V13I2 (Spring 2023) by Redstone Media Group

Innovative VETERINARY CARE

VOLUME 13 ISSUE 2

HOW NUTRITIONAL THERAPY HELPS TREAT CANINE SKIN DISEASE A BALANCED DIET, INCLUDING SUPPLEMENTATION WITH ESSENTIAL NUTRIENTS, CAN BE AN EFFECTIVE WAY TO TREAT SKIN DISEASES IN DOGS. — P. 28

CAN CATS BENEFIT FROM REHABILITATION?

WHY USE AN INTEGRATIVE APPROACH TO CCLD?

SPRING 2023

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Once used mostly for dogs, rehabilitation techniques such as massage and hydrotherapy are also bringing good results for cats. — P. 32

Adding alternative therapies such as acupuncture, laser therapy and stem cell therapy to the treatment plan for a dog with CCLD can increase your chances of success. —P. 16

REGULATING THE EQUINE IMMUNE SYSTEM WITH ADAPTOGENS

NUTRINOURISHMENT — FOR PATIENTS WITH“DRY EYE”

Adaptogens are a class of herbs that can modulate the horse’s response to stress, and help support immunity. — P. 36

CONSIDER ESSENTIAL OILS FOR SKIN DISORDERS

Skin problems in pets can be hard to treat, and medications may have unwanted side effects. Used properly, essential oils are a valuable alternative. — P. 18

How “nutrinourishment” and other modalities can aid in treating keratoconjunctivitis, a common eye problem affecting many dogs and cats. — P. 24

CHRONIC URINARY TRACT INFLAMMATION RESPONDS TO TCVM

Traditional Chinese Veterinary Medicine can be more successful than conventional medicine when chronic urinary tract inflammation in small animals becomes chronic. — P. 42

SPRING 2023

EDITORIAL DEPARTMENT

Editor-in-Chief: Dana Cox Managing Editor: Ann Brightman Associate Editor IVC: Omer Rashid, DVM Senior Content Editor: Ashley Tonkens Graphic Design Lead: Ethan Vorstenbosch Graphic Designer: Joy Sunga

COLUMNISTS & CONTRIBUTING WRITERS

Susan Albright, DVM Kelly Diehl, DVM, MS W. Jean Dodds, DVM Denise Elizabeth Hall, DVM, CVA, MDIV Melissa Kellagher, AHVMA Director of Operations Cynthia Lankenau, DVM Jared Mitchell, DVM, CVMA, CVA, CVFT Lorena Lloret Nadal, DVM, MSTCVM Miraida Rivera-Viera, DVM Terri Rosado, DVM, CTCVMP, CCRT Marlene Siegel, DVM

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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© 2023. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: April 2023.

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

IVC Spring 2023

contents FEATURES

MEDICINE FOR 8 BIOREGULATORY BLADDER CANCER IN DOGS By Marlene Siegel, DVM

Bioregulatory medicine, a modality that factors in everything from lifestyle to biology, is showing promise as an alternative treatment for bladder cancer in canine patients.

OPTIONS FOR 24 INTEGRATIVE KERATOCONJUNCTIVITIS IN PETS

By Denise Elizabeth Hall, DVM, CVA, MDIV An integrative approach to managing KSC or “dry eye” in animal patients includes “nutrinourishment” as well as other modalities such as TCM and laser treatment.

APPROACH TO AIHA NOOK 12 INTEGRATIVE 28 NUTRITION IN DOGS NUTRITIONAL THERAPY FOR CANINE SKIN DISEASES By W. Jean Dodds, DVM

How dietary changes, Chinese herbs, and other alternative therapies can help treat dogs with autoimmune hemolytic anemia.

OPTIONS FOR CCLD IN DOGS 16 NON-SURGICAL By Miraida Rivera-Viera, DVM

Adding alternative therapies — such as acupuncture, laser therapy and stem cell therapy — to the treatment plan for a dog with CCLD increases the chances of recovery.

OILS FOR PET SKIN 18 ESSENTIAL DISORDERS

By Jared Mitchell, DVM, CVMA, CVA, CVFT

32 4

IVC Spring 2023

Skin disorders in pets can be difficult to treat. Conventional medications give rapid relief but may have negative side effects. Essential oils are an amazing and effective alternative.

By Terri Rosado, DVM, CTCVMP, CCRT A balanced diet, as well as supplementation with a variety of essential nutrients, is crucial when it comes to treating canine skin diseases.

32 FELINE REHABILITATION By Kelly Diehl, DVM, MS

Cats getting massages? Kitties on underwater treadmills? Rehabilitation for feline patients takes off.

FOR IMMUNE 36 ADAPTOGENS FUNCTION MODULATION IN HORSES By Cynthia Lankenau, DVM Among other things, adaptogenic herbs can modulate the horse’s response to stress and help regulate the immune system.

TCVM FOR CHRONIC URINARY TRACT INFLAMMATION 42 USING IN SMALL ANIMALS By Lorena Lloret Nadal, DVM, MSTCVM While conventional medicine can quickly treat the signs of chronic urinary tract inflammation, TCVM is more effective when the condition becomes chronic and recurrent.

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

COLUMNS & DEPARTMENTS

7 Editorial

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.

23 From the AHVMA 27 Industry innovations 35 From the VMAA

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.

41 From the VBMA 46 In the news

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

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

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

IVC Spring 2023

contributors 1

1. KELLY DIEHL, DVM, MS

6. LORENA LLORET NADAL, LV, MS, CTCVMP, CVBM

2. W. JEAN DODDS, DVM

7. MIRAIDA RIVERA-VIERA, DVM

Kelly Diehl received her DVM from the University of Tennessee and started her career in an emergency clinic in New Jersey. She completed an internship at the Animal Medical Center in NYC, then completed a residency in small animal medicine at Colorado State University. Dr. Diehl joined the staff of the Veterinary Referral Center of Colorado as co-owner of the internal medicine section. After 14 years, Dr. Diehl left private practice to pursue a career in medical communication and joined Morris Animal Foundation in 2013. Dr. Diehl is a board-certified small animal internal medicine specialist with an interest in gastroenterology and immunology. p.32

Dr. Jean Dodds received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she established Hemopet, the first non-profit national blood bank program for animals. Dr. Dodds has been a member of many committees on hematology, animal models of human disease and veterinary medicine. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1994. p.12

3. DENISE ELIZABETH HALL, DVM, CVA, MDIV

Dr. Hall has a multi-vocational career, first based in professional veterinary medicine, then enriched by a career in professional ministry. She received her Doctorate in Veterinary Medicine from Tuskegee University College of Veterinary Medicine in 1988. Through Wellness Mobile Veterinary Clinics, she applies “wholistic integrative alchemic energy” veterinary medical modalities. As Global Emissary Ambassador Veterinarian for Green Pastures AgriVillages Ashrams, Dr. Hall also consults worldwide for a One Health approach to “small-scale, hemp-based, self-reliant sustainable communities”. p.24

4. CYNTHIA LANKENAU, DVM

Dr. Cynthia Lankenau received her DVM from Cornell University in 1981, and started studying alternative modalities in 1991. She is certified with the IVAS, AVCA and AHV, and in Chinese Herbal Medicine through the Chi Institute and CIVT. Her western herbal certification is through CIVT's Graduate Western Herbal program and David Winston's professional and graduate level course. She completed her MS(TCVM) at Chi Institute, and is a registered herbalist through the American Herbal Guild. Dr. Lankenau is Past President of the VBMA, a board member of ACVBM and NY CAVMA, and owns a private integrative mixed practice. p.36

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

Dr. Jared Mitchell graduated from Mississippi State University’s College of Veterinary Medicine in 2004, and owns Mitchell Animal Clinic in Mobile, Alabama. He has advanced training in essential oils through the VMAA and has published articles for several peer-reviewed journals. Dr. Mitchell is certified in veterinary acupuncture and veterinary food therapy through Chi University, and is enrolled in their Masters of TCVM program. p.18

IVC Spring 2023

Dr. Lorena Lloret Nadal obtained her Degree in Veterinary Medicine from the University of Murcia, Spain, in 2002. She subsequently obtained certificates in veterinary acupuncture (ABVA and Chi Institute), Chinese herbal medicine, food therapy, Tui-Na, and chiropractic. Dr. Lorena is the founding member and director of the Chi Institute of Europe, and teaches vets about TCVM in eight European countries. She has published numerous articles and papers and co-authored books about TCVM. Dr. Lorena is on the Board of Directors of WATCVM. Currently living in Ireland, she runs the Integrative Veterinary Medicine service at www.vetspecialists.ie. p.42

Dr. Miraida Rivera-Viera is the owner of PetLives Consulting LLC in Atlanta, GA, offering veterinary relief services and holistic consults at home. She received her Doctorate in Veterinary Medicine from St. George’s University in Grenada, WI, with clinical training at Cornell University. Her first job at an integrative practice in Brooklyn, NY set her mentality as an integrative veterinarian. Dr. Rivera strives to educate herself in multiple alternative modalities to offer the best medicine to her patients. Her strong passion for holistic veterinary medicine led her to pursue studies in veterinary acupuncture at the Chi Institute in Florida. p.16

8. TERRI ROSADO, DVM, CTCVMP, CCRT

Dr. Terri Rosado graduated from University of California, Davis School of Veterinary Medicine in 2005, then completed a rotating small animal internship at University of Florida College of Veterinary Medicine in 2006. She is a certified Traditional Chinese Veterinary Medicine Practitioner (CTCVMP, Chi University) and certified canine rehabilitation therapist (CCRT, Canine Rehabilitation Institute), practicing integrative medicine since 2010. Dr. Rosado is currently the Medical Director of Chi Animal Hospital and an assistant professor at Chi University. p.28

9. MARLENE SIEGEL, DVM

Dr. Marlene Siegel is an international speaker and innovator in integrative veterinary medicine. Her practice, Pasco Veterinary Medical Center, offers the widest array of alternative therapies and detoxification services in the country. She developed her own raw pet food and supplements company, EvoLoveRaw.com. Passionate about education, Dr. Siegel has online integrative veterinary medicine programs for pet parents and veterinarians. She is launching S’Paws Family Wellness, detox centers for pets and their parents. p.8

editorial

integarapptirvoeach

Taking an

to skin problems

One common skin issue in dogs is atopic dermatitis, a chronic inflammatory condition that can cause itchiness, redness, and flakiness. I remember a five-year-old Labrador Retriever named Max who came to my veterinary clinic years ago with a severe case of atopic dermatitis. He had been suffering from the condition for several years, and his owners had tried various treatments, including steroid medications, without much success. I decided to use an integrative approach to treat Max’s condition. The first step was to identify the underlying cause of his atopic dermatitis, which was likely a combination of genetic predisposition, environmental factors, and dietary allergies. I prescribed a combination of oral and topical medications to control Max's inflammation and relieve his itching. These included corticosteroids, antihistamines, and Omega3 fatty acid supplements. In addition, I recommended a hypoallergenic diet that was free from common allergens. Over the course of several weeks, Max's condition gradually improved. His itching decreased, and his skin became less red and inflamed. His owners were thrilled with the results and were quite grateful. While the treatment I gave this dog worked well, I’m sure additional complementary therapies could have enhanced it. For example, acupuncture can help reduce inflammation and improve circulation, and herbal remedies such as chamomile and calendula possess anti-inflammatory and soothing properties for the skin. Taking an integrative approach to any health condition in our patients is always fruitful. By combining different

treatment modalities, and tailoring our approach to each individual case, we can help our furry friends recover more quickly and completely. The theme for this issue of IVC Journal is dermatology, and our contributors share valuable insights on topics related to skin health. Dr. Terri Rosado provides valuable information on nutritional therapy for skin diseases in canines, while Dr. Jared Mitchell discusses the use of essential oils for skin issues. On other topics, Dr. Denise Elizabeth discusses an integrative approach to treating keratoconjunctivitis (dry eye) in dogs, while Dr. Kelly Diehl shares her expertise on feline rehabilitation. For a TCVM approach to chronic urinary tract inflammation, be sure to read Dr. Lorena Nadal’s article. And don’t miss Dr. Miraida Rivera’s advice on the management of cranial cruciate ligament disease. We also have Dr. Marlene Siegel discussing an integrative approach to bladder neoplasia in dogs, and Dr. Jean Dodds provides an overview of autoimmune hemolytic anemia in canines. I hope the articles in this issue will inspire you in the treatment of your own animal patients. By sharing our knowledge and skills, we can provide the best possible care for our four-legged friends. Sincerely,

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

IVC Spring 2023

The BIOREGULATORY MEDICINE

approach to

Bioregulatory medicine, an integrative modality that factors in everything from lifestyle to biology, is showing promise as an alternative treatment for bladder cancer in canine patients.

BLADDER CANCER

in dogs

BY MARLENE SIEGEL, DVM

Veterinarians worldwide are seeing a tremendous rise in all forms of cancer, including bladder cancers. While bladder cancer itself is still relatively rare, representing an estimated 1% to 2% of all canine cancers, its incidence does appear to be increasing, affecting more than 50,000 dogs every year. This article reviews what the conventional approach to treatment offers, and also presents safe and effective “alternatives” to chemo and radiation.

BREEDS AT RISK FOR TCC Data reveals certain breeds have a much higher chance of developing TCC than others, but no one has studied the role of epigenetics or the impact that a grass fed/finished, balanced, species-appropriate diet may have on lowering the risk of developing TCC. Scottish Terriers have an 18- to 20-fold higher risk of TCC than other dogs, as noted by investigators at the Purdue University School of Veterinary Medicine. The Shetland Sheepdog, Beagle, West Highland White Terrier, American Eskimo Dog, Keeshond, and Wire-haired Fox Terrier are three to five times more likely to develop TCC than other breeds.

TYPES OF BLADDER CANCER

Other species identified as high risk include the Australian Cattle Dog, Australian Shepherd, Bichon Frise, Border Collie, Lhasa Apso, Parson Russell Terrier, Rat Terrier, and Russell Terrier.

CAUSES OF TCC

Transitional cell carcinoma (TCC) is the most common bladder cancer in dogs, representing 90% to 95% of all bladder tumors. Also called invasive urothelial carcinoma, it is similar to invasive bladder cancer in humans. Because TCC arises from the transitional epithelial cells that line the bladder, it can invade any part of the urinary system (kidneys, ureters, prostate, or urethra). If it invades the urethra or ureters, it can obstruct urine flow. In dogs, this tumor invades the deeper layers of the bladder wall, including the muscle layers, requiring full thickness surgical excision. Unlike people, who often develop low grade bladder tumors, dogs often develop the higher grade invasive form of bladder cancer that can grow more quickly and spread throughout the body.

Leiomyosarcoma is another bladder cancer found in dogs. It arises from the smooth muscle tissue found in the bladder wall.

Rhabdomyosarcoma is a very rare, malignant, metastasizing urinary bladder tumor seen in both dogs and cats.

IVC Spring 2023

An allopathic perspective Though the “data” make it look as if some dogs have a genetic predisposition to the disease, genetics actually account for fewer than 5% of cancer causes. Meanwhile, epigenetics (lifestyle factors) may have up to a 90% influence on whether or not the cancer actually expresses itself. However, out of all the literature I looked through, only one from Purdue implicated toxins (herbicides and pesticides sprayed on lawns) as a possible contributor to the disease. No one mentioned diet or epigenetic factors, or discussed the root cause of the disease. High exposure to toxins (in diet, water, environment), stress, electromagnetic frequencies (EMF), and obesity are known to increase the risk of developing bladder cancer. Cigarette smoking is considered the number one cause of bladder cancer in humans. Dogs living in homes where owners smoke may be at increased risk of developing bladder cancer.

A bioregulatory perspective All cancers are caused by a deficiency of essential nutrients, an increased level of toxicity that the body is unable to deal with, or a combination of both, along with mitochondrial dysfunction.

TRADITIONAL THERAPIES FOR TCC

1. 1.

Full thickness surgical intervention may be considered if the mass has not metastasized beyond the bladder and is located away from the trigone (several vital structures in the neck of the bladder will prevent surgical excision of tumors in this location). Chemotherapy or radiation are chosen if surgery is not an option. Common chemotherapeutic agents for TCC include Doxorubicin, Mitoxantrone and Vinblastine. These are often given in combination with nonsteroidal anti-inflammatories that are thought to have some anti-TCC activity.

4. 5. 4.

Heal a leaky gut using herbs, homeopathics, and humic/ fulvic products.

Support a healthy microbiome. This may require a fecal matter transplant as well as supplementation with organic fermented foods.

6. 6.

Detoxify all six organs of elimination. It is critical to ensure these elimination pathways are operational before starting cancer therapies, as otherwise the patient will likely become sicker! Particularly important are the liver (all three phases of liver detoxification) and the lymphatics (movement and drainage).

Clear trapped emotions associated with the “dis-ease”. If you’re not familiar with this concept, work with an experienced practitioner. All dis-ease involves trapped emotions!

BIOREGULATORY PRINCIPLES FOR HEALING •

Shift the patient into a parasympathetic state. This is the only state in which the body can detoxify and heal. I find a variety of frequency therapies highly effective. The frequencies produced must be in the Pica Tesla ranges (very low and in harmony with the body’s natural frequencies). Various frequencies have other beneficial effects on circulation, detoxification, cellular health and more.

•

Reduce/control inflammation. Galectin-3 is the body’s master alarm protein. Small amounts live intracellularly, supporting cell development, growth and communication. Galectin-3 directs cells to respond to threats and injuries. When activated by pathogens, stress, injury, illness, or even

The list of potentially harmful side effects to these medications would be an entire article by itself. The side effects of radiation on the bladder, when given in traditional doses, can lead to complications such as a scarred, shrunken bladder, and damage to surrounding organs. Additionally, these traditional therapies are palliative, not curative! Using these modalities, survival time is considered six to 12 months.

