology chamber. Am Journal of Infect Control. 2016;44:e177-e182.

Sykes J. Canine Viral Respiratory Infections In: Sykes J, ed. Canine and feline infectious diseases. Elsevier 2014:170-181.

Farhangrazi ZS, Sancini G, Hunter AC, et al. Airborne particulate matter and SARS-CoV-2 partnership: virus hitchhiking, stabilization and immune cell targeting — a hypothesis. Front Immunol. 2020;11:579352. 11CDC. Ventilation in Buildings In. https://www.cdc.gov/coronavirus/2019-ncov/community/ventilation. html, CDC; 2020.

Higher ventilation and filtration rates remove indoor air particles faster, reducing the intensity of exposure and the duration that respiratory aerosols are in the air.6 On the contrary, poor ventilation is associated with disease transmission.6 Adequate ventilation rates and enhanced filtration are key components of holistic disease risk reduction strategies.6

Bogdan J, Zarzynska J, Plawinska-Czarnak J. Comparison of infectious agents susceptibility to photocatalytic effects of nanosized titanium and zinc oxides: a practical approach. Nanoscale research letters. 2015;10:1023.

Zhong L, Haghighat F. Photocatalytic air cleaners and materials technologies. Abilities and limitations. Building and environment. 2015;91:191-203.

Allen JG, Waring MS. Harnessing the power of healthy buildings research to advance health for all. J Expo Sci Environ Epidemiol. 2020;30:217-218.

Lee C. Experimental evaluation of in-duct electronic air cleaning technologies for the removal of ketones. Building and environment. 2021;196:2-11.

Improving ventilation and filtration should be implemented, as healthy indoor air is correlated with lower work absenteeism, improved cognitive performance, and fewer sick building syndrome symptoms like headache and fatigue.6,14

Piazza T, Lee R. Survey of the use of ozone-generating air cleaners by the California public. In: California Air Resources Board Research Division; 2006:1-94.

Administration OSHA. TABLE Z-1 Limits for Air Contaminants. In: Occupational safety and health standards: OSHA.

Board CAR. California's Air Cleaner Regulation. https://ww2.arb.ca.gov/about-indoor-air-cleaningdevices-regulation

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BY GARY TASHJIAN

Nutritional support

helps canine patients maintain

healthy weight

Just like their owners, many dogs face weight issues throughout their lives. Indeed, 53% of dogs in the US are estimated to be overweight, according to the Association for Pet Obesity Prevention. Many breeds are predisposed to obesity, while many owners aren’t armed with enough information on pet nutrition to make the right choices for their dogs’ diets. Here, we’ll go through how to help your patients maintain a healthy weight with effective nutritional support. Excess weight can cause discomfort, and obesity can bring on serious health problems, including: • Trouble

breathing Lung problems • Sore joints and orthopedic issues • Torn cruciate ligaments • Hip dysplasia • Arthritis • Immune system problems •

Skin problems • Heart problems • High blood pressure • Pancreatitis • Diabetes • Mammary tumors •

Building a canine nutrition plan The simplest way to maintain a healthy weight in your canine patients is to be more actively involved in their diet. Here are a few steps owners can take: 1. Assess food and portions.  Feeding the right amount of high quality food containing healthy fats will help dogs feel satisfied while still maintaining an ideal body weight and

preventing obesity. 2. Don’t overindulge. Consider treats as part of the daily food allowance. Many healthy treats have little impact on a dog’s overall calorie intake, such as blueberries, yams, carrots, and greens. 3. Create structure. Many owners lose track of how much their dogs eat when they free-feed. Instead, create a meal plan that fits both the dog and your client’s lifestyles. This will eliminate grazing and allow pet owners to better visualize how much their dogs are actually eating.

What should dogs eat for weight loss? Dogs need high quality proteins and right amounts of the correct types of fat. Here are a few things to know about protein: nimals manufacture amino acids A from protein. • Young animals need more protein for growth. • Senior animals need more protein because they cannot manufacture the needed elements as well as younger animals. Dogs also need vitamins and trace minerals, like L-carnitine for strong, healthy muscles. Protein burns more calories and supports strong muscles, and protein and the right fats provide a feeling of satisfaction. Consider calories, too. If your client feeds kibble, choose a type with no more than 400 calories per cup.

and steer clear of fillers, sugar, corn, soy, dyes, artificial flavors, and preservatives like BHA, BHT, and ethoxyquin. Though commercial prescription diets may seem the right answer, be careful of foods that offer too many calories but not enough nourishment. Gary Tashjian is the owner and founder of Darwin’s Natural Pet Products, the first raw pet food company in the Pacific Northwest. Gary spotted the opportunity to help more pets live longer lives with healthier diets and founded the company in 2004. 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.

•

When giving tips on choosing the right dog food, encourage owners to read labels

Ingredients to look for and avoid •

void foods that include corn as one of the A first ingredients.

•

Choose no-grain or very limited-grain meals.

• Be

aware of substitutions like rice or potato in diets labeled corn-free and grain-free.

• The

first ingredients listed should be meat or poultry; avoid foods with “meal” or animal “by-products”.

• Ingredient

lists should also include real vegetables and/or fruits.

• Limited-ingredient

diets, such as fresh, raw food may help reduce heavy carb intake and decrease the amount of fillers and preservatives the dog is ingesting.

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Beyond cuddles and vaccines

How to create a Fear FreeTM experience for puppies & kittens BY JULIE LIU, DVM

hen we see an adorable puppy or kitten for their first visit, it’s a reminder of why we love this profession. They’re often friendly, exploratory, and playful, and can be easily distracted with treats. So how do we go from those trusting puppies and kittens to adult pets who are terrified of us? When we think of vet visits from their perspective, it’s no wonder. Car rides, being handled by strangers, and needle pokes are stressful, and without intervention, can produce pets that have an overwhelming fear of the vet. Fear Free™ was founded in 2016 and strives to protect the emotional health of pets. Not only does this approach show more compassion for our patients; it also provides more compassion for us as veterinary caregivers, because patients with a lower fear of the vet are easier for us to handle, resulting in better patient care. Getting puppies and kittens started with a Fear Free experience takes an active approach at home and at the vet clinic.

THE BODY LANGUAGE OF FEAR, ANXIETY, AND STRESS Think back to the first time you got bitten or scratched by one of your patients. Did it seem to happen out of nowhere? Pets are communicating to us all the time, whether we realize it or not, often nonverbally. When we fail to recognize the signs of

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fear, anxiety, and stress (FAS) and adjust our handling, injury to us or the pet can result. FAS also has numerous negative effects on a pet’s physical health,1-5 and understanding body language will help us minimize it. Similar to learning a foreign language, learning the body language of FAS in dogs and cats is eye-opening. You’ll start to see pets broadcasting their FAS all the time, on your TV screen and at the dog park, and wonder why everyone else seems oblivious. Puppies and kittens don’t often growl or hiss, but it’s not uncommon for them to freeze, move away, or stop eating treats when they get stressed. Taking a few minutes to learn about subtle signs of FAS is vital for a Fear Free puppy and kitten visit, and provides valuable feedback about when to change our approach. These signs are encapsulated wonderfully in the illustrated posters created by the late Dr. Sophia Yin6, 7 and through Fear Free Pets,8 and should be handed out with all puppy and kitten kits.

INCORPORATING BEHAVIOR INTO PUPPY AND KITTEN VISITS Between discussions about vaccines, preventatives, diet, and spaying/neutering, it can be hard to find time to think about behavior. But as with adult pets, everything and everyone a

young pet encounters at the vet influences them in some way, often negatively. If we want to counteract that stress and set them up for success for future vet visits, we must consider behavior and emotional health during puppy and kitten visits. Those happy-go-lucky puppies/kittens may not stay that way if they encounter scary and aversive experiences at the vet, and already fearful puppies/kittens will likely get worse. Here are some steps you can take towards ensuring a Fear Free experience during appointments:9 • U se positive reinforcement during every visit. Positive reinforcement helps lower FAS and allows us to bond with our patients. It’s not enough to have a jar of giant dog biscuits in exam rooms. Stock a variety of delicious treats10 for both cats and dogs, and create a toy drawer to help encourage play. From the moment a pet enters the clinic until the moment they leave, offer a small (pea-sized or smaller) treat every few seconds, especially during handling. Better yet, ask the client to feed treats so you can demonstrate the value of Fear Free while continuing your exam and vaccines. Clients love giving treats as much as pets love eating them, and most puppies and kittens can be easily distracted for vaccines while eating a blob of squeeze cheese or Churu. • M inimize pain and practice compassionate handling. No one likes being poked with needles, and a 22g needle can seem gigantic to the two-pound puppy or kitten you’re vaccinating. Pain is a huge contributor to FAS, so use fresh 25g needles and apply a thin layer of a lidocaine numbing cream such as Supernumb to planned vaccination sites or blood draw sites for feline retroviral testing at the beginning of the visit. Similarly, handling patients roughly increases their FAS, so use a less-ismore approach and adjust your technique if signs of stress are seen. IVC Fall 2021

• U se non-slip mats and towels. The fear of falling can be profound, and we see it every time we put a pet on a slippery scale or exam table as they freeze or start tap dancing in panic. Providing a stable surface for puppies and kittens will lower their FAS, and a cozy towel can be sprayed with Feliway11 or Adaptil12 to further lower stress. • T reat early, when fear levels are mild. We routinely use anxiolytics for adult pets with a fear of the vet, so why not consider them for fearful puppies and kittens? If a puppy/ kitten is hiding, refusing to eat treats, or trembling, their FAS level will likely get even worse over time without intervention. Just as weight management is easier for a pet with a body condition score of 6/9 than one with a BCS of 9/9, don’t wait until a puppy/kitten is showing high levels of fear before recommending medications to help reduce stress. Clients who are resistant to anxiolytic medications may be open to trying supplements such as Zylkene,13 or to using other ways to lower FAS, such as bringing their own treats to vet visits and covering the cat carrier with a towel. • S chedule all puppy/kitten booster appointments as doctor’s appointments. Many clinics schedule some of these as tech appointments if there are no health concerns from the client, but how often have you found a new mass or an ear infection on an adult pet during your exam?

E ven if the puppy/kitten is physically healthy, these are opportunities to assess their level of FAS during the appointment, and to provide positive reinforcement at the vet clinic. If a puppy/kitten was a little nervous at their first visit and is now hiding and refusing to interact, that should be a red flag that further discussion is warranted. Don’t be afraid to recommend additional veterinary visits to work on behavior at the clinic once the puppy and kitten booster series is completed. • A sk about behavior at home. Unfortunately, behavior seems to be one of the least-liked and most-avoided areas among veterinarians in general practice. It rarely offers easy solutions, like a course of antibiotics for pyoderma, and it requires staff and client commitment. As a result, questions about behavior and training often get glossed over in the exam room, leading clients to get advice online or from friends, family, or trainers. If those sources are using aversive techniques such as punishment, clients who adopt those methods can inadvertently increase fear in their pets. Behavioral causes have been cited as the most common reason why pets are relinquished to shelters,14 so troubleshooting issues with housetraining, biting, and anxiety at puppy/kitten visits will increase pet retention.

FEAR FREE CLIENT EDUCATION FOR PUPPIES AND KITTENS We only see our patients for brief periods during their lives, and getting clients involved with their behavioral health is essential

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to success with Fear Free. This is especially true for puppies and kittens as they move through key stages of their development. The socialization period typically occurs between three to 12 weeks in puppies and two to seven weeks in kittens,15,16 and it’s during this time that our young patients are most open to new experiences. Since this window of time is so small, we should encourage all clients to enroll their pets in puppy and kitten socialization classes early, starting a week after their first vaccines and deworming.17 The fear of canine parvovirus looms large for clients, but studies have shown that puppies enrolled in socialization classes have a higher rate of retention in the home and were no more likely to be infected with CPV.18, 19 Socialization classes are not obedience classes; rather, they expose the puppy or kitten to others in their age group in a positive and controlled environment. Questions about training and common behavioral concerns can also be addressed during these classes, and all family members should attend. Socialization with people is also integral at this stage, and these classes expose puppies and kittens to people outside the home. Clients should strive to have their puppies or kittens meet 100 people in 100 days. This includes people of different ages, genders, and ethnicities, and interactions should be positive. Allowing shy puppies and kittens to approach on their own and receive a treat will reward them for confident behavior. Clients should also be instructed to desensitize and counter condition their puppies and kittens to general handling at home. Many pets dislike having their ears, mouths, paws, tails, and abdomens touched, and positive reinforcement training will reduce FAS when those areas are handled at home and at the vet.

Puppies and kittens should also be taught to accept veterinaryspecific handling, such as restraint and having their skin lifted for vaccines.20, 21, 22, 23 Resistance to restraint is common and makes vet visits much more stressful for the pet and veterinary staff, so start training early. Dr. Yin’s socialization and handling checklists24,25 should also be included with all puppy and kitten kits so the client can work through training at home and identify problem areas. Puppy and kitten appointments are about more than cuddling and vaccines. By adopting Fear Free practices and proactively educating clients, we can make a huge impact on our patients’ emotional and physical health throughout their lives.

Tanaka A, Wagner DC, Kass PH, et al. Associations among weight loss, stress, and upper respiratory tract infection in shelter cats. J Am Vet Med Assoc 2012;240(5):570-576.

Buffington CAT, Pacak K. Increased plasma norepinephrine concentration in cats with interstitial cystitis. J Urol 2001;165(6 Pt 1):2051-2054.

Buffington CAT, Teng B, Somogyi GT. Norepinephrine content and adrenoceptor function in the bladder of cats with feline interstitial cystitis. J Urol 2002;167(4):1876-1880.

Cameron ME, Casey RA, Bradshaw JWS, et al. A study of environmental and behavioural factors that may be associated with feline idiopathic cystitis. J Small Anim Pract 2004;45(3):144-147.

Bhatia V, Tandon RK Stress and the gastrointestinal tract. J Gastroenterol Hepatol 2005;20(3):332-339

https://drsophiayin.com/blog/entry/dog-bite-prevention-week-poster-on-the-body-language-of-fearand-aggression/

https://store.lowstresshandling.com/product/body-language-of-feline-anxiety-free-download-ordonation/

https://fearfreepets.com/fas-spectrum/

Lloyd JKF. Minimising Stress for Patients in the Veterinary Hospital: Why It Is Important and What Can Be Done about It. Veterinary Sciences. 2017; 4(2):22. https://doi.org/10.3390/vetsci4020022.

https://fearfreepets.com/top-10-treats/

Pereira JS, Fragoso S, Beck A, Lavigne S, Varejão AS, da Graça Pereira G. Improving the feline veterinary consultation: the usefulness of Feliway spray in reducing cats' stress. J Feline Med Surg. 2016 Dec;18(12):959-964.

Denenberg S, Landsberg GM. Effects of dog-appeasing pheromones on anxiety and fear in puppies during training and on long-term socialization. J Am Vet Med Assoc. 2008 Dec 15;233(12):1874-82.

Beata C, Beaumont-Graff E, Coll C, et al. Effect of alpha-casozepine (Zylkene) on anxiety in cats. J Vet Behav: Clin App Res 2007;2(2):40-46.

A Summary of Fear Free Principles •U nderstand the body language of fear, anxiety, and stress. • Minimize pain and incorporate Fear Free handling into every visit. • Address fear, anxiety, and stress early, and educate the client. • Schedule all puppy and kitten visits as doctor’s appointments to reassess behavior and touch base with the client. •E ncourage clients to enroll their puppies and kittens in a socialization class by nine weeks of age. Additional resources: fearfreepets.com and fearfreeshelters.com for veterinary professionals; fearfreehappyhomes.com for pet owners.

Miller DD, Staats SR, Partlo C, et al. Factors associated with the decision to surrender a pet to an animal shelter. J Amer Vet Med Assoc 1996;209:738-742.

Freedman DG, King JA, Elliot O. 1961. Critical periods in the social development of the dog. Science, 133, 1016-1017.

