Innovative VOLUME 12 ISSUE 2
VETERINARY CARE
MINDFUL COMMUNICATION IN VETERINARY PRACTICE
THE POWER OF COMPARATIVE ONCOLOGY
A look at the influence the animal cancer market is having on human cancer care. — P. 26
IMPROVE RELATIONSHIPS AND RESOLVE CONFLICTS BY HELPING YOUR CLIENTS FEEL HEARD AND UNDERSTOOD. — P. 26
HOW TO AVOID BURNOUT
Foster emotional well-being by considering factors such as workload, rewards, and values. — P. 8
ADDRESSING VACCINE SAFETY
A look at some of the technological advances that are tackling the issue. — P. 14
www.IV C Journal.com
SPRING 2022
HERB SAFETY IN VETERINARY PRACTICE
ACUPUNCTURE POINTS AND INFLAMMATION
DEALING WITH SUSPECTED ANIMAL ABUSE
CONSIDERATIONS FOR PREGNANT VETERINARIANS
How to ensure the herbs you use in your practice are safe and of top quality. — P. 56
How veterinarians can save the lives of animals — and human family members in the same environment. —P. 40
Superficial inflammation in animals appears to overlap with acupoints traditionally associated with the relevant disease. — P. 32
Communication and accommodation support healthy pregnancies and a positive return-to-work experience. — P. 62
SPRING 2022
EDITORIAL DEPARTMENT
Editor-in-Chief: Dana Cox Managing Editor: Ann Brightman Associate Editor IVC: Laurin Cooke, DVM Senior Content Editor: Kari Klasson Content Editor: Rebecca Bloom Graphic Design Lead: Ethan Vorstenbosch Graphic Designer: Hannah Cuenco Graphic Designer: Joy Sunga Graphic Design Intern: Luke Bakos
COLUMNISTS & CONTRIBUTING WRITERS
Susan Albright, DVM Phil Arkow Todd Cooney, DVM, CVH Cheryl A. Cross, DVM, DACVP W. Jean Dodds, DVM Ava Firth, DVM Laura B. Gaylord, DVM, DACVIM (Nutrition) Jean Hofve, DVM Melissa Kellagher, AHVMA Chery F. Kendrick, DVM, MPVM, MLT, ASCP, CFS Cynthia Lankenau, DVM Bethanie Poe, LMSW, PhD Sam Meisler, DVM Donna M. Raditic, DVM, CVA, DACVIM (Nutrition) Suzan Seelye, DVM, CVA, CVTP Élan M. Sudberg Tavor White
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improving the lives of animals... one reader at a time.
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contents FEATURES
PRACTICE 8 INNOVATIVE AVOIDING BURNOUT
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By Sam Meisler, DVM
Burnout is caused by a mismatch between a veterinarian and his or her work environment. Considering a range of factors helps foster job satisfaction and emotional well-being.
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NEWER TECHNOLOGIES THAT ADDRESS VETERINARY VACCINE SAFETY ISSUES
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By Cheryl A. Cross, DVM, DACVP Study indicates that areas of superficial inflammation in animals frequently overlap with acupoints traditionally associated with the relevant disease.
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USING HERBS IN VETERINARY PRACTICE — HOW TO EVALUATE QUALITY, SOURCES, AND TESTING , By Elan Sudberg, CEO, Alkemist Labs Knowing the sources, formulations and quality verification protocols used by product manufacturers ensures the herbs you use in your practice are safe and of the best quality.
Helping your veterinary clients feel heard and understood improves communication and relationships, and resolves conflicts.
ACUPUNCTURE POINTS AND INFLAMMATION
IMMUNITY AND HOMEOPATHY IN DOGS — FOCUS ON NOSODES Nosodes are a potent, safe and effective way to help dogs build specific immunity to many major canine diseases, without the risks and side effects caused by vaccines.
By Bethanie Poe, LMSW, PhD
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By Phil Arkow
By Todd Cooney, DVM, CVH
By Jean Hofve, DVM
COMMUNICATION IN 26 MINDFUL VETERINARY PRACTICE
VETERINARY RESPONSES TO SUSPECTED FAMILY VIOLENCE By recognizing indications of animal cruelty and reporting suspected cases, veterinarians may save the lives of animals and human family members in the same environment.
NUTRITION NOOK FEEDING CATS IN 2022 Encouraging your clients to feed their cats the way nature intended helps prevent obesity and other health problems.
By Suzan Seelye, DVM, CVA, CVTP
Tui-na is an ancient Chinese form of medical massage that can have a profoundly healing effect on a range of conditions seen in veterinary practice.
By W. Jean Dodds, DVM What we currently know about vaccine safety in the veterinary industry, and a look at some of the technological advances that tackle the issue.
THE ART OF TUI-NA FOR DOGS AND CATS
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CONSIDERATIONS FOR PREGNANT VETERINARIANS
By Chery F. Kendrick, DVM, MPVM, MLT, ASCP, CFS Communication and accommodation support healthy pregnancies and a positive return-to-work experience for veterinarians who are new mothers.
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.
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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 coowner of The Healing Oasis Veterinary Hospital, offering massage, rehabilitation, chiropractic and Chinese and Western Herbology. Michelle completed the Chinese Herbal Medicine program from the China Beijing International Acupuncture Training Center, and is certified in Chinese Medicine by the Wisconsin Institute of Chinese Herbology.
COLUMNS & DEPARTMENTS
7 Editorial 13 From the AHVMA 19 Profitable Practice 20 In the News 25 From the VMAA 30 Good News 39 From the AAVA 49 Industry Innovations 54 News Bite
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.
61 From the VBMA 65 From the AVH 66 Need to Know
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. PHIL ARKOW
6. CHERY F. KENDRICK, DVM, MPVM, MLT, ASCP, CFS
2. TODD COONEY DVM, MS, CVH
7. SAM MEISLER, DVM
Phil Arkow is Coordinator of the National Link Coalition, a network of 4,700 multidisciplinary professionals in the U.S., Canada and 53 other nations which since 2008 has served as the National Resource Center on the Link Between Animal Abuse and Human Violence. He may be reached at arkowpets@snip.net or NationalLinkCoalition.org. p.40 Dr. Todd Cooney trained at Purdue University. He worked in private mixed practice, served as an officer in the US Air Force and Army, and as a USDA veterinarian. After 22 years of conventional practice, he took Dr. Richard Pitcairn’s Professional Course in Veterinary Homeopathy, which changed the way he viewed health and disease. Dr. Cooney began using homeopathy right away, with exciting results (naturalanimalconsulting.com or drtcooney@gmail.com). p.50
3. CHERYL A. CROSS, DVM, DACVP
Dr. Chery F. Kendrick is the owner of VetOSHA and The Veterinary Learning Center. She is an active speaker on numerous topics including regulatory control as well as life and work balance. She makes her home in the foothills of the Smoky Mountains of eastern Tennessee, with her cattle dog, Aggy. Nature and teaching make her complete. p.62 Dr. Sam Meisler is the founder and CEO of PetWellClinic, an innovative walk-in veterinary franchise system offering general primary care and vaccinations for pets. He grew up in East Africa where he was immersed in both wildlife and domestic animals. Based in Knoxville, TN, Dr. Meisler owns and operates two full-service animal hospitals and four PetWellClinics. His wife, Julie, keeps him grounded and focused on what is important. He has two wonderful adult children and his own “menagerie” of pets. p.8
Dr. Cheryl Cross is a veteran of both academic and private practice integrative veterinary medicine. Her small animal specialty practice incorporates acupuncture, laser therapy, medical massage and myofascial work, Chinese and Western botanical medicine, and physical rehabilitation. In 2011, she co-founded the Integrative Medicine Service at the University of Tennessee College of Veterinary Medicine and provided student education and clinical service until 2015. Her specialty practice in Knoxville, TN aims to provide down-to-earth and evidence-informed care that honors the roots of traditional medicine. p.32
8. BETHANIE POE, LMSW, PHD
4. 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.14
Dr. Suzan Seelye is an internationally award-winning speaker, clinician and consultant, with 39 years as a licensed veterinarian. After 25 years practicing conventional medicine and raising a family in rural western WA, she pursued further education at the Chi University. Dr. Seelye currently teaches clinics for veterinarians and non-veterinarians along with seeing clients and lecturing nationally and internationally on Tui-na and Quantum Healing for all animals four legged (quantumvet.com). p.35
5. JEAN HOFVE, DVM
10. ÉLAN M. SUDBERG
Dr. Jean Hofve earned her Doctor of Veterinary Medicine at Colorado State University. She also studied veterinary homeopathy, homotoxicology, Reiki and other holistic modalities. She has researched pet food and feline nutrition for more than two decades, and is an expert on holistic pet health and the commercial pet food industry. Dr. Hofve is an official advisor to AAFCO, and co-authored the books Holistic Cat Care and Paleo Dog. p.22
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Dr. Bethanie Poe has been involved with the University of Tennessee Veterinary Social Work program for over a decade, first as a graduate student when she helped develop the Veterinary Social Work Certificate Program, and now as an instructor. Dr. Poe is currently the Middle Tennessee Coordinator for UT’s Human-Animal Bond in Tennessee (H.A.B.I.T) program, where she strives to make animal assisted interventions available to victims of crime. p.26
9. SUZAN SEELYE, DVM, CVA, CVTP
Élan Sudberg is CEO of Alkemist Labs, a passionately committed contract testing laboratory specializing in plant identity, potency, and purity testing to the food and beverage, nutraceutical, and cosmeceutical industries. He holds a degree in chemistry from California State University Long Beach, and is on the American Herbal Products Association board of trustees. p.56
editorial
d n u So Safe and
I’ve recently been playing with the free association of words as a more abstract way to journal my thoughts, and I’ve been intrigued, though not surprised, by what my mind reveals on paper. It goes something like this: I pick up the nearest book and flip to a random page, then (again randomly) put my finger on a word. This is my top word. I then immediately record the next word I think of, based on the top word, and so on, until I have a list of about 30 words. It doesn’t matter what word I start with, whether it’s rose, faint, clock, kitchen, tree, or lemon — in the majority of cases, about 20 words into the process, I arrive at “safe.” I’m sure there are many meanings and interpretations of this that could be derived from my life experiences, but clearly my psyche values feeling safe! In all the helping and healing professions, including veterinary medicine, we try very hard to do no harm. Sometimes we fall short, due to a myriad of reasons. But we try to treat our patients as safely as possible. We try to keep our hospitals safe for our staff. We try to minimize risk. This issue of IVC Journal explores different approaches to safety. Learn how to keep your pregnant staff members safe, both physically and mentally, not only through their pregnancies but also when they return to work. Curious about vaccine safety? Read about the most current vaccine technologies. Want to know more about how to safely source herbal products? Learn about the manufacturing side of supplements and how to make sure your supplier is using best practices.
We all know that veterinary medicine is much more than the patients we treat. Our work lives are filled with people, and we treat the patient within the human-animal bond and the family dynamic. Learn about the link between human domestic violence and animal abuse and the role of the veterinary team in these situations. The pandemic has pushed the stress levels of both clients and staff to breaking points, and we explore how to mindfully communicate in de-escalating ways. We also take a deep dive into the reasons for burnout and how to make sure your practice fosters job satisfaction and emotional well-being. Learn about the restorative practice of Tui-Na, Chinese medical massage. After reading this article myself, I’ve been using the techniques on my patients and my own animals, and we are all the better for it! In such stressful times, these methods definitely feel like a safe and nurturing treatment. Stay safe everyone,
Laurin Cooke, DVM Associate Editor, drlaurin@ivcjournal.com
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innovativepractice
V O I D A ING
N R U B OUT: A DEEPER DIVE INTO THE DAILY WORK LIFE OF A VETERINARIAN
BY SAM MEISLER, DVM
Burnout is caused by a mismatch between a veterinarian and his or her work environment. Considering a range of factors, including workload, rewards, and values, helps foster job satisfaction and emotional well-being. In 2021, according to the American Veterinary Medical Association,1 about 44% of veterinarians considered leaving the profession. More alarmingly, 25% are seriously considering making this move. This is an ominous sign, especially in a profession that has always attracted numerous people to its ranks, even when veterinary salaries have historically been lower than those of other professions. And with a surge in consumer demand for veterinary care, the problem continues to grow. At the heart of the issue is what has been characterized as veterinarian job burnout. Studies from Christina Maslach and Michael P. Leiter2 reveal that burnout results from a mismatch between employees and their work environment, including workload, control, rewards, community, fairness and values. In veterinary medicine, the approach to these areas has been inconsistent.
WORKLOAD A workload mismatch occurs when the veterinarian’s workload exceeds their capacity to both physically and mentally keep up with it. In a veterinary role, the focus
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is often placed on the time needed to serve patients, versus the additional time veterinarians need to deal with emotionally draining situations. Practice owners try to further leverage their veterinarians with the use of support staff, while misunderstanding the pressure veterinarians experience in making decisions about their patients’ care. As more support staff are hired, the more decisions a veterinarian has to make on any particular workday. Obviously, some decisions regarding patient care are weightier than others. Solutions should be reached by examining the overall weight of decisions made on a particular day, and how best to organize them to allow for recovery time.
CONTROL While control and structure are important from the practice owner’s point of view, it is necessary to understand how workplace decisions will affect the veterinarians themselves. Veterinarians often have different expectations in terms of decision-making. (Should the vet be responsible? What
about the practice owner or pet owner?) At the outset, a veterinarian’s responsibilities within a practice should be clearly outlined to cover which decisions they will be making. Role ambiguity leads to both conflict and a perceived lack of control. This can result in job dissatisfaction and a feeling of helplessness. If the veterinarian is experiencing a lack of control, it is important to tackle this head-on and with the practice owner. Discuss and agree upon individual responsibilities before the work starts. A straightforward plan regarding day-to-day activities will help things run smoothly.
REWARDS The rewards of being a veterinarian are both tangible and intangible. Tangible rewards can be identified as a pay raise or an increase in benefits. Intangible rewards can be a simple “thank you” from a client or praise from the practice owner for a job well done. In today’s labor environment, tangible rewards are being negotiated more and more to the veterinarian’s benefit. However, if other areas are not addressed (responsibilities, workload, etc.) the rewards can just be considered as compensation for a difficult job. Practice owners must look at all areas of reward, based on merit, practice growth and more. Examining what a veterinarian needs versus what they want is also key. For example, giving a veterinarian an office day with no patients may be more valuable to job retention than granting a day off. Rethinking an individual veterinarian’s needs can help more vets stay in the profession, and help a practice succeed.
Veterinarians need to feel supported by their team, especially when a patient case takes a downturn. In addition, social media is now a voice for the community. Mentoring veterinarians on how to handle social media, especially in terms of client reviews, can help foster resiliency in this area.
FAIRNESS The perception of fairness in how decisions are made at a veterinary practice has a significant effect on employee burnout. The veterinarian may not like a decision that was made; however, if it is perceived that it was made in a fair, equitable way, the negative impact of the decision is lessened. Fairness also matters in how individual team members are treated — whether related to the vets themselves or to other team members. Practice owners can continue to foster an open atmosphere by discussing decisions and current challenges at regular staff meetings.
VALUES One cannot overemphasize the importance of running a veterinary practice based on values. Most practices have missions and goals for their organization, but these are not always identified and used consistently within the team or with the client community.
COMMUNITY The community as represented by both the veterinary practice staff and the clients they serve is very important when it comes to overall job satisfaction. Developing a trusting, open environment is key to creating a positive team culture.
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Practice owners — with the help of their teams — should create a list of values and corresponding value statements. For example, our values at PetWellClinic® are openness, community, service, growth and kindness. We hire based on these values. All decisions about processes and systems are made with these values in mind. Vet practices will do themselves a great service by creating a team of individuals who truly live the values laid out by the practice owners.
WHAT CAN YOU DO AS A VETERINARIAN? Though it might initially be hard to see, veterinarians have access to many tools for combatting burnout. You can exert control over your workload by learning to delegate decisions to support staff, and setting up tools for decision-making when appropriate. Giving up control in some areas can lead to more control of your personal workload. Being open to new ideas will create a united team, focused on making the workday productive for everyone at the practice. Practice owners want you to advocate for your salary and benefits. As a veterinarian, it is important to know that all economic rewards ultimately need to be paid for. If you are offered an enormous salary by a practice, make
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sure you feel up to the workload that will be expected of you. Efficiencies in a practice will help you as well. Newer veterinary business models make it easier for you to deliver the workload necessary to support a higher reward at a lower emotional cost. Look for these models — your team will thank you. The idea of community culture is more within your control than you think. If you’re experiencing a toxic work culture where people are being negative, it can “infect” others. Veterinarians are very empathic people, so if someone is sharing their thoughts about a fellow employee or a bad interaction with a client, it can rub off on a normally positive person. However, when employees deal with each other directly, a culture of trust is created. Fairness and values are also important. Most instances of “perceived unfairness” might be a misunderstanding. Communication is always key. Asking the practice owner about how a decision was made may bring resolution. Using permission-based questions such as, “May I ask how that decision was made?” rather than, “Why did you make that decision?” will help keep the lines of communication open and impact office culture
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INNOVATING VETERINARY CARE TO
PREVENT BURNOUT In business, if there is not a solution now, one will be found or subsequently created. Remaining optimistic about the veterinary profession is easy. In the veterinary industry, all stakeholders are well aligned. The fundamental tenets of our mission are so genuine: to provide compassionate care to animals and peace of mind to clients. The various facets of employee burnout2 research can help us identify areas of opportunity for sustaining the current veterinarian workforce. Looking at workload, veterinary business models are coming out that focus on more specialized parts of general practice. Some veterinarians focus on providing in-home hospice and euthanasia. Others only do general surgery within a practice. Veterinarians can now find positions in which they do not have to perform surgery, but can still provide preventive and minor ailment care. Some practices focus on urgent care while referring out more serious emergency care. As far as control is concerned, national relief veterinary agencies are springing up that allow veterinarians to set their own schedules. Some groups even auction off shifts to the lowest bidder. Non-veterinarian ownership has also increased, allowing veterinarians to be more in control of patient care as their employers are not medical care experts.
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in a positive way. If your practice does not specify its values, start a discussion to solidify these ideals among the staff, with the permission of the practice owner. The goal of the practice is to serve animals and their owners. In order to do so, the practice must function as a team, with members looking out for one another in challenging situations, and offering solutions.
WHAT CAN YOU DO AS A PRACTICE OWNER? From the practice owner point of view, understanding the emotional impact of your veterinarians’ workload is key. You may have the most highly-skilled support staff, but your veterinarians may have a maximum number of patients they can personally “handle” before needing to pause and regroup. It is worth noting that ten very ill patient case workups will be much more taxing than 20 wellness appointments. Control matters in areas that directly affect the veterinarian’s personal life. Both weekly shift schedules and daily shift duties should be set with all needs taken into consideration. Solidify processes for schedule creations and time off requests, and how these will be communicated. Make it very clear how scheduling and workload decisions are made so there are no surprises. Rewarding associates for a job well done is a great way to show your gratitude to practice staff. The practice owner has a responsibility to look for innovative ways to
reward associates, both tangible and intangible. Individual compliments about patient care are very motivating. Reading positive online reviews at a team meeting is always fun and gets to the core purpose behind every pet visit. You can create a positive work culture by modeling behavior you want to see. Learn about your team members directly, not through second-hand knowledge or a misstep in their work. Trust your team members. Identify your practice values and live by them: every single day. Finally, practice owners are not always the most popular people, but they must embody the qualities of a fair and supportive leader. Though mistakes have been made and some veterinarians will decide to leave the industry for various reasons, practice owners and current staff must keep moving forward. The focus on personal versus monetary values will continue to impact practices and veterinary teams in new ways. The traditional idea of a veterinary practice will continue to change, so now is the perfect time to introduce new processes and new team members to an evergreen business.
1
JAVMA News. (2021, December 01). Fierce competition over veterinary labor. https://www.avma.org/javmanews/2021-12-01/fierce-competition-over-veterinary-labor
2
Leiter MP, Maslach C. Six areas of worklife: a model of the organizational context of burnout. J Health Hum Serv Adm. 1999;21(4):472-489.
From the AHVMA The mindful leader elevating the veterinary profession through innovation, education and advocacy of integrative medicine.
