V12I3 (Summer 2022) by Redstone Media Group

Innovative VOLUME 12 ISSUE 3

VETERINARY CARE

SUPPLEMENTS FOR EFFECTIVE CARDIAC SUPPORT HEART PROBLEMS ARE RELATIVELY COMMON IN DOGS AND CATS, AND THESE SUPPLEMENTS MAKE AN EFFECTIVE ADDITION TO YOUR TREATMENT PLAN. — P. 57

EXERCISES THAT KEEP GERIATRIC DOGS FIT — PHYSICALLY AND MENTALLY

Regular exercise improves memory and cognition, strengthens muscles, and enhances quality of life in senior dogs. — P. 8

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SUMMER 2022

NUTRACEUTICALS FOR FELINE CACHEXIA

HERBS FOR HEARTWORM

This case study shows how herbal therapies can be used to treat heartworm disease when medications aren’t effective. — P. 26

DEALING WITH SEPARATION ANXIETY IN DOGS

How a range of supplements can help manage this complicated condition in cats. — P. 17

Why understanding separation anxiety and separation-related behaviors helps with diagnosis and treatment. — P. 35

3D HOLOGRAPHIC IMAGING IN VETERINARY PRACTICE

OSTEOPATHY FOR EQUINE BACK PAIN

This technology is new to veterinary medicine, but it’s already making a significant difference to diagnostics. —P. 22

How back pain attributed to “kissing spines” can benefit from osteopathic treatment. — P. 62

SUMMER 2022

EDITORIAL DEPARTMENT

Editor-in-Chief: Dana Cox Managing Editor: Ann Brightman Associate Editor IVC: Omer Rashid, DVM Senior Content Editor: Kari Klasson Content Editor: Rebecca Bloom Graphic Design Lead: Ethan Vorstenbosch Graphic Designer: Hannah Cuenco Graphic Designer: Joy Sunga Junior Graphic Designer: Luke Bakos

COLUMNISTS & CONTRIBUTING WRITERS

Nancy M. Brandt, DVM, CVC, CVA, CVMA Todd Cooney, DVM, CVH Kelly Diehl, DVM Ann-Marie B. Hancock, DVM, EDO Moira Hechenleitner, DVM, CSAT Cynthia Lankenau, DVM, RH (AHG) Laurie McCauley, DVM, DACVSMR, CCRT, CVA, CVC Jared Mitchell, DVM, CVMA, CVA, CVFT Evelyn Orenbuch, DVM, DACVSMR, CCRT, CAVCA Nell Ostermeier, DVM Barrie Sands, DVM Nancy Scanlan, DVM, CVA

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IVC Journal (ISSN 2291-9600) is published four times a year by Redstone Media Group Inc. Publications Mail Agreement #40884047. Entire contents copyright© 2022. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: June 2022.

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

IVC Summer 2022

contents FEATURES

THE GERIATRIC DOG'S 35 8 KEEPING BRAIN AND BODY FIT WITH EXERCISE By Laurie McCauley, DVM, DACVSMR, CCRT, CVA, CVC, and Evelyn Orenbuch, DVM, DACVSMR, CCRT, CAVCA

From improving memory and cognition to strengthening muscles and enhancing quality of life, regular exercise benefits the health and well-being to your geriatric canine patients.

8 17

By Moira Hechenleitner, DVM, CSAT Understanding separation anxiety and separation-related behaviors helps with the diagnosis and treatment of affected dogs.

How heart intelligence and coherence techniques allow for increased workplace communication, morale, satisfaction, productivity, innovative problem-solving, and more.

By Jared Mitchell, DVM, CVMA, CVA, CVFT

THE USE AND IMPACT OF 3D HOLOGRAPHIC IMAGING IN VETERINARY MEDICINE By Omer Rashid, DVM, MSc Parasitology 3D holographic imaging has added good value to human healthcare. While this technology has only recently been introduced to veterinary medicine, its footprint can be substantive.

REPORT — USING HERBS TO 26 CASE TREAT HEARTWORM IN A DOG

By Cynthia Lankenau, DVM, RH (AHG)

How herbal therapies were used to successfully treat heartworm disease in a dog that didn’t respond to macrocyclic lactones and melarsenoxide.

35 62 4

IVC Summer 2022

INNOVATIVE PRACTICE HEART INTELLIGENCE FOR VETERINARY TEAMS By Barrie Sands, DVM

NUTRACEUTICALS FOR THE MANAGEMENT OF FELINE CACHEXIA Defining and understanding feline cachexia can be complicated, but the use of nutraceuticals can help manage the condition.

RISK FACTORS AND BEHAVIORS ASSOCIATED WITH SEPARATION ANXIETY IN DOGS

TAKING ON HEART DISEASE IN DOGS AND CATS By Kelly Diehl, DVM

A review of some of the latest studies and recent findings on heart disease — and a look at where cardiology research is heading.

NUTRITION NOOK CARDIAC SUPPLEMENTS FOR , DOGS AND CATS By Nancy Scanlan, DVM, CVA

Heart problems are relatively common in dogs and cats. A range of supplements can help support your cardiac patients, and make an effective addition to your treatment plan.

OSTEOPATHIC TREATMENT FOR BACK PAIN IN HORSES

By Ann-Marie B. Hancock, DVM, EDO How equine patients with back pain attributed to “kissing spines” can benefit from osteopathy.

advisoryboard

42 COLUMNS & DEPARTMENTS

7 Editorial 15 Profitable practice — ImpriMed 20 From the VMAA 25 From the AVH 33 News bite 34 Profitable practice — AnimalBiome 47 From the AHVMA 48 Newsworthy 49 From the VBMA 53 From the IVAS

Dr. Richard Palmquist, DVM GDipVCHM(CIVT) CVCHM (IVAS), graduated from Colorado State University in 1983. He is chief of integrative health services at Centinela Animal Hospital in Inglewood, California, former president and research chair of the AHVMA, and an international speaker in integrative veterinary medicine. Dr. Palmquist is a consultant for the Veterinary Information Network (VIN) and a past president of the AHVM Foundation. He has published two books, one for conventional veterinarians and a second for clients discussing how integrative thinking works.

Michelle J. Rivera, MT, VDT, is an instructor at the University of Wisconsin and The Healing Oasis Wellness Center, a post-graduate educational institution offering state-approved programs. She is 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.

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.

54 In the news 56 Industry innovations 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.

IVC Summer 2022

1. KELLY DIEHL, DVM

Dr. Kelly Diehl received her DVM from the University of Tennessee and started her practice career in an emergency clinic in New Jersey. She completed an internship at the Animal Medical Center in New York City, after which she moved west, completing a residency in small animal medicine at Colorado State University. Dr. Diehl joined the staff of the Veterinary Referral Center of Colorado as the co-owner of the internal medicine section. After 14 years, she left private practice to pursue a career in medical communication and joined the Morris Animal Foundation team in 2013. Dr. Diehl is a board-certified small animal internal medicine specialist and a Certified Veterinary Journalist. p.50

2. ANN-MARIE B. HANCOCK, DVM, EDO

Dr. Ann-Marie Hancock graduated from Colorado State University with a BS in Equine Science, an MS in Anatomy and Neurobiology, and a DVM in 2003. She worked at a general equine practice in North Carolina for ten years. She completed the IVAS Acupuncture course in 2007, the Equine Osteopathy Course at the Vluggen Institute in Texas, and became certified as an Equine Osteopath. Dr. Hancock owned Rectortown Equine Clinic in 2013, then relocated to Marshall, Virginia to open True North Equine Veterinary Services, an expanding hub for practitioners supporting equines in any life stage or discipline. p.62

3. MOIRA HECHENLEITNER, DVM, CSAT

Dr. Moira Hechenleitner graduated in 2007 from Mayor University College of Veterinary Medicine in Santiago, Chile. She is a Certified Separation Anxiety Trainer (CSAT), with a postgraduate in AnimalAssisted Therapy. Dr. Hechenleitner is a founding board member of the Chilean Association of Professional Dog Trainers (APDT Chile) and has spent the last 14 years offering consultation services to pet owners and teaching courses to dog trainers. She is a speaker on the topic of separation anxiety, giving seminars internationally in English and Spanish, and helps dogs and their families from all over the world overcome separation anxiety. p.35

4. CYNTHIA LANKENAU, DVM, RH (AHG)

Dr. Cynthia Lankenau received her DVM from Cornell University in 1981, and started studying alternative modalities in 1992. She is certified with the IVAS, AVCA and AHV, and in Chinese Herbal Medicine through the Chi Institute and CIVT. She is a registered herbalist through the American Herbal Guild and is currently working on CIVT’s Western Graduate Herbal program. She is Past President of the Veterinary Botanical Medicine Association, and owns a private integrative mixed practice. p.26

5. LAURIE MCCAULEY, DVM, DACVSMR, CCRT, CVA, CVC

Dr. Laurie McCauley graduated in 1992 from Colorado State SVM. She became a pioneer in the field of veterinary rehabilitation, designing the first underwater treadmill for dogs. In 1998, Dr. McCauley started the first veterinary rehabilitation clinic, TOPS Veterinary Rehabilitation, and was on faculty at Canine Rehabilitation Institute for 14 years. She is certified in acupuncture and chiropractic,

IVC Spring 2022

and Board Certified in Canine Sports Medicine and Rehabilitation. Dr. McCauley was awarded the 2011 Iams AARV Award of Excellence in the Field of Rehabilitation, and the 2015 AHVMA Holistic Practitioner of the Year Award. In 2017, she opened Red Tail Rehab mobile practice in North Carolina, and in 2020 created Optimum Pet Vitality, an online learning platform. p.8

6. JARED MITCHELL, DVM, CVMA, CVA, CVFT

Dr. Jared Mitchell graduated from Mississippi State University’s College of Veterinary Medicine in 2004. He owns Mitchell Animal Clinic in Mobile, Alabama and began incorporating holistic modalities into his practice. Dr. Mitchell has advanced training in essential oils through the VMAA. He has published articles for several peer-reviewed journals and plans to continue contributing articles and educating colleagues on the therapeutic benefits of essential oils. Dr. Mitchell is also certified in veterinary acupuncture and veterinary food therapy through Chi University and is currently enrolled in their Masters of TCVM program. p.17

7. EVELYN ORENBUCH, DVM, DACVSMR, CCRT, CAVCA

Dr. Evelyn Orenbuch is a Diplomate of the American College of Veterinary Sports Medicine and Rehabilitation and has been practicing veterinary rehabilitation medicine exclusively since 2003, when she started treating agility dogs in the Philadelphia area. In 2009, she moved to Georgia, and in 2011 opened Georgia Veterinary Rehabilitation, Fitness, and Pain Management (GVR), the first and largest stand-alone canine rehabilitation clinic in the state. In 2020, Dr. Orenbuch sold GVR to focus on expanding veterinary rehabilitation nationally through her work with VROMP (Veterinary Rehabilitation and Orthopedic Medicine Partners) and with Optimum Pet Vitality (OPV). p.8

8. NANCY SCANLAN, DVM, CVA

Dr. Nancy Scanlan is Executive Director for the AHVM Foundation, a board member of the World Association of Traditional Chinese Veterinary Medicine, and a consultant on the Veterinary Information Network. She has been using complementary health therapies in her veterinary practice since 1970, including nutraceuticals, acupuncture, non-classical homeopathy, and Chinese and Western herbs. Dr. Scanlan was Executive Director of the AHVMA for three years and president of the VBMA for two years. p.57

9. BARRIE SANDS, DVM

Dr. Barrie Sands received her DVM degree from Ross University in 1991. She achieved her CVA certification from IVAS in 2003, followed by advanced training in food and herbal therapies and homeopathy. Dr. Sands has been working at the VCA Emergency and Referral Center in San Diego since 1996 in the Emergency Critical Care department, and is head of the Integrative Holistic department. She is a certified trainer for the Institute of HeartMath. Dr. Barrie authored the book The Stupid Things My Human Does; True Stories from the Animal ER. p.42

editorial

Healthy hearts

for hear t felt moments I recently joined IVC Journal as the new Associate Editor, and am quite excited to start my journey here. Innovative approaches to veterinary care have immense potential to elevate veterinary practice, and I’ve always been impressed with IVC’s ability to bring that information to you in a professional, easy-to-read format. I remember well how my immense love for animals started — it was with my first kitten, a gift from my parents. I had the most wonderful time with that lovely creature. Unfortunately, it didn’t last very long. I woke up one day to find out my friend was no more. I went to school heartwrenched, and learned a hard lesson. Sometimes you don’t know how much you love something (or someone) until you lose them — and it’s not a good feeling. When it comes to companion animals, a considerable number of mortalities can be blamed on heart diseases. It’s our job as veterinarians to keep animals healthy and playful so they continue to share joyful life experiences with their families. Obviously, that means staying on our toes regarding heart issues, and educating our clients about heart wellness for their companions. A crucial part of heart health is ensuring our patients stay safe from any predisposing factors that may lead to cardiac problems. As we know, preventive measures and healthy routines can result in healthy hearts and extended lifespans.

In this issue, you’ll find vital information pertaining to veterinary cardiology. Refresh your knowledge about heart disease in dogs and cats with a comprehensive article by Dr. Kelly Diehl. Learn about the best cardiac supplements for companion animals from Dr. Nancy Scanlan. And read a fascinating case study regarding heartworm by Dr. Cynthia Lankenau, which will likely change your treatment approach. This issue also contains some valuable information about HeartMath for veterinarians; it will introduce you to techniques that can help you stay free from stress and anxiety. You will also get to read about feline cachexia management, 3D holographic imaging in veterinary medicine, and osteopathic treatment of equine back pain. I hope you enjoy all the intriguing content, and perhaps find some valuable tools you can use to help your patients a little further along on the road to wellness. Please feel free to reach out; I would love to hear from you! Warm regards,

Omer Rashid, DVM, MSc Parasitology Associate Editor, dromer@redstonemediagroup.com

IVC Summer 2022

From improving memory and cognition to strengthening muscles and enhancing quality of life, regular exercise is beneficial to the health and well-being of your geriatric canine patients.

KEEPING THE

GERIATRIC DOG'S

BRAIN AND BODY FIT WITH

EXERCISE

BY LAURIE MCCAULEY, DVM, DACVSMR, CCRT, CVA, CVC, AND EVELYN ORENBUCH, DVM, DACVSMR, CCRT, CAVCA

IVC Summer 2022

We’ve all seen it. The 80-year-old ladies lifting weights, doing Tai chi, going for power walks, staying healthy and mobile. These active octogenarians are striving for not only a long lifespan, but a long health-span as well. Likewise, our older canine patients need to exercise and keep moving to achieve a health-span that matches their lifespan. But first, let’s look at the terminology and science around aging, the changes we are combating, and what exercise can do for the geriatric dog. Currently, geriatric animals account for about half the U.S. pet population, and this percentage continues to increase annually. These animals show age-related decline in organ function, musculoskeletal health, and cognition. Dogs can be defined as geriatric when they have completed 80% of their expected lifespan. Dogs are commonly categorized into life expectancy groups by size, which means their age of becoming geriatric is also based on their size. A small dog is considered geriatric at 11.5 years of age, a medium dog at 10.2 years, a large dog at 8.9 years, and a giant breed dog at 7.5 years of age.

SENESCENCE AND ITS EFFECTS Senescence, a term used in aging, actually occurs throughout an animal’s lifespan. It’s a process by which cells age and permanently stop dividing, but do not die. Over time, large numbers of senescent cells can build up in tissues throughout the body, leading to damage or loss of function in those tissues. Senescence leads to increased susceptibility to infectious and chronic disease, loss of resistance to external and internal stressors, and an inability to maintain and repair somatic systems. In the brain, senescence frequently coincides with changes in the structural plasticity of dendritic spines and aberrant neuronal plasticity directly associated with impaired brain functions.1 This manifests itself as memory loss and cognitive decline.

life have less brain tissue loss than sedentary individuals.5 Synaptic plasticity, neurotransmission, and growth factor gene expression are heightened in the hippocampus of physically active rats and mice.6 Also, physically fit aged humans performed better on cognitive tests than their sedentary counterparts.7 In short, we can use physical exercise to prevent or reverse hippocampus atrophy in our pets and patients.

PREVENTING SARCOPENIA Now on to the muscles. Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength, and is correlated with physical disability, poor quality of life, and death. Risk factors for sarcopenia include age, gender and level of physical activity.8 The loss of muscle mass is associated with an increase in body fat. Despite normal weight, there is a marked increase in weakness. The loss of muscle quantity appears to be mainly due to a degradation of contractile protein, resulting from both the reduction of single muscle fibers and a decrease in the cross-sectional area of residual muscle fibers.9 There is an important correlation between inactivity and loss of muscle mass and strength. This suggests that physical activity should be a protective factor for the prevention and management of sarcopenia. Progressive exercises can produce substantial increases in strength and muscle size, even in the ancient population.10 Preventing or postponing the onset of this condition enhances survival in people, and should also be a natural part of recommended management for our geriatric canine population.

HOW EXERCISE CAN SLOW AGERELATED DECLINE Can we change this decline? Of course, or we would not be writing this. Experiments in mice showed that voluntary running and enrichment produced a doubling in the number of new hippocampal granule cells as compared to mice housed in standard living conditions.2 Why is this important? Because the hippocampus is the area of the brain in charge of memory and learning. In elderly humans, sequential imaging studies have shown hippocampal atrophy.3 Think about your elderly relatives. Do they process as quickly or learn as easily as they used to? Some of this aging process may be prevented or reversed by exercise.4 Indeed, older adult humans who exercise throughout IVC Summer 2022

FIVE EXERCISES FOR THE GERIATRIC CANINE PATIENT Now that we know the science, what are the best exercises for our geriatric pets and patients? We will review five favorites:

Cookie Stretches — When done correctly, this

exercise can be used to flex and extend the cervical, thoracic, and in many dogs, the lumbar spine. They can also be used as a diagnostic tool to assess for pain or restrictions along the spine, and as an exercise to cause weight shifts onto one or a pair of limbs. Cookie Stretches enhance balance and can be considered similar to “doggy yoga”. They can be done every day and performed by most owners with little risk of harm. A cookie is brought sequentially to the shoulder, behind the front foot, back to the shoulder, to the hip, behind the rear foot (repeated on the other side), and to the chest, the floor, between the front feet as far back as possible, and lastly, with the front feet elevated at withers height or higher, the dog’s nose lured straight up to the sky.

Bonus: A nose straight up is of utmost importance

Cavalettis — These can be used to decrease pacing,

enhance even weight-bearing, increase limb joint flexion and stride length, improve balance and proprioception, strengthen muscles, including in the trunk, and reduce foot sliding. Cavaletti spacing depends on the goal and the dog’s speed. The widest is for the patient with severe weakness and/or cognitive or neurological deficits. This width is usually 1 to 1.5 the length of the dog from nose to tail base. This allows all four limbs to cross before the next obstacle is attempted. The distance from floor to withers is a starting point for the trotting dog. Spacing for the walking dog is approximately the distance from floor to point of shoulder. The narrowest spacing is for enhanced limb flexion, balance and proprioception. Small adjustments may need to be made for each option, wider or narrower depending on the speed of the patient. The faster the dog moves, the longer the stride length.

Bonus: To check the distances, video from the side and follow one foot to make sure it hits in the same place between each set of Cavalettis. It is also imperative to start 5’ to 6’ before the Cavalettis to allow the dog to set their stride before they step

for full spinal extension; if the dog can’t do it, there’s

over the first one, and maintain the same speed 5’ to

a problem that needs addressing.

6’ past the last pole.

Ollie Walking over Cavaletti Jacks for enhanced balance, limb flexion, and cognitive function. Cavaletti Jacks can be purchased at www.optimumpetvitality.com/store.

Syd demonstrating full spinal flexion using Cookie Stretches.

IVC Summer 2022

Wobble Board — With the handler controlling

the board, this exercise can be gentle and safe enough for one-week-old puppies and also challenging enough for competitive adult canine athletes. With no shear force on any joint, all the muscles that stabilize the limb joints and spine can be strengthened. By having different-sized domes and the ability to move them or add others, as seen with the OctoBoard (www. optimumpetvitality.com/store), the challenge can be increased, and the limbs protected during exercises.

Bonus: Hold on to a solid surface to prevent losing your balance while you control the movement of the board.

Dr. McCauley and Ollie performing Wobble Board exercises on an OctoBoard, which has six domes in three different sizes that can attach to any position on the Velcro bottom of the octagonal board.