THE BIOREGULATORY APPROACH TO TREATMENT The bioregulatory approach to treating bladder cancer is rooted in prevention, supporting the innate intelligence of the body, and identifying the root cause when disease is present.

Foundation steps

Stop polluting the body! Evaluate food, water, environmental toxins, and EMF. Avoid processed foods and nonorganic ingredients, as well as tap water, or water stored in plastic. Switch the dog to a species-appropriate, organic, grass fed/finished, balanced raw diet. Use highly filtered structured water.

Supply all essential nutrients (amino acids, vitamins, minerals, and fatty acids) in a biologically available form. Essential nutrients are those that must be obtained from the diet.

If the dog is faced with health challenges, give high doses of pancreatic enzymes with meals, and between meals on an empty stomach.

SYMPTOMS of TCC Signs may at first be similar to a urinary tract infection, with blood in the urine and some degree of straining to urinate. Owners may mistake the straining as a sign of constipation. Other symptoms may include frequent urination, incontinence, licking at the genitals, ADR (“ain’t doing right”) or inappetence. Differential diagnoses include bladder infection, bladder inflammation, bladder stones and bladder cancer. As symptoms progress, the dog may exhibit vomiting, weight loss, abdominal pain, or increased anxiety. Less commonly, dogs with TCC can show lameness if the tumor spreads into the bones, or exercise intolerance if it has spread into the lungs. Less commonly seen is a paraneoplastic syndrome called hypertrophic osteopathy.

IVC Spring 2023

normal aging processes, it unleashes a cascade of biochemical inflammatory signals and chain reactions that result in inflammation and fibrosis (uncontrolled scar tissue build-up), severely damaging organs and tissues. This chain reaction reaches down to the cellular level, fueling cancer, cardiovascular disease, arthritis, immune suppression, and sepsis. Galectin-3 is called “The Guardian of the Tumor Microenvironment” because it promotes tumor growth, protects cancer cells from the immune system, and helps cancer cells metastasize. Worse, too much circulating Galectin-3 can block proper healing, making it harder to manage or recover from disease. I use a specific modified citrus pectin that blocks Galectin-3, lowering inflammation and making the cancer tissue visible to the immune system. •

Turn on the body’s ability to make more glutathione (the primary antioxidant, and an anti-inflammatory). Ozone therapy accomplishes both these functions. It can be administered with IV or insufflated into the bladder or rectum. Intermittent fasting is another hormetic stress that can help increase glutathione production.

DETECTION& DIAGNOSTICS

•

Consider that animals (and people) are light beings. The body is designed to biochemically work best when exposed to the visible light spectrum. Photodynamic therapy (PDT) uses photoactivate compounds administered intravenously, followed by intravenous laser therapy using the colors of the rainbow (ultraviolet, blue, green, yellow, red and infrared) to make the products more enzymatically active. PDT with high-dose vitamin C, curcumin, and mistletoe is highly effective against many types of cancer.

•

Improve energy (ATP) production and detoxification. Full spectrum (with low EMF) infrared therapy for at least 30 minutes daily has a profound effect on the mitochondria (increasing the citric acid cycle and ATP production). It also releases nitric oxide, which is important in vasodilation and is a redox signaling molecule.

•

Improve oxygen utilization in tissue. Hyperbaric oxygen therapy (HBOT) helps increase oxygen perfusion into the tissues and improves detoxification. Soft side chambers have made this modality safe and cost effective. For optimal results, daily dives are recommended.

•

Utilize the natural anti-cancer pathways the body already has in place. Pathways in the body recognize and kill cancer cells. The cytochrome P450 enzymes, including cytochrome P450 1B1 (CYP1B1), can activate specific photonutrients and trigger apoptosis in abnormal cells. Natural compounds such as salvestrols (found in several fruit skins or plant roots) and B17 (found in many foods such as apricot seeds, mung beans, and cassava) are activated and metabolized into products that selectively kill cancer cells. These products trigger cancer cell apoptosis, leaving normal cells unharmed.

•

Use anti-angiogenesis therapy. Angiogenesis is the formation of new blood vessels, which when occurring near cancer cells provide them with oxygen and nutrients. This allows the cancer cells to multiply, invade nearby tissue, and spread to other areas of the body (metastasize). Anti-angiogenic therapy may prevent the growth of cancer by blocking new blood vessels from forming, ultimately starving the cancer cells. Angiogenesis inhibitor therapy may stabilize the tumor and prevent it from growing further, or reduce the size of the tumor. By starving the cancer cells, they become more vulnerable and easier to kill. More than a dozen products with anti-angiogenic properties are available in the US. I use a nanoparticle indocyanine green (ICG) that can be photoactived (PDT) with infrared light, given intravenously, for enhanced efficacy.

•

Provide nutraceuticals that support normal biological function. This category is huge but I will share some

At-risk dogs may benefit from screening every four to six months, starting as early as six years of age, especially if they have had frequent UTIs. Screening includes x-rays, ultrasound, urinalysis, and cancer screening tests. VDI Labs has a cancer screening panel that looks for cancer markers and inflammation markers (TK1 for cancer and cCRP for inflammation in dogs; haptoglobin for inflammation in cats). At minimum, a good diagnostic workup would include a complete blood count, serum chemistries, urinalysis and urine culture, and TK1 along with cCRP/haptoglobin. In addition, an abdominal ultrasound complete with three-view abdominal x-rays should be performed. Other possibilities include a CT scan, and for definitive answers, a biopsy or aspiration of the mass. Chest x-rays may be ordered to determine whether the cancer has metastasized. CADET® BRAF is a urine test that evaluates free catch urine samples from dogs for the presence of cells containing a mutation for canine bladder/prostate cancer (TCC/ UC). This test may have merit for monitoring the b-raf mutation during the course of treatment (for therapeutic response), and relapses. The manufacturer claims the assays identify 95% of TCC/UC cases. Its ability to detect as few as ten mutation-bearing cells in a urine sample allows early diagnosis of a developing CC/UC, often several months before any advanced clinical signs become evident.

IVC Spring 2023

of my top picks: homotoxicology, herbs (Chinese and Western), thymus extract, black seed oil, mushrooms, low dose naltrexone, and CBD. •

Utilize hormetic stressors to facilitate repair and regeneration of healthy tissue. Hormetic stressors are short bursts of biological stress that improve the body’s ability to repair and adapt. Strategies include intermittent fasting, high intensity exercise, and extreme temperature exposures (cryotherapy or hyperthermia).

NO THERAPY SHOULD BE WORSE THAN THE DISEASE Allopathic medicine has many great attributes. We were well trained to identify symptoms, to “name it and blame it”, and find a pharmaceutical, chemo, radiation, or surgical fix. However, based on the extraordinary rise of all degenerative diseases in pets, it is painfully apparent that these solutions are not working. Standard allopathic therapies not only fail, but the side effects are often worse than the disease itself! We can no longer approach disease as an isolated symptom. The canine, feline, or human body is a complex biological network of interconnected components (molecules, cells, tissues, organs). Bioregulatory medicine is an integrative approach that takes into consideration everything from lifestyle to biology and provides the foundation for health and longevity in all species. To learn more about this approach, visit www.drmarlenesiegel.com.

REFERENCES https://pubmed.ncbi.nlm.nih.gov/16550168/ https://pubmed.ncbi.nlm.nih.gov/24936033/ www.ncbi.nlm.nih.gov/pmc/articles/PMC5600638/ www.ncbi.nlm.nih.gov/pmc/articles/PMC7378786/ www.vet.purdue.edu/pcop/Miles/docs/ CanineUrinaryBladderCancer.pdf Dhawan D, Ramos-Vara JA, Naughton JF, Cheng L, Low PS, Rothenbuhler R, Leamon CP, Parker N, Klein PJ, Vlahov IR, Reddy JA, Koch M, Murphy L, Fourez LM, Stewart JC, Knapp DW. Targeting folate receptors to treat invasive urinary bladder cancer. Cancer Res 2013;73:875-84. Higuchi T, Burcham GN, Childress MO, Rohleder JJ, Bonney PL, Ramos-Vara JA, Knapp DW. Characterization and treatment of transitional cell carcinoma of the abdominal wall in dogs: 24 cases (1985-2010). J Am Vet Med Assoc. 2013; 15;242:499-506. McMillan SK, Boria P, Moore GE, Widmer WR, Bonney PL, Knapp DW. Antitumor effects of deracoxib treatment in 26 dogs with transitional cell carcinoma of the urinary bladder. J Amer Vet Med Assoc 2011;239:1084-9. Dhawan D, Ramos-Vara JA, Stewart JC, Zheng R, Knapp DW. Canine invasive transitional cell carcinoma cell lines: in vitro tools to complement animal model of invasive urinary bladder cancer. Urolog Oncol 2009; 27:284-292. Raghavan M, Knapp DW, Bonney PL, Dawson MH, Glickman LT. Evaluation of the effect of dietary vegetable consumption on reducing risk of transitional cell carcinoma of the urinary bladder in Scottish Terriers. J Am Vet Med Assoc 2005;22:94-100. Raghavan M, Knapp DW, Dawson MH, Bonney PL, Glickman LT. Topical spot-on flea and tick products and the risk of transitional cell carcinoma of the urinary bladder in Scottish Terrier dogs. J Am Vet Med Assoc 2004;225:389-94. Glickman LT, Raghavan M, Knapp DW, Bonney PL, Dawson MH. Herbicide exposure and the risk of transitional cell carcinoma of the urinary bladder in Scottish Terrier dogs. J Am Vet Med Assoc 2004;1290-1297. Knapp DW, Glickman NW, DeNicola DB, Bonney PL, Lin TL, Glickman LT. Naturally-occurring canine transitional cell carcinoma of the urinary bladder, a relevant model of human invasive bladder cancer. Invited submission to Urol Oncol 2000;5:47-59. Knapp DW, Richardson RC, Chan TCK, Bottoms GD, Widmer WR, DeNicola DB, Teclaw R, and Bonney PL. Piroxicam therapy in 34 dogs with transitional cell carcinoma of the urinary bladder. J Vet Intern Med 1994;8:273-278.

An integrative approach to autoimmune hemolytic anemia (AIHA) in dogs

HOW DIETARY CHANGES, CHINESE HERBS, AND OTHER ALTERNATIVE THERAPIES CAN HELP TREAT DOGS WITH AIHA.

BY W. JEAN DODDS, DVM

Autoimmune hemolytic anemia (AIHA) has been causing significant morbidity and mortality in both humans and animals for at least five decades.1-3 More accurately termed immune-mediated hemolytic anemia (IMHA), this disease is relatively common in dogs.1,2 Excessive or rapid red blood cell (RBC) destruction occurs and is usually due to extravascular causes outside the bloodstream. Intravascular hemolysis from RBC destruction within the blood vessels is less common, but can also occur.3 While conventional treatments can successfully treat and manage AIHA in dogs, an integrative approach that includes both Western and Chinese medicine therapies can be helpful.

DIAGNOSIS CAN BE COMPLICATED The clinical hallmarks of AIHA are pale mucous membranes from anemia, jaundice, abdominal distention from an enlarged liver and spleen, rapid breathing, cold lower extremities, and sudden collapse.2-5 Confirming the diagnosis can be complicated and controversial.3,4 Testing should reveal the following: • A uto-agglutination of RBCs in the syringe during blood

collection, or in the test tube and a microscopic slide of the blood smear • P resence of rounded RBCs (spherocytes) • U sually, a positive direct Coomb’s test (direct antiglobulin test,

DAT).3 A positive DAT signals immune-mediated destruction of RBCs by immunoglobulin G (IgG) and immunoglobulin M (IgM), which binds to the RBC surface.3 Interestingly, a deficiency of regulatory T-lymphocytes does not explain the development of AIHA.5

PREDISPOSING CAUSES The predisposing factors contributing to AIHA/IMHA in dogs are summarized below: • I ncreasing frequency in last two decades • S ex predilection: twice as common in females • B reed type predisposition (see sidebar on page 14) • Genetic influences associated with 3-5 Major Histocompatibility Complex (MHC Class II) genes

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• Hormonal changes: sex, thyroid, adrenal, pancreatic and parathyroid hormones • E xposures to vaccines; certain drugs (sulfonamides,anticonvulsants); heartworm, flea and tick preventives; allium species (onions, too much garlic); certain houseplants and trees; carpet cleaners, flame retardants • Underlying diseases: hemangiosarcoma, other cancers, malignant histiosarcoma, leukemia • Dietary allergies (rare hypersensitivities) and intolerances (more common sensitivities).

CONVENTIONAL TREATMENT Conventional therapy for AIHA/IMHA depends on a cocktail of immune suppressant drugs and medical management to resolve or control any documented or suspected triggering causes/ events.1,4,6,7 Many veterinarians, including this author, have successfully managed and treated pet patients with severe AIHA/ IMHA by using drugs such as corticosteroids, azathioprine, cyclosporine, thyroxine, and novel therapies like extracorporeal plasma exchange.1,4 Blood transfusions with fresh, true universal donor canine packed RBCs (blood type DEA-4), white blood cells, and platelets, as needed, are given when the patient’s hematocrit (packed cell volume, PCT) falls below 14% to 15%.1,4 Transfusion should not be given until this low level is reached, as it will “turn off” the body’s own stimulus to make more blood cells. Each case is unique, however, and may be refractory to initial or long term conventional therapy. Serious side effects from these drugs can arise, along with complications such as peripheral and systemic thrombosis (blood clots), pulmonary embolism, and organ failure, especially of the bone marrow, liver, spleen, adrenals, and kidneys. Patients that have been splenectomized are at particularly high risk.1,3,4

ALTERNATIVE THERAPIES FOR AIHA Alternative remedies and therapies as well as dietary changes have been used successfully in an increasing number of human and companion animal patients.5-9 If conventional therapies don’t

work, these alternative approaches can be employed, including those used and taught by holistic veterinarian and naturopathic physician, Dr. Steve Marsden.6,7 Dr. Marsden describes a step-wise approach to therapy that includes:

1. A different perspective: Alternative paradigms to the conventional therapies described above actually predate immune research, and have been shown to successfully treat immunemediated conditions. The mechanisms involved apparently help control chronic inflammation and immune sensitization. C hronic tissue inflammation results from the cumulative effects of dietary overconsumption and obesity (where the pet is at least 30% overweight), a syndrome referred to by Dr. Marsden as “inflammation dysregulation”.

2. H erbal treatment: A successful acute-acting, anti-inflammatory formula for the treatment of inflammation dysregulation includes Four Marvels Combination (Si Miao San), very commonly used in veterinary Chinese herbal medicine (Table 1). Table 1: Four Marvels Combination (Si Miao San) ingredients7 Atractylodes lancea rhizome (Cang Zhu)

Coix lacryma-jobi seed (Yi Yi Ren)

Achyranthes bidentata root (Huai Niu Xi)

Phellodendron amurense bark (Huang Bai)

3. D ietary treatment: Dietary therapy is the cornerstone for treating inflammation dysregulation or Damp Heat when viewed from both Eastern and Western perspectives. Chinese medicine tenets state that real food diets are more slowly transported, thereby giving the spleen more time to completely transform them into pure “fundamental substances”, which means Dampness does not form. Similarly, an unprocessed diet has been shown to be more advantageous to the body based on biomedical research findings. Processed diets are known to contribute to cardiometabolic disease by mechanisms such as a faster rate of absorption, causing a more rapid rise in insulin levels and more

rapid inhibition of AMP-activated protein kinase, leading ultimately to insulin resistance, obesity, and inflammation.6,7 F reeze-drying foods appears to create a tolerable level of processing, and avoids mechanisms that connect metabolism and inflammation. Home-cooked or commercially available real food and raw diets seem to be more anti-inflammatory than freeze-dried diets. However, Chinese medicine views raw diets as too cold for an overly stressed immune system, which may explain why some elderly animals refuse to eat them. While raw diets are well tolerated by most carnivores, some individual animals do not tolerate them. Perhaps the composition of their microbiomes plays a part.

4. T he microbiome’s role: For several thousand years, Chinese medicine has acknowledged that pathogens invade the body from outside to cause disease — unless the body is successfully defended by its Upright Qi, the umbrella of all Qi types that help protect the body against pathogens. It includes our “defensive Qi”, “nutritive Qi”, and “kidney essence”.7 Kidney essence is the essential foundation underlying the entirety of life, including growth, development, reproduction, aging, and all other functions. The composition and function of the gut microbiome in

people and animals is influenced and controlled by optimizing the expression of genes that benefit and sustain health, while suppressing genes that lead to disease.8,9 As stated earlier, it is also regulated by epigenomic factors, including dietary ingredients, beyond the genes themselves.8 A healthy microbiome protects people and animals throughout life, as it defends against germs, breaks down food to release energy, and produces vitamins. It is present before birth, impacts maternal-offspring health outcomes, maintains the gut-brain axis, and interacts with the immune system.9

5. B rain-gut-skin axis: All types of stress aggravate dysbiosis, the process whereby the normal biosis of the body is disrupted. Dysbiosis impairs bowel wall integrity, which can then lead to T-cell-mediated hypersensitivity.7 Restoring this

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function, or re-biosis, is necessary to optimize gut and skin functions, brain health and memory.9 I n Chinese medicine, dysbiosis is treated with Minor Bupleurum combination (Table 2). Bupleurum has been shown to reduce depression and anxiety in animal models of repetitive stress. Ginseng is an adaptogenic herb that can normalize and optimize adrenal gland output of cortisol to match the body’s needs. And Scutellaria spp have a long history of use in treating anxiety and other CNS and mood disorders.7 Table 2: Minor Bupleurum Combination (Xiao Chai Hu Tang) ingredients7 Buplerum Chinese root (Chai Hu)

Jujube (Ziziphus jujuba) (Do Zoo)

Pinellia ternata rhizome (Ban Xia)

Panax ginseng root (Ren Shen)

Ginger (Zingiber officiinale) rhizome (Sheng Jiang)

Scutellaria baicalensis root (Huang Qin)

6. M icrocirculation: Microcirculation is a blood deficiency and stasis model. Aberrant microcirculation patterns were elucidated in modern medicine just 30 years ago, and are now recognized as playing a central role in disease pathogenesis. Chinese medicine understood this function long ago, with its reliance on pulse diagnosis to guide acupuncture treatments, massage, and the prescription of body movement in the treatment of disease. Over 1,700 review articles cited in the PubMed database describe how disturbed microcirculation lies at the core of degenerative, neoplastic, and inflammatory pathologies.