The effects of early and late handling on the attachment of cats to people. Karsh EB. In Anderson RK, Hart BL, Hart LA (eds): The Pet Connection, Conference Proceedings-St. Paul: Globe Press, 1983, pp 207-215.

https://avsab.ftlbcdn.net/wp-content/uploads/2019/01/Puppy-Socialization-Position-StatementFINAL.pdf

Duxbury MM, Jackson JA, Line SW, Anderson RK. Evaluation of association between retention in the home and attendance at puppy socialization classes. JAVMA. 2003;223(1):61-66.

Stepita ME, Bain MJ, Kass PH. Frequency of CPV infection in vaccinated puppies that attended puppy socialization classes. JAAHA. 2013;49(2):95-100.

https://www.fearfreehappyhomes.com/help-dogs-get-ready-for-annual-exams/

https://www.fearfreehappyhomes.com/home-schooling-preparing-cats-for-their-annual-exams/

https://www.fearfreehappyhomes.com/prepping-pets-for-annual-visits-vaccines/

https://www.fearfreehappyhomes.com/blood-draws-cats/

https://drsophiayin.com/app/uploads/2015/12/Socialization_Checklist.pdf

https://store.lowstresshandling.com/product/create-the-perfect-kitty-resources/

IVC Fall 2021

From the NASC

Exploring

Ashwagandha for animal care

Supporting balanced behavior and overall well-being with a centuries-old botanical. BY CHRIS KILHAM, MEDICINE HUNTER

Herbs have been part of animal care

depending on the season and their

named ashwagandha, and how it can

for millennia. Humans have observed

needs. Bears change the types of

reduce stress in animals.

wild animals using various types of

vegetation they eat prior to hibernation,

botanicals to maintain health, and

while Costa Rican howler monkeys rely

domesticated animals will do the same

on fig leaf sap as a vermifuge. An entire

when they have access to such plants.

field of herbal veterinary medicine

For example, dogs will eat grass to

dates back to antiquity, and pioneers

One of the main aims of animal care

vomit, wolves do the same to expel

like Juliette de Bairacli Levy have

is stress reduction. For this purpose,

worms, and chimpanzees eat bitter pith

articulated entire systems of animal

the botanical ashwagandha (Withania

to get rid of parasites. Other animals

care utilizing herbs of all kinds. Many

somnifera) demonstrates efficacy both

seek botanicals of

herders, farmers and breeders possess

traditionally and in modern published

various kinds

knowledge of herbal care for animals,

studies. The root of the plant, utilized

gained by generations of observation

for several thousand years to enhance

and use. In short, the use of herbs with

human health, has also been traditionally

animals isn’t new, but is rather a broad and well-developed field reaching back to the beginning

of stress. In animals, stress can be caused by a number of factors, including changes in location, separation from the family, transport, alterations in exercise, climate

human history.

and more. Recent veterinary studies show

focuses on a centuries-old herb

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employed to calm animals during times

of recorded This article

ASHWAGANDHA FOR STRESS

that dogs, cats and horses all experienced reduced stress after consuming extracts of ashwagandha.

creatinine, globulin,

antioxidant, adaptogenic, and immune-

glucose, total protein,

stimulating properties and is safe for

HDL cholesterol,

consumption. As a result of these studies,

LDL cholesterol, and

it is clear that ashwagandha deserves a

triglycerides remained at healthy levels.

place in veterinary care, and that animals respond positively to supplementation with ashwagandha root extract.

Studies conducted on dogs (under peer review), 2 cats, and horses supplemented with ashwagandha root extract showed that ashwagandha

HOW DOES ASHWAGANDHA WORK?

is effective in scavenging free radicals released during stress, and acts as an adaptogen in regulating the hormones and cytokines also released during stress. Reduced

Hormones tell a clear story in these

levels of IL-6 concentration

types of studies. With all the animals

indicate the anti-inflammatory

studied, researchers saw a reduction

and immunomodulatory effects of

in the stress hormones cortisol and

ashwagandha. No adverse events were

epinephrine, and an increase in the

observed during these studies.

neurotransmitter serotonin, which promotes a general sense of well-

The results suggest that ashwagandha

being. In a study conducted on horses,

root extract has potent hematopoietic,

P riyanka G, Anil Kumar B, Lakshman M, Manvitha V, Kala Kumar B. Adaptogenic and Immunomodulatory Activity of Ashwagandha Root Extract: An Experimental Study in an Equine Model. Front Vet Sci. 2020;7:541112. Published 2020 Sep 29. doi:10.3389/ fvets.2020.541112.

Under peer review – Adaptogenic Effects of Ashwagandha Root Extract on Reducing Stress and Anxiety in Dogs: A Randomized, Double-Blind, Placebo-Controlled Trial.

Chris Kilham is an author, educator and world traveler who has conducted medicinal plant research and sustainable botanical sourcing in over 45 countries. He has appeared as a guest expert on numerous radio and television programs, speaking about topics such as medicine hunting, traditional botanical medicine and sustainability. Chris has authored 14 books on medicinal plants, natural products and yoga, including The Five Tibetans: Five Dynamic Exercises for Health, Energy, and Personal Power, which has been translated into 27 languages. He is the founder of Medicine Hunter, Inc. and collaborates with companies, including KSM-66 Ashwagandha, to develop and popularize traditional plant-based food and supplement products.

ashwagandha root supplementation demonstrated a significant reduction in Interleukin-6, which indicates decreased inflammation and enhanced immune function. The markers of oxidative stress, including reduced GSH concentration and enhanced SOD production, show the cellular protective activity of ashwagandha root extract. Various markers of blood health including total erythrocytes, total leukocytes, hemoglobin concentration and lymphocyte percentage also increased in the animal studies, while alanine aminotransferase, aspartate aminotransferase, blood urea, serum

IVC Fall 2021

— the newest tool in veterinary science

AI is a valuable tool that can help veterinarians do their jobs with greater speed and precision, freeing them up to focus on complex tasks and concentrate on patient welfare.

BY SUNGWON LIM, PhD

Artificial intelligence (AI) is fairly new to the animal health sector. Over the past decade, however, researchers, scientists, and entrepreneurs have begun to introduce machine learning and AI into veterinary health, with groundbreaking results.

medicine. In fact, AI is already being used in various areas of the animal health industry to help veterinarians diagnose, treat, and make better decisions about animal health.

AI is not always welcomed with open arms when it appears in an industry. People often have concerns. They worry that artificial intelligence will replace humans and remove jobs. However, this is not the case in veterinary science. When it comes to diagnosing and treating diseases in animals, nothing can replace the expertise of a good veterinarian. AI is a valuable, advanced tool that can help veterinarians do their jobs with greater speed and precision, freeing them up to focus on complex tasks and concentrate on the welfare of their patients.

Animals always need x-rays, but unfortunately, there are not as many people to take and interpret those images. Recently, there haven’t been enough veterinary imaging professionals.¹ While teaching staff in universities have been hardest hit by the shortage, even lucrative private veterinary practices are struggling to find and keep veterinary radiologists. AI can fill the gap left by these shortages.

HOW IS AI BEING USED IN ANIMAL HEALTH? The fact that AI is good at repetitive, data-centered, and often mind-numbing tasks that most humans aren’t equipped for means it has the potential to drastically change veterinary

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Imaging

At least two startups are offering AI products that interpret x-ray images.² The computer software created by these companies uses AI to read x-rays and interpret them quickly and inexpensively. The software is cloud-based; users access it by signing into a website and uploading images. The results come back almost immediately so the veterinarian can move on with the process of diagnosis and treatment.

AI is extremely well suited to radiology because pictures really do contain a thousand words. X-rays are filled with data, and AI is able to quickly compare previous and current images, prioritize data, and analyze images. Veterinary radiologists are still needed to read complex images, but AI can streamline the analysis process, filtering out mundane and uninteresting x-rays so that human doctors can concentrate on the images that most need attention and the expertise of a trained clinician.

Data analysis Thanks to continuous improvements in modern medicine, veterinarians are inundated with data from devices, software, and other sources. While more is certainly better, it can also be overwhelming; large datasets are difficult for humans to read. They also might contain irrelevant data or false patterns. Also, when faced with a firehose of data, a human being is likely to miss the big picture. Not so with AI, which never tires, and can sift through large quantities of data to find complex patterns, unprecedented correlations, or small abnormalities humans cannot see. For example, consider some recent work done by veterinarians at the University of California, Davis School of Veterinary Medicine,³ who worked with a computer engineer to develop an algorithm

tasked with finding Addison’s disease in dogs. Addison’s is a rare disorder, potentially fatal because it mimics the symptoms of other diseases. This means it’s often misdiagnosed, going undetected and untreated for years. Dogs with Addison’s present with vague symptoms that look like other conditions, such as kidney and intestinal disease. Normally, when a sick patient first visits the vet, routine blood tests are ordered — a complete blood count and serum biochemical profile. Because Addison’s patients lack critical hormones, their tests often come back with subtle irregularities that are frequently confused with other conditions. The UC Davis team’s algorithm uses AI to analyze blood work data and detect complex patterns unique to Addison’s. The researchers used the test results of 1,000 dogs to train their algorithm to detect the patterns that signal Addison’s. The algorithm functions as an alert system, using information from routine screening tests to flag patients in which Addison’s disease is likely, and inform veterinarians that further investigation is necessary. It has been 99% effective in diagnosing new patients.

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WHAT IS

ARTIFICIAL INTELLIGENCE?

AI is intelligence demonstrated by machines, although this doesn’t mean computers can think and learn like people. Instead, AI means that software is able to learn and make decisions — often more quickly and accurately than its human users. This makes AI the perfect tool for complex tasks that require the analysis of a large quantity of data, for example, or for the sorts of tedious, repetitive tasks that tire humans and cause them to make mistakes. In these cases, AI is much more accurate and consistent than a human could be. It’s worth noting, however, that AI is not infallible. There may be bias in data sets, for example, and predictions are not always 100% accurate, but — in the way all technology is constantly being improved — data scientists are constantly improving their models and algorithms by adding real-world data. And, of course, highly-trained vets also have a role to play in flagging any diagnosis that doesn’t seem correct.

Diagnosis and prediction When it comes to life-threatening diseases, it is critical to catch them before they develop. This may sound impossible, but with the right data, vets can make educated predictions about which animals will develop a disease. Chronic kidney disease (CKD) in cats is a good example — it’s not reversible, and often, by the time it presents, the patient has already suffered kidney damage. It’s also a disease that tends to affect older cats, so by the time a veterinarian catches a case of CKD, the cat’s quality of life is likely to be severely impacted. If the disease occurrence can be predicted, however, the patient can be treated before kidney damage occurs, and the cat’s health and quality of life can be dramatically improved.

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Researchers recently developed an algorithm to predict CKD before a cat gets sick.4 It uses AI to predict whether a cat will develop the disease. Trained on Electronic Health Records (EHR) from 20 years of vet visits, the algorithm looked for specific factors that contributed to CKD in more than 100,000 cats across breeds, geographical areas, and ranging in age from one year old to more than 22. Using this dataset, the team built a recurrent neural network (RNN) that examines blood work for four factors contributing to CKD: creatinine, blood urea nitrogen, urine specific gravity, and age. The RNN was able to predict whether a cat will develop CKD within the next two years with greater than 95% accuracy. The false positives were very low — a huge benefit for vets and pet owners who have traditionally dealt with CKD as a difficult-to-detect disease. This model, say the researchers, can quickly be implemented in hospital practice or diagnostic laboratory software to directly support veterinarians in making clinical decisions regarding sick cats.

Precision medicine Prediction isn’t just about the disease; it’s also about treatment, because not all patients respond well to the same therapeutics. For instance, the treatment of blood cancers, the most common of canine cancers, can benefit from AI. In general, chemotherapy is the most widely-used treatment option for canine blood cancers, but finding the right drugs for each patient can be a challenge for vets. A wait-and-see approach after drug administration to a patient’s body can be costly, time-consuming, and take a toll on the patient and the humans who love them. AI can help veterinarians find the most effective drugs for each individual patient and exclude ineffective ones before treatment even begins, often called a “precision medicine” approach. One application of AI for cancer precision medicine involves the analysis of various drug responses using “live” tumor cells from canine lymphoma patients.5 This approach, in which researchers use fine-needle aspirates of cancer cells from the affected lymph nodes, uses AI to combine molecular, cellular, and clinical information in order to predict which anticancer drugs will work best

for a specific dog’s particular lymphoma or leukemia. Researchers tested and analyzed the live tumor cells’ responses to commonly-prescribed chemotherapy drugs using various AI models, and predicted the drugs most likely to work on the patient. Once the prediction report is made to a veterinarian, he or she can design a course of individualized treatment for each patient. The study found that patients who had been tested achieved clinical remission much more quickly with their selected drugs. Such precision medicine service enables veterinarians to recommend drugs or drug combinations that will help their patients, rather than taking a trial and error approach to chemotherapy.

AI’S ROLE IN THE VETERINARY OFFICE

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

SPLAY LEG RESPONDS TO ESSENTIAL OIL THERAPY A congenital or developmental abnormality, splay leg is frequently seen in newly hatched chicks, both naturally and artificially incubated. One or both legs can be affected, causing them to extend laterally from the chick’s body.

Veterinarians have always applied leading edge advances in technology to animal health: from digital imaging to sophisticated anesthesia, new technology has changed and improved veterinary medicine. So it’s no surprise that vets have begun turning to AI to improve the care and quality of life of their patients. While AI is excellent at crunching numbers and digesting a large amount of data quickly, however, it doesn’t do well at some of the tasks at which humans excel. Creativity, problem solving without a defined training dataset, and of course, bedside manner, are all human skills that AI cannot duplicate. For this reason, AI is an excellent partner to veterinarians. By taking the pressure of diagnosis, prediction, or data analysis off a vet, AI allows vets to really focus on their patients’ health problems, decide on courses of treatments, and make sure an animal has the best quality of life possible.

K elly R. Artificial intelligence use rising in veterinary radiology. VIN News. https://news.vin.com/ default.aspx?pid=210&Id=10118453. Published March 2, 2021. Accessed June 8, 2021.

Contributing factors include temperature and humidity fluctuations during the incubation period and hatch time. Some Bantam breeds (Silkies) may be more susceptible. A difficult hatch or poor chick position inside the egg may also be a cause. In older chicks, brooder overcrowding with leg or foot injuries from slippery flooring may also lead to this situation. Adults fed diets deficient in vitamin B2 have an increased risk of producing chicks with weaker tendons and ligaments. Early recognition and treatment are vital, as some cases may be so severe that, if unable to walk, these individuals are at risk of starvation, drowning in waterers, or being trampled by other chicks. Proper leg stabilization with commercial hobbles or homemade braces is the usual treatment for this condition. Affected individuals should also be placed on a non-slip surface.

Cima G. Specialists in short supply. American Veterinary Medical Association. https://www.avma. org/javma-news/2018-10-15/specialists-short-supply. Published September 26, 2018. Accessed June 8, 2021.

Warren R. Veterinarians Use Artificial Intelligence to Aid in the Diagnosis of Addison's Disease. School of Veterinary Medicine. https://www.vetmed.ucdavis.edu/news/veterinarians-useartificial-intelligence-aid-diagnosis-addisons-disease. Published December 5, 2020. Accessed June 8, 2021.

Bradley R, Tagkopoulos I, Kim M, et al. Predicting early risk of chronic kidney disease in cats using routine clinical laboratory tests and machine learning. J Vet Intern Med. https://www.ncbi.nlm.nih. gov/pmc/articles/PMC6872623/. Published September 26, 2019. Accessed June 8, 2021.

An essential oil I have successfully used for this situation is helichrysum (Helichrysum italicum). It has historically been used when tissue and nerve regeneration are needed. A tiny amount placed neat at the base of the spine (minimum of twice a day) has been extremely helpful in facilitating recovery with or without hobbles/stabilization. I have seen chicks show significant improvement in 24 hours, with most regaining enough strength to start walking within 48 hours.

Bohannan Z, Pudupakam RS, Koo J, et al. Predicting likelihood of in vivo chemotherapy response in canine lymphoma using ex vivo drug sensitivity and immunophenotyping data in a machine learning model. Wiley Online Library. https://onlinelibrary.wiley.com/doi/10.1111/vco.12656. Published October 20, 2020. Accessed June 8, 2021.