EXERCISE AND OSTEOARTHRITIS So many of our patients have osteoarthritis and many veterinarians wonder if exercises should be prescribed for these animals. The answer is an unequivocal yes!

Akie demonstrates how a dog can stand with three limbs on the OctoBoard, allowing the fourth limb to experience maximum strengthening capability in a safe manner.

Wobble Board exercises can be done with the dog controlling the board, but the degree of difficulty or challenge is significantly limited when compared to having the handler control the board. With the handler standing on the board, the dog can have two, three, or four feet on the board. When three feet are on, the fourth limb has to balance the whole body, which is a fast way to increase strength in that limb while performing safe isometric contractions.

In a 2009 paper, Dr. Neil J. Bosomworth concluded that as long as injury was avoided, moderate exercise does not lead to an acceleration of knee osteoarthritis in humans with or without pre-existing disease.11 He went on to state that patients with established osteoarthritis have been shown to derive uniform benefits to physical functioning, with reduction of pain and disability, using aerobic, muscle-strengthening, aquatic, or physiotherapy-based exercise modalities. He found that exercise interventions are underused in the management of established knee osteoarthritis symptoms.

IVC Summer 2022

Backwards Walking — This is one of the best

exercises for strengthening the muscles of standing, rising and propulsion. It can be done any number of ways. Our favorites include placing the dog in a heel position and walking backward; getting in the dog’s space in front of them and walking into them; or luring them with a tasty treat at chest to nose height.

THREE TYPES OF EXERCISE

The idea is to have the dog take large steps with the rear limbs to strengthen the muscles on the caudal aspect of the fore and rear legs — the muscles of propulsion in the rear, and deceleration and standing in the front. Keeping these muscles strong prevents the way-too-often-heard: “We said goodbye because he couldn’t get up any longer.” A very important detail is to have the dog looking straight out or down, not up. If the dog looks up, they are not able to take a long stride with their fore or rear limbs, significantly decreasing the ability to strengthen the targeted muscles. The duration of this exercise can involve backing up as few as three to five steps before each meal for a weak dog, all the way up to walking backwards 100’ to 200’ in the yard for a stronger dog, whether geriatric or young.

Exercise can be broken down into three types; isometric, concentric, and eccentric.

ISOMETRIC EXERCISE — the muscles are contracting, but the length of the muscle fibers stays consistent. This is considered the easiest form of exercise, the slowest to build muscle strength, and has the least chance of muscle injury.

2. 3.

CONCENTRIC EXERCISE — the muscle fibers shorten with contraction. Strength building and chance of injury are moderate. ECCENTRIC EXERCISE — the muscle elongates as it fires, preventing stretching of the muscle fibers. It builds strength the fastest, but has the highest incidence of injury. In aging muscle, this higher injury incidence is exacerbated. In a study using aged rodents subjected to a single eccentric contraction, muscle force deficits were two-fold greater when compared with the same stretch in the muscle fibers of young rodents.9 For this reason, we recommend low force isometric and concentric exercises when starting a physical activity program with geriatric patients.

IVC Summer 2022

Ollie, Dr. McCauley’s 12-year-old Mastiff mix, walking backwards. He can easily walk 100’ backwards without a break.

Sideways Walking — This is the best exercise

for strengthening the muscles that stabilize the hips and shoulders. As dogs age, they frequently have a tendency to lie with their elbows lateral to the body instead of under the shoulders. This puts stress and stretch on the deep and superficial pectoral muscles. As these muscles remain in a stretched position, and atrophy, it creates a situation in which the dog is more likely to have a splay injury. The muscles that support the hip joints also atrophy if the dog is not active as they age. Dogs with hip dysplasia commonly have atrophy of the pectineus, gluteal, and biceps femoris muscles, the muscles that help hold the

joint together. When these weaken, greater laxity can occur in the joint, leading to more pain and less active exercise. By adding Sideways Walking to a dog’s exercise program, we specifically target all these muscles. To perform the exercise, with praise for proper performance, the handler can gently walk into the dog from the side; stand in front of the dog with a treat and walk sideways holding an arm extender to guide the dog; or place a small dog on a raised surface such as a bed or countertop and guide them sideways, so the handler does not have to lean over.

These are our five favorite exercises, but you can also have access to everything you need to know in order to prescribe, perform, teach, and progress 24 exercises for your geriatric and other patients, from puppy to athlete. Since all these exercises are designed for strengthening with safety, they are a great tool to add to your toolbox. You can sign up for Optimum Geriatric Exercises at www.optimumpetvitality.com/courses-professionals. Science shows that exercising decreases the pain associated with osteoarthritis, improves cognitive function, can reverse age-related memory loss, strengthen muscles and improve quality of life in your canine patients.

1Cellular Senescence in Brain Aging. Ewa Sikora, Anna Bielak-Zmijewska, Magdalena Dudkowska, Front

Aging Neurosci. 2021; 13: 646924. Published online 2021 Feb 25. doi: 10.3389/fnagi.2021.646924. 2Enriched

environment and physical activity stimulate hippocampal but not olfactory bulb neurogenesis. Jason Brown , Christiana M Cooper-Kuhn, Gerd Kempermann, et al. Eur J Neurosci. 2003 May;17(10):2042-6. doi: 10.1046/j.1460-9568.2003.02647.x. 3Imaging hippocampal function across the human life span: is memory decline normal or not? Small

SA, Tsai WY, DeLaPaz R, Mayeux R, Stern Y Ann Neurol 51: 290–295. (2002). 4Exercise

Enhances Learning and Hippocampal Neurogenesis in Aged Mice. Henriette van Praag, Tiffany Shubert, Chunmei Zhao, and Fred H. Gage. J Neurosci. 2005 Sep 21; 25(38): 8680–8685. doi: 10.1523/JNEUROSCI.1731-05.2005Aerobic fitness reduces brain tissue loss in aging humans. Colcombe SJ, Erickson KI, Raz N, Webb AG, Cohen NJ, McAuley E, Kramer AF (2003) J Gerontol A Biol Sci Med Sci 58: M176–M180. 5Aerobic fitness reduces brain tissue loss in aging humans. Colcombe SJ, Erickson KI, Raz N, Webb AG,

Cohen NJ, McAuley E, Kramer AF (2003) J Gerontol A Biol Sci Med Sci 58: M176–M180.

6Exercise: a behavioral intervention to enhance brain health and plasticity. Cotman CW, Berchtold NC

(2002) Trends Neurosci 25: 295–301.

7A prospective study of physical activity and cognitive decline in elderly women: women who walk.

Yaffe K, Barnes D, Nevitt M, Lui LY, Covinsky K (2001) Arch Intern Med 161: 1703–1708.

8 Clinical definition of sarcopenia. Valter Santilli, Andrea Bernetti, Massimiliano Mangone, and Marco

Paoloni. Clin Cases Miner Bone Metab. 2014 Sep-Dec; 11(3): 177–180. Published online 2014 Dec 10. PMCID: PMC4269139 PMID: 25568649. 9Age-related

functional changes and susceptibility to eccentric contraction-induced damage in skeletal muscle cell. Seung-Jun Choi. Integr Med Res. 2016 Sep; 5(3): 171–175. Published online 2016 May 20. doi: 10.1016/j.imr.2016.05.004 Previous page and above: Dr. McCauley shows three methods to teach Sideways Walking. Previous page left: Syd on a countertop; Dr. McCauley uses a wand to guide the hip while feeding with the other hand. Previous page right: Using the same method with Ollie, but with a pool noodle as an arm extender, gently tapping the hip if needed. Above: Dr. McCauley walks into Ollie from the side; he moves over as she gets into his space.

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10 Reversing

sarcopenia: how weight training can build strength and vitality. W J Evans. Geriatrics. 1996 May;51(5):46-7, 51-3; quiz 54. 11Exercise and knee Exercise and knee osteoarthritis: benefit or hazard? Neil J. Bosomworth, Can Fam Physician. 2009 Sep; 55(9): 871–878. 11

profitable practice NEW AI TECHNOLOGY from IMPRIMED helps improve CANCER TREATMENT SUCCESS RATES in your practice…

...and fosters better relationships. ImpriMedicine.com CHOOSE THE RIGHT TREATMENT, RIGHT AWAY

CLIENT SATISFACTION AND INCOME POTENTIAL

Successful cancer treatment relies on using the right medications from the start, rather than a trial-and-error approach that wastes precious time and incurs extra costs for your clients. ImpriMed offers individualized drug response prediction profiles for animals suffering from lymphoma and leukemia. Samples are collected via proprietary transport media tubes, and the profile will be in your hands within three to seven days after that.

With ImpriMed, you will be leveling up your practice. It can be used to your advantage by yielding better clinical outcomes in your cancer patients, and helping your clients’ beloved pets recover. You will also see less time wastage, and you will help clients save money because you can direct them, at a very early stage, toward cancer treatments that are data-validated.

IMPRIMED’S DRUG RESPONSE PREDICTION PROFILE The drug response prediction profile is based on insights gathered from multiple sources of data. Chemosensitivity and patient information are used to curate these drug response predictions. Most importantly, an ingenious robotic machine drops drugs onto the live cells as part of their ex vivo assay platform that measures the effect of cancer drugs on the live patient cells. The profile not only contains information about the most suitable drugs, but their expected response times as well. The result is a highly detailed drug prediction profile that can help achieve remission — without beating around the bush.

OTHER SERVICES

Clients who observe excellent results from this AI-based treatment approach will be more inclined to consult you when new needs arise. As well, word of mouth will ensure an influx of new clients heading your way, resulting in higher income. Personalized treatments will inevitably improve clinical outcomes, and benefit your practice by giving your clinical success rate a boost. As a result, relationships with clients will be strengthened, which always translates to a flourishing veterinary clinic.

TRAINING REQUIREMENTS You need to be familiar with the Fine Needle Aspiration (FNA) method for sample collection. You can easily get a refresher regarding FNA by visiting the FAQ section on ImpriMed’s website.

ImpriMed offers additional services such as immunoprofiling using flow cytometry and PCR for antigen receptor rearrangements, flow cytometry only, and PCR for antigen receptor rearrangements only. ImpriMed is also currently providing free immuno-profiles for cats suffering from lymphoma or leukemia. Studies establishing the authenticity of ImpriMed's drug response prediction profile are published in reputable science journals. IVC Summer 2022

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VISIONARY KETO PET FOODS deliver good health

Since 2014, a non-profit organization called KetoPet has saved dozens of dogs from kill shelters. These dogs were placed there due to terminal cancer diagnoses, and were given only weeks to live. Today, more than half the dogs are still enjoying life — going for long walks and barking excitedly over the arrival of dinner — and many are also now cancer-free.

KETO DIET TRANSFORMS CANINE HEALTH Inspired by KetoPet’s work, a group of self-described “lifelong nutritional nerds” did the research and found that feeding dogs a ketogenic diet often gives them a new lease on life. As pet parents themselves, they set out to find ketogenic food for their own dogs, but came up with nothing. So they decided to create their own under the banner of Visionary Keto Pet Foods. While they wouldn’t call the keto diet a cure, they witnessed first-hand nothing less than a transformation for many dogs with cancer, as well as other serious health conditions, while also creating good health in dogs that weren’t sick.

CARBS ARE OUT; FAT AND PROTEIN ARE IN A keto diet is high in protein and fat and low in carbohydrates. Unfortunately, much of today’s dog food is very high in carbs because they’re cheaper than high quality ingredients.

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THE BENEFITS OF A KETO DIET

SMART, HEALTHY AND CONVENIENT

Pet parents feeding their dogs Visionary’s line of foods report softer and shinier coats, rapid relief from allergies, better digestion, and improved skin issues. Poops are more solid and less frequent, and they also report increased energy and endurance, no bloating or gas, and much more. These low-carb diets have additional benefits, such as:

While people may try feeding their dogs a homemade keto diet, making sure they include the right amounts of protein, fat, amino acids, vitamins, and minerals can be overwhelming — especially when that work has already been done for you at Visionary Pet Keto. You can rest assured your canine patients will receive all the necessary nutrition they need for long, healthy lives, in convenient, timesaving formulations.

•

Lowering your dog’s average blood glucose

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Decreasing his insulin response

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Allowing him to use fat as his primary fuel source

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Improving your dog’s overall health with their antiinflammatory qualities.

THE INSIDE SCOOP Visionary’s foods are grain- and gluten-free, and made and sourced in the U.S. The first ingredient in all their foods is 100% real meat. All the company’s recipes have been validated as ketogenic, and contain a macronutrient breakdown of roughly 60% to 70% fat, 30% to 40% protein, and less than 1% carbohydrates as a percentage of their total calories.

GIVING BACK It’s also reassuring to know that Visionary gives back to its community by supporting organizations such as KetoPet. Not only are you giving your clients’ beloved dogs a chance at a healthier life, you’re also helping to transform the lives of other pets.

NUTRACEUTICALS FOR THE MANAGEMENT OF FELINE CACHEXIA BY JARED MITCHELL, DVM, CVMA, CVA, CVFT

Cats that don’t eat for long periods can develop an array of serious secondary health problems. Defining and understanding feline cachexia can be complicated, but the use of nutraceuticals can help manage the condition.

While some animal species can go for long periods without eating, cats are not among them. Laboratory studies have shown that the feline species can survive two weeks without food; however, due to the cat’s metabolic pathways, many secondary problems can occur within a few days of not eating. The most common fall into an intertwining group of disease conditions known as Feline Triaditis, which includes pancreatitis, inflammatory bowel disease, and cholangitis. Other concurrent conditions such as hepatic lipidosis (fatty liver disease), inflammatory liver disease, and vitamin deficiencies can also occur.3 This article looks at feline cachexia and how nutraceuticals can be used to manage it. Cats are a unique species. They are strict carnivores and require a much higher protein intake than omnivores.1 For optimal health and nutrition, special dietary factors must be taken into consideration within the feline diet. It must also include some vitamins and amino acids that cats cannot produce naturally, such as taurine, arginine, and vitamin A.1, 2 Cats can also become very “set in their ways”, often stubborn at times. Once a cat has quit eating, it can be difficult to coax them back to food, especially if it created a feeling of nausea the last time it was eaten. An integrative approach may be most beneficial, and one such option for treating cachexia is nutraceuticals.

THE ROLE OF NUTRACEUTICALS A nutraceutical can be defined as “a food (or part of a food) that provides medical or health benefits, including the prevention and/or treatment of a disease.” 7, 8 The term was coined in 1989 by Stephen DeFelice and is the combination of the words “nutrition” and “pharmaceutical.” 7 In the United Sates, it is estimated that 10% to 33% of dogs and cats are fed a pet supplement or nutraceutical.9 The most common of these include joint and digestive health supplements, followed by those that aid cognition, skin and coat, and heart health.9

A feline patient with Chronic Renal Disease (CRD) and Renal Cachexia. Note the unkempt and matted appearance, and the facial muscle loss.

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The pathophysiological process of cachexia can be multifactorial, and specific characteristics may revolve around the form of cachexia involved. However, inflammation and oxidative stress are at the center of this process. These alter anabolic and catabolic signaling pathways, leading to muscle depletion.8 In human studies, it has been estimated that muscle catabolism increases by 40% to 60% during cachexia.8 Treating exact parameters within the specific forms of cachexia would be ideal. However, this is not always achievable. Therefore, the broader use of nutraceuticals should aim to decrease inflammation, reduce oxidative stress on the body, and help increase appetite. Here are a few choices that may be beneficial in treating feline cachexia.

Omega-3 Fatty Acids are polyunsaturated fatty acids (PUFAs). Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are mainly sourced from marine fish and fish oil. Both EPA and DHA partly restrain inflammation by limiting the production of highly inflammatory eicosanoids, such as prostaglandins and leukotrienes derived from the n-6 fatty acid arachidonic acid (AA)8 Recent human studies include a discussion of the possible mechanisms creating the protective effects seen in cancer cachexia. At this time, the consensus involves the acute phase response reduction, with lower serum levels of C-reactive protein, TNF alpha, and IL-6, as the main effect underlying cancer cachexia prevention.8

Glutamine is an amino acid that is helpful for reducing the diarrhea common with both chemotherapy and radiation.10 It provides fuel for rapidly dividing cells (particularly lymphocytes and enterocytes) as well as the epithelial cells of the intestines. Glutamine maintains gut barrier function and is a precursor for the endogenous antioxidant glutathione.11 With cachexia, myocytes prefer glutamine as a metabolic fuel source.10 Supplementation during cachexia can be very beneficial.

Flavonoids are bioactive polyphenol compounds that are ubiquitously abundant in food and plants.12 They have

This image illustrates the degree of muscle wasting caused by chronic renal disease and renal cachexia.

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DEFINING CACHEXIA So what is cachexia? The truth is, there is still some debate around finding a single definition. In human medicine, the literature gives at least 11 definitions of cachexia.4 One of the more popular working definitions states that cachexia is a complex metabolic syndrome associated with underlying illness, and characterized by muscle loss with or without loss of fat mass.5 In veterinary medicine, cachexia is often defined as the loss of lean body mass in an animal with a chronic disease such as congestive heart failure (CHF), chronic kidney disease (CKD), or cancer.6 Table 1 summarizes the specific forms of cachexia. Sarcopenia is a very similar condition that also causes a loss of lean body mass, but it is important to differentiate the two. While cachexia involves the loss of lean body mass concurrent with a disease process, sarcopenia is defined as the loss of lean body mass without the presence of disease, and is considered part of the aging process.6 As with cachexia, there is still some debate about the definition of sarcopenia. Table 2 highlights the similarities and differences within these two disease processes.

antioxidant and anti-inflammatory properties. Flavonoids can scavenge free radicals, protect against other oxidants, chelate metal ions, and increase the activity and expression of antioxidant enzymes.12 Quercetin is a flavonoid found in many fruits, vegetables, and seeds. It has the potential to reduce oxidative stress-induced damage by acting on the TNF alpha, AKT, PGC1 alpha, and AMPK pathways.8

Milk Thistle (Silymarin) is a very commonly-used supplement in veterinary medicine, with a wide variety of applications. It is well known for its antioxidant properties and for being highly hepatoprotective, demonstrated in numerous experimental models and

The presence of cachexia in cats (and dogs) with kidney disease appears to be relatively high.

Table 1: Specific Forms of Cachexia6 • Longest recognized and most studied form.

Cardiac cachexia

• I n addition to the hemodynamic and neurohormonal alterations in CHF, the loss of LBM that typically accompanies this disease has devastating implications for the patient. • In 1 study of dogs, over 50% of dogs with dilated cardiomyopathy (DCM) and CHF had some degree of cachexia • In one study with dogs, BCS was low in only a minority of cases; however, 35% of dogs had mild to severe muscle wasting. • A study of cats with cancer showed muscle loss in 91% of affected cats.

Cancer cachexia

• In addition, cats that were below optimal body condition had a significantly shorter survival time compared to those with a BCS greater than 5.9. • Very important to assess not only BCS (which assesses fat stores), but also muscle condition score (MCS) and changes in body weight to detect cancer cachexia. • Although the prevalence of cachexia in dogs and cats with Chronic Kidney Disease (CKD) has not specifically been measured, it appears to be relatively high and likely has negative clinical effects.

Renal cachexia

Other forms of cachexia

• The results of a recent retrospective study in 100 dogs with CKD (International Renal Interest Society Stages II–IV) showed that dogs classified as underweight at the time of diagnosis had a significantly shorter survival time compared to both moderate and overweight dogs. • In dogs and cats with chronic respiratory diseases, clinicians often anecdotally note muscle loss.

Table 2: Chachexia vs. Sarcopenia: Differentiating the Two Cachexia

Sarcopenia

• Loss of lean body mass

• Occurs with chronic disease process

• Occurs with the aging process • Similar to cachexia without the diesease process

clinical studies.13 Antioxidants are reported to be one of the main modulators of many physiological pathways, and the antioxidant/pro-oxidant balance (redox balance) in our diet can affect the gastrointestinal organs, blood circulation, and tissues.13 Milk Thistle can be a very important addition to the treatment of cachexia.

Probiotics are also important. The gut microbiome — more specifically, a normal microbiome — plays a key role in many physiological functions within the body. When there are alterations in the microbiome, “dis-ease” can occur, leading to increased systemic inflammation, gut barrier

dysfunction, muscle wasting, and other numerous negative pathologies culminating in a full disease process.14 Prebiotics and probiotics help provide needed supplementation to strengthen the gut microbiome, thus reducing inflammation and helping bring the body back to a more homeostatic state. In studies using mice, a human commensal microbe, Lactobacillus reuteri, was sufficient to lower systemic indices of inflammation and inhibit cachexia.15 Cachexia is a very complicated, multifactorial disease process, and with their unique characteristics, feline patients can make it even more challenging. The use of nutraceuticals can help IVC Summer 2022

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.