SAVE THE DATE The AHVMA will be holding its annual conference at the Palm Beach County Convention Center in West Palm Beach, Florida, from September 10 to 13, 2022. The host hotel, the Hilton West Palm Beach, is conveniently connected to the Convention Center via a covered walkway. It’s located in the heart of downtown, so there is plenty of shopping and dining available! In this year’s keynote address, “Plant Allies: Magical Healing,” Dr. Cynthia Lankenau will explain to us the amazing abilities of plants, and the partnership that humans and animals share with them. The AHVMA Annual Conference offers over 80 hours of lectures on topics ranging from homeopathy and herbal medicine to mindfulness and the endocannabinoid system. Not only will you be exposed to a wealth of knowledge, you will also acquire information on integrating these modalities into your practice. We encourage students from AVMA-accredited veterinary schools to attend these lectures as a way to broaden their veterinary education.
MEMBERSHIP AHVMA offers a subscriber membership that is open to pet owners. Subscribers have access to current and archived journals. We also offer an associate membership to businesses and non-profit organizations directly related to the AHVMA’s mission. Check out all the exciting benefits offered in our brochure (ahvma. org/wp-content/uploads/Associate-Membership-Form.pdf ). If your company is interested in becoming an associate member or subscriber, contact office@ahvma.org.
WITH THANKS Thank you to all who have donated. We are immensely grateful for all the support we have received. AHVMA has been going through a bit of a rough time, but with the support of our members, we are working towards rebuilding. Submitted by Melissa Kellagher, AHVMA Director of Operations
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NEWER TECHNOLOGIES THAT ADDRESS VETERINARY VACCINE SAFETY ISSUES BY W. JEAN DODDS, DVM
What we currently know about vaccine safety in the veterinary industry, and a look at some of the technological advances that tackle the issue.
Heightened awareness about vaccine efficacy and safety issues, along with the hesitancy created by vocal “antivaxxers”, have escalated thanks to SARS-CoV-2 and the COVID-19 disease it causes. A subset of the global population still believes that cats and dogs can become infected with SARS-CoV-2 coronavirus mutants and/or can transmit it to others. While vaccines are not innocuous products, recent notable advances in technology offer improved efficacy and safety for both human and veterinary medicine. The following text summarizes the current information and availability of these newer technologies.
THE CORONAVIRUS FAMILY Coronaviruses belong to a large family of related viruses that can infect and cause diseases of the respiratory and gastrointestinal tracts in all mammals and birds. The human strains were first identified in
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the 1960s and cause common colds, which can lead to bronchitis and pneumonia. While these are zoonotic microbes that can jump between species and are transmitted between animals and people, an intermediate host is required, such as the horseshoe bat, pangolin (scaly anteater), dromedary camel, and civet cat. These viruses do not replicate readily in dogs, pigs, chickens or ducks, but do grow readily in wild, zoo and domestic cats, hamsters, ferrets and mink.
CORONAVIRUSES AND COMPANION ANIMALS No current evidence has found that companion animals can be infected with SARS-CoV-2, although a few positive cat and dog cases have been identified in households where a person infected with COVID-19 resides. There is no evidence that pet cats and dogs can infect other animals or humans. No vaccines are currently available for the respiratory coronavirus infection of dogs.
VACCINE HESITANCY AMID COVID -19 Worldwide infection of SARS-CoV-2 and its disease, COVID-19, has focused healthcare professionals and society on the need for safe and effective vaccines. Even with the few reports of clot formation arising from the AstraZenica and Janssen J & J vaccines, investigations by the WHO, CDC and others indicated a very low adverse reaction rate (about 640 per 11.5 million doses given), which falls well within the expected level of vaccinosis events. In the case of the J & J vaccine, clot formation, when it occurred, was linked to people with a congenital Platelet Factor 4 deficiency or other comorbidities. The rapid development and mass production of effective mRNA, adenovirus vectored, and novel DNA vaccines against these mutating coronaviruses has been remarkable. Once the percentage of vaccinated people reaches 80% or more, the remaining population should be protected by what is known as “herd health immunity” — a concept which applies to all vaccinated species. Further, achieving herd health protection should eventually control the development and emergence of newly infective coronavirus variants. However, even some fully vaccinated people can still develop breakthrough COVID-19 infections, albeit usually in a relatively mild and self-limiting form. Novel vaccines to address the recent Omicron SARSCoV-2 variant with its 37 mutations of the spike protein should be available this spring. The estimated duration of protection from the current SARS vaccines is about five to seven months, with boosters recommended for adults and especially those over 65 years of age. Vaccinating dogs with commercial enteric canine coronavirus vaccines cannot provide cross-protection against SARSCoV-2 and the COVID-19 human disease, as the enteric and respiratory canine coronaviruses are different.
BACKGROUND ON VACCINE SAFETY ISSUES Over 50 years ago, Professor Ron Schultz and I were among the few people cautioning against over-vaccinating pets. We were called irresponsible in public because others were unwilling to consider the idea that vaccines might not always be needed or safe. Since then, an understanding of the efficacy and safety issues pertaining to vaccines has become more widespread. Please remember that there really is no such thing as “up to date” or “due” vaccinations. Even today,
only about 40% of veterinarians are estimated as following the current WSAVA (World Small Animal Veterinary Association), AVMA (American Veterinary Medical Association), AAHA (American Animal Hospital Association), CVMA (Canadian Veterinary Medical Association) and BVA (British Veterinary Association) vaccine policy guidelines. While modern vaccine technology has clearly afforded effective protection of companion animals against serious infectious diseases, this advancement brings increased risk of adverse reactions (vaccinosis). Enlightened veterinarians can now offer separated vaccine components, rather than give them all together, since the published data show more adverse reactions when multiple vaccines are administered at the same time.
VACCINE POLICY STATEMENTS American Animal Hospital Association (AAHA), 2003 Current knowledge supports the following statements: “No vaccine is always safe, no vaccine is always protective and no vaccine is always indicated” and “Misunderstanding, misinformation and the conservative nature of our profession have largely slowed adoption of protocols advocating decreased frequency of vaccination.”
World Small Animal Veterinary Association (WSAVA), 2015-2017 From the late Professor Michael J. Day: “Vaccination should be just one part of a holistic preventive healthcare program for pets that is most simply delivered within the framework of an annual health check consultation. Vaccination is an act of veterinary science that should be considered as individualized medicine, tailored for the needs of the individual pet, and delivered as one part of a preventive medicine program in an annual health check visit.”
Millions of people, pets and livestock are vaccinated annually, and documented adverse events are relatively rare, estimated at about three to five events per 100 vaccines given. They occur in animals and people that are genetically predisposed, and can be acute, sub-acute, and delayed for up to 30 to 45 days. New data links these reactions to the integrity and function of
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the gut microbiome. A few reactions are serious, chronically debilitating, and can even be fatal, so we need to balance the benefit: risk equation. As Dr. Schultz has stated, “Be wise and immunize, but immunize wisely!”
CURRENT AND NEW APPROACHES TO VACCINE SAFETY Vaccine adjuvants These compounds act to accelerate, prolong, or enhance antigen-specific immune responses. They are added into vaccines to enhance their immunogenicity, but they also increase the risk of autoimmune and inflammatory adverse events following vaccination. In fact, killed inactivated vaccines containing adjuvants make up about 15% of the veterinary biologicals used, but have been associated with 85% of post-vaccination reactions. On the other hand, while adjuvants have been used safely in human and veterinary medicine for decades, there is increasing worldwide concern about the safety of incorporating thimerosal (mercury) and aluminum salts into vaccines for humans, pets and livestock. The adverse reactions that cause Autoimmune/Inflammatory Syndrome Induced by Adjuvants (ASIA) produce polygenic autoimmunity, especially of the connective tissue, following human papillomavirus and influenza virus vaccinations.
More on heavy metals and vaccinosis Aluminum and mercury salts have been found in the brains of autistic persons, and in vaccine adjuvants that cross the blood-brain barrier after injection, and then persist life-long. There is an urgent need to remove these heavy metals from neonatal and infant vaccines, as these young individuals receive about 17 times more aluminum from vaccines than allowed if doses were adjusted for body weight. Experts now urge that aluminum and mercury not be given in vaccines until after brain maturation (i.e. six to seven months of age, but preferably 12 months). Safer alternatives are available and include calcium phosphate and zinc.
Non-adjuvanted vaccines PureVax (cats) and RecombitTek (dogs) vaccines are non-adjuvanted, although to date there is no licensed non-adjuvanted canine rabies vaccine. Importantly, leptospirosis vaccines are the second most likely to cause adverse hypersensitivity reactions after rabies vaccines; the brand listed above has the only non-adjuvanted canine leptospirosis vaccine.
Half-dose vaccine products Studies published in the early to mid-2000s showed that, for both cats and dogs, vaccine reactions occurred more often in small animals and when multivalent combination vaccine antigens were given together. This author studied small breed adult dogs weighing less than 12 pounds, between the ages of three and nine years, with the pet caregivers’ informed consent. The dogs were healthy, had received no vaccines for at least three years, and were given a half-dose of a two-way canine distemper virus (CDV) and canine parvovirus (CPV) vaccine. Serum antibody titers were measured at one and six months later and compared to pre-vaccine levels. Results showed that the half-dose vaccine provided sustained protective serum antibody titers for all dogs studied.
The ultra-hybrid FVRCP cat vaccine This ultra-hybrid vaccine for cats contains the three-way FVRCP (Feline Rhinotracheitis-Calici-Panleukopenia), which is a combination of modified live and killed virus products. It contains two feline calicivirus strains and induces a crossneutralizing antibody response against multiple FCV isolates obtained from diverse locales across the US. It can be given to kittens eight weeks of age or older, although the duration of immunity has not been determined.
Subunit vaccines Subunit vaccines contain a purified antigen (proteins, polysaccharides or peptides) instead of whole viruses or bacteria. While intuitively this could be safer, as the components only contain recombinant proteins or synthetic peptides, they can actually be less effective. Subunit vaccines usually do not induce side effects at injection sites and are useful for those with a compromised immune system. The disadvantages of subunit vaccines involve their reduced immunogenicity compared to live attenuated or killed inactivated vaccines. They typically require adjuvants to improve immunogenicity, and multiple booster doses are often needed to provide long-term immunity. As these subunit antigens do not infect the cells, the immune response may only be antibody-mediated, and not cell-mediated, to create long-term immune memory. Also, it can be difficult to isolate the specific antigen(s) that will elicit the necessary immune response. Further, a subunit vaccine may lack the pathogen-associated molecular patterns common to a class of pathogen. These associated molecular structures are used by immune cells for danger recognition, and without them, the immune response is less functional.
ALTERNATIVES
TO CURRENT VACCINE PRACTICES •
Measure serum antibody titers. Protection is indicated by a positive titer result, and any measurable antibody level shows protection.
•
Avoid unnecessary vaccines or over-vaccinating.
•
Use caution for vaccinating sick or febrile animals.
•
Tailor specific minimal vaccine protocols for dog/cat breeds or families at risk for adverse reactions.
•
Start vaccination series later (nine to ten weeks in dogs; eight weeks in cats).
•
Alert caregiver to watch puppy/kitten behavior and health after boosters.
•
Avoid revaccination of those with prior adverse events. IVC Spring 2022
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Kennel cough and canine influenza vaccines Oral and intranasal Bordetella vaccines release interferon, which impairs the growth of other respiratory viruses (parainfluenza, adenovirus-2, influenza), whereas an injectable Bordetella vaccine does not release interferon. Intranasal vaccines can cause hypersensitivity reactions, so the newer oral versions are safer and easier to use. But the kennel cough vaccines are not 100% effective. Similarly, canine influenza vaccines (against the highly contagious H3N2 and H3N8 strains) may not be needed as these viruses typically produce short-lived mild clinical signs, like fever and cough. However, when canine influenza is present in dogs harboring Streptococcus spp. in their lungs, 2% to 3% can become seriously infected and die.
VACCINATION, EXPOSURE, AND PROTECTION CDV (canine distemper virus) vaccinates are immediately protected, if exposed simultaneously to the native virus. MLV CDV does not shed appreciably, but despite the safety moratorium on including the highly infectious Rockborn strain of CDV in today’s MLV vaccines, some still contain traces of it to induce a stronger immune response. CPV (canine parvovirus) vaccinates are protected from natural exposure after 48 to 72 hours, and so exposed pups can get sick during that interim. MLV CPV sheds from vaccinated dogs three to 14 days post vaccine, which provides an exposure risk to the unvaccinated or immune-compromised. Shed vaccine CPV is not seen on the Idexx SNAP test, but is present for two weeks on the fecal CPV PCR test, potentially leading to a misdiagnosis of native CPV infection. The latest advances and technologies outlined in this article have gone a long way toward improving vaccine safety while maintaining adequate protection against infectious diseases.
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RABIES CHALLENGE FUND UPDATE Rabies remains a serious and usually fatal disease in many countries, despite the two-decade absence in North America of documented cases of rabies in vaccinated, truly immunized dogs and cats. While most pet dogs are vaccinated for rabies, fewer cats have historically been vaccinated until recent laws required it. The Rabies Challenge Fund research studies have been completed; and the live rabies challenge phase results showed 80% survival of dogs at six-and-a-half years post-rabies vaccination.
REFERENCES D odds, WJ. (2020) Commentary: Vaccine issues revisited, Adv Vaccines & Vaccination Res2(2), 74-77. D odds, WJ, Herman, K (2019). Heavy metals in vaccines. J Am Hol Vet Med Assoc 57: Winter 2019; 16-18. D odds, WJ. (2018) Vaccine issues and the World Small Animal Veterinary Association (WSAVA) Guidelines (2015-2017). Israel J Vet Med 73 (2), 3-10. D odds, WJ. (2016) Rabies virus protection issues and therapy. Glob Vaccines Immunol 1, 51-54. doi:10.15761/GVI.1000115. Dodds, WJ. Larson, LJ, Christine, KL, Schultz, RD. (2020) Duration of immunity after rabies vaccination in dogs: Can J Vet Res 84, 153-158. Ivanovski I, Ivanovski A, Nikolić D, Ivanovski P. (2019) Aluminum in brain tissue in autism. J Trace Elem Med Biol. 51:138-140. doi: 10.1016/j.jtemb.2018.10.013. Lyons-Weiler J, Ricketson R. (2018) Reconsideration of the immunotherapeutic pediatric safe dose levels of aluminum. J Trace Elem Med Biol. 48:67-73. doi: 10.1016/j.jtemb.2018.02.025. Watad A, Bragazzi NL, McGonagle D, Adawi M, et al. (2019). Autoimmune/ inflammatory syndrome induced by adjuvants (ASIA) demonstrates distinct autoimmune and autoinflammatory disease associations according to the adjuvant subtype: Insights from an analysis of 500 cases. Clin Immunol.203:1-8. doi: 10.1016/j.clim.2019.03.007.
PROFITABLE PRACTICE
BOOST PR ACTICE REVENUE WITH VDI WELLNESS TESTING SOLUTIONS THAT GENERATE INCOME WHILE IMPROVING PATIENT HEALTH. VDILAB.COM/WELLNESS-TESTING/
WELLNESS THROUGH VDI Almost every animal that walks into your practice could benefit from blood testing. VDI Wellness Testing focuses on identifying underlying inflammation that could become chronic and serious, nutritional deficiencies, and signs of degenerative joint disease: all common problems that are too often identified late in their development. When detected early, these issues are not always red-flag diagnostics, but more often an alert to areas of concern that may be managed with targeted products. VDI tests provide patient-specific guidelines for recommended products that have been proven safe and effective for these issues.
TEST & TREAT By introducing Test & Treat wellness into your clinic, you are improving the health of your patients and your practice. Current VDI Test & Treat solutions with integrated dosing guidelines appear in the table below. TEST
Product(s) — Manufacturer
Vitamin D
Rx D3, RxD3 Forte – Rx Vitamins for Pets
Vitamin B12 (Cobalamin)
RxB12, RxB12 Forte – Rx Vitamins for Pets
Magnesium
Magnesium Lotion for Pets – MagnumSolace
Hyaluronic Acid (Joint disease)
TrixSyn – Cogent Solutions
VDI offers these tests as a part of various panels for more comprehensive profiles. Common panels include Essential Vitamins, Essential Wellness, and Complete Wellness.
WHAT CLIENTS LOVE Taking action on abnormal test results gives pet parents confidence that they’re making a difference in their animals’ well-being. VDI partners with companies whose synergistic products allow you to manage patient test results. Safe, effective, and proven supplements are crucial revenue generators, with many being used for the life of the pet.
INCOME POTENTIAL Test & Treat wellness panels offer a recurring source of practice revenue for the life of the pet. Initial testing should occur with every wellness checkup, followed by recommended products to improve patient health and prevent disease. Repeat testing gets the cat or dog back in the clinic within the year for follow-up. VDI tests and products are priced for up to 100% margin, with annual/ biannual testing and ongoing supplementation required.
TRAINING REQUIREMENTS Minimum training is required. It’s recommended that staff attend a live webinar with VDI to learn about the tests and products. These are scheduled one-on-one with VDI and the clinic. Pet Parent trifolds are available for in-clinic education for your clients.
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inthenews
BIOMEDICAL RESEARCH MUST EVOLVE INTO THE 21ST CENTURY POTENTIAL SOLUTIONS • We need 21st century science to address 21st century needs. •W e have an arsenal of human biology-based methods that eliminate the need for animal testing. •N on-animal technologies could put an end to enormous suffering for both animals and humans. •W e need to acknowledge that captivity is harmful to animals and that they want and require freedom. •W e must engage in a global reassessment of how, why, and whether we harm other animals. Using animals for biomedical research has long been a source of outrage for those who are against subjecting live creatures to painful and traumatizing experiments. While this form of research has conventionally been deemed necessary by the medical field, advances in science and technology, as well as a growing awareness of the ethical issues surrounding animal experimentation, are spearheading a move towards new approaches. Recently, an esteemed group of eight experts from the fields of medicine, ethics, the sciences, and public health outlined an innovative and revolutionary roadmap to a more ethical research framework for humans and other animals. They covered both existing problems and potential solutions during a virtual panel discussion, “Transforming Medical Research: Advancing Modern, Ethical Methods to Help People and Animals”, hosted by Phoenix Zones Initiative, a non-profit that promotes justice for both humans and animals.
EXISTING ISSUES • Hundreds of millions of animals are used each year for laboratory research. • Animals are targeted because of their vulnerabilities. • Animal welfare failures have completely upended the integrity of science. • Holding animals captive leads to measurable physiological changes in the brain and immune function. • There is unequivocal evidence that animals in captivity that undergo testing suffer extreme trauma.
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•T hose seeking change must recognize that they too are intrinsically part of the problem. • We must abandon the human supremacy and human exceptionalism that informs our attitudes about the use of animals. • We must make a solid commitment to embrace the medical advancements of the 21st century. • We need a Belmont Report for animals (see sidebar). To watch the panel discussion in its entirety, visit www.youtube.com/watch?v=7WFrU9DLB4E or www.facebook. com/PhoenixZones/videos/1093878178081241.
A BELMONT REPORT FOR ANIMALS “Decades of public outrage over unethical human research eventually led to the 1979 publication of the Belmont Report,” says Dr. Hope Ferdowsian, president and CEO of Phoenix Zones Initiative. “As is now the case with humans, animals should be afforded key protections. Animals…overwhelmingly bear the burdens of research despite their inability to provide informed consent or benefit from the research. We need a transformative paradigm shift to bring medical research into the 21st century. We need a Belmont Report for animals.”
TIPS ON HOW TO SUPPORT
GI DISORDERS BY AVA FIRTH, DVM
IN DOGS
Gastrointestinal (GI) disorders are extremely common in dogs. These problems reduce the digestion or absorption of food, and alter its passage through the digestive tract. Commonlydiagnosed canine GI conditions include acute gastroenteritis, colitis, constipation, diarrhea and pancreatitis. Causes of GI disorders can range from eating something other than dog food, allergies/intolerances to certain foods, infections, stress, and lack of digestive enzymes. Symptoms such as vomiting, weakness, flatulence, weight loss, severe diarrhea, constipation, abdominal pain, and loss of appetite are common. These symptoms can lead to dehydration, acid-base and electrolyte imbalances, and even malnutrition.