Contact a VMAA member for guidance on how to implement safe and effective usage of essential oils for your pets and patients (vmaa.vet).

Submitted by Susan Albright, DVM IVC Fall 2021

CANINE S T E R I L I Z AT I O N BY SARA FOX CHAPMAN, MS, DVM, VETMFHOM, CERTIAVH

Use the current research to individualize your recommendations for canine sterilization.

IVC Fall 2021

ike most veterinarians, I believed for years that responsible people neuter their dogs, period. Most of my patients were neutered, and I believed that intact individuals would have dreadful health and behavioral problems. Many vets and laypeople still believe this, despite mounting evidence to the contrary. Pet overpopulation is a serious problem, as can be seen by a casual perusal of ASPCA statistics.1 Vets aware of the negative effects of neutering still recommend sterilization to avoid unplanned litters, and the majority of shelters and rescue organizations require sterilization, often before adoption. Animals are most often sterilized via removal of the gonads, accurately called gonadectomy, or neutering, in both sexes. “Neutering” is commonly used instead of the term “castration/orchiectomy” for males. In females, when gonadectomy/ovariectomy is accompanied by removal of the uterus, it is referred to as an ovariohysterectomy (OHE), often referred to as a spay. Sterilization that does not remove the gonads includes vasectomy for male dogs; or complete hysterectomy (including the cervix), also called an ovary-sparing spay or OSS, for females. The AVMA now includes these among the sterilization options described to owners on the public information section of their website.2

QUESTIONING ROUTINE GONADECTOMY In the late 1990s, I noticed that many of my neutered patients were obese, despite careful feeding practices. Spay incontinence was common in older spayed bitches. Several neutered canine athlete patients, including my own obedience Utility competitor, ruptured their cruciate ligaments. I reasoned that I was preventing unplanned litters and mammary cancer, yet I (subjectively) saw a similar incidence of mammary cancer in both intact and neutered bitches.

IVC Fall 2021

From 1999 to 2002, I studied homeopathy and holistic practice in the UK. Dogs are less commonly neutered in the UK, and we discussed the suppressive effects of removing the gonads. Our domestic animals do not naturally experience menopause, so removing the gonads in any animal suppresses a natural outlet, potentially increasing the incidence of diseases such as cancer.3

the normal levels following gonad removal. LH increases so dramatically because of the loss of feedback inhibition from the gonadal steroids. This constant stimulation increases the number of LH receptors in tissues throughout the body, increasing their effect. LH binding to cell receptors stimulates cell division and nitric oxide release.6

Vets in the US have limited experience with intact animals, as virtually all pet dogs and cats are gonadectomized due to shelter practices, breeder requirements, and veterinary recommendations. Since the late 90s, the sport and breeding communities have led the way on the question of neutering dogs, challenging the assumption that all dogs should have their gonads removed. The first article I saw regarding the potential negative effects of neutering dogs was a review by Margaret V. Root Kustritz, DVM, PhD, DACT.4 Many dog enthusiasts are now familiar with the potential issues associated with the early removal of sex hormones, so there is an increased interest in later sterilization, or sterilization that does not remove the gonads.

Tissues with increased LH receptor sites that may show higher cancer incidence after neutering include the prostate, bladder, and urethra, vascular endothelium, heart, spleen smooth muscle, the skin, and lymphoid tissue.7

GONAD PHYSIOLOGY Animal bodies develop as a whole, with elegant homeostatic mechanisms and interrelated body systems. The gonads are an integral part of this system, and their removal will have consequences for the animal, depending on their individual susceptibility and the length of time they live without their gonads. Consider the broad physiologic functions of the gonads and gonadal hormones, as summarized by Lawless:5 • Development of secondary sex characteristics • Estrogen production and its role in bone and cartilage homeostasis for normal joint development and maintenance of bone and cartilage strength • Gonadal androgen production and its role in maintenance of muscle mass and strength as well as regulation of fat deposition • Neuroprotective function of testosterone and estrogen • Sex steroid modulation of immune function by enhancing tissue self-recognition. The increased risk of cancer in neutered animals may be related to the long-term effects of high blood levels of luteinizing hormone (LH), which are more than 30 times higher than

IVC Fall 2021

Certain non-cancerous diseases may also increase after neutering due to these artificially high LH levels. The tissues with potentially affected LH receptors include the intestinal and urinary tracts, certain areas of the brain, the pancreas and thyroid, and some cartilages and ligaments.7 Other researchers postulate that neutering may result in decreased vitamin D levels and increased cancer incidence, or that a decrease in thymocytes and consequent immune suppression could be involved.8 It is important to understand the constellation of steroid effects, and the susceptibility of various breeds and individuals. Patients will manifest disease in their weakest or most susceptible system. For a Dachshund or Corgi, that may be IVDD; for a Boxer or Golden Retriever, cancer; for a Vizsla or Springer Spaniel, anxiety may result.

RESEARCH POINTS TO AREAS OF CONCERN Evidence has been accumulating since the late 1980s that neutering has significant health implications. Literature reviews4,8,9,10 have compiled evidence across breed lines showing definite effects caused by removing the gonads, aside from population control. Studies have proliferated, both within and across breeds, revealing significant effects of neutering on the incidence of joint diseases and IVDD,11,12,13,14,15 cancer,12,14,15,16,17,18 behavior problems, including anxiety, aggression, and fearfulness,15,19,20,21,22,23,24 cognitive decline,25 immune disorders,26,27 and spatial performance as measured by maze learning and recall.28 Actual changes in the frequency of various conditions, and the breeds studied, are in the papers

cited above. The increase or decrease in incidence is broadly summarized from the research as follows:

Behavior • Castration decreased roaming behavior. • In one study, aggression toward strangers increased in animals neutered before puberty. In other studies, owner-directed aggression and reactivity increased with gonad removal. Every prospective controlled study of aggression and gonadectomy showed either no effect or an increase in aggression toward people in neutered animals. Gonadectomized dogs were more fearful, anxious, and excitable, and less trainable. • Intact males were significantly less likely to experience cognitive dysfunction than castrates. • Spatial learning was also affected. Intact females learned and recalled a maze better than neutered animals or intact males.

Neoplasia • Mammary tumors (malignant in half of cases) had a decreased incidence in spayed bitches in some studies. • Prostatic tumors (almost always malignant) had an increased incidence in neutered dogs. • Benign prostatic hypertrophy was common in intact older dogs; castration is curative. • Bladder cancer (often malignant) was more prevalent in gonadectomized dogs. • Testicular cancer (rarely metastasizes) occurred in aged male intact dogs; castration is curative. • Ovarian cancer may be malignant and rarely occurs in intact females. • Hemangiosarcoma (variably malignant), osteosarcoma (often malignant), lymphosarcoma, and mast cell tumors had an increased incidence in gonadectomized dogs.

Musculoskeletal problems Hip dysplasia, anterior cruciate ligament rupture, and intervertebral disc disease increased in gonadectomized dogs of susceptible breeds. These issues are worse in animals neutered before puberty, as the growth plates close later, and abnormal joint angles are subjected to more stress.29

Addressing the mammary cancer question The veterinary community as a whole strongly believes that spaying bitches before the first estrus results in a dramatic decrease in the incidence of malignant mammary cancer. Widely publicized statistics show only a 0.5% incidence if the dog is spayed before the first estrus, increasing to 26% incidence if she is desexed after two or more cycles. The source for this information is a 1969 retrospective study.32 A 2002 systematic literature review33 evaluated the 1969 study and 12 other English language studies that examined the relationship between gonadectomy and mammary tumor incidence. Overall, there was slight evidence that gonadectomy had a mild protective effect on the development of mammary tumors. None of the studies controlled for all the important confounding variables, including previous treatment with synthetic ovarian steroids, and the statistical analysis of the data was not complete. Hart et al34 conclude in their breed assessment that there is little or no evidence for decreased mammary cancer incidence with neutering. It is presumptive to assume that a possible slight increase in mammary tumor incidence (roughly half of which are malignant) overrides all other health concerns for all bitches. Overall, the incidence of mammary cancer in US bitches (intact and gonadectomized) is 3.4%.4 In Sweden, where 90% of all dogs are intact, a 2012 study found an overall 13% incidence of mammary tumors (MT), both benign and malignant.35 If we account for the fact that 10% of these bitches are spayed, and use the figure of a 1% incidence of all MT in spayed bitches, we still arrive at a total of 14.3% incidence of MT tumors in intact bitches. Those confounding variables may have been quite significant, particularly as contraceptive synthetic hormones were widely used in dogs during the 1960s. Bear in mind that MT can be diagnosed more readily than internal cancers. The presence of gonads might help protect individuals of cancer-prone breeds from developing problems of greater significance to them than MT.

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IMPORTANT DEFINITIONS • Gonadectomy and neutering — sterilization of either sex by removing the gonads: ovaries (ovariectomy, ovariohysterectomy) or testicles (castration) • Sterilization — prevention of reproduction • Ovary-sparing spay — hysterectomy with removal of the cervix; the individual retains her ovaries and is permanently sterile • Vasectomy — ligation of the vasa, the individual retains his testicles and is permanently sterile

Additional conditions • Urinary incontinence has an increased incidence in neutered female dogs. The collagen to muscle ratio changes after neutering, which negatively affects urethral function.30,31 • Pyometra occurs in roughly 25% of intact bitches over ten years of age. Surgery is curative, with a high incidence of complications. • Hypothyroidism increased after gonadectomy in some studies, and was unaffected in others. • Immune-mediated disease (atopic dermatitis, autoimmune hemolytic anemia, hypoadrenocorticism, hypothyroidism, and immune-mediated thrombocytopenia) increased in incidence in all gonadectomized animals, and lupus increased in neutered bitches. • Obesity occurs in about 3% of the total canine population; however, up to 50% of gonadectomized dogs are obese. • Longevity studies across breeds have shown that neutered dogs of both sexes live significantly longer than intact dogs.7 The neutered dogs were more likely to die of cancer, while the

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intact dogs were more likely to die of trauma (car accidents, etc.) or infectious disease. These studies did not assess if the dogs received similar levels of care. Were they intact due to overall lack of veterinary care sought by the owner, or were they cherished family members? Traumatic and infectious diseases tend to be more preventable than cancer.

BREED AND TIMING OF NEUTERING We can see that this is not a simple choice; we certainly don’t want animals to breed indiscriminately, but we also want our patients to live long, healthy lives. As many animals are susceptible to the problems discussed above, it may be optimal for them to retain their gonads for some period of time, perhaps even lifelong, to see the beneficial effects on these health conditions. The Hart research team has been at the forefront of current exploration into the consequences of neutering on dogs. They evaluated the effect of neutering on the incidence of joint problems (cranial cruciate tear, hip dysplasia, elbow dysplasia) and several cancers (lymphoma, mast cell tumour, hemangiosarcoma, osteosarcoma) in 35 breeds and mixed breeds of five weight categories.34,36 Roughly, they found that certain breeds and mixed breeds (mostly large) were more susceptible to joint disease when neutered before puberty, and that some breeds showed an increased incidence of cancer when neutered at any age, including two small breeds, Boston Terriers and Shih Tzus. Please note that this does not address other problems seen to increase in incidence with neutering, such as cognitive dysfunction, behavioral changes, and multiple metabolic diseases. A holistic approach will also consider an individual’s risk for such problems. The Harts recommend that the owner and their veterinarian discuss the animal’s situation in light of their breed and weight.7,34,36 Many breeds show no apparent increase in joint

problems or cancers. Those animals could be neutered at any age, if none of the other diseases shown to increase in neutered animals are cause for concern. If joint problems are a concern, neutering should be delayed until sexual maturity. If cancer is a concern, the owner may choose to leave the pet intact or consider a vasectomy or ovarysparing spay to retain the hormones lifelong.

GONAD-SPARING STERILIZATION As mentioned earlier, there are alternatives to gonadectomy for permanently sterilizing dogs. Males can be vasectomized, and females can have a complete hysterectomy (including the cervix), also called an ovary-sparing spay. These methods are safe and effective, like traditional OHE and castration, though typically more expensive. Gonad-sparing sterilization can be done at any age, even before puberty, as the dog will develop normally. The ovary-sparing spay (OSS) was pioneered by Dr. Michelle Kutzler, DVM, PhD, DACT at Oregon State University. The procedure is not much more difficult than a traditional spay. The ovaries are left in place, and the entire uterus and cervix are removed, creating a slightly longer and lower midline incision than is typical. It is essential to remove the entire cervix in this procedure, as the ovaries will produce progesterone as normal, and hypertrophy of any uterus remaining could lead to an eventual pyometra. The female will still cycle and be attractive to males, but she will not bleed. Some vets perform tubal ligations. This is not a safe sterilization option, as the uterus remains in the bitch, and the repeated cycling will result in endometrial hyperplasia and the possibility of pyometra. Vasectomy accesses the vasa from the same prescrotal incision used for castration. Delicate separation of the vasa from the accompanying vessels is essential to ensure that testicular blood circulation is not compromised. Dr. Kutzler describes both the OSS and vasectomy;37 visit parsemus.org for more information and an OSS procedure video.38

CAVEATS TO GONAD-SPARING STERILIZATION There are caveats to performing these surgeries. Ensure that owners understand what they are requesting. IVC Fall 2021

• A dog that is sterilized and retains its gonads is psychologically intact, with normal mating desires. This is not problematic for many individuals, as the lack of discharge decreases the spread of estrus pheromones, making bitches less attractive. Vasectomised males will mount, tie, and ejaculate, and hysterectomised females will flag and stand for breeding. This can result in injuries and/or venereal disease. • Some males can develop intermale aggressive tendencies, and this can be severe enough that castration is the only sensible option. • Vasectomised and hysterectomised individuals will still be at risk for developing physical problems more common in intact individuals: prostatomegaly, perianal hernias, perianal hyperplasia/tumors (males), mammary tumors (females), and gonadal cancers (both). • Residual vaginal tissue could develop a cyst; a stump of any tissue can become cystic, and vaginal tissue does respond to hormones to some extent. • Vasectomised dogs reabsorb their sperm, and there may be swelling of the testes/vasa until equilibrium develops. • Hysterectomised bitches may develop behavioral and physical signs of pseudocyesis, like intact bitches. Some dog sport organisations do not allow bitches in heat to compete, and this could include hysterectomised bitches, as they might be attractive to males.

ADVISING CLIENTS Clients vary widely in their healthcare goals, capabilities, and personal opinions, from those who see their dogs as cherished children to those with a more utilitarian view, and everything in between. When they seek advice about best practices for the longevity and well-being of their animal companions, we must advise based upon the entirety of the situation for each dog and owner. It is possible that gonad-sparing sterilization will become the standard of care for well-managed dogs. We simply do not know everything about the delicate interrelationship of the gonads with other body systems. It may be ideal, for the animal’s health, to not sterilize at all. We don’t know if stopping the flow of sperm in a dog’s body, or removing the feedback effects of the uterus on the ovaries, could have deleterious effects. Based on the research evidence, it appears advantageous overall for animals to retain their gonads, if they must be sterilized. There are good reasons to neuter dogs in certain cases, though it should always be a considered decision, not a sweeping generalization.7

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Some individuals and breeds appear to be less negatively affected by neutering. Many clients have never lived with an intact animal and are concerned that behavior will be a problem. Many vets have never lived with an intact dog and do not know how to discuss this with clients. People who cannot or will not supervise their dogs should not have a hormonally intact dog. Intact, vasectomized, and OSS dogs will all try to breed during a female’s estrus, and both parties can be seriously injured or contract venereal diseases in the attempt.

From a population control standpoint, it is vital for rescue groups and shelters to require sterilization. Vasectomy and ovary-sparing spay, as alternatives to conventional gonadectomy procedures, allow animals to retain their normal hormonal influences. These procedures sterilize, yet avoid the reported negative effects of gonadectomy. As with all medical practices, it behooves vets to understand the sterilization situation as well as possible, so that we can counsel owners regarding the best options for their individual dogs and circumstances.

American Society for the Prevention of Cruelty to Animals. Shelter Intake and Surrender. American Society for the Prevention of Cruelty to Animals website. https://www.aspca.org/helping-people-pets/shelter-intake-andsurrender Accessed 11 July 2021.