CASE STUDY ESSENTIAL OILS FOR HEART FAILURE

reduce inflammation, clean up free radicals, and stimulate the cat’s appetite, providing a better quality of life and ultimately helping treat the cachexia. _________________________________________________ Fowler M., Xie H. Chapter 15: Basic Nutrition and Food Therapy in Cats. In Integrative and Traditional Chinese Veterinary Medicine Food Therapy. Chi University Press, Reddick, Florida; 2020. 651-671. 1

Hand MS, Thatcher CD, Remillard RL, Roudebush P. Chapter 11: Normal Cats. In Small Animal Clinical Nutrition, 4th ed. Walsworth Publishing Company; Marceline, Missouri; 2000. 291-347. 2

Simpson KW. Pancreatitis and triaditis in cats: causes and treatment. J Small Anim Pract. 2015;56(1):40-49. doi:10.1111/jsap.12313 3

Santiago SL, Freeman LM, Rush JE. Cardiac cachexia in cats with congestive heart failure: Prevalence and clinical, laboratory, and survival findings. J Vet Intern Med. 2020;34(1):35-44. doi:10.1111/ jvim.15672 4

Evans WJ, Morley JE, Argilés J, et al. Cachexia: a new definition. Clin Nutr. 2008;27(6):793-799. doi:10.1016/j.clnu.2008.06.013 5

Freeman LM. Cachexia and sarcopenia: emerging syndromes of importance in dogs and cats. J Vet Intern Med. 2012;26(1):3-17. doi:10.1111/j.1939-1676.2011.00838.x 6

A 16-year-old spayed female Yorkie in congestive heart failure presented for “passing out” when the owners went to their mountain cabin (7,000 ft above sea level from 2,000 ft). The couple loved to take their dogs to the mountains every weekend. While in the city, the Yorkie was well managed on cardiac medications. To address the issue, the couple used a blend of essential oils that included 25 drops Ylang Ylang, 35 drops Geranium, and 50 drops Orange in 15 ml fractionated coconut oil. Two or three drops of this blend were placed on the dog’s sternum every six hours, starting the day of travel to the mountains. The couple continued using the blend the day of travel back to the city. For the next two years, the dog travelled back and forth to the mountains with her owners at least three times a month without incident at altitude. She passed at 18½ years of age. Ylang Ylang is known for its nurturing effects on heart energy. Geranium is warming to the heart center and Orange brightens the heart’s Qi. Biomedically, all three oils help oxygenate the system and open the airways for better ventilation and oxygen exchange. Overall, this blend was chosen to support the emotion of joy held within the heart Zang fu of TCM medicine. Support the emotion of the organ and you support the organ’s function. Lavandin contains more camphor, which can be caustic to the skin.

Submitted by Nancy M. Brandt, DVM, CVC, CVA, CVMA

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Kalra EK. Nutraceutical--definition and introduction. AAPS PharmSci. 2003;5(3):E25. doi:10.1208/ ps050325 7

Aquila G, Re Cecconi AD, Brault JJ, Corli O, Piccirillo R. Nutraceuticals and Exercise against Muscle Wasting during Cancer Cachexia. Cells. 2020;9(12):2536. Published 2020 Nov 24. doi:10.3390/ cells9122536 8

Finno CJ. Veterinary Pet Supplements and Nutraceuticals. Nutr Today. 2020;55(2):97-101. doi:10.1097/ nt.0000000000000399 9

Dressler D. Integrated approaches to canine cancer: Mitigation of treatment side effects. Inno Vet Care Journal. May 29, 2019. 10

Kim H. Glutamine as an immunonutrient. Yonsei Med J. 2011;52(6):892-897. doi:10.3349/ ymj.2011.52.6.892 11

Kim C, Hwang JK. Flavonoids: nutraceutical potential for counteracting muscle atrophy [published correction appears in Food Sci Biotechnol. 2020 Nov 20;29(12):1773]. Food Sci Biotechnol. 2020;29(12):1619-1640. Published 2020 Sep 16. doi:10.1007/s10068-020-00816-5 12

Fallah M, Davoodvandi A, Nikmanzar S, et al. Silymarin (milk thistle extract) as a therapeutic agent in gastrointestinal cancer. Biomed Pharmacother. 2021;142:112024. doi:10.1016/j.biopha.2021.112024 13

Herremans KM, Riner AN, Cameron ME, Trevino JG. The Microbiota and Cancer Cachexia. Int J Mol Sci. 2019;20(24):6267. Published 2019 Dec 12. doi:10.3390/ijms20246267 14

Varian BJ, Gourishetti S, Poutahidis T, et al. Beneficial bacteria inhibit cachexia [published correction appears in Oncotarget. 2018 Jun 29;9(50):29536. Goureshetti, Sravya [corrected to Gourishetti, Sravya]]. Oncotarget. 2016;7(11):11803-11816. doi:10.18632/oncotarget.7730 15

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SIMPLIFY GI DIAGNOSTICS FOR YOUR PATIENTS You want to do your best for your animal patients and their “parents”, but gastrointestinal issues can sometimes be challenging to diagnose because the causes may be multifactorial. Diseases such as IBD, pancreatitis, PLE, LSA, and SIBO can exist concurrently and no one diagnostic test can cover them all.

HELPING YOU HELP YOUR PATIENTS VDI Laboratory (VDI) has streamlined the process by combining a unique array of tests that help pinpoint the exact problem using a single blood panel. Founded in 2006, VDI has a single purpose: to make advanced diagnostics developed for humans an option for pet care. They are the leading veterinary blood diagnostics provider in the fields of cancer, inflammation, essential vitamins, osteoarthritis, and wellness. As VDI’s Advanced GI Panel entails a simple blood draw, it’s non-invasive, cost-efficient, and effective for initial workup and therapeutic monitoring. It’s a simple blood panel for a complex problem and will answer your fundamental question: “What is wrong with my GI patient?” VDI’s unique GI Lymphoma Panel integrates multiple tests (often run through separate labs) and provides diagnostic insight into: • Lymphoma vs IBD vs food-related • Pancreatitis • Protein Losing Enteropathy • Nutritional deficiencies • Malabsorption and SIBO

Patient-centric: Actionable items start with patient-specific test interpretations and recommendations that are unique to the individual. For all essential vitamin tests, VDI provides individualized dosing recommendations to correct deficiencies. Artificial intelligence (AI): Different disease processes will affect blood parameters differently. Using VDI’s Diagnostic AI, diseases such as IBD, LSA, PLE, SIBO and pancreatitis are not identified on a single test result, but with the synergy of multiple parameters, providing a higher level of diagnostic confidence. Further, VDI includes demographic and signalment details such as age, clinical signs, medication, and more to deliver a true patient-centric profile. Relationships between results are exploited to provide the veterinarian with actionable data. For example, if deficiencies of vitamin D, B12, or Mg are noted, VDI can provide precise patient-specific supplement dosing to correct the problem.

THEY DO THE WORK FOR YOU VDI takes some of the work of GI diagnostics off your shoulders and simplifies the complex interpretation of test results. You have a busy practice, and your time can be better and more effectively served by spending more time with your patients. https://vdilab.com/

KEY FEATURES Context aware: VDI integrates case context, medications, and signalment into their diagnostic AI to improve the interpretation of results, adding confidence to the diagnosis process. Clinical review: Every Advanced GI Panel undergoes a clinical review of any relevant information provided on the requisition form, to ensure all interpretations are contextsensitive and patient-centric.

IVC Summer 2022

The use and impact of

HOLOGRAPHIC IMAGING

in veterinary medicine BY OMER RASHID, DVM, MSC (HONS)

3D holographic imaging has added good value to human healthcare. While this technology has only recently been introduced to veterinary medicine, its footprint can be substantive.

scans and MRIs into contiguous 3D images. These 3D images can be viewed interactively on a compatible screen, or their holographic renditions can be analyzed via a virtual reality headset.

Until recently, radiologists and physicians spent a lot of time and energy accurately deciphering 3D pathologies from 2D images. But radiological diagnostics no longer have to be as cumbersome as they were in the past. With the advent of 3D holographic technology, clinicians can now analyze medical images as real-life physical objects.

Using specialized holography equipment, holographic images are recorded by shining a laser beam on an object and recording it through a medium that clarifies the image.1

3D medical imaging is in no way a new kid on the block. The technology has been around for a while, but is far more advanced now than it was in the initial launch phase around two decades ago. Today’s 3D images are much more detailed, with much less noise. Furthermore, one of the most important breakthroughs in medical imaging technology is the advent of holography. Immersive and interactive holographic images of any multidimensional object can now be produced via specialized equipment. It is also possible to ditch the specialized machinery because the software now available can convert regular medical image datasets such as CT

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HOW DOES 3D HOLOGRAPHIC IMAGING WORK?

The laser is split into two beams: the object and the reference beam. The object beam is made to strike the object, and some of the light reflected off that object is saved in the recording medium. The reference beam is directed toward the recording medium, where it coordinates with the object beam to form a more precise image. A virtual image is created by the interference pattern generated by the object and reference beams.2 In simple terms, the technology captures the light scattered by an object and presents it as a 3D image. Software is also available that simply automates the process of converting CT scans and MRIs into holographic images. The software combines the different CT scan data and forms a single 3D holographic image that can be conveniently analyzed from different angles and depths.3

Based on holographic technology, we also now have augmented reality, which means holographic images can be superimposed onto the patient’s body.

WHERE THE VETERINARY INDUSTRY STANDS ON HOLOGRAPHIC TECHNOLOGY

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Fully formed detailed 3D holographic models of animals present clinicians with the option to reach a more accurate diagnosis. The patient’s area of concern, the organs and related internal structures, can be examined in an interactive way via holograms to pinpoint the root cause of the problem.

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The benefits of holographic technology are not limited to diagnosis. Holographic images make it possible for veterinary surgeons to identify individual anatomical nuances. Surgical planning can be sharpened and individualized by having detailed information about the animal via holographic images. This results in higher surgery success rates and fewer complications.

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Holographic technology can also be used for surgical rehearsal, which allows surgeons to familiarize themselves with the surgical environment without having to face surgery time pressure.

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The digital availability of 3D holograms allows veterinary professionals to easily share them with pet owners. This means clients are better informed about their pets’ conditions, and feel more confident about the course of treatment.

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Veterinarians can also share digital holograms with other veterinary clinicians and experts in real time, for a second opinion. This has the potential to drastically improve veterinary care.

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Veterinarians can further benefit from augmented reality, which allows the superimposition of holographic images onto the animal’s body in real time. The superimposed images can be viewed in conjunction with specialized headsets that can present extra information to the veterinary surgeon, thus optimizing the surgical procedure. This literally translates to surgeons having

The holographic industry is expected to show continuous growth. The factors driving the demand for this technology include higher investments in healthcare facilities, a growing need for technological advancements in surgical rooms, and individualized treatments. A quick Google Scholar search shows that a lot of veterinary research is making use of holographic imaging tools. However, as far as the general veterinary industry is concerned, holographic imaging and augmented reality can in no way be termed the norm.4 Factors such as limited expenditure by veterinary care facilities are resulting in an overall curtailment in the use of this technology. However, the potential benefits of the technology are being appreciated, and there is an upward trend in its adoption. When it comes to veterinary education institutes in the US, serious efforts have been made over the past few years to make use of holographic technology to enhance education delivery.5 One of many examples is the University of Pennsylvania School of Veterinary Medicine, which invested in a 3D medicine program. The program started out with tools concerned only with 3D printing, but has grown to encompass holography and augmented reality as well.6 Completely realistic and textured 3D holographic animal models are now accessible to students in most veterinary institutes.

HOW 3D HOLOGRAPHY CAN BE USED IN VETERINARY MEDICINE 1. A ids clinicians in providing better veterinary care Holographic technology can contribute to providing advanced veterinary care because it has brought much-needed progress to the area of medical imaging. It can be used to provide high resolution 3D visualization of a patient’s body, which is a considerable advantage over 2D medical images. •

Radiologists and clinicians can now better understand patient anatomies and pathologies by interacting with holographic images that present realistic spatial relationships between organs and internal structures.

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X-ray vision, along with digitally displayed information such as heart rate. Traditionally, veterinary surgeons had to move back and forth between the patient and the 2D medical images on their computer screens while performing surgery. Now, holography and augmented reality can ensure all the relevant information is in the surgeon’s field of view. •

3D holography can help get rid of uncomfortable physical procedures. It can also be useful in screening for problems when intricate organs such as the brain or heart are involved.7

2. Improves veterinary education Giving veterinary students the best possible education is of the utmost importance. Well-trained veterinary graduates translate to healthy animals. To achieve a better standard of education, holographic technology has a considerable role to play. Veterinary students sometimes lack complete comprehension of the spatial relationships between different anatomical structures. The skill of mentally visualizing a patient’s area of concern is key to achieving good diagnosis and error-free surgeries.

Fast facts •

The name “holography” was coined by Dr. Dennis Gabor in 1948. He developed the theory of holography while working to improve electron microscope resolution. Dr. Gabor received a Nobel prize for his seminary work on holographic technology.

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Further development in the field of holography took place with the invention of laser in 1960.

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“Holography” means “complete message.” It is meant to convey complete information of a multidimensional object.

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Holography uses purpose-built hardware, software, and advanced programming to create a hologram image.

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3D holographic imaging can enhance veterinary education by providing students with novel methods of anatomical understanding. The technology allows students to experience an elaborate study of patient anatomy and organs without worrying about resource constraints. Students can learn the anatomy of various animals in a more detailed and interactive manner. Virtual reality headsets can significantly enhance their study experience by making it more exciting. Holographic imaging can also be used to better train students for conducting surgeries. The technology can facilitate a virtual environment where they can practice and polish their surgical skills. The technology helps students experience an individualized approach to education. They no longer have to conform to a set way of learning. The traditional use of manuals and preplanned dissections can be done away with, and students can have the freedom to learn as they will. The novel visualization methods and the freedom they bring also incite more affinity for learning in students.

3. Contributes to research Since its introduction to medical science, holography has validated its worth by providing not only better veterinary healthcare and education, but also new tools for research and development. Holographic microscopy is being extensively used to conduct non-invasive studies at a cellular level. The technology has also been helpful in analyzing drug responses and for conducting a better evaluation of clinical trials. Digital holography can also be used in multidimensional sensing.8

FUTURE TRENDS AND DIRECTION Holographic technology can potentially impact every aspect of our lives, but healthcare and veterinary medicine are the fields that can benefit most. The further advancement of holographic technology involves efforts to introduce realistic images that do not require specialized glasses or headsets. It is expected that gearless holographic displays and floating holographic images will become mainstream in the near future. The future application of holography may go as far as introducing “holoveterinarians.” A veterinarian will be able to see detailed holograms of diseased animals and provide treatment remotely. Holography will also prove helpful in manufacturing pharmaceuticals and healthcare products. With time, various advanced holography applications are destined to emerge, and will significantly improve both human and veterinary healthcare services.

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.

HOMEOPATHY FOR HEART DISEASE IN ANIMALS Heart disease is very common in companion animals, while vascular disease is fairly rare, so this column will focus on the former. Cardiac pathology is often sycotic, evidenced by the vegetative lesions seen in valvular disease, or neoplasia such as heart base tumors. Heart disease often has an immune mediated cause, and the strong connection between vaccination and immune disease also supports the connection between sycotic miasm and heart disease. Autoimmune disease is usually connected to the syphylitic miasma, and psora tends to underly both sycotic and syphylitic miasms. For these reasons, anti-miasmatic and especially anti-psoric remedies are good choices for treating heart disease in animals. Both local and constitutional prescribing are often needed, with lower potencies more helpful near the end of life. Diuretics and ACE inhibitors do not seem to antidote homeopathic medicines, and can be used to benefit remedies in some cases. We can often stop conventional drugs when homeopathy begins to take effect. Here are a few useful homeopathic remedies for heart disease in companion animals: •

Spongia tosta can be given when the main symptom is a cardiac cough, which can sound like “sawing through wood.” The cough gets worse when the animal is excited and sitting up, and improves while lying down and drinking water. Fear and anxiety are often part of the disease manifestation.

•

Crataegus oxyacantha has a tonic effect on the heart. This remedy can be given when there is extreme dyspnea with the slightest exertion. The subject is better in fresh air, with rest. The animal has an irritable personality. Crataegus oxyacantha is useful when very few specific symptoms are present for choosing a remedy.

•

Digitalis purpurea can be given when slight movement causes palpitation and the subject has a weak, slow, and irregular pulse.

Tahara T, Quan X, Otani R, Takaki Y, Matoba O. Digital holography and its multidimensional imaging applications: a review. Microscopy (Oxf). 2018;67(2):55-67. doi:10.1093/jmicro/dfy007. 1

Haleem A, Javaid M, Khan IH. Holography applications toward the medical field: An overview. Indian J Radiol Imaging. 2020;30(3):354-361. doi:10.4103/ijri.IJRI_39_20. 2

Handwerk B. Medical holograms are now part of the surgeon’s toolkit. Smithsonianmag.com. March 27, 2015. Accessed May 5, 2022. https://www.smithsonianmag.com/science-nature/ medical-holograms-are-now-part-surgeons-toolkit-180954791/. 3

Wilkie N, McSorley G, Creighton C, Sanderson D, Muirhead T, Bressan N. Mixed Reality for Veterinary Medicine: Case Study of a Canine Femoral Nerve Block. Annu Int Conf IEEE Eng Med Biol Soc. 2020 Jul;2020:6074-6077. doi: 10.1109/EMBC44109.2020.9175620. PMID: 33019356. 4

Norman G. Willis, Fonda A. Monroe, J, et al. Envisioning the Future of Veterinary Medical Education: The Association of American Veterinary Medical Colleges Foresight Project, Final Report. Journal of Veterinary Medical Education 2007 34:1, 1-41. 5

Adorno S. Augmented reality at Penn Vet. Published April 3, 2018. Accessed May 5, 2022. https://www.vet.upenn.edu/about/news-room/bellwether/penn-vet-extra/penn-vet-extraapril-2018/augmented-reality-at-penn-vet. 6

Mishra S. Hologram the future of medicine - From Star Wars to clinical imaging. Indian Heart J. 2017;69(4):566-567. doi:10.1016/j.ihj.2017.07.017. 7

Tahara T, Quan X, Otani R, Takaki Y, Matoba O. Digital holography and its multidimensional imaging applications: a review. Microscopy (Oxf). 2018;67(2):55-67. doi:10.1093/jmicro/dfy007.

Submitted by Todd Cooney, DVM, CVH

IVC Summer 2022

CASE REPORT —

USING HERBS TO TREAT HEARTWORM IN A DOG BY CYNTHIA LANKENAU, DVM, RH (AHG)

How herbal therapies were used to successfully treat heartworm disease in a dog that didn’t respond to macrocyclic lactones and melarsenoxide.

IVC Summer 2022

ABSTRACT A case of heartworm (Dirofiliria immitis) disease in a dog resistant to macrocyclic lactones and melarsenoxide was successfully treated in 3.5 months with several herbal products. The herbs targeted not only the nematode but also the Wolbachia organism, while concurrently supporting the cardiovascular and pulmonary systems. In such cases, the individual’s constitution and unique responses to disease regression determine the specific botanical medicines required.