VITAL TO OVERALL WELLNESS Healthy digestion is essential, enabling dogs to use the nutrients from their food to build and repair tissues and obtain energy. Food can have a significant impact on a dog’s GI tract health. A number of different nutritional approaches are available depending on the specific diagnosis, signs and symptoms.
With the main goal of alleviating symptoms, what is recommended? • Implement a feeding regimen that includes highly-digestible food to help prevent irritation to the sensitive stomach and intestines. The dog’s digestive system was not designed to consume the bulk of ingredients found in dry food. Highly-digestible foods provide a higher level of absorption and nutrient use. Digestibility is an important measure of a food’s nutritional value and quality. • Provide high-soluble and insoluble fiber foods, combined with moderate fat levels, to help support the dog’s intestinal function. High-soluble fiber is essential for healthy bowel movements. it increases stool bulk, guarding against constipation and diarrhea. Insoluble fiber can help dogs lose or maintain body weight by increasing the volume of food consumed without adding calories. Insoluble fiber adds bulk to the stool that stimulates movement within the GI tract, making it helpful in cases of constipation.
• Introduce prebiotics, which are essential to help improve digestion. Nutrients are better absorbed, particularly in the case of minerals. Probiotics also help maintain good gut health by increasing the number of good bacteria in the digestive system. • Monitor hydration to help correct fluid deficiencies. Water is needed to help regulate body temperature, move nutrients throughout the body, release waste/toxins, break down ingested food, and aid in the absorption of nutrients to fully complete the digestive process.
ISOTONIC PREBIOTIC SOLUTION SUPPORTS GI HEALTH DoggyRade Pro checks all the “what is recommended” boxes above to help support GI disorders and other illnesses in dogs: • Oral, ready-to-use, isotonic (quick and complete absorption rehydration solution that helps replenish lost fluids and electrolytes. It’s highly palatable, with an attractive chicken taste and smell. • Fortified with necessary amino acids: glutamine to help prevent and treat stomach and intestinal issues; glycine for restoring a healthy mucosal lining; and glucose, a major source of energy. • Provides essential prebiotics (Fructooligosaccharides) to support gastrointestinal health, maintain gut integrity, and the mucosal barrier. Prebiotics support the growth of probiotics that help keep bad bacteria in the gut under control, while helping to prevent and assist in the cure of GI disorders by improving digestion, hydration, and nutrient absorption, and enhancing the immune system. Dr. Ava Firth received her DVM in 1986 from Ohio State University, and her Master’s degree in Veterinary Science in 1992 from Murdoch University. Currently, she is Director of Research and Development for Tonisity International. She is board-certified by both the American and European Colleges of Veterinary Emergency and Critical Care and a member of the Australian and New Zealand College of Veterinary Scientists.
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nutritionnook
FEEDING
CATS IN
2022
Encouraging your clients to feed their cats the way nature intended helps prevent obesity and other health problems. by Jean Hofve, DVM We heard it all the way through veterinary school: “Cats are not small dogs!” This is especially true when it comes to feeding them. This article looks at the type of diet cats have evolved to eat, feeding problems that lead to obesity and other issues, and how to help keep your feline patients lean and healthy.
DIETARY ADAPTATIONS Let’s review some of the ways cats have evolved to consume their natural diet of prey animals: •T heir teeth are adapted to puncturing and shearing, not chewing. • Feline jaws cannot move side to side. • Their barbed tongues help rasp every last bit of meat from bones. •C ats have specific requirements for taurine, arginine, methionine, cysteine, arachidonic acid, vitamin A, vitamin D, niacin, and vitamin B6. • They can’t convert alpha-linoleic acid into DHA and EPA. • Cats preferentially use protein and fat for energy. • Their protein requirement is two to three times higher than that of dogs. • Cats depend on protein for energy as well as for structural and functional purposes.
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•W hile they can digest and utilize carbohydrates, they are less able to do so than dogs. •C ats cannot up-regulate this utilization, even when dietary carbs are plentiful. •T hey continue to use amino acids for gluconeogenesis, regardless of diet.
BUILD A BETTER MOUSE? Feeding cats a diet that’s as close as possible to what they evolved to eat is just common sense. Of course, science doesn’t rely on common sense, so someone had to do a study about it. At last, the dietary composition preferred by cats has been discovered! It turns out that cats choose foods that most closely mimic their natural prey: about 55% protein, 40% fat, and 5% carbohydrate on a dry matter basis. This is approximately the same composition as a can of kitten food, or a well-formulated homemade or raw diet. It is also closely in line with the diet of feral cats. Nevertheless, despite our best efforts, there is no way we can actually recreate a mouse, because one very crucial part is missing: blood. Blood is made up of plasma, red blood cells, white blood cells, and platelets. Red blood cells are high in protein, iron, and lipids. Plasma is mostly water, but the solid portion comprises proteins such as albumin,
globulins, and clotting factors; amino acids like taurine and lysine; and 1% mineral salts, sugars, fats, hormones, and vitamins. When a cat kills a mouse, she eats the whole thing, including the blood. When an animal is slaughtered for consumption, the first thing that happens is that the blood is drained out of the carcass. The blood is retained, dried, and used for various purposes, such as fertilizer or feed for fish, poultry, and cattle. But by then, it has lost its energetic life force, and is no more than a protein supplement. There is just no way to recapture that lost vitality.
Several factors combine to thwart our goals for healthy cats:
DECREASED METABOLIC NEED AFTER NEUTERING It’s estimated that neutered adults need 25% to 30% fewer calories than intact cats. Those hormones preserve lean muscle and keep activity high. Add to this a less-than-stimulating environment, and there’s the recipe for a fat cat! Environmental enrichment, interactive play, and reduced overall caloric intake (starting around six months of age) will help keep cats mentally and physically fit.
EXCESS CARBOHYDRATES Most dry cat foods are 30% to 50% carbohydrate. Cats have zero physiologic need for carbs. Dietary carbohydrate that is not stored as muscle glycogen or used for immediate energy needs is stored as fat. High-fiber weight loss diets increase dehydration and reduce protein digestibility. The loss of lean body mass and reduced basal metabolic rate that occurs with weight loss make it more likely the cat will stop losing weight — or even regain it — even on the same reduced-calorie food.
“CHONKY CATS” – NOT CUTE, NOT FUNNY
CONSTANT FOOD AVAILABILITY
“Chonky” cats have become quite popular on social media. The latest estimate is that 60% of adult cats are overweight or obese. This can lead to many serious conditions such as arthritis, chronic vomiting and/or diarrhea, allergies, diabetes, skin disease, feline lower urinary tract signs (LUTS), hepatic lipidosis, cancer, and immune system, heart, liver and kidney issues. Preventing obesity is much easier than treating it. It’s on us, as veterinarians, to help our clients get their kittens off to a good start and keep their adult cats on the right track.
Cats are not — and should not be — grazing animals. Too many people not only feed dry food, but leave it out around the clock, every day. A hunting cat will kill eight or nine mice in a 24-hour period, so multiple small meals makes some sense. But cats who are allowed constant access to dry food eat 15 to 20 times per day. Pet food manufacturers are very good at making those blah kibbles irresistible by spraying them with fat and animal digest (often called “natural flavor” on labels). So cats keep eating, and eating.
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ISSUES FOR 2022: SUSTAINABILITY The pet food industry uses the leftovers and wastes of human food processing to create many of the products our clients buy and feed to their cats. This is actually a plus for sustainability. It effectively “recycles” the 30% to 50% of every food animal that people don’t eat. About half of every cow, and more than a third of the live weight of every pig and chicken, go unconsumed. Using non-human-edible animal parts for pet food seems more sustainable. However, most analyses of pet food sustainability do not consider other important factors. One is pet waste. Cats and dogs eating a raw meat-based, highly-digestible diet produce much less fecal waste. They are also healthier, and therefore less likely to be given pharmaceuticals that can end up in groundwater. People who are conscientiously eating and feeding sustainably and regeneratively farmed meats and plants are mitigating the pollution and other negative effects of factory farming. Plant products are not necessarily as earth friendly as pet food makers want you to think. Corn and rice use tremendous amounts of fresh water. The machinery used for growing and harvesting crops depends on fossil fuel. Agricultural chemicals are harmful to the environment. While many of us avoid GMOs, the herbicide glyphosate (the main ingredient in Roundup®) is sprayed on many non-GMO crops to dry them out and make for a more uniform harvest. Legumes, potatoes, and other plants commonly used in pet foods are more heavily contaminated with glyphosate than GMO products themselves. (Legumes and potatoes…why does that ring a bell? Oh yes, those were the exact products the FDA wrongly suggested were causing dilated cardiomyopathy! Glyphosate,
KEEPING CATS LEAN AND HEALTHY Feed high-protein, high-moisture, very low-carbohydrate food, and eliminate dry food. A balanced homemade or commercial raw diet are best for clients who are able to go that route. Reconstituted freeze-dried and dehydrated foods are also good, but watch the carbs! One very popular
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meanwhile, has negative impacts on the microbiome…could that be the link they were looking for?) There are two alternative proteins on the horizon that may help make healthy, species-appropriate cat food more available and sustainable.
INSECT PROTEINS Cats eat bugs. Sometimes they eat a lot of bugs. Insects, particularly insect larvae (grubs) are quite nutritious. Insects produce a lot of protein in far less space, and at far less cost in resources, than factory-farmed cows. Crickets and ants are even high in taurine, which may help reduce reliance on the synthetic taurine currently added to cat foods. Many pet foods and treats featuring insect proteins are already on the market. Currently, only black soldier fly larvae (Hermetia illucens) are legal in pet food, and then only in dog food. But that’s not stopping dozens of companies from using them in cat food, as well as crickets and other grubs in many other pet products.
CULTURED MEAT Most people, when asked about lab-grown meat, respond with “eww!” But there are many advantages, from the immense reduction in resources used to grow it, to the complete absence of factory farms and animal slaughter. How healthy it is will depend on the original animals the cells are harvested from, and what goes into the culture medium that grows it. But it’s easy to foresee completely organic, environmentally-safe, pathogenfree meat in our cats’ bowls. As a common food, it’s likely years in the future, but at least one company plans to release its first cultured meat pet foods this year.
dehydrated diet clocks in at more than 47% carbohydrate! For many clients, canned foods are a reasonable substitute, especially if digestive enzymes and probiotics are added. Cats on a high-protein, low-carb diet — similar in composition to prey — are less liable to gain excess weight. If they need to lose weight, such a diet helps them retain lean body mass.
Feed in timed meals; if possible, feed more small meals. Food should be provided for 30 to 60 minutes at a time, and removed at all other times. Most people can accommodate a three-meal-a-day schedule for their cats: morning, after school or work, and before bed. A good interactive play session followed by the evening meal also helps cats who tend to get the 4am zoomies or want breakfast at the crack of dawn to sleep through the night. Cats figure out the schedule very quickly. You can also reassure people that their cats will not starve if they are late coming home from work. Educating clients about the type of diet cats have evolved to eat, and recommending ways for them to provide high-protein, low-carb foods, will provide a great service to your overweight feline patients, while helping keep lean ones healthy throughout their lives.
References Cammack NR, Yamka RM, Adams VJ. Low number of owner-reported suspected transmission of foodborne pathogens from raw meat-based diets fed to dogs and/or cats. Frontiers in Veterinary Science. 2021 Oct 12. https://doi.org/10.3389/fvets.2021.741575. De-Oliveira LD, Carciofi AC, Oliveira MC, et al. Effects of six carbohydrate sources on diet digestibility and postprandial glucose and insulin responses in cats. Journal of Animal Science. 2008;86:2237–2246.
From the VMAA The Veterinary Medical Aromatherapy® Association (VMAA) is an organization of veterinarians and veterinary technicians dedicated to the responsible use of aromatherapy in animal practices. Their mission is to promote standards of excellence in animal aromatherapy, to provide outreach and education to veterinarians and auxiliary animal practices, and to promote continual improvements in Veterinary Medical Aromatherapy®. The VMAA is elevating the veterinary profession through innovation, education, and advocacy of integrative medicine.
USING ESSENTIAL OILS SAFELY When using essential oils with animals, adhering to some basic safety tenets is important to ensure appropriate and predictable outcomes. While there are many guidelines to consider, here are four starting points.
1. QUALITY The first safety consideration should be the QUALITY of the essential oil. Production of essential oils is basically unregulated in the United States, and labeling follows FDA guidelines for cosmetics or supplements. So it is critical to research the source/company making the essential oil and know about their safety and testing standards.
2. QUANTITY
Dunham-Cheatham SM, Klingler KB, Estrada MV, et al. Using a next-generation sequencing approach to DNA metabarcoding for identification of adulteration and potential sources of mercury in commercial cat and dog foods. Science of the Total Environment. 2021 July 15;778, 146102.
Understanding the QUANTITY of essential oil to be used for a given situation also affects results. Should the chosen oil be diluted or applied neat?
Eyre R, Trehiou, Marshall E, et al. Aging cats prefer warm food. Journal of Veterinary Behavior. 2022; 47:86–92.
3. FREQUENCY AND METHOD OF APPLICATION
Glasgow AG, Cave NJ, Marks SL, et al. Role of diet in the health of the feline intestinal tract and in inflammatory bowel disease. Center for Companion Animal Health, University of California at Davis. 2002.
Hand MS, Thatcher CD, Remillard RL, et al. (eds.) Small Animal Clinical Nutrition, 5th Edition. Topeka KS: Mark Morris Assoc. 2010.
Another consideration involves the FREQUENCY of use and the METHOD of application. How often a oil should be used will differ depending on whether it’s administered via inhalation, topically, or orally. As veterinarians using essential oils in practice, education and experience help make these decisions. Effective communication and teaching clients these principles will benefit the animals in our care.
Hewson-Hughes AK, Hewson-Hughes VL, Miller AT, et al. Geometric analysis of macronutrient selection in the adult domestic cat, felis catus. Journal of Experimental Biology. 2011; 214:1039–1051.
4. ACCURACY OF BOTANICAL NAME ON LABELS
Hamper BA, Bartges JW, Kirk CA. Evaluation of two raw diets vs a commercial cooked diet on feline growth. Journal of Feline Medicine and Surgery. 2016; 19:424–434.
Hoenig M, Thomaseth K, Waldron M, et al. Insulin sensitivity, fat distribution, and adipocytokine response to different diets in lean and obese cats before and after weight loss. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology Physiology. 2007; 292:R227–R234. Hu J, Lesseur C, Miao Y, et al. Low-dose exposure of glyphosate-based herbicides disrupt the urine metabolome and its interaction with gut microbiota. Scientific Reports. 2021; 11:3265. https://doi. org/10.1038/s41598-021-82552-2. Kangas KB. Glyphosate toxins. Presentation 10/18/21, Holistic Actions for Companion Animals.
A final safety consideration is that the BOTANICAL NAME should match what is labeled on the bottle. Lavender oil (Lavandula angustifolia) is often used post-surgery for its skin-healing properties (see photos). If a bottle labeled lavender actually contains lavandin, a hybrid that is chemically different, the outcome will not be the same. Lavandin contains more camphor, which can be caustic to the skin. Photos courtesy of Dr. John Hanover, Cary, Ill.
Kitai T, Kirsop J, Tang WH. Exploring the Microbiome in Heart Failure. Current Heart Failure Reports. 2016; 13(2):103-109. doi:10.1007/s11897-016-0285-9. Mamic P, Chaikijurajai T, Tang WHW. Gut microbiome - A potential mediator of pathogenesis in heart failure and its comorbidities: State-of-the-art review. Journal of Molecular and Cellular Cardiology. 2021; 152:105-117. https://doi.org/10.1016/j.yjmcc.2020.12.001. McCusker S, Buff PR, Yu Z, Fascetti AJ. Amino acid content of selected plant, algae and insect species: a search for alternative protein sources for use in pet foods. Journal of Nutritional Science. 2014;3:e39. Published 2014 Sep 30. doi:10.1017/jns.2014.33 Plantinga EA, Bosch G, Hendriks WH. Estimation of the dietary nutrient profile of free-roaming feral cats: Possible implications for nutrition of domestic cats. British Journal of Nutrition. 2011; 106:S35–S48. Wall M, Cave NJ, Vallee E. Owner and cat-related risk factors for feline overweight or obesity. Frontiers in Veterinary Science. 2019 Aug12; https://doi.org/10.3389/fvets.2019.00266. A three-year-old Quarter Horse post-op. Quality Six weeks later, the patient had returned to full work. lavender oil (Lavandula angustifolia) was generously applied neat twice a day to the entire suture line and surrounding area for four weeks.
Submitted by Susan Albright, DVM IVC Spring 2022
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MINDFUL
COMMUNICATION IN VETERINARY PRACTICE BY BETHANIE POE, LMSW, PHD
Helping your veterinary clients feel heard and understood improves communication and relationships, and resolves conflicts.
T
he veterinary setting has always been a prime area for communication challenges. While it’s tempting to focus on the cute puppies and kittens coming in for their first vaccinations, the reality is that veterinary teams are often faced with intense conversations with clients about difficult medical treatment decisions, financial considerations, and the need for euthanasia. The pandemic has compounded these issues. Like many businesses, veterinary clinics have found themselves swimming in a sea of uncertainty among community shutdowns, changing regulations, and staffing shortages. At the same time, according to the American Society for the Prevention of Cruelty to Animals (ASPCA), more than 23 million U.S. households have adopted pets during the pandemic, leading to higher demand for veterinary services. Now, in year three of the pandemic, clinic schedules remain packed and both staff and clients are experiencing high levels of stress, making the need for clear communication more important than ever.
WHAT'S HAPPENING IN THE BRAIN While it is tempting to focus only on what is coming out of our mouths when we talk about communication, we first need to understand what is going on in the brain. Dr. Dan Siegel has a great way of talking about how the brain works in high stress situations.
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It’s called “The Hand Model of the Brain” (Siegel, D. “Minding the Brain”. https://www.psychalive.org/ minding-the-brain-by-daniel-siegel-m-d-2/). Hold up your hand, palm facing out. Tuck in your thumb towards your palm, and then bring down the remaining fingers to cover your thumb. Now you have a general model of your brain! Your fingers represent the front of your brain which is an area called the prefrontal cortex, while your thumb and wrist represent the interior parts of the brain such as the limbic system and brain stem. The prefrontal cortex allows us to think critically, make logical decisions, and have emotional regulation, while the limbic system and brain stem have more to do with emotions and instinctual responses. This is important because it turns out that the prefrontal cortex is sensitive, and when it gets overwhelmed, it does what Dr. Siegel calls “flips its lid” (quickly straighten out your fingers), giving over control to our more emotional and instinctual impulses. In some situations, this is critical for survival. If you find yourself being physically attacked, you don’t want to ponder the most logical solution, you want to save yourself as quickly as possible! However, when the stressor is a challenging or difficult conversation,
“flipping our lid” is more likely to lead to emotional outbursts, or not being able to speak at all, rather than effective communication. To keep our “lids” where we need them to be, we must first take care of ourselves. While it seems like everyone is touting the benefits of self-care, taking time for oneself can feel like an additional burden when our schedules are already so full. Maintaining healthy eating habits can help us keep our cool. While the advertisers of Snickers didn’t have it exactly right — you are still you when you are hungry — you probably aren’t performing at your best. Hunger can lead to low blood sugar, which can cause fatigue, sleepiness, difficulty concentrating, and poor coordination. It can also lead to a release of cortisol and adrenaline, which can contribute to feeling “hangry” (hungry + angry) when faced with stressors or irritations. While it may feel like you don’t have the time or energy to plan ahead, making time for healthy meals and snacks throughout the day can help keep your mood stable and your energy up. Similar issues arise with a lack of restful sleep. In addition to being associated with potentially serious medical conditions, like high blood pressure, heart disease, and stroke, being sleepdeprived can also contribute to feelings of irritability, problems with memory, an inability to concentrate, and a depressed mood. It’s obvious that if you’re tired, irritable, and having trouble focusing on the situation at hand, your ability to communicate will be impaired. Turning off screens at least an hour before bed, listening to a calming podcast or music, or reading a book, are some things you can add to your routine to help lead you to better sleep. If you have concerns about the amount or quality of your sleep, please consult your medical provider. By maintaining a healthy body and brain, we’re better preparing ourselves to cope with challenging communication scenarios.
NONVERBAL COMMUNICATION Communication goes beyond the words you use. A significant portion of our communication is nonverbal, although there’s some disagreement about the exact percentage.