BREED PREDISPOSITION TO AIHA Genetic predisposition to AIHA/IMHA is documented most often in the American Cocker Spaniel, but is also seen in the Scottish Terrier, Vizsla, Shetland Sheepdog, Old English Sheepdog, Irish Setter, German Shepherd Dog, Miniature and Standard Poodle, and Miniature and Standard Dachshund, especially the long-haired variety. However, the disease can occur in any breed type, as well as mixed and hybrid breeds.1

BACKGROUNDER ON AUTOIMMUNE DISEASES SUCH AS AIHA

A vital function of the immune system is its ability to distinguish between self and non-self antigens. This provides the body with both specific and broad defenses against invading microorganisms. When this self-tolerance fails, it leads to “autoimmunity” or immunity against self, and is due to the body’s immune-mediated reaction to self-antigens.1

Susceptibility to this pathological disorder has an underlying genetic basis in humans and animals, but it requires one or more viruses, bacteria, chemicals, toxins or drugs to act as triggering environmental agents.1-4 This mechanism is regulated by a variety of epigenetic factors that modify gene expression and operate by a process of molecular mimicry and/or non-specific inflammation, and is most often mediated by T cells or their dysfunction.5,6,8 Unlike genetic changes, epigenetic changes are reversible and do not change DNA sequences, but modify them to regulate whether genes are turned on or off.8 The resultant autoimmune diseases reflect the sum of the genetic and environmental factors involved. As discussed in this author’s review, “perhaps the biggest challenge in the future will be the search for the environmental events that trigger self-reactivity.”1

I n Chinese medicine, the liver controls microcirculation and acts as a storehouse of blood to serve and distribute peripheral circulatory needs. A recent excellent review of liver functions, including its detoxifying properties, was published by holistic veterinarian Dr. Ihor Basko.10

When treating dogs with AIHA/IMHA, it’s worth considering the alternative modalities outlined in this article, especially if the patient isn’t responding well to conventional therapy, or is experiencing side effects or complications.

he liver functions by coursing and draining the Qi, which is T the motive force of the blood. Table 3 lists a widely used Chinese herbal formula for tonifying and moving the blood.

1Dodds WJ. Immune-mediated diseases of the blood. Adv Vet Sci Comp Med 1983, 27; 163-196. 2Gershwin LJ. Current and newly emerging autoimmune diseases. Vet Clin Small Anim 2018, 48; 323–338. doi.org/10.1016/j.cvsm.2017.10.010. 3Giger U, Idalan N, Caviezel L, Raj K. Controversies and updates on immunodiagnostics of IMHA in

dogs. Proc of ACVIM Forum, 2021. www.vin.com Table 3: Four Materials Combination (Si Wu Tang) ingredients7 Rehmannia glutinosa root (Shu Di Huang)

White peony (Paeonia lactiflora) root (Bai Shao)

Angelica sinensis root (Dang Gui)

Ligusticum chuanxiong root (Chuan Xiong)

Ginger (Zingiber officiinale) rhizome (Sheng Jiang)

Scutellaria baicalensis root (Huang Qin)

When Qi is not flowing, a thin, wiry vasoconstricted pulse is noted. If the vasoconstriction persists and congestion becomes physically visible or consequential, the patient is experiencing blood stasis.

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4 ACVIM consensus statement on the treatment of immune-mediated hemolytic anemia. J Vet Intern

Med 2019, 33; 1141.

5Swann JW, Woods K, Wu Y, Glanemann B, Garden OA. Characterisation of the immunophenotype

of dogs with primary immune-mediated haemolytic anaemia. PLoS ONE 2016, 11(12); e0168296. doi:10.1371/journal.pone.0168296 6Marsden S, Dodds WJ. Scientific report. Chinese herbal medicine in autoimmune disease: case

reports and speculated mechanism of action. J Am Hol Vet Med Assoc 2015, 33: 31-37.

7Marsden S. Perspective. Advances in treating immune-mediated disease: old systems yield new

approaches. J Am Holist Vet Med Assoc 2022, 68:22–30. doi.org/10.56641/BEYD2448.

8 Dodds WJ. Scientific Reports: Epigenetics. Programming for health and longevity. J Am Hol Vet Med Assoc 2014, 37;16-22. 9 Dodds WJ. How your dog or cat’s gut microbiome affects overall health. Animal Wellness Magazine

2022, 24(4); 10-12.

10Basko I. Supporting liver function and detoxification in canine patients. IVC Journal 2020, June 12;8 pp

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Non-surgical option looks promising for treating cataracts in dogs Cataracts in dogs occur for a variety of reasons, and can affect canines of every age. Breaking the news to a client that their beloved pet is losing his sight because of cataracts is never easy, partially because treatment options are so limited. Surgery, the “go-to” treatment, is not always practical or affordable for clients. In the last few years, though, another treatment option — Lanosterol, a naturally-occurring molecule — has shown promise. A 2015 study published in Nature found that in both in vitro and cell-transfection tests, treatment with lanosterol dramatically reduced protein aggregates. It was also demonstrated that lanosterol therapy could lessen cataract severity in dogs and dissected rabbit cataractous lenses in vitro by increasing transparency.1

HOW LANOSTEROL WORKS Mammals naturally produce lanosterol, a molecule that prevents the aligned crystallin proteins in the eye (which allow light to pass through to the retina) from deforming and aggregating

into cloudy cataracts. Unfortunately, lanosterol is an insoluble molecule and could only be delivered to the aqueous environment of the eye via injection. Recently, though, one company has found a way to make lanosterol soluble, so it can be delivered to the lens via an easy-to-administer topical solution.

thoroughly tested and proven to be effective in resolving cataracts in pets. LumenPro is also affordable and easy to apply, making it a practical solution for clients who are looking for an alternative to surgery for their dogs.

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https://vets.lumenpro.com/veterinary-study IVC Spring 2023

Non-surgical Options for

Cranial Cruciate Ligament Disease in BY MIRAIDA RIVERA-VIERA, DVM

Adding alternative modalities — such as acupuncture, laser therapy and stem cell therapy — to the treatment plan for a dog with CCLD increases the chances of recovery. Cranial cruciate ligament disease (CCLD) in dogs is a common and debilitating problem, and surgery alone may not be the answer. This article explores how an integrative approach that includes alternative therapies, ranging from acupuncture to stem cell therapy, can help dogs with CCLD regain their mobility.

UNDERSTANDING CCLD The cranial cruciate ligament is a fibrous band of tissue that restricts excessive movement between the femur and tibia, the two main bones of the knee. This ligament’s primary job is to stabilize the joint. Cranial cruciate ligament (CCL) injury is one of the most common causes of pelvic limb lameness in dogs. Even though research has greatly progressed over the past years, the local and systemic mechanisms leading to ligament degeneration and structural failure remain largely unknown.1 The initial view of traumatic ligament rupture, fostered by “wear and tear”, has been replaced by a new concept of systemic processes linked to progressive degenerative joint disease and ligament failure; thus the term “cranial cruciate ligament disease” was coined and is generally accepted.1 In cranial cruciate ligament disease (CCLD), primary osteoarthritis (OA) is a key feature.

are not limited to, physical therapy, acupuncture, chiropractic care, low level laser therapy, and stem cell therapy, among others. Managing pain and inflammation in these patients should be the first step. A multimodal approach works best. Many of the modalities mentioned above can be combined and a patientspecific plan developed. Most traditional pain relief drugs (i.e. NSAIDS, steroids, gabapentin, etc.) have numerous side effects; combining them with alternative therapies may mean the patient needs fewer of these drugs to address pain and inflammation.

ACUPUNCTURE AND CHIROPRACTIC CARE Both acupuncture and chiropractic help restore balance in the body. •

Acupuncture stimulates the nerves and muscles, helping to boost the body’s response to pain and improve blood circulation.

•

Chiropractic can also increases nerve and blood flow to the joints. Regular chiropractic adjustments help reduce pain, restore alignment of the pelvis, and maintain symmetrical loading in the hind end. When dogs injure one knee, they tend to shift their weight to the opposite side, which can lead to rotation of the lumbar spine and pelvis. This can cause back pain and asymmetrical loading of the knees. By improving alignment, we can ease discomfort and reduce the extra wear and tear on an already unhealthy arthritic knee.

MULTIMODAL APPROACH TO CCLD The progression of secondary OA can be slowed by jointstabilizing surgery; however, the primary underlying osteoarthritic disease process continues and, in most cases, prevents a full return to integrity.1 Many nonsurgical options can be implemented to help the patient with CCLD. These include, but

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PHYSICAL THERAPY AND LOW LEVEL LASER THERAPY •

Photobiomodulation (PBM) induced by laser therapy involves the application of electromagnetic radiation in

the near infrared spectrum, and is aimed at stimulating healing or analgesia within the target tissue. Currently, laser therapy is being advocated for a variety of conditions, including musculoskeletal pain, osteoarthritis, joint pain and inflammation, neuropathic pain, otitis, dermatitis, chronic or non-healing wounds and ulcers.4 •

Physical therapy can be a tremendous help to the patient with CCLD. Some of the objectives of physical therapy protocols are pain management, periarticular and core muscle strengthening, and correction of proprioceptive deficits. The goal is to limit prolonged disuse of the limb in order to avoid negative effects such as muscle and cartilage atrophy, reduced joint motility, and loss of strength in tendons and ligaments.

STEM CELL THERAPY Intra-articular injection of mesenchymal stem cells for the treatment of CCLD in dogs has demonstrated great clinical benefits. This therapy offers systemic and anti-inflammatory potential by decreasing CD8 lymphocytes c-reactive protein (CRP) and inflammatory cytokines in serum and synovial fluid.3

DIET AND WEIGHT MANAGEMENT A significant number of patients that experience CCLD are at an unhealthy weight and in a state of inflammation. Managing

Risk Factors for Risk factors include body weight, spay/neuter status, breed, physical activity level and age. Obesity poses a health risk for any patient, but studies show it can quadruple the risk of cranial cruciate ligament rupture (CCLR).1 Early neutering (less than 12 months of age) is a risk factor for developing an increased tibial plateau angle and, in general, increases the risk for CCLR by 5% in males and 8% in females.1 Breed-related risk is generally linked to heavy body conformation and large breed dogs (e.g. Boxer, Labrador Retriever, Rottweiler, St. Bernard). Being sedentary with inconsistent or absent daily exercise/activity is detrimental for patients suffering from OA. Reports state that the risk of CCLR in agility dogs is decreased in animals that engage in regular core strengthening exercises, and that compete more frequently, at higher levels, and in more athletically challenging venues.2 I am not stating that to avoid CCLD, all dogs at risk should do agility, but a consistent, frequent, low-impact exercise routine is needed to keep joints healthy.

Natural Pain Control and Anti-Inflammatories • Daily supplementation of Omega 3s and joint supplements (chondroitin, glucosamine, green lipped mussels, colostrum) will help fight inflammation and aid in cell repair. • Palmitoylethanolamide (PEA) is an endogenous fatty acid amide that binds to cells in the body to reduce pain and inflammation. Research has indicated PEA may be beneficial for OA and many other conditions in pets. • Natural herbs can also be very beneficial at controlling pain over the long term in these patients. DGP (Dog Gone Pain) is an excellent product composed of Boswellia extract, marine collagen extract, wheatgrass, etc. • CBD oil products can also help with inflammation and pain. It is always advisable for clients to consult with a veterinarian before using any of these products. the patient’s weight by offering a species-appropriate diet will help decrease inflammation overall. A raw or gently cooked diet is ideal. These diets can either be home prepared with the guidance of a veterinarian, or store bought. Not all store bought raw foods are recommended, so it is important that clients seek the guidance of a veterinarian who is well educated in raw feeding. •

Bone broth can also be added to the diet on a daily basis. Bone broth contains natural collagen that aids in bone and cartilage support. It can be easily made at home.

•

Golden paste is another great super food made by mixing turmeric, coconut oil and black pepper. It offers nutritional support for bone health, joint strength, and flexibility.

Many multiple alternative modalities and natural treatments are available for the CCLD patient. Helping these dogs heal and regain quality of life can be achieved by implementing a multimodal approach.

N iebauer GW, Restucci B. Etiopathogenesis of Canine Cruciate Ligament Disease: A Scoping Review. Animals (Basel). 2023 Jan 4;13(2):187. doi: 10.3390/ani13020187.

Sellon DC, Marcellin-Little DJ. Risk factors for cranial cruciate ligament rupture in dogs participating in canine agility. BMC Veterinary Research. 2022; 18: 39. Published online 2022 Jan 15. doi: 10.1186/s12917-02203146-2.

Dias IE et al. Clinical application of mesenchymal stem cells therapy in musculoskeletal injuries in dogs—a review of the scientific literature. Open Vet Journal.2021 Apr-Jun;11(2):188-202.doi: 10.5455/OVJ.2021.v11. i2.2. Epub 2021 Apr 12.

Wardlaw JL, et al. Laser Therapy for Incision Healing in 9 Dogs. Front Vet Sci.2019 Jan 29;5:349.doi: 10.3389/ fvets.2018.00349. eCollection 2018.

IVC Spring 2023

Essential oils for pet skin disorders BY DR. JARED MITCHELL, DVM, CVMA, CVA, CVFT

Skin disorders in pets can be complicated and difficult to treat. Conventional medications provide rapid relief but may have negative side effects. Essential oils are an amazing and effective alternative.

As most veterinarians in clinical practice can attest, skin conditions are among the most common presenting complaints. From simple itching to severe infection, the clinical appearance of skin problems can run the gambit when it comes to the spectrum of presentation and severity. Another consensus among veterinarians revolves around the complex nature of dermatological conditions and the difficulty in treating them. In most instances, an integrative approach is often warranted. Essential oils can play an integral part in the treatment protocol, and are the focus of this article.

REVIEW OF THE SKIN There is an old saying that the eyes are the mirrors of the soul. In veterinary medicine, however, the skin can be a mirror of a pet’s overall health. As the largest organ of the body, the skin may be influenced by other pathological processes occurring within the body. When evaluating the skin, therefore, it is important to look at the pet as a whole and include environmental and dietary discussions with the owner. The skin is composed of three major layers: the epidermis, dermis, and subcutaneous layer.1

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1. T he epidermis is the outermost layer of the skin. It is composed of numerous cell types and provides protection from the environment as well as foreign substances.2 2. T he dermis is the next layer. It supports and nourishes the epidermis as well as other components of the skin, such as hair follicles, sweat and oil glands, and claws. This layer is rich with blood vessels that supply nutrients for the skin as well as regulate skin and body temperature. Sensory nerves are located in the dermis and hair follicles. 3. T he subcutaneous layer is the innermost layer of the skin. Subcutaneous fat and muscles are located within this layer. It has many functions, including as an insulator; a reservoir for fluids, electrolytes, and energy; and a shock absorber.2

COMMON SKIN DISORDERS With the skin being the largest organ of the body, and reflecting disorders associated with other organ systems, it goes without saying that many pathological processes can affect the skin.3 Before formulating a treatment plan, therefore, it

is critical to determine the cause of the pathology. This can sometimes be challenging when dealing with dermatological conditions. Diagnostic options can be as simple as a physical exam and skin scraping, or as in-depth as allergy testing, biopsies, and referrals to specialists. The sidebar on page 18 outlines some of the common diagnostic options available. While there are many options for treating symptoms, getting to the root cause is critical for the successful management of dermatological disorders. • P ruritis and alopecia: Pruritis is defined as itching or scratching at the skin. More specifically, it can be an unpleasant sensation that provokes a desire to scratch.4,5 A lopecia, on the other hand, is a loss or lack of hair. It can occur in any amount or distribution on the body, even culminating in complete baldness. While alopecia can be a primary disorder (i.e. caused by genetic conditions), it is most commonly a secondary occurrence resulting from other conditions affecting the body.5 • A topic dermatitis: Allergies can be very frustrating for owners and veterinarians, since so many factors can influence a pet’s susceptibility. Environmental allergens, genetic predisposition, and a weakened immune system response are just a few. The Merck Veterinary Manual defines atopic dermatitis as “a condition characterized by chronic pruritis and a typical distribution of skin lesions. It is generally associated with IgE antibodies to environmental allergens to which susceptible animals are genetically predisposed to become sensitized.”6,7 • E ctoparasites: Fleas and ticks comprise the major group of ectoparasites. They can cause severe inflammation and irritation, leading to alopecia and pruritis with secondary skin infections. Fleas and ticks not only affect the skin, but can also transmit diseases to the pet and have the potential to cause zoonotic disease in humans. • M ange: Sarcoptic mange (Sarcoptes scabiei) is a highly contagious disease of dogs. While generally host specific, infection of other animals as well as zoonotic spread to humans can occur. Primary lesions consist of papulocrustous eruptions with thick, yellow crusts, excoriation, erythema, and alopecia. Secondary bacterial and yeast infections may develop.8 D emodex mange (Demodex canis) is the non-contagious form. In small numbers, these mites are considered part of the normal skin flora. However, large numbers of mites cause demodex mange. Immunosuppression, whether

natural or iatrogenic, can precipitate the disease in some cases. Secondary bacterial deep folliculitis, furunculosis, or cellulitis may occur, leading to a guarded prognosis.8 • B acterial and fungal skin infections: Veterinarians have seen an increase in skin infections over the last several years. While there is often an underlying cause, such as allergies, which can weaken the overall immune system, these infections can be challenging to treat. Antimicrobial resistance and concurrent multi-organism infections are at the forefront of the battle.9