INTRODUCTION Veterinarians rely on macrocyclic lactones (MLs) to protect their patients from heartworm disease (HWD) caused by Dirofilaria immitis, and on melarsenoxide for its treatment. Evidence from recent research has shown that subpopulations of heartworm have developed resistance to MLs and melarsenoxide.1,2 In at least one study, every ML compound currently marketed in every form of administration (oral, topical, and parenteral) has been shown to lack 100% efficacy,3 and the incidence of resistance to these drugs is growing.4 In the face of increasing drug resistance, effective alternative therapies must be explored for both preventing and treating HWD. The official guidelines for the treatment of heartworm disease outlined by the American Heartworm Society state: “No ‘natural’ or herbal therapies have been shown to be safe and effective prevention or treatment for heartworm disease.”3 Personal communications with other veterinarians, along with personal practice, have shown this to be incorrect. Successful clinical experience of herbal heartworm prevention does exist.5 There are also cases of successful treatment of heartworm-positive dogs using herbs, although none of these cases has been previously published.

both phylogenetic and biochemical evidence for the obligate symbiosis of D. immitis and the bacteria Wolbachia pipientis. This apparent mutualistic dependency has also offered a novel approach to devitalizing the nematode through the use of antibacterial and anti-rickettsia botanicals that can eliminate the Wolbachia organisms.6,7 The Wolbachia activation of innate inflammation drives inflammatory adverse events in response to chemotherapy with either diethylcarbamazine (DEC) or ivermectin, making the need for alternative treatments more imperative.8

CASE REPORT A seven-year-old castrated male 45-pound Pit Bull cross presented for a wellness exam on June 1, 2014 with the chief complaints of anxiety, rapid breathing and an occasional cough. In the spring of 2013, the dog had been found to be heartworm (HW) positive while in a Kentucky Pit Bull rescue organization. The medical records stated that he was treated in compliance with the American Heartworm Society’s (AHS) official protocol, using doxycycline and a macrocyclic lactone prior to a three-dose regimen of melarsomine (one injection of 2.5 mg/kg body weight followed one month later by two injections of the same dose 24 hours apart).

Botanical medicines have historically been used to kill offending parasites, and also have a general physiologicallysupportive influence on the cardiovascular system during treatment, which can result in a more satisfactory treatment and recovery from this type of parasitic infestation. This generalized physiological effect differs from a pharmaceutical drug’s specific one cell receptortype effect. In cases of heartworm, botanicals are used to “soothe” blood flow, remove obstructions to blood flow (heartworms), and eliminate blood stagnation. Wolbachia bacteria are obligate mutualistic endosymbionts in nematodes. Veterinary scientists have recently discovered IVC Summer 2022

Immediately after treatment, the dog was sent to New York to another adoption group and given a ML-based heartworm preventative. In December of 2013, he was found to be HW positive again, and was retreated with doxycycline and a macrocyclic lactone prior to the three-dose regimen of melarsomine.3 No drug doses were cited on his adoption papers; it was only noted that his treatment followed the standard protocol of the AHS. He was adopted by his new owner in May of 2014.

The dog’s owner was advised to give him a diet high in antioxidants and to keep him relatively quiet. She was to watch his respiration and tongue color. At follow-up on June 15, the dog’s owner reported that he was bright and alert with good appetite. His coughing had stopped and he experienced only occasional periods of more rapid breathing.

On presentation, the dog’s tongue color was purple, with deep red edges and congested sublingual veins. The lung sounds were very harsh, the heart rate was rapid, and the pulse was taut and slippery with a severe choppy quality. He exhibited pain on acupuncture points Bl 14, 15, 18 and 20. The Western medical diagnosis was HW (Dirofiliria immitis) disease based on a positive test result with antigen testing via a Witness: Canine Heartworm Antigen Test (Zoetis).a The Chinese Medical diagnosis was Blood stagnation, pathogenic phlegm, and channel obstruction with secondary Blood Heat with Shen disturbance. Given the dog’s history of two recent unsuccessful heartworm treatments, the owner requested an alternative approach. The initial prescription consisted of four herbal products:

1. Empirical Lung and Heart,c administered at a dose of 1 tsp q 12 hr PO

2. 3.

Black Walnut, (Juglans nigra), a company formulated 1:5 tinctureb at 5 drops q 12 hr PO A combination tincture formulated by the author consisting of 15% 1:5 tincture of Andrographis (Andrographis paniculata)c and 15% 1:5 Sweet Annie (Artemisia annua)c in 70% Blood’s Mansion, Xue Fu Zhu Yu Tang.c The dosage was 40 drops q 12 hr PO.

Finally, the dog was given 10 drops q 12 hr PO of a company formulated 1:5 tincture of Houttuynia cordata.c

IVC Summer 2022

On June 30, when the owner’s horses got loose, the dog spent four hours running very hard while chasing them. He immediately began breathing faster. On examination on July 1, he was panting very hard, and had a purple tongue. He was exhibiting a greater sense of anxiety. Bronchial sounds were very loud and harsh, with areas in the lung field devoid of air sounds. It was suspected that due to the exertion, he had experienced several pulmonary emboli. His herbal formula was changed to Stasis Breaker (JT)d for a strong anti-thrombi effect, at a dose of 1 tsp q 12 hr PO, and 10 drops q 12 hr PO of a company-formulated 1:5 tincture of Blood Root (Sanguinaria canadensis)c for a presumed hepatization of pulmonary tissue. The Blood Mansion tincture was continued, and Black Walnut was discontinued to slow the die-off of nematodes. A conversation with the owner on July 6 revealed that the dog’s breathing was back to normal.

On examination on August 1, the dog was acting normally, with good appetite and respiration. His tongue color was pink, slightly lavender, and his pulse was slightly taut. On palpation, the acupoint Bl 18 was very painful, which indicated the dog had some residual Liver stagnation. Stasis Breaker was discontinued, and he was started on Ge Xie Zhu Yu Tang,d a formula for hepatic circulation. He resumed the Black Walnut and Blood Mansion combination. On August 15, conversation with the owner indicated that the dog was acting normally with a pink tongue and easy breathing, and no cough. He seemed much calmer. On September 15, the dog was HW negative on antigen testing via Witness: Canine Heartworm Antigen Test (Zoetis).a His tongue was pink, his heart rate normal, and his pulse smooth. No abnormal lung sounds were heard, and he was calm.

DISCUSSION From a Traditional Veterinary Chinese Medicine (TCVM) perspective, the treatment goals for this dog were to soothe the Blood Stagnation, clear Blood Heat, clear pathologic phlegm and open obstructions. Herbs with these effects would need to also protect his cardiovascular system, ensure minimal health risks from “dying worms” due to their anti-thrombi effect, and remove pathologic phlegm, all while exerting an anti-nematode and antibacterial effect (to weaken and kill the heartworm parasites and kill the Wolbachia organisms). Due to the synergistic relationship between the Wolbachia organisms and Dirofiliria immitis, a strong intention was to focus on anti-Wolbachia botanicals with the thought that the nematodes would “die off” easier with fewer thrombic concerns.

The effectiveness of this formula is revealed when examining the botanical medicines contained within it. Trichosanthes fruit (Trichosanthes japonica, T. kirilowii,Gua Lou Shi) is traditionally known to clear the Lungs, dissolve phlegm, regulate Qi, expand the chest, dissipate nodules and eliminate pus.9 Our current research supports these traditional actions, showing it has strong controlling abilities in the lung, along with anti-cancer, anti-toxicity,8 and cardioprotective effects.10-12 Sparganium (Sparganium stoloniferum) breaks up and dispels blood stasis, activates Qi circulation and relieves pain. Research has validated these traditional uses, illustrating strong antioxidative and anti-cancer effects, especially in the liver.13,14 In addition, it has been recognized to inhibit platelet aggregation and prolongation of thrombin time.15

Table 1: Empirical Lung and Heart Qi Support: Paw Healer CHINESE NAME

BOTANICAL NAME

Gou Lou Shi

Trichosanthis Fructus

San Leng

Rhizoma Sparganii

E Zhu

Curcuma Zedoaria

Ze Xie

Alismatis

Xing Ren

Armeniacae Semen

Shan Zha

Crataegi Fructus

In TCVM, the Shen or Spirit resides in the Blood and is housed in the Heart; by soothing the Blood, and clearing Blood heat, a strong anti-anxiety effect would occur.

Tao Ren

Persicae Semen

Hong Hua

Carthamus Tinctorius

The leading herbal used in this case was formulated by Paw Healer and called Empirical Lung and Heartb (see Table 1). This formula has been designed to kill nematodes (a product claim through case studies) while soothing Blood flow and removing obstructions (heartworms) and phlegm in the lungs.

Di Long

Lumbricus

Chuan Xiong

Radix Ligustici

The various botanical medicines used in this case have a long history of traditional usage which is reinforced by current “scientific” research. The cardiac, circulatory, and pulmonary supportive effects, as well as the antibacterial and antinematode influences of the leading herbal formula, illustrate the power of botanical medicine.

Curcurcuma zedoaria has research supporting its traditional ability to invigorate Blood circulation, break Blood stasis, and activate Qi circulation; physiologically, this herb prolongs the aggregation of platelets and prevents the formation of thrombi. It also has strong antimicrobial, antiplasodial, and antibacterial effects, and shows very strong antinematode effects. 16-18 Additionally, there are reports IVC Summer 2022

of Curcurcuma zedoaria clinically curing individuals with psychiatric disorders with Blood stasis. 19 The mental state characterized by severe anxiety in the dog in this case report was considered to be due to Blood stagnation (heartworm disease), and his anxiety resolved with this herbal treatment. Alismatis orientalis regulates water circulation, and resolves dampness from the kidney. This herb has an ability to decrease drug resistance through the inhibition of P-glycoprotein.20 Xing Ren (Prunus armeniaca) has been clinically used to arrest cough and relieve wheezing. These actions are supported by research showing strong antibacterial effects and the elimination of bacteria in biofilms.21 Crataegi Fructus (Crataegus cuneata, Shan Zha) is a very popular botanical medicine for cardiac support. Traditionally it is said to activate Blood circulation and disperse Blood stagnation, thereby treating cardiovascular disorders and eliminating stagnation with demonstrated cardiotonic,vasodilating, antihypertensive, and antibiotic effects.22,23 Tao Ren (Persicae Semen, Prunus persica) is traditionally used for activating Blood circulation and moving Blood stasis while also helping drain pulmonary abscesses. This herb has proven antibacterial and antioxidant effects with strong controlling effects in the chest.24,25 Hong Hua (Carthamus tinctorius) is another herb that traditionally activates blood circulation, eliminates Blood Stasis, and opens channels. It is also proven to have strong antibacterial effects.26 Di Long (Lumbricus) is an antipyretic, inhibits formation of thrombi and facilitates their dissolution, and opens channels with a protective effect on the internal organs.27,28 Di Long has very powerful antimicrobial effects which are crucial to countering the Wolbachia organisms.29 Chuan Xiong (Ligusticum chuanxiong) is another blood invigorating and stasis-removing herb that activates Qi and Blood circulation with antiplatelet and anticoagulant effects. It contains activity to increase blood perfusion, and has been shown to have antibacterial effects.30,31

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Black Walnut (Juglans nigra) has a long traditional use as an effective antihelminthic, antiparasitic herb.32 It was used in this case to reinforce the antihelminthic effect of Curcuma with additional thyroid support.33 Blood’s Mansion (Xue Fu Zhu Yu Tang)c is a classical Chinese formula that acts as a carrier to the heart, calms anxiety, and that has an effect on removing Blood Stagnation. The formula was used in this case as a carrier of the antimicrobial herbs to the chest and heart. The ability of botanicals to eliminate Wolbachia organisms34 opens vast potential for them to treat heartworm disease easily and in a safe manner. Two botanicals with evidence of effects against Wolbachia are Sweet Annie (Artemisia annua) and Andrographis (Andrographis paniculata)35,36 In addition, Houttuynia cordata has a wide range of actions, including antiviral, antibacterial, antifungal, antimicrobial, anthelmintic, and larvicidal. It has a specific affinity for the chest and lungs and has been found to significantly increase IL-10, the cytokine synthesis inhibitory factor, and anti-inflammatory cytokine. It downregulates the other cytokines and blocks NF-B activity.37 As the dog’s treatment progressed, he experienced a presumed thrombi crisis after a period of severe exertion. This lifethreatening episode was diagnosed as Blood Stagnation and treated with Stasis Breaker,d a proprietary formula specifically crafted by Jing Tang herbals for cancer. This formula contains Fritillaria (Zhe Bei Mu), Ostrea (Mu Li), Sparaganium (San Leng), Zedoary (Er Zhu), Scutellaria (Ban Zhi Lian), and Oldenlandia (Bai Hua She She Cao). Blood root (Sanguinaria canadensis) is considered specific for pulmonary hepatization. After the pulmonary thrombi were resolved, a slight hepatic imbalance was detected via sensitivity on acupoint Bl 18. Using the flexibility of botanical medicine, the herbal prescriptions were shifted from Blood Moving herbs in the chest to those that influence primarily the Liver, with Ge Xie Zhu Yu Tang, and this physiologic imbalance was rectified.

CONCLUSION In 3.5 months, an anxious rescue dog that remained HW positive after two standard HW treatment regimens was successfully treated with botanical medicines. The HW infection and the anxiety resolved. Botanical medicines have the flexibility to treat complex physiological disease states; in this case, the severe stagnation of Blood within the heart IVC Summer 2022

with secondary pulmonary inflammation. Botanicals also have a significant ability to influence various microbial and parasitic organisms. Due to the single molecular effects of pharmaceutically derived antimicrobials, it is possible for microbes to develop resistance to these treatments. Because of the emergence of macrocyclic lactone and melarsomine resistance in canine HW, the potential for botanical intervention deserves consideration by the veterinary profession.38

20 Fong

WF1, Wang C, Zhu GY, etal; 2007; Reversal of multidrug resistance in cancer cells by Rhizoma Alismatis extract; Phytomedicine.; Feb;14(2-3):160-5. 21Wong RW1, Hägg U, Samaranayake L, et al; 2010; Antimicrobial activity of Chinese medicine

herbs against common bacteria in oral biofilm. A pilot study; Int J Oral Maxillofac Surg.; Jun;39(6):599-605. 22Liu LT, Zheng GJ, Zhang WG, et al; 2014; Clinical study on treatment of carotid atherosclerosis

with extraction of polygoni cuspidati rhizoma et radix and crataegi fructus: a randomized controlled trial; Zhongguo Zhong Yao Za Zhi.; Mar;39(6):1115-9. 23Qin R, Xiao K, Li B, et al; 2013; The combination of catechin and epicatechin callate from Fructus

Crataegi potentiates beta-lactam antibiotics against methicillin-resistant staphylococcus aureus (MRSA) in vitro and in vivo; Int J Mol Sci.; Jan 16;14(1):1802-21. 24Belhadj F, Somrani I, Aissaoui N, et al; 2016; Bioactive compounds contents, antioxidant and

antimicrobial activities during ripening of Prunus persica L. varieties from the North West of Tunisia; Food Chem. 2016 Aug 1;204:29-36. 1Martínez-Valladares

M, Geurden T, Bartram DJ, et al; 2015; Resistance of gastrointestinal nematodes to the most commonly used anthelmintics in sheep, cattle and horses in Spain; Vet Parasitol. 2015 Jul 30;211(3-4):228-33 2Pospichal

H, Brun R, Kaminsky R, et al, 1994, Induction of resistance to melarsenoxide cysteamine (Mel Cy) in Trypanosoma brucei brucei., Acta Trop. Dec;58(3-4):187-97. 3www.heartwormsociety.org/images/pdf/Canine-Guidelines-Summary.pdf. 4Awadzi

K, Boakye DA, Edwards G, et al.: An investigation of persistent microfilaridermias despite multiple treatments with ivermectin, in two onchocerciasis-endemic foci in Ghana. Ann Trop Med Parasitol 2004, 98:231–249. 5Lankenau C;

2015, Heartworm Prevention Study; JAHVMA, vol. 38, Winter 2015 p. 78-80.

Infectious Disease Reports; 2007, Wolbachia in filarial parasites: Targets for filarial infection and disease control; January Volume 9, Issue 1, pp 55–59. 6Current

25Noratto G, Porter W, Byrne D, et al; 2014; Polyphenolics from peach (Prunus persica var. Rich

Lady) inhibit tumor growth and metastasis of MDA-MB-435 breast cancer cells in vivo; J Nutr Biochem.; Jul;25(7):796-800. 26Salem

N1, Msaada K1, Elkahoui S1, et al; 2014; Evaluation of antibacterial, antifungal, and antioxidant activities of safflower natural dyes during flowering; Biomed Res Int.;2014:762397. 27Joo SS, Won TJ, Kim JS, et al; 2009; Inhibition of coagulation activation and inflammation by

a novel Factor Xa inhibitor synthesized from the earthworm Eisenia Andrei; Biol Pharm Bull.; Feb;32(2):253-8. 28Wang Q, Duan LX, Xu ZS, et al; 2016; The protective effect of the earthworm active ingredients

on hepatocellular injury induced by endoplasmic reticulum stress, Biomed Pharmacother., Aug;82:304-11. 29Andleeb

S, Ejaz M, Awan UA, et al; 2016; In vitro screening of mucus and solvent extracts of Eisenia foetida against human bacterial and fungal pathogens; Pak J Pharm Sci.; May;29(3):969-77.

7Taylor MJ, Bandi C, Hoerauf A: Wolbachia bacterial endosymbionts of filarial nematodes. Adv

30 Dang X, Miao JJ, Chen AQ, et al, 2015; The antithrombotic effect of RSNK in blood-stasis model

8Banerjee

31Li Y, Xu C, Zhang Q, et al, 2005; In vitro anti-Helicobacter pylori action of 30 Chinese herbal

Parasitol 2005, 60:245–284.

M, Parai D, Chattopadhyay S, et al, 2017; Andrographolide: antibacterial activity against common bacteria of human health concern and possible mechanism of action, Folia Microbiol (Praha)., May;62(3):237-244. 9 Chen

and Chen, 2004; Chinese Medical Herbology and Pharmacology, Art of Medicine Press, Inc., City of Industry, CA. 10Ni L, Zhu X, Gong C; et al; 2015; Trichosanthes kirilowii fruits inhibit non-small cell lung cancer

cell growth through mitotic cell-cycle arrest; Am J Chin Med. 2015;43(2):349-64. 11Bhattacharya

S, Haldar PK., 2013; Trichosanthes dioica fruit extract ameliorates arsenicinduced brain toxicity in male albino rats. J Environ Pathol Toxicol Oncol.;32(2):141-8.

rats; J Ethnopharmacol.; Sep 15;173:266-72.

medicines used to treat ulcer diseases; J Ethnopharmacol.; Apr 26;98(3):329-33. 32Guarrera

PM, 1999, Traditional antihelmintic, antiparasitic and repellent uses of plants in Central Italy; J Ethnopharmacol., Dec 15;68(1-3):183-92. 33Pant N, Padel KR, Karki R, 2016; Phytochemical profile and biological activity of Juglana rigia;

J Intefr Med; Sept; 14 (5):359-73. 34Francesca

Tamarozzi, Alice Halliday, Katrin Gentil, et al; 2011; Onchocerciasis: the Role of Wolbachia Bacterial Endosymbionts in Parasite Biology, Disease Pathogenesis, and Treatment; Clin Microbiol Rev.; Jul; 24(3): 459–468.

12 Shah

SL1, Mali VR, Zambare GN; 2012; Cardioprotective Activity of Methanol Extract of fruit of Trichosanthes cucumerina on Doxorubicin-induced Cardiotoxicity in Wistar Rats; Toxicol Int.; May;19(2):167-72.

35Ivarsen E, Fretté XC, Christensen KB, et al, 2014; Bioassay-Guided Chromatographic Isolation

13Wang X, Wu Y, Wu Q, et al; 2015; Antioxidant activities in vitro and in vivo of water-soluble

36Arifullah

14Bateman HR1, Liang Q, Fan D, et al, 2013; Sparstolonin B inhibits pro-angiogenic functions and

37 Buhner,

15Chang,Y; Zhong Y, Cheng F, et al, 1994, A Handbook of the Composition and Pharmacology of

38Wolstenholme

16Busari

aWitness: Canine Heartworm Antigen Test (Zoetis, Inc.), Kalamazoo, MI

polysaccharide isolated from Sparganium stoloniferum Buch.-Ham; Pak Pharm Sci. 2015 Jan;28(1):147-51. blocks cell cycle progression in endothelial cells; PLoS One. Aug 5;8(8): common Chinese Drugs, 175-176.

ZA, Dauda KA, Morenikeji OA, et al, 2017; Antiplasmodial Activity and Toxicological Assessment of Curcumin PLGA-Encapsulated Nanoparticles; Front Pharmacol.; Sep 6;8:622. 17Alrubaie

AL., 2015; Effects of alcoholic extract of Curcuma longa on Ascaridia infestation affecting chicken; Indian J Exp Biol. 2015 Jul;53(7):452-6. 18 Jurgens

TM1, Frazier EG, Schaeffer JM, 1994; Novel nematocidal agents from Curcuma comosa.; J Nat Prod. 1994 Feb;57(2):230-5. 19Zhong Xi Yi Jie He Za Zhi, Journal of Integrated Chinese and Western Medicine, 1988; 10:638.