Tone of voice: The entire meaning of a sentence can change based on the tone of voice and inflection you use. For example, can you remember when you were a child and an adult called out your name? Could you tell when you were about to get in trouble? Of course you could! There was something about the way the adult said your name that let you know there was a problem. Make sure your tone of voice matches whatever message you’re trying IVC Spring 2022
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SETTING BOUNDARIES Healthy communication includes maintaining healthy boundaries. While we have no control over what anyone else will say or do, we do have some control over what we will tolerate from others. In the veterinary setting, establishing boundaries about time and behavior are common needs. For clients who call or show up at the veterinary hospital excessively, setting a boundary may look like establishing specific times when the veterinarian will call to discuss the animal’s progress, or blocks of time when the client can visit with their animal. For example: “Mrs. Jones, Dr. Smith will call you sometime between 2 pm and 4 pm to talk to you for up to 30 minutes about how your dog is doing.” If the client calls outside the appointed time, unless it’s an emergency, have staff take a message and tell the client that their concern will be addressed during the scheduled call. If you are not able to keep that appointment, be sure someone contacts the client to let them know. Boundaries of this nature can be negotiated — maybe the client would rather have two shorter calls rather than one long one — but the important thing is that a boundary is set, and the needs of the client and clinic are balanced. Many veterinary clinics have had experiences with clients becoming verbally abusive towards the staff. Verbal abuse can consist of yelling, cursing, calling people names, or even threatening them. Acknowledge what the person is feeling and set a boundary: “Mr. Jones, I can tell you’re angry, but I am not going to let you talk to me that way. If you wish to continue this conversation, I need you to lower your voice.” If the client will not do so, it is appropriate to ask them to leave. The conversation can be picked up at a different time, or other resources may be offered.
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to convey to the other person. If we want people to remain calm, we need to speak calmly, which means regulating the tone and volume of our voices and the speed of our speech.
Facial expressions: We also receive a great deal of information from the facial expressions of the person we are talking to. This has presented a challenge during the pandemic, since we need to wear masks that cover the nose and mouth when we’re in public places. Not only is it a hindrance for those who rely on reading lips to help them determine what people are saying, but we’re now limited to the upper portion of the face, which provides more subtle expressive cues. Many people lack awareness of their facial expressions when they’re talking. Particularly over a mask, those slightly bent eyebrows or furrowed forehead may now be interpreted as anger or grumpiness when people can’t see your mouth. Do you know what your face does when you speak? Stand in front of a mirror and pretend you’re having a conversation. Does your facial expression correspond with the message you are trying to convey? It may feel silly, but an awareness of your facial expressions is the first step to being able to adjust them if needed.
Body language: In addition to tone of voice and facial expressions, we also communicate a great deal with our body language, particularly through gestures and posture. While gestures can be helpful to convey information — location, size, or emphasis — when we’re in a stressful conversation or conflict, we want to keep our gestures calming and neutral. Avoid sudden, large movements and keep your hands near the mid-portion of your body. Your posture can also be interpreted in a variety of ways. While it may simply be comfortable to you, having your arms crossed may give the impression that you are defensive or closed-off.
Standing with your hands on your hips can be seen as being scolding or stubborn. Particularly in times of conflict, aim to keep an open posture. Keeping your hands either at mid-waist or down at your sides conveys that you are relaxed and open to listening.
BEING HEARD AND UNDERSTOOD When we communicate with one another, we want to feel as though our message has been heard and understood. Use active listening skills to help make that happen.
1. Paying attention: Show you’re paying attention by making eye contact, and occasionally nodding your head when appropriate. Don’t interrupt, and pause before answering. Often, we start planning our response before the person has even stopped talking. Listen to understand, not to respond.
2. Reflecting: Repeat back what you heard the person say. For example, if a client is debating treatment options because they have concerns about cost and their animal’s quality of life, you might say something like, “I’m hearing that you’re worried about how much this treatment will cost, and you’re not sure your dog will be able to do the things he loves to do, like go for walks in the park. Is that right?” By reflecting what the client said, you’re showing that you heard them, and also giving them the opportunity to confirm that you have it right, or to correct you if it is not what they meant. For example, “Yes, I am worried about how I will pay for this, but I’m more worried about how much pain my pet will be in.”
3. Clarifying:
If you’re not sure what the other person in the conversation is saying, use clarifying questions or statements such as, “Let me make sure I understood correctly. Are you saying that you’re worried about your dog’s quality of life?”; “Tell me more about that”; or “Can you explain that a little more?” Not only do these open-ended questions help you get more information, but they also show you’re interested and paying attention to what the person is saying.
HOW YOU'RE SAYING IT Just as it’s hard for you to communicate when you’ve “flipped your lid”, this is also true for your clients. If they are stressed, scared, or angry, it is going to be harder for them to focus and understand what you’re saying. Keep your language simple. Medical terminology can be confusing for a layperson on a normal day; during a crisis, it may be overwhelming. Remember, stress is contagious so make an effort to speak slowly and calmly. Stress affects focus and memory. Give clients written materials that reinforce what you’ve told them, so they can review the material later or schedule a follow-up call to go over it again and ask any questions. Ask clients to reflect back to you what you said. “I want to make sure I explained this clearly. Can you tell me how many times a day you will need to give this medicine?” It takes time and effort to connect with people, but helping them feel heard and understood is the first step to resolving conflicts and improving professional-client relationships. By communicating clearly, we can create a better work environment, and better outcomes for animals.
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goodnews
Record-Breaking Increase in Veterinary School Applications For veterinary practices struggling with staff shortages and increased workloads caused by the pandemic, relief is on the horizon. According to the Association of American Veterinary Medical Colleges (AAVMC), veterinary school applications have increased by 5.5% across the country for the 2021-2022 school year. The latest admissions cycle, which closed September 29, 2021, saw a record 10,834 applicants seeking enrollment this year. The Veterinary Medical College Applications Service (VMCAS) has additionally reported that students applied to an average of 5.37 different veterinary schools. With the exception of Texas A&M, all U.S. veterinary colleges vet their student applications through VMCAS. To accommodate the record increase in veterinary school applicants, 24 industry leaders have called on the American Veterinary Medical Association (AVMA) to support an increase in veterinary college class sizes, and to back other initiatives to alleviate what they have called an “acute and growing” workforce crisis, according to an open letter sent to the AVMA board of directors. Photo courtesy of VERG.
Practices such as Veterinary Emergency Referral Group (VERG), a 24-hour specialty and emergency veterinary hospital in Brooklyn, NY, welcome the new interest in veterinary employment. VERG hired 16 new employees since November 2021, and finds the new additions not only help handle the higher demand for veterinary care but also protect the team from burnout.
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GLANDULAR THERAPIES
FOR PETS BY LAURA B. GAYLORD, DVM, DACVIM (NUTRITION) & DONNA M. RADITIC, DVM, CVA, DACVIM (NUTRITION)
Glandular therapy is a medical practice with roots in traditional medicine. It originates from thousands of years of accumulated experience. Also known as organotherapy, tissue therapy, or cell therapy, glandular therapies are characterized by the use of animal tissues to produce biological effects. Whole animal tissues, organs, or special extracts are used to support, repair, or manage early functional health problems. Organ tissues are utilized for their effects on the patient’s corresponding organ tissues, in hopes of achieving beneficial physiologic changes and healing. In essence, the goal is “like heals like.”
from one species to another. Freeze-drying, however, regulates sterility while allowing preservation of cell materials for a longer time. The use of freeze-dried cell ultrafiltrates also removes potential antigenic cell surface material and allows for better quality control.6 The humane treatment of animals is paramount when tissues from one donor species are used to treat another.
ANCIENT USE OF GLANDULAR THERAPY
• Low-dose hormones
Ancient Egyptian medicine and Ayurvedic writings from several hundred years B.C. mention the therapeutic use of animal tissues and glandular materials.1 Glandular therapies then evolved into what would be considered scientific endocrinology in the 19th century; the dramatic healing of a patient suffering from severely low thyroid function (myxomatous edema), using a glandular extract of thyroid tissues, was documented with much enthusiam.3 As glandular therapy gained increased acceptance in mainstream medicine, it became termed “organotherapy”. Crude extracts and whole gland concentrates were developed in the 1920s and 30s, with more reputable supply companies and the clinical use of glandular materials described more extensively in scientific literature.4 Cell therapies consisting of injections of fresh animal cells into patients also emerged in the mid-20th century.2,5
TREATMENT FOR DOGS AND CATS Veterinarians have been using glandular therapies in dogs and cats for decades. Oral freeze-dried concentrates of liver, kidney, heart, and other tissues have been used to treat and manage degenerative conditions with some success. However, this area of veterinary medicine needs further exploration to document efficacy. Some concerns have arisen as to whether whole glandular or live cell therapies might transmit infectious disease, including viruses,
Glandular tissues may provide a source of bioactive compounds, such as the following, which are capable of delivering clinically beneficial effects: • Peptide hormones • Lipids, steroids, and fat-soluble compounds • Pancreatic and other glandular enzymes Glandular tissues may also play a role in modulating the immune system. Ingested proteins may act as antigens by the gut-associated lymphoid tissues (GALT) to help establish oral tolerance. Promoting oral tolerance helps inhibit autoimmunity. Glandular tissues may contain small proteins or peptides that directly or indirectly promote oral tolerance and a balanced immune response. Glandular therapy may be an untapped medical approach for animals and humans alike, although further study is needed to understand its potential benefits. It has a long history of use for a wide variety of health conditions. Glandular therapies may be a rich source of bioactive ingredients, including lipids, steroids, and enzymes. Dr. Laura B. Gaylord is a Board Certified Veterinary Nutritionist and a Diplomat of the American College of Veterinary Internal Medicine (subspecialty Nutrition). She is the owner/founder of Whole Pet Provisions, PLLC, a nutrition consulting company. Dr. Gaylord has been a general practitioner in North Carolina for over 24 years and is a consultant member of Veterinary Nutritional Consultations, Inc. She offers recipes and consultations to pet parents and their vets through PetDiets.com. Dr. Donna M. Raditic is a graduate of Cornell University College of Veterinary Medicine and Board Certified Veterinary Nutritionist (subspecialty Nutrition). She was a professor for both Nutrition and Integrative Medicine Services at the University of Tennessee College of Veterinary Medicine. Dr. Raditic is a member of Nutrition and Integrative Medicine Consultants, Inc. Her career includes being a general practitioner, veterinary nutritionist, academician, and consultant.
Harrower H. Practical Hormone Therapy - a manual of organotherapy for general practitioners. American Medical. 1916. 2Uhlenbruck P. Introduction In: Schmid. Cell research and cellular therapy. Switzerland: Thourne; 1967. 3Schwartz TB. Henry Harrower and the turbulent beginnings of endocrinology. Ann Intern Med. 1999;131(9):702-6. 4Schoen AM WS. Complementary and Alternative Veterinary Medicine. Mosby; 1998. p. 81-91. 5IM P. Cell Therapy. Journal of International Academy of Preventative Medicine. 1977;3:74. 6Allen T, Solorzano H. Cell therapy. In: Alternative medicine: the definitive guide, Purallup, Wash, 1993, Future Medicine. 1
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How acupuncture points correlate to spots of neurogenic inflammation BY CHERYL A. CROSS, DVM, DACVP
Study indicates that areas of superficial inflammation in animals frequently overlap with acupoints traditionally associated with the relevant disease, and that acupuncture can significantly improve symptoms.
Classic canons of indigenous Chinese medicine, compiled over 2,000 years ago, explained that pathologic changes inside the body are reflected on its surface.1 Scholars and practitioners subsequently continued to examine the influence and interplay of the interior and superficial topographical areas in health and disease, creating foundations upon which current acupuncture point (acupoint) atlases are based.2
THE AUTHOR’S RESEARCH In the early days of my acupuncture education, I attempted to reframe the complex and sometimes esoteric historical perspectives of diagnosis and treatment by finding answers in more familiar territory — scouring medical physiology texts and contemporary research articles. The dynamic nature of acupoints transformed from quiescent to active by a wide variety of physiologic stressors began to emerge. The inflammatory soup of neurogenic inflammation created by release of bioactive substances from excited superficial peripheral afferent nociceptors explained the changes in sensitivity, temperature, color, and texture noted 32
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on examination of some acupoints. 3-6 The neighboring position of somatic and visceral afferent cell bodies in dorsal root ganglia, and convergence of their fibers on a common higher order sensory neuron in the spinal cord, not only clarified the origin of referred pain accepted in allopathic medicine (such as when myocardial infarction presents as shoulder or arm pain), but also clarified a connection between viscera and acupoints.7 However, conflicting or contradictory conclusions were made by randomized clinical trials and systematic reviews, ranging from strong support, to noting similar outcomes when acupoints or non-acupoints were treated (sham acupuncture), to the attribution of any benefits to a placebo effect.8-12 As the criteria for the acupoints studied often varied widely, I was left with core questions about the significance of selection: would patient outcomes improve by selecting acupoints that were both sensitized and symptom-indicated? Fortunately, I recently found a unique study that helped clarify some of my questions.13 A brief summary highlighting key findings follows.
ACUPOINTS AND CUTANEOUS INFLAMMATION — A STUDY In “Acupuncture points can be identified as cutaneous neurogenic inflammatory spots”, researchers documented the development of sensitive cutaneous spots (which the study’s authors call “neurogenic spots”) by administering Evans Blue Dye (EBD) to rodents with stressinduced hypertension and colitis. EBD is highly protein bound and leaves a visible blue stain as it extravasates into tissue in areas with increased vascular permeability.14
• In the colitis model, neurogenic spots appeared primarily on the hind limb, with 70% of spots consistent with acupoints on the Spleen and Stomach channels (often used in acupuncture for gastrointestinal disorders). Rats receiving daily acupuncture on neurogenic spots overlying symptom-indicated acupoints had significant weight gain, faster resolution of diarrhea, and less biochemical and histologic evidence of colonic inflammation when compared to controls or when acupuncture was performed over an area 3 mm to 5 mm away which did not accumulate dye.
Stained spots were quantified, their positions crossreferenced with accepted acupoints, and examined via immunohistochemistry. Neurogenic spots had marked increases in CGRP and Substance P (hallmarks of neurogenic inflammation), mechanical hypersensitivity, and electrical conductance.
• Lastly, in the hypertensive rodents, retrograde dye markers injected into a carpal neurogenic spot and the apex of the heart showed double staining of neuron soma in dorsal root ganglia, indicating the convergence of visceral and somatic afferents on the same sensory neuron.
• In the rodents with stress-induced hypertension, neurogenic spots formed predominantly around the palmar side of the carpus/wrist, and 67% overlapped with traditional acupoint locations on the Heart and Pericardium channels (often used in cardiovascular presentations including stress and hypertension). Acupuncture treatment on neurogenic spots that overlapped with accepted acupoints blocked the elevation of blood pressure but had no effect when performed on non-acupoints stained by EBD, or unstained adjacent acupoints.
In summary, this study found that stress-induced hypertension and colitis produced hypersensitive cutaneous spots that frequently overlapped with acupoints traditionally indicated for the associated underlying disease, and acupuncture treatment significantly improved symptoms. It also suggests that patient outcomes may be improved in general if acupoints selected for treatment have both evidence of neurogenic inflammation (such as tenderness and hyperemia) and are traditionally and/or have evidence-based indications for inclusion based on underlying symptoms or organs involved. and/or have evidence-based indications for inclusion based on underlying symptoms or organs involved.
1
X. Y. Zhang and L. G. Ma, The Yellow Emperor’s Canon of Internal Medicine-Miraculous Pivot, Sichuan Science and Technology Press, Chengdu, China, 2008.
10
A. White, E. Ernst, A brief history of acupuncture. Rheum. 2004; 43(5):662–663.doi.org/10.1093/ rheumatology/keg005
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Zhang JH, Wang D, Liu M. Overview of systematic reviews and meta-analyses of acupuncture for stroke. Neuroepidemiology. 2014;42(1):50-58. doi:10.1159/000355435 3
Wu XK, Stener-Victorin E, Kuang HY, et al. Effect of Acupuncture and Clomiphene in Chinese Women With Polycystic Ovary Syndrome: A Randomized Clinical Trial. JAMA. 2017;317(24):2502-2514. doi:10.1001/ jama.2017.7217 Selva Olid A, Martínez Zapata MJ, Solà I, Stojanovic Z, Uriona Tuma SM, Bonfill Cosp X. Efficacy and Safety of Needle Acupuncture for Treating Gynecologic and Obstetric Disorders: An Overview. Med Acupunct. 2013;25(6):386-397. doi:10.1089/acu.2013.0976 W. He, M. Wu, X. H. Jing, W. Bai, B. Zhu, and X. Yu, Entity of acupoint: kinetic changes of acupoints in histocytochemistry. Zhongguo Zhen Jiu. 2015;35(11):1181-1186.
4
B. Zhu, Systems Acu-Medicine: The Revival of Body Surface Medicine, People’s Medical Publishing House, Beijing, China, 2015.
12
X. C. Yu, B. Zhu, J. H. Gao et al., Scientific basis for dynamic process of acupoints. J Tradit Chin Med. 2007;48(11):971–973.
13
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B. Zhu, The plasticity of acupoint. Zhongguo Zhen Jiu. 2015;35(11):1203-1208. Wesselmann U, Lai J. Mechanisms of referred visceral pain: uterine inflammation in the adult virgin rat results in neurogenic plasma extravasation in the skin. Pain. 1997;73:309–317. doi: 10.1016/S0304-3959(97)00112-7. 6 7
Kim, DH., Ryu, Y., Hahm, D.H. et al. Acupuncture points can be identified as cutaneous neurogenic inflammatory spots. Sci Rep. 2017; 7:15214. https://doi.org/10.1038/s41598-017-14359-z 14 Wesselmann U, Lai J. Mechanisms of referred visceral pain: uterine inflammation in the adult virgin rat results in neurogenic plasma extravasation in the skin. Pain. 1997;73:309–317. doi: 10.1016/S0304-3959(97)00112-7.
Linde K, Streng A, Jürgens S, et al. Acupuncture for patients with migraine: a randomized controlled trial. JAMA. 2005;293(17):2118-2125. doi:10.1001/jama.293.17.2118 8
Hinman RS, McCrory P, Pirotta M, et al. Acupuncture for chronic knee pain: a randomized clinical trial. JAMA. 2014;312(13):1313-1322. doi:10.1001/jama.2014.12660 9
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CHOOSING SAFE CHEWS Evading foreign body obstructions and other chew hazards. By Tavor White
This article is the second pre-publication preview (first article: https://ivcjournal.com/ how-much-a-dog-can-bite-off-and-chew/) of a recently-completed, pre-peer review seminal dog chew safety/efficacy study. “Hold on with a bulldog grip, and chew and choke as much as possible” — Abraham Lincoln’s advice to his generals. Unfortunately, his guidance describes many dogs’ chew experience.
A PROFUSION OF DOG CHEW CASUALTIES Most of the 64 million U.S. dog households offer chews to their 90 million dogs. A survey of four studies (Table 1) provides an estimate of annual U.S. chew casualties (Figure 1): 21,000 esophageal obstructions, an associated 393 fatalities, and millions of gingival lesions. There are doubtless many casualties that never make it to the ER and are outside the USA. Additionally, another study found that hard, durable chews provide significant dental health benefits (Table 1, Study 5).
ASSESSING CHEW SAFETY As reported in the last issue of IVC Journal (Winter 21/22), we found that although
many chews claim high digestibility and longevity, most are not safe or durable. As such, they are essentially falsifying claims. While serious dog chew casualties are uncommon, there are a significant number of victims and less severe chew wounds are commonplace. You would not give your child a snack that was not digestibly degradable, and/or might fragment into sharp shards, would you? Of course not!
Figure 1: Estimated Annual Dog Casualties Due to Chews
Figure 2: Chew Safety Index Vs. Chew Durability Proxy for Chews Tested
We developed two composite safety and dura-bility metrics: Chew Safety Index (CSI), a relative measure of digestive degradability and prevention
Table 1: Annual Dog Casualties Due to Chews: Estimation Sources
from fracturing into sharp shards; and Chew Durability Proxy (CDP), a relative measure of durability (visit https:// www.dropbox.com/s/ifvy8p20h08nvsn/0-MANUSCRIPT_T._White_VF_%28no%20 line%20Nos.%29.pdf?dl=0 for the full study). As can be seen in Figure 2, only one chew type we tested, DigestaBone®, can be considered both safe and durable. So, there is an imperative for veterinarians to provide beneficial dog chews and chew safety and efficacy education. Disclosure: The author developed DigestaBone and has a financial interest in Chews Happiness® (chewshappiness.com).