ESSENTIAL OILS AND THE SKIN Topical application is one of the easiest and most effective methods for applying essential oils. This is especially true for conditions affecting the skin, where direct treatment at the site of the lesion is important. Essential oils can be applied neat or diluted with a carrier oil. Other than with certain emergency situations, it is always best to follow proper dilution and safety guidelines. Topical applications can be subdivided into specific techniques, including direct topical application; petting along the body; rubbing oils on the tips of the ears; applying them to the pads and feet; and adding them to shampoos and ointments.10 Of these, direct application to a lesion, petting along the body, and oils added to shampoos and ointments are most commonly used. The effects essential oils have on the skin and its disorders can be numerous. The benefits of adding an essential oil regimen to skin care dates back thousands of years and can be both preventative and curative. The ancient Egyptians recognized this and were among the first to include essential oils in their daily lives.11 Following are some of the benefits essential oils offer to the skin:

1. Nourishing and protecting the skin Essential oils have been used for many years in the cosmetic and perfumery industries. They are well known for their ability to help nourish and protect the skin from the results of aging and UV exposure. Research is now underway to further develop the use of essential oils in products designed for UV protection.12 Essential oils are also being studied for their powerful antioxidant abilities. Antioxidants help with scavenging the free radicals and other pathophysiological components that can lead to inflammation and cellular damage.13 IVC Spring 2023

2. Alleviating pruritis Pruritis (itching) is a very common symptom with most skin disorders seen in veterinary medicine. It’s often what pet owners notice first, and is honestly what concerns them the most. Essential oils, studied alone and in combination with polyunsaturated fatty acids (PUFAs), have shown great success in improving pruritus in dogs with canine atopic dermatitis (CAD).14,15

3. Easing inflammation A great number of essential oils are known for their antiinflammatory properties. A large number of these have been researched over the years, with some better known than others. The inflammatory cascade produced within the body is a very complex response. Essential oils, with their large number of constituents and synergistic properties, can produce anti-inflammatory effects through varying mechanisms. One such mechanism is the inhibition of degranulation and the expression of cytokines and other inflammatory mediators.16

4. Offering antimicrobial properties Over the years, the overuse of antibiotics and other antimicrobial medications has created multi-drug-resistant organisms. This creates an urgent problem for the future of healthcare, both human and veterinary, as conventional treatments can be limited at best. But essential oils can provide a viable alternative in the fight against resistant organisms. Essential oils and their constituents have been studied in great detail for their antimicrobial properties. While most essential oils possess some degree of antimicrobial action, it should be noted that of all the commercially available oils (approximately 250 at this time), only about a dozen possess high antimicrobial potential.17 In fungal pathogens, essential oils establish a membrane potential across cell walls and disrupt ATP assembly, leading to cell wall damage. Essential oils can also disintegrate mitochondrial membranes interfering with the electron transport system (ETS) pathway. When it comes to bacterial pathogens, essential oils primarily destabilize the cellular architecture, leading to the breakdown of membrane integrity and disrupting many cellular activities, including energy production and membrane transport. Membrane rupture induced by essential oils can lead to the leakage of cellular components and loss of ions.18

5. Healing wounds Wound healing is a very complex mechanism, involving the collaborative functions of multiple body responses working

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Diagnostic options for skin disorders • • • •

External parasite examination

• • • • • •

Fungal culture/DTM

• • •

Skin scraping Skin cytology acterial skin culture and B sensitivity Trichogram Skin biopsy Allergy testing Thyroid blood panel yperadrenocorticism H (Cushing’s) testing pecialized hormonal, mineral, S and toxic exposure testing Specialized genetic testing on’t forget the basics: CBC D and chemistry panel

together to rebuild and repair the injury. In one study, essential oils containing the constituents of thymol and carvacrol were able to modulate the release production of reactive species, such as nitric oxide; pro-inflammatory cytokines such as TNF-α and IL-1β; and growth factors such as TGF-1β involved in the initial stages of the healing process. Carvacrol and thymol have been shown to stimulate re-epithelialization, angiogenesis, formation of granulation tissue and deposition of collagen fibers.19

6. Helping to control external parasites External parasites can be vectors for spreading diseases to humans and animals. Many pharmaceutical products on the market have a proven success rate at treating these unwanted visitors. However, these products are not without their side effects. The proper use of essential oils can help control external parasites.20,21

A SAMPLING OF ESSENTIAL OILS USED IN SKIN DISORDERS A wide variety of essential oils can benefit the skin. It is important to remember that each patient is an individual and may prefer or respond better to one oil or blend over another. For the best results, always use the purest and most therapeutic essential oils, and the proper technique for the species being treated. LAVENDER (Lavandula angustifolia) Lavender is one of the most well-known essential oils. Its popularity has also made it one of the most adulterated. It is important for the veterinarian or client to make sure they are using a pure grade Lavender oil when working with animals. Known as the “Swiss Army Knife” of essential oils, Lavender oil can provide calming and anti-anxiety properties as well as being anti-infective and displaying wound healing abilities. Topical application of Lavender oil has been shown to promote collagen synthesis and differentiation of fibroblasts, accompanied by up-regulation of TGF-β. These data suggest that Lavender oil has the potential to promote wound healing in the early stages by accelerating the formation of granulation tissue, remodeling tissue by collagen replacement, and by wound contraction through up-regulation of TGF-β.22 FRANKINCENSE (Boswellia carterii) Most veterinary aromatherapists consider Frankincense one of the must-have oils. It is safe, well tolerated, and very versatile in treating a number of conditions. Frankincense is

probably best known for its use in the treatment of various forms of cancer, but its other benefits are endless due to its amazing properties. It has anti-inflammatory actions, antiinfective properties, aids in tissue healing, and is immunostimulating, and antitumoral.23 Frankincense is a more expensive oil, since the growing and harvesting process is very time and labor intensive. A cheaper version, while appealing, is usually of poor quality or adulterated and should not be used. COPAIBA (Copaifera officinalis) Copaiba can have wonderful anti-inflammatory effects on the skin. Its main chemical constituent is β-caryophyllene, a sesquiterpene hydrocarbon with powerful anti-inflammatory effects. It acts much like an NSAID by blocking the oxidation of 5-lipoxygenace, a major player in the inflammatory cascade, thus reducing pain and inflammation.24 HELICHRYSUM (Helichrysum italicum) This is an amazing essential oil. Reported medical properties include antioxidant and antispasmodic properties. It may also chelate chemicals and toxins, and help with neurologic issues by regenerating nerves. For disorders of the skin, Helichrysum has been reported to help prevent or lessen bruising, aid with tissue healing, and help stop bleeding.25 GERANIUM (Pelargonium graveolens) Geranium essential oil is well known for its positive effects on the skin. It has been used for centuries to help regenerate and heal the skin. It is now being studied alone and in combination with other essential oils for its antioxidant effect and SPF properties.26 Geranium is also noted to be very useful in treating fungal infections such as ringworm.27

MARJORAM (Origanum majorana) Marjoram was known as the “herb of happiness” by the ancient Romans, and “joy of the mountains” by the Greeks. It is best known for its wonderful musclesoothing properties, that help relieve muscle and joint discomfort. When it comes to skin conditions, it has anti-fungal properties and is very helpful when treating ringworm.28 OREGANO (Origanum vulgare) Oregano is considered a “hot” oil and should be used very carefully.29 Proper dilution and careful monitoring of the skin is a must. Within the current research, Oregano has many uses and has been shown to be very effective for a variety of cancers, as well as for eliminating internal parasites, and reducing stomatitis. Research on Oregano and its benefits for skin conditions include its ability to inhibit numerous strains of antibiotic-resistant bacteria (e.g. MRSA).29,30

Two important tips When we consider the treatment of skin disorders, especially from a conventional standpoint, we often think of topical applications and shampoos. We sometimes find ourselves falling into the same thought process when it comes to essential oils. While it is true that skin disorders benefit from direct topical applications, it is important to remember that all forms of essential oil application can be beneficial. Diffusing essential oils should not be overlooked.

Another helpful suggestion is to focus on the entire pet as a whole. In other words, treat the primary medical condition to provide immediate relief, but do not forget that skin conditions usually have underlying causes. Every effort should be made to isolate and confirm the inciting cause. Essential oils can be used for this as well; for example, an oil blend could be used to help directly treat the skin conditions, while another blend could be used to treat any behavioral or anxiety issues that may be contributing to the skin conditions.

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SUMMARY Skin disorders can be very complicated and create frustration among pet owners and veterinarians alike. It is crucial that you work with the client to get to the underlying cause of the disorder. While conventional medications have been shown to help, they can have unwanted side effects. Essential oils provide a wonderful alternative.

1Al-Bagdadi F. The Integument. Chapter 3. Miller’s Anatomy of the Dog, 3rd ed. W.B. Saunders

Company. Philadelphia, Pennsylvania. 1993. 98-121.

2Moriello K. Structure of the Skin in Dogs. www.merckvetmanual.com. Last review/revision Jun 2018 | Modified Oct 2022. Last accessed 2/24/2023. 3Montagna, William. The Skin. Scientific American 212 (2). 1965. 56–69. www.jstor.org/

stable/24931778.

4Bensignor E, Marignac G, Crosaz O, Cavana P. Pruritus in dogs. Vet Dermatol. 2013;24(2):292.

doi:10.1111/vde.12005.

5Lorenz M. Chapter 15: Pruritus. Small Animal Medical Diagnosis, 2nd ed. Lippincott Williams

and Wilkins. Philadelphia. 1993. 105-110.

6Diaz S. Canine Atopic Dermatitis. www.merckvetmanual.com. Last review/revision August

2020 | Modified Oct 2022. Last accessed 2/24/2023.

7Nuttall TJ, Marsella R, Rosenbaum MR, Gonzales AJ, Fadok VA. Update on pathogenesis,

diagnosis, and treatment of atopic dermatitis in dogs. J Am Vet Med Assoc. 2019;254(11):12911300. doi:10.2460/javma.254.11.1291. 8 Dryden MW. Mange in Dogs and Cats. www.merckvetmanual.com. Last review/revision May

2015 | Modified Oct 2022. Last accessed 2/24/2023. 9 Dadgostar P. Antimicrobial resistance: implications and costs. Infection and drug resistance.

2019. 3903-3910. 10Shelton M. Topical Applications. ADR II: The Animal Desk Reference, 2 nd ed. 2018. 174-183 11Farrar AJ, Farrar FC. Clinical Aromatherapy. Nurs Clin North Am. 2020;55(4):489-504 doi:

10.1016/j.cnur.2020.06.015.

12High Throughput Preparation of UV-Protective Polymers from Essential Oil Extracts via the

Biginelli Reaction. Tengfei Mao, Guoqiang Liu, Haibo Wu, Yen Wei, Yanzi Gou, Jun Wang, and Lei TaoJournal of the American Chemical Society 2018 140 (22), 6865-6872 doi: 10.1021/ jacs.8b01576.

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

13Miguel, M.G. Antioxidant and Anti-Inflammatory Activities of Essential Oils: A Short

Review. Molecules 2010, 15, 9252-9287. https://doi.org/10.3390/molecules15129252.

14Blaskovic M, Rosenkrantz W, Neuber A, Sauter-Louis C, Mueller RS. The effect of a spot-on

formulation containing polyunsaturated fatty acids and essential oils on dogs with atopic dermatitis. Vet J. 2014;199(1):39-43. doi:10.1016/j.tvjl.2013.10.024. 15Tretter S, Mueller RS. The influence of topical unsaturated fatty acids and essential oils on

normal and atopic dogs. J Am Anim Hosp Assoc. 2011;47(4):236-240. doi:10.5326/JAAHAMS-5607. 16Yang J, Choi WS, Kim KJ, Eom CD, Park MJ. Investigation of Active Anti-Inflammatory

Constituents of Essential Oil from Pinus koraiensis (Sieb. et Zucc.) Wood in LPS-Stimulated RBL-2H3 Cells. Biomolecules. 2021;11(6):817. Published 2021 May 31. doi:10.3390/ biom11060817.

17Wińska K, Mączka W, Łyczko J, Grabarczyk M, Czubaszek A, Szumny A. Essential Oils as

Antimicrobial Agents-Myth or Real Alternative? Molecules. 2019;24(11):2130. Published 2019 Jun 5. doi:10.3390/molecules24112130.

18Tariq S, Wani S, Rasool W, et al. A comprehensive review of the antibacterial, antifungal

and antiviral potential of essential oils and their chemical constituents against drugresistant microbial pathogens. Microb Pathog. 2019;134:103580. doi:10.1016/j.micpath. 2019.103580.

19 Costa MF, Durço AO, Rabelo TK, Barreto RSS, Guimarães AG. Effects of Carvacrol, Thymol

and essential oils containing such monoterpenes on wound healing: a systematic review. J Pharm Pharmacol. 2019;71(2):141-155. doi:10.1111/jphp.13054.

20 Oliveira LM, de Almeida Chaves DS, Raquel de Jesus IL, et al. Ocimum gratissimum

essential oil and eugenol against Ctenocephalides felis felis and Rhipicephalus sanguineus: In vitro activity and residual efficacy of a eugenol-based spray formulation. Vet Parasitol. 2022;309:109771. doi:10.1016/j.vetpar.2022.109771.

21Pohlit AM, Lopes NP, Gama RA, Tadei WP, Neto VF. Patent literature on mosquito repel-

lent inventions which contain plant essential oils—a review. Planta Med. 2011;77(6):598617. doi:10.1055/s-0030-1270723.

22Mori HM, Kawanami H, Kawahata H, Aoki M. Wound healing potential of lavender oil

by acceleration of granulation and wound contraction through induction of TGF-β in a rat model. BMC Complement Altern Med. 2016;16:144. Published 2016 May 26. doi:10.1186/ s12906-016-1128-7. 23Shelton M. Frankincense. Essential Oil Singles. ADR II: The Animal Desk Reference, 2 nd ed.

2018. 256-261.

24Baylac S, Racine P. Inhibition of 5-lipoxygenase by essential oils and other natural fragrant

extracts. Int J Aromather. 2003;13:138-142.

25Schnaubelt K. Chapter 11: Essential Oils and the Skin. The Healing Intelligence of Essential

ANNUAL CONFERENCE REMINDER Save the dates for the 2023 AHVMA Annual Conference and Exhibition in San Diego, California from October 7 to 10. Expect over 100 hours of complementary and integrative CE sessions, hands-on labs, and special events. Over the past six years, AHVMA has applied for and received AAVSB RACE approval for over 80 hours of continuing education. The Conference Program Committee has been busy putting together an exciting lineup of speakers for this year’s conference. You can expect lectures on cannabis and mushrooms, homeopathy, rehabilitation, TCVM, ozone, and much more! AHVMA returns to the beautifully remodeled Town and Country Resort and Convention Center in San Diego. In 2017, when AHVMA was last in San Diego, we had our largest attendance ever! It’s the perfect place to see and connect with everyone in person.

NEW EXECUTIVE DIRECTOR The AHVMA Board is pleased to announce they have contracted Heather Vaughn, with Vaughn Management, LLC, as the new Executive Director. Heather has worked with several other groups, including state associations and other allied holistic groups. We are excited to have Heather as part of the AHVMA family and look forward to working with her. Her knowledge of organized veterinary medicine, as well as her experience with association management and conference planning, make for a hopeful future for the AHVMA.

INTERESTED IN SPEAKING AT THE 2024 CONFERENCE?

Oils. Healing Arts Press. Rochester, Vermont. 2011. 152-163.

26Lohani A, Mishra AK, Verma A. Cosmeceutical potential of geranium and calendula essential

oil: Determination of antioxidant activity and in vitro sun protection factor. J Cosmet Dermatol. 2019;18(2):550-557. doi:10.1111/jocd.12789. 27Shelton M. Geranium. Essential Oil Singles. ADR II: The Animal Desk Reference, 2 nd ed. 2018.

262-263.

28 Marjoram. Chapter 4: Single Essential Oils. Essential Oils Animal Desk Reference. Life Science

Publishing. 2017. 65.

The Conference Program Committee is still taking speaker submissions for the 2024 AHVMA Conference. For consideration, submit your proposal(s) via the online Call for Papers portal no later than November 1, 2023. Those selected will be contacted by the committee. Submitted by Melissa Kellagher, AHVMA Director of Operations

29Shelton M. Oregano. Essential Oil Singles. ADR II: The Animal Desk Reference, 2 nd ed. 2018.

300-302.

30 Kim BC, Kim H, Lee HS, et al. 4-Chloro-2-Isopropyl-5-Methylphenol Exhibits Antimi-

crobial and Adjuvant Activity against Methicillin-Resistant Staphylococcus aureus. J Microbiol Biotechnol. 2022;32(6):730-739. doi:10.4014/jmb.2203.03054.