American Veterinary Medical Association. Spaying and Neutering. American Veterinary Medical Association website. https://www.avma.org/resources/pet-owners/petcare/spaying-and-neutering Accessed 11 July 2021.

Saxton J, Gregory P. Textbook of Veterinary Homeopathy. Beaconsfield, UK: Beaconsfield Pub Ltd., 2005.

Root Kustritz MV. Effects of surgical sterilization on canine and feline health and on society. Reprod Dom Anim. 2012;47(s4):214–222. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1439-0531.2012.02078.x Accessed 12 July 2021.

Lawless CW. Assessment of the general effects of gonadectomy on canines: Theriogenology research review paper. 2010 Ohio State University College of Veterinary Medicine. http://dogtorj.com/main-course/neuteringmisconceptions/the-truth-about-gonadectomy/ Accessed 11 July 2021.

Zwida K, Kutzler MA. Non-reproductive long-term health complications of gonad removal in dogs as well as possible causal relationships with post-gonadectomy elevated Luteinizing Hormone (LH) concentrations. J. Etiol Anim Health. 2016;1:1-11. https://www.parsemus.org/wp-content/uploads/2015/03/Zwida-andKutzler-2016.pdf Accessed 12 July 2021.

Hart LA, Hart BL. An ancient practice but a new paradigm: Personal choice for the age to spay or neuter a dog. Front. Vet. Sci. 2021;8:244. https://www.frontiersin.org/articles/10.3389/fvets.2021.603257/full Accessed 11 July 2021.

Oberbauer AM, Belanger JM, Famula TR. A review of the impact of neuter status on expression of inherited conditions in dogs. Front. Vet. Sci. 2019;6:397. https://www.frontiersin.org/ articles/10.3389/fvets.2019.00397/ full Accessed 11 July 2021.

Farhoody P, Mallawaarachchi I, Tarwater PM, Serpell JA, Duffy DL, Zink C. Aggression toward familiar people, strangers, and conspecifics in gonadectomized and intact dogs. Front. Vet. Sci. 2018; 5:1-18. doi:10.3389/ fvets.2018.00018 Farhoody P, Zink MC. Behavioral and physical effects of spaying and neutering domestic dogs: Summary of findings of a Masters thesis. New York: Hunter College, City U of NY, NYC. 2010. http://www.atftc.com/health/ SNBehaviorBoneDataSnapShot.pdf Accessed 11 July 2021. Kaufmann CA, Forndran S, Stauber C, Woerner K, Ganslosser U. The social behaviour of neutered male dogs compared to intact dogs (Canis lupus familiaris): Video analyses, questionnaires and case studies. Vet Med Open J. 2017; 2(1): 22-37. doi:10.17140/VMOJ-2-113. Kim HH, Yeon SC, Houpt KA, Kee HC, Chang HH, Lee HJ. Effects of ovariohysterectomy on reactivity in German Shepherd dogs. Vet. J. 2006;172(1):154-159.

McGreevy PD, Wilson B, Starling MJ, Serpell JA. Behavioural risks in male dogs with minimal lifetime exposure to gonadal hormones may complicate population-control benefits of desexing. PlosOne 2018; 13(5):e0196284. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0196284 Accessed 11 July 2021.

Neilson JC, Eckstein RA, Hart BL. Effects of castration on problem behaviors in male dogs with reference to age and duration of behavior. J Am Vet Med Assoc. 1997;211(2):180-182.

Hart BL. Effect of gonadectomy on subsequent development of age-related cognitive impairment in dogs. J Am Vet Med Assoc. 2001;219(1):51-6.

Sundburg CR, Belanger JM, Bannasch DL, Famula TR, Oberbauer AM. Gonadectomy effects on the risk of immune disorders in the dog: a retrospective study. BMC Vet Res 2016;12:278. https://bmcvetres.biomedcentral. com/articles/10.1186/s12917-016-0911-5 Accessed 12 July 2021.

Kelch WJ, Lynn RC, Smith CA, New JC. Canine Hypoadrenocorticism (Addison's Disease). Compend Contin Educ Vet. 1998;20(8):921-935.

Houlihan KE. A literature review of the welfare implications of gonadectomy in dogs. J Am Vet Med Assoc. 2017;250(10):1155-66.

Sanborn LJ. Long-term health risks and benefits associated with spay / neuter in dogs. National Animal Interest Alliance website. 2007.

Chai O, Harrosh T, Bdolah-Avram T, Mazaki-Tovi M, Shamir M. Characteristics of and risk factors for intervertebral disk extrusions in Pekingese. J Am Vet Med Assoc. 2018; 252(7):846-851. http://www.naiaonline.org/pdfs/ LongTermHealthEffectsOfSpayNeuterInDogs.pdf Accessed 12 July 2021.

Hart BL, Hart LA, Thigpen AP, Willits NH. Long-term health effects of neutering dogs: Comparison of Labrador Retrievers with Golden Retrievers. PlosOne. 2014;9(7). http://journals.plos.org/plosone/article?id=10.1371/ journal.pone.0102241 Accessed 11 July 2021.

Packer RMA, Seath IJ, O’Neill DG, DeDecker S, Volk HA. DachsLife2015: an investigation of lifestyle associations with the risk of intervertebral disc disease in Dachshunds. Canine Genet Epidemiol. 2016;3:8. https://cgejournal. biomedcentral.com/articles/10.1186/s40575-016-0039-8#citeas Accessed 12 July 2021.

Torres de la Riva G, Hart BL, Farver TB, Oberbauer AM, McV.Messam LL, Willits N, Hart LA. Neutering dogs: effects on joint disorders and cancers in Golden Retrievers. Plos One. 2013; 8(2):e55937. https://journals.plos. org/plosone/article?id=10.1371/journal.pone.0055937 Accessed 12 July 2021.

Zink MC, Farhoody P, Elser SE, Ruffini LD, Gibbons TA, Rieger RH. Evaluation of the risk and age of onset of cancer and behavioral disorders in gonadectomized Vizslas. J Am Vet Med Assoc. 2014;244(3):309-19.

Bennett PF, Taylor R, Williamson P. Demographic risk factors for lymphoma in Australian dogs: 6201 cases. J Vet Intern Med. 2018;32(6):2054-2060. https://onlinelibrary.wiley.com/doi/full/10.1111/jvim.15306 Accessed 1 July 2021.

Cooley DM, Beranek BC, Schlittler DL, Glickman NW, Glickman LT, Waters DJ. Endogenous gonadal hormone exposure and bone sarcoma risk. Cancer Epidem. 2002; 11(11):1434-40. https://cebp.aacrjournals.org/ content/11/11/1434.long Accessed 11 July 2021.

Obradovich J, Walshaw R, Goullaud E. The influence of castration on the development of prostatic carcinoma in the dog. 43 cases (1978-1985). J Vet Intern Med. 1987;1(4):183-7.

Mongillo P, Scandurra A, D’Aniello B, Marinelli L. Effect of sex and gonadectomy on dogs’ spatial performance. Applied An Behav Sci. 2017;191:84–89. Salmeri KR, Bloomberg MS, Scruggs SL, Shille V. Gonadectomy in immature dogs: effects on skeletal, physical, and behavioral development. J Am Vet Med Assoc. 1991;198(7):1193-203. Ponglowhapan S, Church DB, Khalid M. Differences in the proportion of collagen and muscle in the canine lower urinary tract with regard to gonadal status and gender.Theriogenology. 2008;70(9):1516-24.

Salomon JF, et al. “Experimental study of urodynamic changes after ovariectomy in 10 dogs.” Vet Rec. 2006;159(24):807-11.

Schneider R, Dorn CR, Taylor DON. Factors influencing canine mammary cancer development and postsurgical survival (Summary). J Natl Cancer Inst. December 1969;43(6):1249-61. https://academic.oup.com/jnci/articleabstract/43/6/1249/910225 Accessed 12 July 2021.

Beauvais W, Cardwell JM, Brodbelt DC. The effect of neutering on the risk of mammary tumours in dogs – a systematic review. J Small Animal Prac. 2012; 53: 314-322. doi: 10.1111/j.1748-5827.2012.01220.x

Hart BL, Hart LA, Thigpen AP, Willits NH. Assisting decision making on age of neutering for 35 breeds of dogs: Associated joint disorders, cancers, and urinary incontinence. Front. Vet. Sci. 2020;7:388. https://www. frontiersin.org/articles/10.3389/fvets.2020.00388/full Accessed 11 July 2021.

Jitpean S, Hagman R, Ström Holst B, Höglund OV, Pettersson A, Egenvall A. Breed variations in the incidence of pyometra and mammary tumours in Swedish dogs. Reproduction in Domestic Animals. 2012;s6:347–350. https://onlinelibrary.wiley.com/doi/full/10.1111/rda.12103 Accessed 11 July 2021.

Hart BL, Hart LA, Thigpen AP, Willits NH. Assisting decision making on age of neutering for mixed breed dogs of five weight categories: Associated joint disorders and cancers. Front. Vet. Sci. 2020;7:472. https://www. frontiersin.org/articles/10.3389/fvets.2020.00472/full Accessed 11 July 2021.

Parsemus Foundation. Pet Health: Hormone-sparing sterilization. Parsemus Foundation website. https:// www.parsemus.org/pethealth/hormone-sparing-sterilization/ Accessed 12 July 2021.

Kutzler MA. Gonad-sparing surgical sterilization in dogs. Front. Vet. Sci. 2020;7:342.

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nutritionnook

EDUCATING CLIENTS ABOUT DIETS FOR PUPPIES AND KITTENS BY MIRAIDA RIVERA-VIERA, DVM

Offering a healthy diet very early in life will set a solid foundation for an animal to thrive. This article looks at how to make informed dietary choices for both cats and dogs. A species-appropriate or species-specific balanced diet is one of the major pillars of health. What animals eat can transform their health at the cellular level. Many of the chronic debilitating diseases that affect our companion animals arise from a combination of environmental factors, including a poor diet. Feeding the wrong diet can lead to a perpetuating state of inflammation that equals disease in the body.1 Choosing a diet for a new companion animal can be very overwhelming for clients, as there are numerous formulations (raw, home-cooked, freeze-dried, dehydrated, canned, and kibble) as well as many brands to choose from. As veterinarians, we have the obligation to educate and guide clients on choosing a diet that will provide a solid foundation of health for their companions so they can thrive and age gracefully. Many chronic debilitating conditions can be prevented with a proper diet. When selecting a diet for a new animal companion, pet parents must take into account their budget and the diet’s affordability; the time they are able to invest in providing the diet; and the age and any health conditions the pet may have.

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TYPES OF DIET Raw diets A raw diet is biologically specific, devoid of any preservatives, and high in nutrients, as it has not been altered with chemicals and processing. These diets tend to be composed of fresh meat, meat organs, uncooked bones, and other ingredients such as fresh vegetables, fruits, eggs, etc. Raw diets can be served in the form of a commercially available formulation that is complete and balanced, or it can be prepared at home. When choosing one over the other,

owners should think about how home preparing a well-balanced raw diet requires more time and effort, but also understand that they can control exactly what goes into the pet’s food bowl. Some examples of good quality brands for both dogs and cats include Answers Pet Food, Smallbatch, and Allprovide. Good quality raw diets contain human grade meats that have been pasture or grass fed, and humanely sourced when possible, without the use of antibiotics or hormones. If the diet contains vegetables and other ingredients, always make sure they are free from pesticides and genetic alteration. The diets should also be free from fillers, colorants and artificial additives.

Cooked diets These diets are still highly nutritious, high in moisture, and the owner can still control what goes into the food bowl. The drawback is that some nutrients are altered due to heat during cooking, but these diets still provide a great alternative for pets that don’t do well on a completely raw diet, or for owners who don’t feel comfortable feeding raw.

SPECIES BACKGROUND

— ancestral diets of cats and dogs It is important to educate owners on the ancestral diets of cats and dogs so they understand how to feed their pets properly.

Felines Cats are strict obligate carnivores and require a high protein, high fat diet (making up 75% to 90% of the diet) with a lower percentage of vegetables and starches (10% to 25% of the diet).2 A lower quantity and percentage of protein may be required as the cat ages. Cats thrive on a high moisture diet, and feeding high quality meats in a rotating fashion is ideal along with some vegetables and starches to provide fiber, minerals, and vitamins. The ancestral feline diet does not involve direct consumption of carbohydrates and fiber but rather indirect consumption of what is already present in the gut of their prey, which has already undergone some digestion. For this reason, cats don’t do well consuming diets high in processed carbohydrates; their digestive systems are not designed for this.

Canines Wild dogs and their ancestral relatives ate what was available in the particular regions they inhabited, ranging from small to big prey, along with fruits, insects, and plant material, among other foods. Their diet was diverse and rich in wholesome nutrients.3 Most modern commercial diets are highly processed and high in starch, — not the diet dogs were biologically made to digest and process.

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deal with raw or home-cooking. Smallbatch and Vital Essentials are two companies that carry a quality line of freeze-dried products for dogs and cats.

Dehydrated foods These foods are heat processed, which removes all the moisture and affects the nutritional profile. Most vitamins and minerals are lost in this process. Dehydrated foods are less expensive than freeze-dried, and are very convenient, as owners need only add water to reconstitute and serve them. They are still a good option for owners on the go who want to feed a good quality diet but don’t have time to prepare raw or home-cooked. Cooked diets can also be batch prepared, stored in the freezer, and then thawed as needed. It is important to note that bones cannot be cooked and fed, as they can become fragile and potentially lead to gastrointestinal issues and obstruction. Due to the fact that these diets lose some of the nutritional value during cooking, a vitamin and/or mineral supplement that is NASC approved should be added to the daily diet regime. Owners should always make sure the diet is well balanced with the guidance of a veterinarian. Here are several veterinarian-written books related to homecooked diets, with easy recipes for owners to follow: •F resh Food Ancient Wisdom by Ihor Basko, DVM, CVA •F eeding Cats: A Holistic approach by Ihor Basko, DVM,CVA •D r. Becker’s Real Food for Healthy Dogs and Cats: Simple Homemade Food by Karen Becker, DVM •Y in & Yang Nutrition for Dogs: Maximizing Health with Nutrition, Not Drugs by Judy Morgan, DVM and Hue Grant

Freeze-dried Freeze-dried diets are made from raw food that has been frozen and then goes through a vacuum pressure process to remove the ice and water. In comparison to regular raw diets, their moisture content is significantly lower but they still retain the same great nutritional profile and have a long shelf life once vacuum sealed. Of all the diets, these tend to be most expensive but are very convenient for owners who want to take their raw food while traveling, or need to leave their pets with a dog sitter or family member who does not want to

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Canned diets Owners tend to be very familiar with these diets. They are highly processed, and most cans contain unwanted chemicals like BPA (Bisphenol A). Canned food is high in moisture, which is something to consider for finicky cats that won’t accept any of the previously mentioned diets.

Dry kibble These diets are also highly processed, with a very low percentage of moisture and lower nutritional content. Of all the diets, this is the least favorable to be fed as the primary source. Many of these diets contain poor quality ingredients like corn, soy, and wheat, and they have been associated with shorter life expectancy and the development of preventable chronic debilitating diseases such as obesity, cancer and allergies, among others.1 If owners decide to offer kibble, topdressing with fresh fruits, vegetables, and good quality meat can add a lot of nutritional value.

A dry diet worth mentioning is Carna 4. They offer a dry nugget for dogs that is produced by undergoing a short cycle of heat and then air drying. Their products are free of preservatives and synthetics.