Tavor White founded the Chew Safety Institute (chewsafetyinstitute.org), holds B.S./M.S. degrees in Chemical Engineering, and has conducted hundreds of dog chew safety/efficacy tests (info@chewsafetyinstitute.org).
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T-nuia THE ART OF
FOR DOGS AND CATS BY SUZAN SEELYE, DVM, CVA, CVTP
Tui-na is an ancient Chinese form of medical massage that can have a profoundly healing effect on a range of conditions seen in veterinary practice, from osteoarthritis to respiratory symptoms.
Tui-na is one of the five arms of Traditional Chinese Medicine. The others include herbology, acupuncture, Qigong, and food therapy. Tui-Na is a safe and effective manual therapy, with no known side effects, used for disease treatment and prevention in people and pets. Although randomized placebo-controlled studies are limited, there is overwhelming evidence of historical use and appreciation for this specialized applied manual therapy.1 The active participation of the dog or cat owner is essential for optimum results. The use of Tui-na promotes open communication between the owner and the veterinarian, greatly facilitates the healing process, and honors the human-animal bond.2,3 Often referred to as Chinese medical massage, Tui-na dates back to the Shang Dynasty, around 1700 BC. “Tui” means push and “Na” means pull or lift. It uses massage, acupressure, traction, and manipulation techniques for the prevention and treatment of disease.2
WHY ADD TUI-NA TO YOUR PRACTICE? Incorporating the art of Tui-na into your practice can benefit both your patients and clients, enhancing other treatments you already utilize. Tui-na can alleviate pain and stiffness
and efficiently treat paralysis and hemiplegia.4,5 It can improve respiratory symptoms such as nasal congestion and discharge, cough, and asthma, and can help treat vomiting, megaesophagus, and constipation. Tui-na can be incorporated into therapeutic plans for diabetic patients and those in renal failure. It can help with incontinence and prostate disorders, and help support animals with immunodeficiency. This is just a few applications for this ancient technique. In this article, I will share what the animals have taught me are the most effective Tui-na techniques. In most cases, you will see results within a few days. Clients benefit from improved mental and emotional well-being because their animals are happier, healthier and more pain-free. They also receive healing effects from actually performing the movements on their animals, and often on themselves.
TUI-NA AND AGING I have also witnessed the phenomenon of age reversal in the tissues of animals receiving Tui-na. This is due to the optimization of all organ systems, allowing animals to maintain exceptional health and active lifestyles far IVC Spring 2022
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beyond their average lifespans. I have seen older patients who receive regular Tui-na from their caretakers appear much healthier than younger patients, who are already more compromised in function (circulation, neurology, energy, and flexibility). William “Dub” Leigh describes the same observation from his work with people. In his book, Bodytherapy, he describes numerous cases of people in their 20s having tissues that are much more compromised in function and flexibility than those in people decades older.6,7 This is probably why the Chinese historically refer to Tui-na as the “Immortal Techniques.”8
lighter, faster, and slower. Every animal, on any given day, on any given part of the body, might prefer different depths of firmness or lightness and speed. Mo-fa also helps with general circulation, as the subcutaneous connective tissue is very vascular. Begin with three to five minutes of Mo-fa (see Figure 1).
TUI-NA TECHNIQUES AND ACTIONS There are many Tui-na techniques. Those I am covering here are listed in the order I recommend doing them. They include Mo-fa (touching of the skin and muscle), Pai-fa (patting), Doufa (shaking) for joint and limb health, Nie-fa (pinching), and Na-fa (pulling) for whole body optimization. These techniques yield the greatest improvements in the shortest time. Learn to listen to the animals and let them be your teacher as to how fast, slow, light, or firm they would like the movements done. Be sure and connect with your patients first, allowing them to get relaxed before you start. Tell them in your mind or aloud what you would like to do and ask them, just as you would a human, if it is all right to proceed. No one knows their bodies better than the animals themselves. Work with them, not on them. It’s appropriate to pause at times to let them integrate what you have offered. Wait for signs that they are ready to continue. This may be indicated by behaviors such as a big deep breath, a whole body shake, or even a yawn. Note that Tui-Na is contraindicated for open wounds, fractures, phlebitis, and around the lower abdomen of pregnant animals.
MO-FA (TOUCHING OF THE SKIN AND MUSCLE), PRONOUNCED “MOE-FA” This technique stimulates the skin and underlying tissues in preparation for deeper work. Start at the top of the neck on one side and work caudally to the tail, going top to bottom, from the dorsum to the feet. Be sure to do the legs and abdomen also. This is a circular gliding movement with the palms and/ or fingers on the skin, going with the direction of the hair with both hands staying in contact. Practice by going firmer,
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Figure 1: Mo-fa being performed on a dog’s leg.
PAI-FA (PATTING), PRONOUNCED “PIE-FA” This is a rapid patting motion using your palms and/or fingers, depending on the size of the animal. With smaller animals, you may want to use just one or two fingers. Your wrist must be loose and allowed to flex when doing Pai-fa. The palm should remain slightly concave. Follow the same pattern as with Mo-fa, moving cranial to caudal and dorsal to ventral on both sides of the animal. Again, be sure to do the legs and abdomen. As you get comfortable with this technique, begin to focus on the vibration going all the way through the body. As you do this you will find that your patting becomes softer, lighter and more effective as every cell in the body receives this healing vibration. This is a good technique to practice on a family member or friend. Apply over the upper and mid back of the person until you get the vibration to be felt at the person's solar plexus. You may find a desire to pat harder, but to be effective you in fact need to pat lighter with focused intent.
When done correctly, this technique can affect every cell in the body. Perform Pai-fa for one to five minutes, depending on the size of the animal (see Figure 2).
Figure 2: Pai-fa uses a rapid patting motion.
DOU-FA (SHAKING), PRONOUNCED “DOUGH-FA” This shaking/vibrational movement is used on the legs. It is easiest if the animal will lie down on their side in a relaxed manner. Place your hands softly under the joints, supporting the stifle and hock in the rear, and the elbow and carpus in the front. You can also do this with the animal sitting or standing. Direct a light, rapid shake/vibration up the leg, into the shoulder, and into the spine. This is my go-to technique for preventing/treating arthritis and joint problems. In several cases, I have seen a full reversal of long-standing osteoarthritis. Thirty seconds to one minute per leg is suggested (see Figures 3 and 4).
Figures 3 & 4: Dou-fa is used on the legs to help with arthritis and other joint problems.
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NIE-FA (PINCHING), PRONOUNCED “KNEE-FA”
NA-FA (PULLING), PRONOUNCED AS WRITTEN
This technique is known for regulating the spine with no side effects. Using the thumb and fingers, softly pinch and lift the skin and underlying fascia. I use this technique up the dorsum from the base of the tail to the neck to release adhesions along the spine.
This technique is similar to Nie-fa, except you include the muscle when gently pinching and lifting. It is effective for helping with Qi and blood stagnation. I also use this technique along the spine if adhesions prevent the use of Nie-fa. I will use Na-fa first up the dorsum from tail to neck to clear the adhesions and then follow with Nie-fa.2,3 (See Figures 6 and 7).
Figure 5: Nie-fa is a “pinching” technique that regulates the spine.
Photos for Figures 1—7 courtesy of Dr. Suzan Seelye
I have found that this movement alone has a profound effect on overall body health by increasing Qi and blood flow, thus optimizing oxygen and nutrient delivery to every cell in the body (See Figure 5).
Figures 6 & 7: Na-fa is a “pulling” motion that helps with Qi and blood stagnation.
CLIENT PROTOCOLS FOR
NIE-FA (PINCHING)
Nie-fa & Dou-fa
Two to four minutes, gradually increasing to six or more minutes, twice daily for ten days. Then once daily for two weeks. Then two to three times per week for life. Have clients use both hands, from the tail to the neck. I describe this as a skin roll up the spine, with the two thumb tips touching and the fingers “crab-walking” up the back without releasing the hold. If the skin is too tight, it is best to use Na-fa (pulling) first to loosen the skin and underlying fascia so the spinal skin roll can be done. If the animal is not receptive to beginning at the tail head, see if they will allow you to start at the neck and work caudally. Animals and their humans seem to mutually enjoy this technique.
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DOU-FA (SHAKING) Twice daily for two to four weeks initially. Then two to five times per week for life. Thirty seconds to one minute per leg. This is a good technique for reminding the client that less is more. In their enthusiasm, I find clients often perform Dou-fa too long or vigorously, creating a patient that no longer enjoys the Tui-na.
CLIENT AFTERCARE AND HOMEWORK PROTOCOL •
I suggest that the client choose a time when they and their animal are relaxed. Before bedtime often works well.
•
I demonstrate for the owner some recommended mindful grounding techniques to perform before starting — three to ten slow deep breaths, and a body scan to remove any tension in their own body.
•
I also get a feel for how many movements the owner is willing to commit to before assigning aftercare. If they are only able to perform two, I give them Nie-fa and Dou-fa. Clients tell me that even just these two techniques, done for five minutes twice daily, can result in a noticeable difference within a week. See sidebar on previous page.
•
If I feel the client will do more, I recommend Mo-fa and Paifa. Na-fa is given if the tissues along the spine are too tight for performing Nie-fa.
CONCLUSION I have found the techniques of Chinese Tui-na to be a simple and effective way to facilitate the healing of a wide variety of problems seen in veterinary practice. As a result, I use it as my initial treatment for all animals I see. I also give every client homework, and have found this to be integral in achieving treatment success. Owners not only develop a deeper bond with their animals by applying a hands-on self-care program, but they also exponentially facilitate their pets’ speed of improvement and return to health. I challenge you to consider using some of these Tui-na techniques on yourself and your family (two- and fourlegged) to experience the magical results they produce. As well, offer one or two techniques to your clients to implement for themselves, and see what amazing feedback you receive.
From the AAVA The American Academy of Veterinary Acupuncture (AAVA) is committed to improving animal healthcare through the advancement of veterinary acupuncture. The AAVA’s seat within the American Veterinary Medical Association’s (AVMA) House of Delegates (HOD) gives us multiple opportunities to represent veterinary acupuncture. The AAVA strives to bring veterinary acupuncture practitioners together to promote acupuncture to veterinarians and the public.
The 17th annual meeting of the AAVA took place in Memphis, Tennessee from April 8 to 10, 2022. Planned by practitioners, for practitioners, this yearly conference is an extraordinary opportunity to learn and receive top quality CE that is RACE and IVAS approved. It's also a great opportunity to meet experts in the field, and to network. AAVA additionally provides complimentary live and on-demand online CE options for their members. Non-members are required to pay $150 but will be awarded a one-year free membership, giving them access to all member benefits. AAVA plans to hold three new webinars this year! Webinars are also available in the AAVA on-demand library at aava.org. All are IVAS and RACE approved for two CE hours. Visit aava.org to learn more.
Wang Z, Wang Q, Luan C, Chinese Massage Therapy. Jinan China: Shandong Science and Technology Press, 1990. 2 Xie H, Ferguson B, Deng X. Application of Tui-na in Veterinary Medicine. 2nd ed. Reddick, FL: Chi Institute of Chinese Medicine, 2007:20-23, 52-53, 199-200. 3 Seelye S. Chinese Tui-na – A Manual Therapy. In: Proceedings Annual Conference of the American Holistic Veterinary Medical Association. Abingdon, MD: AHVMA, 2021;387-391. 4 Seelye S. TCVM treatment of intervertebral disc disease (IVDD) with complete hindlimb paralysis and loss of deep pain reflex. In: Clinical Application of Different TCM Schools & Thoughts in Veterinary Practice Proceedings of the 18th Annual International TCVM Conference. Reddick, FL: Chi Institute Press, 2018:239-242. 5 Chen R (1997). Treatment of apoplectic hemiplegia by digital acupoint pressure – a report of 42 cases. J Tradit Chin Med. Sep;17(3):198-202. 6 Seelye SK. The magic of Tui-na – complete reversal of shoulder arthritis along with age reversal in two eventing thoroughbreds. In: Traditional Chinese Veterinary Medicine for the Diagnosis and Treatment of Lameness and Pain in Dogs, Cats and Horses Proceedings of the 17th annual International TCVM Conference. Reddick, FL: Chi Institute Press, 2015;253-256. 7 Leigh WS. Bodytheraapy: A Zen Approach to Bodytherapy (From Rolf to Feldenkrais to Tanouye Roshi). Honolulu, Hawaii: International Zentherapy Institute, Inc., 1994;93-110, 128. 8 Han Ping. An-Mo-Tui-Na and Integrated Therapeutics, Beijing, China: Beijing Medical University Press, 1995. 1
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VETERINARY RESPONSES TO SUSPECTED FAMILY VIOLENCE BY PHIL ARKOW
By recognizing indications of animal cruelty and reporting suspected cases for investigation, veterinarians may not only save the lives of animals but also human family members living in the same environment. 40
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Since the 1990s, veterinarians have recognized that innovative One Health responsibilities may include the response to abuse and neglect of animals and, by extension, humans. The “Link” movement describes areas in which animal abuse and interpersonal violence intersect, with animal abuse often predicting or indicating co-occurring child maltreatment, domestic violence, and elder abuse. Veterinarians can take a leadership role in these innovations — albeit a role tempered by the practitioner’s fear of unknowns, lack of training, and financial and liability concerns. A six-step process is helping innovative practitioners become as proactive in responding to animal maltreatment as physicians have long been with regards to child abuse. These six steps, which remove personal, professional, peer, and organizational normative barriers, parallel earlier processes in the human medical fields.1
STEP 1: BUILD AWARENESS THAT ANIMAL ABUSE IS A SIGNIFICANT PROFESSIONAL CONCERN In 1996, Munro identified a “battered pets” syndrome,2 analogous to the 1962 “battered child” syndrome3 which described child maltreatment as a definable, preventable clinical condition which physicians have a duty to fully evaluate and ensure that such trauma will not be repeated. This laid the groundwork for the medical professions to examine responsibilities regarding other types of interpersonal violence, notably domestic violence4-7 and elder abuse.8,9 More than 1,600 publications address animal abuse and neglect as linked to human health and safety, and as worthy of multidisciplinary, multi-species response.10 Over 260 of these publications are specific to veterinary recognition and reporting.11-22 Surveys of veterinarians in the U.S., Canada, New Zealand, and elsewhere have measured practitioners' awareness of non-accidental injury (NAI) and its intersectionality with interpersonal violence.23-28 The research is augmented by training programs in colleges of veterinary medicine and continuing veterinary medical education.
STEP 2: ASSIST PRACTITIONERS IN RESOLVING CONTENTIOUS ETHICAL DILEMMAS Animal maltreatment is one of the most challenging diagnoses in clinical work, requiring time, experience, emotional energy, sensitivity, tact, and not a small measure of courage.29 While animal cruelty cases may be infrequent, they are invariably problematic and difficult to diagnose and resolve.13 Practitioners may be reluctant to admit that a client would present abused animals for treatment. They may base the differential diagnosis on the incorrect assumption that the client’s account of the animal’s history is accurate. Most practitioners will be presented with animal victims of NAI, neglect, abuse, cruelty, or torture.15,24-26,28,30-35 In rural areas, the public may more likely refer a case of suspected cruelty to their veterinarian rather than to a humane society or law enforcement.27 Ethical dilemmas in animal cruelty cases can give veterinarians reservations about becoming involved. Reasons for this reluctance include: inadequate understanding of statutory definitions of animal abuse; insufficient training on the diagnosis of animal cruelty; lack of correlative literature offering veterinary pathology support; and practice management concerns over confidentiality, client base erosion, personal safety, community reputation, and liability.1 Veterinary guidances published in the U.S., Canada, the U.K., and New Zealand help navigate the challenging responses, client communications, and diagnostic indicators of potential animal abuse and neglect.36-45 These guidances help resolve these concerns and what Rollin46 called a fundamental dilemma of veterinary medicine: whether the primary responsibility is to the patient or the client.
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STEP 3: PROVIDE GUARANTEES OF LEGAL PROTECTION National veterinary associations and legislative bodies have taken significant steps to permit or mandate veterinarians to report suspected animal maltreatment to appropriate authorities, without fear of civil or criminal liabilities or administrative sanctions. While veterinarians remain divided on whether reporting suspected abuse should be mandated,1 it may be argued that a statutory or administrative mandate eliminates this moral dilemma36 by making the decision automatic and explainable to the client. Once a decision has been made, the issue becomes how to appropriately implement a reporting process to comply with the duty. Currently, 20 U.S. states and ten Canadian provinces mandate veterinarians to report suspected animal abuse to humane or law enforcement authorities for further investigation and possible prosecution; 20 additional states permit veterinarians to make such reports. In 33 states, veterinarians enjoy immunity from civil and criminal liability for reporting in good faith, and the release of confidential client records may be allowed (see Figure 1).47 Reporting mandates improve animal welfare; reports to the Massachusetts SPCA of suspected abused animals increased 46% following a new state law requiring veterinarians to report.48
Figure 1: Veterinary Reporting of Suspected Animal Abuse
STEP 4: PROVIDE TRAINING TO IDENTIFY CLINICAL INDICATORS OF ABUSE AS A DIFFERENTIAL DIAGNOSIS The definitions of animal cruelty, abuse and neglect vary across geographic jurisdictions, cultural traditions and professional boundaries. Statutory language is necessarily vague: e.g., a law may require that animals have non-specific “adequate” shelter, allowing the investigator to make a common-sense judgment based upon ambient environmental conditions and an animal’s metabolic needs.50 Statutes generally proscribe socially unacceptable actions or omissions that inflict “unnecessary” pain or distress. What constitutes “unnecessary” varies in any given culture and the prevailing standard can be determined only by the courts.51 Numerous guides can assist the practitioner in raising an index of suspicion by recognizing clinical signs, client profiles and behaviors, and environmental considerations of the more common presentations of NAI, neglect, hoarding, and abuse,36-38,45,52-56 and in learning about forensic processing, collection and preservation of evidence.57-60
Veterinarians are reminded that they are medical, not legal, experts. They do not have to “know” if a condition is cruelty. Their role is to be the animals’ first line of defense; to report and document findings for further investigation; and to present them in a court of law if necessary.49 Whether a situation is prosecutable can be determined only by the courts.
No single incident necessarily raises the index of suspicion, but rather a combination of factors, a pattern of actions and behaviors, or injuries that are not adequately explained. The person presenting the animal may not be the perpetrator or may be under coercion from the person who caused the injury.61 The situation is best handled by an experienced clinician with a firm policy in place. It is important to remain calm, polite and objective, indicating that your inquiries are in the animal’s best interests. A client questionnaire36 describing family members’ relationships with their animals may uncover patterns of abusive behaviors and inability to provide proper animal husbandry. It could be administered when welcoming a new client to the practice or whenever an abusive etiology is suspected. Continued on p. 44
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Continued from p. 42
STEP 5: DEVELOP STANDARDIZED PRACTICE MANAGEMENT RESPONSES THAT BALANCE THE INTERESTS OF THE PRACTICE, STAFF, CLIENTS, PATIENTS, AND OTHER ANIMALS IN THE HOUSEHOLD The complexities of animal cruelty cases and their inherent ethical dilemmas challenge junior members of the team if senior members do not believe abuse has occurred. A practice-specific decision-making protocol should be established in advance. Several guidances review these procedures in detail.36-45 The National Link Coalition has compiled veterinary hospital policies and forms that may serve as models.62 Findings and notes should be signed, dated, and entered in the patient’s file, including base information, assessments undertaken, diagnoses, and advice and treatment given. Documentation should be more detailed than normal in case you are asked to testify in court. Another veterinarian could conduct a second examination to review your findings.61
Maintain all records and notes as a “chain of evidence” for potential prosecution. Keep a chronological record of the movement or transfer of any ante- or post-mortem physical evidence from the diagnostic processes, including any courier services utilized, from the time it was taken until the production of the evidence in a courtroom. Evidence must be securely packaged and stored, including in a freezer or refrigerator for necropsy by a forensic pathologist, so as to not be contaminated or degraded.60 The decision around whether to report suspected abuse, educate the owner, or monitor the situation may be guided by several criteria, including whether reporting is mandated by the state or province; the severity, frequency and duration of injuries; whether it’s an isolated incident or recurrent problem; the client’s intentionality or willingness and ability to correct adverse conditions; the history of the patient and client’s other animals; information from family and witnesses; and indications of cooccurring child, elder or domestic abuse.61 When in doubt, seek clarification from your veterinary association or legal counsel. Staff members should be fully briefed on the situation.