IVC Spring 2023

Integrative options for keratoconjunctivitis (KCS) in pets BY DENISE ELIZABETH HALL, DVM, CVA, MDIV

The incidence of KCS or “dry eye” is increasing in veterinary patients. An integrative approach to managing the condition includes “nutrinourishment” as well as other modalities such as TCM and laser treatment. The condition known as “dry eye” or keratoconjunctivitis sicca (KCS) affects many of us, both human and animal. The medical terminology refers to an inflammation of the cornea and surrounding tissues, with severe desiccation, often causing a sticky mucus or exudate to accumulate near the medial canthus. This common eye condition results from an inadequate production of the aqueous tear film by the lacrimal tear gland and/or the third eyelid gland. In this article, we will explore the integrative options that can be used to treat KCS in pets.

that produce a portion of the tear film. This reduction of tear film results in decreased overall tear production. Many identify dry eye (KCS) as an inherited disorder. Other considerations include: •

Nutritional deficiency

•

Systemic distress/inflammation/infection/“dis-ease” (e.g. canine distemper), and overall “stress”.

•

Congenital disorders

•

Breed predisposition, particularly in Cocker Spaniels, Shih Tzus, Bichon Frises, Lhasa Apsos, Bulldogs, Schnauzers, and Terriers

It is normally essential for eyes to have a protective tear film, a mixture of mucus, fatty liquid, and water. Tear production must be adequate enough to lubricate the cornea and keep it healthy, supplying it with moisture, oxygen and precious nutrients. Tears also assist with removing particulate debris or possible infectious agents.

•

Pharmaceutical drugs (e.g. sulphonamides — sulfa-based drugs)

•

Endocrine abnormalities (e.g. low-functioning thyroid gland, hypothyroidism)

•

Neurological/nervous system symptomatology (e.g. inner ear malady, “neurogenic KCS”)

Dry eye results from a lack of enough moisture to protect the outer layers of the eye. When injured, the cornea can become pigmented, scarred, and ulcerated. Ultimately, if the dry eye condition is left untreated, vision loss may result.

•

Surgical “excision” of the third eyelid gland in cherry eye cases.

LACK OF MOISTURE LEADS TO KCS

ETIOLOGY OF KCS What is commonly understood as “immune-mediated” challenges to the “physical body temple” may cause damage to the tear-producing glands. Immune-mediated conditions are the most common cause of dry eye (KCS). For the most part, this condition’s pathogenesis is poorly understood. It appears the body’s own immune system attacks the cells

IVC Spring 2023

INTEGRATIVE NAVIGATION PLAN UPON SCHIRMER'S TEAR TEST CONFIRMATION

“Nutrinourishment” assessment – dietary and supplementation options Not all nutrition is nourishing. Review the patient’s daily regimen, along with any previous immune/allergic reactions such as “allergic dermatitis” (e.g. food, contact).

OBJECTIVE CLINICAL SIGNS AND SYMPTOMATOLOGY Here in Southern California, it is not uncommon for dogs and cats to show painful, red, irritated eyes. Signs of KCS include excessive tearing, rubbing, eye cloudiness, stinging/burning, staining of the haircoat, and excessive heavy mucous secretions (often dry exudate). Frequent squinting, excessive blinking, or holding the eyes shut are early signs. It is important to note that any excess hair near or around the eye, where it constantly “taps” on the cornea, may be a cause.

Novel primary proteins such as fish, lamb, duck, bison, and wild hog are suggested. Also consider whole food nutrition and supplements: •

A whole food approach is optimal, so that vitamins A, C, B-6, magnesium, and others will biochemically and synergistically collaborate toward homeostasis. Nutritional cofactors are required for all fatty acid enzymatic metabolism activity. Vitamin A nourishes healthy goblet cell/lacrimal gland mucin production for the tear film’s base layer. These nutrients are all significant in maintaining normal eye function and optimal health.

•

Black currant seed oil provides the most biologically stable source of vegetable-based Omega-6 fatty acids. It supports normal eye function by aiding in tear film production (e.g. aqueous water layer).

•

Omega-3 fatty acids from fish oil (e.g. krill) are needed. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are important fatty acids for tear film production (e.g. lipid top layer). EPA plays an important role in supporting a normal inflammatory response in the presence of noted symptoms (e.g. systemic inflammation commonly associated with dry eye).

•

Proteins such as apo-lactoferrin (ironbinding) and lactoferrin support the entire “physical body temple”, including the overall health and well-being of the animal’s eyes.

•

Curcumin naturally supports an overall healthy inflammation response when there has been disruption or malfunction of the immune system.

A thick, yellowish, mucoid discharge is often present, resulting from a decrease in the aqueous (watery) component of the tear film. It’s important to con-sider corneal ulceration. For chronic cases, obtain a thorough history where blindness, dark and scarred corneal tissue with blood vessels, and recurrent eye injuries, ulcers, or conjunctivitis may have been present over an extended period.

•

Standard Process (StandardProcess.com) offers the best whole food daily nutritional supplement for canine, feline, and equine species. It is best to avoid fractional nutrition. Whole Body Support is a daily multiple vitamin complex (Veterinary Formulas). Oculotrophin PMG is a sup-plement formulated to support eye health.

Traditional Chinese Medicine

TCM offers multiple options for KCS, such as acupuncture or acupressure. For dry eye, initial treatments may be intense — twice per day (BID) for one week. Reassessments and follow-up may be completed via TeleVetMed for Veterinary-Client-Patient-Relationship (VCPR) and

IVC Spring 2023

continuation of care. The TCM assessment is considered alongside patient compliance levels with the integrative nature of the prescribed plan. Acupoint options for owners who wish to do acupressure are BL2, ST4, LIV3 — rotate both clockwise and counterclockwise for 15 to 20 seconds, and alternate the eyes.

Home treatment applications and air purifiers

These approaches are beneficial because they’re easily accessible to the owner. A treatment may be simply applied to a pet’s eyes, while keeping the area around the eye wellgroomed and free of debris minimizes the challenges faced with KCS. As well, air purifiers are absolutely necessary in many regions, such as Southern California. Cost range is wide, yet often dictates quality. The Vollara is highly recommended for households. For a simple direct treatment, apply warm compresses to each eye for ten minutes twice per day. This may be especially necessary in very dry climates with high winds, to help with dust, allergens, and poor air quality. Establishing a client practice of checking and cleaning both eyes is also important. Home remedies have a lot of appeal with our renewed sense of “One Wellness” — realizing that the connections between humans and animals cross-pollinate into overall health and well-being for both species. In other words, when an owner is able to access a KISS-principled (aka “Keep It Super Simple”) home remedy for themselves, they may consider similar options for their animal’s health. However, it’s crucial to proceed using great caution with owners who seek health solutions without professional veterinary consultation.

•

Green tea is another option. Some practitioners have experienced great results applying it as “topical eyedrop”. The main concern with any eye product is sterility; be mindful of sterility for any option applied directly to the eye. If using a green tea extract, look for one that is alcohol-free. Begin with one drop per eye per day. Reassess in one week, then three weeks.

•

Medicinal cannabis (CBD) must be considered, systemically and immunologically. Start at 0.1 mg per pound, twice per day (BID). The entourage effect offers the entire “physical body temple” relief from inflammation, and helps it back toward homeostasis. Similarly, the immune-modulating benefits of medicinal cannabis are well-established in medical literature.

•

Other products to be considered, on an individual patient basis, include natural eye drops and organic tears.

CONCLUSION The incidence of dry eye is increasing and “remains a major challenge in ophthalmology”.3 It may be an indicator of “nutrinourishment” issues, Qi energy imbalances, poor air quality, potential allergen exposure, and other etiologies. Using an integrative approach, a thorough intake and consultation exam is warranted, based on the skill set of the practitioner. Dry eye involves management, and this is what most practitioners have come to realize. Certainly, prevention is important and “nutrinourishment” is of utmost concern. The challenge is for animal stewards to focus on label reading and provide their pets with nutrition that is actually nourishing the “physical body temple”. This is a core value for holistic and integrative care, not just for the eyes, but for overall health and well-being.

Outside of warm compresses, here are some other home remedies to consider: •

Sterile castor oil may be used as a topical at one drop per day (SID) q seven days. Reassess in one week, then again in three weeks. Monitor for long term continuation of care.

Gong L, Guan Y, Cho W, et al. A new non-human primate model of desiccating stress-induced dry eye disease. Sci Rep 12, 7957 (2022). https://doi.org/10.1038/s41598-022-12009-7.

Shinomiya K, Ueta M, Kinoshita S. A new dry eye mouse model produced by exorbital and intraorbital lacrimal gland excision. Sci Rep 8, 1483 (2018). https://doi.org/10.1038/s41598-018-19578-6.

Huang W, Tourmouzis K, Perry H, Honkanen RA, Rigas B. Animal models of dry eye disease: Useful, varied and evolving (Review). Exp Ther Med. 2021;22(6):1394. doi:10.3892/etm.2021.10830

light therapy is an innovative way to relieve dry eye symptoms. Treatments consist LASER Laser of quick pulses of light to the skin around the eyelids and face, directed at the specific TREATMENT acupuncture points mentioned in this article. It may assist in the release of oil secretion Rental devices are often available for owner use, but review the settings as each AROUND EYES buildup. one is different. MultiRadiance has multiple handheld devices. Perhaps begin with 50 Hz CAN HELP at three minutes per eye to start. Reassess in one week, then again in three.

IVC Spring 2023

industry innovations Maintain the microbiome The microbiome plays a major role in the health of our canine and feline patients. Visbiome® Vet is a high potency veterinary probiotic for pets, featuring a proprietary eight-strain probiotic blend. It supports normal inflammatory responses in the GI tract, and helps maintain gut health. It aids in reducing occasional loose stools due to environmental stress or dietary changes; supports the protective layers of the bowel and maintains proper gut flora; and helps maintain normal kidney function. Studies have shown that Visbiome® Vet demonstrates superior efficiency in normalizing and maintaining gut health. http://exegipharma.com/animal-products/

Treating cataracts in dogs — without surgery Surgery is the main treatment for cataracts in dogs, but is not always affordable for clients. Lanosterol, a naturally-occurring molecule, is another treatment option. It prevents the aligned crystallin proteins in the eye from deforming and aggregating into cloudy cataracts. A study published in Nature found that treating cataracts with lanosterol dramatically reduced protein aggregates. LumenPro Veterinary Strength™ eye drops combine lanosterol with the antioxidant N-acetylcarnosine. The company is inviting veterinarians to participate in a patient study on the product, which has been thoroughly tested. https://vets.lumenpro.com/veterinary-study

Controlling OA pain in cats Nearly 40% of cats show signs of osteoarthritis (OA) pain, yet the condition is undertreated. Solensia™ (Frunevetmab injection), the first and only FDA-approved monoclonal antibody treatment for the control of pain associated with feline OA, is now available to veterinary clinics across the US. Administered in the veterinary clinic as a single monthly injection, Solensia controls feline OA pain by targeting a protein called Nerve Growth Factor, a key driver of this pain. This innovative medication helps cats regain their quality of life by increasing their mobility and improving their overall comfort. www.SolensiaVetTeam.com

Support their cardiovascular health Keeping your canine and feline patients well and happy includes taking care of their heart health. NOW ® Pets Cardiovascular Support is veterinarian formulated and designed to support normal circulation and cardiovascular function in dogs and cats. This unique pet supplement is made with carnitine, taurine, antioxidants, and botanicals. For more flavor, the company added chicken bone broth, sourced from the US, that’s free of both growth hormones and steroids. Can be given during or after mealtime. www.nowfoods.com/products/pet-health/

IVC Spring 2023

nutrition nook

NUTRITIONAL THERAPY for canine skin diseases BY TERRI ROSADO, DVM, CTCVMP, CCRT

A balanced diet, as well as supplementation with a variety of essential nutrients, is crucial when it comes to treating canine skin diseases. Canine skin diseases are common in pet dogs and can result in significant discomfort, itching, inflammation, secondary infections, and hair loss. Proper nutrition plays an important role in maintaining healthy skin and coats in dogs, and can aid in the management of skin diseases. The skin is the largest organ of the body, and the second largest part of the immune system. It plays a crucial role in protecting against external factors such as infections and harmful substances. It also helps regulate body temperature and hydration levels. Along with genetics, age, and environmental conditions, the health of a dog’s skin and coat depends on a balanced diet and the presence of certain essential nutrients.

NUTRIENTS ESSENTIAL FOR SKIN HEALTH To maintain healthy skin, dogs need a balanced diet that provides important nutrients, including proteins, fatty acids, vitamins, and minerals. Supplementing specific nutrients beyond their normal daily requirement can be helpful in the management of some skin diseases. • P olyunsaturated fatty acids (PUFAs) are essential

fatty acids that must be provided through diet in the form of Omega-3s and Omega-6s. PUFAs help reduce inflammation, hydrate the skin, and prevent skin

IVC Spring 2023

infections by maintaining a healthy skin barrier via the epidermal lipid barrier.1 T he Omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are available in high concentration in fish oils and are immediately usable for dogs. Plant-based sources of Omega-3 fatty acids, such as flaxseed oil, contain alpha-linoleic acid (ALA) which needs to be converted to EPA and DHA for utilization. Dogs and cats do not convert ALA to EPA/DHA. The amount of ALA needed to reach therapeutic levels of EPA and DHA in the dog can cause gastrointestinal upset and lead to excessive caloric intake. B eyond a doubt, the most common skin diseases managed by general practitioners are the inflammatory skin diseases of flea allergy dermatitis, atopic dermatitis, and adverse food reactions (food allergies and food intolerances). It is generally now well accepted that supplementing Omega-3 fatty acids can help reduce inflammation and pruritus in these patients. Current dosing recommendations are found in Table 1. O mega-6 fatty acids, linoleic and arachidonic acids, are also required for skin health. However, the addition of Omega-6s beyond the recommended daily requirement for health does not appear to play a significant role in the management of skin diseases.

• Vitamins A, B complex, C, D, and E all play important

dietary deficiencies are uncommon when dogs are fed

roles in maintaining healthy skin and coat in the dog.

a properly balanced diet, hereditary zinc-responsive dermatoses, as seen in many arctic/Northern breeds,

○ Vitamin A helps maintain skin hydration, regulates

require additional zinc beyond the minimum

skin cell growth and differentiation, and plays an

recommended amounts (see Table 1).

immunomodulatory role. It may be helpful in the treatment of seborrhea in certain breeds, and was

○ Copper should not be fed in excess; however, copper

shown in a case report to play an essential role in the

deficiency can lead to dry, discolored, brittle hair and

management of a dog with severe seborrhea when

alopecia.

given in high doses.2 Severe skin disease is often a symptom of underlying internal ○ B complex vitamins, including B1, B2, B6 and B12,

organ or endocrine dysfunction, and may require significant

are important for the formation and maintenance

diet supplementation. A case report from the University of

of healthy skin cells. As with Omega-6 fatty acids,

Missouri Veterinary Health Center demonstrated significant

B-complex vitamins given in excess of the daily

skin health improvement in a dog with superficial necrolytic

requirement may not be beneficial for skin disease

dermatitis (aka metabolic epidermal necrosis, hepatocutaneous

management. However, additional B vitamin admin-

syndrome) using a nutritionally-balanced, home-prepared diet

istration is needed to maintain healthy skin when

high in quality protein, lysine, and vitamins A and D. While it

absorption is reduced.

was unclear which factors of the diet contributed to the patient’s improvement, it was clear that the diet was an essential element

○ Vitamin C is necessary for the production of collagen.

of the treatment protocol.3

Additionally, it is an antioxidant that can protect skin cells from free radical damage. ○ Vitamin E is another antioxidant essential for skin

Table 1: Common dosing guidelines for specific nutrients in select canine skin diseases

health. It plays an important role in maintaining the skin barrier. Vitamin E supplementation is often recommended in the management of autoimmune

Nutrient

skin diseases such as varieties of pemphigus, vasculitis, and lupus, as well as inflammatory skin disease caused by allergies and food intolerances.

It is important to note that vitamins A and E are fat-soluble, so supplementation beyond what’s naturally found in whole foods should be done with foods containing fats. Additionally, excess fat-soluble vitamins can be stored in body fat and cause toxicity when given chronically at very high doses. B-complex and C vitamins are water-soluble so can be given with or without food. High doses are much less likely to lead to toxicity. However, this is no evidence to suggest that very high doses of B vitamins or vitamin C are beneficial to skin health.

EPA/DHA

Vitamin E

○ Z inc is important for the growth and repair of skin tissue and the maintenance of healthy skin. While

Conditions

Comments

125mg/kg ^0.75/d PO10 50-300mg/ kg/d 1

Inflammatory skin diseases

Give with a meal

200-800 IU PO BID1

Inflammatory skin diseases

Give with a meal

Vitamin A (retinol)

625-1000 IU/ kg/d PO1

Zinc

Zn sulfate: 10mg/kg/d Zn methionine: 2mg/kg/d1

• Z inc and copper are minerals that both play impor-

tant roles in skin health and specific skin diseases.