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and Identification of Antibacterial Compounds from Artemisia annua L. That Inhibit Clostridium perfringens Growth., J AOAC Int.; Sep-Oct;97(5):1282-90.

M, Namsa ND, Mandal M, 2013, Evaluation of anti-bacterial and anti-oxidant potential of andrographolide and echiodinin isolated from callus culture of Andrographis paniculata Nees; Asian Pac J Trop Biomed.; Aug;3(8):604-10; discussion 609-10. S; 2015; Natural Treatments for Lyme coinfections, Healing Arts Press, Rochester, Vermont. AJ, Evans CC, Jimenez PD, et al; 2015; The emergence of macrocyclic lactone resistance in the canine heartworm, Dirofilaria immitis; Parasitology.; Sep;142(10):1249-59. bPaw Healer, San Diego, CA; 877-255-388 cHerbalist and Alchemist, Washington, NJ; 1-800-611-8235 dJing Tang Herbs, Reddick, FL eKan Herbal, Santa Cruz, CA; 1-800-543-5233

newsbite

STUDY REVEALS HOW DOG-OWNER

BOND INFLUENCES

CANINE

SLEEP T

he bond between dogs and their owners has a range of profound effects on canine behavior. Dogs see their humans as a “safe haven” and therefore look to their owners for protection, guidance and comfort in unfamiliar or stressful situations. The dog-owner bond may even have an influence on canine sleep patterns, according to recent study conducted by researchers at the Department of Ethology at Eötvös Loránd University in Hungary. Published in the journal Animals, the study looked at the quality of sleep experienced by dogs who slept in a new environment with their owners, and how it was impacted by the attachment between the dogs and their people.

ATTACHMENT BEHAVIOR AND SLEEP EEG The researchers did parallel studies of attachment behavior and sleep electroencephalography (EEG) in 42 dogs. The bond the dogs had with their owners was measured using an adapted version of the Strange Situation Test, developed by psychologists to assess the human infant-mother bond. Each dog’s sleep was examined during an afternoon nap with their owner in an unfamiliar place — the university’s sleep lab — using a completely non-invasive EEG method (similar to that used in humans).

PATTERNS it is important to sleep “well”. The quality of sleep can be measured by different parameters — for example, by sleep fragmentation or the length of deep sleep.”

STRONGER BONDS = BETTER SLEEP The researchers found that higher attachment scores in the study dogs were associated with more time in deep sleep, known as the most relaxing sleep phase. “Sleeping in a new place for the first time can be stressful,” says study author Cecília Carreiro. “But these results suggest that dogs with higher attachment scores sleep better, presumably because the owners provide a more secure environment for their dogs, so they can relax and have a good nap.” https://biologia.elte.hu/ en/content/differencesin-the-dog-ownerattachment-arereflected-in-dogssleep.t.27668

"Sleep plays an important role in processes such as learning, emotion processing and development,” explains Vivien Reicher, PhD student at the university. “When a human (or dog) sleeps, IVC Summer 2022

profitable practice

ANIMALBIOME VETERINARY MAKES

DIAGNOSING AND TREATING

DERMATOLOGICAL & GI ISSUES EASIER https://www.AnimalBiome.vet, 1-888-493-1727

WHO IS ANIMALBIOME VETERINARY? AnimalBiome Veterinary sells innovative microbiome testing and restoration supplements to help veterinarians identify and resolve dermatological and gastrointestinal issues in cats and dogs. Since 2016, the company has helped thousands of veterinarians worldwide and boasts one of the largest sets of pet microbiome health data in the world.

David Basak-Smith, DVM

IVC Journal spoke with David BasakSmith, DVM, of Monroe Town and Country Veterinary Hospital, in Monroe, Connecticut, for his comments on the role AnimalBiome Veterinary has played in creating a positive outcome for both his patients and his bottom line.

IVCJ: How do clients react to incorporating AnimalBiome Veterinary’s gut microbiome health tests and treatments into annual wellness exams? DB-S: Including AnimalBiome Veterinary microbiome tests during our wellness exams allows us to achieve a level of preventative medicine that really was not possible before. In 2021, we did a small pilot study and found that 80% of dogs coming in for regular wellness exams were in some state of gut microbiome dysbiosis. Testing as a preventative measure allows us to get ahead of chronic disease, and has been embraced by our clients as it has enabled us to use a more integrative approach. In addition, for any chronic issue that has been treated multiple times with medication, yet keeps recurring, we have the pet’s gut microbiome tested. We have even found that in dysbiotic situations with inflammation in the gut, inflammatory cells can end up in the joints and cause issues such as arthritis to become more severe. Lastly, we have seen the coats of animals improve greatly once we’ve corrected the microbiome and supported it with proper diet.

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IVCJ: What are the results you’ve seen with AnimalBiome Veterinary’s Gut Restore FMT Supplement and FMT Enema Material for patients dealing with severe gastrointestinal and skin cases? DB-S: We see great improvement in both GI and derm cases, but I’ve been most pleasantly surprised by improvements in allergic skin disease when using AnimalBiome FMT products. I used to do allergy testing and desensitization regularly, with marginal results and at great expense. By correcting the microbiome with FMT capsules, and FMTs via enema, we’ve seen better results in allergic skin cases. Clients then use supplements and change their pets’ diets to support the microbiome, and end up happy with the results they see. IVCJ: How has AnimalBiome Veterinary created more revenue for your practice? DB-S: We use gut microbiome testing as a diagnostic tool to help guide our patients into a more integrative support system. Microbiome tests are coupled with a dietary consult which starts a conversation with our clients about the importance of proper diet and the use of recommended veterinary supplements. Because we use this integrative approach, we have also seen an increase in our ability to utilize other treatments such as stem cell therapy and PRP. The overall effect AnimalBiome Veterinary has had on our hospital is undeniable, for both patient treatment and overall practice financial success.

RISK FACTORS AND BEHAVIORS ASSOCIATED WITH SEPARATION ANXIETY IN DOGS BY MOIRA HECHENLEITNER, DVM, CSAT

Understanding separation anxiety and separation-related behaviors helps with the diagnosis an d treatment of affected dogs.

here has never been a time when the term “separation anxiety” was more widely known as it is now. Both during and since the pandemic, the words “separation anxiety” are frequently on the lips of dog guardians and professionals alike, all around the world. Lockdowns and work-from-home mandates hugely increased the number of dogs who were no longer left home on a regular basis, as well as those that

were adopted but never introduced to being alone because of the circumstances. When people resumed their normal activities and started leaving the house again, many observed a variety of reactions from their dogs when left alone. These reactions included vocalizing, destroying objects in the home, trying to escape, and inappropriate elimination. People started referring to the issue as separation anxiety. IVC Summer 2022

SEPARATION-RELATED BEHAVIORS But is separation anxiety what our dogs are currently experiencing? Although the problem is highly prevalent around the world, and can even be referred to as one of “the dog behavior diseases of the 21st century” thanks to our fastchanging environment and the challenging time dogs have while adapting to it, the reality is that there are many other reasons dogs could display these behaviors when left home alone without humans. Statistics show the high prevalence of separation-related behaviors, with numbers up to 80% in the UK (APBC 2012), and 50% to 56% worldwide (Bradshaw 2002). However, these aren’t strictly separation anxiety cases. So how do separation-related behaviors differ from separation anxiety? Separation-related behaviors are all those undesirable behaviors a dog can display when left home alone without humans. A wide range of behaviors can fall into this description, with vocalizing, destruction, and inappropriate elimination being the most common. But pacing, panting, hyper-salivating, self-harming behaviors, and trying to escape can also be placed within this category.

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Lack of communication and understanding between dogs and guardians regarding expected boundaries, and which behaviors are off-limits, could lead to behaviors such as destruction and elimination when human guidance is absent.

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Being introduced to a new home without subsequently being left alone in the new environment could be reason enough for a dog to display some of these behaviors when finally left for the first time. Understanding that the dog doesn’t necessarily know the new place is safe can make it easier to understand this reaction. However, dogs who don’t suffer from separation anxiety know how to effectively use their coping mechanisms to face this new challenge. Therefore, a decrease in the intensity of the signs, as well as the length of time it takes the dog to process the situation and relax, will be observed over time.

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Dogs who are confined when home alone, either in a crate or room, or by setting up restrictions such as baby gates or x-pens, could display signs of distress due to confinement issues. The dog experiences confinement as an aversive stimulus, and being exposed to it releases a fight or flight emotional response that triggers involuntary behaviors such as vocalizing and trying to escape. Although there is a high correlation between confinement issues and separation anxiety, there are various cases where only the former is observed.

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There are other behavior challenges that dogs can face separately or in conjunction with sepa-ration anxiety. A dog who suffers from noise sensitivity could display signs of distress when left alone because of a particular noise present in the environment at that time, or during that season. Fireworks, thunderstorms, high-pitched noises such as fire alarms, and construction noises, among others, could be triggering an emotional response that can look like separation anxiety.

However, the underlying motivation for a dog to display any of these behaviors when alone can vary. •

There are many reasons why a dog may bark when alone, for example. It could be that the environment is triggering the behavior — barking may occur in dogs living in a busy neighborhood, or in a home with wide front windows from which they can see other dogs passing by, children playing outside, or the mail carrier coming up the walk.

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Perhaps the dog’s health could be impacting his behavior. Pain or discomfort can trigger behaviors such as vocalizing, eliminating in undesirable places, and pacing, among others.

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A dog whose mental and physical needs aren’t being met, or who belongs to a breed that doesn’t match the routine and environment provided for him, could engage in destructive behaviors when alone and unsupervised.

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Ruling out what is eliciting these behaviors will allow us to successfully address them by implementing an appropriate management, training, and medical plan that targets the root of the matter.

Photos courtesy of Beth Vogel

SO WHAT IS SEPARATION ANXIETY? Separation anxiety is defined as a disorder in which the dog exhibits an extreme fear of being alone. A dog with separation anxiety experiences being left alone as an aversive stimulus, which elicits an emotional and involuntary response. This behavior challenge is considered dysfunctional due to the dog’s scarce chances to naturally adapt to it, increasing the likelihood of the behaviors escalating over time and inhibiting the dog’s daily life functions.

CAUSES OF SEPARATION-RELATED BEHAVIORS

The fast-changing world of the last century has resulted in a very different environment than the one that dogs from 50 years ago knew. Artificial selection has impeded genetics in keeping up with these changes and allowing dogs to adapt better to these constant shifts. Captivity, in its turn, has prevented dogs from having a choice about their environment and developing tools to face it. These events, although not yet fully recognized, have created an imbalance between the environment and the genetics of dogs, like a round key in a square lock (L.E.G.S. model®, Kim Brophey), and could be the ultimate cause of the exponential increase in emotional disorders, such as separation anxiety, in first world countries during the 21st century.

Health issues Environment Miscommunication between dog and guardian Adaptation to a new home Energy level (age, genetics) Confinement issues Other behavior challenges Separation anxiety

Why does a dog lose the ability to adapt? Why does this become a disorder? Although the cause of separation anxiety is still unknown, evidence suggests a genetic predisposition to it. A high correlation has been found between different anxiety disorders such as noise sensitivity, generalized anxiety, confinement issues, and separation anxiety. This leads to the hypothesis that some dogs have a greater likelihood of developing these issues at some point during their lives.

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SEPARATION ANXIETY RISK FACTORS Although there isn’t a specific known cause that guarantees the onset of separation anxiety at some point of a dog’s life, some environmental factors can facilitate its expression if the dog has a pre-existing underlying predisposition to it. These factors are usually catalogued as changes in the dog’s environment that could have been perceived as traumatic events for that dog. Traveling by air, losing a member of the household, moving to a new house or town, experiencing a fear-driven event such as loud noises, fire-works, or a car crash, and health issues that affect the overall quality of life, among others, could fall into this category. Dogs who suffer from separation anxiety have a challenging time adapting to change. Any alteration in their routine and/or environment, even positive ones, can lead to a tremendous amount of stress and struggle to adapt. Therefore, it is likely that change could act as a trigger for separation anxiety. Throughout their lives, dogs are exposed to a great variety of changes, which increases the possibility of developing separation anxiety at any age.

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In some cases, it won’t be possible to determine what the environmental factor was that triggered the onset of separation anxiety. Since the approach to help a separation anxiety dog heal will be the same either way, knowing what elicited it isn’t completely necessary and won’t alter the treatment success rate. However, knowing that what the dog is experiencing is really separation anxiety and not a separation-related behavior caused by something else is a must in order to implement an appropriate plan of action, and a successful one.

WHAT DOGS WITH SEPARATION ANXIETY HAVE IN COMMON The behaviors that dogs with separation anxiety display when alone are nothing but the expression of the underlying fear and anxiety they are experiencing, which means their involuntary nature and potential to vary from dog to dog. Considering that separation-related behaviors are also unspecific and could have different underlying motivations, determining that a dog suffers from this disorder can prove to be a challenge. Although there is no rule in terms of what signs or combination of signs a dog needs to display to be classified as

having separation anxiety, there are a few things that dogs with this disorder have in common. When exposed to an aversive stimulus, in this case being left alone, a separation anxiety dog will unsuccessfully try to adapt by using various coping mechanisms. However, as the intensity of the stimulus increases (i.e. the length or duration of the absence), the dog won’t be able to continue doing so and the stimulus will become aversive to him. This stage, called the threshold (Eileen Anderson, “Over Threshold: The Changing Definition”, PPG Webinar, 2013), will be marked by the first overt behavior suggesting distress. After this point, the dog won’t be able to settle again and will continue displaying signs of distress until the intensity of the stimulus decreases or until it is removed (i.e. the absence ends and someone returns). Instead, the signs will either increase in intensity over time, or will occur cyclically until someone is back.

SIGNS THAT SEPARATION ANXIETY DOGS HAVE IN COMMON Body language that suggests distress Threshold reached within the first 30 minutes of absence Escalation of signs after reaching threshold, and until the aversive stimulus is removed

References and Resources Brophey, Kim. Meet your Dog, Chronicle Books LLC, 2018 Crowell-Davis, Sharon L. & Murray, Thomas. Veterinary Psychopharmacology, Blackwell Publishing, 2006 DeMartini, Malena. Treating Separation Anxiety in Dogs, Dog Wise Publishing, 2014

If no training plan has been successfully implemented and the dog hasn’t yet learned to be relaxed for longer than 30 minutes of absence, it is likely that the threshold will be reached within that first 30 minutes. Even though the unspecific nature of the signs surrounding separation anxiety could lead to confusion, body language that suggests distress while performing these behaviors will allow the differentiation between alert barking, destructive behavior due to excess of energy and/or boredom, and the behaviors being triggered by fear and anxiety. Accessing a specialist and implementing an alone time assessment to objectively observe the behaviors that a dog displays when left on his own will be the cornerstone of the separation anxiety diagnosis. Ensuring an accurate diagnosis will in turn allow us to choose the appropriate training plan and medical aids, which will ultimately help the dog rehabilitate and succeed.

Eileen Anderson. “Over Threshold: The Changing Definition”, PPG Webinar, 2013 LS de Assis et al.. Developing Diagnostic Frameworks in Veterinary Behavioral Medicine: Disambiguating Separation Related Problems in Dogs, Front. Vet. Sci., 17 January 2020 Overall, Karen L. Manual of Clinical Behavioral Medicine for Dogs and Cats, Elsevier Inc. Mosby, 2013 Sherman et al. Effects of Reconcile (Fluoxetine) Chewable Tablets Plus Behavior Management for Canine Separation Anxiety, Veterinary Therapeutics, Vol.8, Nº1, 2007 Tiira, Katrina et al. Prevalence, Comorbidity, and Behavioral Variation in Canine Anxiety, Journal of Veterinary Behavior, Elsevier Inc., 2016 Wilde, Nicole. Don't leave me! Phantom Publishing, 2010 https://believeinyour.dog https://dogdoorcanineservices.com https://malenademartini.com https://separationanxietydog.com

Photo courtesy of Beth Schwartz

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IMPRIMED: A BREATH OF FRESH AIR for traditionally ONEROUS CANCER TREATMENT journeys According to AVMA, one in four dogs is likely to develop cancer, and half of canines over the age of ten suffer from the disease. Cats are also at significant risk. Pet owners who see their animals suffering from cancer know how taxing the experience is — and they are not alone. Veterinarians have to cope with certain limitations while trying to ensure the best possible treatments and outcomes. However, an innovative company called ImpriMed has answers that can make the cancer treatment journey easier and more streamlined for your patients and their owners. ImpriMed is the brainchild of two visionary Stanford graduates who were on a mission to curtail cancer. Instead of exploring the avenue of drug development, they came up with the novel idea of quickly identifying available medicines that can bring the best clinical results on a case-by-case basis. To make their idea a reality, the relevant data were collected, state-of-the-art AI-based tools were developed, and ImpriMed was born. The company initiated its services in the sphere of veterinary cancer, with a plan to expand into the domain of human oncology. They currently provide personalized drug prediction profiles for canine lymphoma and leukemia. Since ImpriMed’s inception, more than 8,200 tests have been ordered and reported for canine lymphoma alone.

significantly substantive because the AI calculations are based on an elaborate proprietary database of real-life clinical outcomes. Pet owners whose animals are diagnosed with cancer suffer emotional upheaval. And once they set out on a treatment journey, they can be shattered by hearing the news that the recommended remedy did not work. It can also be frustrating for the veterinarian to confront situations in which treatments yield zero results and precious time elapses. ImpriMed’s breakthrough technology is validated by clinicallyproven results — peer-reviewed and published in renowned scientific journals. Collaborating with ImpriMed means you will have the peace of mind to go with the best possible databacked treatment for your cancer patients. Above all, it can potentially save lives and give your clients the joy of seeing their four-legged companions healthy again. The ImpriMed platform is a harbinger of personalized cancer treatment. It gives veterinarians much-needed access to valuable and precise prognostic information that can markedly increase early cancer remissions. ImpriMedicine.com

The company’s personalized prediction profile provides vets with information on the likelihood of patient responses to CHOP and 13 other single-agent drugs. You also get an estimate of response timing and the efficacy probability of CHOP alternatives. For both first-time and relapsed patients, you can receive immunophenotyping insights, and can get reports that track different stages of their cancer. You can also access drug predictions specifically for animals belonging to clients who cannot or do not want to visit you weekly. Additionally, ImpriMed offers clonality testing reports, which are formulated by performing PCR for antigen receptor rearrangements. Cancer is an invasive disease that often presents to veterinarians as a race against time. Applying the most suitable and efficient treatments during the early stages is pivotal. With the ImpriMed platform, you can get personalized drug recommendations within a week. This report helps you stay clear of drugs with a high probability of being inefficacious, while also providing you with a list of drugs that AI algorithms calculate as being most likely to cause remission. These reports are IVC Summer 2022

HEART INTELLIGENCE FOR V ET ER IN A RY T E A M S BY BARRIE SANDS, DVM

How heart intelligence and coherence techniques allow for increased workplace communication, morale, satisfaction, productivity, and innovative problemsolving, as well as decreased employee turnover and absenteeism. The veterinary profession is extremely unique in that we focus not only on care of the animal but also of the human. This situation lends itself to very specific challenges across the variety of interactions that we experience within the hospital setting. This article looks at the concept of heart intelligence and how it can be used to combat the stress, morale issues, and other problems facing veterinary teams today. The inner workings of a veterinary team can at times be compared to a military special ops unit. Most hospitals have a mix of doctors, receptionists, technicians, kennel workers or clean-up crews, as well as a human resource (HR) or business management team. Some larger hospitals have specialty services with doctors exhibiting specific certifications, including, but not limited to, surgeons, radiologists, cardiologists, internists, and integrative practitioners.

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Over the past few years, the veterinary profession has seen caseloads increase dramatically due to a variety of circumstances secondary to the policies put into play during the pandemic. The surge in the acquisition of shelter and rescue animals, along with the increase in diseases experienced either from a rise in proximity observation or from increased exposure to human stresses and the exacerbation of chronic disease states, tells us there will never be a shortage of sick and injured animals. Now more than ever, a smooth coherent operating system is imperative for the veterinary practice and the people within it to thrive. The influx of cases, and the stresses caused by the current state of global affairs, has left no one untouched. The result has often been an inner systems breakdown, affecting both the hospital and the individual within it at a more profound level

than was perhaps realized. A rise in stress, reduced morale and job performance, and an increase of ineffective communication leading to misunderstandings and secretive animosity among team members, are all factors.