STEP 6: KNOW HOW TO REPORT Unlike standardized systems for investigations of child, elder and domestic abuse, animal maltreatment cases are handled exclusively by independent local agencies with varying degrees of enforcement powers, training, and organizational capacity. They may be local humane societies or SPCAs (none of which are affiliates of national organizations with similar names); municipal or county animal control agencies, which may or may not be empowered to investigate animal abuse charges; or police and sheriffs for whom animal cases may not be prioritized. Wildlife and livestock cases are often handled by departments of agriculture or wildlife conservation. To reduce this confusion, the National Link Coalition’s National Directory of Abuse Investigation Agencies lists telephone numbers for reporting animal, child, elder, and domestic abuse in over 6,500 U.S. communities.63
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RESPONSES TO SUSPECTED CHILD AND ELDER ABUSE 5. Compromised service delivery
What is a practitioner’s response to
All Canadian residents have a duty
possible cases of child maltreatment
to report child abuse and neglect to
by caseworkers or home health
or abuse of elders and vulnerable
provincial and territorial child welfare
aides unwilling to enter homes
adults? Veterinary training in these
agencies, social service ministries or
overrun with animal waste and
areas has been minimal.
police; professionals who work with
vermin resulting from hoarding or
children and youth have an added
neglectful pet care.
The adverse impact upon children
responsibility to report.78
6. Depression over the death of a
who witness or commit animal cruelty can be significant.76 Child
Elder abuse includes physical and
pet, which may be the person’s
protection originated within local
emotional abuse, neglect, isolation,
last link with a deceased spouse,
humane societies and SPCAs, many
financial exploitation, sexual abuse,
or the only motivation for daily
of which had dual functions in child
abandonment, and self-neglect;
exercise and responsibilities.
and animal protection from the
specific definitions vary by jurisdiction.
(Veterinarians should call a suicide
1870s until the enactment in the
Guidances can similarly help medical
prevention hotline when a client
1970s of a national network of state
professionals recognize the most
unexpectedly requests that all of
and county child welfare agencies.
common indicators of each type.79
his or her pets be euthanized.)
There are four distinct types of
7. Jealousy over a disabled
child abuse: physical, sexual and
Seven animal welfare issues can
emotional abuse, as well as child
co-occur with abuse of seniors or
partner’s emotional and physical
neglect. Guidances can help medical
the disabled:80
dependence upon a service animal.
professionals recognize the most common indicators of each type.77
1. Neglect of animals when financial,
All states have Adult Protective
physical, transportation, cognitive,
Services agencies and ombudsmen
In all U.S. states, professionals who
or social isolation situations
who review alleged elder abuse in
work with children or in healthcare
impede the ability to provide
long-term care facilities. All states
or law enforcement are mandated
veterinary and grooming care.
mandate a variety of professionals
by law to report suspected child maltreatment to the aforementioned
to report suspected elder abuse;
2. Self-neglect by elders who spend
Colorado and Illinois are the only
agencies. While only Colorado
their limited financial resources
states that specifically name
and California specifically name
on their pets rather than on their
veterinarians, although 16 states
veterinarians as mandated reporters,
own medical or nutritional needs,
require all individuals to report. 81
in 18 states all residents are required
or who defer going into hospitals
to report.63
or long-term care facilities
In Canada, adult protection is
because they have no one to care
primarily addressed at the provincial
for their animals.
and territorial level. Various jurisdictions have taken different
3. Financial exploitation by children holding their elderly parents’ animals
approaches and definitions to address adult abuse and neglect.82
hostage in order to extort money. The National Link Coalition’s National
4. Animal hoarders, who can come
Directory of Abuse Investigation
from any demographic cohort
Agencies lists hotlines for reporting
but who tend to be elderly and
suspected child and elder abuse in
socially isolated.
all 50 states.63 In most states, anyone may report suspected child or elder abuse to the appropriate authorities, generally without fear of civil or criminal liability for a good-faith report. IVC Spring 2022
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DOMESTIC VIOLENCE AND THE DVM The latest innovation in this area is veterinary response to situations of potential domestic violence. In addition to physical and emotional harm to humans in intimate partner violence, animals often become collateral damage when abusers exploit their victims’ emotional attachments to pets, as depicted in Figure 2. American awareness of this phenomenon accelerated in 2018 when a woman in DeLand, Florida, being held at gunpoint by her boyfriend, convinced him that their dog needed to see the veterinarian. She sneaked a note to the staff reading, “Call the cops. My boyfriend is threatening me. He has a gun. Please don’t let him know.” The couple were separated, police were called, the boyfriend was arrested, and the surveillance video of the incident went viral.64 Active discussion is occuring on how veterinarians and their staff, the majority of whom are now women,65 should respond to suspected domestic violence among clientele.66-71 The U.K. and New Zealand have been the most proactive. Medics Against Violence, a Scottish collaborative of human and veterinary healthcare professionals, created a Domestic Abuse Veterinary Initiative to train practitioners to help pet owners escaping
domestic violence.43 In 2015, a £115,000 national campaign in Scotland trained 100,000 frontline professionals in three fields identified as most likely to encounter domestic violence survivors: veterinarians, dentists and hairdressers.72 The U.K.’s Code of Professional Conduct for Veterinary Surgeons states, “Given the links between animal, child and domestic abuse, a veterinary surgeon or veterinary nurse reporting suspected or actual animal abuse should consider whether a child or adult within that home might also be at risk.”73 The New Zealand Veterinary Association supported a national response to family violence by describing veterinary medicine as a “three-dimensional profession” with a unique voice in animal life, human life, and the environment. NZVA called for domestic violence protection-from-abuse orders to specifically include animals, and for a change to the definition of domestic violence to include “coercive control”, which would include emotional and psychological abuse to family members through threats or harm to pets or farm animals.74 The Veterinary Council of New Zealand, whose Code of Professional Conduct recommends that veterinarians confronting animal abuse should consider whether people within that home might also be at risk, suggested preparing the practice to respond to domestic violence.39
Figure 2: The "Power and Control Wheel" of Animal Abuse and Domestic Violence
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Veterinarians wary of entering such uncharted waters might consider adding a veterinary social worker to the practice from the collaborative Veterinary Social Work Certificate Program in the College of Veterinary Medicine and the College of Social Work at the University of Tennessee-Knoxville.75 Unlike animals, children or vulnerable adults (see sidebar on page 45), victims of domestic violence are considered to have the capacity to report or escape their situations. Consequently, there are no mandates for professionals to report these situations to authorities.
CONCLUSION By recognizing the significance of animal cruelty and by reporting suspected cases for further investigation, veterinarians may not only save the lives of animals but also of humans living in the same environment. A British model of the One Welfare paradigm includes several references to medical response to animal and interpersonal violence, as shown in Figure 3. The canary in the coal mine of an abusive home may literally be an abused canary. By responding to the injury or death of that canary, we can potentially save many other pets and people.83
Figure 3: One Welfare Approach
ANIMAL WELFAR E
NSERVATION MENT CO IRON ENV
HUMAN WELLBEING
ANIMAL/HUMAN ABUSE
POVERTY & LOCAL COMMUNITY SUPPORT
LIFE CHANCES
SOCIOECONOMICAL ISSUES
FARM/WORKING ANIMALS
PETS/COMPANION ANIMALS
PRISON PROJECTS
SUSTAINABILITY
DOMESTIC VIOLENCE
HOMELESS
HOARDING
REDUCTION ANIMAL HUMAN ABUSE
MULTIDISCLIPINARY INSPECTIONS FOOD SAFETY
CHILD ABUSE
FOOD SECURITY
WORKING ANIMALS IN LOCAL REDUCTION OF COMMUNITIES AGGRESSIVE BEHAVIOR LIVESTOCK WORRYING SEPARATION LIVESTOCK/ CRIME ANXIETY FARMER WELLBEING REDUCTION
GANGS & DANGEROUS DOGS
CROSS-AGENCY COLLABORATIONS
CONSUMERS
CARE FARMING
INCREASED PRODUCTIVITY
LIVESTOCK ROLE IN SUSTAINABLE PRODUCTION
WILDLIFE
Figures 1—3 courtesy of National Link Coalition
A One Welfare approach helps to identify and recognize the links that exist between different sectors
Arkow P, Munro, H. The veterinary profession’s roles in recognizing and preventing family violence: The experiences of the human medicine field and the development of diagnostic indicators of non-accidental injury. In: Ascione FR, ed. The International Handbook of Animal Abuse and Cruelty: Theory, Research and Application. Purdue University Press; 2008:31-58. 2 Munro HMC. Battered pets. Irish Vet J. 1996;49:712-713. 3 Kempe CH, Silverman FN, Steele BF, Droegenmuller W, Silver HK. The battered-child syndrome. JAMA. 1984;251(24):3288-3294. 4 Walker LA. The Battered Woman. Harper & Row; 1979. 5 Salber PR, Taliaferro E. Physician’s Guide to Domestic Violence: How to Ask the Right Questions and Recognize Abuse. Volcano Press; 1995. 6 Schornstein SL. Domestic Violence and Health Care: What Every Professional Needs to Know. Sage Publications; 1997. 1
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Jordan CE, Nietzel M, Walker R, Logan TK. Intimate Partner Violence: Clinical Training Guide for Mental Health Professionals. Springer; 2004. 8 National Center on Elder Abuse. Mandated reporting of abuse of older adults and adults with disabilities. Accessed January 28, 2022. https://ncea.acl.gov/NCEA/media/Publication/NCEA_NAPSA_MandatedReportBriefFull. pdf. 9 Hildreth CJ, Burke AE, Golub RM. Elder abuse. JAMA. 2011;306(5):568-568. 10 Bibliography of the Link between Animal Abuse, Domestic Violence, Child Abuse and Elder Abuse. Animal Therapy.net. Published August 28, 2019. Accessed January 24, 2022. http://animaltherapy.net/animalabuse-human-violence/bibliography/ 11 Arkow P. The correlations between cruelty to animals and child abuse and the implications for veterinary medicine. Canadian Vet J. 1992;33(8):518-521. 12 Arkow P. Child abuse, animal abuse, and the veterinarian. JAVMA 1994;204(7):1004-1007. 13 Crook A. The CVMA animal abuse position – how we got here. Canadian Vet J. 2000:41(8):631-633. 14 Lockwood R. Animal cruelty and human violence: The veterinarian’s role in making the connection — the American experience. Canadian Vet J. 2000;41(11):876-878. 15 McGuinness K, Allen M, Jones BR. Non-accidental injury in companion animals in the Republic of Ireland. Irish Vet J. 2005;58(7):392-396. 16 Parry, NM. How to deal with animal neglect cases. Amer Vet. 3(1). Accessed January 28, 2022. https://www. dvm360.com/view/avma-2017-how-to-deal-with-animal-neglect-cases. 17 Whiting TL, Brennan SC, Wruck GC. The veterinary profession’s role in policing animal welfare. Canadian Vet J. 2006;47(11):1065-1072. 18 Arkow P. The veterinarian’s responsibility in family violence. Amer Assoc Human-Animal Bond Vet. 2006;(17):4. 19 Canadian Veterinary Medical Association. Animal abuse: What veterinarians can do. Accessed January 28, 2022. https://www.canadianveterinarians.net/policy-advocacy/animal-abuse. 20 Yoffe-Sharp BL, Loar LM. The veterinarian’s responsibility to recognize and report animal abuse. JAVMA. 2009;234(6):732-737. 21 Benetato MA, Reisman R, McCobb E. The veterinarian’s role in animal cruelty cases. JAVMA. 2011;238(1):31-34. 22 Arkow P. A ‘one health’ approach to ending family violence: The responsibilities of veterinary professionals in recognizing and reporting animal abuse, domestic violence, child abuse and elder abuse. In: Tiplady C, ed. Animal Abuse: Helping Animals and People. CAB International; 2013:83-92. 23 Stolt LB, Johnson YJ, Kaneene JB. Attitudes of veterinarians, animal control directors, and county prosecutors in Michigan regarding enforcement of state cruelty legislation. JAVMA. 1997;211(12):1521-1523. 24 Donley L, Patronek GJ, Luke C. Animal abuse in Massachusetts: A summary of case reports at the MSPCA and attitudes of Massachusetts veterinarians. J Appl Anim Welf Sci. 1999;2(1):59-73. 25 Green PC, Gullone E. Knowledge and attitudes of Australian veterinarians to animal abuse and human interpersonal violence. Australian Vet J. 2005;83(10):619-625. 26 McKerchar H. Survey of veterinary practitioner awareness of non-accidental injury in companion animals. Soc Comp An Stud J. 2005;17(3):8-13. 27 Enns A. MVMA Public Awareness and Attitude Survey, Final Report. Manitoba Veterinary Medical Association; 2006. 28 Williams VM, Dale AR, Clarke N, Garrett, NKG. Animal abuse and family violence: Survey on the recognition of animal abuse by veterinarians in New Zealand and their understanding of the correlation between animal abuse and human violence. N Z Vet J. 2008;56(1):21-28. 29 Lockwood R, Arkow P. Animal abuse and interpersonal violence: The cruelty connection and its implications for veterinary pathology. Vet Path. 2016;53(5):910-918. 30 American Humane Association. Non-accidental Injury in Dogs and Cats in Colorado: Final Report to Animal Assistance Fund. 2003. 31 Wilkins C. Protect yourself while protecting animals: What every veterinarian should know outside of medicine: How veterinarians can get involved in animal laws and protect themselves from liability. GA Vet. 2021 (Summer):6-8. 32 Gullone E, Johnson J, Volant A. The Link Between Animal Abuse and Family Violence: A Victoria-wide Study. Australian Veterinary Association; 2004. 33 Landau R. The veterinarian's role in recognizing and reporting abuse. In: Ascione FR, Arkow P, eds. Child Abuse, Domestic Violence, and Animal Abuse: Linking the Circles of Compassion for Prevention and Intervention. Purdue University Press; 1999:241-249. 34 Patronek GJ. Animal cruelty, abuse and neglect. In: Miller L, Zawistowski S, eds. Shelter Medicine for Veterinarians and Staff. Blackwell; 2004:427-452. 35 Sharpe MS. A survey of veterinarians and a proposal for intervention. In: Ascione FR, Arkow P, eds. Child Abuse, Domestic Violence, and Animal Abuse: Linking the Circles of Compassion for Prevention and Intervention. Purdue University Press; 1999:250-256. 36 Arkow P, Boyden P, Patterson-Kane E. Practical Guidance for the Effective Response by Veterinarians to Suspected Animal Cruelty, Abuse and Neglect. American Veterinary Medical Association; 2011. 37 The Links Group. Recognizing Abuse in Animals and Humans: Guidance for Veterinary Surgeons and Other Veterinary Employees. The Links Group; 2013. 38 New Zealand Veterinary Association. The Veterinarians Animal Welfare Toolkit. The Association; 2011. 39 Veterinary Council of New Zealand. Guidance for Veterinarians Dealing with Cases of Suspected or Actual Animal Abuse and Family Violence. The Council; 2013. 40 Animal Folks. Reporting Animal Cruelty: Role of Veterinarian: Establishing Protocols to Identify and Report Suspected Animal Cruelty in Minnesota. Animal Folks; 2016. 41 Animal Folks & The Kirkpatrick Foundation. The Role of the Veterinarian Reporting Animal Cruelty: Establishing Protocols to Identify and Report Suspected Animal Cruelty in Oklahoma. Kirkpatrick Foundation; 2018. 42 Animal Folks, Tufts University Cummings School of Veterinary Medicine, & Animal Rescue League of Boston. Reporting Animal Cruelty: The Role of the Veterinarian: Establishing Protocols to Identify and Report Suspected Animal Cruelty in Massachusetts. Tufts University Cummings School of Veterinary Medicine; 2018. 43 Animal Welfare Foundation and The Links Group (2016). Recognising Abuse in Animals and Humans: 7
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Comprehensive Guidance for the Veterinary Team. British Veterinary Association. British Columbia Society for the Prevention of Cruelty to Animals. Handbook for Veterinarians Assisting with BC SPCA Cruelty Cases. BC SPCA; 2018. 45 Ohio Veterinary Medical Association. Animal Abuse Recognition & Reporting. OVMA; 2020. 46 Rollin BE. Veterinary and animal ethics. In: Wilson JF, ed. Law and Ethics of the Veterinary Profession. Priority Press; 1988:24-49. 47 National Link Coalition. Immunity for Veterinarians Reporting Suspected Animal Abuse. 2021. 48 National Link Coalition. Massachusetts cross-reporting law increases reports by 46%. LINK-Letter 2019;12(10):4. 49 Arkow P. A species-spanning approach: 6 stages of veterinary response to animal cruelty, abuse, and neglect. Canadian Vet J. 2017;12(6);1-8. 50 Arkow P, Lockwood R. Definitions of animal cruelty, abuse, and neglect. In: Brewster MP, Reyes CL, eds. Animal Cruelty: A Multidisciplinary Approach to Understanding. Carolina Academic Press; 2013:3-24. 51 Blood DC, Studdert VP. Saunders Comprehensive Veterinary Dictionary, 2nd ed. W.B. Saunders; 1999. 52 Munro HMC, Thrusfield MV. Battered pets: features that raise suspicion of non-accidental injury. J Small Anim Pract. 2001;42(5):218-226. 53 Munro HMC, Thrusfield MV. Battered pets: non-accidental physical injuries found in dogs and cats. J Small Anim Pract. 2001;42(6):279-290. 54 Munro HMC, Thrusfield MV. Battered pets: sexual abuse. J Small Anim Pract. 2001;42(7):333-337. 55 Munro HMC, Thrusfield MV. Battered pets: Munchausen syndrome by proxy. J Small Anim Pract. 2001;42(8):385-389. 56 Tong LJ. Fracture characteristics to distinguish between accidental injury and non-accidental injury in dogs. Vet J. 2014;199(3):392-398. 57 Sinclair L, Merck M, Lockwood R. Forensic Investigation of Animal Cruelty: A Guide for Veterinary and Law Enforcement Professionals. Humane Society of the United States; 2006. 58 Cooper J, Cooper M. Introduction to Veterinary and Comparative Forensic Medicine. Blackwell; 2007. 59 Munro R, Munro HMC. Animal Abuse and Unlawful Killing: Forensic Veterinary Pathology. Saunders; 2008. 60 Merck M. Veterinary Forensics: Animal Cruelty Investigations, 2nd ed. Blackwell; 2013. 61 Arkow, P. Recognizing and responding to cases of suspected animal cruelty, abuse and neglect: What the veterinarian needs to know. Vet Med: Research and Reports. 2015;6:349-359. 62 National Link Coalition. Veterinary Hospital Policies and Procedures for Reporting Suspected Animal Abuse. 2022. 63 National Directory of Abuse Investigation Agencies. NationalLinkCoalition.org. Published March 3, 2017. Accessed January 28, 2022. https://nationallinkcoalition.org/how-do-i-report-suspected-abuse. 64 The staff from deland animal hospital saved her life from violent boyfriend who promised to kill her. YouTube.com. Published January 29, 2019. Accessed January 28, 2022. https://www.youtube.com/ watch?v=TkBbwj1MQFQ. 65 Moorcock A. Women in veterinary medicine: Why more women doesn’t equal more equality. VetsPanel.com. Published March 16, 2021. Accessed January 28, 2022. https://www.vetspanel.com/women-in-veterinarymedicine-why-more-women-doesnt-equal-more-equality/. 66 Newland X, Boller M, Boller E. Considering the relationship between domestic violence and pet abuse and its significance in the veterinary clinical and educational contexts. NZ Vet J. 2019;67(2): 55-65. 67 Larkin M. When domestic violence arrives at the clinic door: How veterinary staff can respond to abused clients and patients. JAVMA. 2018;253(6): 656-660. 68 Allison M, Satterwhite C, Ramaswamy M, Hynek MT, Agnew-Svoboda Z. Strategies veterinary practices can use to address the problem of intimate partner violence. JAVMA. 2017;250(1): 42-45. 69 Lathey L. Recognizing domestic violence in clients and their pets. West Coast Vet. 2020;40:44-45. 70 Lathey L. Helping people with animals who are fleeing domestic violence. West Coast Vet. 2020;41:17. 71 Gordon E, Lathey L. Domestic violence and animal abuse during COVID-19: The role of the veterinarian. West Coast Vet. 2020;39:18-19. 72 Paterson K. Vets enlisted in bid to stop domestic abuse. The National. Published September 15, 2015. Accessed January 28, 2022. https://www.thenational.scot/news/14899535.vets-enlisted-in-bid-to-stop-domestic-abuse/. 73 Royal College of Veterinary Surgeons. Code of professional conduct for veterinary surgeons, Supporting guidance No. 14 (client confidentiality), 2016. 74 National Link Coalition. “Three-dimensional” New Zealand veterinarians respond to domestic violence. LINKLetter. 2015;8(10): 5. 75 Arkow P. Human-animal relationships and social work: Opportunities beyond the veterinary environment. Child and Adolescent Social Work. 2020;37(6): 573-588. 76 Campbell AM. The intertwined well-being of children and non-human animals: An analysis of animal control reports involving children. Social Sciences. 2022;11:46. 77 Palusci VJ, Fischer H. Child Abuse & Neglect: A Diagnostic Guide for Physicians, Surgeons, Pathologists, Dentists, Nurses and Social Workers. CRC Press; 2011. 78 Canadian Child Welfare Research Portal. Frequently asked questions. Published 2021. Accessed January 30, 2022. https://cwrp.ca/frequently-asked-questions-faqs. 79 Patel K, Bunachita S, Chiu H, et al. Elder abuse: A comprehensive overview and physician-associated challenges. Cureus. 2021;13(4), e14375. doi:10.7759/cureus.14375. 80 Arkow P. Elder abuse and animal abuse: Implications and strategies for adult protective services. Washington, DC: National Adult Protective Services Association; 2018. 81 American Bar Association. Adult protective services reporting chart, 2019. Published 2020. Accessed January 28, 2022. https://www.americanbar.org/content/dam/aba/administrative/law_aging/2020-elder-abusereporting-chart.pdf. 82 Canadian Centre for Elder Law. A Practical Guide to Elder Abuse and Neglect Law in Canada. 2011. 83 Woolf J. The connection between animal abuse and interpersonal violence. Veterinary Partner. 2021, July 20. Accessed January 28, 2022. https://veterinarypartner.vin.com/default.aspx?pid=19239&id=10366616. 44
industry innovations Effective allergen immunotherapy Your clients already suspect that identifying the specific environmental allergen triggers of atopic dermatitis is imperfect at best. Published studies on the reliability of serum, hair, and saliva “allergy tests” have confirmed their suspicions, showing poor agreement, and frequent false positive and negative readings. RESPIT® allergenic extracts enable you to prescribe effective, prescription strength allergen immunotherapy without depending on unreliable allergy testing. Important allergens for your geographic region, selected by a board-certified veterinary dermatologist, are included in oral or injectable versions of RESPIT. vetrespit.com
Supplements for whole pet wellness Looking for something to help support whole body wellness in your patients? Canine and Feline Whole Body Support from Standard Process® provides daily support of all body systems, with an emphasis on a healthy endocrine system. These products provide 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 they use to create their human products. standardprocess.com/veterinary-formulas
Investing in early cancer detection The key to successful cancer treatment is early detection. Companion Animal Health has announced a strategic agreement, including an equity investment, with HT BioImaging to co-brand and exclusively sell HTVet in the U.S. and Canada. HTVet enables a non-invasive, real-time diagnostic of suspicious cutaneous and subcutaneous masses, and delivers accurate results within minutes, enabling simple and accurate in-clinic testing. HTVet’s innovative technology involves Heat Diffusion Imaging (HDI), an AI-based algorithm that recognizes cancerous cells by their unique dynamic heat-flow properties. companionanimalhealth.com
Medicinal mushroom extract Coriolus versicolor is a medicinal mushroom with a range of beneficial effects. I’m-Yunity® contains the proprietary and standardized extract from Coriolus versicolor, and is used to strengthen the immune system, reduce pain, improve appetite and energy levels, reduce side effects from chemotherapy. and raise overall quality of life. I’m-Yunity® is well researched and clinically proven; for example, a Penn Vet study found that it lengthens survival time in dogs with cancer. Learn about these promising study results at buyimyunity.com
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IMMUNITY AND HOMEOPATHY IN DOGS – FOCUS ON NOSODES BY TODD COONEY, DVM, CVH
Nosodes are a potent, safe and effective way to help dogs build specific immunity to many major canine diseases, without the risks and side effects caused by vaccines.