Dose in body weight unless otherwise stated

Seborrheic dermatosis of Cocker Spaniels, Miniature Schnauzers, and Labrador Retrievers

Zincresponsive dermatoses

Give with a meal

Give without food; also give EPA/DHA; avoid excessive copper and calcium

IVC Spring 2023

Table 2: TCVM food energetic properties9 Category

Temperature

TCVM

and food energetics While it is beyond the scope of this article to discuss in detail, food energetics as practiced in Traditional Chinese Veterinary Medicine (TCVM) is worth mentioning. The proper application of this method can, in the experience of this author and other veterinarians, greatly improve skin disease and maximize skin health. In TCVM, each food has specific effects on the body that exceed its nutrient profile. These are described as the energetics of the food, and include temperature, taste, the patterns treated, and the channels/ organs affected.9 Table 2 provides examples of TCVM food therapy principles. While phrases such as “tonifying Qi” or “resolving Stagnation” sound strange to a Westerntrained veterinarian, further investigation can help one appreciate and even understand how food energetics can impact the body. As an extreme but simple example, consider the effects of eating a hot pepper. The pepper is not actually hot; however, it will cause the lips and mouth to burn, the head to become red, and the body to sweat as if exposed to thermal heat. Likewise, when we eat watermelon, we feel cooled and replenished by both its fluids and energy. Every food contains its own unique set of properties and affects the body in different ways.

IVC Spring 2023

Properties

Cold, cool, neutral, warm, hot

Examples

• Peppers are hot • Watermelon is cold

Taste

Pattern targets

Sweet, sour, bitter pungent, salty

• Kelp is salty

• Watermelon is sweet

Qi/Blood/Yin/ Yang/Jing tonics,

• Beef is a Blood and Qi tonic

drain Damp, transform Phlegm, resolve Stagnation

• Bok choy resolves Stagnation

Spleen (pancreas),

TCVM channel/ organ treated

Stomach, Heart, Small Intestine, Lung, Large Intestine, Kidney, Bladder, Gallbladder,

hicken affects • C the Spleen ranberry affects • C the Kidney

Liver, etc.

WEIGHT CONTROL CAN BE IMPORTANT Beyond a balanced diet and the additional supplementation of certain PUFAs, vitamins, and minerals, maintaining a healthy weight may be important in managing some canine skin diseases. The link between obesity and several skin conditions, including the inflammatory condition of psoriasis, has been established in people.4 It has been postulated that obesity may contribute to skin disease by increasing inflammation and altering hormonal levels in the body. The impact of obesity on skin diseases in dogs has yet to be fully explored, but weight control should be considered an important part of management until further information is available.

COMMERCIAL OR HOMEPREPARED FOOD? A discussion about the effects of nutrition on canine skin diseases should not exclude the controversies around feeding processed commercial pet foods versus home-prepared diets. When adverse food reactions are suspected, a food trial in the form of a commercial novel protein/novel carbohydrate or hydrolyzed diet is often recommended. Commerciallyprepared diets, while convenient and generally balanced with essential nutrients, come with certain challenges: 1. U nless the diet is “prescription”, most over-the-counter limited ingredient diets are contaminated with or contain ingredients not on the label, the effects of which are undetermined. 5 2. T here is little to no information available on how (and where) ingredients in commercial foods are farmed or harvested. Sensitivities to chemicals contained in or on individual ingredients within a diet could appear as an adverse food reaction. 3. M any prescription limited ingredient diets and hydrolyzed diets are extremely expensive, with a 20 lb bag of dry kibble easily exceeding $100. 4. T here are limits to the available ingredient options, many of which are now routinely added in regular maintenance diets. 5. H ydrolyzed diets can contain protein pieces large enough to still stimulate an immune response.6

The main challenges in feeding nutritionally-balanced, home-prepared diets largely relate to client compliance. Namely, ensuring proper ingredient measurement, cooking ingredients according to instructions, avoiding changes to the diet without rebalancing it, and consistent and persistent use of the correct supplements to safely balance the diet. When it comes to preventing adverse food reactions, considerable research in the human literature indicates that a varied diet early in life reduces the risks of atopy and the development of food allergies.8

CONCLUSION Canine skin disease is a common presentation in general small animal practice and can cause a significant impact on patient and client life quality. Nutrition plays a critical role in the management of skin disease by providing essential nutrients, controlling weight, and improving the skin barrier. Food therapy using Chinese medicine principles (see sidebar on page 28) can also improve skin health and reduce the risk of skin disease. By providing a balanced and nutritious diet and incorporating theories of food energetics, owners can help maintain the health and integrity of their dogs’ skin while reducing the use of medications that can be costly and have adverse effects.

1Hand MS, Thatcher CD, Remillard RL et al. Small Animal Clinical Nutrition, 5th Ed. Mark Morris

Institute, 2019.

2Ihrke PJ, Goldschmidt MH. Vitamin A-responsive dermatosis in the dog. J Am Vet Med Assoc.

1983;182(7):687-690.

3Jaffey JA, Backus RC, Sprinkle M, Ruggiero C, Ferguson SH, Shumway K. Successful Long-Term

Home-cooking, using balanced recipes, can provide solutions to many of the challenges presented with commerciallyprepared foods:

Management of Canine Superficial Necrolytic Dermatitis With Amino Acid Infusions and Nutritionally Balanced Home-Made Diet Modification. Front Vet Sci. 2020;7:28. Published 2020 Jan 31. doi:10.3389/ fvets.2020.00028 4Shipman AR, Millington GW. Obesity and the skin. Br J Dermatol. 2011;165(4):743-750. doi:10.1111/

j.1365-2133.2011.10393.x.

1. I ngredients can be tightly controlled and easily changed. 2. O rganic and/or local ingredients can be used and inspected by the client, and responsibly sourced. 3. A s long as a client has access, a huge variety of ingredient choices is available. 4. O ne study found that feeding a commercial dry diet for chronic enteropathies was less expensive than feeding a similar home-prepared diet with similar ingredients.7 But because of the wider ingredient options available, it can be less expensive to homecook than to purchase prescription foods.

5Fossati LA, Larsen JA, Villaverde C, Fascetti AJ. Determination of mammalian DNA in commercial

canine diets with uncommon and limited ingredients. Vet Med Sci. 2019;5(1):30-38. doi:10.1002/ vms3.125. 6Masuda K, Sato A, Tanaka A, Kumagai A. Hydrolyzed diets may stimulate food-reactive lymphocytes

in dogs. J Vet Med Sci. 2020;82(2):177-183. doi:10.1292/jvms.19-0222.

7Kratzer GR, Shepherd M, Delaney SJ, Winston JA, Rudinsky AJ, Parker VJ. Home-cooked diets

cost more than commercially prepared dry kibble diets for dogs with chronic enteropathies. J Am Vet Med Assoc. 2022;260(S3):S53-S60. Published 2022 Sep 27. doi:10.2460/javma.22.07.0284. 8 Baker MG, Nowak-Wegrzyn A. Food allergy prevention: current evidence. Curr Opin Clin Nutr Metab

Care. 2020;23(3):196-202. doi:10.1097/MCO.0000000000000651.

9 Fowler M, Xie H. Integrative and Traditional Chinese Veterinary Medicine Food Therapy: Small Animal

and Equine. Chi University Press, 2020.

10 Bauer JE. Therapeutic use of fish oils in companion animals. J Am Vet Med Assoc. 2011;239(11):1441-

1451. doi:10.2460/javma.239.11.1441.

IVC Spring 2023

FELINE REHABILITATION BY KELLY DIEHL, DVM, MS

Cats getting massages? Kitties on underwater treadmills? Rehabilitation for feline patients takes off. Rehabilitation for dogs has become commonplace in veterinary medicine and has demonstrable health benefits. While rehabilitation for cats has lagged behind, more rehab facilities are seeing feline patients, and the scope of treatments is widening. Knowing what’s available for feline rehabilitation is important, so practitioners can deliver the best care to their cat patients. In this review, we’ll start by taking a step back and talking about diagnosing and localizing pain in cats; move on to a detailed look at current trends in feline rehabilitation; and end with a discussion of what veterinarians and other pet healthcare professionals can expect in the future.

RECOGNIZING PAIN IN CATS CAN BE TOUGH For those of us who’ve ever tried to do an orthopedic or neurologic examination on a cat in the clinic setting, the encounter often ends with an angry cat and a frustrated veterinarian. Cats and their owners interact in different ways to dogs and their owners. Most clients don’t walk their cats, or play catch or fetch, activities that in dogs often uncover pain or altered mobility. Veterinarians also can attest to how the stress of

IVC Spring 2023

simply taking a cat for a veterinary exam can mask pain. But there are tools veterinarians can use to help diagnose pain in their feline patients. In addition to a physical and/or neurologic exam, questionnaires to assess pain in cats are available for both veterinarians and owners. The Feline Musculoskeletal Pain Screening Checklist (Feline MiPSC) was recently developed as a screening tool to evaluate cats for pain. Once a cat has been screened using this instrument, experts recommend using other questionnaires as a way to monitor efficacy, such as the Feline Musculoskeletal Pain Index (FMPI), the Client-Specific Outcome Measures (CSOM), or the Montreal Instrument for Cat Arthritis Testing (MICAT — there are two surveys, one for caretakers and one for veterinarians). Other questionnaires are also available or in development for veterinarians. Data suggests these questionnaires are helpful in objectively assessing pain in cats (especially pain associated with osteoarthritis), when used by both veterinarians and cat owners. They’re also great ways for veterinarians to engage with clients as partners in their cats’ healthcare. Although diagnosis is challenging, owners can look for clinical signs that may point to pain. Interestingly, almost all

signs of pain in cats are tied to behavior changes. The most common include: • Hesitance or avoidance of jumping • Reluctance to go up or down stairs • Using a step to get on a surface instead of jumping • Decreased interactions with owners or other animals • Increased irritability

MISPERCEPTION is biggest barrier to physiotherapy

• Isolation • Decreased food and water consumption • Resentment at being brushed, patted or touched • Greasy coat and dirty nails • E limination accidents — difficulty getting in or out of the litterbox • S udden vocalization and running away for no apparent reason • S uddenly turning to look at a region of the body for no apparent reason The bottom line for veterinarians is that in cats, unlike dogs, behavior changes are dominant when it comes to pain, especially osteoarthritis-associated discomfort. Unfortunately, some of these signs overlap with other feline diseases such as hyperthyroidism and kidney disease, so it’s important for veterinarians to regard any behavior changes as potential signs of disease, and not simply a product of aging.

PROBLEMS THAT FELINE REHABILITATION CAN ADDRESS Although developmental orthopedic diseases and injuries are less common in cats than dogs, a growing body of evidence suggests osteoarthritis is more common in cats than previously suspected — with some studies suggesting that >90% of cats have some evidence of osteoarthritis in at least one joint.1-3

Probably the biggest roadblock to a successful rehabilitation program for any cat is a misperception on the part of both owner and veterinarian that cats cannot (or will not) be willing participants. “I feel that veterinarians and cat owners often have a misperception about rehabilitation in terms of feline compliance with common rehab modalities such as hydrotherapy,” says Janine Ross, a certified canine rehabilitation practitioner, certified veterinary pain practitioner, registered veterinary technician, and owner of Four Paws Rehab and Fitness in Toronto, Canada. The good news is that Janine says she’s seeing more cats referred to her practice for rehabilitation. Dr. Uccheddu has had a similar experience. “When I came to this clinic, our veterinary physiotherapist, Dr. Laura Sinigoi, and I realized there were no cats in our physiotherapy unit,” she says. “We saw lots of cats in our orthopedic and neurology services, but they didn’t move beyond this step. I started intercepting my colleagues in the hallway and asking, ‘why is this cat not in physiotherapy?’ I was able to convince them to give it a try and they’ve been pleased with our success.”

Many conditions affecting cats can be treated with rehabilitation and physiotherapy. These include: • Osteoarthritis

• N eurologic conditions

• Post-operative therapy

• Obesity

HARNESSING NORMAL FELINE BEHAVIOR KEY TO SUCCESS Cats have short attention spans and tend to dislike restraint. Keeping rehabilitation sessions short (only a few minutes at first) is important when starting on a therapy program. IVC Spring 2023

Dr. Stefania Uccheddu, a veterinary behavior specialist at the San Marco Veterinary Clinic and Laboratory in Veggiano, Italy, illustrates this point in a story about one of the first cats they started in their physiotherapy program. The cat came out of the carrier and went back in after only a minute, at which point Dr. Uccheddu announced the session was over. “The caregiver was surprised,” she says. “However, we had good communication with this person, and eventually, the cat was using the underwater treadmill!” Cats have strong hunting and stalking instincts that can also be leveraged in rehabilitation programs. For example, Drum et al talk about the use of laser lights to get cats to move in certain directions or engage in specific movements.1

BROAD SCOPE OF MODALITIES AVAILABLE FOR CATS Many of the same techniques used by human and canine therapists can be used for cats.1-4 A brief overview of techniques follows: • M assage — A variety of massage techniques has been used successfully in cats. These include effleurage (stroking), petrissage (kneading) and tapotement (rhythmic percussion).

used in cats, although cats tend to be less tolerant of passive ROM than dogs. • L aser therapy — Typically, lasers are used to manage pain and in wound healing. They also can be used in cats but require special equipment and training to keep staff and patients safe. • T herapeutic ultrasound — This method is used for deep tissue healing. It also requires special equipment and training. • E lectrical stimulation — This technique can be used in cats but must be introduced slowly. Again, electrical stimulation requires specialized equipment and training. • U se of heat or cold — The application of both heat and cold has been used in cats. These therapies can be easily used by trained hospital staff, and also taught to cat owners. • S wimming and underwater treadmill — Yes, cats can do this! Just as with dogs, it can be a valuable tool for rehabilitation post-surgery, aid in weight loss, and as therapy for osteoarthritis. The key is to work slowly and keep sessions short until the cat adapts to it.

• R ange-of-motion (ROM) exercises, including stretching — Both passive and active exercises can be used in cats. Many of the same exercises described for dogs can be

FAST FACTS

•

any cats do well with rehabilitation M for orthopedic problems.

•

isperceptions are the biggest barM rier to rehabilitation success.

•

arnessing normal feline behavior H enhances rehabilitation.

•

broad range of therapeutic modalA ities is available to cats.

•

any canine rehabilitation facilities M also work with cats.

IVC Spring 2023

Janine Ross works with cats on an underwater treadmill.

It’s important to recognize that while many of these modalities are commonly used for feline rehabilitation, few research studies confirm the effectiveness of any single technique.

CURRENT STATE OF THE INDUSTRY There are no certified feline rehabilitation specialists, but many canine rehabilitation facilities also offer services for feline patients. If you’re considering referral, try a local canine rehabilitation service first. Some veterinary practices are also beginning to offer rehabilitation and physiotherapy services for feline patients. However, it’s important to ensure you have the proper facilities, expertise, and time to appropriately manage these patients. For most veterinarians, referral is the easiest option.

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

USING ESSENTIAL OILS FOR OPHTHALMIC ISSUES One of the first caveats taught when using essential oils is to avoid the eyes and ears. Without proper veterinary assessment, this is a good guideline; but in practice, necessity can foster integrative protocols. Essential oil use can be a viable option in select cases, such as the following:

• Walley, a six-year-old M/N Boston terrier, had his left eye enucleated in February of 2014. In June of that year, he presented with a descemetocele in the right eye. Surgery was not an option. Treatment began with the following: 1. Tobramycin drops twice a day.

Rehabilitation and physiotherapy for cats is a growing industry that shows few signs of slowing. It’s important that veterinarians recognize the potential benefits of this therapy for their feline patients.

2. Autologous serum eye drops administered every two to three hours when awake. 3. A solution of helichrysum/copaiba* diluted in a mixed carrier oil base and applied three to four times a day, waiting 15 minutes before application when coinciding with steps 1 or 2. At 54 days, there was a residual scar on the cornea and Walley’s eye was comfortable with no apparent visual impairment.

1Drum MG, Bockstahler B, Levine D. Feline Rehabilitation. Vet Clin Small Anim. 2015

Jan;45(1):185-201. doi: 10.1016/j.cvsm.2014.09.010.

2 Sharp B. Feline physiotherapy and rehabilitation 1. Principles and potential. J. Feline Med.

Surg. 2012;14:622-632. doi: 10.1177/1098612X12458209.

3Sharp B. Feline physiotherapy and rehabilitation 2. Clinical application. J. Feline Med. Surg.

2012;14:633-645. doi: 10.1177/1098612X12458210.

4 Goldberg ME. Feline physical rehabilitation. Today’s Veterinary Nurse. 2016;Nov-Dec: https://

todaysveterinarynurse.com/rehabilitation/feline-physical-rehabilitation/. Published October 11, 2016.

• Fairlight, a nine-year-old F/S English bulldog, had surgery for cherry eye with recurrent prolapse of the gland on the right side. Treatments for chronic KCS with tacrolimus, cyclosporine, and neo/poly/dex drops were not giving her relief. There was no ulcer present so one to two drops of a combination of rosemary/cypress/ frankincense and copaiba** in a carrier oil was administered bilaterally two to three times a day. The owner felt the essential oils greatly improved Fairlight’s condition.

*4 drops helichrysum + 2 drops copaiba qs 6 ml carrier oil (V-6, a proprietary blend of carrier oils from Young Living). **5 drops frankincense + 5 drops rosemary + 5 drops cypress + 4 drops copaiba + 15 ml carrier oil (olive oil, FCO, or V-6).

Resources Canine Rehabilitation Institute (many rehabilitation facilities are adding services for cats), www.caninerehabinstitute.com/Find_A_Therapist.html Four Paws Rehab and Fitness, http://fourpawsrehab.ca/category/cats-need-rehab-too/ Learn more about Dr. Uccheddu’s work, https://icatcare.org/expert-panel/stefania-uccheddu/

Walley 6-2-14

Walley 7-26-14

Fairlight

Submitted by Susan Albright, DVM IVC Spring 2023

Among other things, adaptogenic herbs can modulate the horse’s response to stress and help regulate the immune system.