THE IMPORTANCE OF TEAM COHERENCE The introduction of heart intelligence as a concept for veterinary teams is designed to facilitate solutions that result from a co-created, collaborative effort between the individual and the team. The importance of individual well-being cannot be understated. Many studies have shown that people in situations characterized by isolation, social disorganization, instability or disconnectedness are at increased risk of acquiring many types of diseases. Research done by Dr. James Lynch demonstrated that in high technologically-advanced societies, loneliness and the effects it has on the heart, blood pressure, and immune system has become the leading cause of premature death. Hypertension and shifts in blood pressure are shown to be a consequence of the “vascular seesaw of human dialogues.”5 Blood pressure rises when we speak to others, yet falls below baseline levels when we listen to others, relate with animals, or go out in nature. Correlative research also shows that close, meaningful relationships and social networks significantly reduce mortality, decrease susceptibility to infection and chronic disease, and improve recovery from cardiac conditions.6,7 The HeartMath Institute (HMI), established in 1991, is an innovative organization that researches the intuitive intelligence of the heart and provides simple tools and techniques for stress management, coherence training, and resilience building. Hospitals that have implemented HeartMath training programs for their staff have seen increased personal, team and organizational benefits. Studies show an increase in positive outlook, gratitude, motivation, calmness, and a decrease in fatigue, anxiety, depression, resentfulness and overall stress symptoms.8 More specifically related to medical health fields, results show positive statistical changes in work attitude, goal clarity, communication effectiveness, time pressure, intention to quit, strategic understanding, productivity, and improved relationships between nursing staff and leaders.9

allows for the efficient flow and utilization of energy and communication required for optimal cohesion and action.”10 The foundation of a strong social coherent environment begins with the individual, and the ability to create a level of personal emotional self-regulation, resilience, and selfmastery. The progression to a coherent system always starts with the individual.

HEART INTELLIGENCE Only in the last 300 years has science recognized the heart as a mechanical pump aiding in the circulation of blood; before that, the heart was recognized by ancient and indigenous cultures as the seat of our emotions and intuition, and the gateway to spiritual insights and divine wisdom. Over the last 30 years, within the discipline of neurocardiology, scientific investigation by cardiophysiologists and neuroanatomists has uncovered the existence of a complex and sophisticated intrinsic nervous system that has been classified as the “heart brain”. Containing over 40,000 neurons, this “little brain” gives the heart the ability to independently sense, process information, make decisions, and even demonstrate a type of learning and memory. In essence, it appears that the heart is truly an intelligent system.11,12 In 1983, the heart was also classified as an endocrine gland, manufacturing and secreting hormones and neurotransmitters such as atrial natriuretic peptide, oxytocin, norepinephrine, epinephrine and dopamine.13 The heart, as an organ, is the largest generator of electrical and magnetic energy in the body, as detected by an electrocardiogram (ECG) and magnetometer respectively.

When members of any work group, team, family, or social organization get along well, there is a natural tendency towards cooperation, efficiency and good communication. They act as a collective. The definition of social coherence is a “stable, harmonious alignment of relationships that IVC Summer 2022

The heart produces a toroidal shaped electromagnetic biofield around the body that is 5,000 times stronger than the brain, and has been measured out to a diameter of nine feet.14 This field is a carrier of information that is sensed by other individuals and animals, and has an influence on the world around us.15,16

processes. In other words, coherence is when the heart, brain, hormonal, immune and autonomic nervous systems (ANS) are synchronized and in alignment with each other.20 It has been shown that generating and sustaining positive emotions facilitates a shift into a specific measurable physiological state that is correlated to overall health and well-being.20,21

As the “seat of our emotions”, the heart has been shown by scientific research to not only respond to emotion, but to actually play a major part in determining the quality of our emotional experience from moment to moment via the electromagnetic signals generated by its rhythmic activity. The quality is detected by pattern recognitions of heart rhythms.17 This has been demonstrated by technology designed to measure the amount of coherence based on a complex mathematical model of the relationship between heart rate variability (HRV), resonant heart frequencies, respiration, blood pressure, and skin conductance.18 HRV is the time interval between heart beats that is associated with heart rhythm patterns and overall systemic wellness. In general, the greater the HRV the healthier a system is.19

It is important to understand that coherence is not the same as relaxation. At the physiological level, relaxation is characterized by an overall reduction in autonomic outflow and a shift in ANS balance towards increased parasympathetic activity. Coherence is also associated with a relative increase in parasympathetic activity, thus encompassing a key element of the relaxation response. However, it is physiologically distinct from relaxation in that the coherent system oscillates at its natural endogenous resonant frequency, subsequently causing an increase in the harmony and synchronization of nervous system and heart–brain dynamics. When we are relaxed, our mind and body are both in a calm state, in which we tend to be disengaged from emotional and cognitive processes. In a state of coherence, there is an active engagement of positive emotions and a shifting into a more balanced state of calm conducive to everyday functioning and interaction. This includes the performance of tasks requiring mental acuity, focus, problem-solving, and decision-making, as well as physical activity and coordination.22 This type of training is used by NASA, Navy Seals, EMTs, law enforcement, and

WHAT IS COHERENCE? Coherence is used to describe the degree of order, harmony, and stability in the various rhythmic activities within living systems over any given time period. Psychophysiological coherence pertains to our mental, emotional, and physiological

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QUICK COHERENCE TECHNIQUE 1. Heart Focus: Focus your attention in the area of your heart. 2. Heart Breathing: Imagine your breath is flowing in and out through that area. Breathe a little slower and deeper than usual — five seconds in, five seconds out. 3. Heart Feeling: Continue to breathe through the area of the heart. As you do, recall a positive feeling, experience, or memory of care, compassion or appreciation for someone or something and try to re-experience it. Allow yourself to feel this good feeling.

other governmental agencies. From this, you can see that individual and group coherence lends itself to a smooth-flowing cooperative working environment.

HEART-BRAIN COMMUNICATION Our thoughts and emotions are the foundational drivers of our physiology. It is said that the brain thinks, but the heart knows. Thoughts are the language of the brain and feelings are the language of the body. The heart and brain are in constant communication: neurologically, mechanically, biochemically and energetically. It is a dynamic bidirectional communication: not only does the heart respond to the brain, but the brain continuously responds to the heart.23 In the past, it was believed that heart function was primarily controlled by the brain. Research over the last 30 years has shown that 90% of afferent information travels from the heart to the brain, meaning that the heart actually sends more signals to the brain than the brain sends to the heart.24,25

When we understand the dynamics of the way the heart and brain communicate, we gain an appreciation for the ability we have to facilitate the conversation within our own bodies. The smooth and harmonious flow of communication between the heart and brain depend on our emotional state. Research done at HMI has demonstrated that different emotional states have distinct effects on cognitive function and heart rhythm patterns. States of stress and negative emotions such as fear, judgment, irritability, resentment, and anger create a distorted signal and neural inhibition of our neocortex or higher thinking brain. This has shown to limit our ability to think clearly, remember, learn, reason, and make effective decisions. This helps explain why we may often act impulsively and unwisely when we’re under stress. In contrast, positive emotional states like care, appreciation, gratitude, and compassion facilitate a clear signal and increase cognitive function. This also acts to perpetuate selfgenerating positive emotions and emotional stability.26,27

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In essence, learning to generate increased heart rhythm coherence, by using scientifically proven techniques and sustaining positive emotions, not only benefits the entire body, but also profoundly affects how we perceive, think, feel, and perform.

IN CONCLUSION

EFFECTS OF JOB STRESS

Techniques used to generate emotional self-regulation, and build personal resilience, benefit the individual, the team, and the organization as a whole (see sidebar on page 45 for a Quick Coherence Technique). They allow for increased workplace communication, morale, satisfaction, productivity, innovative problem-solving, decreased employee turnover and absenteeism. As we learn to navigate our emotional landscape with a level of self-mastery and observational awareness from a place of compassion and care for oneself and each other, we can begin to build and sustain a level of coherence not only in ourselves but with our teams.

The leading causes of stress in adults are money issues and the social environment at work. Hoel, H.K. Sparks, and C.L. Cooper. The cost of violence/stress and the benefits of a violence/stressfree work environment. Geneva: International Labour Organization, 2001. 1

Job stress is estimated to cost American companies more than $300 billion a year in health costs, absenteeism, and poor performance.

Kalia M. Assessing the economic impact of stress, the modern day hidden epidemic. Metabolism, 2002. 51 (6):p 49-53. 2

Cooper C, Payne, R. Causes, Coping and Consequences of Stress at Work. 1988, John Wiley & Sons Ltd: New York. 3

Here are some statistics:

Goetzel R.Z, et al. The relationship between modifiable health risks and healthcare expenditures. An analysis of the multi-employer HERO health risk and cost database. The Health Enhancement Research Organization (HERO)Research Committee. Journal of Occupational and Environmental Medicine, 1998, 40 (10): p843-854. 4

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40% of job turnover results from stress ●

Healthcare expenditures are nearly 50% higher for workers who report high levels of stress2 ●

An estimated 60% of all job absenteeism is caused by stress3 ●

Depression and unmanaged stress are the top two most costly risk factors in terms of medical expenditure.4

Specifically related to the veterinary field, veterinarians are 2.7 times more likely than the general public to die by suicide. According to a 2020 study from Merck Animal Health in partnership with the American Veterinary Medical Association, female veterinarians have higher levels of suicidal thoughts, but male veterinarians have a higher rate of suicide attempts. 46

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Lynch J.J. A Cry Unheard: New Insights into the Medical Consequences of Loneliness 2000. Baltimore, MD. Bancroft Press.

Berkman L.F., Syme S.L. Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. Am J Epidemiol, 1979. 109(2): p. 186-204. 6

Marmot M.G., Syme S.L. Acculturation and coronary heart disease in Japanese-Americans. Am J Epidemiol, 1976. 104(3): p. 225-47. 7

Pipe T.B., et al. Building personal and professional resources of resilience and agility in the healthcare workplace. Stress and Health, 2012. 28(1): p. 11-22. 8

Goldfisher A.M., Hounslow B., Blank J. Transforming and Sustaining the Care Environment. Global Advances in Health and Medicine, 2014. 3(Suppl 1): p. BPA11.

From the AHVMA

Bradley R.T. Charisma and Social Structure: A Study of Love and Power, Wholeness and Transformation. 1987, New York: Paragon House. 10

Armour J.A. Anatomy and function of the intrathoracic neurons regulating the mammalian heart, in Reflex Control of the Circulation, I.H. Zucker and J.p. Gilmore, Editors. 1991, CRC Press: Boca Raton. p. 1-37. 11

Armour J.A., Potential clinical relevance of the ‘little brain’ on the mammalian heart. Exp Physiol, 2008. 93(2): p. 165-76. 12

Cantin M., Genest J. The heart as an endocrine gland. Pharmacol Res Commun, 1988. 20 Suppl 3: p. 1-22. 13

Baule G., McFee R. Detection of the magnetic field of the heart. American Heart Journal, 1963. 55(7): p. 95-96.

The mindful leader elevating the veterinary profession through innovation, education and advocacy of integrative medicine.

ANNUAL CONFERENCE The AHVMA will hold its Annual Conference at the Palm Beach County Convention Centre in West Palm Beach, Florida from September 10 to 13. The host hotel, the Hilton West Palm Beach, is conveniently connected to the Convention Center via a covered walkway.

Tiller W.A., McCraty R., Atkinson M. Cardiac coherence: A new, noninvasive measure of autonomic nervous system order. Alternative Therapies in Health and Medicine, 1996. 2(1): p. 52-65. 15

McCraty R., Atkinson M., Tiller W.A. New electrophysiological correlates associated with intentional heart focus. Subtle Energies, 1993. 4(3): p. 251-268. 16

McCraty R., Atkinson M., Tomasino D., Bradley R.T. The coherent heart: Heart-brain interactions, psychophysiological coherence, and the emergence of system-wide order. Integral Review, 2009. 5(2): p. 10-115. 17

Bigger J.T. Jr., et al. Frequency domain measures of heart period variability and mortality after myocardial infarction. Circulation, 1992. 85(1): p. 164-71. 18

Shaffer F., McCraty R., Zerr C. A healthy heart is not a metronome: An integrative review of the heart’s anatomy and heart rate variability. Frontiers in Psychology, 2014. 5:1040. 19

Tiller, W.A., McCraty R., Atkinson M. Cardiac coherence: A new, noninvasive measure of autonomic nervous system order. Alternative Therapies in Health and Medicine, 1996. 2(1): p. 52-65. 20

McCraty R., et al. The effects of emotions on short-term power spectrum analysis of heart rate variability. American Journal of Cardiology, 1995. 76(14): p. 1089-1093. 21

Increase Performances in Ski-Biathlon by Reducing Anxiety Stress Using Mental Training Techniques. HeartMath Institute, 2018, www.heartmath.org/research/research-library/abstracts/ ski-biathlon-mental-training-techniques/. 22

McCraty, R. Chapter 1: Heart- Brain Communication. Science of the Heart: Exploring the Role of the Heart, by Doc Lew Childre et al., HeartMath Research Center, Institute of HeartMath, 2001, pp. 1-7. 23

Cameron O.G. Visceral Sensory Neuroscience: Interception. 2002, New York: Oxford University Press.

Armour J.A. Peripheral autonomic neuronal interactions in cardiac regulation, in Neurocardiology, J.A. Armour and J.L. Ardell, Editors. 1994, Oxford University Press: New York. p. 219-244. 25

McCraty R, Atkinson M, Tomasino D., Bradley, R.T. The coherent heart: Heart-brain interactions, psychophysiological coherence, and the emergence of system-wide order. Integral Review, 2009. 5(2): p. 10-115.

In this year’s Keynote Address, “Plant Allies: Magical Healing”, Dr. Cynthia Lankenau will teach us that when we are connected with plants, they become much stronger allies in our quest to heal our patients. The conference (Program 20-901994) has been AAVSB RACE approved for 84 hours of continuing education; 21 hours maximum for anyone, veterinarian or veterinary technician. Lecture topics include Homeopathy, Botanical Medicine, Traditional Chinese Veterinary Medicine, Photobiomodulation, Aromatherapy, and so much more!

RESTORATIVE RETREAT The Council of Elders would like to invite you to the Annual Restorative Retreat, held before the 2022 AHVMA Annual Conference from September 6 to 9 at Our Lady of Florida Spiritual Center in North Palm Beach, Florida. Open to all AHVMA members, the retreat will help you connect through meditation and reflections from a variety of cultures and practices. Share in a Drumming Journey as well as Spirit Animal, Animal Totem, and Native American Wisdom sessions. Awaken all the senses through movement, flow, smell, “tastings” and other sensory experiences! Register at www.ahvma.org/annual-retreat.

Lane R.D, et al. Activity in medial prefrontal cortex correlates with vagal component of heart rate variability during emotion. Brain and Cognition, 2001. 47: p. 97-100 27

HeartMath.org Quick Coherence Technique.

AHVMF SILENT AUCTION The future of holistic medicine depends on today’s veterinary students. This year’s Silent Auction will be held on September 11, and all proceeds benefit students interested in integrative medicine. Auction items include jewellery, books, art, and vacation getaways (just to name a few). Please consider donating a product or service; all donations are greatly appreciated and tax deductible — visit www.AHVMF.org for details. Submitted by Melissa Kellagher, AHVMA Director of Operations

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newsworthy

“Seek and destroy”

CANCER TREATMENT OFFERS ALTERNATIVE TO SURGERY Because cancer is so common in both people and animals, new treatment options are bound to make waves. This year, for the first time, an innovative “seek and destroy” alternative to cancer surgery is being tested at the University of Guelph’s Ontario Veterinary College (OVC). The new method combines nanotechnology and laser light therapy, potentially offering a targeted, nonsurgical way to diagnose and treat tumors while preventing overtreatment and reducing common side effects, according to Dr. Michelle Oblak, a veterinary surgeon oncologist and professor in the Department of Clinical Studies.

PORPHYSOMES AND PTD The ground-breaking cancer treatment combines light-activated nanoparticles called porphysomes, along with photodynamic therapy (PTD). Dr. Oblak notes that while using PTD to destroy tumors isn’t new, this is the first time the technique has been paired with new nanoparticle technology developed by a researcher at Toronto’s University Health Network (UHN).

in the tumor or any other spot where the cancer may have spread. The lightactivated molecule has a fluorescent glow that allows the team to track its location using a special light source. Besides pinpointing the tumor’s whereabouts, the porphysomes make the tissue more vulnerable to damage from laser light. A beam of near-infrared laser light directed through a nano-fiber activates the porphysome, which then destroys cancerous tissue. For the clinical trial, the team is destroying only a portion of the cancerous tumors, then taking samples of the tumor and lymph nodes to assess the therapy’s results. Patients in the trial still undergo standard-of-care surgery to remove the entire tumor.

models to human medicine. During the trial, researchers aim to refine the new porphysome treatment for use in animals; ultimately, it will be used for treating various types of human cancer, including thyroid cancer, as an adjunct or alternative to surgery. Dr. Oblak states that photodynamic therapy is less invasive than surgery and targets tumors cleanly without harming normal tissue. The technology also avoids harmful side effects, including neck scarring and nerve damage that may affect the voice. Dr. Oblak adds that this technology might also be utilized in the future for tumors that are difficult to eliminate through surgery. In dogs, it could be used for treating small thyroid tumors as well as other head and neck cancers.

FOCUS ON THYROID CANCER “This is such an exciting opportunity, to have

The OVC team is seeking dogs with thyroid cancer for its clinical trials. Dr. Oblak says that investigating dogs with thyroid cancer is a more reliable way to study naturally-occurring disease and treatment, adding that canine studies translate more readily than mouse

an impact on how cancer is treated in both humans and pets, and to be involved in such an incredibly innovative idea and invention,” says Dr. Oblak. “This could change the way we treat and diagnose cancer.”

https://ovc.uoguelph.ca/news

This year’s clinical trail will include ten canine patients. The OVC team is injecting the porphysomes into each dog’s bloodstream, where they collect

Miya, a yellow Lab who is part of OVC's clinical trial, receives a porphysome infusion.

IVC Summer 2022

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? Maitake (Grifola frondose) is an immune-stimulating mushroom that’s also anti-inflammatory, hepatoprotective, anti-diabetic, and adapatogenic. It can lower blood pressure, offer antiviral and antibacterial effects, and modify the gut microbiome. It’s also one of the tastiest mushrooms! Maitake protects healthy cells while inhibiting tumor growth and preventing metastasis. It can also help in cases of atopic dermatitis, and augments dexamethasone so the latter drug can be decreased or stopped.

CASE REPORT Sidney was an eight-year-old male feral cat, who when caught had a scruffy coat and constant upper respiratory disease. The owner’s conventional veterinarian diagnosed miliary eczema and placed Sidney on 5 mg of prednisone twice a day, a dose he stayed on for six months before coming to my clinic with a chief complaint of aggression. It was felt that Sidney’s long-term treatment with a steroid was the main contributing factor to his aggression. With the help of Maitake, we were able to discontinue his steroids while improving his skin and coat.

in the Catskill Mountains. Matthew spoke on many current problems seen in practice, including autoimmune diseases, Lyme disease, and cancer. He also spoke on “The Wisdom of Nature: Plants and Animals as Teachers.” Matthew views nature as living and intelligent, and discussed the doctrine of signatures. • On May 24, David Winston, RH (AHG) spoke on herbal strategies for pain relief; a fantastic class with traditional usage supported by current research and clinical applications.

COMING EVENTS Alaskan Eco-tour: This will be a unique adventure. We have full use of the Twin Bear campground north of Fairbanks from August 4 to 10. The mixed program starts with a native herbalist, Kathleen Hildebrand Meckel; followed by two days with our leading esoteric veterinarian, Are Thoresen, DVM; then two days of herbal and stone hikes with Alaskan natives, Leslie and George. We will also enjoy hot springs, hikes in the woods, the use of a small lake, and wonderful comradery. Register at nycavma.org. VBMA at AHVMA: The VBMA will have a speaker track at the AHVMA conference, which runs September 10 to 13 this year. Our track features Renee Prince, RH (AHG), a clinician, educator, and ecologist, with five hours of lectures on skin topics, intestinal and blood parasites, formulations, and flower essences. Register at ahvma.org. Submitted by Cynthia Lankenau, DVM

GUESS THIS HERB!