In today’s world, immunity is a hot topic. Homeoprophylaxis is a great way to build solid protection against disease, and homeopathic remedies, including nosodes, can help with this process. Nosodes can be a confusing topic, but knowing about this wonderful type of homeopathic medicine is well worth the effort. This article reviews nosodes, and provides examples of how to use these valuable tools to help dogs build and maintain optimum immunity.
IMMUNE CONFUSION Vaccines cause confusion or dysfunction of the immune system, and this is not a secret or recent finding. The Purdue Vaccine Study in the 1990s showed autoimmunity developing in dogs after a single vaccine, whereas none of the dogs in the unvaccinated group did so. What is not widely known is that immunologists do not truly understand immunity, and have really stopped searching for the basis of real immunity without understanding the existing
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paradox. What paradox, you ask? Dr. Tetyana Obukhanych, an immunologist, addressed this at the Homeoprophylaxis Worldwide Choice Conference 2016, in a talk titled “The Crossroads of Immunology and Homeopathy.” She stated first that protective immunity is not based on immunologic memory, as previously thought. Humoral immunity (serum) is falsely believed to be antibody-based. This belief persists despite clinical evidence that contradicts the idea. Dr. Obukhanych also presented evidence that cell-mediated immunity alone does not protect, shooting down two widely held beliefs in a short paragraph. She then stated that protective immunity is humoral in nature, and can be transferred for a short term (maternal immunity transfer, via placenta or breast milk), or immune system transfer (nosodes might fit in this category, or hyperimmune serum, for example). This all sounds a bit technical, but bear with me, it’s worth it.
Though humoral immunity is believed to be antibody-based, antibodies are neither necessary nor sufficient to cause immunity. Here’s a good example, from the human side: “ Early clinical studies showed antibody production is not necessary either for recovery from or for the development of immunity to measles in children… children with agammaglobulinemia (no antibodies at all) showed a normal measles course with typical rash which faded at the normal time, and was followed by just as substantial immunity against reinfection as would be shown by any other convalescent.” - Sir MacFarlane Burnet, Natural History of Infectious Diseases, 1940, p. 79
So these children developed full-blown measles, and developed solid immunity against it without any antibodies at all! Dr. Obukhanych then talks about the difference between protective serum and antibodies. Protective serum titer tests do not measure antibodies — they measure protective immunity, which may be a yet-to-be-discovered carrier of immunity. These titers are usually done in research — serum is incubated with live virus to determine the highest dilution that destroys the virus. Antibody titer tests measure levels of virus-specific antibodies based on the binding properties of antibodies to antigens. This describes the common distemper and parvo titer tests done for dogs as an alternative to vaccination. The problem is, it does not relate to immunity. Here’s another example illustrating this point: “ Hospital employees working in patient care areas from July through November 1990 were screened for measles antibody levels using a commercially available enzyme immunoassay (EIA). Four healthcare workers vaccinated in the past developed measles. All had positive pre-illness measles antibody levels.”
LEPTO, CUBA AND NOSODES Most tropical regions have major problems with Lepto, which peaks each year with the rainy season. The disease in humans is similar to that in canines, and causes serious illness with death rates as high as 50%. Conventional efforts to control this disease involve vaccination programs which are very expensive and often harmful to health themselves. In 2007, 2.1 million people (88% of population) in three high risk provinces of Cuba received a Lepto nosode (Nosolep). In the fall of 2007, each person in this large group got two doses of Nosolep 200c, with seven to nine days between doses. About one year later, another two doses of Nosolep 10m were given, also seven to nine days apart, to 2.3 million people (96% of population) in the same three provinces. The results were amazing. The incidence of Lepto cases in humans dropped 84% in the provinces given nosodes, while cases in the provinces not receiving nosodes increased 22% (even though they were at lower risk and vaccinated). The nosode provinces were also considered higher risk for Lepto, and still showed a drastic decrease in cases. The icing on this cake is that the cost of nosodes was only about 2% the cost of vaccines.
- Ammari et al. (1993) Infect Control Hosp Epidemiol 14:81-86
So four hospital workers, all required to have measles vaccines, all had positive titers and still got measles. This is why Dr. Obukhanych says in her book, Vaccine Illusions, that titers in vaccinated individuals are meaningless. They do not relate to protection. Let’s talk about a better way!
NOSODES, A REVIEW Nosodes are potentized remedies prepared from diseased tissues or discharges (products of disease). Gross stuff, for sure. The word derives from the Greek nosos (disease) and eidos (like). Potentized simply means diluted and succussed in serial fashion like other homeopathic medicines. IVC Spring 2022
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Dr. Samuel Hahnemann first prepared remedies from diseased tissues, mainly the miasmatic nosodes, for the three major miasms he identified and defined (“miasm” refers to large categories of inherited or acquired chronic disease). The three miasms are Psora, Sycosis and Syphilis, and the corresponding nosodes are Psorinum, Medorrhinum, and Syphylinum. Only the first two have common use in veterinary homeopathy.
More recent examples in veterinary homeopathy include using Distemperinum (nosode from canine distemper) in a large shelter to decrease cases in dogs (Saxton 1991), and controlling a kennel cough outbreak in a large boarding facility just by adding the nosode to drinking water (Day 1987). Most homeopathic veterinarians agree on the protective effect of nosodes. There are few custom-designed trials to support this notion, however, so the idea of nosodes being helpful remains contentious. But several cases of homeopathy being used on a large scale to curb epidemic disease exist in the scientific literature, and a recent example involves a disease well known to many dog owners, Leptospirosis (the “L” in DHLP). See sidebar on page 51.
HOW TO USE NOSODES
The major nosodes all underwent provings, and their use in veterinary homeopathy is the same as with any other remedy, matching patient symptoms to those of the remedy. Later in the 1800s, veterinarians began to use nosodes developed for specific diseases, such as anthrax in cattle (Anthracinum), and distemper in dogs (Distemperinum). During this era, Dr. Constantine Hering introduced the nosode Hydrophobinum from the saliva of a rabid dog, and used it to treat and prevent rabies in dogs and humans, usually giving 30c every three to four days, and increasing the interval as the patient improved. This is the same nosode we call Lyssin today, commonly used to deal with bad effects from the rabies vaccine.
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Nosodes carry the energy pattern of a disease, just as other homeopathic medicines carry the energy pattern of their original material. The energy pattern of the disease includes both the causative agent, and the host’s response to that disease. This modified, vibratory disease energy can fill the susceptibility of the patient to the actual disease. Nosodes work best when given shortly before to shortly after exposure to a disease, and protection is only transient, so intermittent use is best. I’ll explain how I now use nosodes, although it’s by no means the only method. The key idea to remember is that nosodes work best when given close to exposure time; as noted above, a few days before or after at most. Most practitioners recommend a 30c potency given one to two times weekly until the animal is six to eight months old, then dosing based on exposure risk after that (training class, boarding, grooming, dog park, etc.).
Since it is impossible to know when all exposures occur, and nosodes do not seem to provide lasting protection, we need to repeat at regular intervals until immunity is solid. Most dogs have a competent immune system by the time of puberty, so no longer need nosode protection after that; they have developed good natural immunity from natural exposure, especially if not vaccinated (which blocks natural immunity in most cases).
Over the past ten years I’ve had great success giving each pup a single dose of Canine Combination nosode (Hahnemann Labs, California) 200c. This contains nosodes for distemper, parvo, hepatitis, lepto, kennel cough, and hydrophobinum. We then send home a one-ounce glass dropper bottle with filtered water and parvo nosode 200c, and a small amount of brandy as preservative. I recommend giving this weekly until the pup is at least six months old. During this period, we have lost no pups to parvo if they only received nosodes; the only deaths occurred in pups previously vaccinated. We have also seen a steady decline in parvo cases over the past three years, possibly due to the culling of vaccinated dogs from our client population over time. Heartworm nosode also offers a great drug/ chemical-free option to boost immunity to this parasite. We have yet to see a dog test positive while taking the nosode, and have even used homeopathy and/or nosodes to treat heartworm positive dogs that come in from outside the practice. I recommend either 30c or 200c given every one to two weeks during heartworm season, which varies with geographical location.
CONCLUSION In a veterinary world characterized by excessive vaccines, drugs, toxic chemicals and processed foods, nosodes offer a potent, safe and effective option to help dogs build specific immunity to many major canine diseases, whether viral, bacterial or parasitic. We do not have to understand the exact mechanism of action to say that nosodes have a beneficial impact on health, without the risks and side effects inherent to most conventional drug options.
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newsbite
AAFP Celebrates
10 YEARS
of Cat Friendly Practice Program
As a veterinarian, you probably have feline patients that become extremely stressed and agitated by clinic visits. As a member of the American Association of Feline Practitioners (AAFP), you can learn how to minimize stress for these patients through their Cat Friendly Practice (CFP) Program. This year marks the 10th anniversary of the program, which was created by the AAFP and the International Society of Feline Medicine (ISFM). The CFP Program was designed to elevate cat care by enhancing the veterinary environment and clinic visit experience with the goal of reducing stress for the cat, owner, and veterinary care team. It helps veterinary practices implement solutions to create a better experience for each cat visit. This includes reducing stress during the veterinary visit by understanding and assessing the environment from the cat’s point of view.
An exclusive membership benefit of the AAFP, CFP designation demonstrates that a veterinary practice has committed to providing the highest standards of care for cats, and assures cat owners that the practice has taken extra time and effort to consider each feline patient’s experience and care. The AAFP also provides an extensive toolkit of marketing resources, client education materials, exclusive newsletter content, and a public directory that cat owners can use to search for CFP-designated practices.
CFPs See Significant Benefits
• Cat Friendly Practices will receive special care packages mailed to their practices, as well as new marketing materials which are found in the online Cat Friendly Practice® Marketing Toolkit.
The results of the 2021 Cat Friendly Practice® survey demonstrate significant benefits to cats, caregivers, and veterinary teams. Respondents cited the following top benefits: Less stress for feline patients Higher client satisfaction with veterinary visits Dedicated display of care for feline patients Improved client retention and frequency of visits. Additional key findings include a 99% satisfaction rate among current CFP practices, and a 92% positive team dynamic impact when handling, treating, and caring for cats.
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To celebrate the 10th anniversary of the CFP, the AAFP is rolling out a suite of activities and educational materials, including: •U pdates to the feline handling and nursing care guidelines, which will be launched as two cutting-edge resources — Cat Friendly Veterinary Interactions Guidelines and Cat Friendly Veterinary Environment Guidelines.
• The release of a new education program designed for cat caregivers. •A special 10th anniversary celebration of our CFPs hosted during the 2022 AAFP Annual Conference from October 27 to 30 in Pittsburgh, PA. •D istribution of a report that demonstrates how team members at Cat Friendly Practices® experience fewer injuries because of the techniques they employ. To learn more about the Cat Friendly Practice Program, visit catvets.com/cfp.
Why a Keto Diet is a Good Choice for Dogs You probably know someone who is on a keto diet, and might be wondering if it could have similar health benefits for your canine patients. Read on to learn why keto pet food is the up and coming thing for canine companions.
WHAT EXACTLY IS A KETO DIET? “Keto is a metabolic state in which your body switches from primarily burning glucose and carbohydrates as fuel, to fat and ketones,” says Paul Raybould of Visionary Keto Pet Foods. “This way of eating typically involves consuming a low carbohydrate, moderate protein, and higher fat diet. When you do this, your body starts to increase fat breakdown, which produces ketones and puts you into a state known as ketosis. A keto/ketogenic diet can help you lose fat, lower your appetite, improve mental focus, and more.”
KETO AND DOGS Research is ongoing, but feeding dogs a ketogenic diet may offer them a range of additional health benefits. Along with facilitating weight loss, this low-carb, high-fat approach can help reduce inflammation, balance blood sugar, improve insulin sensitivity, boost energy levels, enhance skin and coat health, improve digestion, reduce the risk of chronic diseases such as diabetes, and even help treat epilepsy.
through nutrition,” he adds. “It was founded in 2014 to give shelter dogs with terminal cancer a ‘forever home’ and save them from being euthanized. KetoPet has rescued dozens of dogs from kill shelters and placed them on a ketogenic diet as a form of cancer therapy.” Research has shown that because cancer cells feed on glucose from carbohydrates, a low-carb diet can starve these malignant cells and slow cancer growth. “We found that a low-carb, ketogenic diet not only improved outcomes for dogs with cancer and other illnesses, but that it also supports optimal health and well-being for all dogs. Remarkably, 55% of the dogs who graduated from the KetoPet program are still going for long walks, eating a raw keto diet, and experiencing a quality of life far beyond their original prognosis. We now believe that a ketogenic diet is the optimal diet for all adult dogs.” visionarypet.com
KETOGENIC PET FOOD Visionary Keto Pet Foods is a cutting-edge company that formulates their own line of ketogenic foods for dogs. “We searched high and low for a commercially-available, low-carb, ketogenic dog food, but couldn’t find one,” says Paul. “So we created our own.” The line includes dry, freeze-dried, and raw frozen selections, along with freeze-dried treats, all made from top quality ingredients. “Our premium keto dry food is high in fat (40%) and protein (60%), and very low in digestible carbs (less than 1g per cup),” says Paul. “We were inspired by the work done by our non-profit, KetoPet, which focuses on improving canine health IVC Spring 2022
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USING HERBS IN VETERINARY PRACTICE HOW TO EVALUATE QUALITY, SOURCES, AND TESTING BY ÉLAN SUDBERG, CEO, ALKEMIST LABS
Knowing something about the sources, formulations and quality verification protocols used by product manufacturers are all essential ways to ensure the herbs you are using in your practice are safe and of the best quality. Therapeutic herbs are being used with increasing frequency for both companion and working animals. This means it’s important for veterinarians to know how to determine quality as they evaluate the various products on the marketplace for inclusion in their practices. Here’s a step-by-step procedure for helping to ensure the herbal products you’re using and recommending are safe and of high quality.
So the first question to ask a manufacturer is: do they work with the same suppliers year in and out, who can verify the origin, handling, and quality of the ingredients, or are they buying whatever they can get the best price on from a variety of suppliers? If they are working with powders, ask if they are using any branded ingredients backed by clinical studies, because there are a lot of them on the market today.
CONSIDER THE SOURCES
UNDERSTAND HOW PRODUCTS ARE FORMULATED
Herbal products all begin as plants, but can take very different paths before they reach the end user. Historically, herbalists worked with fresh or dried herbs, including roots, stems, leaves, flowers, seeds, and fungi, which they often gathered themselves. They would administer them as tea, in an alcohol extract, or sometimes in food form. In today’s marketplace, most large manufacturers work with dried and powdered herbs or herbal extracts delivered in drums, which they then encapsulate. Some manufacturers use more traditional methods, such as alcohol extraction of fresh herbs shipped to them overnight.
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Depending on the herb and its desired effects, different plant parts are used, since they may have very different effects, potencies, and sometimes toxicity levels. For those new to herbs, it’s important to know that they usually work best in a formulation rather than as a single herb. Looking for a single herb to address a health condition is an allopathic view; however, a skillful formulation of herbs that synergistically complement the other ingredients creates a far more effective remedy, and is how most herbalists treat patients. This is why herbal products should be designed by trained herbalists.