Adaptogens

for Immune Function Modulation in Horses BY CYNTHIA LANKENAU, DVM

Many horses today are living with overwhelming stress: emotional, physical, and spiritual. If stress continues unabated, it leads to processes in the body that can ultimately result in immune system dysfunction. This article looks at how a category of herbs called adaptogens can help horses whose immune function has been negatively impacted by stress.

SOURCES OF STRESS IN HORSES Emotional stress in the form of confinement stabling, with minimal turnout and little to no social interaction, creates boredom and frustration, often resulting in anger and phobias. Additionally, horses often have little to no ability to graze “healthful” weeds because paddocks have become grass monocultures. Physical stress arises in the form of long periods of inactivity interspersed with intense periods of work. Then there are the ingested, injected, and topical toxins, including vaccines, pesticides, glycophosphates, herbicides, organophosphates, GMOs, and pseudo-estrogens from plastics. Owner stress can also translocate to horses, creating a form of spiritual stress to the equine.1

STRESS AND CORTISOL

biochemical, and physiological changes are referred to as the stress response. This stress response prepares the body for physical exertion by stimulating the heart, increasing blood flow to the muscles and brain, raising blood pressure, and liberating sugar stored in the liver. The body is prepared for fight or flight, and is given the energy to meet the challenge with the release of cortisol and adrenaline. If the reaction is too strong, blood pressure surges, the excess cortical creates a catabolic state with cell and muscle destruction and gastric ulcers, and increases glucose levels. If the stresses continue, the body enters a state where it resists the stress and tries to return to normal homeostasis. In this stage, the cortisol level is high, and the DHEA level drops. Ultimately, an exhaustion state is entered. Energy levels are depleted, and we find fatigue and immune system dysfunction.

ADRENAL AND IMMUNE DYSFUNCTION Adrenal dysfunction is caused by: 1. Excess or deficiency of cortisol, DEAH, ACTH, and/or 1. CRH

The common factor in any type of stress is an increase in resting cortisol levels. Stress is managed by two different physiological systems: the hypothalamic-pituitary-adrenal (HPA) axis and the sympathoadrenal-SAS system. When stress is perceived in the limbic system within the brain, the hypothalamus releases corticotrophin-releasing hormone. This stimulates the release of ACTH from the pituitary, which in turn stimulates the release of glucocorticoids from the adrenal cortex.

FIGHT OR FLIGHT AND THE STRESS RESPONSE The sympathetic nervous system stimulates the release of catecholamines — adrenaline from the adrenal gland — and the noradrenalin-fight or flight response. The induced behavioral,

IVC Spring 2023

2. Hormone imbalance 2. 3. Loss of sensitivity of the hypothalamus and pituitary to 3. the normal controlling aspects of these hormones

4. General energy depletion. 4. Our equines face several conditions caused by immune system dysfunction: •

Hypofunction — seen in cancerous conditions or postLyme neuropathies

•

Hyperfunction — seen in conditions like chronic obstructive pulmonary disease (COPD), trigeminal neuralgias, or recurrent uveitis.

HOW DO ADAPTOGENS DIFFER FROM OTHER HERBS? Adaptogens are a relatively new class of herbal medicines. Dr. Nikolai Lazarev conducted pioneering work in this field when he started researching botanical chemical compounds that could help promote health by decreasing the negative effects of acute or chronic stress. In the 1960s, Israel Brekhmann continued research into these botanicals. Adaptogens must fit three criteria:2 1. They are non-toxic even if used long term. 1. 2. They produce a nonspecific state of resistance to stress. 2. 3. 3. They create a normalizing influence on the animal’s

physiology by modulating hyper and hypo functions. Adaptogens must be shown to work by re-regulating the two master control systems in the body — the HPA axis and the SAS.

There is some overlap of herbs that are considered Chinese Qi tonics and Ayurvedic rasayana herbs, but only those that work through the HPA axis or the SAS are adaptogens. Adaptogens can modulate the horse’s response to stress and help regulate the interconnected endocrine, immune, and nervous systems; provide an anabolic effect; protect energy resources from depletion; enhance the action of cellular ATP; stimulate the mitochondria; and at a cellular level, act as strong antioxidants. Metabolically, they prevent the formation and acumination of beta-lipo-proteins, substances that block key enzymes responsible for transforming glucose. In short, they improve the capacity and sustaining power of the body to adapt to stress and minimize its effects.

ADAPTOGENIC HERBS AND THEIR QUALITIES While adaptogens can support and modulate the immune system, and enhance humoral and cellular immunity with concurrent anti-inflammatory and antiallergic activity, each herb has its own unique characteristics and energetics. This demands knowledge of each botanical medicine, knowing their specific indications so they can be used to their fullest potential. Any herb must be prescribed based on the patient’s energetic diagnosis. In general, all the herbs, except wild American Ginseng (which is endangered — see below), can be given to equines at two to three times the labelled human dose.

American Ginseng (Panax quinquefoliumm) is a truly amazing herb — but it is severely endangered in the wild. Never purchase wild-crafted American Ginseng; only purchase from a sustainably cultivated source. This herb is sweet, bitter, slightly warm or slightly cooling due to its moistening effect. It will replenish lost fluids caused from fighting chronic heat toxins such as Lyme or viral infections. Lung and Spleen meridian organs are primarily affected. The root is the part used to make medicine. It has a long history of use by Native American peoples. Interestingly, the sale of American Ginseng supported the American Revolutionary War and was the most valuable cargo to leave the NY harbor by ship. American Ginseng is very helpful for replenishing the HPA axis and the adrenal glands. It reduces elevated cortisol levels, thereby enhancing immune function and increasing resistance to bacterial and viral pathogens. It’s beneficial for allergies and COPD as well as immune deficiency conditions and metabolic syndrome. Chinese medicine classifies American Ginseng as a Yin, Spleen and Lung Qi tonic. “It exerts a decidedly beneficial influence in exhaustion of the brain from overwork, and it is probable that its influence is as much in this direction as upon the stomach,” wrote Scudder, an 18th century herbalist.

Amla fruit or Indian Gooseberry (Phyllanthus emblica, formerly Emblica officinalis) is a plant of extraordinary importance to the Indian culture. It plays a pivotal role in health and longevity, and is a great help in treating periodic ophthalmia or moon-blindness. Although this herb is not classified as an immune modulator, it is a probable adaptogen. This fruit is sour and sweet with a cool and drying energy, affecting the Heart, Liver, and Kidney. Amla is classified as a Blood and Yin tonic that stabilizes the small capillaries in the eye, helping with vision. It can protect the liver from drugs and viruses, restore the appetite and relieve nausea. Amla is indicated in any rheumatoid problem with oxidative damage to the connective tissue as it nourishes the blood in all tissues, repairing small capillary beds. IVC Spring 2023

Adaptogens

& the Immune System Immune system normalizers American

Ginseng

(Panax

quinquefolium),

Ashwagandha (Withania somnifera), Asian ginseng (Panax

ginseng),

Cordyceps

(Ophiocordyceps

sinensis, Cordyceps militaris), Holy basil (Ocimum tenuiflorum), Jiaogulan, (Gynostemma pentaphyllum), Licorice

(Glycyrrhiza

glabra),

Reishi

(Lingzhi,

Ganoderma lingzhi), Rhodiola (Rhodiola rosea) and Schisandra (Schisandra chinensis).

Immune system nourishers & stimulators Codonopsis Eleuthero

(Codonopsis

pilosula,

(Eleutherococcus

Dang Shen),

senticosus,

Siberian

Ginseng), Prince Seng (Pseudostellaria heteropylla), Rhaptonticum

(Rhapontiucm

carthamoides)

and

Shatavari (Asparagus racemosus).

Ashwagandha (Withania somnifera) root is bitter, warm, and dry. It has been used widely in India for centuries, and is reputed to give one “the strength of a stallion”. It is a rasayana herb that prolongs life, stimulates the mind, and enhances vigor, and is used for many conditions such as paralysis, coughs, impaired cognitive function, asthma, and infertility. Ashwagandha’s unique and specific use is as a calming adaptogen, and it is specific for nervous and restless exhausted horses with hypothyroid tendencies. It improves thyroid function, is a Yang tonic but also sedative, and supports sound sleep. A keynote for its use would be stalled horses that are “trashed” up from nervous restless pacing while stabled. Ashwagandha is also beneficial for hyper and hypoimmune conditions such as sarcoids, as it has antispasmodic effects in Lyme arthralgias.

Asian Ginseng (Panax ginseng, Ren Shen) root is sweet, bitter, warm, and moist. It has a very long history of use, and is a king tonic remedy. In Chinese medicine, it supplements the five Yin organs, calming the mind and pacifying the soul, both ethereal and corporeal.

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Ren Shen has many functions. It’s an immune amphoteric that normalizes immune function; reduces excessive immune response in COPD; strongly tonifies the Yuan Qi when used for extreme collapse; tonifies the Lung and augments Qi for wheezing and shortness of breath; strengthens the Spleen and tonifies the Stomach for lethargy and lack of appetite; generates fluids and stops thirst; benefits the Heart Qi and calms the anxious spirit. This is not an herb to be used in cases of acute inflammation.

Cordyceps (Ophiocordyceps sinensis, Cordyceps militaris) is a caterpillar fungus traditionally used only for the emperor or royal family in ancient China. Today it is grown on a plant protein. It is sweet, slightly acrid, warm, and moist. It affects the Kidney and Lung. This mushroom is indicated for conditions of deficient Kidney Yin or Yang when caused by chronic disease, excessive physical exertion, or autoimmune conditions. Cordyceps enhances aerobic capacity and cellular energy stores, and is the prime choice for drug-induced glomerulonephritis.

Codonopsis (Codonopsis pilosula, Dang Shen) root is sweet, moist, and slightly warm. It is a Qi tonic for weak, deficient, and tired individuals. It strengthens Stomach/Spleen Qi, enhancing appetite, improving digestion, building blood and increasing RBCs. Dang Shen is indicated for individuals that suffer from chronic coldlike symptoms, as it can build defensive energy (Wei Qi). It is one of the herbs used in Fu Zheng therapy, a branch of herbology designed to mitigate the ill effects of chemotherapy while simultaneously enhancing its benefits.

Eleuthero (Eleutherococcus senticosus) root and stembark are sweet, slightly bitter, and slightly warm. This herb is commonly called Siberian Ginseng. It strengthens the immune system, decreasing the incidence of upper respiratory infections and flu when under stress. Think of its use when new horses come into the barn. Eleuthero is the herb for athletes as it increases endurance and stamina, enhances mitochondrial activity, speeds recovery, and prevents

immune depletion from excessive training. It’s strongly indicated for stressed athletes. This herb is easily combined with other adaptogens such as Cordyceps, Rhodiola, and Schisandra for enhancing athletic performance and improving alertness and cognitive function when under severe stress.

Note: Watch for banned herbs under competition. Holy Basil (Ocimum tenuiflorum) is pungent, sweet, and warm (leaves are used). It is sacred to the Hindu god Vishnu, purifying the air where it dwells. It is a dopamine adrenergic agonist, helping to prevent pituitary degeneration as seen in Cushing’s disease. Holy basil is useful in metabolic syndromes as it helps regulate blood sugar. It improves memory and enhances cerebral circulation, treating brain fogs post Lyme disease or EPM. This herb prevents increases in corticosterone levels from stress, including noise stress; helps prevent gastric ulcers; reduces pulmonary allergies; helps remove meningeal toxins; and is indicated for head shakers, and other forms of allergic rhinitis. According to David Winston, this is one of the herbs for treating “stagnant depression”, situational depression that develops from traumatic events when the horse gets “stuck”. If your horse faces radiation therapy for a squamous cell carcinoma, Holy Basil protects the normal cells and chromosomes against radiation damage.

Jiaogulan (Gynostemma pentaphyllum) leaves are sweet and slightly bitter, with a neutral energy. It has a long folk use in the treatment of fatigue, cold prevention, and enhancing longevity. It is a calming herb with good indication for hyper horses. If your horse is traveling, it’s commonly used for jet lag and altitude sickness (with Dang Shen).

Licorice (Glycyrrhiza glabra) root has been in use since the time of Dioscorides, an ancient Greek physician. This neutral, sweet herb clears heat and dispels toxins. It minimizes the poisons from pesticides, herbicides, and pharmaceuticals,

Case examples Picasso,

an 18-year-old gelding Connemara cross, was treated for Lyme disease in 2007. In 2008, he was found to be exhausted and Yin deficient, with a dry coat and no energy. He was started on a formula with American Ginseng as its king herb. He was given 15 to 20 drops twice a day. After six weeks, Picasso had returned to a full level of performance.

Star,

a seven-year-old Arab mare, developed a chronic cough post respiratory infection, which seemed to be developing into COPD. She was treated with American Ginseng for two months, with the cough fully resolving.

Barack,

a six-year-old warm blood gelding,

Jiaogulan has recently been found to enhance immune system function in cancer patients, and to prevent reverse immunosuppression from chemo or radiation therapy. It increases endogenous superoxide dismutase. It decreases allergic reactions, and is indicated for allergic rhinitis and COPD. This herb enhances immune function, especially macrophage activity, T lymphocytes, and NK cells, and acts as a cancer inhibitor.

was

given

conventional wormer and suffered an acute reaction. He

was

diagnosed

Cornell with non-responsive acute renal failure. After two weeks of treatment, their final recommendation was to “dig a hole”. Barack made a full recovery with the use of homeopathic Nux Vomica, along with herbal nettle seed and Cordyceps. IVC Winter 2023

being very hepatoprotective, and alleviates symptoms arising from their toxicity. This herb will retain sodium, so is not to be used with any case of hypertension. Licorice can strengthen sinews and bones, Stomach and Spleen, and aids in the treatment of diarrhea, fatigue, gastric ulcers, and chronic coughs.

Prince Seng (Pseudostellaria heteropylla) root is sweet, slightly bitter, cool, and moist. It is considered the “Ginseng of the Lungs” as it strengthens the Lungs and Spleen, nourishing weak, dry, and damaged lung tissue. A wonderful addition in chronic COPD cases, it is also strongly indicated for improving the immune system of local mucus membranes, being a Fu Zheng herb.

Reishi (Lingzhi, Ganoderma lingzhi) is a sweet and bitter, neutral to warm mushroom. It strengthens all five viscera, tonifying Heart, Liver, Kidney, Lung Qi and Blood. It soothes the spirit and soul and has good specific indications for horses with emotional and spiritual stress, as it transforms phlegm so they can “see” things more clearly. Reishi is strongly hepatoprotective and is indicated for any allergic tendencies, allergic rhinitis, ocular issues, and senile heart. “It is the thing that Immortals live on,” wrote Li Zhi Shen in 1593.

Rhaponticum (Rhaponticum carthamoides) root is bitter, slightly sweet, resinous, cool, and slightly dry. It grows in southern and eastern Siberia, and was traditionally used for respiratory, liver, and kidney disease as well as fevers and sore throats. This herb has been found to enhance recuperation after illness, relieve tiredness, and promote physical and mental performance. It is also indicated for athletic stress; it improves performance, endurance, and recovery from intensive training. Rhaponticum also promotes the building of muscle tissues; enhances the excretion of uric and lactic acid; and stimulates blood flow to the muscles and brain. Workers report an increased resistance to cold, heat, noise, and lack of sleep. Rhaponticum enhances immune function, helps stabilize blood sugar levels, and prevents hemolytic anemia, as well as anemia from chemotherapy and radiation treatments.

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Rhodiola (Rhodiola rosea), also called Arctic rose, grows in northern circumpolar regions. It is sweet, slightly bitter, spicy, cool, and dry. This herb enhances alertness, reduces fatigue, improves memory, relieves depression, and is indicated for post-Lyme brain fog, and emotional and spiritual stress. It aids recovery from head trauma. Rhodiola relieves muscle spasms and stiffness while improving athletic performance and endurance, and promotes the building of muscular tissue.

Schisandra (Schisandra chinensis) is a Chinese herb that is sour, sweet, salty, bitter, pungent, warm and dry — it contains all five flavors. It benefits all five Yin organs: Liver, Kidney, Lung, Heart, and Spleen. Schisandra is used to astringe the Jing, and control leakages like diarrhea, frequent urination, excessive vaginal discharge, and spontaneous sweating as seen in Cushing’s disease. It enhances reflexes, work performance, alertness, and mental activity, yet is also calming and helps relieve anxiety and stress-induced asthma or palpitations, hence it’s well indicated for COPD. This herb is helpful for hyperactive immune responses, allergies, or hypo conditions, such as Lyme arthralgias and any allergic condition. It is also a hepatoprotective agent and prevents chemical stress.

Shatavari (Asparagus racemosus) root is sweet, bitter, warm, and moist. It is a powerful herb used to enhance physical strength, maintain youthfulness, improve memory and intelligence. It is a female reproductive tonic, and will increase milk flow.

In summary, adaptogens are powerful agents that support and normalize our horses’ immune systems. However, they should be used with their energetics and specific indications in mind, and included in a well-thought-out formula.

Thoresen, Are. Acupuncture and Translocation, Kindle books, 2019.

Wilson, David. Adaptogens: Herbs for Strength, Stamina, and Stress Relief, Healing Arts Press; Rochester, Vermont; 2019.