VBMA ACTIVITIES • V BMA’s webinar schedule for 2022 started off with a fantastic speaker on a very important topic. On February 3, Barbara Fougere, DVM, lectured on “Medicinal Mushrooms in Veterinary Practice” and Maitake was one of the mushrooms discussed! (Webinars can be purchased at vbma.org). • In late April, the VBMA supported the NYCAVMA conference, with Matthew Wood, RH (AHG), at a small Buddhist retreat

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

IVC Summer 2022

TAKING ON HEART DISEASE IN DOGS AND CATS — A REVIEW OF RECENT FINDINGS AND NEW RESEARCH BY KELLY DIEHL, DVM

Heart disease is a common problem in cats and dogs. Although cardiac physiology is the same between these species, some diseases are more common in dogs than cats. Heart disease has been a focus of Morris Animal Foundation funding for almost 75 years, but there’s still a lot researchers don’t know. This article will review some of the Foundation’s latest studies and recent findings — and look at where cardiology research is heading.

THICK HEARTS AND BIG CLOTS — ATE AND HCM IN CATS For nearly 40 years, Morris Animal Foundation has funded studies into hypertrophic cardiomyopathy (HCM) and aortic thromboembolism (ATE) in cats.

Aortic thromboembolism One of the most influential was the FAT CAT study. Researchers considered whether clopidogrel or aspirin was superior in preventing a recurrence of ATE in cats that had survived a previous episode. Clopidogrel was found to be clearly superior in preventing recurrence, and cats receiving clopidogrel that

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did have another episode had a longer-than-average time to recurrence. Thanks to this study, clopidogrel is now a routine frontline therapy for cats with ATE.1 Although clopidogrel can be an important drug for preventing ATE in cats, not all cats metabolize the drug in the same way. This variation can result in improper drug dosing, which can lead to treatment failure. Foundation-funded researchers at the University of California, Davis, studied the genetics behind differences in clopidogrel metabolism, and are currently developing genetic test procedures to help veterinarians determine the best dose of the drug. The team hopes this will be a first step toward personalized medicine for cats suffering from HCM.2

Hypertrophic cardiomyopathy HCM in asymptomatic cats can be difficult to detect using just a physical examination or even an X-ray. Echocardiography is the gold

standard for diagnosing HCM, but it can be costly and timeconsuming for owners as a screening test and can require referral to a cardiology specialist. A Foundation-funded team at Tufts University recognized the need for a quick test that could be done by a general veterinary practitioner during a routine office visit. The team developed a screening protocol that was effective in detecting moderate to marked HCM in asymptomatic cats and was easy for non-specialist veterinarians to learn and master.3 The Foundation was also a funding partner in one of the largest studies ever conducted on HCM in cats. An international team of collaborators from 21 countries contributed data on more than 1,700 cats, both with and without HCM. The findings of this massive undertaking were published in two papers. The team found that roughly 30% of the cats in the study developed complications secondary to their disease. Only 10% of cats with preclinical HCM lived what was defined as a “long life” (nine to 15 years of age). The researchers also found no significant difference in outcomes between cats with obstructive or nonobstructive HCM.4,5

GENETICS TAKES CENTER STAGE FOR DOGS WITH HEART DISEASE The search for the genetic under-pinnings of heart disease in dogs has been a subject of multiple studies funded by the Foundation over the last 20 years. Technological advances coupled with decreasing costs make it easier to analyze genetic data associated with complex conditions such as heart disease. Certain breeds are predisposed to different types of disease, suggesting an underlying genetic component. Identifying genetic abnormalities that may be responsible for disease is a first step toward new diagnostic tests and possibly even prevention.

Subvalvular aortic stenosis Thanks in part to Foundation funding, genetic testing is now available for subvalvular aortic stenosis (SAS) in Newfoundland dogs. A group of talented researchers based at North Carolina State University was able to identify the genetic mutation responsible for the disease in this breed, leading to the development of a genetic test that is now commercially available. The results of this study were

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NEW HORIZONS

IN COMPANION ANIMAL

HEART DISEASE

The future is looking brighter for animal patients suffering from heart disease. The Foundation is funding several cutting-edge studies using the latest technological tools, new drugs, and innovative strategies to tackle heart disease. One study at the University of California, Davis, is looking at rapamycin’s ability to reverse remodeling in dogs with severe SAS. Rapamycin inhibits one of the key regulators of cell growth and nutrient response, and there is evidence it prevents remodeling secondary to laboratory-induced cardiac pressure overload. Rapamycin has been safely used experimentally in dogs as a chemotherapeutic agent, and in studies of aging. Given the extremely poor prognosis for dogs with severe SAS, this study, if successful, could have a significant impact on canine patients diagnosed with this terrible disease, and their veterinarians. A team at the University of Florida is testing whether it’s possible to use the gene editing tool CRISPR/Cas9 to treat dilated cardiomyopathy (DCM) in Doberman pinschers. After taking stem cells from Dobermans and differentiating them into cardiomyocytes, researchers will attempt to use CRISPR/Cas9 to correct defects in genes important for heart function in dogs. Specifically, the team will edit a known mutation and two proteins associated with DCM, and measure its impact on heart cell function. If successful, the team hopes it can translate the treatment into a clinical trial. The genetics of HCM in cats is the subject of another newly-funded study. Estimates suggest one in seven cats will develop this disease. Although breed-specific tests to assess risk do exist, there are still large knowledge gaps in our understanding of the genetics underlying HCM. A team of geneticists at University of California, Davis, are using whole-genome sequencing techniques to develop the largest feline genetic data set ever studied. The researchers are comparing cats with HCM, and geriatric cats without the disease. The team hopes to use this information to develop novel testing, and to identify new drug therapy targets to improve the care of cats with this devastating heart disease. In addition, the data set will be freely available as a first-of-its-kind, open-access genetic resource for other researchers, in an attempt to facilitate and accelerate research. It will be exciting to see what these talented researchers discover about heart disease in dogs and cats.

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particularly significant because they represent the first genetic mutation identified for a congenital heart defect in dogs.6

Myxomatous mitral valve disease The same team turned their attention to myxomatous mitral valve disease (MMVD). Using funds granted through the first Mark L. Morris Jr. Investigator Award, the researchers spent five years studying the complex genetics of MMVD. Their aim was ambitious — to search for the gene(s) responsible for this common disease. The group just completed its project and began to publish results. They didn’t find a single genetic variant that explained MMVD development in the population they studied. Likewise, they didn’t find a single breed-specific genetic variant for the development of MMVD in miniature poodles, dachshunds, Yorkshire terriers or Cavalier King Charles spaniels. However, the team did discover a specific signaling pathway that could be involved in the pathogenesis of MMVD across different breeds. More work is needed on teasing out the specifics, but the team hopes veterinarians will soon be able to screen dogs for MMVD via disruptions in this pathway.7 Another important finding from the project centered on differences between Yorkshire terriers and miniature Schnauzers diagnosed with MMVD. As part of their genetic research, the team reviewed medical records associated with dogs in the study. They noted that miniature Schnauzers were significantly younger at the time of MMVD diagnosis than Yorkshire terriers, and their clinical signs differed.8 The study generated several publications and has been a springboard for research groups to tackle complex genetic diseases. The authors’ findings also emphasized that even a common disease such as MMVD can be more complex than previously thought, and that gaining a deeper understanding of the problem can help veterinarians provide more personalized and effective care for their patients.9

Cardiac disease remains one of the most common problems seen by veterinarians, affecting untold numbers of cats and dogs each year. Morris Animal Foundation, thanks to donor support, continues to fund innovative research in heart disease to help veterinarians provide the best care for their patients.

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

ACUPUNCTURE FOR SUPPORTING DOGS WITH HEART MURMURS

1Hogan

D, Fox P, Jacob K, et al. Secondary prevention of cardiogenic arterial thromboembolism in the cat: the double-blind, randomized, positive-controlled feline arterial thromboembolism; clopidogrel vs. aspirin trial (FAT CAT). J Vet Cardiol. 2015;17:S30. 2Ueda Y, Li RH, Nguyen N, et al. A genetic polymorphism in P2RY1 impacts response to clopidogrel

in cats with hypertrophic cardiomyopathy. Sci Rep. 2021;11:12522.

3Loughran K, Rush J, Rozanski E, et al. The use of focused cardiac ultrasound to screen for occult

heart disease in asymptomatic cats. J Vet Intern Med. 2019;33(5):1892-1901.

4Fox P, Keene B, Lamb K, et al. International collaborative study to assess cardiovascular risk and

evaluate long-term health in cats with preclinical hypertrophic cardiomyopathy and apparently healthy cats: The REVEAL Study. J Vet Intern Med. 2018;32(3):9 5Fox P, Keene B, Lamb K, et al. Long-term incidence and risk of noncardiovascular and all-cause

mortality in apparently healthy cats and cats with preclinical hypertrophic cardiomyopathy. J Vet Intern Med. 2019;33(6):2572-2586. 6Stern

J, White S, Lemkuhl L, et al. A single codon insertion in PICALM is associated with development of familial subvalvular aortic stenosis in Newfoundland dogs. Hum Genet. 2014; 133(9): 1139–1148. 7Williams

B, Friedenberg S, Keene B, et al. Use of whole genome analysis to identify shared genomic variants across breeds in canine mitral valve disease. Hum Genet. 2021;140(11):15631568. 8DeProspero D, O’Donnell K, DeFrancesco T, et al. Myxomatous mitral valve disease in Miniature

Schnauzers and Yorkshire Terriers: 134 cases (2007-2016). J Am Vet Med Assoc. 2021;259(12):14281432. 9Adin

D, Atkins C, Friedenberg S, et al. Prevalence of an angiotensin-converting enzyme gene variant in dogs. Canine Med Genet. 2021;8(1):6.

Deciding how to use acupuncture to treat non-specific or non-pathologic heart murmurs in dogs can be confusing. Many canine patients, especially seniors, show up for reasons unrelated to cardiac disease but have heart murmurs that are detected on exam. In the best case scenario, these dogs will have thoracic radiographs done and/or visit the cardiologist for an echocardiogram so we know whether or not there are any pathologic changes in the heart. In many cases, there aren’t. What can you do for a cardiac murmur that isn’t really causing any problems yet? My strategy for acupuncture in these cases shifts from treatment to supportive or preventive care. If a murmur is present, we can be fairly certain the blood is not flowing as smoothly as it should, which will lead to stagnation over time. In addition, the heart needs to use more Qi to efficiently pump blood forward. Over time, this can have effects on the cardiac muscle. Therefore, the acupuncture strategy I employ is to support the smooth flow of blood, the Heart Qi, and the heart muscle. A great case example is Juno, a ten-year-old Corgi I treat mainly for IVDD. She also has a non-pathologic cardiac murmur. The acupoints I use for Juno’s preventive cardiac care include SP 6 or SP 10 to move and nourish blood while supporting the spleen and muscle; PC 6 to strengthen and protect the heart; and LIV 3 to move blood and Qi smoothly throughout the body.

Submitted by Nell Ostermeier, DVM, Certified Veterinary Acupuncturist (IVAS), FAAVA People + Pet Integrative Therapies (www.peopleandpet.com)

IVC Summer 2022

Inthenews

AI MODEL facilitates EARLY DETECTION of LEPTOSPIROSIS in dogs Leptospirosis can be lethal in dogs, and may result in kidney failure, liver disease, bleeding lungs, and death. However, early detection can enable veterinarians to nip the disease in the bud. Now there’s an AI model for detecting leptospirosis in the early stages.

The UC Davis leptospirosis prediction AI model removes all the diagnostic roadblocks and has shown groundbreaking results so far. In a test group of new dogs, nine were identified as positive. All the predictions were correct, translating to 100% sensitivity.

Created by UC Davis, the model was developed by analyzing data from more than 400 canine patients tested for leptospirosis at the university’s facility. AI was deployed that used intricate statistical methods to look for patterns associated with a leptospirosis outcome in the dogs’ blood work. A system was then developed that could be applied to new lab work for making a prediction about the presence of infection.

The developers’ goal for the AI model is to make it a readily available online resource for veterinarians so they can easily reach an early diagnosis in cases of leptospirosis.

Traditionally, Leptospira testing lacks sensitivity in the early phase of the infection. Leptospirosis tests also involve the quantification of an increasing number of antibodies in blood samples over time. It usually takes over two weeks to detect the disease — which is unfortunate because of the severe pathogenic potential of the bacterium.

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This recent initiative highlights the value of AI-based diagnostics. “AI-based, clinical decision making is going to be the future for many aspects of veterinary medicine,” says Mark Stetter, Dean of the UC Davis School of Veterinary Medicine.

https://www.ucdavis.edu/health/news/using-artificialintelligence-predict-life-threatening-bacterial-disease-dogs

NATURAL ASTAXANTHIN may hold the key to keeping aging dogs healthy

As our dogs age, natural astaxanthin gives them the added support they need to maintain quality of life. Astaxanthin is the plant-based nutrient that gives salmon its distinctive red color, although most dogs don’t eat enough of it to benefit from its astaxanthin. However, studies show dogs can profit by taking supplements containing AstaReal® astaxanthin from algae.

ASTAXANTHIN SUPPORTS MITOCHONDRIA

to maintain mobility. A sedentary lifestyle can exacerbate progressive muscle loss, and we know that staying active also helps promote cardiovascular health and cognitive function. Natural astaxanthin helps support muscle endurance, recovery, and also boosts the effects of exercise.

CARDIOVASCULAR HEALTH Blood flow efficiency declines with age, and blood vessels tend to lose their elasticity, making it harder for nutrient and oxygen-rich blood to reach the organs that need it, such as the muscles, brain, and eyes. Furthermore, as dogs age and become more sedentary, they often gain weight, putting them at greater risk of developing cardiovascular disease. Astaxanthin helps maintain blood flow and supports healthy blood lipid profiles. In a study of young healthy dogs, astaxanthin lowered diacylglyceride levels and serum markers of oxidative stress and inflammation.

Supporting mobility, cardiovascular health, cognitive function, and vision can improve the lives of aging dogs. All of these functions depend on healthy organs that need a lot of energy to do their jobs: skeletal muscle, heart, brain, and eyes. This energy is made by the powerhouses of the cell —mitochondria. In a study involving aging dogs that took natural astaxanthin, the dogs’ mitochondrial ATP production increased by 14%, and their mitochondrial enzymes increased by over 500% after eight weeks. By supporting mitochondria, natural astaxanthin promotes COGNITIVE FUNCTION the function of energy-hungry organs critical to maintaining the health of The role of astaxanthin in supporting aging dogs. cognitive function is an emerging benefit, with human clinical studies showing improved reaction times and memory. MOBILITY Exercise plays an important role in mainOlder dogs naturally lose muscle mass taining brain health and the development and strength, making it harder for them of new neurons throughout adulthood.

Mice showed more new neuron formation in the hippocampus when exercise was combined with astaxanthin supplementation, compared to just exercise alone. Studies in aging dogs show that dietary antioxidants improve learning, and that astaxanthin crosses the blood-brain barrier where its antioxidant activity protects delicate structures in the brain.

VISION Astaxanthin crosses the blood-retinal barrier and has been found in both the retina and the muscles framing the lens. The muscles around the lens mediate dynamic focus, and human clinical studies have shown that astaxanthin improved the function of these muscles and alleviated eyestrain. In dogs, astaxanthin combined with other ingredients helped slow the progression of refractive error and reduced symptoms of dry eye. AstaReal® harvests natural astaxanthin from microalgae grown in an indoor cultivation facility near the Columbia River in Washington State. Their research has culminated in over 160 studies on astaxanthin, along with new product developments that deliver all the benefits of AstaReal® Astaxanthin to our beloved companion animals. https://astarealusa.com IVC Summer 2022

industry innovations

Drug-free pain and anxiety relief Targeted Pulsed Electromagnetic Field (tPEMF™) therapy uses electromagnetic waves, targeted at specific frequencies, to stimulate an animal’s natural recovery process. Safe and drug-free, this clinically-proven, peer-reviewed technology includes Assisi LOOP® products, which target pain and inflammation related to orthopedic injuries, degenerative disorders, post-surgical discomfort, etc.; and Calmer Canine® products, which focus on treating anxiety disorders. assisianimalhealth.com

Test measures blood levels of Omega-3 Omega-3s play an important role in supporting a number of body systems, but they can’t deliver their benefits if they’re not in the blood. The Omega-3 Index for Pets Test from Standard Process® allows veterinary professionals to measure the levels of Omega-3 fatty acids in red blood cells — a marker correlated with overall health. It’s the first step towards recommending important dietary changes, which can be continually monitored and adjusted through regular testing. standardprocess.com

Tackle oxidative damage with astaxanthin Natural astaxanthin from algae is one of nature’s most powerful known antioxidants. It helps protect cell membranes and mitochondria by quenching reactive oxygen species that accumulate in the bodies of aging dogs. Canine studies have shown that natural astaxanthin promotes mitochondrial health, supports cardiovascular health, and helps maintain visual function. Look for Golden Years with AstaReal®, the most studied brand of natural astaxanthin, made in the US by a NASC-preferred supplier. astarealusa.com

Effective allergen immunotherapy 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” show poor agreement, as well as 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

IVC Summer 2022

nutrition nook

CARDIAC SUPPLEMENTS FOR DOGS AND CATS BY NANCY SCANLAN, DVM, CVA

Heart problems are relatively common in dogs and cats. A range of supplements can help support your cardiac patients, and make an effective addition to your treatment plan.

The most common types of heart or heart-related disease in cats are hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), hypertension, and chronic heart failure (CHF). In dogs, we most often see chronic valvular disease, DCM, heartworm, and primary arrhythmias. This article provides an overview of cardiac-supportive supplements for dogs and cats. Note that some of these heart problems are breed-related, so response to supplements can also be breed-related.

TAURINE This is probably the most important supplement for the prevention and treatment of heart disease. Its importance for cats in particular has prompted AAFCO to increase the

recommended amounts of taurine in cat food. However, we still see cases of feline heart disease which are responsive to taurine. A recent in-depth nutritional analysis of 26 commercial plant-based diets found that none met the minimum nutritional standards recommended by AAFCO and FEDIAC. Taurine was the most common under-supplied nutrient. Crude protein in most of these diets was above the recommended minimum, projecting a false idea of their nutritional adequacy. Homemade diets were also found to be problematic for taurine content. Dogs can also have taurine-responsive cardiac problems, which are especially prominent in certain breeds, most commonly the Golden Retriever, American Cocker Spaniel, and Newfoundland. This would suggest that recommendations

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for taurine levels are too low for canine as well as feline diets. Unlike cats, dogs can manufacture their own taurine, but this mechanism most likely works best for dogs on a meat-based diet, not those on a low quality commercial diet. Dogs such as the Golden Retriever, which have a higher-than-average chance of developing taurine-responsive DCM, have probably lost some of this capacity, compared to their wild relatives. A retrospective study of dogs with DCM, which included 56 dogs on grain-free diets, showed that subsequent supplementation of taurine helped the dogs in the grain-free group live significantly longer (up to 455 days longer) than those that stayed on the same diet with no supplementation. ACVIM guidelines for the use of taurine in canines and felines with non-DCM heart disease in general are positive, but conservative. They recommend measuring plasma taurine concentrations and only supplementing when plasma concentrations are low or animals are in later stages of heart disease. Taurine does not easily diffuse from within a cell to plasma. So plasma concentrations of taurine do not immediately reflect intracellular levels. Because of the number of cardiac problems that are responsive to taurine, it would be more prudent to initiate taurine supplementation whenever a heart abnormality is detected, even if the dog or cat is not yet exhibiting clinical signs.

Recommended dose: For cats, dosage varies from 125 mg per day (for growth and maintenance) to 250 mg q 12 hr for cardiomyopathy (as high as 500 mg bid with B6 for epilepsy). For dogs with DCM, one recommended dose is 500 mg bid, accompanied by 1,000 mg l-carnitine bid. A second recommendation is 20.6 mg/kg PO q 12 hr (375 mg per 40 lb). Taurine is palatable and non-toxic, and the contents of a taurine capsule can be poured onto a pet’s food — even for cats.

L-CARNITINE This supplement does not have as much published research behind it, but cardiologists and many veterinarians recommend its use in heart disease, along with taurine. L-carnitine is crucial for transporting fatty acids across the membrane of mitochondria for use in ATP production. L-carnitine

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improves exercise endurance in human heart patients. A retrospective study of Chinese human cardiac patients who were given l-carnitine as a supplement showed improved symptoms for heart disease and increased survival times. Some veterinary researchers mentioned cost as a negative factor, but the cost of 500 mg of l-carnitine is just three times as much as the very low cost of 500 mg of taurine. L-carnitine is well within the limits of what pet owners are able to pay.