SETTING THE FOUNDATIONS FOR HEALTH Most weaned puppies and kittens start off eating a dry kibble diet, canned diet, or a combination of both. Transitioning them to higher quality diets like raw or home-cooked is very doable, but requires the guidance of a trained animal nutritionist or veterinarian in order to avoid nutritional deficiencies, which include skeletal issues when there is an imbalance of calcium to phosphorus and under-supplementation of vitamin D (rickets); poor wound healing; and issues with ligaments when trace minerals like selenium, zinc, copper, manganese and iron are missing. It is not necessary for every meal to be balanced but it is important that every nutrient is provided during the course of each week. It is best to start with a reputable company that makes a complete balanced product. Then transition to a home-prepared diet, either raw or home-cooked, if desired. Offering a healthy diet very early in life will set a solid foundation for an animal to thrive. Offering fresh ingredients is key, but understandably not every owner will have the time and means of providing raw or home-cooked diets. Owners can still upgrade less favorable diets like kibble by complementing with wholesome, fresh, high quality ingredients such as human grade pieces of meat, organs, fruits, and vegetables, although it is advisable that owners consult with a veterinarian first to make sure

ingredients that are toxic to pets are avoided. This can be a fun activity for the whole family and can also strengthen the human-animal bond.

D odds JW, Laverdure DR. Canine nutrigenomics: The new science of feeding your dog for optimum health. Wenatchee, Washington: Dogwise Publishing; 2015.

Basko I. Feeding Cats: A Holistic Approach. Kauai, Hawaii. https://www.drbasko.com/product/feeding-cats-aholistic-approach/#. Accessed on August 2, 2021.

Basko I. Fresh food ancient wisdom: preparing healthy and balanced meals for your dogs. Makana Kal Publishing; 2011.

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industry innovations Support for your patients’ kidneys Looking for something to support natural kidney function and help maintain the health of aging kidneys in your canine and feline patients? AminAvast® complements a protein-restricted diet and has no reported side effects or drug interactions. In three clinical studies, the active ingredient in AminAvast® was shown to be well tolerated and to significantly support kidney health. Clients have reported improvements in their animals’ coats, appetite, behavior, weight, and overall health. aminavast.com/aminavast/

CBD products you can trust CBD oil is becoming increasingly popular with veterinarians who want to offer holistic ways to support patient health. But not all CBD products are created equal. Joy Organics offers USDA Certified Organic tinctures and leads the industry in quality and transparency. Whether your patients are experiencing stress or just struggling to get around like they used to, Joy Organics offers premium and effective CBD formulas you and your patients can trust. joyorganics.com/collections/pet-products

Keep canine patients hydrated Proper hydration is vital to good health. Petralyte’s electrolyte supplement for dogs is a proprietary formula created by a team of veterinarians. It can boost hydration while delivering a rich load of nutrients. Available in a variety of tasty flavors, including chicken, beef or turkey, these canine electrolyte supplements come in 16-pack, 32-pack, or 64-pack sizes. Your clients can simply pour the supplement into their dogs’ water for them to receive instant nutritional benefits. petralyte.com

Supplements for whole pet wellness Optimal health depends on all body systems functioning properly. Canine and Feline Whole Body Support supplements from Standard Process® provide daily support of all body systems, with an emphasis on a healthy endocrine system. They offer an excellent nutritional foundation because they are made from whole food ingredients, organ and tissue extracts, botanicals, and other ingredients that can help fill nutritional gaps. All Standard Process Veterinary Formulas™ are made using the same meticulous processes the company uses to create their human products. standardprocess.com/veterinary-formulas 42

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Vet-recommended Omega-3 softgels Omega-3 fatty acids are important for joint health, brain function, and a normal immune response to seasonal challenges. Omega-3 Support from NOW® Pets is a great option for your canine and feline patients. Each softgel contains 1,000 mg of natural fish oil concentrate. Omega-3 Support is recommended by renowned veterinarian Dr. Barbara Royal, DVM, CVA, founder of The Royal Treatment Veterinarian Center. nowfoods.com/pet-health/omega-3-support-softgels-dogs-cats

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.

PEDIATRIC VETERINARY HOMEOPATHY “The best doctor is a veterinarian — his patients can’t talk, he’s just got to know.”

— Will Rogers

Veterinary practice is very similar to pediatrics in general, and pediatric animal patients can be a special challenge. Fortunately, a wealth of helpful homeopathic medicines is available to help animals in their early days of life. Conventional drugs offer limited options for treating the young animal, and often only suppress symptoms, worsening the overall condition or resulting in “side effects.”

Stop occasional diarrhea flare-ups Diarrhea is a common complaint. Gut Maintenance Plus™ is a powerful prebiotic and probiotic blend that contains a unique blend of: • Saccharomyces boulardii, a yeast probiotic shown to resolve diarrhea within five days, supported by 250+ peer-reviewed articles •M annan oligosaccharides (MOS), a prebiotic that activates the immune system, binds to pathogens, and feeds beneficial bacteria • P reForPro™, a prebiotic bacteriophage cocktail shown to target pathogenic strains of E. coli AnimalBiome.com

Young animals are challenged in many ways, as they develop their innate immunity to various pathogens and develop a healthy gut microflora. Various homeopathic remedies have special import in helping this process, stimulating the animal’s vital force to perform in the best way possible. Major anti-miasmatic remedies can strengthen the constitution of young animals, and address a variety of common signs of illness. Among the most useful are Calcarea carbonica and Sulphur, each covering almost every pediatric symptom imaginable. Often, a single dose of 30c or 200c will stimulate a rapid, sustained healing response in a young animal, if similar to the symptom totality. Belladonna, Mercurius, Silicea, and Arsenicum album are very helpful as well, and may be needed in higher potency in some situations. Two of the most useful remedies for young animals might be Chamomilla and Nux vomica, for covering a dozen or so common illness symptoms, such as gastrointestinal, respiratory, or febrile disorders. Knowing a few of these remedies very well will help treat many pediatric troubles.

Submitted by Todd Cooney, DVM, CVH IVC Fall 2021

PROFITABLE PRACTICE

INCREASE YOUR INCOME WITH AMINAVAST®

This new nutritional supplement can help support natural kidney function in your canine and feline patients — and increase your clinic’s profitability. aminavast.com

INVESTING IN INNOVATION What is AminAvast®?

AminAvast ® is a nutritional supplement designed to help support normal kidney function in cats and dogs. It is a combination of naturally-occurring amino acids and a peptide that does not need refrigeration and has a three-year shelf life. Cats and dogs have enjoyed millions of meals with AminAvast with no negative side effects reported. Active Ingredients: AB070597 (Glycine, L-aspartic acid, L-glutamic acid, L-glutamine, L-carnosine, L-histidine, L-arginine).

What does the research say? In a comprehensive clinic study, 124 cats received AminAvast for two years. A smaller (59) feline study and a small canine study have also been performed and published. The supplement was well tolerated and was shown to support kidney health.

HEALTHY KIDNEYS, HEALTHY BOTTOM LINE Cats and dogs have seen benefits within weeks of starting AminAvast. Clients have reported improvements in coat, appetite, behavior, increased weight, and generally improved well-being. AminAvast: • Helps maintain the health of aging kidneys • Complements a protein-restricted diet • Maintains normal renal health • Supports normal renal cell structure • Maintains natural low levels of oxidative stress • Supports a healthy coat • Supports overall health and vitality.

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INCOME POTENTIAL: Thanks to a competitive wholesale cost, you can work AnimAvast into your regular patient compliance portfolio with a suggested 100% markup in retail. This gives you an easy opportunity to contribute to your clinic's overall retail growth, and ensures that your patients' kidney function becomes a regular part of their health and longevity regimen. To learn more about the income potential of offering AminAvast to your clients, visit aminavast.com/veterinarians.

TRAINING REQUIREMENTS: Technical information regarding the use of AminAvast is made available through your clinic’s individual distributor.

TIME TO IMPLEMENT: AminAvast is only available to pet parents through their veterinarians, so the company strives to ensure that every participating clinic receives its first (and all subsequent) shipments in a timely manner.

PEER-REVIEWED Many medications used in everyday practice are often designed for older animals, making dosing difficult in younger animals, and increasing the risk of stronger side effects. This is why alternative treatment options, such as essential oils, are so important. When used properly, essential oils can be safe and effective for young animals.

Using Essential Oils in young animals BY JARED MITCHELL, DVM, CVMA

As veterinarians, we see our fair share of difficult cases, from disgruntled clients to hard-to-handle pets. It can make diagnosis and treatment challenging, to say the least. It is no secret that puppies and kittens also sometimes fall into this “difficult to treat” category.

WHAT ARE ESSENTIAL OILS? In scientific terms, essential oils are concentrated lipophilic extracts of aromatic terpenoid constituents.1 In more general terms, essential oils are highly concentrated liquids distilled from certain parts of plants. The distillation process can include the leaves, bark, roots, and flowers of particular plants, and in some cases, the rinds of fruit for production of citrus oils.2 Not all plants, or parts of a plant, will produce essential oils. Scientists have estimated that there are about 400,000 plant species on the planet. Of these, there are 3,000 known essential oils, and only 300 that are commercially available.3 Even then it is important to remember that not all these oils can be used safely with animals, especially in the developing systems of our youngest patients. The keys to safe and successful outcomes include knowledge, oil purity, and proper dilution techniques.

ESSENTIAL OIL SAFETY IN YOUNG ANIMALS With essential oils, a little can go a long way. They are so concentrated that one to two drops are often all that is needed to achieve a therapeutic response in some animals. That is why using proper dilution techniques are so important. This is especially true when using oils with our younger animals. Dilution is such an important aspect of safe essential oil use that entire book chapters are devoted to understanding the proper technique.4 Numerous ratios and calculations can go into properly diluting an essential oil. However, one of the most important aspects is to always be aware of the species of animal to be treated. Certain animals may be more sensitive to particular oils, while others may need a higher or lower concentration to achieve therapeutic effects.4 One technique often utilized in human aromatherapy for treating pediatric patients is to begin with diffusing the essential oil.5,6 This allows for more precise control to prevent overexposure. This same technique could also be used in veterinary medicine with our younger animals. It is important to remember, however, that a dog’s sense of smell can be 10,000 to 100,000 times stronger than a human’s.7 Another safety tip when using diffusers is to IVC Fall 2021

Case report: essential oils helped resolve rectal issue in stray puppy An approximately eight-week-old, intact male, mixed breed stray puppy was abandoned at a grooming and boarding facility. The staff noted that something was wrong with his anal area and contacted a local rescue group who agreed to help. The puppy was presented to our clinic for evaluation and treatment. This eight-week-old stray puppy presented for issues with the anal area.

The initial appearance of the anal tissues, which were inflamed and close to prolapsing.

The condition was resolved following two weeks of treatment with an essential oil spray containing lavender (Lavendula angustufolia), frankincense (Boswellia carterii), and copaiba (Copaifera officinalis).

T he physical exam was within normal limits and the puppy was in pretty good condition apart from highly-inflamed anal tissue which appeared to be predisposing him to the beginnings of an anal prolapse. A broad spectrum dewormer was administered along with vaccines required by the rescue. After discussing medical and surgical options with the rescue, they were concerned about the long-term health and financial limitations these options could present. I t was decided that we should try a medical approach with essential oils. We chose to mix three essential oils known for having beneficial effects on wound healing and tissue damage: lavender (Lavendula angustufolia), frankincense (Boswellia carterii), and copaiba (Copaifera offcinialis). Two drops of each oil were mixed with 1 tablespoon of a carrier oil (in this case coconut oil) and topped off with distilled water in a 4 oz stainless steel spray bottle. The rescue was given instructions to shake the bottle well and then spray the puppy’s anal area twice daily (every 12 hours) for two weeks. On follow-up, the anal area was normal in appearance, and the puppy was doing great with no issues.

always allow for an escape route for the animal so they may come and go as needed to prevent overexposure. Given that our patients have such a heightened sense of smell, always use the smallest amount of oil needed in the diffuser to achieve the desired effect. Young animals, like children, are often curious about the world around them. They are often into everything as they are growing and learning. Storing essential oils properly can prevent accidental overdosing which could lead to devastating outcomes. Make sure essential oils are securely stored out of reach of both pets and children.8 For more info on safe essential oil use, see sidebar on page 47.

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HOW ESSENTIAL OILS CAN BE USED IN YOUNG ANIMALS

1. Desensitizing phobias and reducing stress in situations that produce anxiety Anxiety plagues both humans and animals, and if severe enough can predispose a young animal to a lifetime of phobias and behavior issues. While medications can be used for treating anxiety, these are not without potential side effects. This is why aromatherapy is gaining favor and is being studied for its ability to safely reduce anxiety. When using aromatherapy for anxiety, imprinting is an important concept to consider. Imprinting is the process of using an aroma to “lock in” a memory. These can be pleasant experiences or negative ones. With our younger patients, we certainly want to create a calm and pleasant environment to help reduce stress and set up future positive visits. While lavender is one of the most researched essential oils used to alleviate anxiety, others such as vetiver and cedarwood can also produce calming effects. Vetiver (Vetiveria zizanioides) contains upwards of 100 sesquiterpene-type compounds and their derivatives, which are thought to produce the calming effects noted from this oil. It is considered to be psychologically grounding, calming, and stabilizing and is a great choice for calming and balancing a pet.9 Cedarwood (Cedrus atlantica) has been shown to stimulate the limbic region of the brain along with the pineal gland, which in turn releases melatonin, an antioxidant hormone associated with easing restlessness and producing deep sleep.10 Essential oils are showing positive effects in human neonatal units as well. In one hospital, they are being used as a nonpharmaceutical therapy to treat babies experiencing stress and medical complications related to withdrawal from drug exposure in the womb, or neonatal abstinence syndrome (NAS).11 The results are very promising. While more scientific studies must be conducted, veterinarians can extrapolate these results for the positive benefits of using essential oils in young animals.

2. Alleviating stress-related digestive issues When a pet enters a new household, no matter how loving and wonderful that environment may be, the change can produce a form of stress leading to dietary upsets that can manifest as inappetence, vomiting, or loose stools. In young

Using essential oils safely 1. Use an unadulterated, pure quality essential oil. 2. E ssential oils should be clear in appearance with no chemical or rancid smell. A few color exceptions can appear based on specific constituents found within the oil. 3. U se and store oils in airtight, amber glass bottles and avoid direct sunlight. 4. K eep stored in appropriate locations and out of reach of children and pets. 5. B efore adding essential oils to a treatment protocol, perform baseline blood work and diagnostic testing, and monitor periodically. 6. W hen diffusing essential oils, allow for an “escape” route so the animal can move to an area without essential oil exposure, if needed. Do not run diffusers for extremely long periods. Start slow with no more than ten to 15 minutes at a time. 7. A lthough essential oils are used for treating medical conditions, when possible alternate the oils that are being diffused. 8. W hen topically applying oils, use dilution guidelines and patch test. 9. A void or use with extreme caution in pets that are pregnant or debilitated with medical conditions such as seizures. 10. A void or be extremely cautious with oral administration. 11. A void exposing photosensitive oils to sunlight. These include orange, lemon, tangerine, and other citrus oils. 12. A void using essential oils directly in the eyes and ears. 13. I f essential oils get into the eyes, do not use water to flush them initially. Water will spread the oils and can sometimes make the burning sensation feel worse. Instead, use carrier oils such as coconut oil to help dilute and disperse the essential oil. When the eyes feel better, one can then flush them with a saline solution. 14. I f a skin reaction occurs, wash with (unperfumed) soap and water for at least ten minutes.

animals whose digestive systems and immune systems are still developing, it is advisable to avoid medications when possible. This is where essential oils can help. Fennel, tarragon, ginger, anise, and peppermint essential oils are excellent choices that can help create anti-inflammatory responses as well as increase circulation, reduce nausea, and strengthen the digestive system. Most digestive blends have been reported to be administered orally in all species of animal with no reported ill effects when using pure oils and proper oral administration techniques.12 However, topical administration with pure quality, properly diluted oils can also achieve the desired results. IVC Fall 2021

Dilution examples Multiple calculations and techniques are used for diluting essential oils. Here is one example of how to dilute an essential oil for safe use with young animals. 90% solution = 1 drop of essential oil + 9 drops of a carrier oil 80% solution = 2 drops of essential oil + 8 drops of a carrier oil 70% solution = 3 drops of essential oil + 7 drops of a carrier oil This technique can continue until reaching a 10% solution. The higher the percentage of the solution, the more diluted it is. The 90% solution has 1 drop of essential oil to 9 drops of carrier oil, versus a 10% solution which has 9 drops of essential oil and 1 drop of carrier oil. Thus, the 90% solution is more diluted and would be a better choice for use in young animals. For both smaller and younger animals, begin slowly by applying 1 to 2 drops of the diluted (80% to 90%) solution. Once it is determined how the pet is responding to the oil, more drops may be applied by titrating up in slow increments until reaching a maximum of 5 drops. From “Percentages and General Guidelines. Chapter 1: Plants and animals”. In Essential oils animal desk reference. Lehi: Life Science Publishing; 2017:10.