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? Hibiscus (Hibiscus sabdariffa) flower has a multitude of pharmacological effects, including anti-inflammatory, antioxidant, antipyretic, antispasmodic, antitumor, astringent, diuretic, hepatoprotective (mild), hypocholesterolemic, hypoglycemic, hypotensive, natriuretic, and vasorelaxant. Its specific indications are for mild hypertension with elevated blood sugar and cholesterol levels; stabilizing mast cells and inhibiting allergic responses; and as a soothing diuretic for cystitis with hematuria. Hibiscus is pleasant-tasting, and most animals are very compliant with its ingestion. It is very helpful in cases of metabolic syndrome with signs of hypertension.

current research. This very enjoyable webinar showed how easy it can be to access a literal pharmacy of herbs. All past webinars can be purchased at vbma.org.

VBMA CERTIFICATION EXAM This annual exam to become a registered veterinary herbalist was held at a Purple Moon herbal training facility in November 2022. It can be taken by any veterinarian who feels they have studied Western or Chinese herbal medicine adequately; or any RH (AHG) who has shown a proficiency with animals.

ADDITIONAL EVENTS •

CASE REPORT Charisma is a 30-year Morgan mare who was developing mild signs of metabolic syndrome, with a slightly increased digital pulse in all four feet, and an insulin level of 55 (4.9–45.5) μU/ mL. One teaspoon of ground hibiscus flowers was added in her drain twice a day, along with additional carbohydrate control. In two months, her insulin level was 35 uU/mL.

WEBINAR ON URBAN HERBS Rona Sherebrin, DVM, recently presented a webinar on an urban herb walk in the alleyway behind her house. She found an amazing number of treasures growing there, including a mystery species of bidens (Bidens spp), goldenrod (Solidago spp.), horsetail (Equisetum spp.), plantain (Plantago major), motherwort (Leonurus cardiac), Japanese knotweed (Polygonum cuspidicum), yellow dock (Rumex cripus), burdock (Arctium lappa), chicory (Cichorium intybus), calendula (Calendula officinalis), bittersweet nightshade (Solanum dulcamara), mallow species, prickly lettuce (Lactuca serrolia), dandelion (Taraxacum officinalis), stinging nettles (Urtica urens), and more. Dr. Sherebrin showed pictures of these herbs as seen throughout the year, pointing out many identifying features with a description of traditional uses and

•

On February 7, the VBMA hosted their first webinar of 2023. “A Practitioners Panel on Feline Respiratory Disease” presented three different approaches for this alltoo-common problem. Dr. Sherebrin discussed Chinese formulas, Dr. Fougere used a Western herbal approach, and Dr. Lankenau addressed tough-to-resolve chronic cases. From June 9 to 11, the International Herbal Symposium takes place on site and will also be live-streamed. The VBMA has a fantastic lineup for the event: Dr. Silver is presenting mushroom talks; Drs. DiNatale and Moran will discuss different techniques for herbal preparations; Dr. Sherebrin offers some amazing topics; and Dr. Lankenau will be discussing Gu syndrome and neonatal septicemia. Registration can be linked via the VBMA website or at internationalherbsymposium.com/registration/. Be sure to sign up for the veterinarian track for CE!

Submitted by Cynthia Lankenau, DVM

GUESS THIS HERB!

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

IVC Spring 2023

THE TCVM APPROACH TO CHRONIC URINARY TRACT INFLAMMATION IN SMALL ANIMALS

While conventional medicine can quickly treat the signs of chronic urinary tract inflammation, TCVM is more effective when the condition becomes chronic and recurrent.

BY LORENA LLORET NADAL, DVM, MSTCVM

Chronic lower urinary tract inflammation (UTI) is one of the most challenging and frustrating conditions seen in small animal practice. This article discusses how a TCVM approach can be effective at treating this common problem in dogs and cats.

DEFINING CHRONIC UTI Biomedically, chronic UTI is defined here as a recurrent or persistent bacterial infection of the urinary bladder in the absence of neoplasia, urolithiasis, concurrent disease, and/ or structural and functional abnormalities of the bladder. It can also include sterile inflammation of the urinary tract and absence of a documented bacterial infection. The clinical signs include dysuria, stranguria, pollakiuria, hematuria, pyuria, crystalluria, foul-smelling urine, urine dribbling and pain. Cystitis is the term used to describe bladder diseases that result in inflammation.

THE CHINESE MEDICINE APPROACH In Chinese Medicine, a disease is not traced back to a single cause, but rather to a combination of body signs and symptoms

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that are carefully analysed to determine a pattern. The ability to recognize patterns of illness is fundamental to the practice of Chinese Medicine. Two animals may have the same disease according to Western medicine, but the pattern of signs and symptoms can be different in each individual, therefore requiring a different treatment strategy. Chinese Medicine defines urinary tract infection as Lin Zheng (dysuria syndrome) and many patterns exist; the form described here is commonly referred to as Urinary Bladder Damp Heat. The primary pathogenic factor seen in chronic UTI is Damp Heat, which affects the lower Jiao and can be generated from multiple causes that include inappropriate diet, obesity, and underlying Zang-Fu organ dysfunction which facilitate exogenous pathogen (bacterial) invasion of the bladder.2 Multiple overlapping patterns are often responsible for the chronic nature of the disease, which will vary depending on the individual animal. The most common pattern seen in longstanding infections of the urinary bladder in the dog and cat is dual deficiency of the Kidney and Spleen. Chinese Medicine is often effective at treating and resolving chronic UTI because it can accurately identify the underlying patterns of disease responsible for its development and recurrence.

A Chinese medicine treatment plan may include the use of herbal medicine, acupuncture, food therapy, and conventional medications as needed for an integrative approach. Antibiotics are energetically cold and bitter and effectively clear Heat. However, chronic use of antibiotics easily injures the Spleen, causes Liver Qi stagnation, and negatively impacts the normal bacterial flora of the gastrointestinal and urinary tracts. Acute UTI often becomes chronic because residual Damp is not cleared and/or continues to be produced. The use of cold, bitter herbal medications should be undertaken carefully in weak patients. This is especially true if the animal is already on long-term antibiotic therapy and a prescription diet.

TCVM ETIOLOGY AND PATHOPHYSIOLOGY Conventional Western medicine attributes acute and chronic urinary tract infection to invasion of bacteria in the urinary bladder. In acute uncomplicated UTI, a single course of antibiotics is usually sufficient to resolve the infection. However, because conventional treatment is unable to recognize other contributing disease factors responsible for the development of chronic UTI, it is typically restricted to chronic antibiotic therapy. Low dose chronic antibiotic therapy is often prescribed for the life of the animal, with an increased potential for the development of antimicrobial resistance and superinfection over time. In Chinese medicine, chronic UTI is considered multifactorial in nature and develops from exogenous and endogenous causes. The basic pathophysiology revolves around the presence of Damp Heat. This can result from the invasion of exogenous Damp Heat pathogens (bacteria), or be generated

internally from Zang Fu organ dysfunction. Damp Heat obstructs the normal Qi activity of the urinary bladder, resulting in stranguria, pollakiuria, pyuria, and pain. Damp Heat can transform into Fire and damage the blood vessels of the bladder, causing hematuria, and long-term Damp Heat can congeal into crystals and stones. If the condition is not appropriately treated during the acute phase, it then becomes chronic. It should be noted that a documented bacterial infection is not necessary to make a diagnosis of Urinary Bladder Damp Heat; some animals exhibit classic signs of cystitis and have sterile urine on laboratory evaluation. Chronic UTI typically develops from an underlying dysfunction of the internal organs in conjunction with bacterial infection, so a mixture of both excess and deficiency is typically seen at presentation. The recognition and appropriate treatment of these underlying patterns, in addition to the treatment of bacterial infection, is essential to prevent continued development or persistence of Damp Heat, and recurrence of the disease. In TCVM, lower urinary tract diseases associated with cystitis can be divided into four common patterns: 1.

D amp Heat (Re-Lin and Stone Lin syndromes)

H eat (Blood Lin Syndrome )

L iver Qi Stagnation (Qi Lin Syndrome)

K idney Deficiency (Lao Lin Syndrome)

These patterns commonly develop in animals that are purebred; have Kidney Jing deficiency; are old; have chronic illness; are overbed or given a species-inappropriate diet; are not regularly exercised (weakens the Spleen); are kept isolated for long periods (stress-induced); or are confined indoors or in conditions that necessitate holding their urine for prolonged periods. The process of normal urination flushes out ascending bacteria and debris within the urinary tract. Any situation that prevents regular micturition and the healthy flow of urine can weaken the kidney and bladder and facilitate the development of UTI. Dampness and Heat are the two primary pathogens associated with cystitis. Liver Qi Stagnation and Kidney Deficiency are also important factors. These patients are often cats that are very stressed and irritated by different situations and have recurrent episodes of FIC during stressful times. Recent

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literature has described FIC as an imbalance in the neuroendocrine system, in which excitatory sympathetic nervous system outflow is not controlled by the cortisol. This results in increased permeability of the bladder wall. We can summarise the TCVM treatment of the major patterns involved in lower urinary tract disease as described in the table below: TCVM treatment for cystitis in small animals Pattern

Clinical Signs

Suggested Acupoints

Chinese Herbal Medicine

Damp Heat (Re-Lin)

Scant, frequent, urgent and painful urination Red/yellow urine Painful abdomen Urinary tract infection Tongue: red Pulse: slippery and rapid

SP6, SP9, BL22, BL28, BL39, BL66, LIV2, CV3, GV14, Wei-jian

Ba Zheng San ( Eight RighteousJT)

Frequent, urgent and/or straining urination with pain. Scant urination with crystals/stones in the kidney/bladder Anuria secondary to obstruction in the urinary tract Tongue: red Coating: yellow Pulse: surging, rolling (slippery), rapid

SP6, SP9, BL22, BL28, BL39, BL65, LIV3, CV1, CV3, GV14, Wei-jian

Crystal Stone FormulaJT*

Painful and difficult urination with blood or dark urine Tongue: red Coating : +/- yellow Pulse: rapid

SP10, HT8, BL17, BL22, BL39, BL66, LIV2, CV3, GV14, Duan-Xue, Weiben, Wei-jian

Urine dribbling Irritability Fullness and pain in lower abdomen Tongue: purple Pulse: wiry

BL22, BL28, BL39, BL66, GB34, LIV1, LIV2, LIV3, GV14, Wei-jian

Chronic urinary dribbling Urination that starts and stops Hematuria Urge to urinate when tired Weakness of lower back and pelvic limbs Tongue: pale Pulse: weak

LI10, ST36, SP6, SP9, BL22, BL23, BL26, BL28. BL39, CV3, CV4, CV6, GV20, Yan-chi, Moxibustion

Damp Heat (Stone-Lin)

Blood Lin (Xue Lin)

Stagnation Lin (Qi Lin)

Deficiency Lin (Lao Lin)

Si Miao San

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Uroliths taken from a cat's urine sample, under the microscope.

Red Front DoorJT San Qi (Notoginseng)

Liver HappyJT

San Qi (Notoginseng) Lao-Lin FormulaJT

*In a retrospective study of the efficacy of integrated veterinary treatment with Chinese herbal medicine for small animal urolithiasis, the treatment included a veterinary specific Chinese herbal medicine, Crystal Stone Formula. This is a modification of the classical Chinese herbal formula Ba Zheng San, and was used in in combination with conventional biomedical treatment including antibiotics and diet modification. Study results demonstrated complete dissolution of stones in 87.5% of the animals, with mean treatment duration significantly shorter than 90 days (p=0.002). Uroliths were diagnosed by ultrasound and radiographs. They ranged in size from crystalloid sediment (sand to 1.31 cm x 1.04 cm and were primarily identified as struvite or calcium oxalate types). Other measurements, such as improvement of clinical signs affecting quality of life, were monitored (hematuria, dysuria, water intake, appetite, patient activity) and showed improvement within one to four days. Conventional treatment of urolithiasis typically takes three months or more, (range two to five months) and can be associated with multiple complications including recurrence of stone formation.

Chinese herbal medicine in combination with biomedical treatment of urolithiasis provide benefits of low-cost, non-invasiveness, and minimal side effects. The results of this study, encourage and support a larger randomised controlled study, that could provide evidence based support for this integrated treatment as a reliable alternative for patients with urolithiasis.3

CONCLUSION Cystitis is a very common problem in clinical veterinary practice. A number of different patterns of imbalance can develop and lead to the clinical signs of cystitis. Conventional medicine can be effective at quickly resolving the signs, but when cystitis becomes chronic and recurrent, TCVM can be used to effectively resolve these imbalances. In some cases, a combination of conventional medicine and TCVM is needed to resolve or control the condition.

1Huisheng Xie et al. Practical Guide to Traditional Chinese Veterinary Medicine, Vol II, Small Animal

Practice , Chi Institute press 2014, 846-857

2ISigne Beebe. A Chinese Veterinary Medicine Approach to Chronic Urinary Tract Inflammation.

AJTCVM Vol 3, No.1, 2008.

3Melissa Alvarenga Haddad et al. A Retrospective Study of the Efficacy of Integrated Veterinary

Treatment with Chinese Herbal Medicine for Small Animal Urolithiasis. AJTCVM Vol 13, No1, February 2018.

CLINICAL CASE EXAMPLE A five-year-old male spayed domestic shorthair cat presents with a one-year history of recurring bladder infections and crystalluria. He has also been urinating outside the litter box for over a year. Although treated with a prescription diet, the crystalluria remains (calcium oxalate). He also has frequent hematuria but recent ultrasound examination reveals no stones at this time. This cat has a dominant personality and loves to hunt when outside. He drinks large amounts of water.

TCVM EVALUATION

The caretaker presents the cat for TCVM evaluation. On physical examination, he is overweight, lethargic, and has a tendency to be aggressive in stressful situations. He quite frequently vomits undigested food. His eyes are red, with a watery damp discharge. His coat is oily, and his ears, nose and paws are warm. His tongue is red/purple and wet with swollen edges. He pulses are wiry and rapid, and he turns aggressive when the vet tries to feel them.

DIAGNOSIS

This cat’s personality would be considered Wood, according to TCVM. His diagnosis is Liver Qi Stagnation with Heat; Heart Heat leading to Shen Disturbance; Bladder Damp Heat and Spleen Qi Deficiency. His aggression, Wood constitution, red watery eyes, purple tongue, and wiry pulses indicate Liver Qi Stagnation plus Heat. His increased weight, lethargy, oily coat, swollen tongue and crystalluria indicate the presence of Damp in the body. The hematuria/crystalluria, increased thirst, red eyes and rapid pulses, warm paws and body indicate Heat in the body. Liver Qi Stagnation can result in Heat, which then rises to affect the Heart. Heart Heat can move to the paired organ (the Small Intestine according to TCVM) and then through the Tai Yang connection to the Bladder. Liver Qi Stagnation can also overact on the Spleen, leading to Spleen Qi Deficiency (vomiting undigested food, overweight, lethargy) and turns into creation of Damp which tends to combine with the Heat to make Damp Heat, a very difficult combination to resolve.

•

Dry needle acupuncture is performed at BL15, BL18, BL20,

•

Herbal prescription of Liver Happy and Crystal Stone

•

Dietary recommendations are wet food only, with addi-

BL28, BL39, GV14, GV20, AnShen, Tian-men, LIV3, LI4, TH5, PC6, and HT7. Each treatment consists of ten needles maximum, one week apart, for three treatments. Points were alternated depending on the treatment. Afterwards, the treatments were lengthened to once every two weeks for another month.

Formula are given for six months.

tional water and homemade food if available.

The cat’s behaviour improves within the first two weeks of treatment. He uses the litter box again, his behaviour is happier, relaxed, and calmer, and he allows the family to pet him. After eight weeks of therapy, crystalluria is no longer present, his coat is shiny and soft, and his energy levels are improved. The family has not seen him vomiting, though he’s still overweight. The cat receives monthly treatments of acupuncture for another six months, with no relapses during the following year.

Acupuncture treatment helps the cat relax.

TREATMENT

Treatment strategies are to move the Liver Qi Stagnation, Calm Shen, drain Damp, clear Heat in the Lower Burner, and later, tonify Spleen Qi.

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In the news

STEM CELLS USED TO TREAT EQUINE OSTEOARTHRITIS

In January 2023, two studies conducted by Dr. Judith Koenig and her team at the Ontario Veterinary College looked at how stem cells might be used to treat equine osteoarthritis. Equine Guelph provided funding for both studies, which demonstrated the effectiveness and safety of equine pooled cryopreserved umbilical cord blood MSCs in treating joint pain and inflammation in horses.

practical as it allows for the treatment of more horses and is readily available from a cell bank. After no systemic reactions were observed, the second study was initiated to test stem cell therapy in horses with lameness due to fetlock osteoarthritis. A lameness evaluator conducted this second study and was blinded as to which horses received stem cell treatment and which the saline placebo.

In the first study, equine umbilical cord blood MSCs from multiple donors were compared to saline injections in research horses. According to Dr. Koenig, this type of cell is more

The six Standardbreds in the study received equal daily exercise on treadmills, along with follow-up MRIs, for four months. The group treated with equine pooled cryopreserved umbilical cord blood MSCs showed significant improvement compared to the control group after MRIs, x-rays, ultrasounds, and weekly lameness evaluations. The arthroscopic score was also

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considerably lower in the MSC group after six weeks of treatment. These initial findings are very promising for the future of treating equine osteoarthritis with stem cell therapy. The researchers plan to conduct another trial with six horses this spring. Equine Guelph does projects at the University of Guelph through funding provided by the racing industry (Standardbred, Thoroughbred, and Quarter horse organizations), the Horse Improvement Program from the Horsemen’s Benevolent and Protective Association, and the E.P. Taylor Foundation, which was started by veterinarians. www.equineguelph.ca/pdf/newsletter/ Research_Annual-Vol.20_2023.pdf