Recommended dose: 1,000 mg to 2,000 mg twice a day.

ARGININE Arginine is the immediate precursor for nitric oxide, a vasodilator. It can reduce injury from hypoxic conditions and increase vasodilation, which can benefit the heart and decrease blood pressure.

Recommended dose: 760 mg/100 kcal.

OMEGA-3 FATTY ACIDS The American Heart Association (AHA) recommends just one supplement for human individuals with coronary heart disease: Omega-3-fatty acids. Eicosapentanoic acid and docosahexaenoic acid (EPA and DHA) found in fish body oil have a beneficial effect on echocardiographic measurements and cardiac biomarkers in cats with HCM. Fish oil decreases arrhythmias and the potential for arrhythmias. It increases survival time in dogs with chronic heart disease, and improves cardiac cachexia. Molecularly distilled fish oil can help decrease the amount of environmental contamination. Another way to accomplish the same thing is by using algae-derived EPA and DHA.

Recommended dose: 300 mg combined DHA and EPA per 10 pounds body weight per day.

COQ10 Also known as coenzyme Q10 or ubiquinol, this supplement has not received enough attention in the veterinary world. It has shown benefits for ischemic heart disease in humans. CoQ10 plays an essential part in ATP production, as an electron carrier in the mitochondrial respiratory chain. Without it, oxidative phosphorylation could not occur.

CoQ10 production in the body declines as we age, partly explaining the declining energy levels in elderly pets. It also acts as a lipid-soluble antioxidant, and can repress expression of pro-inflammatory genes. It helps improve cardiovascular health, increase energy levels, and lower blood pressure. ACVIM recommends its use in dogs with mitochondrial myopathy. In view of its role in ATP production, and the lower concentrations in older animals, it would be wise to use it in any older pet with heart disease.

Recommended dose: 100 mg once a day.

ANTIOXIDANTS Vitamin E requirements rise with an increase in polyunsaturated fatty acids. It has an anti-inflammatory effect and reduces oxidative stress, and has been shown to be beneficial in human heart disease. Decreased levels of vitamin E are found in both dogs and cats with DCM. Cats with hypertrophic cardiomyopathy exhibit increased oxidative stress markers, and some cardiologists recommend that antioxidants be added to the treatment regimen for this disease. The natural d-alpha form is preferred to the dl-alpha form, since the latter has only 42% of the activity of the d form.

Recommended dose: 5 IU d-alpha tocopherol per pound body weight. This can be added to the food as a gel cap or oil.

ADDITIONAL SUPPLEMENTS •

Vitamin C is another antioxidant, and is generally useful for cardiac disease, especially as it progresses. When vitamin E acts as an antioxidant, it is transformed into its pro-oxidant form. Vitamin C is the cofactor that cycles vitamin E back into its antioxidant form. In any condition involving increased oxidative stress, when vitamin E is given, vitamin C should also be included.

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B vitamins may be depleted when animals are given diuretics. Riboflavin or thiamine given at a dose of 100 mg once a day can be helpful with mitochondrial myopathy.

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Magnesium is the most important mineral for the cardiac patient. It can help with canine arrhythmias, and when heart failure progresses. IVC Summer 2022

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Dogs with cardiac disease may suffer from hypomagnesemia, and magnesium levels should be included in their lab tests. Magnesium should always be added for any dog with low magnesium blood levels. One study of supplements for heart disease added magnesium to a supplement mix regardless of blood status. Magnesium is a coenzyme for sodium-potassium ATPase and serves as a cofactor for hundreds of enzymatic reactions. It plays a big part in calcium reactions, modulating its release from sarcoplasmic reticulum. It also decreases the excitability of nerve and muscle membranes, and can help reduce high blood pressure. The level of magnesium in critical care diets and total parenteral nutrition formulas is low and not sufficient to treat hypomagnesemia. Magnesium chloride, magnesium gluconate, magnesium oxide, or magnesium hydroxide can be given at 1-2 mEq/kg PO q 24 hrs. Magnesium must be used with caution in patients with renal insufficiency. The recommendation is to decrease the recommended dose by 50%.

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Potassium supplementation should not be required unless the patient is on diuretics. Serum potassium may be low in such a case, but this most commonly occurs when using torsemide. Hyperkalemia may also be seen with heart disease, but this is rare in patients being treated with diuretics. The only time supplemental potassium should be given is when hypokalemia is present, confirmed by laboratory analysis.

STUDIES ON CARDIAC SUPPLEMENTS Less research has been done on cardiac supplements for dogs with chronic valvular disease than in dogs or cats with DCM or HCM. In one study, dogs with early chronic valvular disease with clinical signs were given a diet that included Omega-3 fatty acids, vitamins C and E, arginine, taurine, and carnitine. They showed significant measurable improvement after four weeks. The internal diameter of both the left atrium and left ventricle decreased, and mitral valve regurgitation was reduced.

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Another study of dogs with early preclinical mitral valve disease involved feeding them a diet enriched with MCT oil, fish oil, fish meal, l-lysine, dl-methionine, taurine, magnesium sulfate, and additional dl-alpha tocopherol. The diet reduced left atrial enlargement in these dogs.

SUPPLEMENTS

BENEFICIAL

FOR CARDIAC PATIENTS • • • • • • • • •

TAURINE L-CARNITINE ARGININE OMEGA-3 FATTY ACIDS COQ10 VITAMIN E VITAMIN C B VITAMINS MAGNESIUM

USING MULTIPLE SUPPLEMENTS These trials along with previous research show the benefits of using multiple supplements rather than a single one. Because these supplements work in different ways to benefit the heart, it makes sense that the more that can be added without danger of toxicity, the better the effects. Taurine and vitamin E are two palatable supplements with beneficial effects that can be added to food without causing rejection because of the taste.

The AKC also recommends several supplements, including Omega-3 fatty acids, CoQ10 and antioxidants, so clients who follow them may ask you about those three. Familiarity with these and the other supplements highlighted in this article will help increase client confidence in the recommendations you make.

Li Q., Heaney A., Langenfeld-McCoy N. et al, Dietary intervention reduces left atrial enlargement in dogs with early preclinical myxomatous mitral valve disease: A blinded randomized controlled study in 36 dogs. MC Veterinary Research 2019 15:425

References

Michałek M, Tabiś A, Pasławska U, Noszczyk-Nowak A. Antioxidant defence and oxidative stress markers in cats with asymptomatic and symptomatic hypertrophic cardiomyopathy: a pilot study. BMC Vet Res. 2020 Jan 30;16(1):26.

Dodd, S.A.S., Shoveller, A.K, Fascetti, A.J, et al, A Comparison of Key Essential Nutrients in Commercial Plant-Based Pet Foods Sold in Canada to American and European Canine and Feline Dietary Recommendations. Animals 2021, 11, 2348. Freeman LM, Rush JE, Markwell PJ. Effects of dietary modification in dogs with early chronic valvular disease. J Vet Intern Med. 2006 Sep-Oct;20(5):1116-26. Freeman L. M., Stern J.A., Fries R., et al, Diet-Associated Dilated Cardiomyopathy in Dogs: What do we know? JAVMA 2018, 253:. 11 Freid KJ, Freeman LM, Rush JE, Cunningham SM, Davis MS, Karlin ET, Yang VK. Retrospective study of dilated cardiomyopathy in dogs. J Vet Intern Med. 2021 Jan;35(1):58-67.

Luis Fuentes LV, Abbott J, Chetboul V, Côté E, Fox PR, Häggström J, Kittleson MD, Schober K, Stern JA. ACVIM consensus statement guidelines for the classification, diagnosis, and management of cardiomyopathies in cats. J Vet Intern Med. 2020 May;34(3):1062-1077. Mantle D, Heaton RA, Hargreaves IP. Coenzyme Q10 and Immune Function: An Overview. Antioxidants (Basel). 2021 May 11;10(5):759.

Pion PD, Kittleson MD, Rogers QR, et al. Myocardial failure in cats associated with low plasma taurine: a reversible cardiomyopathy. Science 1987;237:764–768 Scarpa M, Rigo A, Maiorino M, et al. Formation of alpha-tocopherol radical and recycling of alpha-tocopherol by ascorbate during peroxidation of phosphatidylcholine liposomes. An electron paramagnetic resonance study. Biochim Biophys Acta. 1984 Sep 28;801(2):215-9. Twedt, DC, Applications of Nutraceutical Antioxidants in Veterinary Medicine, Western Veterinary Conference 2009

Gompf R. E, .Nutritional and Herbal Therapies in the Treatment of Heart Disease in Cats and Dogs, JAAHA 2005 November/December , Vol. 41

van Hoek I., Hodgkiss-Geere H., Bode E. F. et al ,Association of diet with left ventricular wall thickness, troponin I and IGF-1 in cats with subclinical hypertrophic cardiomyopathy. J Vet Intern Med. 2020;34:2197–2210

Keene BW, Atkins CE, Bonagura JD, et al. ACVIM consensus guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs. J Vet Intern Med. 2019;33(3):1127-1140.

Weiser H, Brubacher G, Wiss O. 1-alpha-Tocopherylacetate: biological activity. Science. 1963 Apr 5;140(3562):80.

Kittleson MD, Keene B, Pion PD, Loyer CG. Results of the multicenter spaniel trial (MUST): taurineand carnitine-responsive dilated cardiomyopathy in American cocker spaniels with decreased plasma taurine concentration. J Vet Intern Med. 1997 Jul-Aug;11(4):204-11.

Weng Y, Zhang S, Huang W, et al. Efficacy of L-Carnitine for Dilated Cardiomyopathy: A Meta-Analysis of Randomized Controlled Trials. Biomed Res Int. 2021;2021:9491615. Published 2021 Jan 12.

How PEMF can benefit your patients Pulsed electromagnetic field (PEMF) therapy has been available in FDA-cleared devices since the 1970s. Since then, however, the technology has advanced by leaps and bounds. Targeted pulsed electromagnetic field (tPEMF™) therapy, patented by Assisi Animal Health, has revolutionized animal pain management, proving that PEMF can successfully manage countless painful and inflammatory conditions — all without the use of pharmaceuticals. In addition, PEMF’s ability to also manage behavioral conditions has become clear in just the last few years. In 2021, a groundbreaking, double-blind, randomized, and placebo-controlled North Carolina State University study confirmed that targeted PEMF therapy clinically reduces canine separation anxiety (CSA). Using a unique electromagnetic signal, a revolutionary device called the Calmer Canine Anxiety Treatment System® targets the source of anxious symptoms: inflammation in the anxiety center of the brain. This means that, unlike fast-acting drugs, this device offers long-term relief. After just four weeks of using this tPEMF device, almost twothirds of dogs more than doubled the time they spent at rest when left alone. By the end of six weeks, dogs treated with

tPEMF therapy showed a six-fold greater improvement in passive behaviors compared to dogs treated with a placebo device. For the estimated 13 million dogs in the US alone that are suffering from CSA, this technology offers immense relief. For veterinary professionals, these findings mark a change in the way behavioral conditions can be safely and successfully managed, using Calmer Canine as an effective, well tolerated, and drug-free treatment option.

https://assisianimalhealth.com/

IVC Summer 2022

Osteopathic

Treatment for Back Pain in Horses How equine patients with back pain attributed to “kissing spines” can benefit from osteopathy.

As you most likely know, the modalities and treatment options available for treating back pain in equine patients are varied. This article looks at how osteopathy can be used to treat immobilities in the spine and other areas, and achieve long-lasting solutions to back pain.

KISSING SPINES I have many clients who come to me because they have a horse with back pain diagnosed from radiographs, bone scans or ultrasound. The diagnosis of “kissing spines” is often given along with a poor prognosis and a lifelong sentence of “back problems”. I don’t think this is the case. Often, the back pain results from immobilities in the spine, back or pelvic viscera, fascia and muscles, and is often exacerbated by poor saddle fit, poor riding posture, and negative palmar angles in the feet, among other things.

• When a rider has a nice easy seat and light hand, and the horse has his neck in front of the vertical, with the feet balanced and the saddle shaped to allow the back to flex and lift, the spine should come into flexion and the sacrum should move so that the cranial portion of the sacrum is slightly higher than the caudal portion. In these cases, the horse’s back lifts and the tail lowers. As you can see in Figure 1, the vertebrae get spaced further apart and the risk of kissing spines begins to decrease.

Let’s start by taking a look at the sacrum osteopathically, and imagine how it could relate to kissing spines.

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Figure 1

• Conversely, in the case of a rider with a driving seat or heavy hand; a horse with his neck behind the vertical; a banana-shaped saddle that puts pressure on the back preventing a rounded flexion; or a horse with negative palmar angles (especially in hind end), the opposite sacral position may occur. Some of the common osteopathic immobilities associated with the second picture (see below) include a depression or lack of motion in the cranial aspect of the sacrum, and in L4, L5 or L6. Often, the pelvic portion of the SI joint will lack full motion and be unable to move dorsally and medially. This often creates a posture in which the hind legs are out behind the horse. The horse will appear to be unable to track easily into the front footprint when asked to move up. The psoas muscles on these horses are often contracted and tight, pulling the lumbar spine down and caudal towards the proximal femur and ilial wing. Viscerally, these horses often have restrictions in the groin area, near the inguinal ring or in the length of the suspensory ligament of the ovary. They can also have tension and restrictions around the branching of the caudal aorta and sacro-iliac region. As you can see from Figure 2, this posture positions the spinous processes closer together and makes kissing spines much more likely to occur. Figure 2

have profound effects on the ability of the horse’s spine to flex. This will then allow the horse to lift his spine and come under himself easily and efficiently by just mobilizing the spine using the gluteal muscles to lift the cranial sacrum.

OSTEOPATHY — 3 PILLARS OF THERAPY One of the things that makes osteopathy so different from chiropractic is its three pillars of therapy: structural manipulation, visceral manipulation, and cranial sacral manipulation. All these are performed during each exam and therapy session to create maximum improvement and help make long-lasting changes.

Another interesting osteopathic connection The diaphragm and psoas are intimately interwoven and connected right at Th17, Th18, L1 and maybe all the way to L3. This area is often where the back of the saddle rests. In many cases, saddles balance incorrectly and put excessive pressure on this area. One side of the diaphragm is attached at the underside of the spine and transverse processes (where it interweaves with the psoas minor), and the other side attaches to the edges of the ribs (on the ventral side and cartilaginous portions of the ribs) and also to the caudal portion of the sternum. Restrictions in the sternum can then also add to tightness and restrictions in the ribs in the girth area and behind the withers. I believe there are also connections between the hyoid and TMJ that are related to the restrictions in the sternum. For this reason, we can start to correlate hind end lameness and restrictions with poll and TMJ restrictions.

The good news is that spinal remodeling can change, and either improve or worsen with our influence! Mobilizing the sacrum and visceral structures associated with this area can

When working on mobilizing the spine in the horse, I think it is critical to balance these “ventral line” restrictions that are pulling the spine and thorax ventrally and into extension. This includes manipulating and releasing the psoas major, psoas minor and iliacus; mobilizing the diaphragm and ribs; mobilizing the sternum and thoracic inlet; and mobilizing the TMJ and hyoid and its related structures. IVC Summer 2022

It is common for horses to only need osteopathic treatment once every few months after their initial exam. Osteopaths believe in the idea that if mobility is created in the body, then the body’s natural immune response, nervous system response and vascular response to a given area will also improve and help the area maintain the correction and improve further on its own.

STRUCTURAL MANIPULATION

First, let’s discuss structural manipulation of the spine and sacrum. I frequently find that horses with back pain have very little motion in the sacrum. They especially have a hard time lifting up the cranial aspect of the dorsal. I manipulate these areas by releasing the psoas muscles and supraspinous ligaments first, then use a long lever technique to have the horse lift the upper part of the sacrum and increase mobility in the SI joint. I also use a rotational/lifting long lever technique to mobilize the lumbo-sacral joint and create motion in the lateral joints of the L-S joint. Then I mobilize the pelvic portion and any rotational restrictions down the hind leg.

Most of the lumbar spine will become free just from these maneuvers, but any restrictions the area still present are then manipulated individually. Next, I look at the ribs and rib cage and any diaphragm connections holding it in restriction. Once these are released, I deal with any further thoracic restrictions and finish off with a sternal release.

VISCERAL MANIPULATION

What about visceral osteopathic connections of the lumbar spine and sacrum? From an osteopathic standpoint, we always need to take into account the neurological inputs to a given area — motor, sensory, and especially the autonomic nervous system. Hypertonicity and upregulation in the autonomic nervous system sympathetic chain ganglions can have an influence on the mobility of structures and overall health of the tissues and organs they innervate. This can happen due to a spinal immobility at the level of the sympathetic ganglion. For example, lumbar immobility along L3 can affect the innervations of the bladder, flank area, stifle area and hip. Another example might be immobility in the suspensory ligament of the ovary, feeding back and impacting the sympathetic chain at the level of L1, L2 or L3 and preventing lasting resolution of immobility when structural manipulations are perfomed in this area. Sacral immobility can affect parasympathetic nervous system innervation to the majority of the body’s organs, as well as innervation to the perineal area and any area that is innervated by the sciatic nerve. For this reason, any time I find restrictions in the sacrum, poll, TMJ and at least two or three continuous lumbar segments, I will include a rectal exam with manipulation of the organs and muscles restricted in these areas. I also find that indirect manipulation to the stomach and esophageal region can have a profound effect on releasing the chest and likely mobilizing and affecting the vagus nerve.

IVC Summer 2022

CRANIAL SACRAL MANIPULATION

Lastly, in order to really connect a horse from front to back, and allow fluid motion of the spine, osteopathic manipulation should include a cranial sacral exam and treatment. This may often include an assessment as part of the initial diagnostic exam, and involves treatment after all structural and visceral components have been addressed. This gives the osteopath the best way of having an effect using cranial sacral techniques. Patterns that show a significant restriction in the skull and occiput on midline will often show significant findings in the

sacrum and coccygeal vertebrae, and vice versa. Patterns that show significant temporal bone asynchrony will also often have significant pelvic/ilial restrictions on the same side, and can be addressed structurally and with cranial sacral techniques. Osteopathy can have a profoundly positive effect on back pain caused by immobilities in a horse’s spine and related areas. It’s a modality to consider next time you are presented with a equine patient that has been diagnosed with kissing spines.

IVC Summer 2022

needtoknow

VETERINARY SEDATIVE INVOLVED

IN OPIOID OVERDOSE DEATH For decades, xylazine has been used in veterinary medicine as a tranquilizer, sedative, analgesic and muscle relaxant, mostly in large animals such as horses, but also occasionally in dogs and cats. More recently, however, the medication is being used for a much more sinister purpose.

MEDICATION BEING USED AS STREET DRUG Although xylazine is a non-opioid, drug traffickers and dealers in the US are combining it with fentanyl, cocaine, benzodiazepines, heroin and other street drugs to enhance their psychoactive effects and boost the length of the high experienced by users. Tragically, the result is an increasing number of opioid overdose deaths, according to a study recently published in the journal Drug and Alcohol Dependence. The rise in mortality is significant — from 0.36% of deaths in 2015 to 6.7% in 2020, in ten jurisdictions around the country. Philadelphia is a hotspot for the use of xylazine-enhanced drugs — known on the streets as “tranq” — accounting for 25.8% of deaths, followed by Maryland (19.3%) and Connecticut (10.2%). And these percentages may be an undercount, since many jurisdictions do not routinely look for xylazine in overdose deaths.

XYLAZINE HAZARDOUS TO HUMANS Xylazine was first created in the 1960s but was not approved for use in humans due to dangerous side effects such as sedation, slow heart rate and low blood pressure. Dr. Christy

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Corp-Minamiji of the Veterinary Information Network explains that different animal species respond differently to xylazine depending on their body weight. “If I give a 1,500-pound cow the same amount of xylazine I would use for standing sedation in a 1,500-pound horse, the cow will fall over and likely have severe respiratory suppression,” she explains. “For humans, that threshold is even lower than for a cow – almost none.” This means xylazine can increase the chances of a fatal overdose in humans when combined with other drugs like fentanyl, because it might exacerbate the respiratory depression caused by opioids. To make things worse, naloxone, a drug used to reverse opioid overdoses, is ineffective against xylazine. https://news.vin.com