In farm animals, studies are being conducted to evaluate the use of essential oils in neonatal animals to help reduce diarrhea, improve oxidation of the tissues, and improve growth rates.13, 14 One such study focused on reducing neonatal diarrhea in calves. The calves in the study were given oregano essential oil for the first ten days of their lives. The results demonstrated that the oregano oil effectively diminished the severity of naturally-acquired diarrhea under field conditions and, under certain hygiene practices, possessed a preventive effect against neonatal diarrhea syndrome.14

This is by no means an all-inclusive list. Essential oils are very versatile and can fit into many treatment protocols. Veterinarians and pet owners should work together to find areas in which to safely and effectively incorporate essential oils to benefit their patients, including the young ones.

3. Enhancing wound healing

3 Dasgupta, S. How Many plant species are there in the world? Scientists now have an answer. May 12, 2016.

Young animals are often curious about their environment. Sometimes this exuberant curiosity can get them into trouble. From abscesses to punctures, and everything in between, essential oils alone or in combination with other treatment modalities may help mend some of these wounds.

BJ, Tallian KT. Essential oil of lavender in anxiety disorders: ready for prime time? Ment Health Clin [Internet] 2017;7(4):147-55. doi: 10.9740/ mhc.2017.07.147e.

1 Malcolm

DG. Essential oils: the missing link in modern medicine. In Essential oils: integrative medical guide. Lehi: Life Science Publishing; 2003:1-16.

2 Young,

Mongabay. Available at: www.news.mongabay.com/2016/05/many-plants-world-scientists-maynow-answer/. Accessed July 15, 2021. M. Essential oil dilution rates. In The animal desk reference: essential oils for animals. 2nd ed. Scotts Valley, CA: CreateSpace Independent Publishing Platform; 2018:117-126.

4 Shelton

5 Conlon PM, Haack KM, Rodgers NJ, et al. Introducing essential oils into pediatric and other practices at an

academic medical center. J Holist Nurs. 2017 Dec;35(4):389-396. doi: 10.1177/0898010116677400. Epub 2016 Nov 11. PMID: 27837082. The gentle touch for babies and children. In The complete book of essential oils and aromatherapy. Novato, California:New World Library; 1991:167-197.

6 Worwood VA. Chapter 9:

P. Dogs' dazzling sense of smell. Oct 3 2012. NOVA. https://www.pbs.org/wgbh/nova/article/ dogs-sense-of-smell/. Accessed July 24, 2021.

7 Tyson

Lavender, frankincense, copaiba, and helichrysum are excellent choices for wounds. They are known to be anti-inflammatory, help slow or stop bleeding, prevent bruising, and improve wound healing. In one study, topically-applied lavender (Lavendula angustufolia) promoted collagen synthesis and differentiation of fibroblasts, accompanied by up-regulation of TGF-β. The researchers concluded that lavender oil has the potential to promote wound healing in the early phase by accelerating the formation of granulation tissue, tissue remodeling by collagen replacement, and wound contraction through up-regulation of TGF-β(15).

VERSATILITY FOR YOUNGER ANIMALS In this article, we have touched on a few of the areas where essential oils can be used with our younger animal patients.

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R, Young R. Toxicity. In Essential oil safety: a guide for health care professionals. 2nd ed. Amsterdam: Elsevier, 2014: 23-28.

8 Tisserand

9 Kaufmann C. Vetiver. In Roots and rhizomes. In Nature’s essential oils: aromatic alchemy for well-being.

New York: The Countryman Press; 2018:210.

10 Cedarwood

2017:43.

(Cedrus atlantica). In Essential oils animal desk reference. Lehi: Life Science Publishing;

11 Adams

E. Pediatric experts find aromatherapy effective for promoting infant healing, NAS recovery. May 15, 2017. https://medicalxpress.com/news/2017-05-pediatric-experts-aromatherapy-effectiveinfant.html. Accessed July 27, 2021.

12 Shelton M. Essential oil blends. In The animal desk reference: essential oils for animals. 2nd ed. Scotts

Valley, CA: CreateSpace Independent Publishing Platform; 2018: 339.

13 Forte

C, Ranucci D, Beghelli D, Branciari R, Acuti G, Todini L, Cavallucci C, Trabalza-Marinucci M. Dietary integration with oregano (Origanum vulgare L.) essential oil improves growth rate and oxidative status in outdoor-reared, but not indoor-reared, pigs. J Anim Physiol Anim Nutr (Berl). 2017 Oct;101(5):e352-e361. doi: 10.1111/jpn.12612. Epub 2017 Jan 9. PMID: 28067421.

14 Panagiotis

D. Katsoulosa Maria A. Karatziaa. Chrysostomos I. Dovis, Et al. Evaluation of the in-field efficacy of oregano essential oil administration on the control of neonatal diarrhea syndrome in calves. Research in Veterinary Science. Volume 115, December 2017, Pages 478-483.

15 Mori

HM, Kawanami H, Kawahata H, Aoki M. Wound healing potential of lavender oil by acceleration of granulation and wound contraction through induction of TGF-β in a rat model. BMC Complement Altern Med. 2016 May 26;16:144. doi: 10.1186/s12906-016-1128-7. PMID: 27229681; PMCID: PMC4880962.

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? Dutchman’s breeches (Dicentra cucullaria) is rarely used due to limited sustainable availability, but historically it has been utilized as an alterative and blood purifier to treat conditions ranging from syphilis to skin conditions. It is fine to find herbs like Dutchman’s breeches and appreciate them for their beauty, while using more plentiful herbs when seeking an alterative.

PAST ACTIVITIES Despite COVID-19, the VBMA had a very busy spring, hosting two very successful virtual webinars.

1. A Practitioner’s Panel: Integrating Herbs into Practice: This webinar included advice for incorporating medicinal mushrooms by Dr. Ihor Basko, and a discussion of unique factors to consider when using herbs in equines by Dr. Cynthia Lankenau. Dr. Rona Sherebrin talked about herbal safety issues, and Dr. Jamie Moran shared insights about blending herbal medicine into mixed conventional practice. 2. Equine Protozoal Myeloencephalitis (EPM): Presented by Dr. Shen Xie, this webinar covered the history of EPM disease, followed by TCVM treatment, including both acupuncture and herbal medicine. The VBMA also presented a veterinary speaker track as part of over 87 hours of lectures at the 2021 International Herbal Symposium. This year's event was held virtually, with all monies going to support United Plant Savers. Based in Rutland, Ohio on a 379-acre botanical sanctuary, United Plant Savers is a non-profit organization whose goal is to promote the preservation of native North American medicinal plants. The group maintains a list of at-risk plants that are considered scarce in the wild, such as ginseng,

goldenseal and slippery elm. Founded by Rosemary Gladstar and other horticulturists, the organization encourages the creation of private land “botanical sanctuaries” across the country, where at-risk plants can be preserved and propagated. This is a wonderful organization to join and support. You can still purchase access to the symposium and listen to Dr. Constance DiNatale’s excellent food therapy lectures; Dr. Gary Richter’s thorough intensive on cannabis; Dr. Alexis Tsakiris’s talk on llamas and grief; and Dr. Cynthia Lankenau’s discussion of FIP and metabolic syndrome, as well as herbalists from around the world lecturing on a wide variety of topics.

UPCOMING EVENTS The VBMA’s professional sister organization, ACVBM, is developing an advanced curriculum to weave an understanding of phytopharmacology with traditional uses of botanical medicines. This year’s annual conference, to be held virtually on October 9, will delve into this topic. Our featured speaker, Richard Mandelbaum, RH, has been a practicing herbalist since 1998, and has a background in both Chinese and Western herbal traditions and a passion for our native, local plants. He is co-founder and co-director of the ArborVitae School of Traditional Herbalism in New York City, and is on the faculty at David Winston’s Center for Herbal Studies, with a focus on botany and phytochemistry. The recording will be available for three months post-conference. Register at vbma.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.

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THE EVOLUTION OF GUT HEALTH: what new research reveals

The science behind species-specific probiotics. BY JULIE ANNE LEE, DCH, RCHOM

Probiotics for dogs are intended to help maintain digestive health and hasten recovery from diarrhea and other illnesses (including antibiotic-associated diarrhea). However, commercially available formulations for dogs generally use probiotics of human origin. Since probiotic bacteria can evolve host-specific traits, and because the gastrointestinal tracts of humans and canines have unique anatomical, physiological and biochemical differences, we aimed for a higher standard: the pursuit of species-specific probiotics for dogs.

OUR COLLABORATIVE RESEARCH For this research, we worked with Dr. Jake Burlet of CanBiocin. Together, we developed a process to investigate the viability, bioavailability, and survival rates of canine-specific probiotics. We specifically isolated Gram-positive bacteria (Lactobacilli) from freshlyvoided healthy canine feces and used the appropriate tests to eliminate duplicate isolates. The probiotic

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candidates were subjected to a series of evaluations including (but not limited to): tolerance to simulated gastric and intestinal conditions; production of antibacterial substances; host immune modulation capabilities (using two canine cell lines); antibiotic resistance testing; and strain stability. We isolated 11 distinct Grampositive, rod-shaped bacteria that were subsequently identified as Lactobacillus spp. The isolates were assigned the designation K9-1 and K9-2 for differentiation. By subjecting these isolates to the experiments in the paragraph above, we eliminated strains from the list based on their unique properties. Ultimately, we were left with two unique microbial isolates (K9-1 and K9-2) that have promising immune modulation capabilities and excellent stability. We thus chose to pursue a strain cocktail to encompass the positive attributes of both K9-1 and K9-2 in one formulation. Additional testing was done to determine Section Shelf Life and Survival in simulated gastric and intestinal conditions.

SHELF LIFE Shelf life is an important element when including probiotics in formulations for administration to dogs (and other companion animals). The ability to confer positive outcomes in the target species is a function of probiotic organism viability as well as the accompanying prebiotics and postbiotic metabolites. Prebiotics help provide fuel for the growth of speciesspecific probiotics and foster their ability to colonize in the intestinal tract. Postbiotics include metabolites which have specific functions as well as inanimate organisms. Viability over time decreases for nonspore-forming probiotic organisms. Viability can be enhanced with micro-encapsulation as well as careful attention to recommendations regarding handling and storage. One to two log reductions in live cell viability over time are well documented and to be expected. We recognized the importance of an integrated approach to formulation, taking into consideration the synergies of prebiotics, probiotics and their postbiotic metabolites.

IMMUNE MODULATION Cytokines are small proteins that help control the activity of other immune system cells. Cytokines direct the immune system to do its job.

towards specific species produces a synergy that aids in the healing of the mucosal lining, supports the chelation of toxins, provides anti-inflammatory properties, and creates a diverse gut

ecosystem that builds the pillars of a balanced, healthy body. *For Part 1 of this article, see the Spring 2021 issue of IVC Journal.

DH82 (canine macrophage-like cell line) or MDCK (canine epithelial cell line) cells were co-incubated with K9-1 or K9-2. Cell lysates were analyzed for their cytokine expression levels by qRT-PCR. The results showed that CanBiocin species-specific probiotics were associated with increased cytokine production within the intestinal lumen. Intestinal epithelial M cells become stimulated to transport pathogens (bad bacteria) as well as inflammatory antigens out of the intestinal lumen to the sub-epithelium. Within the subepithelium, macrophages and other immune cells process and “dispose” of the pathogens and antigens.

CONCLUSIONS AND CURRENT WORK Together with Dr. Burlet, our goal is to continue developing host-specific probiotic products with supportive natural formulas for canines, felines, and equines. We all agree that current probiotics have a genuine foothold when it comes to the health and well-being of our companion animals, but with this exciting new research showing the postbiotic metabolites and the immune modulation of these species-focused bacterial strains, we’ve been able to reinforce their far-reaching effects in comparison to the strains we have been using in practice to date. Combining these strains with prebiotics that are geared IVC Fall 2021

innovativepractice

HOW TO ATTRACT AND RETAIN OWNERS OF

PEDIATRIC PETS:

Strengthening the human-animal bond makes a difference BY: LAURIE JONES, BA, RVT

The veterinary community has witnessed a subtle cultural shift, as more people consider their pets cherished family members rather than personal property. The veterinarian is seen as another “family doctor.” The best way to attract new clients is to provide extraordinary service from the very first pediatric appointment. Success in business depends largely on an effective marketing strategy. Although the veterinary practice is primarily a medical facility, practice owners must be cognizant of the need for good salesmanship. And while having a strong online social media presence is important, the most effective form of advertising is word of mouth. In fact, 64% of people aged 18 through 34 said they would choose a brand recommended by someone they trust.1 A firsthand report from a familiar source is, after all, the most convincing form of social media.

research. For this reason, the practice’s website must be attractive, informative, and current. Moreover, clients want to know what makes a practice unique. Storytelling is an effective marketing tool, according to Phil Tucak, BSc, BVMS, a veterinary communications management consultant in Perth, Australia.2 Clients are attracted to a practice whose story is relatable and aligns with their beliefs on a personal level.

WHAT IS YOUR CLINIC’S STORY?

During the first few months of their pets’ lives, new clients will come to the practice an average of every two to three weeks. To promote loyalty, the practice must address the client’s concerns at each visit. Rather than following predetermined protocols or a “cookie-cutter” approach, the veterinary team needs to create an individualized preventive plan based on the pet’s and client’s lifestyle. Compliance improves when clients understand the benefits of the team’s recommendations. By using a tailored medical approach, the veterinary team reinforces its role as pet health advocate.

When new puppy and kitten owners begin the search for a veterinary practice, most will heed the recommendations of those they trust. Because pediatric pets require more care, new owners will seek a practice with a reputation for being responsive and attentive. Clients do not want to be treated as if they are on an assembly line, and perception of value decreases when they are treated this way. Before their first visit, pediatric pet owners will likely also conduct online

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INDIVIDUALIZED CARE

CLIENT EDUCATION FROM ALL TEAM MEMBERS Every member of the veterinary team must be prepared to answer client questions during their pets’ pediatric life stage. For this reason, all team members must be able to communicate appropriate information. Commonly, puppy and kitten owners want to know why their pets have to be examined so often. They may not recognize that because of their pets’ relatively rapid growth rate, more frequent examinations are indicated to identify developmental abnormalities. Clients may also question the practice’s vaccine booster protocol. A simple explanation of the pediatric immune system may be necessary to ensure compliance. Understanding leads to greater trust.

Nutritional guidance Puppy and kitten owners often come to the practice unsure of which diet to feed. Doubtless, they have received advice from other pet owners or they may believe halftruths presented in advertisements. The best approach, when confronted with biases such as these, is to give the client fact-based information. Pet owners have a seemingly limitless variety of diets to choose from. Helping them find the right choice for their pets will alleviate a lot of the stress involved with this decision. Once a diet is chosen, clients will need guidance on how much and how often to feed. Counselling clients about nutrition during the early years strengthens their bond to the practice.

boosters. Client confidence in the protocol depends on their understanding of core versus “lifestyle” vaccines. If the team recommends a vaccine protocol tailored to the individual pet’s needs, the owner is more likely to see that the practice is focusing on the pet and not profit. While most practices engage in extensive client education about vaccination as a way to prevent disease in pets, they

MY HEALTH IS IMPORTANT TO ME. THAT’S WHY I CHOOSE CAT.