VERIFY QUALITY Manufacturers are required by law to confirm the identity of materials used in dietary supplements, but FDA guidelines are somewhat vague on what that means and how it should be done. Where and how a manufacturer has their products tested to meet these criteria creates a litmus test of sorts, which helps identify manufactures that are truly serious about quality, and those that are not. For companies that work with fresh herbs to produce products made by trained and experienced herbalists, organoleptic (smell, taste, appearance) identification usually works fine. For the vast majority of manufacturers that work with powdered ingredients, rigorous testing by a highly competent lab is essential to confirming the high quality that carefully-sourced and meticulously-processed ingredients can achieve. A label on a bin of powder that looks like all the other powders in the warehouse is not sufficient proof of identity and quality. You also have to be clear on what the lab is testing for, such as identity, purity, and potency. The lab needs to know what it’s testing for before it starts, and be equipped for the assignment. The proficiency of the lab is crucial, as not all labs are created equal. Our own clients set specs, and we try to make sure they are getting what they asked for. If all they care about in their green tea powder is that the caffeine spec is met, they could be trading saw dust fortified with caffeine, and they are also probably not going to the best labs. Sometimes color can vary, and when botanicals are highly processed, they could be almost anything.
Aspects of botanicals can vary from season to season and region to region, which is why we test against several different verified reference materials when confirming identity.
TESTING METHODS MATTER In deciding which test methods are best for a specific sample, expertise is essential in knowing which instruments and methods are appropriate. There is a huge difference between methods appropriate for testing raw materials vs. finished products. You might use DNA, microscopy and or HPTLC and HPLC to identify your raw ginger root for example (see sidebar on page 58). If it’s an extract, or a finished product with extracts in it, or one that is highly processed, then only HPTLC and HPLC can be used. The point is, to get accurate results, you have to choose verified, accepted methods that are fit for the purpose. If and when newer technologies get to the point of being verified and accepted by all relevant bodies, then and only then should they join the pantheon of tests we all rely on today. The National Animal Supplement Council (NASC) has done a good job of setting standards for supplements used for animals, and can be a great resource. We’re starting to see manufacturers make test results public, which will make it easier to identify those companies committed to rigorous product testing. We should all be asking for that level of transparency.
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EXPLAINING TESTING TOOLS IDENTITY TESTING
POTENCY TESTING
High Performance Liquid Chromatography (HPLC) fingerprinting is a useful and complementary technique used to assess the identity and quality of complex herbal blends and various ingredients from a marker compound perspective. Chromatographic fingerprints give information that assists manufacturing control and assures batch-to-batch conformity.
High Performance Liquid Chromatography (HPLC) and Ultra Performance Liquid Chromatography (UPLC) are used to separate, identify, and quantitate compounds. They are considered the most powerful tools in analytical chemistry. HPLC/UPLC can be used to assess the purity of samples from a variety of matrices that can be dissolved in a liquid/solvent. In many situations, this testing is able to quantify compounds and adulterants at very low concentrations. HPLC/UPLC is applicable to the accurate quantitation of several types of chemical constituents of crude raw botanicals, from powdered to whole form, extracts (powdered or liquid) and finished products/blends, as well as all vitamins and amino acids. This is a preferred technique worldwide.
High Performance Thin-Layer Chromatography (HPTLC) assesses the identity and quality of botanicals and various ingredients. Many times the test is able to detect adulterants and contamination, such as the inclusion of incorrect plant parts, closely-related species, and unknowns. This technique is applicable to crude raw botanicals from powdered to whole form, extracts (powdered or liquid), and finished products/ blends. HPTLC is the preferred technique worldwide. Microscopy is one of the oldest and still most effective techniques employed to assess identity and quality of botanicals. It is often able to detect adulterants and conta-mination, including fillers, extracts, and incorrect plant parts. This technique is applicable to crude raw botanical, from powdered to whole form, and is a preferred technique. Microscopy
HPLC Testing
Composite Reference Botanicals (CRBs) are custom blends of verified botanicals from multiple sources and locations to support internal lab testing. Each component is internally qualified and then combined to create a better representative sampling of the botanical versus any single reference botanical available on the market.
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Gas Chromatography (GC) is a term used to describe the group of analytical separation techniques utilized to analyze volatile substances in the gas phase. In gas chromatography, the components of a sample are dissolved in a solvent and vaporized in order to separate the analytes by distributing the sample between two phases: a stationary phase and a mobile phase. The mobile phase is a chemically inert gas that serves to carry the molecules of the analyte through the heated column and then through the one of the various detectors used, where the separated compounds are identified by comparing with known compounds. This technique is the preferred method for the quantitation of the various components of fish oils, oils in general, or many essential/volatile oils of botanicals, as well as a wide variety of combustible compounds found in many different matrices
Ultraviolet-visible Spectroscopy or Ultraviolet-visible Spectrophotometry (UV-Vis or UV/Vis) refers to absorption spectroscopy in the ultraviolet–visible region of the spectrum. This means it uses light in the visible and adjacent (near-UV and near-infrared) ranges. UV/Vis spectroscopy is routinely used in the quantitative determination of solutions of highly conjugated organic compounds, and biological macromolecules. It is also frequently used to quantitate organic compounds found in many natural products and dietary supplements. UV/VIS has the limitation of not being as specific or accurate as HPLC or GC, but can be a quick and easy way of quantitating compounds or groups of compounds for “process control” or when one needs a reproducible way of measuring the quality of any material, such as an extract or botanical, without the need for the specificity of more accurate techniques. Ultraviolet-visible Spectroscopy
analysis due to its high selectivity and sensitivity. We developed and optimized a method using this technology for the determination of multiple pesticide residues in various samples matrices prepared by a QuEChERS extraction technique. Atmospheric Pressure Gas Chromatography Triple Quadrupole Mass Spectrometry (APGC-MS/MS) is used with QuEChERS extracted samples for multiple residue pesticide analysis in numerous matrix type samples. The APGC source is a “soft” ionization technique with reduced fragmentation, and a high level of matrix tolerance gives the sensitivity and specificity for pesticide residue compliance analysis. Inductively Coupled Plasma Mass Spectrometry (ICP-MS) is used to determine heavy metals in botanicals and dietary supplements. Heavy metals, which are associated with health risks, can be introduced in botanicals when grown in contaminated soil or during manufacturing processes. Microwave digested samples are analyzed using ICP-MS for trace level analysis of these elemental impurities. Headspace Gas Chromatography Triple Quadrupole Mass Spectrometry (HS-GC-MS/MS) identifies volatile organic compounds used or produced in the preparation of botanical extracts and dietary supplements. A method using HS-GC-MS/MS and GC-MS/MS for all Class 1 and Class 2 USP <467> Residual Solvents has been developed for dietary supplement formulations.
Wet Chemistry is analysis that is generally performed in the liquid phase, and contains many different types of methods, such as Titration, Gravimetric analysis, Moisture, pH, Specific Gravity, Loss on Drying, Ash, Environmental, and some Elemental analyses of samples. Generally, Wet Chemistry is sometimes used to analyze single components in samples to which the method is targeted, but due to the non-specific nature of Wet Chemistry methods it is frequently only able to measure larger groups/classes of compounds versus single markers, hence is not as accurate as HPLC or GC.
Spectrometry
PURITY TESTING Ultra-Performance Liquid Chromatography Triple Quadrupole Mass Spectrometry (UPLC-MS/MS) with Electrospray Ionization is used for multi-residue pesticide
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From the VBMA
The Veterinary Botanical Medicine Association is a group of veterinarians and herbalists dedicated to developing responsible herbal practice by encouraging research and education, strengthening industry relations, keeping herbal tradition alive as a valid information source, and increasing professional acceptance of herbal medicine for animals.
DID YOU GUESS LAST ISSUE’S MEDICINAL HERB? It was Chelone glabra, also known as turtle head or balmony. This herb clears heat, dries dampness, and functions as a bitter tonic. Pharmacologically, it is an alterative, anthelmintic, aperient, bitter tonic, cholagogue, and choleretic. Balmony is an excellent bitter digestive tonic. It enhances digestion, absorption, and elimination, especially of fats in cases of slow transit time. A lack of appetite is often noted with intestinal dysbiosis, accompanied by flatulence and borborygmus, and Chelone glabra can help with this.
CASE REPORT Zahra is a four-year-old female Scottish Deerhound who was diagnosed with liver vascular shunts when she was ten weeks old. She has grown up well but is very intolerant of too much fat in her diet. When she indulges in an excessive amount of fat (e.g. eating outdoor bird suet!), Chelone glabra helps her greatly through the subsequent dietary issues.
WEBINAR SCHEDULE Our webinar schedule began on February 3, 2022 with a fantastic speaker on a very important topic. Barbara Fougere, DVM, lectured on medicinal mushrooms in veterinary practice. She explored seven fungi and their practical application in practice, including their actions, indications and safety. She presented fungi that enhance senior pet well-being; help with cancer; and support patients with renal and liver disease. Finally, Dr. Fougere reviewed the easy cultivation of mushrooms at home. You can purchase webinars on-demand at vbma.org.
COVID safety in mind. Both tours are being held through the New York Complementary and Alternative Veterinary Medical Association (NY CAVMA). 1. O n April 25 to 29, 2022, Matthew Wood, RH (AHG) will lead a three-and-a-half day program at Menla Retreat in the Catskill Mountains. Called “A Potpourri of Herbal Wisdom and Insights,” the program includes a lecture on Lyme disease and co-infections and the herbs that can help. Matthew will share his experience with these problems in humans, and discuss teasel, blue vervain, wild bergamot, cleavers, red clover, and holly. He will share insights and treatments for autoimmune disease, discuss the extracellular matrix with its implications for therapy, and present specific animal medicines. 2. F rom August 4 to 10, our Alaskan eco-tour will provide a unique adventure. We have full use of the Twin Bear campground north of Fairbanks. We offer a mixed program, starting with a native herbalist, Kathleen Hildebrand Meckel, followed by two days with our leading esoteric veterinarian, Are Thoresen, DVM, and finishing with two days of herbal and stone hikes with two Alaskan natives, Leslie and George. Interspersed will be hot springs, hikes in the woods, use of a small lake, and wonderful comradery! Register for both tours at nycavma.org. Submitted by Cynthia Lankenau, DVM
GUESS THIS HERB!
COMING EVENTS We look forward to more speakers this year, including David Winston, as well as two eco-tours, which will occur with
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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CONSIDERATIONS FOR PREGNANT VETERINARIANS BY CHERY F. KENDRICK, DVM, MPVM, MLT, ASCP, CFS
Communication and accommodation support healthy pregnancies and a positive return-to-work experience for veterinarians who are also new mothers.
Women now comprise 63% of the veterinary workforce. This means veterinary teams need to be aware of the unique considerations of their female staff during pregnancies, along with when they return to work after giving birth. For this article, I spoke with several pregnant veterinarians and technicians, as well as those who are just returning to work or have been back for a few months. I also spoke to practice managers and asked how they support a pregnant workforce.
WHEN TO “SHARE THE GOOD NEWS”
Understandably, many women are hesitant to share the news of their pregnancy during the first trimester, but this is also a critical time to protect the growing fetus from potential workplace hazards. So even if you are hesitant to officially share the good news, be sure to keep in mind your exposure to things that are potentially harmful to the fetus in the first trimester.
CHEMICAL EXPOSURES Anesthetic agents • Much has been studied and written about the anesthetic agents we use, and in fact this research led to a change in the type of agents routinely utilized in veterinary medicine. • Common anesthetic agents, such as isoflurane, along with the high quality scavenger systems of our anesthetic machines, make the surgery suite a much safer environment for all, including pregnant team members. • OB/GYNs no longer recommend the use of bulky volatile chemical respirators in the surgical suite, claiming them to be unnecessary. Medications Many medications we routinely use come with precautions to wear gloves. Make sure you use pill counters when preparing a prescription, but also wear gloves. It is a simple precaution to take. If you are cutting pills or mixing powders, it is also a good idea to wear a mask to prevent inhalation of dust particles from the medications. Chemotherapeutic agents While we all should be wearing full chemo PPE when administering or assisting in the administration of chemotherapeutic agents (double gloves, longsleeved fluid-resistant gowns, face shield and mask), it is highly recommended that, even with these precautions, women should forgo administering or assisting in the administration of chemotherapeutic agents during pregnancy.
ANIMAL HANDLING, LIFTING AND RESTRAINT
Animal handling concerns arose in every interview I conducted. Be mindful when lifting patients, do not hesitate to ask for assistance, and use those wonderful lift tables. Effective animal restraint is a serious concern for several reasons. It is critical that you have a proficient handler to protect you not only from bites, but also from being knocked over (yes, balance can be a little off during pregnancy). Also, as you progress in your pregnancy, it may be harder for you to react and get out of the way. Pregnant women do not necessarily lose their athleticism, but reflexes may be a bit slower, their balance may not be as sharp as it was pre-pregnancy, and sometimes in that last trimester, especially as a woman nears her delivery date, it can be cumbersome to change positions from standing, kneeling, or squatting. It is essential to have good assistants who are proficient at restraint.
SLIPS AND FALLS It is important to take extra care around slippery floors or icy stairs and parking lots. Even if a pregnant woman does not actually fall, slipping and stretching of the pubic symphysis is even more painful and will stay painful for the rest of the pregnancy.
RADIOLOGY
Our radiology machines are safer than ever, and properly-worn PPE is good protection from any scatter. The general rule is to stay out of the room when radiographs are being taken, if you can, just to be extra safe. Be sure you are reviewing the dosimeter readings and that the machines are being carefully monitored and certified for the best level of protection from ionizing radiation.
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STANDING, BREAKS, AND ANTI-FATIGUE MATS
Another change that many women make during pregnancy involves how much time they spend standing. For example, pregnant veterinarians in spay and neuter clinics may adjust their time standing, make sure to take more breaks, and use anti-fatigue mats. These are good self-care reminders for all of us, pregnant or not.
CONSIDERATIONS WHEN RETURNING TO WORK
The primary concern moms had upon returning to work was having a clean and private place to pump breast milk. Sounds reasonable, right? The Department of Labor thinks so too. Section 7 of the Fair Labor Standards Act (FLSA) General Requirements states that all employers are required to provide “reasonable break time for an employee to express breast milk for her nursing child for 1 year after the child’s birth each time such employee has need to express the milk.” Employers are also required to provide “a place, other than a bathroom, which is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk.” (US Department of Labor. Fact Sheet #73: Breaktime for nursing mothers under the FLSA. April 2018. https://www.dol.gov/agencies/whd/ fact-sheets/73-flsa-break-time-nursing-mothers). This area should have restricted access while the mother is using it. Remember, it needs to be a place other than the bathroom. During my VetOSHA clinic inspections, as part of our compliance management services, I am thrilled to see the many wonderful spaces that clinics have created for their nursing moms. Practice managers report that taking special care in providing a place to pump breast milk is very rewarding. Providing a comfortable and private space for nursing moms not only shows respect, but also demonstrates that every employee is valued and cherished. Practices can support new moms by making them comfortable during the transition period from staying at home with the new baby to returning to work. 64
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EMPHASIZE COMMUNICATION AND DOCUMENTATION
The best practice is to always make sure you are communicating with management and that all meetings and accommodations are well documented. All the practice managers interviewed recommended that pregnant employees communicate clearly with their OB/Doula to make sure the latter are aware of the type of work they do, and to see if they have any special recommendations or precautions they want the pregnant women to take. Working while pregnant is a common and empowering time for mothers-to-be. Communication, documentation, and accommodation all support healthy pregnancies and a positive return-to-work experience for our valued colleagues. So keep in mind these few points and recommendations, and enjoy your pregnancy. We all look forward to welcoming these new little ones into the veterinary family!
SUPPORTING THE POSTPARTUM MOM’S MENTAL HEALTH Many of the moms I spoke with also talked about emotions, not only during pregnancy but also upon returning to work after maternity leave. Pregnancy and birth cause intense hormonal fluctuations. This along with the newness of being pregnant, giving birth, and then having to leave the baby in another’s care to return to work, can cause widely fluctuating moods and reactions. These moms mentioned the importance of having the veterinary team cut them a little slack, to understand these mood changes, and to know that emotionality can be a part of the pregnancy, birth, and postpartum experience. Patience and understanding from team members are much appreciated.
ADVICE FROM PRACTICE MANAGERS Inform: Let practice managers know of your pregnancy as soon as possible, so that a plan can be implemented to provide a safe work environment for mom and baby. Communicate: Let practice managers know what you feel safe doing while pregnant, and determine what accommodations need to be made. Keep communicating throughout the pregnancy, as these parameters are likely to change as the pregnancy progresses. Identify hazards: Discuss hazards with practice managers. While it is the veterinarian’s responsibility to know about workplace hazards, practice managers might be able to share additional information about which medications should not be handled and which cleaners to avoid. Document: Practice managers should provide an outline of these discussions and have the veterinarian sign and date the document, acknowledging that the topics have been addressed. Also, they should encourage an open-door policy to which pregnant veterinarians can bring any concerns that may arise.
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.
SAFETY AND ANIMALS — A HOMEOPATHIC PERSPECTIVE The Merriam-Webster dictionary defines safety as: 1) freedom from harm or danger; the state of being safe; 2) the state of not being harmful or dangerous, and 3) a place free from harm or danger; a safe place. Nationwide Insurance reports that injuries caused by animals are the second leading cause of emergency room visits, resulting in over five million visits annually: • 7 0% are dog bites to children under ten years old; 77% involve the facial area • 7 7% of bites are caused by dogs owned by family or friends, and happen in familiar settings • 6 5% of serial attacks and 79% of rampage attacks (multiple people at once) are caused by Pit Bulls Terriers and Rottweilers. It’s obvious from these stats that we must practice proper restraint of high-risk dogs (and other species), and teach children how to be safe around these animals. But what about the safety of the animals themselves? From a homeopathic view, safety really falls into the category of “hygiene”. Lack of safety in an animal’s world creates an obstacle to cure that the best homeopathic prescribing will struggle to overcome. A few more hygiene factors that are also obstacles to cure include: • Poor diet and improper supplementation • Air and water quality problems • Poor housing or bedding • Exposure to toxins (pesticides, chemicals) • T herapeutic/treatment choices (vaccines, allopathic medicines) Dealing with these basic factors first will increase the success of any homeopath in applying the safest medicine on the planet. “With this matchless curative mode, no violent attack upon the organism is required in order to extirpate even a stubborn old malady. The cure takes place only by a gentle, unnoticeable and yet often swift transition from the tormenting natural suffering to the permanent health that is desired.” Dr Samuel Hahnemann, from the Organon, 6th edition; aphorism 51
Submitted by Todd Cooney, DVM, CVH IVC Spring 2022
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NEW PROGRAM ADDRESSES MENTAL HEALTH CRISIS AMONG VETERINARIANS As you’re no doubt aware, a mental health crisis is surging among veterinarians and their clinical staff. According to the CDC, in fact, vets and their employees suffer the highest suicide rates of all medical professionals. What you may not be aware of is the development of the Veterinary Mental Health Initiative (VMHI), the first and only program in the U.S. to specifically address the mental health crisis in the veterinary profession. VMHI provides free, multi-level, virtual mental health counseling to veterinarians and their clinical staff, regardless of where they live and work. Two specific services are offered: professional peer support groups and one-on-one support sessions. Counseling is conducted by expert clinicians with experience in grief and loss, work-life balance, trauma, depression and anxiety, and suicide prevention. VMHI was founded by two concerned women – a pet owner and a doctorate in psychiatry from Stanford University — whose lives were intertwined by their mutual love of animals, along with an awareness that the veterinary profession was under threat of collapse from untreated mental health strain. The high stress levels of practicing veterinary medicine, caused by work overload, emotional fatigue from exposure to consistent life/ death trauma, and client rage, take a serious toll on the mental health of vets and their staff. Those working in the veterinary field also have one of the highest debt-toincome ratios of all professionals. The COVID-19 pandemic created yet another major stressor — a perfect storm. People acquired over 23 million new pets in just one year, from 2020 to 2021. This resulted in increased caseloads and an excessive shortage of veterinarians to care for all these new animals, according to the ASPCA. Another COVID-related layer of stress involves the financial pressures of caring for pets whose owners can’t
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afford medical care, putting veterinarians in the position of providing free care to their own financial detriment, or of prematurely euthanizing pets they could otherwise save. Despite everything that veterinarians do to care for animals and the community, mental health resources are difficult to access due to prohibitive costs. As well, the stigma associated with mental health issues remains a barrier to care. VMHI’s fully funded/free programs are available to any veterinarian or veterinary staff member. To find out more, visit www.shanti.org/programs-services/veterinary-mental-health-initiative/.