DISEASE PREVENTION Throughout the course of pediatric visits, the veterinary team must reiterate the importance of disease prevention. With so many different philosophies on vaccination, it is reasonable for clients to have questions. The veterinary team will succeed in gaining their clients’ trust if they can communicate the importance of appropriate and timely

Reprinted with permission from HABRI.org. View the full-sized chart at www.ivcjournal.com/choose-cat

By educating the client during the pet’s first months, the veterinary team creates a sense of partnership in promoting good health for the life of the dog or cat. Clients are more likely to follow instructions when they believe the veterinary team has their pets’ best interests in mind. This is especially important in the early life stage when clients have so many concerns. Often they will turn to the internet for answers, but much of the information found there is unreliable. The veterinary team can help clients avoid the pitfalls of internet misinformation by offering educational handouts during pediatric visits. Forward-booking pediatric appointments is another effective method of client retention because it stresses the importance of continuity of care and makes scheduling easier. Clients are less likely to miss appointments when they have ample time to prepare.

Scientific research shows that CAT may1 Reduce risk of heart attack

Relieve depression

Speed up heart attack recovery

Lower blood pressure

Lessen risk of allergies and eczema in children

Reduce stress levels

ASK YOUR VETERINARIAN ABOUT CAT Facts

Active ingredient .......................................... The Pet Effect

WARNINGS Side effects may include:  CAT on your computer when you need to work  Issues packing because CAT is in your suitcase  Trouble peeing because CAT is staring at you  You may spend all day posting pictures of CAT on social media  You may feel a strange sensation that you don’t own CAT and that CAT actually owns you

DIRECTIONS:  Adults and Children: take 1 CAT daily  If symptoms persist, increase dosage When using CAT  Come up with nicknames like Cat Benatar  Lay on the floor for increased effect

Discover the healing power of pets.

Figure 1. HABRI posters designed for veterinary practices emphasize the human-animal bond.

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Figure 2.

Reprinted with permission from HABRI.org. View the full-sized chart at www.ivcjournal.com/discover-dog

DISCOVER A MORE HEALTHFUL LIFE. DISCOVER DOG. Scientific research shows that DOG can help1 Reduce stress levels

Lower blood pressure

Relieve depression

Strengthen the immune system

Lower cholesterol and triglyceride levels

Slow heart rate

ASK YOUR VETERINARIAN ABOUT DOG Facts

Active ingredient ........................................ The Pet Effect

WARNINGS Side effects may include:  Picking up poop  Being jealous of DOG kissing other people  Having full on discussions with DOG  Chewed up shoes  Chasing after squirrels with DOG  Feeling guilty if you don’t tell DOG you love them before you leave the house  Excessive social media posts

DIRECTIONS:  If you don't have a pulse  If you have a problem with love and affection When using DOG  Stock up on toys and treats  Speak in silly pet voices

Their next task is to prescribe appropriate preventatives. If clients understand how and why to use a product, they will be more likely to give it as directed. Many new clients will come to the practice with their own opinions of which products are best. They may be influenced by friends and relatives, or they may prefer a recognized brand. Television, radio, and magazine advertisements deliver convincing messages about the effectiveness of one product over another. Consumers do not always recognize the information is promotional, not necessarily factual.

Discover the healing power of pets.

must also inform clients of zoonotic risks. Clients will then have a greater understanding of how pet health affects human health. The veterinary team is responsible for conveying to owners the risk of zoonoses to themselves and their families.

A bond-centered practice The bond between pet and owner is central to the success of promoting the veterinarian as a trusted family doctor. When people value their pets, they invest more in their care. The Human Animal Bond Research Institute (HABRI) has published the results of numerous studies, all indicating the positive effects companion animals have on people’s mental and physical health. Most notably, pet ownership is associated with lower blood pressure and decreased risk of heart attack. Research also indicates that people suffering from depression experience a decrease in clinical signs after acquiring a pet.3 HABRI conducted a study comparing the healthcare costs of pet owners and non-pet owners. Those with pets made fewer doctor visits as a result of overall better health.4 To emphasize the value of the human-animal bond, veterinary practices can display HABRI posters in the lobby. (See Figures 1 and 2 on pages 53 and 54.) While they wait, clients may absorb the information and ask questions during the office visit. They may even enter into conversation outside the veterinary practice. Word of mouth remains an effective form of “grass roots” social media.

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Some pet owners mistakenly believe their pets are not exposed to parasites. From a client’s point of view, it is difficult to understand how something you cannot see can be so harmful. The Companion Animal Parasite Council is a great resource for parasite prevalence maps and prevention guidelines. Information presented on the website (capcvet.org) is intended for practitioners and pet owners alike. Every successful practice carries preventatives indicated for the parasites endemic to their particular region. By educating clients about the importance of prevention, the veterinary team affirms its position as an advocate for the well-being of pets and owners alike.

TRAINING AND SOCIALIZATION Puppy and kitten owners need to be educated on effective training methods. The first goal of training is socialization, as this is the basis for a well-adjusted pet. Unsocialized pets tend to be more fearful, anxious, and difficult to manage. Often, these animals become a liability for their owners. Many pets are surrendered to shelters, or abandoned for displaying undesirable behaviors. Properly socialized, well-behaved pets become cherished family members, enriching the lives of the people around them. Pet owners have different goals when it comes to training. Some want a pet who will learn a new trick every week, while others just want one who will come when called. The level of complexity is unimportant; the act of working together

to achieve a desired result is the key to strengthening the human-animal bond. By advocating for well-mannered pets, the veterinary team is reinforcing a relationship that benefits the animal, the owner, and the practice.

From the IVAS The mission of the International Veterinary Acupuncture Society (IVAS) is to provide, promote and support veterinary acupuncture and related treatment modalities through quality basic, advanced and continuing education, internationally recognized certification for veterinarians, and responsible research.

ACUPUNCTURE AND LASER THERAPY FOR TICK EXPOSURE IN A PUPPY Every year, I seem to see more ticks in our urban area. We are located in the Pacific Northwest, where ticks are not (or haven’t been) as common as in other areas of the United States.

Veterinary assistant comforting a pediatric patient

A reputation for attentive care will attract qualityconscious clients to a practice, but loyalty will be earned only when the veterinarian is seen as a trusted advisor to a concerned pet owner. Rather than turn to the internet for answers, a loyal client will ask the practice. By addressing these questions from pediatric through adult and geriatric life stages, the veterinary practice becomes the pet’s advocate for a lifetime of good health. Furthermore, the practice supports the well-being of clients by strengthening the human- animal bond. When clients recognize the benefits of pet ownership beyond mere companionship, they will value the veterinary practice for promoting their own well-being as well.

Schwarz R. The power word-of-mouth has in advertising and how to cultivate it. forbes.com, 2020.

d vm360 staff. Episode 29: Using storytelling to retain and attract new veterinary clients. dvm360, 2010.

McFarland M. The pet effect. habri.org, 2017.

Clower TL, Neaves TT. The health care cost savings of pet ownership. habri.org, 2015.

Dixon was a 16-week-old puppy when we found his first tick during a puppy wellness appointment. It was latched on and taking a blood meal. I removed the tick and followed up with both acupuncture and laser therapy. Acupuncture points were chosen to support immune function and Wei Qi, Dixon’s tick bite wound. as well as to Clear Heat from the Blood. The following points were dry needled using 15 mm J Type Seirin needles: GV 20, SP 21, SP 10, LI 4. A Class 4 therapeutic laser was used on the “swelling and inflammation” setting to treat the local area where the tick had been attached. Dixon was also started on Canine Whole Body Support, a supplement by Standard Process. When he returned for a four-week follow-up visit, the site was healed, and he had no symptoms of Lyme or other tickborne disease. I sent out a comprehensive vectorborne disease panel to the lab to rule out exposure and infection. Thankfully, the panel was negative. Dixon is now 1.5 years old and doing fabulously. Dixon’s eyes are protected during laser therapy.

Submitted by Nell Ostermeier, DVM, CVA, FAAVA IVC Fall 2021

PROFITABLE PRACTICE

NUTRISOURCE PET FOODS CAN HELP INCREASE YOUR PATIENTS’ HEALTH — AND YOUR BOTTOM LINE! nutrisourcepetfoods.com

WHAT SETS THEM APART? Quality and safety NutriSource pet food brands – NutriSource, PureVita, Element Series and Choice — are dedicated to the long-term health of dogs and cats. That very commitment is what drives their promise of quality and safety in every bag. “When formulating our NutriSource products we carefully consider every ingredient,” says Adam Martodam, Marketing Director at NutriSource Pet Foods. “We’re particular about our suppliers so we can guarantee that our raw ingredients will pass our very stringent testing. We manufacturer our own kibble and treats in state-of-the-art facilities. We mill our own grains, grind our own meats and cook at lower temperatures to maximize nutrition. These efforts help result in nutrient dense recipes that maximize bio-availability.”

A focus on gut health The addition of a revolutionary supplement system called Good 4 Life® benefits your patients no matter their level of health. This proprietary blend of ingredients work together to repair and promote gut health. Disease begins in the gut. Conversely, so does good health. Good 4 Life supports proper absorption of the nutrients that matter while helping to ensure the animal’s body is adequately prepared to defend itself against infection and disease.

INCOME POTENTIAL: Product retail margins range from 25% — 50% depending on distributor pricing and product selection.

TRAINING REQUIREMENTS: NutriSource provides product and nutritional training for all their lines, so you don’t have to spend countless hours researching!

TIME TO IMPLEMENT:

PRODUCTS, PASSION AND PROFIT NutriSource Pet Foods is a third generation family-owned company based in northern Minnesota where they've been making healthy pet food since 1964. Today, NutriSource® offers over 110 different dog and cat food products across their four lines of NutriSource®, NutriSource PureVita®, NutriSource Element Series and NutriSource Choice. Their product offerings include kibble, cans and treats. NutriSource® Pet Foods was founded on strong relationships with all their partners with a focus on the independent pet channel. It has been, and will remain their focus, to continue partnering with people and companies they trust, doing their very best to ensure the long term success of their approximately 6,000 brick and mortar partners across the US and Canada. They are proud to support the independent channel by employing one of the largest sales forces in the industry, dedicated and focused on building relationships, training, and providing that unmatched support at an unmatched level.

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Timing is based on what products are ordered and your clinic’s proximity to the chosen distributor. Contact NutriSource customer service to be connected with a NutriSource representative in your area.

(800) 525-9155 tufcustservice@klnfamilybrands.com

While vaccines are needed to protect against infectious disease, they are not innocuous products and can cause adverse reactions and contribute to other diseases. When it comes to vaccinating puppies and kittens, the timing and benefits/risks need to be carefully assessed.

VACCINE CONSIDERATIONS FOR

PUPPIES AND KITTENS BY W. JEAN DODDS, DVM

A year ago, I wrote an article on vaccination protocols for pets in midlife (“Vaccination in Adult Dogs and Cats,” IVC Journal, Fall 2020). As a follow-up, I will now look at vaccination considerations for puppies and kittens, using a proactive pediatric approach that ensures vaccination safety and efficacy in these young animals. This is especially important given the residual maternal immunity that may interfere with vaccines and prevent successful immunization. Addressing this issue is hampered, however, by an ongoing misunderstanding of the principles of immune memory and protection; the fact that pet caregivers and breeders often give their own vaccines; and that they often choose to do so at a very early age, even at four weeks, when it is unsafe. Vaccine labels state that these MLV vaccines should not be given before six weeks of age as they can induce a mild case of vaccine-induced viral infection.

Further, vaccines contain other excipients such as fetal calf serum or egg albumin, immune stimulators, and tissue culture remnants. More focused educational efforts are clearly needed within academic veterinary medicine, clinical practice, and companion animal breeders and pet parents. Vaccines are not innocuous products, so the timing and benefits/risks need to be assessed carefully before vaccinating puppies and kittens. Vaccines should be thought of as medications, and used as necessary to accomplish the true health needs of the recipients.

VACCINE-ASSOCIATED SIDE EFFECTS AND DISEASES While modern vaccine technology has permitted us to effectively protect companion animals (and people) against IVC Fall 2021

VACCINATION PROTOCOLS FOR PUPPIES AND KITTENS

● Should receive MLV or recombinant “core” vaccines (canine distemper, parvovirus and hepatitis/adenovirus) preferably either at nine to ten and 14 to 16 weeks of age (minimum protocol), or at nine, 12 and 16 to 18 weeks of age. ● Rabies vaccines are all adjuvanted killed products and are given as required by law, preferably separately from other vaccines, and as late as legally allowed – e.g. 20 to 24 weeks of age. Thimerosal-free (mercury-free) rabies vaccines are preferred and safer. ● Other vaccines are optional, and depend on lifestyle circumstances and disease exposure risk in the area. ● For the optional Bordetella or kennel cough vaccines, the oral version is preferred over intranasal, although both offer more complete protection than the injectable version. ●L eptospirosis vaccines protect against only four serovars of the organism and are second to rabies vaccines in their risk of hypersensitivity and other adverse effects. Use if leptospirosis is endemic in the area of concern. ● While canine influenza viruses (H3N2 and H3N8) are highly contagious, most infected dogs have mild to no clinical issues, unless they develop a high fever and are at risk for secondary pneumonia. Vaccination, while being widely promoted, is still optional. ●T hree or more days after the last round of vaccines, puppies can be out and about for socialization. In the interim period, between ten and 14 weeks of age, socialization can take place in the backyard or at puppy training classes with known friends and healthy dogs. ● Until fully vaccinated, puppies should not walk on unfamiliar or public grounds; they should be carried about when travel through those areas is needed. ● If titer testing is desired instead of giving another vaccine after 12 weeks of age, wait until at least 16 weeks to avoid measuring residual maternal immunity.

PUPPIES

● Core vaccines (feline panleukopenia, feline calicivirus, feline rhinotracheitis/herpes) given as MLV or killed, inactivated or intranasal products, are started in a two- or three-dose series beginning, for example, at seven to nine weeks of age and 12 to 16 weeks, or at seven, 11 and 16 weeks. ● Rabies vaccines are recommended as for puppies, although cats can receive a recombinant non-adjuvanted vaccine, which is preferred over the adjuvanted killed rabies vaccines given to dogs. This non-adjuvanted rabies vaccine is not yet available for dogs. ● Some consider the feline leukemia virus (FeLV) vaccine important for cats, especially those that live outdoors or are indoor/outdoor. Options are a recombinant nonadjuvanted or a killed adjuvanted vaccine. ● The feline immunodeficiency virus (FIV) vaccine previously available as an adjuvanted killed virus vaccine for cats was discontinued in 2017.12

KITTENS 58

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● Other vaccines (Chlamydia, FIP) are generally not recommended or are optional, and depend on circumstances and disease risk in the area. ● Socialization and vaccine titer testing options follow those discussed for puppies.

serious infectious diseases, vaccinations are increasingly recognized, in genetically predisposed individuals, as causing immune-mediated blood, skin, bowel, bone, and joint diseases; bone marrow and organ failure; central nervous system excitation; and behavioral aberrations.1-6 These adverse events (termed vaccinosis) are relatively rare, with estimates at three to five events per 100 vaccines given.3 In cats, while adverse vaccine reactions may be less common than in dogs, aggressive tumors (fibrosarcomas) can occasionally arise at the site of vaccination, as they can in dogs.7-9 Their prevalence over the last 20 years has not decreased, nor has the age of affected cats increased, despite changes in vaccine formulations and worldwide protocol guidelines.9 Other cancers such as leukemia have also been vaccine-associated.9

VACCINE DOSAGE Dogs, no matter what the size or breed type, are currently vaccinated with the same quantity of vaccine.1,2 This makes little immunological sense, particularly when the manufacturer’s clinical trials are typically performed on laboratory beagles and with minimal field testing in different breed types prior to licensing.3 More vaccine adverse events have been documented in smaller dogs.2 Toy and smaller dogs should require less vaccine than giant and large dogs to achieve full immunization, and puppies and kittens should require less vaccine volume than adults.1 This

Today, only about 40% of veterinarians are estimated to be following the current World Small Animal Veterinary Association, American Veterinary Medical Association, American Animal Hospital Association, and British Veterinary Association vaccine policy guidelines.3 As published data shows more adverse reactions when multiple vaccines are administered at the same time, separated vaccine components are now available to offer a staggered approach to safer immunization, especially in the young puppy or kitten.

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author studied healthy, adult, small breed dogs that had not been vaccinated for at least three years.10 They were given a half-dose of bivalent distemper and parvovirus vaccine, and all the dogs developed increased and sustained serum vaccine antibody titers.10 This approach should apply also to puppies, and perhaps kittens, although they have less size disparity than puppies.

ALTERNATIVES TO CURRENT PET VACCINE PRACTICES When an adequate immune memory has been established by measuring serum antibody titers, it would be unwise to introduce unnecessary antigen, adjuvant, and other excipients, as well as preservatives, by administering more vaccine boosters.3-5 For legally required rabies vaccines, however, alternative options are often limited by necessity, given the exposure risk to this fatal disease.11

OTHER ISSUES WITH OVER-VACCINATION The increased cost in time and dollars needs to be considered, despite the justified solicitation of clients, so that pets receive a wellness examination.1,3 Giving unnecessary boosters also increases the risk of adverse reactions from the repeated exposure to foreign substances.1-4

While some veterinarians may tell their clients there is little scientific evidence linking vaccinations with adverse effects and serious illness, this confuses an impressionable client.3 On the other hand, polarized views by vaccine naysayers just add more confusion. The current controversies and misinformation surrounding the exposure risk of SARSCoV-2 and COVID-19 disease and its vaccination is a potent example. Vaccination immune responses are similar in duration to those following a natural infection. Adaptive immunity to viruses develops earliest and is highly effective, whereas the adaptive immune response to bacteria, fungi or parasites develops more slowly, and the duration of immunity (DOI) is generally shorter than with most systemic viral infections. While older dogs and cats rarely die from vaccinepreventable infectious disease, especially when they have been vaccinated and immunized, young animals do die, mainly because vaccines were either not given or given at an inappropriate age (e.g. too early in life in the presence of maternally derived antibody.1-3 Vaccinating puppies and kittens should involve a careful assessment of the benefits and risks of vaccines to young animals. Determining the right ages at which to administer these vaccines must also be considered. See the sidebar on page 58 for optimal vaccination protocols for puppies and kittens.

Day M J, Horzinek MC, Schultz R D, Squires R. WSAVA Guidelines for the vaccination of dogs and cats. J Sm Anim Pract 2016; 57: E1-E45.

American Animal Hospital Association (AAHA). Canine Vaccination Task Force: Ford RB, Larson LJ, Schultz RD, Welborn LV. 2017 AAHA canine vaccination guidelines. J Am Anim Hosp Assoc 2017; October: 26-35.

Dodds WJ. Vaccine issues and the World Small Animal Veterinary Association (WSAVA) Guidelines (20152017). Israel J Vet Med 2018; 73 (2): 3-10.

Dodds WJ, Herman K. Heavy Metals in vaccines. J Am Hol Vet Med Assoc 2019; 57: Winter 16-18.

Dodds WJ. Adjuvants and additives in human and animal vaccines. Med Res Arch. 2016; 2(5): 1-8.

Dodds WJ. Rabies virus protection issues and therapy. Global Vaccines Immunol. 2016; 1: 51-54.

Schultz RD, Thiel B, Mukhtar E, Sharp P, Larson LJ. Age and long-term protective immunity in dogs and cats. J Comp Pathol. 2010; Jan;142 Suppl 1: S102-8.

Scherk MA (Chair), et al. 2013 AAFP Feline Vaccination Advisory Panel Report. J Fel Med Surg 2013; 15:785-808.

Wilcock B, Wilcock A, Bottoms K. Brief communication. Feline postvaccinal sarcoma: 20 years later. Can Vet J 2012; 53: 430-434.

Dodds WJ. Efficacy of a half-dose canine parvovirus and distemper vaccine in small adult dogs: a pilot study. J Am Hol Vet Med Assoc 2015; 41:12-21.

Dodds WJ, Larson LJ, Christin, KL, Schultz RD. Duration of immunity after rabies vaccination in dogs: The Rabies Challenge Fund research study. Can J Vet Res 2020; 84:153–158.

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S tilwell N. What Is FIV and why Is the FIV vaccine no longer available? PetMD. July 9, 2020. https://www. petmd.com/cat/care/what-fiv-and-why-fiv-vaccine-no-longer-available

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One in five dogs across all ages — including young ones — develop osteoarthritis. When identifying at-risk individuals, it is important to consider ways to help protect their joints, and find joint support formulations that best suit each patient’s needs.

AN EARLY, PROACTIVE APPROACH TO KEEPING

CANINE JOINTS HEALTHY

BY ROBIN DOWNING, DVM, MS, DAAPM, DACVSMR, CVPP, CCRP

Dogs are living longer (and better) than ever. But longer lives bring consequences, including wear and tear on joints. The statistics are sobering — approximately 20% of dogs across all ages suffer the effects of painful osteoarthritis (OA), although the risk and incidence increase with age. Is there is any way to prevent or postpone the progression of OA in canine patients? Fortunately, we have strategies to help accomplish this. By paying attention to details, we can set the stage in the early life of a dog and contribute to lifelong comfort and mobility.

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1. ALLOW PUPPIES TO GROW UP NICE AND SLOW The myth that a roly-poly puppy is a healthy puppy is just that — a myth. When puppies grow too quickly, they develop an excess of fat cells, setting them up for a lifetime of being overweight and/or obese. This is truly one area in which an ounce of prevention is worth a pound (or many pounds) of cure! Chasing a normal body composition score (BCS) once

a dog is obese is challenging for everyone — the veterinary healthcare team, the dog’s owner, and the dog himself. Creating the habit of portion feeding, with meals delivered at regular times, allows for finetuning to match intake with output. It also allows the client to notice any deviation from normal eating habits that can be an early sign of disease. It is the moral obligation of the veterinary healthcare team to make a specific nutritional recommendation, with conviction, tailored to the needs of the individual puppy, and with the guidance of clinical nutritional science. Regular weigh-ins at the practice during growth help the client stay on track and allow for precision portioning. This is a terrific opportunity for a veterinary technician or assistant to spearhead impactful client/ patient outreach. Since overweight and obesity contribute to both the development and the progression of OA, preventing obesity provides excellent and important preventive health care.

physiology and physique. Shih tzus are not built to run alongside their owners’ bicycles. Conversely, Labradors were not designed to be couch potatoes. Part of our job as veterinary healthcare experts is to guide our clients toward the most appropriate exercise to which their dogs are suited. Exercise and overall activity should not be limited to simple walks around the neighborhood. Therapeutic exercises build strength and flexibility in specific parts of the body. Identifying potential problem areas created by the dog’s conformation (over which neither the dog nor owner have any control) can guide your choices about which therapeutic exercises to assign. Several excellent rehabilitation

2. ENCOURAGE CLIENTS TO MAINTAIN AN ACTIVE LIFESTYLE FOR THEIR DOGS Dogs need exercise to remain healthy, and joints need to be used to remain strong and functional. It’s important, however, to ensure that activity levels match each breed’s

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texts as well as other rehabilitation resources offer a choice of specific exercises/ activities for particular patients. Consistent daily activity coupled with specific therapeutic exercises, starting early in life, can ward off “weekend warrior” syndrome and help dogs retain their functional ability well into old age. Just as with monitoring weight and body composition, this is an area in which a veterinary nurse or assistant can take the lead to help clients fine-tune their techniques by teaching and executing therapeutic exercises with their dogs. Clients appreciate it when we partner with them for the benefit of their dogs.

3. INITIATE JOINT SUPPORT EARLY This is especially important in dogs whose conformation or activity portfolio (e.g. agility, backcountry rescue, longdistance hiking/backpacking, etc.) may set them up for early-onset OA. Some dogs look as though they were built by a committee. Their backs may be super long and coupled with legs that are super short (and often crooked). Some breeds have a higher incidence than the general population of developmental orthopedic issues like elbow or hip dysplasia. While we do not have studies that clearly demonstrate that we can prevent OA by initiating joint support at some pre-symptomatic time, there are a few scenarios in which doing so makes good medical sense. The crooked legs of chondrodysplastic breeds like Basset hounds and dachshunds are subjected to biomechanical forces that may foreshadow orthopedic issues later in life. Dogs diagnosed with developmental orthopedic issues like OCD or dysplasia (hip or elbow) can benefit from joint support. Likewise, dogs who experience any traumatic injury or whose movement is altered thanks to limb amputation can also benefit from joint support. In these cases, initiating evidence-based joint support may slow the inevitable progression of joint deterioration and the development of OA.

4. DEVELOP A STRATEGY FOR CHOOSING JOINT SUPPORT PRODUCTS It’s important to have joint support supplements available for clients to take with them when you prescribe these products. Choosing supplements to provide joint support to canine patients at risk for OA means carefully considering the formulation, not just the ingredients. It is important to look for products whose formulations have been documented to provide benefit in the target species. Fortunately for our patients, more and more companies recognize the need for such information. Some ingredients that have been formulated into products for canine patients with naturally occurring OA include: •O mega-3 fatty acids (particularly EPA, and in a triglyceride form) •U C-II (undenatured collagen type-II) • Microlactin •P erna canaliculus (green-lipped mussel)

SUMMARY Some of our canine patients will find themselves on a path that can lead to joint deterioration and painful OA. That 20% statistic noted earlier is worth remembering because it translates to one in five dogs across all ages — including young dogs who might be easy to overlook. When we identify at-risk individuals, it is logical to consider ways to protect their joints from more rapid decline. And, in considering options for these patients, we have an obligation to look hard at available data for specific formulations in order to be confident that we are making defensible decisions on their behalf. This is about advocating for beings who cannot advocate for themselves. We owe it to them!

References Cline MG, et al. 2021 AAHA Nutrition and Weight Management Guidelines for Dogs and Cats. JAAHA Jul/Aug 2021. 57:4;153-178. Downing R, Gaynor J. Therapeutic goals. In: Handbook of Veterinary Pain Management. 3rd ed. Gaynor JS, Muir WW, eds. Elsevier, St. Louis. 2015. Fox SM, Millis D. Multimodal Management of Canine Osteoarthritis. Manson, London. 2010. Fox SM. Nutraceuticals. In: Chronic Pain in Small Animal Medicine. Manson, London. 2010. Freeman L, et al.WSAVA Nutritional Assessment Guidelines. J Sm An Pract. Vol 00;June 2011;1-12. Henderson A, et al. Protocol development and protocols. In: Canine Rehabilitation and Physical Therapy. 2nd ed. Millis DL, Levine D eds. Elsevier, Philadelphia. 2014. McCauley L, Van Dyke JB. Therapeutic exercise. In: Canine Sports Medicine and Rehabilitation. 2nd ed. Zink C, Van Dyke JB eds. Wiley Blackwell, Hoboken. 2018. Raditic DM, Bartges JW. The role of chondroprotectants, nutraceuticals, and nutrition in rehabilitation. In: Canine Rehabilitation and Physical Therapy. 2nd ed. Millis DL, Levine D eds. Elsevier, Philadelphia. 2014.

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Class 3B

versus Class 4 laser systems

BY ROGER DUMOULIN-WHITE

— what’s best for my veterinary practice? Therapeutic laser systems are an excellent tool for any veterinary clinic, for treating various pain conditions, reducing inflammation, and for deep tissue healing. However, there are many lasers on the market, possessing both pros and cons, and understanding the differences between them can be challenging. Two of the laser systems most prominently utilized by healthcare practitioners are what are known as Class 3B and Class 4 lasers. Both of these laser types have benefits and risks, and knowing which is which is key for your practice.

LASER CLASSIFICATION Laser classification was first established by the American National Standards Institute to outline the differences in power output of a laser system and the hazard it presents to the user and other persons in the immediate vicinity. A common misconception is that Class 4 lasers are a technological advancement to Class 3B lasers. In fact, the Class 4 was the first laser to be used for medical purposes. A few years later, Class 3B lasers were introduced and deemed more suitable for medical purposes due to their viability to heat tissue while

not compromising efficacy, therefore making them safer to use on patients. Thus, the classification of lasers simply refers to the power output of a system and its thermal risk to patients.

CLASS 4 LASERS Traditionally, Class 4 lasers were known as “surgical grade” lasers, as their primary use in medical applications was to induce thermal effects on tissue — e.g. burning, cauterizing, or destroying specific tissues. Class 4 lasers can be used for pain conditions, but the thermal effects must be mitigated. This can be done by lowering the output power into the 3B laser power range, or by increasing the beam diameter (area) to lower the power density (W/cm2) of the laser beam to <500mW/cm2 , the maximum limit for Class 3 lasers for near infrared (200mW/cm2 is the maximum limit for visible lasers).

CLASS 3B LASERS Class 3B lasers, on the other hand, can be held in direct contact with tissue, indefinitely, without any risk of thermal damage. This is because their power

density is low enough not to induce thermal effects to tissue (although therapeutic treatments are generally a few minutes in duration).

POWER OUTPUT Another difference between Class 3B and Class 4 lasers is the power output. Class 4 lasers do indeed offer a higher power output; however, as far as laser applications go, more is not necessarily better. There is an ideal amount of optical power required to bio-stimulate tissue cells, and both laser types are able to deliver this amount. For further information about the differences between Class 3B and Class 4 lasers, head to the Theralase website (https://theralase.com) to read our recent blog post.

Roger DuMoulin-White graduated from the University of Western Ontario with a Bachelor of Engineering degree and has been a registered professional engineer since 1989. He is the founder and Director of Business Development for Theralase Technologies Inc. (TSXV: TLT/OTCQB: TLTFF). DuMoulin-White has been actively involved in the research, development, design and commercialization of Cool Laser Therapy (“CLT”) systems, used to eliminate nerve, muscle and joint pain, since 1994; and Medical Laser Systems (“MLS”), used to activate Photo Dynamic Compounds (“PDCs”) to destroy cancer, bacteria and viruses, since 2003. IVC Fall 2021

newsbites

WOMEN VETERINARIANS EARN LESS THAN MEN Cornell University’s College of Veterinary Medicine has found that female veterinarians make less than their male counterparts. The research paper represents the first overarching study of the wage gap in the veterinary industry, and shows that the disparity predominantly affects recent graduates and the top half of earners. Among the top quarter of earners, the annual difference is around $100,000. “Similar to what’s been found in the human medicine world, we found the wage gap was more prominent in the beginning of their careers but dissipates after about 25 years,” said the paper’s senior author, Dr. Clinton Neill, assistant professor in the Department of Population Medicine and Diagnostic Sciences. “This has large implications for lifetime wealth and earnings, as men will consequently have a larger sum of wealth at the end of their careers.” The reasons for this inequality are challenging to identify. The researchers cite unconscious bias, practice size, less external financing, and societal expectations as potential factors. The type of practice ownership also plays a role. Partnerships, for example, are more beneficial for women’s income earning potential than sole proprietorships, while any form of ownership benefits men’s incomes. When it comes to the number of years worked, the study found that men move into higher income brackets at lower levels of experience than women. The paper was published in the Journal of the AVMA and is also the first peer-reviewed publication for the newly established Center for Veterinary Business and Economics. https:// n e w s .c o r n e l l .e d u /s to r i e s /2 0 21/0 3 /w o m e n veterinarians-earn-less-men-study-finds

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IS OBESITY A RISK FACTOR FOR ASTHMA IN HORSES? Morris Animal Foundation-funded researchers at Texas A&M University are investigating the association between obesity and asthma in horses. If a link is identified, the findings will help improve our understanding, diagnosis and management of asthma, especially in obese equines. The team will study 60 horses, of any breed, from those brought into the Texas A&M Veterinary Medical Teaching Hospital. The chosen horses will be divided into four groups of 15: obese and asthmatic, non-obese and asthmatic, obese and healthy, and non-obese and healthy. The researchers will look for markers of inflammation, including cytokine levels (in humans, cytokine levels differ between obese asthmatic and non-obese asthmatic patients). The second part of the study will examine the horses’ lung microbiota to see if there are any noteworthy differences in asthmatic horses with and without obesity. “Obesity and equine asthma are both significant problems for horse health and management,” says Dr. Janet Patterson-Kane, Morris Animal Foundation Chief Scientific Officer. “Knowing more about potentially significant associations between such important conditions has implications for tailoring prevention and treatment methods to individual animals. Most importantly, if this association exists, we might be able to identify horses that are at higher risk to help their owners prevent disease or at least intervene earlier.” http://www. morrisanimalfoundation.org/article/horse-obesityasthma-association

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